Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers.

In this article, we review relational factors in early childhood believed to contribute in unique ways to pragmatic skill development in deaf and hard of hearing (DHH) infants and toddlers. These factors include attending to infant interactions with caregivers and others, supporting development of theory of mind through play and use of mental state language (ie, describing one's own or others' thoughts, feelings, and beliefs), and providing accessible opportunities for social interaction. On the basis of a review of the literature and clinical experience, we offer prescriptive strategies for supporting DHH children's development in these areas. To improve outcomes for DHH children, medical care providers and allied health professionals have a responsibility to support the development of young DHH children's pragmatic abilities by understanding these variables, coaching caregivers regarding their importance, and facilitating referrals for support when necessary.

Deaf adolescents in a hearing world: a review of factors affecting psychosocial adaptation.

Adolescence has long been viewed as a time of rapid change in many domains including physical, cognitive, and social. Adolescents must adapt based on developing skills and needs and acclimate to growing environmental pressures. Deaf adolescents are often faced with the additional challenge of managing these adaptations in a hearing world, where communication and access to information, especially about their social world, are incomplete at best and nonexistent at worst. This article discusses the research on several factors that influence a deaf adolescent's adaptation, including quality of life, self-concept, and identity development. Gaps in our knowledge are pointed out with suggestions for future research programs that can facilitate optimal development in adolescents who are deaf.

Utility of the ImPACT test with deaf adolescents.

OBJECTIVE: The goals of the study included empirical examination of the utility of the Immediate and Post-Concussion Assessment and Cognitive Testing (ImPACT) test with adolescents who are deaf or hard-of-hearing and to investigate patterns of performance at baseline that may arise in the assessment of this population. Baseline assessment of student-athletes has been conducted on a widespread scale with focus on performance of typically developing student-athletes and some clinical groups, though to date no studies have examined adolescents who are deaf or hard-of-hearing. METHOD: Retrospective and de-identified ImPACT baseline test used with deaf and hard-of-hearing high-school student-athletes (N = 143; 66% male, mean age = 16.11) was examined. RESULTS: Review indicated significant differences in some composite scores between the deaf and hard-of-hearing group and hearing normative comparisons. A possible marker of task misunderstanding was identified to occur more frequently within the deaf and hard-of-hearing sample (13% in deaf sample vs. .31% in hearing sample). CONCLUSIONS: Results may provide support for the consideration and use of additional measures to ensure comprehension of task demands when considering this tool for use with deaf and hard-of-hearing adolescents.

Hearing Parents' Appraisals of Parenting a Deaf or Hard-of-Hearing Child: Application of a Positive Psychology Framework.

Hearing parents of deaf and hard-of-hearing children face unique challenges and stressors, the understanding of which has been the focus of numerous studies; yet, relatively little is known about their positive experiences. Using a qualitative purposive sampling design, interviews were conducted with 11 hearing parents (8 mothers, 3 fathers) exploring parents' positive appraisals of their experiences in raising a child who is deaf or hard of hearing (D/HH). Interviews were transcribed and a thematic analysis was conducted, which allowed the researchers to identify themes and patterns in the parents' appraisals. Nine key themes emerged, which characterized parents' positive perceptions of raising a child who is D/HH: knowing the child, appreciating everyday positives, increasing involvement with the child, relishing the highs, taking less for granted, letting go, learning, advocating, and experiencing personal growth A positive psychology framework was employed to foster understanding of the interview findings and their implications. When asked about the positive aspects of raising a D/HH child, hearing parents were readily able to identify ways in which their parenting experience had been enhanced and their lives improved as a result of their unique situations. The implications of these findings are discussed.

Review of intellectual assessment measures for children who are deaf or hard of hearing.

OVERVIEW: Intellectual assessment of children who are deaf or hard of hearing presents unique challenges to the clinician charged with attempting to obtain an accurate representation of the child's skills. Selection of appropriate intellectual assessment instruments requires a working knowledge of the strengths and weaknesses of the measure and what changes in standardized administration might be necessary to accommodate for the needs of children who are deaf or hard of hearing. In the case of some available instruments, there is limited guidance and objective research available examining the performance of children who are deaf or hard of hearing. This review summarizes available information on widely used and most recent editions of intellectual assessment measures with special attention to guidance on accommodations, score interpretation, subtest selection and other test-specific considerations when assessing children who are deaf or hard of hearing. SUMMARY: There is much opportunity for further inquiry in the field of intellectual assessment as it applies to children who are deaf or hard of hearing, as many measures have not been closely scrutinized for their appropriate use with this population. Clinicians must recognize inherent difficulties with intellectual assessment measures with children who are deaf or hard of hearing and issues in providing for an accessible and accurate administration of test items.

It is not just stress: parent personality in raising a deaf child.

This study examined the impact and predictive ability of parental personality and perceived stress on behavior problems of their deaf child. One hundred and fourteen parents with a deaf child completed measures of personality, parenting stress, and child behavioral functioning. Higher parental neuroticism, which reflects a susceptibility to emotional and psychological distress, significantly predicted greater internalizing behaviors in younger deaf children, whereas higher levels of parenting stress and lower levels of parental conscientiousness were strongest predictors for externalizing behaviors. For older deaf children, higher levels of parental openness to experience predicted higher levels of internalizing and externalizing behavior problems. Results suggest a complicated interaction between parent personality and stress related to child adjustment, with implications for professionals working with parents of deaf children.

Deaf children with autism spectrum disorders.

Epidemiological studies investigating the prevalence of autism have increased in recent years, within the United States and abroad. However, statistics as to how many of those children may also have a comorbid hearing loss is lacking. The prevalence of school-administrator reported diagnosis of autism spectrum disorders (clinical diagnosis [DSM-IV] and/or IDEA classification) among children with hearing loss in the US was estimated from the 2009­2010 Annual Survey of Deaf and Hard of Hearing Children and Youth conducted by the Gallaudet Research Institute. Results indicate that during the 2009­2010 school year 1 in 59 children (specifically 8-year olds) with hearing loss were also receiving services for autism; considerably higher, than reported national estimates of 1 in 91 (Koganet al. in Pediatrics 124(4):1­8, 2009) and 1 in 110 (CDC 2007) for hearing children. Significantly more children with profound hearing loss had a comorbid diagnosis of autism than those with milder forms of hearing loss. These results are discussed, while highlighting the need for increased awareness and research in a population that has thus far received little services or attention.

Hemiparesis is a clinical correlate of general adaptive dysfunction in children and adolescents with Sturge-Weber syndrome.

This study sought to identify neurologic correlates of adaptive functioning in individuals with Sturge-Weber syndrome. A total of 18 children, adolescents, and young adults with Sturge-Weber syndrome with brain involvement were recruited from our Sturge-Weber center. All underwent neurologic examination (including review of clinical brain magnetic resonance imaging) and neuropsychological assessment. Neuropsychological assessment included measures of intellectual ability and standardized parent report of adaptive functioning. Overall, Full Scale IQ and ratings of global adaptive functioning were both lower than the population-based norms (P < .05). Negative correlations were identified between adaptive functioning ratings, clinician ratings of cortical abnormality, and ratings of neurologic status. Hemiparesis (minimal versus prominent) was the only individual component of the rating scales that differentiated between individuals with nonimpaired and impaired adaptive functioning scores. Information obtained during neurological examination of children and adolescents with Sturge-Weber syndrome particularly hemiparetic status is useful for identifying children who may need additional intervention.

Attachment in deaf mothers and their children.

In attachment research, there has been a growing interest in how adults conceptualize their relationships with their own parents as well as in the transmission of attachment status from parent to child and the variables that influence that transmission. The primary goal of the present study was to examine the transmission of attachment from deaf mother to child. Adult Attachment Interviews were collected on 32 deaf women and Strange Situation Procedure data were obtained from their children. While the distribution of deaf mother attachment classifications was similar to that found with hearing samples, the concordance between mother and child in terms of attachment status was lower than in hearing samples. Having a deaf parent did not affect a deaf adult's attachment status. Post hoc analyses suggested a trend towards a dismissing stance in attachment relationships. Results are discussed in terms of variables affecting attachment status as well as the transmission of attachment.