Psychosocial functioning, emotion understanding and social skills in hard of hearing preschool children

Children with hearing loss are at risk for developing psychosocial problems. Children with mild to severe hearing loss are less frequently subject to research, in particular in preschool, and we therefore know less about the risk in this particular group. To address this, we compared psychosocial functioning in thirty-five 4–5-year olds with hearing aids to that of 180 typically hearing children. Parent ratings of psychosocial functioning and social skills, as well as scores of receptive vocabulary, were obtained. Children with hearing loss evidenced more psychosocial problems than hearing agemates. Female gender and early detection of hearing loss predicted better psychosocial functioning among children with hearing loss, whereas vocabulary and degree of hearing loss did not. Early intervention addressing psychosocial functioning is warranted for children with all degrees of hearing loss, including mild and moderate. Gender differences should be investigated in future research. Children who are deaf and hard of hearing (DHH) are at risk for psychosocial problems (Fellinger, Holzinger, Sattel, & Laucht, 2008; Moeller, 2007). Identifying the prevalence of psychosocial problems and their potential causes are vital to prevent and ameliorate these. Research has often addressed children with cochlear implants (Hogan, Shipley, Strazdins, Purcell, & Baker, 2011), but we know comparatively less about the psychosocial development of hard-of-hearing (HH) children; that is, children with mild to severe hearing loss (25–89 dB) who often use spoken language as their main language and who benefit from hearing aids rather than cochlear implants. By many, this group has been described as “historically underserved” (Holte et al., 2012, p. 163). This lack of knowledge even concerns basic information such as gender differences in psychosocial problems, as outcomes about this particular group are rarely reported separately in DHH research. Psychosocial adjustment includes emotional, social, and behavioral aspects. Development within these areas is associated with one’s mental health, which is defined by WHO as “a state of well-being in which every individual realizes his or her own potential” (WHO, 2014). There is a substantial continuity in psychosocial difficulties from preschool years to middle childhood and adolescence (Luby, Gaffrey, Tillman, April, & Belden, 2014), thus emphasizing the importance of early intervention in this area. Even so, most research has been directed towards middle childhood and adolescence. It is therefore especially important to study preschoolers to provide a knowledge base to build early interventions upon. Specifically, there is a considerable lack of knowledge about (a) the prevalence of psychosocial problems and (b) its relation to degree of hearing loss, gender, and other potential risk and protective factors in HH preschool children. The overarching aim of this study is therefore to provide such information. Degree of Hearing Loss The majority of the DHH population has mild to moderate hearing loss. The share varies due to different samples and definitions, but numbers between 55% and 70% are reported (Caluraud et al., 2015; Russ et al., 2003; Wake, Poulakis, Hughes, Carey-Sargeant, 260 | Journal of Deaf Studies and Deaf Education, 2016, Vol. 21, No. 3 & Rickards, 2005). Although some aspects of deafness are applicable regardless of degree, for example, the inability to follow a conversation in noisy surroundings, there are important differences between milder and more profound hearing loss. HH children have to some degree access to language very early in life; in contrast, children with profound loss have no access to language until cochlear implantation or hearing aid fitting, unless their parents are familiar with sign language. On the other hand, HH children may be at risk for not receiving timely intervention. Firstly, they may be diagnosed later than deaf children, as the hearing loss is not as easily observable. Secondly, intervention can be delayed as parents may be less aware of the need for such if the hearing loss is mild or moderate (Walker et al., 2014). Thus, different degrees of hearing loss may affect psychosocial development through different mechanisms. Psychosocial Problems in HH Children Several studies have documented increased prevalence of psychosocial problems in DHH children. However, as demonstrated in a recent review (Stevenson, Kreppner, Pimperton, Worsfold, & Kennedy, 2015), very few studies include preschool children. Though language problems tend to be more severe in children with profound hearing loss than in HH children (Fitzpatrick, Crawford, Ni, & Durieux-Smith, 2011), the association between degree of hearing loss and psychosocial problems is less clear. Whereas one study reports little relationship between degree of hearing loss and prevalence of diagnosable mental health problems (Fellinger, Holzinger, Sattel, Laucht, & Goldberg, 2009), another study suggests that higher degree of hearing loss predicted psychosocial adjustment problems in elementary, secondary, and high school students (Polat, 2003). To complicate further, HH children may even suffer more than those with profound hearing loss; in a study by Wake, Hughes, Collins, and Poulakis (2004), parents of 7to 8-year-old children with milder hearing loss reported lower health-related quality of life for their children, as compared to parents of children with more severe losses. Thus, there is no clear lesson to be learned from studies of DHH children regarding the psychosocial adjustment in HH children. Heterogeneity regarding age range and degree of hearing loss may explain some of the inconsistencies in previous research (Moeller, 2007). In the present study, we therefore included only HH children in a narrow age range. Psychosocial Problems in Preschool Age Studies demonstrate lower social competence and more behavior problems in deaf or cochlear implanted preschool children, compared to children with typical hearing (TH) (Barker et al., 2009; Hoffman, Quittner, & Cejas, 2015; Wiefferink, Rieffe, Ketelaar, & Frijns, 2012). Although older research suggests similar difficulties for HH children (Prior, Glazner, Sanson, & Debelle, 1988), newer research on infants and toddlers has been inconclusive. To illustrate, Stika et al. (2015) recently found that early identified HH children displayed social competence scores comparable to TH peers at the age of 12–18 months. In contrast, Topol, Girard, St. Pierre, Tucker, and Vohr (2011) found more symptoms of withdrawal and internalizing problems in children aged 18–24 months. Notably, the symptoms were more prevalent among children with mild or unilateral hearing loss compared to those with moderate to profound hearing loss, which the authors suggested could be related to lacking amplification in the mild/unilateral hearing loss group. However, a study on preschoolers with hearing loss ranging from mild to profound found social skills to be within the normal range, and that degree of hearing loss did not predict outcomes (Leigh et al., 2015). In sum, it seems that although many HH children may have social skills comparable to TH children, other areas may still be problematic. There is a need for a closer description of the different areas of development that may be at risk.