Stephanie C. P. M. Theunissen

Depression in hearing-impaired children

OBJECTIVE The purpose of this study was to examine the levels of depressive symptoms and the unique contribution of two aspects of emotion regulation (coping and mood states) to the development of depression in hearing-impaired children and a control group. METHODS In order to compare the groups, self-report questionnaires concerning symptoms of depression, coping strategies, and mood states were used. The study group consisted of 27 children with cochlear implants, 56 children with conventional hearing aids, and 117 normally hearing children. RESULTS Hearing-impaired children reliably reported more symptoms of depression than their normally hearing peers. Degree of hearing loss, socioeconomic status, gender, and age were unrelated to the level of depressive symptoms. But attending mainstream schools or using exclusively speech for communication were related to fewer depressive symptoms. The associations with depressive symptoms differed between the groups. For hearing-impaired children, the cognitive aspects (coping) and the affective aspects (mood states) of emotional functioning contributed separately to the prediction of depressive symptoms. For normally hearing children an integration of cognitive and affective aspects was detected: adequate coping skills prevented the development of negative mood states and in turn depressive symptoms. CONCLUSIONS Hearing-impaired children reported more depressive symptoms than normally hearing children. Prevention and treatment of depression in hearing-impaired children could focus on the use of coping strategies adequately, because these strategies have a direct relation with the level of depression.

Psychopathology and Its Risk and Protective Factors in Hearing-Impaired Children and Adolescents: A Systematic Review

IMPORTANCE Pediatric hearing impairment is a chronic handicap that can potentially lead to the development of psychopathology. Yet, for hearing-impaired children and adolescents, the exact occurrence of various forms of psychopathology and its causes are unclear, while this knowledge is essential to enable targeted screenings and interventions. OBJECTIVE To investigate the level of psychopathological symptoms in hearing-impaired children and adolescents as compared with normally hearing peers. Second, the influence of type of hearing device and possible risk and protective factors on psychopathology were examined. EVIDENCE REVIEW A systematic literature search was performed covering relevant databases, including PubMed, Embase, and Web of Science. Two independent researchers identified the relevant articles. The final search was performed on May 2, 2013, and resulted in a total of 35 articles. FINDINGS Literature consistently demonstrated that hearing-impaired children and adolescents were more prone to developing depression, aggression, oppositional defiant disorder, conduct disorder, and psychopathy than their normally hearing peers. Levels of anxiety, somatization, and delinquency were elevated in some, but not all, hearing-impaired participants, for reasons related to sex, age, and type of school. Divergent results were obtained for the level of attention-deficit/hyperactivity disorder and the influence of type of hearing device on psychopathology. Possible risk and protective factors were identified, including age at detection and intervention of hearing loss, additional disabilities, communication skills, intelligence, type of school, and number of siblings. CONCLUSIONS AND RELEVANCE Literature on psychopathology in hearing-impaired children and adolescents is scarce and sometimes inconsistent. To define a more precise occurrence of psychopathology, more studies are needed. These studies should have a longitudinal design to draw firmer conclusions on causality. Hopefully, this will lead to more knowledge in the future to help and support each hearing-impaired individual.

Peer Victimization Experienced by Children and Adolescents Who Are Deaf or Hard of Hearing

Victimization is a relatively common, yet serious problem, with potentially severe consequences for childrens psychosocial and academic functioning. Children who are Deaf or Hard of Hearing (DHH) may be at a higher risk for victimization than hearing children. The aims of the present study were to compare DHH and hearing children on i) self-reported experiences of victimization and ii) associations between victimization, parental- and child variables. In total 188 children (mean age 11;11 years) from the Netherlands and Dutch-speaking part of Belgium participated in the study. No difference between DHH and hearing children were found on general experiences of victimization. However, differences between the groups were found on specific forms of experienced victimization and on the associations between victimization and parental variables. For DHH children, parental sensitivity and parents who challenge their DHH children to become competent in the practical, emotional, cognitive and social domain is associated with them being less victimized. For hearing children at this age these relations were reversed, absent or more complex. Finally, DHH children in special schools were more victimized than DHH children in regular schools. It can be concluded that parents can play an important role in reducing social problems experienced by DHH children and young adolescents.

Anxiety in children with hearing aids or cochlear implants compared to normally hearing controls

The objectives of this study were to examine the levels of anxiety in hearing‐impaired children with hearing aids or cochlear implants compared to normally hearing children, and to identify individual variables that were associated with differences in the level of anxiety.

Low Empathy in Deaf and Hard of Hearing (Pre)Adolescents Compared to Normal Hearing Controls

Objective The purpose of this study was to examine the level of empathy in deaf and hard of hearing (pre)adolescents compared to normal hearing controls and to define the influence of language and various hearing loss characteristics on the development of empathy. Methods The study group (mean age 11.9 years) consisted of 122 deaf and hard of hearing children (52 children with cochlear implants and 70 children with conventional hearing aids) and 162 normal hearing children. The two groups were compared using self-reports, a parent-report and observation tasks to rate the children’s level of empathy, their attendance to others’ emotions, emotion recognition, and supportive behavior. Results Deaf and hard of hearing children reported lower levels of cognitive empathy and prosocial motivation than normal hearing children, regardless of their type of hearing device. The level of emotion recognition was equal in both groups. During observations, deaf and hard of hearing children showed more attention to the emotion evoking events but less supportive behavior compared to their normal hearing peers. Deaf and hard of hearing children attending mainstream education or using oral language show higher levels of cognitive empathy and prosocial motivation than deaf and hard of hearing children who use sign (supported) language or attend special education. However, they are still outperformed by normal hearing children. Conclusions Deaf and hard of hearing children, especially those in special education, show lower levels of empathy than normal hearing children, which can have consequences for initiating and maintaining relationships.

Self-esteem in hearing-impaired children: the influence of communication, education, and audiological characteristics.

Objective Sufficient self-esteem is extremely important for psychosocial functioning. It is hypothesized that hearing-impaired (HI) children have lower levels of self-esteem, because, among other things, they frequently experience lower language and communication skills. Therefore, the aim of this study was to compare HI childrens self-esteem across different domains with those of normal hearing (NH) children and to investigate the influence of communication, type of education, and audiological characteristics. Methods This large (N = 252) retrospective, multicenter study consisted of two age- and gender-matched groups: 123 HI children and 129 NH controls (mean age  = 11.8 years). Self-reports were used to measure self-esteem across four domains: perceived social acceptance by peers, perceived parental attention, perceived physical appearance, and global self-esteem. Results HI children experienced lower levels of self-esteem regarding peers and parents than NH controls. Particularly HI children who attended special education for the deaf were at risk, even after correcting for their language development and intelligence. Yet, levels of global self-esteem and self-esteem involving physical appearance in HI children equalled those of NH controls. Furthermore, younger age at implantation and longer duration of having cochlear implants (CIs) were related to higher levels of self-esteem. Conclusion HI children experience lower levels of self-esteem in the social domains. Yet, due to the heterogeneity of the HI population, there is high variability in levels of self-esteem. Discussion Clinicians must always be aware of the risk and protective factors related to self-esteem in order to help individual patients reach their full potential.

Early identification: Language skills and social functioning in deaf and hard of hearing preschool children.

OBJECTIVE Permanent childhood hearing impairment often results in speech and language problems that are already apparent in early childhood. Past studies show a clear link between language skills and the childs social-emotional functioning. The aim of this study was to examine the level of language and communication skills after the introduction of early identification services and their relation with social functioning and behavioral problems in deaf and hard of hearing children. STUDY DESIGN Nationwide cross-sectional observation of a cohort of 85 early identified deaf and hard of hearing preschool children (aged 30-66 months). METHODS Parents reported on their childs communicative abilities (MacArthur-Bates Communicative Development Inventory III), social functioning and appearance of behavioral problems (Strengths and Difficulties Questionnaire). Receptive and expressive language skills were measured using the Reynell Developmental Language Scale and the Schlichting Expressive Language Test, derived from the childs medical records. RESULTS Language and communicative abilities of early identified deaf and hard of hearing children are not on a par with hearing peers. Compared to normative scores from hearing children, parents of deaf and hard of hearing children reported lower social functioning and more behavioral problems. Higher communicative abilities were related to better social functioning and less behavioral problems. No relation was found between the degree of hearing loss, age at amplification, uni- or bilateral amplification, mode of communication and social functioning and behavioral problems. CONCLUSION These results suggest that improving the communicative abilities of deaf and hard of hearing children could improve their social-emotional functioning.

Symptoms of Psychopathology in Hearing-Impaired Children

Objectives: Children with hearing loss are at risk of developing psychopathology, which has detrimental consequences for academic and psychosocial functioning later in life. Yet, the causes of the extensive variability in outcomes are not fully understood. Therefore, the authors wanted to objectify symptoms of psychopathology in children with cochlear implants or hearing aids, and in normally hearing peers, and to identify various risk and protective factors. Design: The large sample (mean age = 11.8 years) included three subgroups with comparable age, gender, socioeconomic status, and nonverbal intelligence: 57 with cochlear implants, 75 with conventional hearing aids, and 129 children who were normally hearing. Psychopathology was assessed by means of self- and parent-report measures. Results: Children with cochlear implants showed similar levels of symptoms of psychopathology when compared with their normally hearing peers, but children with hearing aids had significantly higher levels of psychopathological symptoms, while their hearing losses were approximately 43 dB lower than those of children with implants. Type of device was related with internalizing symptoms but not with externalizing symptoms. Furthermore, lower age and sufficient language and communication skills predicted less psychopathological symptoms. Conclusions: Children who are deaf or profoundly hearing impaired and have cochlear implants have lower levels of psychopathological symptoms than children with moderate or severe hearing loss who have hearing aids. Most likely, it is not the type of hearing device but rather the intensity of the rehabilitation program that can account for this difference. This outcome has major consequences for the next generation of children with hearing loss because children with profound hearing impairment still have the potential to have levels of psychopathology that are comparable to children who are normally hearing.

Alexithymia in children with cancer and their siblings

OBJECTIVE The purpose of this study was to examine the levels of alexithymia in children with cancer, in siblings of children with cancer, and in healthy controls. METHOD In order to compare the groups the Alexithymia Questionnaire for Children was used. The study group consisted of 97 children with cancer, 95 siblings, and 151 healthy controls. RESULTS The highest level of alexithymia was reported by children diagnosed with cancer, followed by their siblings. Healthy controls reported the lowest level of alexithymia. No gender differences were observed. The intensity of cancer was a significant predictor of the alexithymia score, with patients with the most severe cancers reporting the highest levels of alexithymia. No differences were found between the patients with moderately severe and least severe cancers. CONCLUSIONS Not only children with cancer, but also their siblings show significantly more alexithymia than their healthy counterparts. Professionals should aim at preventing or reducing the psychological problems in both patients and their siblings.

Pathways Underlying Somatic Complaints in Children and Adolescents Who Are Deaf or Hard of Hearing

Frequent somatic complaints are not only a problem in themselves but also related to other difficulties. So far, no conclusive findings have been reported about the prevalence of and factors underlying these complaints in children and adolescents who are deaf or hard of hearing (DHH). Such information would be valuable for prevention and intervention. Therefore, the aim of this study was to examine the prevalence of somatic complaints and their relation with emotional functioning in DHH youngsters, as compared with hearing youngsters. This was established by assessing how somatic complaints, mood states, and sense of coherence were experienced by 186 Dutch participants (mean age = 11;07 years). DHH and hearing groups were compared using multivariate analysis of variance and structural equation modeling. The results showed that somatic complaints were reported equally often for both groups, but that the pathways leading to these complaints were partly different. Only in DHH participants were feelings of fear associated with more somatic complaints. The results suggest that DHH children and adolescents would benefit from support in the regulation of fear and its causes. Other aspects affecting adjustment outcomes of DHH youngsters were education type and communication mode.