This section highlights the impact of hearing loss upon child development and the implications that might affect the family as a consequence of such loss. Social and emotional, behavioural and cognitive dimensions are discussed in turn. The
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following section then presents a consideration of the educational implications of hearing loss.
Social, Emotional and Independence Implications
Relationships, work, leisure, safety, and security can be significantly affected, not only by deafness but also by hearing impairment. Burkey (2006) argues that implications of hearing impairment are determined by social science studies and personal narratives. Hearing loss could also have a negative impact that is more notable than any other physical disability combined with inadequate communications skills (McKenna and O’Sullivan, 2009). Burkey (2006) claims that hearing impairment can often reduce independence as a result of communication difficulty and feelings of exclusion and isolation.
It is now claimed that communication skills are more important to the workforce than physical abilities (McKenna & O’Sullivan, 2009). The treatment of people with hearing impairment in a workforce environment is one of the challenges that could affect these people. Although the effects of hearing loss can be mitigated by 50% as a result of using hearing aids, Kochkin (2007) conducted a survey of more than 40,000 households utilising the National Family Opinion survey panel in the US. The findings showed a negative impact uponthe average families’ income up to $12,000 annually, depending on the level of hearing impairments of the incumbents. In addition, it has been stated that the likelihood of a workforce excluding people with a hearing impairment is eight times higher compared with others who do not have such impairment (McKenna & O’Sullivan, 2009). So, hearing impairment has far- reaching implications in terms of employment prospects.
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With respect to psychological implications of deafness, there are different factors that might influence a deaf pupil’s experience of friendship, personality and socialisation. Cambra (2002) argues that the formation of the self-concept could be affected by two main groups of factors. Firstly, explicit variables, such as deafness itself and the implications that might arise as a consequence, such as difficulty making lasting friendships; secondly, implicit variables, such as issues related to educational settings, degree of disability, and acceptance by parents, relatives, peers, teachers and the local community. Furthermore,according to Backenroth (1986, pp. 124-131), “The most important problems that have confronted deaf persons over the years have not been the hearing impairment as such but rather the lack of understanding on the part of their surroundings as to what deafness implies”. Also, Harter (1992) states that feeling frustration, anxious or ashamed about parents’ negative response over academic failure could harm child’s self-perception.
Gill and Feinstein (1994, as cited in Burkey, 2006) conclude that quality of life is a multifaceted personal perception that must be measured from an individual’s point of view. However, it is suggested that the impact of hearing impairment on an individual’s life could be measured effectively by exploring the concept of quality of life. It appears that medical concept such as the function of the ear is a dominating approach in terms of measuring such impact. In addition, Burkey (2006) argues that confusion could result from exploring quality of life as an individual measure of status, while using this concept interchangeably with the concept of functionwhich is an independent measure. Such confusion might exist even in identifying variables which could influence educational outcomes.
Kramer, Kapteyn, Kuik and Deeg (2002) have conducted research on a sample consisting of 3,107 hearing impaired adults and pointed out that:
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The hearing impaired elderly reported significantly more depressive symptoms, lower self-efficacy and mastery, more feelings of loneliness, and a smaller social network than that of normally hearing peers. Whereas chronic diseases demonstrate significant associations with some outcomes; hearing impairment is significantly associated with all psychosocial variables (p. 122).
Nevertheless, it is claimed that methodological procedures might lead to conflicting findings that occur in studies linking hearing impairment with difficulties, such as depression or anxiety. This is either because of possible confounding variables that have not been taken into account or limitations in the participants, who have a hearing impairment and were involved in these studies (McKenna & O’Sullivan, 2009).
Dalton, Cruickshanks , Klein , Klein , Wiley & Nondahl (2003) state that in their research “severity of hearing loss was significantly associated with having a hearing handicap and with self-reported communication difficulties” (p. 663). Personal relationships within the family, work environment and social networks could be affected by difficulty in joining in conversations. In addition, experiences of feeling left out and everyday non-verbal sounds, such as doorbells, music and traffic, cannot be perceived consciously by deaf people (Graham, Baguley & Ballantyne, 2009).
The life of the parents of deaf children could be substantially affected regarding the inability to solve problems, communicate cooperatively and perhaps the difficulty of having an effective relationship with extended family members (Park, Hoffman, Marquis, Turnbull, Poston, & Mannan, 2003). An illustration of this in the Saudi context is that the relationship with the extended family is considered a core issue in community culture, which has a significant impact on a child and/or his/her parents.
It is claimed that the presence of a disabled child has a significant impact on family relations, and that this often represents a disappointment to the aspirations of the
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parents and leads to profound variations in expectations (Qandial, 2000). The implications of deafness might also have a negative impact on the relationships with extended family members. Therefore, enhancing the child’s preferred communication mode could influence the degree of ease of interacting with extended family members (Jackson & Turnbull, 2004).
The growth of a child’s social and emotional development including the ability to adapt to the family could be hindered by a hearing disability, which might also lead to a lack of adequate response to social, linguistic and audio stimuli (Hughes, 1998). The relationships between families and those of their children with severe hearing loss can often face significant challenges compared with those with children who have mild or lesser degrees of hearing impairment (Hintermair, 2000). Understanding spoken language cannot be achieved without effort, although a hearing-impaired person might accomplish this by focusing on effective strategies, for example, thinking and trying to identify what is said to him/her (Burkey, 2006).
Guthmann and Vicki (2004) claim that an absence of experience and knowledge with respect to treating the D/deaf and people with hearing impairment, is a major obstacle that could prevent these people receiving the support they need. Bodner and Johnson (2001) argue that uncertainty might occur as a result of a lack of parents’ knowledge in terms of teaching children with deafness. Therefore, the many potential difficulties associated with interaction and communication that is caused by deafness might have a substantial effect on all aspects of an individual’s life.
Although deafness does not usually affect an individual’s physical mobility, deaf people’s ability to function independently might still be limited. It is claimed that deafness and hearing impairment can lead to depression (Heine & Browning, 2002).
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Burkey (2006) argues that depression can result in reduced enjoyment of social situations, feelings of isolation, loneliness, reduced confidence, anxiety, stress, and tiredness. However, it is possible that CI intervention can remove these obstacles to well-being to some extent, such as enjoyment of school and enjoying rewarding friendships.
Behavioural Implications
Relationships between language, attention, and child behaviour problems have been found to be significant. In the context of executive functioning and communicative competence, a study conducted by Hintermair (2013) discussed the behavioural problems of deaf and hard-of-hearing school-aged children. A significant developed problem regarding the degree of executive functions was shown in the deaf and hearing-impaired pupils compared with a normative sample of hearing children.
Behavioural problems in young children might emerge from the lack of language and communication (Barker et al., 2009). Thus, the role of development of language and communication should not be excluded in predicting and assessing such problems (Barker et al., 2009). For instance, Van Gent, Goedhart and Treffers (2011,p. 720) have highlighted “the importance of considering self-concept dimensions, peer problems and deafness- and context-related characteristics when assessing and treating deaf adolescents”.
Measurements of performance in a study (Barker et al., 2009) of 116 profoundly deaf and 69 normally hearing children aged 1.5 to 5 years also showed greater difficulties in terms of behaviour, attention, language and less than hearing children in time spent communicating with their parents. Furthermore, self-segregation attitudes to network with those of similar hearing status are also displayed by hearing-loss
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groups (Shiff & Hoffman, 2011). Nevertheless, Martin, Bat-Chava, Lalwani and Waltzman (2011) argue that hearing-impaired children networking in one-to-one situations have shown better outcomes, and girls display better performance than boys.
There is evidence that change in family roles and expectations, and the accompanying emotional reactions to the loss of hopes and aspirations associated with the birth of a child as a result of the child’s disability (Calderon & Greenberg, 1999). This situation might also lead to great pressure on both parents and child, resulting in behavioural problems. From an Arabic-country perspective, Algaruty (2006, p. 311) has argued that ‘‘The hearing disability affects growth of child’s socialisation and his/her involvements and interactions with others and integration into the community’’.
Cognitive Implications
Reduced cognitive abilities may also be an issue associated with hearing impairment. Arlinger (2003) states that many studies have found a correlation between hearing impairment and reduced cognitive function. It is argued that hearing people view deafness at birth as a disability that affects cognitive, social, and intellectual development and causes substantial sensory impairment (Pisoni et al., 2008). However, it is critical to point out, not only that hearing and auditory processing might be related specifically to deafness and difficulty of language, but also that the processes of cognitive control, self-regulation and organisation, which are neurocognitive systems, display disturbances (Pisoni et al., 2008). Also, it argued that such correlations are challenged to be distinguished and determined in terms of whether reduced cognitive abilities occur because of or alongside hearing
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impairment. This might lead to the perspective that the difficulty of language is not only related to hearing impairment but also to the neurocognitive systems that show disturbances.
Jerker (2003) has claimed that important general predictions and applications can be derived by neurocognitive data such as the long-term memory, storage capability, feature of phonology and overall processing for both spoken- and signed-language conditions. A working-memory framework could also be involved as a cognitive contribution in understanding both speech and sign languages (Jerker, 2003). Therefore, such cognitive abilities have to be supported and enhanced.
Interaction effectively between parents and their deaf child can play an important role in support and enhance cognitive abilities. Not only could the development of perception, attention and memory be enhanced by parents and family members who interact effectively with their deaf child, but a wide scale of sensory-motor coordination, visual-spatial processing that are different process of neurocognitive might also be enhanced (Pisoni et al., 2008). It has also been stated that influences upon improvements in both literacy skills and language could be provided by interactions in concept-related language and cognitive processes between deaf pupils (Marschark, 2003).
From the arguments discussed above, it can be seen that deafness can exert a significant impact upon both child and family in all different aspects of life. Therefore, the necessary intervention and treatments should be delivered and all possible solutions have to be taken into account. Intervention treatment and management needs to take a holistic view of child’s life. Before possible treatments
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and solutions are highlighted, the following section focuses on the educational implications of hearing loss and the background of inclusive education.