Nicoletta Gentili

1

The Mental Health of Deaf Children
The limits of my language means the limits of my
worldL. Wittgestein

• Nicoletta Gentili
• Consultant Child Adolescent Psychiatrist
• National Deaf Child and Family Services
• Corner House Inpatient Unit

2
Background

• 60, 000 hearing disabled children in UK
• 20,160 in England
• 90-95 of deaf children are born to hearing
  parents
• 3.4 require specialist service every year
• 10,000 Sign language users in school
• 50-70,000 BSL users in Deaf community
• 42 are severely/profoundly deaf

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Mental health problems in deaf children

• 1.5-2x more common than in hearing children
• Increased rate of emotional and behavioural
  problems
• Increased rate of autism? True increase,
  misdiagnosed speech and language disorder, or
  developmental delay linked to early language
  deprivation (incidental learning)?

4
Emotional understanding in Deaf children

• Greater proportion of deaf children with delays
  in recognising, understanding and using emotional
  experience (Gray et al 2002)
• Greater proportion of deaf children with delays
  in developing Theory of Mind (Remmel et al 2002)

5
Impact of parenting

• Significant number of parents with minimal or no
  sign language deaf children with significant
  delay in signed or spoken language
• Deaf children of Deaf parents have same incidence
  of Mental Health Problems as their hearing peers
• Finland Study (Sinkkonen, 1994)

6
Language Thinking

• Significant language delay associated with delays
  in developing abstract thinking
• Language delay and reading delay compounds
  reduced access to incidental learning

7
Consequences of impact of deafness on emotional
development

• Deafness can lead to
• Isolation
• Lack of defined identity
• Low self-esteem
• Poor attachment
• 40 of D, vs 25 of H, have a mental health
  problem at some point in their life (NHS Health
  Advisory Review)

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Deaf Culture

• 90 of deaf children are born into hearing
  families so vertical transmission is not possible
• Residential school was historical milieu of
  transmission (Dolnick 1993)
• As a result much of cultural acquisition
  child-child rather than adult-child (Moores 1987)
• Mainstreaming and cochlear implantation impact?

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Cause of mental health problems in Deafness

• Organic cause of the deafness such as
  prematurity/CMV/Rubella
• Poor intersubjective relationship
• Early language deprivation
• Abuse

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Intersubjectivity Trevarthen C, Aitken P, 2001
Trevarthen C, 2004
Active involvement in communication Imitation
Companionship
Attachment relationship Emotional
development Language Development
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Emotional Development

• FEELING TONES
• CONTENTMENT DISTRESS INTEREST
• (familiarity established) SURPRISE (6th/12)
  
• JOY (3rd/12) DISGUST (3rd/12)
• SADNESS (3rd /12)
• ANGER (4th/12) (Pursuing a Goal 4th /12)
• FEAR (6th/9th month)
• CURIOSITY
• SUBTLE EMOTIONS
• Michael Lewis, The Emergence of Human Emotions,
  Handbook of Emotions, 2000

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• Exposed Emotions or Self-Conscious Evaluative
  Emotions
• (Follow the development of the awareness of
  Self and Other)
• ENVY EMBARRASSMENT EMPATHY
• (second half of second year)
• Self-Conscious Emotions
• (from 30 to 36 months)
• PRIDE SHAME GUILT
• (These emotions complete their development by
  the 6th/9th year of age)
• M Lewis, 2000

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Why deafness affects emotional development

• Deaf children are at greater risk of
• parental distress
• lack of access to language and developmental
  experience
• additional learning difficulties
• abuse

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Emotional Response to Deafness

• Parents
• Parents remember when, where, how, who (Hindley
  93)
• Relief or Panic what about
  attachment?
• Shock, denial, grief, anger, guilt andresolution
  (Webster 94)
• Parents react unpredictably, possibly influenced
  by manner of the telling (Beazley Moore 95)
• Children
• Child may show anxiety, fear, anger, or
  behavioural disturbance if sudden and late
  hearing loss

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Abuse

• 72 of sexual abuse is extra familial
• Deaf and HH with behavioural problems are at
  greater risk of physical abuse
• Children with disabilities are at greater risk of
  intrafamilial abuse than hearing children
• Children with disabilities 1.8x more likely to be
  neglected, 1.6x to be physically abused and 2.2x
  likely to be victim of sexual abuse than their
  non disabled counterpart
• Mothers of children with profound hearing loss
  more likely to use physical discipline than
  mothers of hearing children (Knutson 2004)

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Abuse

• Children with sensory disabilities are more at
  risk (Sobsey Varnhagen, 1988)
• Children with behavioural problems are more at
  risk (Salomons, 1979)
• Children with parental history of abuse, highly
  deprived (Friedrich Boriskin, 1978 Frodi,
  1981)
• Mostly occurring in residential settings
  (Sullivan, Vernon Scanlan, 1987)
• Hearing parents of Deaf children more likely to
  use physical coercion (Schlesinger Meadow,
  1972)
• Highest incidence of sexual abuse or a
  combination of sexual and physical abuse
  (Sullivan, 1991 Willging, Bower Cotton, 1992)
• Males with disabilities more at risk than hearing
  counterpart
• No gender differences within the abused children

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Language acquisition developmentfrom
impossible to miracle

• St Augustine (354-430) Behaviourism
  empiricist associationism (Skinner, 1959)
• Chomsky nativism LAD (1975)
• Bruner LAD LASS (1985)

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Language Acquisition

• Before childs utters first lexicogrammatical
  speech
• Within intersubjective relationship
• input
• the child masters
• - Grammar
• - How to refer and mean
• - How to realise his/her intention communicatively

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Language Acquisition Processes

• Children grammatical skills are extremely
  variable over the first 2.5 years of their life
• 2 reasons
• Some children are more efficient learner
• Girls are better language learner
• children with larger working memory seem to learn
  and process language more efficiently (Adam
  Gathercole, 2000)

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Language Acquisition Processes

• Importance of language learning environment
• Providing young children with extra exemplars of
  complex syntactic constructions facilitates their
  acquisition of such constructions (Nelson, 1977)
• Childrens mastery of complex constructions is
  strongly related to the frequency with which both
  their parents and teachers use them(Huttenlocher
  et al., 2003)
• Children acquisition of some particular
  grammatical English morphemes were facilitated
  when mothers used these morphemes as immediate
  recast (Farrar, 1990 1992)

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Effects of parental style of interaction on
language development in very young severe and
profound deaf children Fatima Janjua a, Bencie
Woll b, Jim Kyle c a Child Development Centre,
Addenbrookes University Hospital, Hills Road,
Cambridge CB2 2QQ, UK b Department of Language
and Communication Sciences, City University,
Northampton Square, London EC1V OHB, UK c Centre
for Deaf Studies, University of Bristol, 8
Woodland Rd, Bristol BS8 1TN, UK Received 7
July 2001 received in revised form 27 February
2002 accepted 6 March 2002
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Conclusions

• Exposure to language in early childhood is
  essential to establish a first language (Mayberry
  2002), to develop EF, to articulate emotions and
  to socialise
• No evidence that signing interferes with
  acquisition of spoken language (Marschark 1993)
• Incidental Learning Deaf children in hearing
  families miss out on adult talk social
  communication