Adverse Childhood Communication Experiences Associated With an Increased Risk of Chronic Diseases in Adults Who Are Deaf

Deaf legal theory: challenging the law's hearing bias

Bryan and Emery introduced a new concept in legal jurisprudence through which a critical examination of how the law deals with deaf people can be undertaken: deaf legal theory (DLT). They define it as "how the law seeks to frame Deaf people" and argue that legal systems should be reoriented to recognise and accommodate the unique perspectives and experiences of deaf people. Current legal systems are biased in favour of hearing people and these bias disadvantage deaf people in a variety of ways, including in their access to justice, employment, and education. The aim of this article is to advance Bryan and Emery's DLT by expounding its main arguments, situating it within its jurisprudential home of critical legal studies, considering the justification for its existence and providing a framework to apply it. The concept was introduced not within legal discourse but within Deaf Studies discourse and is therefore not yet widely known in legal scholarship. This article aims to bridge the gap between the two disciplines and firmly establish DLT as a legal theory in jurisprudence following which it can be applied to various legal subjects of intellectual enquiry.

Adverse childhood experiences among deaf and hard-of-hearing adults

BACKGROUND

The adverse childhood experiences (ACEs) screening tool is a research measure that has not been frequently employed within the scientific literature addressing deaf and hard-of-hearing (DHH) populations.

OBJECTIVE

To evaluate whether those who are DHH are more likely to cross-sectionally report a high-risk number of ACEs than those who are not DHH.

METHODS

Data consisting of a weighted total of n = 24,797,770 US adults' responses to the 2021 BRFSS survey were utilized for this study.

RESULTS

The DHH-ACE association was effect modified by age group. In the 25-to-34 (aOR = 2.98; 95 % aOR CI: 1.81, 4.92; P < 0.0001), 35-to-44 (aOR = 3.17; 95 % aOR CI: 1.98, 5.08; P < 0.0001), 45-to-54 (aOR = 1.74; 95 % aOR CI: 1.23, 2.45; P = 0.0016), and 55-to-64-year-old (aOR = 1.85; 95 % aOR CI: 1.41, 2.42; P < 0.0001) age groups, those who are DHH were significantly more likely than their same-age hearing peers to report a high-risk number of ACEs. The findings for the 18-24 years and 65+ age groups were not statistically significant.

CONCLUSION

The results of this study highlight the need for trauma-informed care and improved early intervention and ACEs screenings for the DHH population.

Diabetes Care Disparities in Deaf/Hard of Hearing and Blind/Low Vision Populations

PURPOSE OF REVIEW

Describe the connection between Deaf/hard of hearing (DHH) and diabetes, explain the bidirectional relationship of blind/low vision (BLV) and diabetes, characterize challenges DHH and BLV populations face when seeking healthcare regarding their diabetes management. Highlight the inaccessibility of diabetes technology in these populations. Provide best practices when communicating with DHH and BLV people in the clinical setting.

RECENT FINDINGS

Diabetes disparities exist in DHH and BLV populations due to systemic barriers to health equity related to access and communication. Structural barriers, risk factors, social determinants of health, and the U.S. healthcare system do not support the DHH and BLV communities. Importantly, healthcare professionals do not receive adequate training on communication and treatment of DHH and BLV populations. Together, social determinants of health, such as healthcare access and quality, education access and quality, and lack of adequate clinician training allow ableism to persist and drive health disparities in these communities. Health disparities faced by DHH and BLV populations are driven by barriers to diabetes standards of care. These inequities must be rectified to improve and maintain high quality care.

Challenging the "norm": a critical look at deaf-hearing comparison studies in research

This study critically examines the biases and methodological shortcomings in studies comparing deaf and hearing populations, demonstrating their implications for both the reliability and ethics of research in deaf education. Upon reviewing the 20 most-cited deaf-hearing comparison studies, we identified recurring fallacies such as the presumption of hearing ideological biases, the use of heterogeneously small samples, and the misinterpretation of critical variables. Our research reveals a propensity to biased conclusions based on the norms of white, hearing, monolingual English speakers. This dependence upholds eugenics ideas and scientific ableism, which reinforces current power dynamics that marginalize the epistemologies and lived experiences of deaf populations. Going forward, it will be imperative for deaf people to be included in meaningful roles in deaf-related research as active contributors who help define the whole research process. Without this shift, the research risks remaining detached from the very populations it seeks to understand.

Exploring the Interplay of Diabetes, Deaf Patient Reported Outcomes, and Cancer Screening in Deaf and Hard of Hearing Women

Purpose

Some deaf and hard-of-hearing (DHH) individuals face health information barriers, increasing their risk of diabetes mellitus (DM) and subsequent cancer development. This study examines if health-related quality of life (HRQoL) and deaf patient-reported outcomes (DHH-QoL) mediate the relationship between DM diagnosis and cancer screening adherence among DHH individuals.

Patients and Methods

In a cross-sectional study, US DHH adults assigned female at birth answered questions on cervical and breast cancer screenings from the ASL-English bilingual Health Information National Trends Survey (HINTS-ASL) and the PROMIS (Patient Reported Outcome Measurement Information System) Deaf Profile measure's Communication Health and Global Health domains. Odds ratios (OR) and 95% confidence intervals (CI) were obtained from multivariable logistic and linear regression models, examining the association between DM, DHH-QoL, and cancer screening adherence, adjusting for other covariates and HRQoL. A Baron and Kenny causal mediation analysis was used. A two-sided p < 0.05 indicated significance.

Results

Most respondents were White (66.4%), heterosexual (66.2%), did not have DM (83.9%), had health insurance (95.5%), and adhered to pap smears (75.7%) and mammograms (76.9%). The average (standard deviation) DHH-QoL score was 50.9 (8.6). Those with DM had lower HRQoL scores (46.2 (9.5) vs 50.2 (8.8); p < 0.0001) than those without. Non-significant multivariable models indicate that those with DM were more adherent to pap testing (OR: 1.48; 95% CI: 0.72, 3.03; p = 0.285) and mammograms (2.18; 95% CI: 0.81, 5.88; p = 0.122), with DHH-QoL scores slightly increasing them to 1.53 (0.74, 3.16; p = 0.250) for pap testing and 2.55 (0.91, 7.13; p = 0.076) for mammograms. DHH-QoL was significantly associated with mammograms (p = 0.027), with 6% increased adherence per unit increase in the score. Overall, HRQoL and DHH-QoL were not significant mediators.

Conclusion

While HRQoL/DHH-QoL in DHH individuals with DM does not mediate cancer screening adherence, higher DHH-QoL scores are associated with it. DHH-focused health literacy and communication training can improve cancer-related outcomes.

An approach designed to fail deaf children and their parents and how to change it

The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language - a sign language - introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds.

Health outcomes in Deaf signing populations: A systematic review

OBJECTIVES

(i) To identify peer reviewed publications reporting the mental and/or physical health outcomes of Deaf adults who are sign language users and to synthesise evidence; (ii) If data available, to analyse how the health of the adult Deaf population compares to that of the general population; (iii) to evaluate the quality of evidence in the identified publications; (iv) to identify limitations of the current evidence base and suggest directions for future research.

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase, PsychINFO, and Web of Science.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The inclusion criteria were Deaf adult populations who used a signed language, all study types, including methods-focused papers which also contain results in relation to health outcomes of Deaf signing populations. Full-text articles, published in peer-review journals were searched up to 13th June 2023, published in English or a signed language such as ASL (American Sign Language).

DATA EXTRACTION

Supported by the Rayyan systematic review software, two authors independently reviewed identified publications at each screening stage (primary and secondary). A third reviewer was consulted to settle any disagreements. Comprehensive data extraction included research design, study sample, methodology, findings, and a quality assessment.

RESULTS

Of the 35 included studies, the majority (25 out of 35) concerned mental health outcomes. The findings from this review highlighted the inequalities in health and mental health outcomes for Deaf signing populations in comparison with the general population, gaps in the range of conditions studied in relation to Deaf people, and the poor quality of available data.

CONCLUSIONS

Population sample definition and consistency of standards of reporting of health outcomes for Deaf people who use sign language should be improved. Further research on health outcomes not previously reported is needed to gain better understanding of Deaf people's state of health.

Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients

BACKGROUND

Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients.

METHODS

This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach.

RESULTS

Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes.

CONCLUSIONS

This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine.

PATIENT OR PUBLIC CONTRIBUTION

This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.

Exploring spirituality and quality of life in individuals who are deaf and have intellectual disabilities

PURPOSE

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs.

METHODS

Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained.

RESULTS

The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices.

CONCLUSIONS

Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

Associations of childhood hearing loss and adverse childhood experiences in deaf adults

Childhood trauma and adverse childhood experiences have a strong relationship with health disparities across the lifespan. Despite experiencing approximately doubled rates of trauma, Adverse Childhood Experiences (ACEs) are poorly characterized in deaf populations. We sought to characterize deaf-specific demographic factors and their association with multiple experiences of ACEs before the age of 18 years old. An analytical cross-sectional approach was used to ascertain associations of deaf-specific demographic factors and experiences with ACEs. The complete dataset included 520 participants for a total response rate of 56%. After adjusting for confounding effects, less severe hearing loss of 16-55 dB (2+ OR: 5.2, 4+ OR: 4.7), having a cochlear implant (2+ OR: 2.1, 4+ OR: 2.6), and not attending at least one school with signing access (2+ OR: 2.4, 4+ OR: 3.7) were significantly and independently associated with reported experiences of multiple ACEs. We conclude that factors associated with childhood hearing loss and language experiences increase risk of experiencing ACEs. Given the strong relationship between ACEs and poor social outcomes, early intervention clinical practice and health policies should consider interventions to support healthy home environments for deaf children.

Introducing the READY Study: DHH Young people's Well-Being and Self-Determination

READY is a self-report prospective longitudinal study of deaf and hard of hearing (DHH) young people aged 16 to 19 years on entry. Its overarching aim is to explore the risk and protective factors for successful transition to adulthood. This article introduces the cohort of 163 DHH young people, background characteristics and study design. Focusing on self-determination and subjective well-being only, those who completed the assessments in written English (n = 133) score significantly lower than general population comparators. Sociodemographic variables explain very little of the variance in well-being scores; higher levels of self-determination are a predictor of higher levels of well-being, outweighing the influence of any background characteristics. Although women and those who are LGBTQ+ have statistically significantly lower well-being scores, these aspects of their identity are not predictive risk factors. These results add to the case for self-determination interventions to support better well-being amongst DHH young people.

Supporting deaf learners in Nepal via Sustainable Development Goal 4: Inclusive and equitable quality education in sign languages

PURPOSE

To highlight the World Federation of the Deaf's (WFD) development of inclusive education policies for deaf learners as part of the community of people with communication disability. These policies were developed alongside and included baseline data collection regarding deaf education in Nepal.

RESULT

The commentary will report on sustainable partnership practices, the development of governmental accountability measurements, and data gathered during fieldwork in Nepal to provide evidence regarding deaf people's access to inclusive and equitable quality education in sign language.

CONCLUSION

The recommendations from this project focus on enhanced access, policy, and training to ensure a free education in sign language for all deaf learners and their families in low-income countries using Nepal as a model. Existing bilingual settings in sign languages should be considered as part of a national inclusive education system, and this is in keeping with the views of deaf organisations in Nepal. Free education in sign language for all deaf learners and their families is an integral and wholly attainable part of inclusive education systems. This commentary focuses on good health and well-being (SDG 3), quality education (SDG 4), peace, justice and strong institutions (SDG 16) and partnerships for the goals (SDG 17).

Deaf Children's Engagement with American Sign Language-English Bilingual Storybook Apps

Design features of American Sign Language (ASL)-English bilingual storybook apps on the tablet computers, based on learning research, are intended to facilitate independent and interactive learning of English print literacy and of ASL skill among young learners. In 2013, the Science of Learning Center on Visual Language and Visual Learning introduced the first in a series of storybook apps for the iPad based on literacy and reading research. The current study, employing a sample of signing deaf children examined children's self-motivated engagement with the various design features presented in the earliest of the apps, The Baobab, and analyzed the relationships of engagement with ASL skill and age of first exposure to ASL, ASL narrative ability, and grade-appropriate English reading ability. Results indicated a robust level of engagement with the app, and a relationship between app pages specifically targeting reading and early exposure and skill levels in ASL. No evidence of relationships between narrative and vocabulary skills and app reading engagement was found. Topics for future research, and strategies for app improvement are discussed.

Deaf Children Need Rich Language Input from the Start: Support in Advising Parents

Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.

Development and Implementation of a Curriculum for Pediatric Trainees on Caring for Children Who Are Deaf and Hard of Hearing: A Pilot Study

INTRODUCTION

Children who are deaf or hard of hearing (DHH) are at risk for poor developmental outcomes related to incomplete language access. Evidence based interventions are available to improve early access to language. With a better understanding of caring for DHH children, pediatricians will be more prepared to work with families in improving outcomes for this population. To date, there are no formal curricula on educating pediatric trainees on childhood hearing differences.

METHODS

The authors designed a novel pilot curriculum to educate pediatric trainees on caring for DHH children, including screening, diagnosis, signed languages, and hearing technologies. The curriculum was delivered to pediatric interns in a 1-hour seminar. Pre-lecture, immediate post-lecture, and 6-month post-lecture surveys were developed and conducted to evaluate the effectiveness of the curriculum. Descriptive statistics were used to determine differences in understanding concepts before and after the curricular intervention.

RESULTS

A total of 55 residents participated in the curriculum over a 14-month study period from 2018 to 2019. There were significant differences in responses between the pre- and post- surveys related to residents' understanding of childhood deafness and their confidence in their ability to care for DHH children.

CONCLUSION

Pediatric trainees gained an understanding of the challenges faced by DHH children and of the interventions that aim to provide them with access to language during the critical period of development. As a result, trainees will be in a better position to care for patients and their families after a new diagnosis of a hearing difference and guide them through early language-based interventions.

Intellectual Disability Profiles, Quality of Life and Maladaptive Behavior in Deaf Adults: An Exploratory Study

Individuals who are prelingually deaf and have intellectual disabilities experience great challenges in their language, cognitive and social development, leading to heterogeneous profiles of intellectual and adaptive functioning. The present study describes these profiles, paying particular attention to domain discrepancies, and explores their associations with quality of life and maladaptive behavior. Twenty-nine adults with prelingual deafness (31% female) and mild intellectual functioning deficits (mean IQ = 67.3, SD = 6.5) were administered the Vineland Adaptive Behavior Scales-II (VABS-II) and an adapted sign language version of a quality of life scale (EUROHIS-QOL 8). Intellectual disability domain discrepancies were characterized as at least one standard deviation difference between the social domain and IQ and the practical domain and IQ, and a significant difference, according to the VABS-II manual, between the social and practical domains. Domain discrepancies were found between intellectual functioning and both the practical (58.6%) and social domain (65.5%). A discrepancy between intellectual and social functioning was significantly associated with a higher level of internalizing maladaptive behavior (T = 1.89, p < 0.05). The heterogeneous profiles highlight the importance of comprehensive assessments for adequate service provision.

The Self-Determination Inventory: Student Report American Sign Language Translation

Research literature and community narratives both emphasize the importance of self-determination in the lives of deaf youth. This paper describes the development, initial validation, and potential applications of a translated measure of self-determination for deaf youth, the SDI:SR ASL Translation (SDI:SR ASL). A sample of 3,309 young people who completed the SDI:SR, of whom 392 were deaf, was used in this validation study. Results provide preliminary support for the use of SDI:SR ASL with deaf youth. Findings also indicate that deaf youth who take the SDI:SR ASL score more similarly to youth without disabilities taking the SDI:SR than youth with disabilities. The SDI:SR ASL can be an important tool for researchers and practitioners to better understand self-determination among deaf youth and facilitate continued development of self-determination skills.

Effects of Age-of-Acquisition on Proficiency in Polish Sign Language: Insights to the Critical Period Hypothesis

This study focuses on the relationship between the age of acquisition of Polish Sign Language (PJM) by deaf individuals and their receptive language skills at the phonological, morphological and syntactic levels. Sixty Deaf signers of PJM were recruited into three equal groups (n = 20): (1) a group exposed to PJM from birth from their deaf parents; (2) a group of childhood learners of PJM, who reported learning PJM between 4 and 8 years; (3) a group of adolescent learners of PJM, who reported learning PJM between 9 and 13 years. The PJM Perception and Comprehension Test was used to assess three aspects of language processing: phonological, morphological and syntactic. Participants were asked to decide whether a series of signs and sentences were acceptable in PJM. Results show that the age of PJM acquisition has a significant impact on performance on this task. The earlier deaf people acquire PJM, the more likely they were to distinguish signs and sentences considered permissible and impermissible in PJM by native signers. Native signers had significantly greater accuracy on the phonological, morphological, and syntactic items than either the Childhood or the Adolescent signers. Further, the Childhood signers had significantly greater accuracy than the Adolescent signers on all three parts of the test. Comparing performance on specific structures targeted within each part of the test revealed that multi-channel signs and negative suffixes posed the greatest challenge for Adolescent signers relative to the Native signers. The above results provide evidence from a less-commonly studied signed language that the age of onset of first language acquisition affects ultimate outcomes in language acquisition across all levels of grammatical structure. In addition, this research corroborates prior studies demonstrating that the critical period is independent of language modality. Contrary to a common public health assumption that early exposure to language is less vital to signed than to spoken language development, the results of this study demonstrate that early exposure to a signed language promotes sensitivity to phonological, morphological and syntactic patterns in language.

Language not auditory experience is related to parent-reported executive functioning in preschool-aged deaf and hard-of-hearing children

Much research has found disrupted executive functioning (EF) in deaf and hard‐of‐hearing (DHH) children; while some theories emphasize the role of auditory deprivation, others posit delayed language experience as the primary cause. This study investigated the role of language and auditory experience in parent‐reported EF for 123 preschool‐aged children (M_age = 60.1 months, 53.7% female, 84.6% White). Comparisons between DHH and typically hearing children exposed to language from birth (spoken or signed) showed no significant differences in EF despite drastic differences in auditory input. Linear models demonstrated that earlier language exposure predicted better EF (β = .061–.341), while earlier auditory exposure did not. Few participants exhibited clinically significant executive dysfunction. Results support theories positing that language, not auditory experience, scaffolds EF development.

Therapeutic living communities for adults who are deaf and have intellectual disabilities: A conceptual model linking social communication and mental health

As a consequence of long-lasting experiences of communicative and social deprivation and exclusion, adults who are deaf and have intellectual disabilities must be considered a high-risk group for the development of mental health problems. A therapeutic living community model with special emphasis on social communication development that has been implemented at three different sites in Austria is described. Through the development of the therapeutic living communities and subsequent observations, an approach is suggested to understand the mediating role of signed language and social communication skills in mental health outcomes for those with such mental health risk factors. The model requires further empirical verification.

Measuring Receptive ASL Skills in Novice Signers and Nonsigners

We tested the utility of two standardized measures of receptive skills in American Sign Language (ASL) in hearing adults who are novice signers: the ASL Comprehension Test (ASL-CT; Hauser, P. C., Paludneviciene, R., Riddle, W., Kurz, K. B., Emmorey, K., & Contreras, J. (2016). American Sign Language Comprehension Test: A tool for sign language researchers. Journal of Deaf Studies and Deaf Education, 21(1), 64-69. https://doi.org/10.1093/deafed/env051) and the ASL Receptive Skills Test (ASL-RST; Allen, T. E., & Enns, C. (2013). A psychometric study of the ASL Receptive Skills Test when administered to deaf 3-, 4-, and 5-year-old children. Sign Language Studies, 14(1), 58-79. https://doi.org/10.1353/sls.2015.0006; Enns, C. J., & Herman, R. C. (2011). Adapting the Assessing British Sign Language Development: Receptive Skills Test into American Sign Language. Journal of Deaf Studies and Deaf Education, 16(3), 362-374. https://doi.org/10.1093/deafed/enr004). We also administered these tests to hearing nonsigners, with the goal of identifying items where the correct answer can be readily deduced through iconicity and/or test-taking skills, even by people with no prior ASL knowledge. We predicted that removing such items would strengthen the correlation between test score and ASL experience (as measured by semesters of instruction). We found that this relationship was stronger for the ASL-CT than the ASL-RST in this population, but still weaker than previously reported, and not substantially improved by any item selection strategy that we employed.

Adverse Childhood Experiences

Adverse childhood experiences are found in adults regardless of race, socioeconomic level, or education. They can be identified in a clinical environment by answering a retrospective questionnaire . Adverse childhood experiences are clearly linked to high-risk health behaviors and multiple chronic diseases. Extensive knowledge exists about the severe impact of adverse childhood experiences in adults. Identification efforts have begun for children showing the prevalence and categories of abuse. National surveillance surveys capture prevalence data for children at the state level. The for Disease Control and Prevention has distributed prevention strategies to decrease the likelihood of adverse childhood experiences in children.

Cross-Sectional Analysis of Medical Conditions in the U.S. Deaf Transgender Community

Purpose: This first U.S.-based, descriptive study of transgender Deaf adults looks to contribute to the gap in research regarding those who lie at the intersection of Deaf and transgender identities. The study objective is to identify characteristics that associate with medical conditions, including depression and anxiety disorders, among Deaf transgender adults. Methods: We gathered self-reported data from 74 Deaf transgender adults who used American Sign Language. Modified Poisson regression with robust standard errors was used to calculate relative risk estimates of having a medical condition among nonbinary individuals compared with gender binary individuals. Results: The sample lifetime prevalence for medical conditions in the Deaf transgender sample were as follows: 48.6% for depression/anxiety disorders, 28.8% for hypertension, 20.3% for lung conditions, 16.2% for arthritis/rheumatism, 12.3% for diabetes, 7.0% for cirrhosis/liver/kidney problems, 5.5% for heart conditions, and 2.7% for cancer. In cross-tabulation analysis across binary and nonbinary subsamples, the lifetime prevalence was significantly different only for depression and anxiety disorder with higher percentage in the nonbinary subsample. After adjusting for covariates in a regression model, identification as nonbinary increased a Deaf person's risk for being diagnosed with depression or anxiety disorder by 80% (95% confidence interval, 1.11-2.90) relative to Deaf people who self-identified as a binary gender. Conclusion: Study findings suggest that the Deaf transgender community is at risk for developing mental and physical health conditions.

Impact of communication modality on caregiver ratings for deaf and hard of hearing children

PURPOSE

Literature on children who are deaf or hard of hearing (DHH) suggests overall increased rates of difficulties in emotional/behavioral and adaptive functioning. However, limitations of this literature include the failure to integrate issues unique to the experience of children who are DHH, such as home and school communication modalities and the consistency of modalities across settings.

METHOD

This study examined de-identified data from a clinical database. Data included caregiver ratings of emotional/behavioral and adaptive functioning in a diverse sample of clinically referred children who are DHH (N = 177). Caregivers also reported home and school communication modalities (e.g., match, partial match, different modalities). We examined mean score differences between our sample and normative samples and compared functioning across subgroups of children with various home-school communication modality combinations.

RESULTS

Consistent with the literature, we found overall increased rates of emotional/behavioral and adaptive functioning concerns on parent rating scales. Emotional/behavioral concerns did not differ among children with spoken language match, sign language match, or partial match communication modalities combinations. Within adaptive functioning, communication and functional academics were significantly lower among children with partial match home-school communication modalities. Adaptive functioning did not differ between spoken language match and sign language match groups.

CONCLUSIONS

Our findings suggest possible benefits to adaptive functioning among children who are DHH when home and school communication modalities match, regardless of which modality is used.

Global Regulatory Review Needed for Cochlear Implants: A Call for FDA Leadership

INTRODUCTION

Using the United States Food and Drug Administration (FDA) as example, we argue that regulatory agencies worldwide should review their guidance on cochlear implants (CIs).

METHODS

This is a position paper, thus the methods are strictly argumentation. Here we give the motivation for our recommendation. The FDA's original approval of implantation in prelingually deaf children was granted without full benefit of information on language acquisition, on childcaregiver communication, and on the lived experience of being deaf. The CI clinical trials, accordingly, did not address risks of linguistic deprivation, especially when the caregiver's communication is not fully accessible to the prelingually deaf child. Wide variability in the effectiveness of CIs since initial and updated approval has been indicated but has not led to new guidance. Children need to be exposed frequently and regularly to accessible natural language while their brains are still plastic enough to become fluent in any language. For the youngest infants, who are not yet producing anything that could be called language although they might be producing salient social signals (Goldstein et al. Child Dev 80:636-644, 2009), good comprehension of communication from caregiver to infant is critical to the development of language. Sign languages are accessible natural languages that, because they are visual, allow full immersion for deaf infants, and they supply the necessary support for this comprehension. The main language contributor to health outcomes is this combination of natural visual language and comprehension in communication. Accordingly, in order to prevent possible language deprivation, all prelingually deaf children should be exposed to both sign and spoken languages when their auditory status is detected, with sign language being critical during infancy and early childhood. Additionally, all caregivers should be given support to learn a sign language if it is new to them so that they can comprehend their deaf children's language expressions fully. However, both languages should be made accessible in their own right, not combined in a simultaneous or total communication approach since speaking one language and signing the other at the same time is problematic.

RESULTS

Again, because this is a position paper, our results are our recommendations. We call for the FDA (and similar agencies in other countries) to review its approval of cochlear implantation in prelingually deaf children who are within the sensitive period for language acquisition. In the meantime, the FDA should require manufacturers to add a highlighted warning to the effect that results with CI vary widely and CIs should not be relied upon to provide adequate auditory input for complete language development in all deaf children. Recent best information on users' experience with CIs (including abandonment) should be clearly provided so that informed decisions can be made. The FDA should require manufacturers' guidance and information materials to include encouragement to parents of deaf children to offer auditory input of a spoken language and visual input of a sign language and to have their child followed closely from birth by developmental specialists in language and cognition. In this way parents can align with providers to prioritize cognitive development and language access in both audio-vocal and visuo-gestural modalities.

DISCUSSION

The arguments and recommendations in this paper are discussed at length as they come up.