Health-related quality of life and associated developmental domains of children provided early with cochlear implants.

OBJECTIVES: Quality of life plays an important place in the psychosocial development of children with Cochlear Implants (CI). We assesd health-related quality of life (HRQoL) in children with CI and in hearing children and determined relationships between HRQoL and other developmental characteristics (social-emotional development, Theory of Mind (ToM), spoken language skills). METHODS: A longitudinal study was conducted including children with CI and hearing children. We used instruments that are widely employed and have been validated for research. At time 1 social-emotional development, ToM and spoken language skills were assessed.HRQoL was assessed using the generic KINDL questionnaire, as was social-emotional development, 2.5 years later (time 2). RESULTS: No significant difference was seen in HRQoL between hearing children and children with CI. We show that the age of detection, the age of hearing care, and the start of early intervention are not related to HRQoL of children with CI, but relationships with some domains of social-emotional development are evident. CONCLUSIONS: This study highlights the importance of targeted intervention not only to improve spoken language skills at preschool age, but also strengthen social-emotional and social-cognitive competences.

Fathers of Deaf and Hard-of-Hearing Infants and Toddlers - Experiences, Needs, and Challenges.

Studies on fathers with deaf and hard-of-hearing (DHH) children are quite rare in deaf education; if they are conducted, they narrowly focus on preschool-age or school-age children. The study reported here presents data from a survey on 92 fathers of very young DHH children with a mean age of 26 months. Questionnaires were used to measure the impact of children's hearing loss on parenting, the frequency of fathers' participation in early intervention appointments, and the level of fathers' involvement in daily care as well as in early intervention activities. Furthermore, information on fathers' perceived support from early intervention agencies, general self-efficacy, parenting self-efficacy, and marital satisfaction was assessed. The results confirmed data from other studies addressing fathers with children who have a disability. In particular, a strong relationship between parenting self-efficacy, perceived support by early intervention agencies and activities, and impact of child's hearing loss on parenting became evident. This indicates the importance of participation and involvement of fathers in early intervention activities; therefore, early intervention services must enable fathers to participate as much as possible in sessions.

Preliminary Evidence Assessing Social-Emotional Competences in Deaf and Hard of Hearing Infants and Toddlers Using a New Parent Questionnaire.

Social-emotional competences are an important developmental domain for deaf and hard of hearing (DHH) children and early diagnosis of problems is needed to ensure that DHH children receive appropriate support in this domain. In order to explore the usefulness of an instrument, which was recently developed for very young children, two studies in DHH infants and toddlers were conducted from Germany using the Social-Emotional Assessment/Evaluation Measure (Squires et al. (2013). Social-Emotional Assessment/Evaluation Measure (SEAM). Baltimore, ML: Brooks). Preliminary analysis of data obtained from a sample of 182 DHH children aged between 2 and 36 months (Study 1) suggests that it provides valid, reliable data and is suitable for use in practice. The data also corroborate well-known findings from other research in deaf education, in particular the role of parental responsivity for the development of social-emotional competences. Study 2 documents the consistency of evaluations of 44 DHH children by their mothers and by early intervention providers using the scales. Overall, the results suggest that this new evaluation instrument has potential applications in deaf educational practice but further research is needed to demonstrate its full value.

[Social-emotional competences in deaf and hard-of-hearing toddlers ­ results from an empirical study with two current parent questionnaires]. / Sozial-emotionale Kompetenzen hörgeschädigter Kleinkinder.

Objective: Hearing loss in the deaf and hard of hearing (DHH) is associated with an elevated risk of problems in socio-emotional development. Early assessment is necessary to start timely interventions. The present study tested two parent questionnaires that allow evaluation of the socio-emotional development of toddlers from a competence perspective. Method: 128 parents with DHH toddlers aged 18 to 36 months were asked to evaluate the development of their children and their own educational competences using two preliminary German adaptations of internationally well-known social-emotional assessment measures. Results: In addition to a series of results within the normal range, the data also reveal some specific problems in the socio-emotional development of children with hearing loss. DHH toddlers in particular show more problems developing empathic competences and maintaining relations with peers. DHH toddlers with additional handicaps have a higher risk of developing socio-emotional problems. Parental responsivity proves to be important regarding the development of socio-emotional competences in toddlers. Conclusions: The presented data strongly confirm results available from deaf research regarding the development and promotion of DHH children. The two questionnaires used in this study provide the opportunity to evaluate socio-emotional competences in DHH toddlers and to start appropriate interventions very early.

[Social-Emotional Competence in Young Children with Hearing, Visual or Intellectual Impairments - an Explorative Study with the ITSEA]. / Beurteilung sozial-emotionaler Kompetenzen von Kleinkindern mit einer Seh- oder Hörschädigung oder einer drohenden geistigen Behinderung.

Social-Emotional Competence in Young Children with Hearing, Visual or Intellectual Impairments - an Explorative Study with the ITSEA Early emotional and social competence is considered as an important requirement for social participation in family and child care settings. We report on a study exploring the usefulness of the competence scales as a part of the "Infant-Toddler Social and Emotional Assessment" (ITSEA) for one- to three-year old children in a sample of 253 toddlers with hearing, visual or intellectual impairments. Internal consistency of the six scales is good (alpha > .86). An ANOVA reveals significant differences between the three groups and a correlation with additional disabilities. These explorative results support the development of a German standardization of the ITSEA.

[On the relationship between executive functioning and social-emotional problems of deaf and hard-of-hearing students at general schools]. / Zum Zusammenhang exekutiver Funktionen und sozial-emotionaler Auffälligkeiten bei integriert beschulten Kindern mit einer Hörschädigung.

PROBLEM: As part of inclusive efforts more and more deaf and hard-of-hearing (D/HH) children are attending general schools. This makes it important to consider significant developmental prerequisites necessary for this step. This study analyzed the socioemotional problems of hearing-impaired children from general schools with respect to their executive functioning and communicative competence. METHOD: The executive functions of a sample of 69 hearing-impaired students were assessed by their teachers with a German version of the Behavior Rating Inventory of Executive Functions (BRIEF). In addition, a questionnaire measuring communicative competence as well as a German version of the Strengths and Difficulties Questionnaire were administered. The data were compared with those from a hearing normative sample, and further correlation and regression analyses were performed. The relationships between executive functioning and sociodemographic variables were also analyzed. RESULTS: There was a significantly higher rate of problems in executive functions for the group of D/HH students than for a hearing normative sample on nearly all scales, with the prevalence rate for executive dysfunctions being on average about three times higher. In addition to the children's sex, the BRIEF index for behavior regulation proved best for predicting socioemotional problems. CONCLUSION: The consequences for practical work are discussed. The results from the study suggest that D/HH students at general schools benefit in their psychosocial development from educational concepts that, in addition to promoting language and communicative competences, explicitly include strengthening self-efficacy and self-control.

Executive functions and behavioral problems in deaf and hard-of-hearing students at general and special schools.

In this study, behavioral problems of deaf and hard-of-hearing (D/HH) school-aged children are discussed in the context of executive functioning and communicative competence. Teachers assessed the executive functions of a sample of 214 D/HH students from general schools and schools for the deaf, using a German version of the Behavior Rating Inventory of Executive Functions (BRIEF-D). This was complemented by a questionnaire that measured communicative competence and behavioral problems (German version of the Strengths and Difficulties Questionnaire; SDQ-D). The results in nearly all the scales show a significantly higher problem rate for executive functions in the group of D/HH students compared with a normative sample of hearing children. In the D/HH group, students at general schools had better scores on most scales than students at schools for the deaf. Regression analysis reveals the importance of executive functions and communicative competence for behavioral problems. The relevance of the findings for pedagogical work is discussed. A specific focus on competencies such as self-efficacy or self-control in educational concepts for D/HH students seems to be necessary in addition to extending language competencies.

[Parental self-efficacy in family-centered early intervention]. / Zutrauen in die eigene Kompetenz als bedeutsames Merkmal familienorientierter Frühförderung.

Parental self-efficacy is seen as an important concern in family-centered early intervention. This article reports the data from 125 parents of young children with intellectual disabilities, hearing impairment or visual impairment. The relationship between parental self-efficacy, parental stress and several parent and child variables is analyzed. The results support the relevance of parental self-efficacy for parental coping. Some recommendations for promoting their experience of participation and partnership in early intervention services are discussed.

Health-related quality of life and classroom participation of deaf and hard-of-hearing students in general schools.

A group of deaf and hard-of-hearing (D/HH) students at mainstream schools (N = 212) was investigated in a questionnaire-based survey using the Inventory of Life Quality of Children and Youth (ILC) and the Classroom Participation Questionnaire. The ILC data for the D/HH sample are for the most part comparable with the data from a normative hearing sample. Item-total correlations showed that the domains of school and social activities with peers were more important for the Health-Related Quality of Life (HRQoL) of the D/HH students than for that of the hearing students. The results also reveal differences in the HRQoL levels of the two samples, with the D/HH sample having higher scores for school experiences, physical and mental health, and overall HRQoL, though the effect sizes for the differences are small to moderate. Specific characteristics of the D/HH sample may be responsible for this result. There are also relationships between quality of life and perceived classroom participation in certain domains: Students who perceive classroom participation as satisfying have higher scores for quality of life in school, social contact with peers, and mental health. This also applied to the scores for global assessment and a summarized quality of life indicator.

[Quality of life of mainstreamed hearing-impaired children--results of a study with the Inventory of Life Quality of Children and Youth (ILC)]. / Lebensqualität integriert beschulter Kinder mit einer Hörschädigung. Ergebnisse einer Studie mit dem Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen (ILK).

PROBLEM: Because in future more and more hearing-impaired children will go to school in inclusive settings, the life quality of this group constitutes a significant psychosocial indicator for participation in societal life. The Inventory of Life Quality of Children and Youth (ILC) was tested to examine its usefulness in diagnosing hearing-impaired children. METHOD: The ILC was filled in by 212 children. The procedure's inter-item-correlations, factorial structure and reliability were tested, and also the level of life quality compared to the procedure's standardization sample. Determined in addition were interrelations with sociodemographic variables, children's competencies and children's experienced participation at school. RESULTS: For hearing-impaired children as well, the ILC with all its relevant statistic values proves to be a procedure for measuring life quality that provides very satisfying results comparable to those of available standardization samples. The level of life quality of the tested sample is not impaired as compared to that of with children with good hearing. As expected, there are some significant relations to other variables, such as communicative competence, intelligence, academic achievements, and participation. CONCLUSION: The ILC provides a valid screening procedure that can be applied in the diagnosis of hearing-impaired children to measure the psychosocial well-being of hearing-impaired children in general education classrooms, and to get evidence for timely interventions.

The social network map as an instrument for identifying social relations in deaf research and practice.

Social support has shown itself to be an important factor in many areas in regard to mental health development and conservation. Numerous empirical findings also document its significance in various areas of research into deafness. Questionnaires are only one means of gathering information when we are trying to gain access to the social networks of deaf and hard of hearing people, their families, and relatives. The social network map is an approach that provides qualitative access to insights into social relationships and has proven, in conjunction with a qualitative interview, to be a useful tool in allowing a more detailed description and in-depth understanding of the processes of both social support and stress. The special strength of the social network map lies in the combination of visualizing social relationships and reflecting them in an interpersonal dialogue. This article describes how to go about creating a network map and illustrates this with an example of a mother of a multi-handicapped, deaf child. It concludes with a discussion of the opportunities that the use of a social network map offers as well as its potential limitations.

Self-esteem and satisfaction with life of deaf and hard-of-hearing people--a resource-oriented approach to identity work.

In the context of the current identity discussions, the interrelations between acculturations, psychological resources, and self-esteem as well as the satisfaction with life of deaf and hard-of-hearing people (N = 629) were examined by means of a questionnaire-based survey. To check these interrelations, one-factor and two-factor analyses of variance were employed. The results show that bicultural, deaf, and hearing acculturation styles have the advantage over marginal acculturation, but the results for marginal acculturation need to be discussed in depth to ensure a comprehensive understanding of them. All in all, bicultural acculturation seems to be a secure option for psychosocial well-being. The availability of psychological resources (optimism, self-efficacy) seems to be of special importance for the quality of self-esteem and satisfaction with life. On the other hand, the power of these psychological resources is closely associated with good communicative conditions in the individual biographies of the participants in this study as well as with their education level. Going beyond a methodological discussion then, the mission for educators would seem to be one of making good communicative conditions available to each deaf or hard-of-hearing child and optimizing academic achievement so as to ensure a secure, comprehensive, and differentiated opening up of the world and psychological empowerment. In this way, a good foundation can be laid for developing quality of life.

Prevalence of socioemotional problems in deaf and hard of hearing children in Germany.

The German version of the Strengths and Difficulties Questionnaire (SDQ) was used in a study to examine its usefulness in diagnosing socioemotional problems of deaf and hard of hearing children. The SDQ parent version was completed by 213 mothers and 213 fathers. The factor structure and reliability were tested, and the prevalence rate of socioemotional problems determined and compared to the German standardization sample. The statistical data were uniformly satisfactory; thus, the SDQ can serve as a valid yet economical screening procedure to identify endangered children at an early age, and to refer them to more exact diagnosis and subsequent advice and therapy. This is very important, as the prevalence of socioemotional problems in the sample of deaf and hard of hearing children was clearly greater for almost all scores, a result that is nearly identical with findings from many other recent studies.

Parental resources, parental stress, and socioemotional development of deaf and hard of hearing children.

In recent years, empowerment and resource orientation have become vital guidelines for many of the sciences. For the field of deaf education, it is also highly important to look carefully at these guidelines if we are to acquire a better understanding as regards both the situation of the parents involved and the development of the deaf and hard of hearing children themselves. A resource-oriented approach to deaf education has therefore proved especially helpful. If both the theoretical and practical aspects of educating deaf and hard of hearing children are to benefit, research on parental experience with deafness and research on the socioemotional development of the children must always be combined and studied in the context of resource availability. In a study of 213 mothers and 213 fathers of deaf and hard of hearing children, we used an array of different questionnaires (PSI, SDQ, SOC, F-SozU, etc.) to examine the correlation between parental resources, sociodemographic variables, parental stress experience, and child socioemotional problems by way of a path analysis model. The results show that high parental stress is associated with frequent socioemotional problems in the children, thus emphasizing the importance of a resource-oriented consulting and support strategy in early intervention, because parental access to personal and social resources is associated with significantly lower stress experience. Child development seems to profit enormously from a resource-oriented support concept. In addition, the results confirm two earlier findings: parents with additionally handicapped children are especially stressed and the child's communicative competence makes for a more sound prediction than its linguistic medium (spoken language or sign). The path models for mothers and fathers agree in all essential factors. The results are discussed with a view to their meaning for pedagogical practice, and recommendations for further research are given (longitudinal data, more representative samples, cochlear implant).

[Socio-emotional problems among hearing-impaired children--initial results of the German version of the Strengths and Difficulties Questionnaire (SDQ-D)]. / Sozial-emotionale Probleme hörgeschädigter Kinder--erste Ergebnisse mit der deutschen Version des Strengths and Difficulties Questionnaire (SDQ-D).

OBJECTIVES: Many studies demonstrate the precariousness of hearing-impaired children's socio-emotional development and bring home the necessity of early and reliable diagnosis. The German version of the Strengths and Difficulties Questionnaire (SDQ-D) is a fairly new screening procedure examined here with a view to its usefulness in diagnosing hearing-impaired children. METHODS: The SDQ-D parent version was completed by 213 mothers and 213 fathers of hearing-impaired children within their families as part of a larger study on familial socialisation. The procedure's factorial structure and measurement accuracy were tested, and the prevalence rate of emotional and behavioural disorders was determined in comparison to the German standardization sample (Woerner et al., 2002a) in the context of other variables (age, sex, communicative competence, educational status). RESULTS: With the exception of the "Behaviour Disorders" scale, the SDQ-D factorial structure can be reproduced in a satisfactory manner. The same can be said for its measurement accuracy. The prevalence of behaviour disorders under the condition "Hearing Impairment" is clearly higher on almost all scales, as well as for the total problem score. Special attention should be paid to the scores in the fields "Emotional Problems" and "Peer Problems" because of their significant correlation to the children's age. CONCLUSIONS: The SDQ-D provides a valid yet economical screening procedure which can also be applied in the diagnosis of hearing-impaired children; children whose psychological development is especially endangered at an early age can be identified and referred for a more exact diagnosis and continuing counselling and therapy.

Ethics, deafness, and new medical technologies.

In the last 50 years, several new technologies have become enormously important within the Deaf community and have helped significantly to improve deaf people's lives in a hearing world. Current public attention and admiration, however, seems unduly focused on medical technologies that promise to solve "the problem" of being deaf. One reason for this interest, we argue, is the public's preoccupation with deafness as a disability and promises that technological breakthroughs such as the cochlear implant will "cure" deafness. Pressure on parents to make quick and early decisions and lack of adequate information about alternatives often leave them unprepared for the consequences of these decisions. To allow deaf individuals and their families to make better informed decisions about their lives and their futures, we argue finally that professionals who interact with these families adopt inclusive and individualizing ethics.

Sense of coherence: a relevant resource in the coping process of mothers of deaf and hard-of-hearing children?

This study examined the importance of reported sense of coherence (Antonovsky, 1987) in mothers of children with hearing impairment. Sense of coherence was explored as a factor in relation to the experience of stress and subjective life satisfaction and in the context of other relevant variables in coping (e.g., social support, additional handicaps of the child, child's hearing status, means of communication). Two hundred thirty-five mothers completed a questionnaire, and path analysis corroborated a theoretical model in which sense of coherence was delineated as a factor contributing directly to stress perception. Both sense of coherence and the experience of social support were identified as resources that reduced reported stress and improved quality of life, with sense of coherence especially important in reducing stress. Child variables, including additional handicaps and extent of hearing impairment, intensified reported stress for the mothers, but mode of communication with the deaf child did not affect stress experience. The findings are discussed within the context of socialization theory. Recommendations for further research (e.g., longitudinal data, control designs, socio-economic status, applicability to fathers) are made.