Search Results (58)

Background: Emotions—including joy, sadness, fear, and anger—are fundamental expressions of human experience. For children and adults who are deaf or hard-of-hearing, emotional experiences and communication can differ due to linguistic and communication-related factors. Methods: This scoping review identifies instruments that are suitable for assessing emotional intelligence in the context of the lived and cultural experiences of individuals who are deaf or hard-of-hearing. A comprehensive search was conducted in April 2024 following the JBI methodology. Results: Out of 3091 articles, 21 studies were included. Two adapted methods were identified: the Meadow/Kendall Social–Emotional Assessment Inventory and ISEAR-D. Assessments supported by sign language revealed no significant differences in age or gender. Conclusions: The authors recommend further development of screening instruments that reflect the specific experiences of the population who are deaf or hard-of-hearing. Full article

Objective: This study aimed to investigate the effects of dual-task stroboscopic visual training (DTSVT) on balance, functional mobility, and gait in children who are hard-of-hearing. Methods: This randomized controlled study included 31 children (17 girls, 14 boys) with congenital sensorineural hearing loss. Participants were assigned to one of three groups: control group, conventional balance training (CBT) group, and DTSVT group. The CBT and DTSVT groups participated in an exercise program for 16 weeks, twice weekly, for 40 min (a total of 24 sessions). Static balance was assessed using the Tandem Romberg test and Single-Leg Stance (SLS) test, while dynamic balance was evaluated using the Functional Reach Test (FRT), balance disc test, and the Four Square Step Test (FSST). The Pediatric Balance Scale (PBS) was used as a subjective balance assessment. Functional mobility was assessed using the Timed Up and Go (TUG) Test, Step Test, 10 m Walk Test (10 MWT), and Functional Gait Assessment (FGA). Postural sway parameters were recorded using the GyKo device, including Sway Area (EA, cm²), Distance Length (DL, cm), Length (anterior–posterior (AP)) (cm), Length (medial–lateral (ML)) (cm), Mean Distance (D) (cm), Mean Distance (AP) (cm), and Mean Distance (ML) (cm). Results: Significant between-group differences were primarily observed in favor of the DTSVT group post-treatment, particularly in PBS scores, GyKoDL values during the eyes-open SLS test, and TUG test completion times (p < 0.05). Some baseline differences were noted among groups in functional reach distance, FSST completion time, and eyes-closed duration on the Balance Disc test (p < 0.05). Within-group comparisons revealed significant improvements in FSST times in both intervention groups, reduced postural sway parameters during the FRT in the DTSVT and control groups, and increased eyes-closed Tandem Romberg duration in the CBT group (p < 0.05). Most other outcome measures did not demonstrate statistically significant changes either within or between groups (p > 0.05). Conclusions: Dual-task stroboscopic visual training was more effective than conventional balance training in improving specific aspects of balance and functional mobility in children who are hard-of-hearing. These findings highlight the potential of adding cognitively demanding and visually engaging balance tasks to rehabilitation programs for this population. Larger and more diverse samples in future studies are needed to enhance the generalizability of these results. Studies that assess balance and gait using standardized clinical or laboratory tests may be particularly valuable. Given the small sample size and multiple comparisons, the results should be considered preliminary and exploratory. Full article

Early parent–child interactions are crucial for children’s social–emotional development. Mental state talk (MST)—language referring to thoughts, feelings, and intentions—is a key contributor. MST may be reduced in hearing parents of deaf or hard-of-hearing (DHH) children, who face unique communication challenges. Yet, existing research on MST in hearing parents of DHH children and on MST use by DHH children themselves is limited and fragmented, often focusing on MST quantity in a single context. Few studies have examined MST quality, variation across contexts, or its relationship with children’s social–emotional functioning. This study addresses these gaps by investigating MST quantity and quality across two activities and its associations with children’s MST and social–emotional development. Forty-eight hearing parent–DHH child dyads (ages 2–5) participated. MST was studied during storybook reading and free play. Children completed tasks on emotion understanding and theory of mind; parents reported on MS vocabulary and family characteristics. The results showed that parents adjusted MST complexity based on children’s age but not audiological characteristics. MST varied by activity, with different contexts eliciting distinct types of MST. Parental and child MST were associated, though not linked to children’s task performance. Findings highlight the importance of diverse interaction contexts and suggest a need for longitudinal research on MST’s developmental impact. Full article

Parenting stress significantly affects caregivers of deaf and hard-of-hearing (DHH) children, influenced by unique challenges and stressors. Background/Objectives: This study aims to develop the Chinese Family Stress Scale (CFSS) and to identify the stressors and contributing factors to elevated stress levels. Methods: The study involved 257 caregivers of DHH children aged 0–12 years old. The CFSS was used to assess parenting stress in caregivers of DHH children, with its reliability and validity evaluated. Factors such as speech intelligibility, oral language use, self-compassion, and social support were examined for their impact on parenting stress. Results: Key stressors included financial issues, discipline, education concerns, medical care, and safety. Elevated parenting stress was significantly associated with poor speech intelligibility of the child, inadequate oral language use, negative aspects of self-compassion, and insufficient social support. The CFSS showed good reliability and validity in measuring parenting stress among caregivers of DHH children. Conclusions: The CFSS is an effective tool for assessing parenting stress in caregivers of DHH children. Interventions to reduce parenting stress can focus on improving children’s communication skills, enhancing caregiver self-compassion, and bolstering social support networks. Full article

We investigated aspects of language and cognitive development in three bimodal bilingual deaf children in hearing families. Some previous research finds cognitive delays for deaf children, which may be due to an early lack of access to language input. Studies of children having strong early language access through parental use of American Sign Language (ASL) support the hypothesis that language delays are behind such cognitive delays. We ask whether hearing parents who are novice learners of ASL provide sufficient support for early language and cognitive development. The three case studies in this report used both ASL and English, with support for ASL development provided by our ASL specialist. We assessed the children’s general cognition, executive function, ASL vocabulary, English vocabulary, and overall language ability in both ASL and English. We found strong language development outcomes and correspondingly, age-appropriate cognitive development. These results are consistent with the conclusion that novice signer parents can support their children’s development as ASL-English bilinguals, establishing a strong foundation for further cognitive and linguistic growth. Full article

The understanding of hidden emotions—situations in which individuals deliberately express an emotion different from what they genuinely feel—is a key skill in theory of mind (ToM) development. This ability allows children to reason about discrepancies between internal emotional states and external expressions and is closely tied to linguistic development, particularly vocabulary related to mental states, which supports complex emotional reasoning. Children who are deaf or hard of hearing (DHH), especially those born to hearing non-signing families and raised in oral language environments, may face challenges in early language exposure. This can impact the development of social and emotional skills, including the ability to understand hidden emotions. This study compares the understanding of hidden emotions in hearing children (n = 59) and DHH children (n = 44) aged 7–12 years. All children were educated in spoken language environments; none of the DHH participants had native exposure to sign language. Participants completed a hidden emotions task involving illustrated stories where a character showed a certain emotion in front of two observers, only one of whom was aware of the character’s true emotional state. The task assessed children’s understanding of the character’s emotional state as well as their ability to reason about the impact of hiding emotions on the beliefs of the observers. The results showed that the hearing children outperformed their DHH peers in understanding hidden emotions. This difference was not attributed to hearing status per se but to language use. Specifically, children’s spontaneous use of cognitive verbs (e.g., think or know) in their explanations predicted task performance across the groups, emphasizing the role of mental state language in emotional reasoning. These findings underscore the importance of early and accessible language exposure in supporting the emotional and social cognitive development of DHH children. Full article

This research compares speech discrimination abilities between 17 children who are hard-of-hearing (CHH) and 13 children with normal hearing (CNH), aged 9 to 36 months, using either a conditioned head turn (CHT) or condition play paradigm, for two phoneme pairs /ba-da/ and /sa-ʃa/. As CHH were tested in the aided and unaided conditions, CNH were also tested on each phoneme contrast twice to control for learning effects. When speech discrimination abilities were compared between CHH, with hearing aids (HAs), and CNH, there were no statistical differences observed in performance on stop consonant discrimination, but a significant statistical difference was observed for fricative discrimination performance. Among CHH, significant benefits were observed for /ba-da/ speech discrimination while wearing HAs, compared to the no HA condition. All CHH were early-identified, early amplified, and were enrolled in parent-centered early intervention services. Under these conditions, CHH demonstrated the ability to discriminate speech comparable to CNH. Additionally, repeated testing within 1-month did not result in a change in speech discrimination scores, indicating good test–retest reliability of speech discrimination scores. Finally, this research explored the question of infant/toddler listening fatigue in the behavioral speech discrimination task. The CHT paradigm included returning to a contrast (i.e., /a-i/) previously shown to be easier for both CHH and CNH to discriminate to examine if failure to discriminate /ba-da/ or /sa-ʃa/ was due to listening fatigue or off-task behavior. Full article

Filled pauses are thought to be reflections of linguistic processes (e.g., lexical retrieval, speech planning and execution). Uh may be a self-directed cue for when a speaker needs more time to retrieve lexical–semantic representations, whereas um serves as a listener-directed, pragmatic cue. The use of filled pauses has not been examined in children who are hard of hearing (CHH). Participants included 68 CHH and 33 children with typical hearing (CTH). Participants engaged in conversations, expository discourse, and fable retells. We analyzed filled pauses as a function of hearing status and discourse contexts and evaluated the relationship between filled pauses and language ability. CHH produced uh across discourse contexts more often than their hearing peers. CHH did not differ in their use of um relative to CTH. Both um and uh were used more often in conversational samples compared to other types of discourse. Spearman’s correlations did not show any significant associations between the rate of filled pauses and standardized language scores. These results indicate that CHH produces uh more often than CTH, suggesting that they may have difficulty retrieving lexical–semantic items during ongoing speech. This information may be useful for interventionists who are collecting language samples during assessment. Full article

This paper offers an overview of a large study of language and cognitive development in deaf and hard of hearing children. Specifically, we investigated how acquiring a signed or spoken language (language modality) and when a child’s access to language begins (i.e., at birth or later in development) influence cognitive development. We conducted in-person behavioral assessments with 404 children 3–10 years old (280 deaf and hard of hearing; 124 typically hearing). The tasks measured a range of abilities along a continuum of how strongly they depend on language input, such as general vocabulary and number words (strongly dependent) vs. skills such as tracking sets of two to three objects and standardized ‘nonverbal’ picture-similarity tasks (relatively independent of language). Overall, the timing of children’s access to language predicted more variability in their performance than language modality. These findings help refine our theories about how language influences development and suggest how a STEAM pedagogical approach may ameliorate the impacts of later access to language. These results underscore children’s need for language early in development. That is, deaf and hard of hearing children must receive fully accessible language input as early as possible through sign language, accompanied by hearing technology aimed at improving access to spoken language, if desired. Full article

Deaf and hard-of-hearing (DHH) children are often reported to show deficits on working memory (WM) tasks. These deficits are often characterized as contributing to their struggles to acquire spoken language. Here we report a longitudinal study of a large (N = 103) sample of DHH children who acquired American Sign Language (ASL) as their first language. Using an n-back working memory task, we show significant growth in WM performance across the 7–13-year-old age range. Furthermore, we show that children with early access to ASL from their DHH parents demonstrate faster WM growth and that this group difference is mediated by ASL receptive skills. The data suggest the important role of early access to perceivable natural language in promoting typical WM growth during the middle school years. We conclude that the acquisition of a natural visual–gestural language is sufficient to support the development of WM in DHH children. Further research is required to determine how the timing and quality of ASL exposure may play a role, or whether the effects are driven by acquisition-related corollaries, such as parent–child interactions and maternal stress. Full article

Typically developing peers are the key factor for children with disabilities to participate in inclusive settings. Good peer relationships can improve the social communication and language expression of children with disabilities, and typically developing children play a role as “gatekeepers” in the social activities of children with disabilities in the schools. In this study, 36 primary school students from grades 1 to 3 received online picture book teaching for 3 weeks, 6 units, 12 class hours, and 40 min per class hour with six volumes of disability picture books (including physical disability, deaf and hard of hearing, visual impairment, intellectual disability, learning disability and autism spectrum disorder) selected by experts in summer vocation. The attitudes of typically developing children toward peers with disabilities of participants were tested before and after attending the online picture book course. The teaching of disability-themed picture books online has significantly improved the attitudes of typically developing children in lower grades toward peers with disabilities. Specifically, there are significant differences in the sub-dimensions of emotion and positive behavior and negative behavior before and after the intervention. The results showed that online picture book teaching activities with disability themes can effectively improve the attitudes of typically developing children in primary schools toward children with disabilities in terms of cognition, emotion, and behavior, and they can be used in schools to create an inclusive climate for students with disabilities. Full article

Background: Early Hearing Detection and Intervention (EHDI) is essential for minimising the negative impact of childhood hearing loss on speech, language, and cognitive development. However, in low- and middle-income countries such as South Africa, various challenges hinder the implementation of EHDI services, leading to delayed diagnosis and intervention. Aim: This study explores caregivers’ experiences with EHDI services, identifying key challenges and facilitators affecting access and timely intervention. Methods: A narrative inquiry approach was used as part of a broader research initiative on family-centred EHDI. Nine caregivers of children who are deaf or hard of hearing (DHH) were purposively sampled, and data were collected through semi-structured interviews. Results: Thematic analysis revealed systemic and structural challenges, logistical and financial constraints, and caregiver-related factors that hindered access to EHDI services. Key facilitators included caregiver knowledge and advocacy, family support services such as counselling and South African Sign Language training, and high-quality audiological and educational services. Conclusions: Findings emphasise the need for policy-driven reforms, including expanding newborn hearing screening programmes, improving financial assistance mechanisms, and increasing public awareness. Addressing these challenges and leveraging facilitators can help South Africa align with global EHDI benchmarks and improve outcomes for DHH children. Full article

Background: Cochlear implants (CIs) have become a widely used intervention for Deaf and hard-of-hearing (DHH) children, particularly for developing spoken language. However, parental decision-making regarding CIs is influenced by a range of factors, including socio-economic status, healthcare accessibility, cultural beliefs, and societal attitudes. While extensive research on parental perceptions of CIs exists in high-income countries (HICs), there is limited research on these perspectives in low- and middle-income countries (LMICs), like South Africa, where disparities in healthcare access significantly impact CI uptake. Objectives: This study aimed to explore the views and perceptions of South African parents regarding CIs for their DHH children, with a specific focus on how financial, cultural, and informational barriers influence decision-making. Methods: A mixed-methods approach was used, combining Q-methodology for quantitative data and thematic analysis for qualitative insights. Nine parents of DHH children participated. The Q-set survey ranked parental attitudes toward CI risks, benefits, and accessibility, while semi-structured interviews provided deeper insights into decision-making processes. Factor analysis grouped participants into clusters based on their perceptions, and qualitative data were analysed using a thematic framework approach. Results: Findings revealed two distinct parental clusters: (a) Cluster 1 parents viewed CIs as essential for speech development and strongly supported implantation, and (b) Cluster 2 parents recognized CI benefits but emphasized that outcomes vary based on individual circumstances. Three overarching themes emerged from thematic analysis: (1) financial barriers restricting CI access, (2) parental reliance on medical professionals for decision-making, and (3) persistent stigma and cultural beliefs influencing CI perceptions. Conclusions: This study highlights critical barriers to CI access in South Africa, including socio-economic inequities, limited healthcare infrastructure, and persistent stigma. While parents largely recognized the benefits of CIs, their decisions were shaped by financial constraints and concerns about Deaf identity and societal acceptance. This study calls for the expansion of publicly funded CI programmes, the development of culturally tailored parental counselling protocols, and targeted public awareness campaigns to reduce stigma surrounding hearing restoration devices. These interventions can help mitigate financial and cultural barriers to CI adoption in South Africa. Full article

Family-centred early hearing detection and intervention (FC-EHDI) is an established framework globally recognized for its emphasis on family involvement in supporting children who are deaf and hard of hearing (DHH). In the African context, unique sociocultural and systemic challenges necessitate tailored approaches to ensure effective implementation. This narrative review explores the relevance of FC-EHDI in Africa, highlights barriers to its implementation, and offers recommendations for creating sustainable and culturally aligned interventions. A narrative review methodology synthesizing evidence from African countries to examine the intersection of FC-EHDI with cultural practices, systemic barriers, and opportunities for innovation was adopted. Databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed journal articles, books, and reports published between 2000 and 2024. Keywords included “family-centred care”, “EHDI”, “Africa”, “cultural responsiveness”, and “early hearing detection and intervention”. Studies were included if they addressed EHDI in African contexts, explored family-centred approaches, or provided barriers and recommendations specific to the region. Thematic analysis was employed to synthesize findings into barriers, evidence, and strategies for FC-EHDI implementation. Data were extracted and analysed thematically to identify patterns and gaps in knowledge. Key challenges identified include resource limitations, economic constraints, linguistic and cultural diversity, and fragmented healthcare systems. Evidence highlights the effectiveness of community-based care, linguistic inclusivity, and culturally tailored interventions in enhancing family engagement and programme outcomes. Recommendations focus on leveraging technology, interdisciplinary collaboration, and policy advocacy. FC-EHDI offers a transformative approach to addressing DHH African children by integrating family involvement, cultural responsiveness, and systemic innovations. Future efforts should emphasize technology, scalable models, and family empowerment to create sustainable and equitable services. Full article

Purpose: The purpose of this study was to evaluate the clinical and audiological outcomes in long-term cochlear implant (CI) users, focusing on hearing performance and device failures. Methods: A retrospective study was conducted on patients who underwent CI surgery, with a minimum follow-up of 10 years. Device survival was analyzed using Kaplan–Meier curves, and failure rates were classified as device failure explants or medical-related explants. The time to revision and causes of reimplantation were assessed. Statistical analyses included Pearson correlation for audiological outcomes, Student’s t-test for group comparisons, and the log-rank test for survival comparisons among implant brands. Results: In this study, data from a total of 211 CIs were collected. Fourteen major postoperative complications were reported in this series, resulting in a global major complication rate of 6.6%: 5.2% due to hard failure and 1.4% due to medical problems and soft failure. The revision rate was 4.1% for the children’s group and 10% for the adult group. The overall device survival rates were more than 96% at 10 years and 91% at 20 years. The median postoperative follow-up was 16.3 years. Moreover, a highly significant correlation was observed (r = 0.669, p < 0.0001) between pure tone average (PTA) thresholds at implant activation and those at the last follow-up, as analyzed using Pearson’s correlation coefficient. Conclusions: The CI is a lifelong device; however, the technology is constantly evolving. Therefore, careful patient counseling (or counseling of parents in the case of pediatric patients) is necessary. The device may wear out over time, requiring revision surgery. These data are essential for audiologists and ENT specialists when selecting patients and determining surgical indications. Full article