Factors that influence stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants

OBJECTIVE

Stress levels among caregivers of children with hearing loss could influence caregiver-child interactions and ultimately, children's developmental outcomes. Given the limited understanding of stress levels among caregivers of Australian children with hearing loss, the present study aimed to examine stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants and to identify factors associated with greater stress levels.

METHODS

A total of 99 caregivers of 70 hearing aid users and 29 cochlear implant users participated in the study. Caregivers' stress was measured using the 68-item Pediatric Hearing Impairment Caregiver Experience (PHICE) questionnaire that examines caregivers' context-specific stress levels in relation to caring for a child with hearing loss. Factors contributing to stress were identified in relation to eight domains including communication, education, emotional well-being, equipment, financial, healthcare, social, and support.

RESULTS

Across domains, the three most common predictors of increased stress were the use of cochlear implants over hearing aids, use of sign and oral language (mixed) over oral language as the communication mode at home, and increased behavioural difficulties of the child.

CONCLUSION

Overall, reported stress levels among Australian caregivers were low. Identified factors influencing stress levels can inform service provision improvement.

Paediatric Cochlear Implantation Outcomes: Parental Expectations and Experiences

To study parental pre-implant expectations and post-implant experiences of their children's cochlear implant outcomes. Parents of 27 children with cochlear implant participated in the survey. Study investigated and compared the pre-implant expectations and experiences of post-implant outcomes using ICF based questionnaire on items related to domains listening, communication, learning and applying knowledge, interpersonal interactions and relationships and environmental factors. Parental expectations of their children's cochlear implant outcomes were high and largely been met. Benefits with cochlear implant surpassed the expectations in the domains of listening and environmental factors. Positive high correlation was observed between all domains related to expectations. All domains related to experiences of CI outcomes except listening showed positive and significant correlation with each other. No correlation was observed between child variables; current age, age at implantation and implant age and any of the domains. With regards to expectations, fathers held significantly high expectations when compared to mothers. Parents demonstrate high pre-implant expectations and positive experiences post cochlear implantation across range of outcomes.

Mothers' emotional experiences related to their child's diagnosis of deafness and cochlear implant surgery: Parenting stress and child's language development

OBJECTIVES

The present study aims to assess the emotional experiences, specifically parenting stress, of mothers of children with cochlear implants (CIs), and their children's language development before surgery and at three and six months after CI activation.

METHODS

Twenty mothers of children with CIs were interviewed before their children's surgery about their experiences in connection with the diagnosis of deafness, the surgery and the activation of the CI. The Parenting Stress Index questionnaire and the MacArthur-Bates-Communication Development Inventory were administered before the surgery and at 3 and 6 months after the CI activation.

RESULTS

Analysis of the qualitative data resulting from the interviews showed that the mothers' emotional experiences before the CI surgery were complex. Mothers reported both positive and negative emotions related to deafness, diagnosis and surgery, benefits of the CI, coping strategies and future expectations. The mothers of children with more advanced lexical production six months after CI activation displayed a high frequency of themes related to positive emotions, thoughts and coping strategies before the surgery. Distress on the part of the mothers, perceptions of difficulties in their child and instances of parent-child dysfunctional interaction were negatively and significantly related to the child's language and communication development.

CONCLUSIONS

The findings support the importance of assessing the mother's emotional experience in relation to diagnosis and CI activation before the surgery. IMPLICATIONS FOR CLINICAL PRACTICE ARE DISCUSSED: specifically, the importance of the support offered to the parents, aimed at enhancing both their awareness of their expectations about their child's rehabilitation process and their self-efficacy in supporting the child's adaptation to the use of the CI.

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

Phenomenological needs assessment of parents of children with cochlear implants

Background

The use of cochlear implants has been a remarkable success in reducing disabilities in those with impaired hearing, which have made a significant change in the patients’ quality of life. Only by relying on cochlear implants, disabilities cannot be eliminated in the hearing impaired, and, alongside this intervention, rehabilitation practices such as through family and community support are necessary.

Aim

To explain the needs of parents of children with cochlear implants to increase the quality of rehabilitation services and family-based interventions.

Methods

A descriptive phenomenology study was performed with the participation of 16 people, including eight mothers, three fathers, and five experts involved with the rehabilitation of children aged 2–7 years with cochlear implants. The research setting was centers with speech therapy service providers for hearing-impaired children in the city of Shiraz (Iran) in 2015. Information was gathered through in-depth interviews with participants and analyzed by using Colaizzi’s nine-step analysis method and MAXQDA (Ver10) applications.

Results

The mean age of participants was 34 years, and the average age of diagnosis of hearing problems in children was 12 months. The obtained data from the analysis of interviews about the needs of parents of children with cochlear implants were categorized into 19 sub-contents and five contents, as follows: the need for access to health care services; psychological needs; mood-related needs of a child; educational needs and financial requirements.

Conclusion

Parents of children with cochlear implants have numerous needs, and they encounter problems based on their situation and experiences. The results indicate the necessity of close cooperation among different professionals such as an audiologist, pediatrician, psychologist, and speech therapist for the program’s success.

Perceptions of the support that mothers and fathers of children with cochlear implants receive in South Australia: A qualitative study

OBJECTIVE

The study explored the perceptions of parents of children with cochlear implants regarding the support they have received.

DESIGN

Semi-structured interviews were conducted and the resultant data was subjected to thematic analysis.

STUDY SAMPLE

Participants were 12 mothers and four fathers from South Australia with a child with cochlear implants.

RESULTS

Three major themes emerged: (1) a journey into a new world for parents, (2) services meet many but not all needs, and (3) parent connections and relationships. Most parents were satisfied with surgical, audiology, and early intervention services as well as specialist hearing-impairment schools, and perceived this support as helpful and adequate. However, some parents were critical of non-specialized teaching staff, and technical support for hearing devices. Parent recommendations for improved service provision included increased support, improved information, and additional professional services.

CONCLUSIONS

Parent contributions suggest a need for service providers to develop support that is not only child-need oriented, but parent-need oriented, to better address service gaps. With a deeper understanding of parents' experiences and needs, service providers will have a greater capacity to develop a broader model of service that enhances parental engagement and coping.

Parents' narratives on cochlear implantation: reconstructing the experience of having a child with cochlear implant

This paper discusses parents' narratives on cochlear implantation in Bogotá, Colombia using a qualitative approach. The main research objective was to identify how parents perceived the processes of diagnosis of their child's hearing loss, making the decision for cochlear implantation and the post-surgery period. All participants were hearing couples (n = 13) with similar socio-cultural backgrounds whose children had undergone cochlear implant surgery. Results show why cochlear implants are a very highly valued technological device with great symbolic power for parents. The study also deals with how perceptions about oral/sign language and disability, as well as social expectations for their children's lifetime opportunities, determine how the parents themselves have experienced their journey through the process of their children's cochlear implantation.

Psychological aspects when counseling families who have children with cochlear implants

The report begins with the latest debate on Cochlear Implants (CI) - the role they play during the development of a deaf child, analyzing the psychological aspects which characterize the experiences of families of children who do get implanted, starting from the detection of deafness until after implantation. The aim is to demonstrate how in these experiences and during all developmental phases the significant role the psychologist plays and how important timely intervention of specific programs is for both child and parents. Numerous studies have demonstrated that CI offers advantages in terms of recuperating capacity to hear and the development of spoken language. Recent studies focusing on psychological aspects have shifted the attention to the positive results of CI in comparison to the social environment in addition to family traits such as the parental reaction to the diagnosis of their child's deafness, mental coping strategies and the subsequent behaviors they adopt. In 90% of these cases, the parents are hearing and often have no experience in regards to deafness, and this is why when they find out that their child is deaf, their reaction is similar to that of bereavement. Consequently, prior to implantation it is necessary that a psychologist makes an accurate assessment in order to be able to intervene in situations where there is parental stress and help them cope by implementing a copying paradigm. The reaction to child deafness and the strategies of copying that they have acquired influence the family's expectations in respects to the CI, and in turn this influences the outcome after implantation. During the assessment, an important aspect for the psychologist is evaluating the motivation towards the rehabilitative program and the strong interaction between the parents and the child - both of these elements are closely connected to a positive outcome of the CI. During the post implant period, recent studies have shown an improvement of parental behavior as well as the development of the child in the domains of shared attention, problem solving, symbolic play and social functioning. In addition, during this stage the relationships between parents and children are more effective, and all parental figures are positively motivated towards appropriate behaviors. Hence the effects of CI are no longer limited to the implanted child, but now entail the entire family. In fact, the parents judge the quality of their lives on the basis of how successful they perceive the results obtained by having their child undergo a CI. Consequently, they regulate their behavior and attitudes influencing the child's development. Parents themselves maintain that specialized psychological support is fundamental during all stages connected to CI and more generally to the overall development of their child.

Children with cochlear implants: the communication journey

Cochlear implantation is now a well-established procedure for profoundly deaf children providing access to speech through hearing for many of them. Much attention has focused on which communication mode to adopt with this group of children but very little work has looked at the choices that parents make before and after cochlear implantation. This study, following on from two earlier studies, looked in depth at the experiences of 12 families. It finds that parents choose the most effective way of communicating with their child but retain as their goal, the development of oral communication skills. For many this is a journey in which different approaches are utilised at various stages in the child's development.