Mothers of Deaf Children in the 21st Century. Dynamic Positioning Between the Medical and Cultural-Linguistic Discourses.

Traditional research examining the communicational choices made by families with deaf children tends to emanate from the premise that families engage with either of the two grand discourses on deafness (i.e., the medical or cultural-linguistic perspective). This study investigated hearing mother's engagement with the educational options for their child from a dynamic, poststructural perspective. Three Flemish mothers were interviewed in-depth at the child's ages of 6, 9, 12, 18, and 24 months. The data were analyzed within a theoretical model that describes the positioning process of the mothers. This method yielded alternative explanations for former findings concerning mothers' decision-making processes, especially the difficulty of learning sign language as a second language in an effort to provide a bilingual-bicultural education, and highlighted the importance of having rich experiences. It further showed that a bilingual-bicultural position was scarcely available and poorly supported for these mothers. These findings are discussed in relation to recent international consensus statements on best practices in early intervention.

The association between parental imprisonment and the mental health of Palestinian adolescents.

BACKGROUND: Since 1967, the Palestinian Occupied Territories are marked by a protracted political conflict. During this conflict, about one fifth of the Palestinian population has been detained; a considerable part of them having children outside prison. Although parental detention negatively impacts children's psychological well-being, little is known about this impact within contexts of protracted armed conflict. Therefore, this study aimed at gaining insight into the impact of parental detention onto adolescents' psychological well-being. METHOD: Of 314 (11- to 18-year old) Palestinian adolescents who took part, the fathers of 204 adolescents were detained in Israeli prisons. The adolescents completed two self-report questionnaires: the UCLA-PTSD-Reaction Index, investigating symptoms of posttraumatic stress, and the Strengths and Difficulties Questionnaire, looking at overall psychological problems. Several hierarchical regression analyses investigated mental health differences between both the groups, and possible associations between sociodemographic characteristics and the witnessing of the father's arrest, and the mental health outcomes. RESULTS: Parental detention largely impacted adolescents' mental health, with one fifth to two thirds of the adolescents reporting considerable mental health problems. Witnessing the arrest of the father even increased this risk considerably. Above, girls, younger adolescents, participants living in refugee camps, and those living with extended families also reported higher scores on both questionnaires. CONCLUSIONS: Detention of fathers in the context of protracted armed conflicts has a large impact on adolescents' mental health. Besides an overall plea to end armed conflicts as fast as possible, the study also delineates considerable implications for the support and care for these adolescents and their families.

Imprisoned Husbands: Palestinian Wives and Experiences of Difficulties.

This study aimed to investigate difficulties experienced by the wives of Palestinian men arrested and held in Israeli prisons. 16 captives' wives were interviewed using a semi-structured interview to provide them with a greater opportunity to speak about their experiences. Three main research questions were discussed; community difficulties, social support, and coping strategies. A thematic analysis was used throughout the interviews. We concluded that in addition to the stress of being separated from their husbands, the frustrating visitation process to prison and the ongoing political conflict, the wives expressed a frustrating social network characterized by constant interferences in their personal lives and the choices they make. Most women expressed a lack in psychosocial support given through governmental and non-governmental organizations; in addition they expressed a need for that kind of support. Coping strategies ranged from religious, acceptance, distraction, to planning strategies.

The Impact of Parental Detention on the Psychological Wellbeing of Palestinian Children.

BACKGROUND: Since 1967, the Palestinian Occupied Territories are marked by a political conflict between Palestinians and Israel. During this conflict, about one fifth of the Palestinian population has been detained; about one quarter of these are parents. Although we know that father's incarceration might impact their children's psychological wellbeing, little is known about the impact of father's imprisonment on young children (under 11 years old), and when the incarceration is framed in contexts of political conflict. Therefore, this study aimed at gaining insight into the impact of parental detention on young children's psychological wellbeing, and the impact of witnessing the detention process itself. METHODS: Based on the list of imprisoned Palestinian men with children living in the West Bank, a group of 79 (3- to 10-years old) children was randomly composed. Above, through schools and health centers, a comparison sample of 99 children who didn't experience imprisonment of a family member was selected. Mothers of these children completed two cross-culturally validated questionnaires on their children's psychological wellbeing, the UCLA-PTSD-Index and the Strength and Difficulties Questionnaire (SDQ). RESULTS: Results showed higher levels of PTSD and general mental health problems associated with father's capturing. Above, when the children watched the arrest process of their fathers, scores still increased further. Younger children tended to show higher SDQ scores, and children living in villages reported higher posttraumatic stress scores compared to children living in urban areas or refugee camps. Little gender differences were found. CONCLUSION: This study shows the important impact of parental detention on the psychological wellbeing for young children and urges for more psychological care and support for family members--in particular children--of detainees.

A cross-cultural comparison of tonal synchrony and pitch imitation in the vocal dialogs of Belgian Flemish-speaking and Mexican Spanish-speaking mother-infant dyads.

This study reports a cross-cultural comparison of the vocal pitch patterns of 15 Mexican Spanish-speaking and 15 Belgian Flemish-speaking dyads, recorded during 5min of free-play in a laboratory setting. Both cultures have a tradition of dyadic face-to-face interaction but differ in language origins (i.e., Romanic versus Germanic). In total, 374 Mexican and 558 Flemish vocal exchanges were identified, analyzed and compared for their incidence of tonal synchrony (harmonic/pentatonic series), non-tonal synchrony (with/without imitations) and pitch and/or interval imitations. The main findings revealed that dyads in both cultures rely on tonal synchrony using similar pitch ratios and timing patterns. However, there were significant differences in the infants' vocal pitch imitation behavior. Additional video-analyzes on the contingency patterns involved in pitch imitation showed a cross-cultural difference in the maternal selective reinforcement of pitch imitation. The results are interpreted with regard to linguistic, developmental and cultural aspects and the 'musilanguage' model.

Whose clock makes yours tick? How maternal cardiorespiratory physiology influences newborns' heart rate variability.

This study examined the existence of direct maternal-infant physiological relatedness in respiratory sinus arrhythmia (RSA) when the infant was age 1, 2, 4, 8, and 12 weeks. We instructed mothers to breathe at 6, 12, 15, 20, and 6 cycles per minute while their infants lay on their body. The mother-infant ECG and respiration were registered and video recordings were made. RR-interval (RRI), respiration rate (fR) and RSA were calculated and mother-infant RSA response-patterns were analyzed. The results revealed that infants adjusted their RSA levels to their mothers' levels during the first 2 months of life, but not at 3 months of age, which could be interpreted as a continuing intra-uterine effect. The attenuation between 2 and 3 months could be a reflection of the 2-month developmental shift of social orientation.

The Cocreation of Crazy Patchworks: Becoming Rhizomatic in Systemic Therapy.

In the field of systemic therapy, there has been much discussion recently about the narrative self. This concept refers to the idea that the self is narratively constructed in and through the stories which someone tells about him/herself. The story is thereby not only viewed as a metaphor for selfhood: Selfhood is not compared to a story, it is a story. But what kind of story are we talking about here? If the self is a story, what does that story look like? These questions are explored in this article. Starting from the possibilities and limitations of traditional and postmodern visions on the self as a story, an alternative vision is illustrated. By considering the self as a rhizomatic story, we not only create a useful view of the way narrative selfhood is constructed within a therapy context, but we also stimulate therapists to coconstruct-together with their clients-patchworks of self-stories. By using story fragments of our own practice, we illustrate the rhizomatic thinking and its possibilities in therapy.

Do you hear the same? Cardiorespiratory responses between mothers and infants during tonal and atonal music.

This study examined the effects of tonal and atonal music on respiratory sinus arrhythmia (RSA) in 40 mothers and their 3-month-old infants. The tonal music fragment was composed using the structure of a harmonic series that corresponds with the pitch ratio characteristics of mother-infant vocal dialogues. The atonal fragment did not correspond with a tonal structure. Mother-infant ECG and respiration were registered along with simultaneous video recordings. RR-interval, respiration rate, and RSA were calculated. RSA was corrected for any confounding respiratory and motor activities. The results showed that the infants' and the mothers' RSA-responses to the tonal and atonal music differed. The infants showed significantly higher RSA-levels during the tonal fragment than during the atonal fragment and baseline, suggesting increased vagal activity during tonal music. The mothers showed RSA-responses that were equal to their infants only when the infants were lying close to their bodies and when they heard the difference between the two fragments, preferring the tonal above the atonal fragment. The results are discussed with regard to music-related topics, psychophysiological integration and mother-infant vocal interaction processes.

Shall we dance? Music as a port of entrance to maternal-infant intersubjectivity in a context of postnatal depression.

The present study introduces the concept of a mother-infant group therapy that makes use of music, singing, and moving to establish maternal-infant intersubjectivity. It was conducted in a residential mother-baby unit for mothers with postnatal depression and their infants over a 5-week period. Maternal-infant intersubjectivity of four dyads in relation to the group dynamics were microanalyzed for Sessions 1 and 5. We made within-session (i.e., beginning-middle-end) and between-session (Session 1 vs. Session 5) comparisons for the number of intersubjectivity moments (ISMs), total time of intersubjectivity (IST), and the mean duration of ISMs on a dyadic (i.e., own mother/infant involved) and a nondyadic level (i.e., own mother/infant not involved). In addition, three ISM levels (degree of group contribution) were distinguished. The results indicated a significant increase of ISMs/IST from Session 1 to Session 5. Within-session analyses showed that ISMs/IST significantly decreased through Session 1 and remained stable throughout Session 5. Intersubjectivity occurred mainly on ISM Level 1 during Session 1 and on ISM Level 3 during Session 5, suggesting increased dyadic autonomy and self-efficacy. The results are discussed in relation to the musical characteristics of mother-infant dyads, music improvisation techniques, group processes, and intersubjective development.

Beyond child soldiering: the interference of daily living conditions in former child soldiers' longer term psychosocial well-being in northern Uganda.

Given the various developments in former child soldiers' psychosocial well-being over time, the question arises as to which factors are associated with the prevalence of psychological distress. An ongoing debate points to the plausible importance of child soldiering-related and post-child soldiering factors. This study is an exploratory analysis of both types of association with former child soldiers' psychosocial well-being in the longer term. Follow-up data on a convenience sample of 424 northern Ugandan former child soldiers are analysed. Psychological symptoms are assessed by a review of the intake and assessment forms of the Rachele Rehabilitation Centre, which were not validated and did not include a standardised translation into the local language. These psychological symptoms and possible associated factors are analysed using binary logistic regression analysis. Thereby, both child soldiering-related and post-child soldiering variables are accounted for. The outcomes reveal almost no significant main effects of child soldiering-related variables, while a range of post-child soldiering variables (number of meals a day, school attendance, insults and professional support) are clearly associated with the prevalence of the measured psychological symptoms in the longer term. These exploratory conclusions should be further investigated in representative samples of former child soldiers using validated assessment tools.

Resistance and resilience in a life full of professionals and labels: narrative snapshots of Chris.

In this article, the authors relate the life of Chris through narrative snapshots. Chris asked the authors to tell her story. They decided that it could be used to provide an insight into the different ways people with labels are confronted with professional practices and rituals. Although Chris lived a "tough life," her story is full of resilience and resistance. Chris will be kept in the authors' memory as a strong woman, a teacher, and a friend.

First information parents receive after UNHS detection of their baby's hearing loss.

The first information parents receive after referral through Universal Newborn Hearing Screening (UNHS) has significant consequences for later care-related decisions they take and thus for the future of the child with a hearing loss. In this study, 11 interviews were conducted with a representative sample of Flemish service providers to discover (a) the content of the information provided to parents and (b) the service providers' assumptions and beliefs concerning deafness and care. To do this, we conducted an interpretative phenomenological analysis, followed by a discourse analysis. Results showed that parents receive diverse information, depending on the reference center to which they are referred. Moreover, all service providers used a medical discourse. We suggest that there is value to be gained from closer consideration of the nature of follow-up services provided in response to UNHS in Flanders and from auditing the professional preparation of service providers that are involved in providing information to parents.

Alliance rupture and repair in conjoint family therapy: an exploratory study.

In this article, we introduce a methodology for studying alliance rupture and repair in conjoint family therapy. Using the System for Observing Family Therapy Alliances (Friedlander, Escudero, & Heatherington, 2006), we identified rupture markers and repair interventions in a session with a single mother and her 16-year-old "rebellious" daughter. The session was selected for analysis because a severe rupture was clinically evident; however, by the end of the session, there was an emotional turnaround, which was sustained in the following session and continued until the successful, mutually agreed upon termination. The first rupture occurred when the psychotherapist suggested that the mother explore, in an individual session, how her "personal stress" may be affecting her daughter. The observational analysis showed repeated rupture markers, that is, confrontation and withdrawal behavior, hostile within-family interactions, and a seriously "split" alliance in family members' expressed feelings toward the psychotherapist. The time-stamped behavioral stream showed that the psychotherapist focused first on safety, then on enhancing his emotional connection with each client, and finally on helping mother and daughter understand each other's behavior and recognize their shared isolation.

Deaf parents and pediatric cochlear implantation: an exploration of the decision-making process.

The study examined factors in deaf parents' decision between cochlear implantation (CI) and traditional hearing aids for their child. The subjects were 6 Flemish children ages 5-9 years with severe/profound congenital hearing loss, with at least 1 deaf parent. The researchers, who conducted thematic content analysis of qualitative data collected through parent interviews, found that with the exception of a family with 1 hearing parent, parents gave priority to Deaf identity, sign language, and ethical issues in deciding between CI and hearing aids. Medical risks were also mentioned. The researchers conclude that the decision-making processes of the parents involved factors that have also been found among hearing parents, as well as aspects that have not been reported to play a role in hearing parents' decision making. A further conclusion is that deaf parents' perspective merits attention in professional practice and empirical research.

Forced conscription of children during armed conflict: experiences of former child soldiers in northern Uganda.

OBJECTIVE: Child soldiering can be considered as one of the worst practices of institutionalized child abuse. However, little is known about the scope and nature of this abuse and the consequent experiences of children enrolled in an armed faction. This research aims at enriching the knowledge on the experiences of child soldiers in the Lord's Resistance Army (LRA) in northern Uganda. METHODS: The databases of 4 former Interim Care Centres for returned child soldiers in northern Uganda, comprising socio-demographic information of 8,790 returnees, and additional data from the Rachele Rehabilitation Centre on war-related experiences of 1,995 former child soldiers, are analyzed using descriptive statistics, analysis of covariance and regression analysis. RESULTS: During on average 1.5 years in captivity, nearly all participants had various war-related experiences, whereby 88% witnessed and 76% forcibly participated in atrocities. Variations in exposure to warfare appear to be mainly associated with age of abduction, duration of captivity, location of captivity, being military trained, and being a rebel's wife. CONCLUSIONS: These findings testify to the vastness of abuse lived through by the child soldiers in this study. They fulfilled a multifaceted position in the LRA, which delivers a range of potential direct and indirect consequences. The variables decisive in differential experiences unveil trends in the strategic abduction by the LRA and in differential exposure to warfare among child soldiers. IMPLICATIONS: The variation in exposure to warfare urges for an individualized approach and monitoring of returning child soldiers. In order to address the potential indirect impact of child soldiering, support also needs to be oriented towards the child's network, based on a socio-ecological approach.

Congenitally deaf children's care trajectories in the context of universal neonatal hearing screening: a qualitative study of the parental experiences.

The objective of this study is to examine the early care trajectories of congenitally deaf children from a parental perspective, starting with universal neonatal hearing screenings. The analysis using a three-dimensional care trajectory concept is aimed at developing a basic typology of postscreening care trajectories. Children with severe/profound hearing loss, registered in the Flanders' (Belgium) universal neonatal hearing screening program, born between 1999 and 2001. Thematic content analysis of qualitative data collected retrospectively from participant's parents. Two basic types of care trajectories emerged; based on differences in care-use in the phase of further diagnosis and related parental experiences. Subtypes resulted from events related to cochlear implantation. Five trajectory phases were identified: screening, further diagnosis, care and technology, cochlear implantation, and reduction of care and were characterized by specific parental experiences such as confusion, disbelief, disappointment, and uncertainty. Those experiences relate to care professionals' acts and communication and the child's functional evolution. Early care interventions could benefit from coordinated transition between phases, parent support throughout the care trajectory, and a broad approach to deafness in professionals' communication.

Negotiating the pathways into care in a globalizing world: help-seeking behaviour of ultra-Orthodox Jewish parents.

BACKGROUND: The study of the pathways into care as a social process subject to a wide range of influences is needed to build appropriate and effective mental health services for culturally diverse societies. MATERIAL: Grounded theory and situational analysis of 21 in-depth interviews explores the help-seeking behaviour of ultra-Orthodox Jewish parents: which help-seeking pathways parents follow and how they make the decision to consult regular services for their child. DISCUSSION: Three help-seeking pathways are influenced by globalization dynamics and gender: parents draw on diverse parenting discourses and strategies, socio-religious frameworks and cultural realities. CONCLUSION: Strategies are suggested to enhance the accessibility of services.

Pediatric cochlear implantation: a qualitative study of parental decision-making processes in Flanders, Belgium.

Factors contributing to parents' decision when they choose between cochlear implantation (CI) and traditional hearing aids for their child were examined. The subjects were children with severe/profound hearing loss, born 1999-2001, registered in the universal neonatal hearing screening program in the Flanders region of Belgium. Qualitative data collected retrospectively from parents were subjected to thematic content analysis. In their responses to professional advice, parents were segmented into 3 groups: (a) those whose primary considerations were the importance of oral language development and the relative potential of CI and traditional hearing aids; (b) those for whom alternative factors (e.g., medical risks, ethical issues) were paramount, even in the face of professional advocacy of CI; (c) those who followed professional advice against CI. The researchers conclude that care professionals should be sensitive to the impact of their advice and other factors in parental decision making.

Tonal synchrony in mother-infant interaction based on harmonic and pentatonic series.

This study reports the occurrence of 'tonal synchrony' as a new dimension of early mother-infant interaction synchrony. The findings are based on a tonal and temporal analysis of vocal interactions between 15 mothers and their 3-month-old infants during 5 min of free-play in a laboratory setting. In total, 558 vocal exchanges were identified and analysed, of which 84% reflected harmonic or pentatonic series. Another 10% of the exchanges contained absolute and/or relative pitch and/or interval imitations. The total durations of dyads being in tonal synchrony were normally distributed (M=3.71, SD=2.44). Vocalisations based on harmonic series appeared organised around the major triad, containing significantly more simple frequency ratios (octave, fifth and third) than complex ones (non-major triad tones). Tonal synchrony and its characteristics are discussed in relation to infant-directed speech, communicative musicality, pre-reflective communication and its impact on the quality of early mother-infant interaction and child's development.