Educational Outcomes for Children With Hearing Loss Peer Reviewed

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Peer-reviewed

Research Article

Self-Esteem in Hearing-Dumb Children: The Influence of Advice, Education, and Audiological Characteristics

• Stephanie C. P. M. Theunissen,
• Carolien Rieffe,
• Anouk P. Netten,
• Jeroen J. Briaire,
• Wim Soede,
• Maartje Kouwenberg,
• Johan H. Thousand. Frijns

10

• Published: April 10, 2014
• https://doi.org/10.1371/journal.pone.0094521

Figures

Abstract

Objective

Sufficient self-esteem is extremely important for psychosocial performance. It is hypothesized that hearing-impaired (Hullo) children have lower levels of self-esteem, because, amid other things, they frequently feel lower linguistic communication and communication skills. Therefore, the aim of this study was to compare HI children's self-esteem across different domains with those of normal hearing (NH) children and to investigate the influence of communication, type of pedagogy, and audiological characteristics.

Methods

This big (Due north = 252) retrospective, multicenter written report consisted of two age- and gender-matched groups: 123 HI children and 129 NH controls (mean age  = xi.8 years). Self-reports were used to measure out self-esteem across four domains: perceived social acceptance past peers, perceived parental attention, perceived physical appearance, and global self-esteem.

Results

HI children experienced lower levels of self-esteem regarding peers and parents than NH controls. Particularly How-do-you-do children who attended special didactics for the deaf were at risk, even later on correcting for their language development and intelligence. Yet, levels of global self-esteem and cocky-esteem involving concrete appearance in Howdy children equalled those of NH controls. Furthermore, younger historic period at implantation and longer duration of having cochlear implants (CIs) were related to higher levels of self-esteem.

Conclusion

How-do-you-do children experience lower levels of self-esteem in the social domains. However, due to the heterogeneity of the HI population, there is loftier variability in levels of self-esteem.

Word

Clinicians must always be aware of the take chances and protective factors related to self-esteem in order to help individual patients reach their full potential.

Commendation: Theunissen SCPM, Rieffe C, Netten AP, Briaire JJ, Soede Due west, Kouwenberg Chiliad, et al. (2014) Self-Esteem in Hearing-Dumb Children: The Influence of Advice, Education, and Audiological Characteristics. PLoS ONE nine(four): e94521. https://doi.org/ten.1371/journal.pone.0094521

Editor: Brett Thombs, McGill Academy, Canada

Received: May 8, 2013; Accustomed: March 17, 2014; Published: April 10, 2014

Copyright: © 2014 Theunissen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted utilise, distribution, and reproduction in any medium, provided the original writer and source are credited.

Funding: This inquiry was supported by the Innovational Research Incentives Scheme (a VIDI grant) past The Netherlands Organization for Scientific Enquiry (NWO), no. 452-07-004 to Carolien Rieffe. The funders had no role in study blueprint, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors accept declared that no competing interests exist.

Introduction

Cocky-esteem refers to one's general evaluation or appraisal of the self, including feelings of self-worth [1]. Likewise an evaluation of the self, self-esteem as well denotes how one values oneself. This bones appreciation of the self has effects on multiple dimensions in our lives, such as our friendships, our successes, and our academic career. Moreover, individuals with college levels of self-esteem are improve able to cope with stressful life events [1], whereas lower levels of self-esteem are associated with more than loneliness, peer rejection, assailment, delinquency, and psychopathology [2]–[six]. Hence, it is of the utmost importance to have a sufficient level of cocky-esteem.

I would presume that hearing-impaired (Hullo) individuals meet more difficulties regarding their self-esteem because they oft face up multiple challenges, such as speech and linguistic communication delays, communication problems, and less or no access to the sound-dominated globe [7]. These issues could potentially harm HI children's level of cocky-esteem, resulting in for example less stable friendships and more bullying [8]. Well-developed linguistic communication and communication skills have been linked to higher levels of self-esteem [9]. Nowadays, deaf children who can have no or minimal benefit from conventional hearing aids receive cochlear implants (CIs), which considerably alter and often improved outcomes for them in the aforementioned domains [ten], [11]. Recently, CI recipients have been plant to have levels of cocky-esteem that equal those of NH children [12], [xiii], which emphasizes the importance of adequate language evolution for self-esteem.

Studies that looked at levels of self-esteem in a more heterogeneous group of HI children showed inconsistent results. When compared to normal hearing (NH) peers, some researchers reported lower cocky-esteem in children with mild to profound hearing losses [14]–[16], while others demonstrated that levels of self-esteem were similar to those of NH counterparts [12], [xiii], [17]–[19]. In the literature, no consensus has been reached for the effect of blazon of education on Hullo children's self-esteem: some researchers showed higher cocky-esteem in HI children attending mainstream instruction than the ones attention special instruction, whereas others found no difference [19]–[21]. Possibly, HI children evaluate their abilities differently in unlike school contexts. Whilst Hullo children attending special schools evaluate themselves inside a compatible peer grouping, HI children in a mainstream setting will compare themselves with their hearing peers. [21]. Conversely, it could likewise exist argued that HI children attending mainstream schools actually feel a higher self-worth, because they are able to fit in with hearing peers, which can exist perceived equally a major achievement.

Self-esteem is frequently conceptualized as being multidimensional, consisting of several specific domains that are related to various facets of life (e.g. perceived parental attention, social credence past peers and physical appearance), also equally a more general view of oneself, frequently called 'global cocky-esteem' [three], [22]. Levels of cocky-esteem tin can vary considerably beyond these different domains, particularly during adolescence, equally this is a transition stage marked by crucial emotional and behavioral changes [iii], [23]. Parents go less influential, while close friends' and classmates' judgments go increasingly of import [24]. Attention to and perception of 1'south concrete appearance as well increase. A child may exist at risk of low self-esteem in one specific domain only non in some other [21]. Although it has been postulated that cocky-esteem interventions do not directly improve outcomes, being aware of these distinctions can support the caregiver when helping or counseling the child [2].

Besides the contrasting findings of past inquiry regarding differences in How-do-you-do and NH children's levels of global self-esteem, there is a paucity of data concerning the more specific domains of self-esteem in HI children compared to NH children. Simply a few studies have reported on specific domains of self-esteem in Howdy children when compared to NH controls. These found that the Howdy children had more difficulties regarding peer acceptance and family unit relations although they felt equally confident near their physical appearance [fifteen], [19], [25]. To the best of our noesis, no other studies accept been performed to appointment in which these specific domains were studied and compared in both HI and NH children.

Hence, our goal here was not only to investigate the level of global self-esteem in a large and diverse sample of HI and NH children and adolescents, but also to examine iii more than specific domains of self-esteem: perceived social acceptance by peers, perceived parental attention and perceived physical advent. Secondly, we wanted to written report whether linguistic communication development and communication skills, type of pedagogy, and audiological characteristics would influence the level of self-esteem. Based on (the majority of) the existing literature, we expected that adequate communication skills would result in higher self-esteem [9], [12], [13] and that children attending special education would take lower cocky-esteem than children in mainstream education [19]–[21]. Concerning audiological factors, no recent studies were available on which to base our predictions. Therefore, we take performed several explorative analyses to see whether relations betwixt these factors and the different domains of self-esteem be.

Materials and Methods

Participants

A total of 252 children (Hateful age  = eleven.eight years, SD = ane.vii) participated in this study of which 123 were Hullo children and 129 were NH controls. All children had a nonverbal IQ of at least 80, and no other known learning issues. Children were not included if they experienced comorbidities such as visual harm or Autism Spectrum Disorders. The How-do-you-do children were included if they experienced a loss of at to the lowest degree 40 decibels in the all-time ear, which was detected prelingually (<iii years) or perilingually (three–five years). Tabular array 1 shows the characteristics of all included children. For the CI recipients specifically, the mean historic period at implantation was 3.8 years (SD = 2.7; range  = 0.9–10.8 years). The mean duration of CI utilize was viii.3 years (SD = 2.6; range 0.viii–13.0 years). Most CI users (north = 40; 76%) had one CI, and xiii (24%) children were bilaterally implanted.

Procedure

The NH controls were recruited from primary and secondary mainstream schools across the Netherlands to reach a geographically and socio-economically diverse sample. To collect a sample that represented the complete spectrum of Hi children, we recruited from 14 (both primary and secondary) mainstream schools and special schools for the HI (schools that supported development of auditory and oral skills, with or without the use of signs), two hospitals, 5 Speech communication and Hearing centers or residential schools, and via newsletters in the Netherlands and the Dutch-speaking office of Belgium.

The questionnaire was administered on a laptop. Questions appeared one by ane on the screen. Instructions for all tests were provided in the child'southward preferred mode of advice to ensure that the child understood. The Hi children could choose between two versions of the questionnaire: the first version which comprised written items exclusively, and the second version in which each item was presented in written text and sign language simultaneously by means of a video clip in the upper right-hand corner of the screen. Translation from spoken language into sign language was performed past a qualified interpreter and back translation of all signed items showed good convergence with the original items.

Parents or caregivers were requested to complete a questionnaire assessing demographic variables such every bit net income and level of education. In the HI group, several audiological variables were derived from the kid's medical and audiological notes after informed consent was given. SES was calculated equally the mean of parental pedagogy, job, and net income. Unfortunately, due to privacy reasons, almost half of the parents did not fill up out the question concerning internet income, so these were not taken into business relationship.

Ideals statement and privacy regulation

Approval for the written report was obtained by the Medical Ethics Commission of the Leiden Academy Medical Center nether number P10.137, and carried out in accordance with the standards set out by the Declaration of Helsinki. All parents or caregivers gave written consent for their child's participation prior to information collection. Next to parents and caregivers, all children aged 12 or older gave written consent as well. Before the assessment started, all children were assured that their responses would exist processed anonymously.

Self-esteem questionnaire

To assess cocky-esteem, the self-report Children'south Self-Confidence and Acceptance Scale [26], [27] was used, which had only been used in NH children previously. The scale showed a strong convergent validity with the CBSK, which is the well-established Dutch version of Harter'southward cocky-esteem scale (The Self-Perception Profile for Children [28], [29]). Harter's scale was used because we wanted to address the different specific domains of self-esteem instead of the more general global self-esteem measured by the Rosenberg self-esteem scale [30]. The items of the questionnaire were formulated by a team of child psychologists, targeting central aspects of self-esteem. Sentences were formulated brusque and elementary, and then Hello children with language comprehension problems would be able to sympathise these items and answer to them coherently. The reason for choosing a self-report instead of parent or teacher reports is that self-reports requite the near accurate scores when measuring self-esteem [31], [32].

The questionnaire represents three relevant domain-specific categories, and one overall category, that could exist answered on a 3-signal Likert scale:

1. The perceived social acceptance by peers ('peers', five items) domain examines the perception of the child of how well he or she is accepted past peers or feels popular (Instance item: "Children ask to play with me").
2. The perceived parental attention ('parents', seven items) domain assesses the cocky-perceived degree to which parents or caregivers are interested in and give support to the child'southward thoughts and needs ("My begetter or mother are happy with me").
3. The perceived physical advent ('physical advent', 5 items) domain reflects the kid'due south idea of how expert-looking or attractive he or she is ("Other children think my appearance is overnice").
4. The global self-esteem ('global', 5 items) measures the kid'south perceptions of general statements concerning the self ("I am happy with myself"). These v items address comparable issues to those used in Rosenberg's self-esteem scale [30].

Children were asked to rate the items on a 3-indicate Likert-type scale (1 = not true, 2 = sometimes true, 3 = often true). The internal consistency was skilful for both the HI and the NH group (Tabular array 2).

Linguistic communication development and advice skills

Language development and communication skills were measured considering of their known positive influence on self-esteem [nine]. Two types of language evolution were assessed: sentence comprehension and story comprehension. Hi children using spoken language and NH controls received ii corresponding subtests of the Dutch version of the Clinical Evaluation of Language Fundamentals - 4th Edition (CELF) [33], [34]. HI children who employ sign or sign-supported language received specific subtests of the Assessment Instrument for Sign Language of the Netherlands [35]. All original language scores were transformed to norm scores and these were corrected for chronological historic period. The judgement comprehension task was not administered to 10 Hello and xvi controls and the story comprehension job was not administered to v Hi and xvi NH controls.

The Children'southward Advice Checklist version 2 was used to evaluate communication skills indicated by the parents or caregivers [36]. This questionnaire, consisting of seventy items, has been predominantly designed to appraise social and pragmatic language of children aged 4 to xvi, although it also assesses other qualitative aspects of language. The checklist contains 8 scales: speech production, syntax, semantics, coherence, inappropriate initiation, stereotyped conversation, use of context, and not-verbal communication. Ii composite scores are conventionally obtained from these scales: the general communication composite (GCC) and the businesslike composite (PC). Each item can be scored from 0 (never or less than in one case a week) to 3 (several times a twenty-four hours or always). Higher scores indicate more (social) language bug. To the parents of the HI children using sign or sign-supported language, the speech production and syntax scales were non administered.

Intelligence

An index of the nonverbal intelligence was obtained with 2 tests from the Wechsler Intelligence Scale for Children - Tertiary Edition: block design by copying geometric designs with cubes, and film organisation by sequencing pictures to make logical stories [37], [38]. All raw scores were converted into historic period-equivalent norm scores based on Dutch standards (10 =  boilerplate). A random sampling (n = 23) across Howdy children who were previously assessed with a complete intelligence examination (either the Snijders-Oomen nonverbal intelligence examination [39] or the WISC) showed a high correlation betwixt the scores of our tests and the IQ score, r = .79, p<.001. The tasks were not administered to eight HI and 17 NH children, due to time constraints.

Statistical analyses

First, in gild to compare the levels of the specific domains of self-esteem betwixt Hullo and NH children, Multivariate Assay of Variance (MANOVA) and Multivariate Assay of Covariance (MANCOVA) were used. In the MANCOVAs, several covariates were incorporated one past one, including intelligence, socio-economic status (SES) and language and advice skills. For the second and third research questions (i.e., influence of communication skills and type of education on the different domains of self-esteem, respectively) MANCOVAs were performed, and confounding variables were included one by one in case of group differences. Several continuous audiological factors (eastward.g., duration of CI use, age at implantation) and their association with the dissimilar domains of cocky-esteem were addressed by Pearson's correlations. Nominal variables (uni- or bilateral CI, pre-or perilingual onset of HI) were compared past ways of MANOVAs. When a score or variable was not available, the participant was excluded from the analysis concerned. Information technology was checked whether in that location were group differences on age, gender, SES, and blazon of hearing device between those who completed and those who did not complete all the questionnaires and this was not the case. The plan Statistical Packages for the Social Sciences (version 20.0) was used.

Results

Cocky-esteem in Hullo versus NH children

Regarding global self-esteem, the scores of NH and HI children did not significantly differ (Δ = −.007, p = .881). To compare the groups with respect to their specific domains of cocky-esteem, a MANOVA was carried out with grouping (NH or HI) as the between-subjects variable and the levels of cocky-esteem in each of the specific domains as the within-subjects variable. This analysis revealed a primary result for cocky-esteem F_HF (i.62, 403.73) = 56.78, p<.001 η_p ^two  = .xix, and for group F(1, 250) = 11.77, p = .001 η_p ⁱⁱ  = .05 which was qualified by a group ten self-esteem interaction consequence F_HF (ane.62, 403.73) = 6.xvi, p<.01 η_p ²  = .02. Post-hoc t-tests showed that HI children had lower self-esteem than NH controls on two domains: the peers' domain (Δ = .xx, p<.002) and the parents' domain (Δ = .20, p<.001) (Figure ane). For the physical appearance domain, no significant group deviation was constitute. A MANCOVA was performed in which we controlled for several important variables (age, gender, intelligence, and SES). The to a higher place-described furnishings retained their significance, so these results were omitted from the results presented hither.

When comparing children wearing HAs with those using CIs, the groups did not significantly differ on their level of global self-esteem (Δ = .086, p = .eighteen). A 2 (HA or CI) x three (domains of self-esteem) MANOVA too revealed no pregnant differences between the groups in the unlike domains of self-esteem F(ane, 121) = .014, p = .91 η_p ² <.001.

Language development, communication skills and self-esteem

As expected on the ground of by research, t-tests revealed that Hello children had lower linguistic communication and communication skills than NH children (story comprehension, Δ = .eight, p<.038, general communication composite, Δ = 17.4, p<.001, and businesslike composite, Δ = 10.iv, p<.001, respectively). Therefore, a ii (group: HI or NH) x 3 (domains of self-esteem) MANCOVA corrected for linguistic communication development and communication skills was carried out. Again a master result for group was detected, which was qualified by a group 10 self-esteem interaction effect: Wilks' Λ = .96 F(2, 165) = 3.80 p = .024 η_p ²  = .044. Postal service-hoc MANCOVAs showed slightly dissimilar results than the MANOVAs: HI children however reported lower self-esteem with respect to the parents' domain F (ane, 216) = iv.89 p = .028, whereas differences in the peers' domain were no longer statistically significant F (1, 216) = .03 p = .86.

Type of education and self-esteem

In order to properly examine levels of self-esteem between HI children in special education (for the HI or deaf) and in mainstream education, these two groups were compared on several factors: age, gender, intelligence, SES, and language and communication skills. HI children attending mainstream didactics had significantly ameliorate language skills (Δ = iii.17, p<.001), higher intelligence scores (Δ = 2.22, p<.001), and higher communication skills (Δ = −22.69, p<.001) than children attention special instruction.

Regarding global self-esteem, the scores of Hello children attending mainstream educational activity did not significantly differ from those attending special didactics (Δ = .10, p = .14). A two (type of school: special or mainstream) x three (domains of self-esteem) MANCOVA which corrected for language development, advice skills and intelligence revealed a significant departure in the parents' domain just, with children in mainstream didactics scoring higher then children attending special teaching: Wilks' Λ = .82 F(iii, 67) = 4.87 p = .004 η_p ²  = .18.

Audiological factors

Finally, a serial of Pearson's correlations were carried out to see which continuous audiological factors were associated with the specific domains of cocky-esteem (Table three). For the peers' and physical appearance domains and for global self-esteem, no pregnant associations were detected. Still, for the parents' domain, younger age at implantation, and consequent longer duration of having CIs, were related to higher self-esteem: r (47) = −.359 p = .006 and r (47) = .376 p = .004 respectively. These correlations remained significant when a correction for historic period and language development was performed, using partial correlation analyses: r (41) = −.28 p = .035 and r (41) = .28 p = .034 respectively. To analyze differences within the CI group between 2 nominal variables (i.e. uni- or bilateral implantation, and pre- or perilingual detection of hearing loss), a MANOVA was carried out for each variable. The independent variables were uni- or bilateral implantation and pre- or perilingual onset of hearing loss, and the dependent variables were the 3 specific domains of cocky-esteem. No differences betwixt the groups were establish: Wilks' Λ = 1.0 F(three, 49) = .06 p = .98 η_p ²  = .004 and Wilks' Λ = .94 F(3, 112) = 2.37 p = .075 η_p ²  = .06 respectively.

Discussion

Self-esteem is a principal prerequisite for healthy psychosocial development and enables children to arrange to stress or burdens [40]. HI children often face demanding situations, so information technology might be even more than important for them to accept sufficient levels of self-esteem. Past tapping into self-esteem across a number of domains, a differentiated moving picture of self-esteem was obtained. Beginning, nosotros constitute that the levels of global self-esteem and perceived physical appearance of HI children did not significantly differ from those of NH controls, despite the one-time group wearing external distension devices visible to those around them. This suggests that HI children do not feel more than insecure almost their looks than other teenagers around this age, which is a positive finding. However, HI children reported lower self-esteem in the domains of perceived social acceptance by peers and perceived parental attention when compared to NH peers. Adequate language evolution and communication skills can increase self-esteem in the peers' domain, but not in the parental domain.

The fact that HI children reported lower levels of cocky-esteem than NH children in the social domains indicates that HI children experience less liked and appreciated past parents and peers. This is in line with other studies with HI children [15], [xvi], [25]. The reasons for lower cocky-esteem involving parents could be subjective or objective. Children might perceive that their parents spend less time with them, while in fact parents might spend equal time with them as with their NH children. The quality of contact received past NH versus HI children could exist unlike. Parents usually experience more than stress and worries raising a HI than a NH child, because they have to suit to a new situation which necessitates the investment of time, effort, and resources [41]–[44]. For instance, an Hi kid requires frequent hospitals visits and interest in intensive rehabilitation programs. Chronic parental stress can influence the child'southward functioning and development in a negative mode (e.thousand., more behavioral problems and impaired psychological operation) [8], [45]. First of all, parents are a role model for their children. When parents have difficulties coping with stressful events, children volition learn and apply these reactions likewise. Secondly, more parental stress will besides bring virtually a less positive atmosphere in the home, creating a less optimal environment for good for you evolution in children. Thirdly, parents might exist focused on the impact of the hearing loss and medical site of this, overlooking the child'southward emotional demand for back up and guidance. Possibly, parents try hard to back up their HI child by speaking slowly, helping with homework, or explaining difficult words [46]. Yet, HI children might translate this actress attending every bit if they are failing or falling behind.

On the other mitt, linguistic communication evolution and communication skills influenced cocky-esteem in the peers' domain. This ways that Hi children'due south self-esteem regarding peers equals that of NH children when their linguistic communication and communication skills are well-adult. Nevertheless, HI children are born into a sound-dominated world, where the focus lies on oral communication, resulting in less satisfactory communication. For case, making friends can be harder for HI children and they are also more neglected and less accepted by NH peers [16], [47]–[50]. The communication barrier between Hello and NH children tin can function as an obstacle for successful interpersonal relationships and may hamper these children in developing solid social networks [51], [52]. This process may pave the fashion for social isolation and loneliness, with consequences for the kid's cocky-esteem [53], [54]. Hence, by improving language development and communication skills, the HI child might feel improve contact with peers, which in turn would likely improve their self-esteem in this domain. In this respect, it has to be mentioned that language development and communication skills did non differ between hearing aided children and CI recipients in our sample. Though the literature oftentimes showed that CI recipients have better skills in this regard [10], [55], nearly of the literature reports on early on-implanted children, while our sample is mainly late-implanted. Therefore, nosotros call back that the next generation of CI recipients, with meliorate language and communication will, in plow, have higher cocky-esteem.

Moreover, this research has revealed that children who attend special instruction for the HI or deafened have lower self-esteem apropos parents when compared to Hello children attending mainstream instruction. Although we accept to bear in mind that Howdy children with proficient language skills and/or college intelligence are more than easily referred to mainstream education [xx], [56]–[58], this report is the first to bear witness that even subsequently correcting for these variables, children in special instruction nonetheless have lower levels of self-esteem. It could exist hypothesized that this stems from reasons related to bigotry or stigma. Hi children often take to travel far to attend special pedagogy, which results in different environments: they have friends at school and different friends at home. Less contact with peers could hinder bonding and attachment, maybe resulting in lower self-esteem [59]. However, longitudinal studies are needed to reproduce these findings, because a cross-exclusive written report rules out cartoon conclusions most causal relations. Additionally, such longitudinal studies must include larger samples in guild to examine the influence of parental and friends' hearing statuses on the level of cocky-esteem.

A limitation of this study was missing data, especially concerning communication, intelligence and language development. It is possible that this missing data did not occur at random. For case, children who read slowly might not accept had enough time to complete all the tests. Yet, comparison showed that the group for which data on these measures was missing did non differ from the group with no missing values on important other variables, including age, gender, SES, and the different domains for self-esteem. This seems to strengthen the basis for our conclusions, but future studies are needed to confirm these outcomes.

To conclude, self-esteem in HI children differs from NH children in the social domains just; the levels of perceived concrete appearance and global self-esteem practise non differ from those of NH children. Improving language evolution and advice skills could assist to build upwardly college levels of cocky-esteem regarding peers. Unfortunately, irrespective of their linguistic communication and communication skills, HI children in special education show lower levels of self-esteem in the parental domain. The aim of this inquiry was to create more than awareness concerning this vulnerable grouping of children, resulting in increased attention and monitoring past professionals, in club to promote practiced mental health in each HI child.

Acknowledgments

We gratefully acknowledge all children and their parents for participation in this study.

Author Contributions

Conceived and designed the experiments: ST, AN, CR, MK, WS, JB, JF. Performed the experiments: ST, MK. Analyzed the information: ST, AN, CR. Wrote the paper: ST, AN, CR, MK, WS, JB, JF.

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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094521

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