A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss.

OBJECTIVE: To explore the process of paediatric cochlear implant assessment, from referral to implantation, from the perspective of parents, cochlear implant professionals, and through observations of clinics. DESIGN: Qualitative approach, using grounded theory methodology. STUDY SAMPLE: Twelve families with children under 5 years with permanent hearing loss referred for a cochlear implant or received an implant in the past year, and six professionals who refer or assess children for cochlear implants. Data collection involved interviews and ethnographic observations of assessment clinics. RESULTS: The core theme derived from interview and observation data related to the work of the cochlear implant assessment for families. The relationship between the work generated by the assessment process and capacity of parents to do the work provides a model to examine access to early implantation, consistent with the Burden of Treatment theory. We identified variation in terms of workload, relating to factors such as a child's additional needs or number of appointments required, and in terms of capacity, relating to factors such as social circumstances or health literacy. Social, peer and professional support and information helped families manage the workload. CONCLUSIONS: Findings have implications for delivery of paediatric cochlear implant services.

The impact of print exposure on deaf student literacy.

Recent studies suggest that benefiting early from both a cochlear implant (CI) and exposure to cued speech (CS, support system for the perception of oral language) positively impacts deaf children's speech perception, speech intelligibility, and reading. This study aims to show how: 1/CS-based speech perception ("cue reading"), and speech intelligibility might also constitute precise measures for determining the impact of CI and CS on deaf students' literary performance; 2/print exposure might also be a predictive factor in this equation. We conducted regression analyses to examine the impact of these three variables in two experiments conducted on Grade 2-3 deaf children and Grade 6-9 deaf adolescents. Results indicate print exposure significantly contributes to literacy skills across experiments, with additional contributions from cue reading and speech intelligibility in older students. The predictive aspect of the print exposure, cue reading, and speech intelligibility variables will be discussed, as will the consequences for educational and pedagogical practices.

Communication issues between pharmacists and d/Deaf people: a qualitative study in Thailand.

BACKGROUND: People who are d/Deaf face challenges when communicating with pharmacists, especially during medication counseling. AIM: This study aimed to explore and understand the perceptions and experiences of d/Deaf people regarding medication counseling by hospital pharmacists. METHOD: Five sets of semi-structured in-depth interviews (44 total) and one focus group were conducted among d/Deaf people, hospital pharmacists, and Thai sign language (TSL) interpreters. Data from d/Deaf people's perspectives were triangulated with data from pharmacists and TSL interpreters. RESULTS: Five themes emerged from the interview: (1) d/Deaf people believe that deafness is stigmatized, (2) d/Deaf people's needs during medication counseling, (3) skills for d/Deaf people to communicate with pharmacists, (4) values identified in d/Deaf people, 5) emotions related to medication counseling with pharmacists. Effort, trust, confidentiality, and privacy were values associated with counseling. d/Deaf people preferred communicating with pharmacists in TSL to communicating with pharmacists via TSL interpreters because of trust and confidentiality. They also preferred pharmacists with d/Deaf knowledge and skills. Moreover, d/Deaf people believed that deafness was stigmatized, so signing in nonprivate areas was embarrassing. When TSL was not used in communication, language, lipreading, and technology skills became important. With these non-TSL communications, d/Deaf people may not have understood the conversation. However, they may not have asked pharmacists because they felt Krengjai (the hesitancy to bother). CONCLUSION: Thai d/Deaf people have negative experiences during medication counseling. Skills and emotions can act as barriers to communication with pharmacists. TSL should be used to improve d/Deaf people's experiences during medication counseling.

A Virtual Reality Platform for Evaluating Deficits in Executive Functions in Deaf and Hard of Hearing Children-Relation to Daily Function and to Quality of Life.

Background: Childhood hearing loss is a common chronic condition that may have a broad impact on children's communication and motor and cognitive development, resulting in functional challenges and decreased quality of life (QoL). Objectives: This pilot study aimed to compare executive functions (EFs) as expressed in daily life and QoL between deaf and hard-of-hearing (D/HH) children and children with typical hearing. Furthermore, we examined the relationship between EFs and QoL in D/HH children. Methods: The participants were 76 children aged 7-11 yr: 38 D/HH and 38 with typical hearing. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and Pediatric Quality of Life Inventory (PedsQL), while the child performed a shopping task in the virtual action planning supermarket (VAP-S) to reflect the use of EFs in daily activity. Results: D/HH children showed significantly poorer EFs (as measured by BRIEF and VAP-S) and reduced QoL. Difficulties in EFs were correlated with lower QoL. BRIEF scores were significant predictors of QoL domains. Conclusions: Difficulties in EFs may characterize children with D/HH and reduce their QoL. Therefore, EFs should be screened and treated. VAP-S and BRIEF are feasible tools for evaluating EFs that reflect children's challenges due to EF difficulties in real-life contexts.

Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey.

PURPOSE: This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English. METHODS: DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity. RESULTS: The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use. CONCLUSIONS: DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.

An enquiry into the usefulness of an information portal for Deaf and hard of hearing people prior to x-ray examinations and improvement ideas.

INTRODUCTION: Healthcare information resources are extremely limited currently in Irish Sign Language and studies of the preferred methods of gaining information in the Deaf and hard of hearing (DHH) community are scarce. This study aims to explore the opinions of DHH people on an information portal designed for a radiology department, taking account of their preferred methods of gaining information and past experiences of participants that may be addressed by a portal of this kind. These opinions inform the overall objective of creating a template for further improvements to the portal. METHODS: An information portal containing what to expect before, during and after a chest x-ray examination was created. Ethical approval was granted to interview 11 DHH adults via zoom and in person to explore their opinions of an information portal's value prior to chest x-ray examinations. The preferred media type for obtaining information prior to x-ray examinations was also explored. Interview methods reflected the heterogeneity of DHH people's communication methods. Transcripts of the study were analysed using qualitative thematic analysis. RESULTS: The resultant themes from the study were; positives of the information portal as it stands, feelings, pitfalls of the information portal, accessibility considerations, d/Deaf awareness, previous issues that may be helped by the information portal, improvement suggestions and further developments. The majority of participants preferred the subtitled video over other media types. Participants felt they would have been better prepared for their x-ray if they had used the information portal prior, and it would have increased their ability to give informed consent. Participants highlighted experiences of audism in radiology departments and cited the need for healthcare worker's deaf awareness to be improved. Improvements to the information portal were provided by participants. CONCLUSION: The idea of this information portal was supported by the participants. Increased deaf awareness particularly in healthcare workers will improve this resource and improve patient experiences in radiology. IMPLICATIONS FOR PRACTICE: A national policy is needed to implement accessible information in radiology departments to improve the provision of medical autonomy. This policy should be supported by ISL interpreters.

Speech production skills of bilingual children using cochlear implants.

Evidence is lacking on the impact of bilingualism on the speech skills of children with cochlear implants (CIs). This study described the speech production of children with CIs acquiring French and one or more additional spoken languages. Four groups of children aged 4-11 were included: bilinguals (n = 15) and monolinguals (n = 14) with CIs and bilinguals (n = 14) and monolinguals (n = 20) with typical hearing. Data were collected about the percentage of consonant correct (PCC) and vowel correct (PVC) produced in French and intelligibility in all languages they spoke. Bilingual and monolingual children with CIs had comparable speech accuracy in French, but the pattern differed, impacting PCC for bilinguals and PVC for monolinguals. Most children with CIs had accurate and intelligible speech in French, but few bilingual children with CIs were highly intelligible in their home language. Therefore, bilingualism did not impede the speech production outcomes of bilingual children with CIs in the language of the wider community.

The ineffective emotion regulation of deaf college students: an ERP study.

Introduction: Deaf students have more difficulties with emotion regulation due to their hearing loss. They are suffering higher socio-emotional risk than the hearing person. But there are few studies explored the neural mechanisms of impaired emotion regulation in the deaf college students. Methods: Thirty hearing college students and 27 deaf college students completed the emotion regulation task while recording ERP data and subjective emotion intensity. Results: Behavioral results found that deaf college students had higher emotional experience intensity compared to healthy controls. The ERP results showed the deaf college students had lower LPP amplitudes both using reappraisal and suppression strategies. Moreover, the LPP of expression suppression was associated with the increase of depression scores among deaf college students. Discussion: Deaf college students may have impaired emotion regulation so that they are more accustomed to using expression suppression strategies to regulate their negative emotions which lead to high risk to be depression.

A longitudinal study on moral emotions and psychosocial functioning among preschool children with and without hearing loss.

Moral emotions such as shame, guilt and pride are crucial to young children's social-emotional development. Due to the restrictions caused by hearing loss in accessing the social world, deaf and hard of hearing (DHH) children may encounter extra difficulties in their development of moral emotions. However, little research so far has investigated the development trajectory of moral emotions during preschool years in DHH children. The present study used a longitudinal design to explore the development trajectories of shame, guilt, and pride, in a sample of 259 Chinese DHH and typically hearing (TH) preschoolers aged 2 to 6 years old. The results indicated that according to parent reports, DHH children manifested lower levels of guilt and pride compared to their TH peers, yet the manifested levels of shame, guilt, and pride increased throughout the preschool time at a similar pace in all children. Moreover, whilst guilt and pride contributed to increasing levels of psychosocial functioning over the preschool years, shame contributed to lower social competence and more externalizing behaviors in DHH and TH preschoolers. The outcomes imply that early interventions and adjustment to hearing loss could be useful to safeguard the social development of children with severe hearing loss, and cultural variances shall be taken into consideration when studying moral emotions in a Chinese cultural background.

Role of auditory feedback for vocal production learning in the Egyptian fruit bat.

Some species have evolved the ability to use the sense of hearing to modify existing vocalizations, or even create new ones, which enlarges their repertoires and results in complex communication systems.1 This ability corresponds to various forms of vocal production learning that are all possessed by humans and independently displayed by distantly related vertebrates.1,2,3,4,5,6,7 Among mammals, a few species, including the Egyptian fruit bat,8,9,10 would possess such vocal production learning abilities.7 Yet the necessity of an intact auditory system for the development of the Egyptian fruit bat typical vocal repertoire has not been tested. Furthermore, a systematic causal examination of learned and innate aspects of the entire repertoire has never been performed in any vocal learner. Here we addressed these gaps by eliminating pups' sense of hearing at birth and assessing its effects on vocal production in adulthood. The deafening treatment enabled us to both causally test these bats' vocal learning ability and discern learned from innate aspects of their vocalizations. Leveraging wireless individual audio recordings from freely interacting adults, we show that a subset of the Egyptian fruit bat vocal repertoire necessitates auditory feedback. Intriguingly, these affected vocalizations belong to different acoustic groups in the vocal repertoire of males and females. These findings open the possibilities for targeted studies of the mammalian neural circuits that enable sexually dimorphic forms of vocal learning.

Are Deaf College Students More Sensitive to Unfair Information? Evidence from an ERP Study.

To better understand the individual differences in fairness, we used event-related potentials (ERPs) to explore the fairness characteristics of deaf college students through the ultimatum game task. Behaviorally, the significant main effect of the proposal type was found, which meant both deaf and hearing college students showed a lower acceptance rate for the more unfair proposal. Interestingly, we found a significant interaction between group and proposal type in the early stage (N1). Moreover, in the deaf college group, N1 (induced by moderately and very unfair proposals) was significantly larger than that of fair proposals. However, we found that deaf college students had smaller amplitudes on P2 and P3 than hearing college students. These results suggested that deaf college students might pursue more equity strongly so they are more sensitive to unfair information in the early stage. In a word, we should provide more fair allocations for deaf college students in our harmonious society.

Effectiveness of STEM based workshop for deaf education: Exploratory study.

STEM education for deaf students aims to engage and include intellectual and experiential learning other than normal classrooms. These programs improve students' critical thinking, problem-solving, creativity, and complex decision-making, which are essential for academic and life success. This study aims to explore several aspects of a STEM based workshop including problem solving skills, STEM skills, subject knowledge, and effectiveness of the workshop for a group of 27 deaf students. The workshop spanned five consecutive days and focused on problem-solving principles within the context of global warming. Moreover, in this study, the Creative Problem-solving approach developed by Osborn and Parnes was implemented to measure improvement of the constructs above, through a post questionnaire. Cronbach's alpha and McDonald's Omega coefficient exceeded .7 for each construct. The data obtained from the questionnaire demonstrated a random distribution of data according to the Shapiro-Wilk test performed (p < 0.05), leading to the use of non-parametric analysis tools. The results based on the non-parametric test analysis (Kruskal Wallis test) show that high school students' problem-solving abilities improved despite the data's randomness (Mean rank = 16.72). The workshop was enhanced for the Preparatory students, who tended to gain more STEM skills and problem-solving abilities from it (Mean rank = 14.75). It also improved the knowledge and STEM skills of Primary-stage students (Mean rank = 18.13 and 18.06, respectively). This study contributes to the existing body of literature by examining how addressing challenges of global warming can enhance various abilities among deaf students.

Narrative reconstruction in deaf and hearing children: A comparative study in the context of Arabic diglossia.

This study explores the narrative skills of deaf and hearing children within the context of Arabic diglossia, a linguistic environment characterised by significant differences between spoken dialects and formal written language. Using Stein and Glenn's (1979) and Bruner's (1991) frameworks, the research analyses the narrative constructions of 13 hearing and 13 deaf children in Kuwait. The findings reveal that hearing children, benefiting from consistent exposure to spoken and formal Arabic, produced more coherent and detailed narratives compared to deaf children. Hearing participants also demonstrated greater vocabulary diversity. Age-related improvements in narrative skills were more pronounced among hearing children, while the impact of sign language exposure on narrative abilities was significant among deaf children. The study underscores the critical role of early language exposure and educational support in fostering narrative development, particularly in a diglossic context. These findings highlight the need for specialised educational strategies to support the unique narrative development needs of deaf children.

Differences in the type of vocabulary understood by deaf and hearing students: Results to guide interventions.

INTRODUCTION: Vocabulary knowledge is an essential element in language development. There is evidence of significant differences in vocabulary knowledge between deaf children and hearing peers of the same age. These differences put deaf students at a disadvantage when compared to their hearing counterparts. The aim of this study was to investigate whether certain types of words characterise the lexical difficulties of deaf students. Our starting point is that this knowledge is needed to design interventions that are adapted to the particular needs of these students for their lexical development. METHODS: We evaluated the lexical comprehension of 90 Spanish students. The sample comprised 45 hearing students and 45 students with severe or profound hearing loss. Both groups were attending the later years of primary school (8 to -12-year-olds). They were tested using the Spanish Peabody Picture Vocabulary Test-III. The performance of both groups was statistically compared using percentiles and standard scores as well as a selected set of words from the test. RESULTS: No significant differences between hearing and deaf groups were found by age, sex, and sociocultural level. Significant differences were found between groups in their percentile and standard scores. There were no significant differences in performance between the two groups on only five of the 25 words with the highest error rate in the deaf group. The qualitative analysis of the remaining 20 words that were especially challenging for deaf students reveals results of interest which could help guide interventions. CONCLUSIONS: The results indicate the need for lexical intervention for deaf students in the final years of primary school. The specialised support service for deaf learners should approach the intervention by targeting a specific type of vocabulary, making the semantic relationships between these words more transparent and promoting a deeper understanding of them.

Reading metacomprehension of Spanish deaf and hard-of-hearing students.

Difficulties in monitoring reading comprehension result in poor comprehension. One key aspect of monitoring is metacomprehension, which refers to one's awareness of one's own reading comprehension. Previous studies have observed difficulties in metacomprehension among the deaf or hard-of-hearing (DHH) population. This study aims to determine whether the metacomprehension of DHH students corresponds to their reading score and whether they are truly capable of adjusting their metacomprehension to the difficulty of the text. We evaluated 25 Spanish-speaking DHH students with reading scores approximately equivalent to Grades 5 or 6 of Primary School. Participants were asked to read a text and answer questions. The texts corresponded to three levels of difficulty (explicit, inferable, and noninferable). The results revealed that the metacomprehension of DHH students corresponded to their reading score. The DHH population may have better reading metacomprehension than is typically assumed, although the manifestation of this skill may depend on the type of task demanded of them (comprehension judgment or knowledge judgment).

Sleep disturbances associated with DEAF1 pathogenic variants.

Neurodevelopmental disorders and sleep disturbances share genetic risk factors. DEAF1 genetic variants are associated with rare syndromes in which sleep disturbances are commonly reported, yet the specific sleep disorders in these patients, and the molecular mechanisms underlying this association, are unknown. We aimed to pinpoint specific biological processes that may be disrupted by pathogenic variants in this gene, comparing a list of DEAF1 regulatory target genes with a list of insomnia-associated genes, and using the intersect gene list as the input for pathway enrichment analysis. Thirty-nine DEAF1 regulatory targets were also identified as insomnia-associated genes, and the intersecting gene list was found to be strongly associated with immune processes, ubiquitin-mediated proteolysis pathways and regulation of the cell cycle. This preliminary study highlights pathways that may be disrupted by DEAF1 pathogenic mutations and might be putative factors underlying the manifestation of insomnia in patients harboring such variants.

Reading achievement and deaf students with cochlear implants.

OBJECTIVES: The purpose of this study was to investigate the reading outcomes of a Canadian cohort of school-aged deaf learners with cochlear implants (CIs). The goal was to investigate whether achievement approached that of hearing age peers and identify demographic factors influencing performance. METHODS: Participants represent a subset of 13 students with CIs from a larger sample of 70 deaf students in grades four through 12 educated in inclusive settings within a large school board in central Canada. Data sources included demographic information, teachers' ratings on the Categories of Auditory Performance (CAP), and scores from the Woodcock-Johnson III Diagnostic Reading Battery [WJ III-DRB].Results/Discussion: Participants performed within the low average range in all areas except for Phonological Awareness, which was in the low range; however, there was wide variability in scores across participants. None of the demographic variables (e.g. home language, additional disabilities) had a statistically significant association with performance, although older students had higher mean scores on the Phonological Awareness cluster. CONCLUSION: These findings add to the body of research on literacy achievement and cochlear implantation, providing evidence that this technology has a significant positive effect on outcomes for a population that has heretofore underperformed in this area.

An investigation on the face inversion effect in deaf children.

The face inversion effect is an important indicator of holistic face perception and reflects the developmental level of face processing. This study examined the face inversion effect in deaf or hard of hearing (DHH) children aged 7-17 using the face dimensions task. This task uses photographic images of a face, in which configural and featural information in the eye and mouth regions have been parametrically and independently manipulated. The study aimed to discuss the effect of face inversion on facial processing in DHH children, including two aspects of information processing types (configural versus featural) and processing regions (eyes versus mouth) and compared the results with hearing children. The results revealed that DHH children aged 7-17 years exhibit significant face inversion effect, with disruptions observed in both the featural and configural processing of eyes and mouths when faces were inverted. Configural processing was more affected by inversion than featural processing in all children, with larger differences observed in DHH children than in hearing children. This supports the dual-mode hypothesis of holistic face processing. Age correlations were observed in the sensitivity of DHH children to face inversion effect but not among hearing children. The inversion effect of configural mouth processing decreases with age in DHH children.

Neurocognitive outcomes in young adults with cochlear implants: The role of early language access and crossmodal plasticity.

Many children with profound hearing loss have received cochlear implants (CI) to help restore some sense of hearing. There is, however, limited research on long-term neurocognitive outcomes in young adults who have grown up hearing through a CI. This study compared the cognitive outcomes of early-implanted (n = 20) and late-implanted (n = 21) young adult CI users, and typically hearing (TH) controls (n=56), all of whom were enrolled in college. Cognitive fluidity, nonverbal intelligence, and American Sign Language (ASL) comprehension were assessed, revealing no significant differences in cognition and nonverbal intelligence between the early and late-implanted groups. However, there was a difference in ASL comprehension, with the late-implanted group having significantly higher ASL comprehension. Although young adult CI users showed significantly lower scores in a working memory and processing speed task than TH age-matched controls, there were no significant differences in tasks involving executive function shifting, inhibitory control, and episodic memory between young adult CI and young adult TH participants. In an exploratory analysis of a subset of CI participants (n = 17) in whom we were able to examine crossmodal plasticity, we saw greater evidence of crossmodal recruitment from the visual system in late-implanted compared with early-implanted CI young adults. However, cortical visual evoked potential latency biomarkers of crossmodal plasticity were not correlated with cognitive measures or ASL comprehension. The results suggest that in the late-implanted CI users, early access to sign language may have served as a scaffold for appropriate cognitive development, while in the early-implanted group early access to oral language benefited cognitive development. Furthermore, our results suggest that the persistence of crossmodal neuroplasticity into adulthood does not necessarily impact cognitive development. In conclusion, early access to language - spoken or signed - may be important for cognitive development, with no observable effect of crossmodal plasticity on cognitive outcomes.