Multidisciplinary Support for Deaf Children

Understanding how hearing impairment adversely affects the development of children is crucial to the effectiveness of the support provided. The purpose of this assignment is to outline a multidisciplinary package that can be implemented to meet the developmental needs of deaf children. It considers Case Study A: Collette, a pupil in a secondary mainstream setting with a resource base. It will consider a holistic approach to developing the child and will outline a multidisciplinary package of support that aims to meet the child’s and family’s needs.

There is a strong belief that family-centered practice enhances the outcomes for children and families alike (Jackson & Turnbull, 2004; Moeller et al., 2013). Jackson and Turnbull (2004) highlighted that deafness does not belong to just the child, but in essence belongs to the whole family. Open communication, shared tasks, reciprocity, trust, respect and honesty form the foundations of a balanced relationship between families and professionals (Moeller et al. 2013). Furthermore it is important that families are supported in a way that accommodates their beliefs, values, culture, emotions and family dynamics (Moeller et al. 2013). In the current case study, Collette’s parents have little contact with the school and developing a relationship with Collette’s family should be a priority. Her grandparent’s involvement in her life is a strength. Grandparents can be very influential in a child’s life and a good relationship with extended family members can enhance the quality of life for deaf children (Jackson & Turnbull, 2004). However such family members can often be underutilized and must have the support to interact and communicate with their deaf family member (Jackson & Turnbull, 2004; Morton, 2000). Offering grandparents the opportunity to develop their understanding will in-turn contribute to the “academic, social and emotional growth” of deaf young people (Morton, 2000, p.364). ToDs must be attuned to the extended family’s needs and we have a responsibility to provide support to strengthen them as a family (Morton, 2000). Providing a positive supportive approach can potentially facilitate the family’s sense of positive experience and develop happiness amongst family members (Szarkowski & Brice, 2016).

In the current case study, Collette was diagnosed with a bilateral profound sensorineural hearing loss at aged 8 months. She was implanted at 8 years old and currently wears a cochlear implant (CI) on her right ear and a hearing aid (HA) on her left. She has had no problems with her HA or CI at school and has recently started wearing them for the majority of time at home. This is strength of Collette’s, however, it could suggest that she has not been a consistent wearer of her HA and CI at home in the past. As Collette was not implanted until the age of 8, it is possible that Collette may have missed opportunities access incidental language in the home, which may have impacted on her language development. Young children are receptive to third party interactions and can learn words via overhearing in the absence of mutual conversation (Akhtar, 2005; Shneidman et al., 2009).

At school Collette is not proactive in alerting staff when her HA battery is dead and she doesn’t mange her own HA or CI independently. This could indicate that her hearing may have deteriorated and she is unable recognize this with her HA. Psychoacoustic and electroacoustic checks offer an insight into whether the HA is performing as expected and if contact with the audiology clinic is required. Good management of audiology is crucial for the optimum development of listening, language and learning and it involves the cooperation of parents, families, audiologists and teachers and head teachers at the child’s school (McCracken & Laoide-Kemp, 1997). Therefore positive relationships must be established with Collette’s family and the audiology department.

Collette used a radio aid (RA) in primary school but has struggled with the management of the system in mainstream high school and no longer uses it. She chooses to sit near the front of the class in most of her lessons. This is a strength and demonstrates she is aware of and accepts her hearing situation. Research conducted by Kent and Smith (2006) provided insights into reasons why young people rejected HAs and found that deaf young people’s perceptions about feeling ‘normal’ determined their willingness to wear HAs. Rejecting RAs is not uncommon and perhaps the management of the RA elicited unwanted attention for Collette and may have presented difficulties in her efforts to feel ‘normal’. Support could be provided so that the handover and return of the RA in lessons is smooth and discreet. As Collette struggles to immerse herself in conversation and takes on the role as an onlooker with her hearing peers, she could be offered a discrete RA device that she can use to enable her to actively listen to conversations among her peers. Furthermore, promoting deaf awareness for pupils could enable Collette’s peers to appreciate Collette’s difficulties and help them support her and make her feel more included. Kent and Smith (2006) found that positive relationships with peers who perceived HAs as normal provided the deaf young person with more confidence and a better sense of identity (Kent & Smith, 2006). This suggests that peer support enriches the inclusion of deaf children in the mainstream setting. In the study conducted by Kent and Smith (2006), the sample consistent of participants of New Zealand or Maori ethnicity and therefore the findings cannot be generalised to other populations due to cultural differences. In contrast to the possible psychosocial motivations behind rejecting assistive hearing technology, Reddekal (2014) argue that it is Teachers’ attitudes towards such technology appear to be a major factor affecting their use. Providing Collette’s teachers with knowledge about the benefits if RAs and could have a positive influence on their attitudes and increase Collette’s use of the RA in the classroom.

As children grow older, the importance of social relationships increases and when their ability to interact with hearing peers is compromised, it can become very frustrating for deaf young people (Bat-Chava & Deignan, 2001). Collette comes across as direct and to the point and she has difficulty in recognising social strategies of others. She interprets discussions very literally causing misunderstandings with her peers. Recognising and interpreting emotional expressions can be difficult for deaf children (Sidera et al., 2017; Wiefferink et al., 2013) and it could be possible that some of Collette’s difficulties lie with a deficit in emotional understanding. A study conducted by Sidera et al. (2017) looked into the influences on facial emotion recognition in deaf children and found a delay in deaf children’s ability to recognise some emotions and suggested a link with their linguistic development. However their research didn’t consider the role of auditory input in the recognition of emotions something that deaf children, like Collette, find difficulty with. In Collette’s case, she may not be interpreting social cues due to her inability to hear the auditory expressions. Wiefferink et al. (2013) also argue that language delays are likely to cause a delay in emotional recognition in facial expressions, however they suggest that such are not the only explanation. They suggest that a delay in cochlear implantation and a lengthier time of deprivation could give a child less time to learn about emotions. Furthermore, they suggest that a delay in emotion understanding could be explained by low exposure to quality interactions in the home and a lack of modelling from adults before cochlear implantation and access to spoken language (Wiefferink et al., 2013). As Collette was only implanted at 8 years old, this could further explain her difficulties with reading people. However, Wiefferink et al. (2013) did not find evidence to substantiate their claim and suggested further research into other factors contributing to emotion recognition in deaf children with CIs.

Reading people and emotional understanding can be attributed to a person’s ability to recognise the mental state of themselves and of other people and understand how they differ. This can include ones beliefs, intentions, desires, feelings, knowledge and understanding and is known as Theory of Mind (ToM). Research conducted by Chilton and Beazley (2013) demonstrated that “subtle initial shades if difference in social experience and environment provided to individuals with impairment leads to deepening additional unintentional social exclusion” (p.185). This has relevance to Collette, as it seems she has been the victim of inadvertent exclusion amongst her hearing peers. It has been argued that quality of early language experiences has an effect on the development of ToM and research has suggested that children’s vocabulary should be expanded to further enhance children’s capacity to develop ToM (Westby & Wilson-Taber, 2016; Chilton et al., 2018; Woolfe, Want & Siegal, 2002). However, despite there being substantial literature looking at the relationship between language and ToM, there has been limited research investigates the relationship between literacy and ToM leaving questions open about the connection between ToM and written language (Chilton et al., 2018).

Collette is working below the expected levels in English and struggles to express complex ideas. Despite this, she has good literal comprehension. Many students who are deaf exhibit marked difficulties in making inferences and the ability to do this when reading, listening or watching conversations and taking part in effective social exchanges requires a well-developed ToM (Westby & Wilson-Taber, 2016). Language interventions could help Collette develop understanding of others and develop language to enable her to resolve conflict within social situations. Westby and Wilson-Taber (2016) outline a number of interventions to foster ToM and highlight the importance of initial and on-going assessment of narrative comprehension. This could include monitoring mental state and emotion vocabulary used in conversation, personal and fiction narratives, syntactic and discourse organisation, responses to literal and inferential questions (Westby & Wilson-Taber, 2016).

However, it is not just about the development of ToM for the child. It is important that the ToD working with the child develops their understanding of ToM. By doing this it provides opportunities for potential enriching of communication and fostering of enhanced social inclusion (Chilton & Beazley, 2013). Collette’s mainstream teachers have described her as ‘rude’ and ‘unresponsive’. Collette may not able to recognise the thoughts and feelings of others due to immature ToM. This coupled with compromised hearing due to a hostile acoustic environment in school could therefore make Collette appear rude and disengaged to her teachers. Chilton and Beazley (2013) proposed that having the knowledge of ToM can help both families and professionals recognise how and why social misunderstandings occur and how to scaffold mediation without over supporting. Making Collette’s teachers aware of ToM and why it is important would enhance their understanding and open their minds to Collette’s challenges.

Evidence has suggested that CIs can improve language acquisition, which enables exposure to mental state language in turn can positively impact ToM (Remmel & Peters, 2009). However HAs and CIs do not promise literacy skills that are comparable to their hearing peers and research has highlighted that, even with good amplification, deaf children differ from hearing counterparts in the way process cognitive, social, emotional and visual information (Westby & Wilson-Taber, 2016). Furthermore deaf children, including those with CIs, display underdeveloped executive function (EF) and working memory in comparison to their hearing peers (Kronenberger & Pisoni, 2016). ToM and EF are closely interrelated with each affecting the other (Westby & Wilson-Taber, 2016).

EF refers to the cognitive control and self-regulatory skills required for concentrating, managing distractions, holding and manipulating information, shifting attention, and creatively and consciously reacting to new situations (Figueras et al., 2008; Diamond, 2013). EF skills are crucial for the “mental and physical heath; success in school and life; and cognitive, social and psychological development” (Diamond, 2013. p. 136). Collette often falls behind or doesn’t complete homework; she struggles to find what she was supposed to do and doesn’t always bring in the correct books or homework when they’re due. Collette also struggles with the management of her audiology and she is distracted in class. All of the above indicate potential issues with Collette’s EF and working memory. Delays in children’s EF can also be linked to delays in language acquisition (Figueras et al., 2008), and similarly to ToM, language proficiency is fundamental for the healthy development of EF (Hall et al., 2018). Moreover, it has been suggested that deaf children’s disinhibited behaviours and poor working memory could be linked to poorer language causing difficulties for the child to use inner speech for self regulation (Figueras et al., 2008). However, research conducted has not explored the interrelationships among experience of language, proficiency of language and EF in deaf children (Hall et al. 2018), and to further understand language and the correlation with EF further research is necessary.

Learning strategies that promote visual clues can put less emphasis on language and thus help deaf children with EF (Figueras et al., 2008). Modelling to children how to rehearse and apply self-talk strategies for planning and problem solving could further develop and better utilise their EF skills (Figueras et al., 2008). Furthermore, according to Diamond (2013), EF can be improved at any age; challenging EF improves them and children will demonstrate better EFs if they are in a well-supported environment, if their bodies are strong and healthy and if their social, emotional needs are acknowledged (Diamond, 2013). Thus challenging and developing EF can have a positive impact on Collette’s mental health.

Good metal health and self-esteem is imperative for psychosocial functioning (Theunissen et al., 2014) and is something that Collette is potentially struggling with. Since moving to mainstream high school from a primary resource base, Collette has expressed that she is unhappy. Research conducted by Theunissen et al. (2014) has suggested that children with hearing impairment have lower self-esteem in the social areas. Furthermore they found that adequate language development and communication skills could enhance self-esteem (Theunissen et al., 2014). A study by Bat-Chava and Deignan (2001) found that deaf children formed special relationships with their deaf peers and recommended that deaf children should be encouraged to socialize with similar others to help them feel a sense of normality in their experiences. It is suggested that socializing with deaf peers can help develop positive relationships skills that can be transferred to hearing peers (Bat-Chava & Deignan, 2001). Furtehrmore, Jambor and Elliott (2005) found that identification with the deaf peers had a positive impact on self-esteem. However in the research conducted by Jambor and Elliott (2005), the sample of students came from a large deaf student cohort and therefore the findings cannot be generalized to deaf students who are predominantly surrounded by hearing peers.

Collette is able to use simple sign for communicating with deaf peers and this is another strength of hers that could be built upon. Therefore it could be suggested that the ToD could seek out local BSL classes to help support Collette in developing her receptive skills and thus emerge her better amongst her deaf peers. The ToD could help support Collette in setting up a BSL club in school with the potential outcomes being threefold; she can further develop her skills for BSL, develop relationships with her peers and raise awareness of deafness in the school. Cochlear implant centers provide summer camps and there are community clubs for deaf children could help Collette build relationships with others.

Providing a multidisciplinary approach to working with a deaf child aims to open up channels of communication, to view the bigger picture and ensure that children with hearing loss and their families are effectively and appropriately supported. It is important that practises implemented and the goals are family centred to optimise outcomes for Collette. Therefore when providing a multidisciplinary approach the views of the family and the voice of Collette are essential. Setting measurable goals is important. It gives all collaborators a clear focus and enables progress to be tracked. Furthermore setting goals help determine what support and interventions are required to achieve them. The following table outlines short and long term goals for Collette.

In order to be effective the ToD must have the knowledge to advise parents, pupils, teachers etc., and must contribute to the multidisciplinary assessment of the child. ToDs must have the skillset to show empathy and understanding to families of hearing impaired children as well as the hearing impaired child as they develop though childhood into adolescence and beyond. It is important that the ToD does not allow their unconscious bias to cloud their judgement and they must offer their advice tactfully and sensitively to parents using appropriate language that they are able to understand. Keeping pace with current technology, research, training and good practise to meet the needs of the children is vital for the ToD and they must ensure that what they deliver is relevant and tailored to meet the child’s needs. However, one must stop and consider what it actually means to “meet the needs” of a child. It sometimes means more than what we do as ToD. Every child and family is unique, as are their hopes and aspirations (Stewert & Adams, 1997). Children grow and needs change and approaches must adapt. ToDs should promote a bespoke “range of protective resources and repertoires of skills developed through challenging experiences of risk and responsibility” for children (Young, Green & Rogers, 2008, p.52.) Therefore ToDs must not only have a variety of specialized teaching strategies at their disposal but must be able to offer a well-tuned holistic approach that enhances the potential for deaf children and paves the way for healthy and happy futures. For deaf children, successfully navigating through the everyday social and structural barriers their world demands nothing short of true resilience. Therefore, family-professional partnerships must be formed to confront such barriers and share responsibility for nurturing the whole child and giving them the freedom flourish.

References

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