Poorna Kushalnagar

School placement and perceived quality of life in youth who are deaf or hard of hearing.

In the education of students who are deaf and hard of hearing (DHH), there is much debate about how placement affects educational outcomes and quality of life. This study examined the relationship between quality of life and educational placement that include and do not include other DHH youth. Participants included 221 DHH youth, ages 11-18 with bilateral hearing loss. Results showed that there were few differences in quality of life related to school placement (with age, gender, depression symptoms, and hearing level as covariates). For both participation and perceived stigma, there was an interaction between school placement and parent hearing status, with no single school placement showing the best results. DHH youth with hearing parents in schools specifically for DHH students scored lower than DHH with deaf parents in some domains (Participation and Perceived Stigma). When the DHH youth were compared with the general population, those in schools that included DHH students scored lower in some aspects of quality of life, particularly Self and Relationships. This study demonstrates that DHH students may not differ much in terms of quality of life across schools placements, but that there may be differences in subsets of DHH youth.

Validation of a quality-of-life measure for deaf or hard of hearing youth.

Objective. Quality-of-life (QOL) measures targeting youth with hearing loss are useful in population needs assessment, educational placement, and program design and evaluation. This study assesses the cross-sectional validity of the Youth Quality of Life Instrument–Deaf and Hard of Hearing Module (YQOL-DHH). Study Design. Instrument development and cross-sectional survey. Setting. Recruitment through schools, professional organizations, clinics, and programs for youth who are deaf or hard of hearing. Subjects and Methods. Thirty-five candidate items were administered to 230 adolescents aged 11 to 18 years: 49% female, 61% white, 11% mild hearing loss, 20% moderate/moderate-severe, 41% severe/profound, and 28% with cochlear implants. Participants completed individual or group-administered questionnaires by paper and pencil (58%), Web-based English (29%), American Sign Language (ASL) or Pidgin Signed English (PSE) (9%) on DVD, or interviewer-supervised ASL or PSE DVD (4%). The Children’s Depression Inventory (CDI-S) was also completed. Factor structure, reliability, construct validity, and respondent burden were assessed. Results. Thirty-two items were retained in the final instrument covering 3 domains: self-acceptance/advocacy (14 items, Cronbach α = 0.84), perceived stigma (8 items, Cronbach α = 0.85), and participation (10 items, Cronbach α = 0.86). QOL was not significantly associated with hearing level. One-week test-retest coefficients were acceptable: self-acceptance/ advocacy (0.70), perceived stigma (0.78), and participation (0.92). As predicted, the total CDI-S score was associated in the appropriate direction (P < .0001) with all YQOL-DHH domains. Time to complete the paper-and-pencil version was 12 minutes. Conclusion. The YQOL-DHH shows good reliability and validity for assessing hearing-specific QOL in adolescents.

Engaging the Deaf American Sign Language Community: Lessons From a Community-Based Participatory Research Center

Background: Numerous publications demonstrate the importance of community-based participatory research (CBPR) in community health research, but few target the Deaf community. The Deaf community is understudied and underrepresented in health research despite suspected health disparities and communication barriers.Objectives: The goal of this paper is to share the lessons learned from the implementation of CBPR in an understudied community of Deaf American Sign Language (ASL) users in the greater Rochester, New York, area.Methods: We review the process of CBPR in a Deaf ASL community and identify the lessons learned.Results: Key CBPR lessons include the importance of engaging and educating the community about research, ensuring that research benefits the community, using peer-based recruitment strategies, and sustaining community partnerships. These lessons informed subsequent research activities.Conclusions: This report focuses on the use of CBPR principles in a Deaf ASL population; lessons learned can be applied to research with other challenging-to-reach populations.

Bilingualism and attention: a study of balanced and unbalanced bilingual deaf users of American Sign Language and English.

Early deafness is thought to affect low-level sensorimotor processing such as selective attention, whereas bilingualism is thought to be strongly associated with higher order cognitive processing such as attention switching under cognitive load. This study explores the effects of bimodal-bilingualism (in American Sign Language and written English) on attention switching, in order to contrast the roles of bilingual proficiency and age of acquisition in relation to cognitive flexibility among deaf adults. Results indicated a strong high-proficiency bilingual advantage in the higher order attention task. The level of proficiency in 2 languages appears to be the driving force for cognitive flexibility. However, additional data are needed to reach conclusive interpretation for the influence of age of second language acquisition on higher order attention-switching ability and associated cognitive flexibility.

Health websites: accessibility and usability for American sign language users.

To date, there have been efforts toward creating better health information access for Deaf American Sign Language (ASL) users. However, the usability of websites with access to health information in ASL has not been evaluated. Our article focuses on the usability of four health websites that include ASL videos. We seek to obtain ASL users’ perspectives on the navigation of these ASL-accessible websites, finding the health information that they needed, and perceived ease of understanding ASL video content. ASL users (n = 32) were instructed to find specific information on four ASL-accessible websites, and answered questions related to (a) navigation to find the task, (b) website usability, and (c) ease of understanding ASL video content for each of the four websites. Participants also gave feedback on what they would like to see in an ASL health library website, including the benefit of added captioning and/or signer model to medical illustration of health videos. Participants who had lower health literacy had greater difficulty in finding information on ASL-accessible health websites. This article also describes the participants’ preferences for an ideal ASL-accessible health website, and concludes with a discussion on the role of accessible websites in promoting health literacy in ASL users.

Reading Among Diverse DHH Learners: What, How, and for Whom?

Students who are deaf and hard of hearing (DHH) face challenges in learning to read. Much has been written about the relative importance of the different factors associated with success in reading, but these factors are disputed within the literature on DHH readers. The Center on Literacy and Deafness, funded by the Institute of Education Sciences, is engaged in a nationwide project to identify child-by-instruction interactions related to instructional factors that are malleable within the classroom context. In the present article, the authors describe the project, present the conceptual model on which it is based, explain the processes and procedures used to choose assessment tools, and discuss their theoretical view of how reading and instruction might differ based on an individual student’s language and level of functional hearing.

Language Needs of Deaf and Hard- of-Hearing Infants and Children: Information for Spiritual Leaders and Communities

Leaders of spiritual communities should support a family welcoming a deaf or hard-of-hearing child in such a way that the entire community offers the child genuine inclusion. The ideal situation for protecting mental, emotional, and spiritual well-being is to raise the child bilingually. The community leader can guide as the community participates in nourishing the child by providing information and suggestions for action. The community needs to understand deafness as primarily a condition of gaining a culture and language rather than sensory loss, so that family and others evolve from grieving the loss of their expectations of what their childs life might be like to looking forward with hope to the unique contributions that child can bring to the world.

Avoiding Linguistic Neglect Of Deaf Children

Deaf children who are not provided with a sign language early in their development are at risk of linguistic deprivation; they may never be fluent in any language, and they may have deficits in cognitive activities that rely on a firm foundation in a first language. These children are socially and emotionally isolated. Deafness makes a child vulnerable to abuse, and linguistic deprivation compounds the abuse because the child is less able to report it. Parents rely on professionals as guides in making responsible choices in raising and educating their deaf children. But lack of expertise on language acquisition and overreliance on access to speech often result in professionals not recommending that the child be taught a sign language or, worse, that the child be denied sign language. We recommend action that those in the social welfare services can implement immediately to help protect the health of deaf children.

Language Choices for Deaf Infants Advice for Parents Regarding Sign Languages

The principle of respect for autonomy in modern medical ethics leads doctors to avoid persuasion and aim for neutrality when discussing language choices regarding deaf infants. However, at times persuasion to overcome biases is necessary and ethically mandatory. Many parents and health professionals have faith in the ability of cochlear implants (CIs) to allow deaf children to “hear” and achieve normal language and speech development. While it is good to encourage parents’ hope for their children’s future, to avoid bias, medical professionals must acknowledge the reality that CIs do not replace normal hearing. As of 2006, 80% of deaf infants in Northern Europe were receiving CIs, and as of December 2010, roughly 40% worldwide. Parents need to know that CI may not guarantee their child’s language acquisition. While a CI is usually given only to a child who will not benefit from a hearing aid, it is important to recognize that CIs are not “super hearing aids”; even hospitals that perform CI surgery make statements such as: “For most patients, a cochlear implant will not work as well as a hearing aid” 5 and studies support that statement. That’s because a hearing aid (HA) simply amplifies sound, whereas with CIs sound is transformed into electrical impulses delivered directly to the cochlear nerve. The CI-child must undergo long-term extensive training to interpret those electrical impulses. Unpredictable individual variation in outcomes is pervasive even with great effort and dedication from caregivers and the deaf child; some deaf children receive little to no auditory benefit from CIs in acquiring language. The neuronal plasticity of the brain with respect to language acquisition is maximal before the age of 3 years; if a child is not fluent in a language by the age of 5 years, that child may never achieve full fluency in any language. At the same time during this critical period, the increase in synaptic density occurs earlier and more rapidly in the occipital cortex than in the auditory; so the deaf infant’s brain is primed for visual input. Sign languages provide this visual input; access to signing can ensure language acquisition for deaf children and avoid cognitive deficits associated with linguistic deprivation. The deaf child who signs well does better academically than the deaf child who doesn’t, regardless of all other factors, and most attribute this to the fact that the signing deaf child is not at a linguistic disadvantage. Given evidence such as this, a recent panel of specialists concluded that all children born deaf should be taught a sign language immediately. We are a team of specialists in education studies, linguistics, pediatric medicine, and developmental psychology; our work focuses on deaf individuals. In order to help the practicing pediatrician, we offer here responses to common family questions. Our responses respect families’ autonomy while bearing in mind the difficulty that many parents have coming to terms with children who are different. The evidence-based information related to deaf children’s language and speech development here should help enable parents to better be involved in making the relevant decisions. Our intention is for the advice below to go directly to parents or indirectly via those involved in the educating of deaf children.

Making Cancer Health Text on the Internet Easier to Read for Deaf People Who Use American Sign Language

People with relatively limited English language proficiency find the Internet’s cancer and health information difficult to access and understand. The presence of unfamiliar words and complex grammar make this particularly difficult for Deaf people. Unfortunately, current technology does not support low-cost, accurate translations of online materials into American Sign Language. However, current technology is relatively more advanced in allowing text simplification, while retaining content. This research team developed a two-step approach for simplifying cancer and other health text. They then tested the approach, using a crossover design with a sample of 36 deaf and 38 hearing college students. Results indicated that hearing college students did well on both the original and simplified text versions. Deaf college students’ comprehension, in contrast, significantly benefitted from the simplified text. This two-step translation process offers a strategy that may improve the accessibility of Internet information for Deaf, as well as other low-literacy individuals.