Tools for Effective Psychiatric Treatment for Pediatric Patients With Hearing Loss
Although there is a high prevalence of deafness and hearing loss in youngsters, there is little understanding of the social, educational, cultural, and psychological needs of these children.
Deafness and hearing loss are common in children. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), about 2 to 3 out of every 1000 children in the United States are born with a detectable level of hearing loss in one or both ears.1 Of these, more than 90% are born to hearing parents.2 It is estimated that approximately 14.9% of children between the ages of 6 and 19 years have some type of hearing loss, defined as “low- or high-frequency hearing loss of at least 16-decibel hearing level in one or both ears.”3
Despite the high prevalence of deafness and hearing loss in youngsters, there is a paucity of understanding of the social, educational, cultural, and psychological needs of these children. “Hearing loss is more prevalent than diabetes mellitus, myelomeningocele, all pediatric cancers, and numerous other medical conditions. However, medical professionals typically learn little about hearing impairment, about how to advise parents of children who are deaf or hard of hearing, or about the special considerations needed in the care of children with hearing loss.”4
“There is a great need for practitioners with increased understanding of deaf children,” according to Lisalee Egbert, PhD, vice president of the American Society for Deaf Children (ASDC) and a member of the Governor's Advisory Committee for the Deaf and Hard of Hearing (ODHH) in the state of Maryland.
“There are many labels and stereotypes, and the needs of Deaf children have been dismissed for years,” she told Psychiatry Advisor.
The Importance of Nomenclature
Educating members of the public and healthcare professionals about working with children who are Deaf or Hard of Hearing begins with using appropriate terminology, noted Dr Egbert, who is herself Deaf.
“It is important to convey to professionals that we prefer the word Deaf—with a capital ‘D'—and Hard of Hearing rather than ‘hearing impaired.” The term “hearing impairment” was coined by the medical and legal community and lacks awareness of the “cultural linguistics” behind that term, she explained.
Although the phrase “hearing impaired” was once regarded as more sensitive and politically correct, Deaf people now regard it as negative because they are being compared to others and found lacking.5 “We are neither ‘hearing' nor ‘impaired,'” Dr Egbert said.
Instead, Deaf people should be regarded as a minority who have a unique culture rather than a medical condition. “Like other minorities, we have our own language, culture, values, and issues that arise within marriage and relationships,” she said. “We don't necessarily want to be hearing. We enjoy our culture and are proud of it.”
How Should Deaf Children First Learn to Communicate?
There are many controversies surrounding teaching Deaf or Hard-of-Hearing children how to communicate.
It has been a “long-standing belief” among parents and educators that teaching a child to sign will impair the child's ability to communicate verbally in the future.6 However, this contention is not evidence based and leads to poorer outcomes in children. Delaying effective means of communication results in missing the "one-time-sensitive-language acquisition window,” which can potentially lead to permanent brain damage that might include cognitive delays, mental health difficulties, lower quality of life, higher trauma, and limited health literacy.6 There is no solid evidence base to support withholding signing from young children.7
It is not only important to encourage Deaf children to sign, but also to encourage parents to learn sign language so as to communicate with their children, according to Annie Steinberg, MD, clinical professor of psychiatry at the Perelman School of Medicine of the University of Pennsylvania, Philadelphia.
“If a child is primarily a signer and the parent is not, opportunities for misunderstanding and miscommunication are enormous, since the parents and children do not share the same language,” she told Psychiatry Advisor.
Deaf children of hearing parents who do not use sign language are “unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak.”8 These children lack adequate means of self-expression, communication, and mastery of language. Moreover, they feel isolated from their family of origin, which further increases the risk to their mental health, Dr Steinberg said.
Mood Issues That Affect Deaf Children
A literature review found that children and adolescents who are Deaf or Hard of Hearing are more prone to developing depression, aggression, oppositional defiant disorder, conduct disorder, and psychopathy than their normally hearing peers.9 The review found that levels of anxiety, somatization, and delinquency were elevated in some children, depending on 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. Risk and protective factors that suggested which children would develop a mood or conduct disorder included age at detection and intervention of hearing loss, additional disabilities, communication skills, intelligence, type of school, and number of siblings.9
Even children who feel understood and able to communicate with their families might run into difficulties in school as they are increasingly mainstreamed in hearing environments, Dr Steinberg said. “They may experience feeling left out, feeling ineffective, and feeling part of two worlds, not knowing where they fit in.”
She noted that the frustration and discomfort they experience might spill over into their home lives. “Parents may not understand why their child is behaving disruptively at home.” She advised psychiatrists to explain this to parents and also to ascertain from the school if there are any academic, social, or functional issues that might be playing a role in the behavior.
Should Deaf Children Receive Cochlear Implants?
Prosthetic approaches to hearing restoration are being applied to younger children at increasing rates, with close to 59% of US children with early-onset deafness receiving a cochlear implant (CI).8 The decision whether to pursue cochlear implantation for a Deaf child is complex and controversial.8
Claims that CIs are more effective than sign language-inclusive approaches are not empirically supported.6 CIs are an “unreliable stand-alone first-language intervention for deaf children.” Rather, the priorities of Deaf child development should “focus on healthy growth of all developmental domains through a fully-accessible first language foundation such as sign language, rather than auditory deprivation and speech skills.“6
Children with CIs require intensive rehabilitation throughout childhood to learn to communicate orally. Even with this training, some children become better oral communicators than others.