Mental Health of Deaf and Hard-of-Hearing Adolescents: What the Students Say

This study by Margaret Brown and Andrew Cornes, from the University of Melbourne, investigated mental health issues as reported by Deaf or hard of hearing (DHH) adolescents in New South Wales, Tasmania, and Western Australia, ranging from 11 to 18 years of age. It assessed Deaf students’ mental health using a survey delivered in each student’s preferred form of communication in order to uniquely improve the accuracy of the results. Overall, the prevalence of mental health problems was 39%, far above the 14% reported for Australian hearing children and adolescents (Page 80).

Background Facts & Figures

The most recent report from Australian Hearing (2013) indicates that each year about 12 children per 10,000 live births are born with a moderate, severe, or profound hearing loss in both ears. A further 23 children per 10,000 will acquire a hearing impairment that requires hearing aids because of accident, illness, or other causes. Each year, Australian Hearing fits around 2,000 children with hearing aids for the first time. Currently, there are approximately 16,300 individuals under the age of 21 being supported with hearing aids and cochlear implants in Australia. Given that a national survey of the mental health of Australian children and adolescents revealed that 14% of children and adolescents were categorized as being in the clinical range, a conservative estimate of mental health problems in deaf and hearing-impaired students would be between 2,500 to 3,000 (Page 75).

Approximately 90–95% of deaf children are born to hearing parents and frequently, there are significant difficulties with parent–child interaction as parents adjust to the knowledge of their child’s deafness and find the most effective way to communicate with their child. Moreover, for deaf and hard-of-hearing (DHH) children, access to incidental learning within school and family contexts is often restricted because of difficulties in communication associated with hearing loss. These children may also display difficulties in abstract thinking and problem-solving skills that adversely affect their academic achievement, ability to form peer relationships and the development of self-esteem. In short, the unique patterns of social and emotional development seen in DHH children may predispose them to increased psychological distress (Page 75).

‘Experts’ originally suggested that just having a hearing impairment could cause a child to develop psychiatric disorders, but more recently, the assumption has been that deaf children display more behavioral problems because of their frustration with a lack of communication. Given that ease of communication with family and peers are critical to self-awareness, self-esteem, and identity, the researchers believed that communication within the family and at school would be a contributing factor in mental health problems (Page 76).

Difficulties Getting Accurate Results

Much of the research reporting on mental health problems in DHH youth has used information from the parents, with only a few studies collecting data from children and students themselves. A big problem has been the unsuitability of written questionaires, surveys and tests, particularly for children and students using a signed language such as Auslan. Auslan is not traditional English, it is its own unique language with its own grammatical structures and rules for creating meaning. How accurate can a questionnaire, written in one language, be in assessing responses composed in another language, that uses a different system to create meaning? (Page 76).

In an effort to overcome this, some studies have used simplified versions of the instruments in which the language has been simplified, but similarly, this was shown to result in incidents of underreporting when the results were compared to those collected with a ‘signed’ questionnaire. For example, one study reported that 54% of students with hearing loss were experiencing a mental health problem, another found that 39% of boys and 34% of girls were affected, while yet another reported an overall rate of 32.6% (Page 76).

Findings From the Australian Study

To address these issues, the study used a modified version of the Youth Self Report (YSR), a test designed for students in this age group, which takes about 20 min to complete and yields three different types of scores: a Total Problems Score, to rate overall mental health; scores for eight narrowband syndromes (or symptoms) – Anxious/Depressed, Withdrawn, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-breaking Behavior, and Aggressive Behavior; and finallly, a third type of score which measures whether students internalise or externalise their problems (Page 77).

Overall, the prevalence of mental health problems was 39%, far above the 14% reported for Australian hearing children and adolescents (Page 80).

For the students using Signed English at home, two-thirds of the group reported mental health problems. For students using Auslan, there were almost equal numbers of students with and without reported problems while in contrast, just under one-third of the students who were using Spoken English reported mental health issues. students using Signed English at home reported elevated prevalence rates for all measures on the YSR: namely, Total Problems and each of the narrowband and broadband syndrome scores (page 78).

In contrast, the students using spoken English at home reported elevated levels only for Internalizing Problems and Somatic complaints. Elevated levels of clinical problems were found in the Auslan using group for both of the broadband syndromes and all of the narrowband syndromes with the exception of Anxiety/Depression (Page 78).

For the eight narrowband syndrome scales, the prevalence was between two and seven times higher than that of hearing adolescents – DHH students were seven times more likely to report Social Problems and Thought Problems. Given the significant communication difficulties faced by DHH students, the incidence of Social Problems is unsurprising. The high incidence of Though Problems possibly reflects a difficulty that these students may experience with self-reflection, inner speech, and emotional self-regulation (Page 80).

The age of onset and progression of mental health problems in children with hearing loss is little understood. Other studies have found increased levels of social problems and anxiety/depression as DHH students grew older, however, age was not a contributing factor in this study in predicting mental health outcomes. In fact, the authors found a prevalence of mental health problems of 35% even in the younger group. This then suggests that there is a considerable problem by the start of secondary school and yet we know little about the genesis of mental health problems earlier than this. There is some evidence that preschoolers who are deaf or hard of hearing are delayed in their social development, but not deviant, experiencing difficulties with reciprocity, mutuality, and social problem solving. Furthermore, young DHH students have been shown to exhibit a reduced range of strategies for initiating and maintaining social interaction with peers. Whether the prolongation of such difficulties (including misinterpreting social information and a lack of access to incidental learning) experienced by these students in their primary school years lie at the heart of mental health problems remains to be investigated (Page 80).

When students were categorised according to the language they used at home and the prevalence rates of reported mental health problems calculated, the students using spoken English with their families emerged as experiencing fewer problems than did those whose families were using Auslan or Signed English. Those using Signed English at home reported elevated rates for all narrowband and broadband syndromes, but particularly for Internalizing, Externalizing, Rule breaking behavior, and Somatic complaints. Given that these students would have been predominantly born into hearing families, it is possible that the efforts that parents make to communicate in this way may compromise the quality and sensitivity of communication between them and their child (Page 80).

Elevated levels were also found for the students who used Auslan at home. While some of these students would have come from Deaf families, others would have been from hearing families in which the parents were attempting to communicate in a second language acquired in adulthood. This would affect not only their fluency, but also their ability to communicate deeply and sensitively which could interfere with attachment. About half of these students reported Internalizing, Externalizing, and Social Problems, although they were significantly less likely to report Anxiety/Depression. These findings emphasise the importance of quality of communication rather than mode of communication (Page 80).

The students using spoken English at home reported almost twice the prevalence of Internalizing problems as did their hearing counterparts, but the incidence was much less than that reported for the students who used a form of signing at home. Interestingly, these students also reported a level of Externalizing behavior that was like that of their hearing peers, whereas this was a major issue for the remaining students. These results suggest strong links between social problems, behavior, communication, and mental health (Page 80).

The more restricted communication occurring between DHH students, and their parents and teachers may result in discussions about concrete themes and less abstract thoughts and emotions. As children develop it is important that such communication not only reflects their current level of development but also promotes it, and this may be problematic for DHH children. This has implications for teachers and others who work with these students and their parents, particularly in promoting social and emotional aspects of learning. Clearly, the decision about which communication approach to use is an important one for parents to make to ensure communication in the early years, but it has important ramifications for shared communication in the home and therefore the social and emotional well-being of DHH individuals. Although this was a small sample of students, the finding regarding the language used at home requires further investigation (Page 80 – 81).

Reference: Brown, M., and Cornes, A. (2015). Mental Health of Deaf and Hard-of-Hearing Adolescents: What the Students Say: Deaf Studies and Deaf Education. University of Melbourne and View Psychology Limited. Pages 75–81 .