Assessing and Understanding Mental Health and Quality of Life in Deaf and Hard-of-Hearing Children and Adolescents

Mental health problems are more prevalent in deaf and hard-of-hearing - (D)HH - children and adolescents. Using written measures to assess mental health problems in (D)HH children and adolescents has been found to underestimate symptoms and prevalence. Misdiagnosis is also more common among (D)HH children and adolescents due to an overlap of cultural, linguistic and clinical factors. Therefore, validated measures in sign language are needed. Controversies still exist regarding Quality of Life (QoL) in (D)HH children and adolescents compared to typically hearing (TH) children and adolescents. Good communication skills in spoken and sign language are associated with better mental health in (D)HH children and adolescents. Technological advances, recognition of sign languages as natural languages, universal neonatal hearing screening and early intervention programs have been introduced, affecting language outcomes. These changes are also likely to have impacted mental health and QoL outcomes. To improve assessment and interventions for (D)HH children and adolescents, this thesis aimed to translate reliable and valid questionnaires for mental health and QoL into Norwegian Sign Language (NSL) and validate these. The second aim of the study was to gain a better understanding of signing DHH and hard-of-hearing (HH) children and adolescents’ mental health, QoL and communication as well as associations between these aspects. To do so, the Strengths and Difficulties Questionnaire (SDQ) and the Inventory of Life Quality in Children and Adolescents (ILC) were translated into NSL. Then, 107 (D)HH children and adolescents, 60 DHH and 47 HH, and their parents completed the self- and parent-reports of the SDQ and ILC. DHH children and adolescents completed both the written and NSL versions in randomised order, while the HH children and adolescents completed the written versions only. Parents also provided information about their children’s spoken and sign language skills, communicative competence, hearing loss (HL), and school. Data were collected between 2016 and 2018. The SDQ-NSL and the ILC-NSL showed acceptable reliability and construct validity. Their psychometric properties were also found to be similar to the original validations. The lack of associations between the two language versions of the child ILC, however, requires further attention. The prevalence of self-reported mental health problems in the clinical range was about twice as high for DHH and HH children as their TH peers. The SDQ-NSL seemed to differentiate better between mental health problems in the normal, borderline and clinical range for DHH children and adolescents than the SDQ-NOR. Self-reported QoL of (D)HH children and adolescents, on the other hand, was found to be similar to that of TH children and adolescents. Associations between communicative competence and parent-reported mental health and QoL were significant, whereas severity of hearing loss (HL) was not associated with either QoL or mental health. In conclusion, the SDQ-NSL and ILC-NSL are reliable and valid measures to assess mental health and QoL in signing DHH children and adolescents. The elevated prevalence of mental health problems in (D)HH children and adolescents emphasises the importance of early detection of HL, early intervention and regular monitoring of socio-emotional, cognitive and language development, mental health and QoL. The risk of misdiagnosis combined with the elevated prevalence also confirms the need for robust and accessible specialised CAMHS for (D)HH children and adolescents. Furthermore, validated measures for assessment of pragmatic skills and social communication in NSL are needed to improve assessment of co-morbid language disorders and future research

Validation of the Strengths and Difficulties Self-Report in Norwegian Sign Language

The majority of studies on mental health in deaf and hard-of-hearing (DHH) children report a higher level of mental health problems. Inconsistencies in reports of prevalence of mental health problems have been found to be related to a number of factors such as language skills, cognitive ability, heterogeneous samples as well as validity problems caused by using written measures designed for typically hearing children. This study evaluates the psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) in Norwegian Sign Language (NSL; SDQ-NSL) and in written Norwegian (SDQ-NOR). Forty-nine DHH children completed the SDQ-NSL as well as the SDQ-NOR in randomized order and their parents completed the parent version of the SDQ-NOR and a questionnaire on hearing and language-related information. Internal consistency was examined using Dillon-Goldstein's rho, test-retest reliability using intraclass correlations, construct validity by confirmatory factor analysis (CFA), and partial least squares structural equation modeling. Internal consistency and test-retest reliability were established as acceptable to good. CFA resulted in a best fit for the proposed five-factor model for both versions, although not all fit indices reached acceptable levels. The reliability and validity of the SDQ-NSL seem promising even though the validation was based on a small sample size

Quality of Life, family function and mental health of deaf and hard-of-hearing adolescents in mental health services in Norway - a pilot study

Object: The main aim of this study was to gain a better understanding of Quality of Life, family functioning and mental health for Norwegian deaf and hard-of-hearing children and adolescents. Method: We used the Inventory of Life Quality for Children (ILC), McMaster Family Assessment Device (GFS) and the Strengths and Difficulties Questionnaire (SDQ). These instruments were used to assess Quality of Life, family functioning, emotional and behavioural problems in deaf and hard-of-hearing (n= 20) and hearing Child and Adolescent Psychiatry (CAP) patients (n = 717) as well as in a hearing normative sample (n= 1032). Results: We found that Quality of Life and family functioning of deaf and hard-of-hearing (DHH) CAP patients were comparable to those of their hearing CAP peers. DHH CAP patients showed a non-significant tendency to report more emotional and behavioural difficulties than hearing CAP patients. Conclusion: Based on these results, Norwegian deaf and hard-of-hearing CAP patients score similarly to their hearing peers in CAP on measures of Quality of Life and family function, whereas there may be a tendency for DHH CAP patients to report more emotional and behavioural problems than hearing CAP patients. Due to the very small sample size more research is needed on the subject.publishedVersion©This is an Open Access Article which permits unrestricted noncommercial use, provided the original work is properly cited

Quality of Life, family function and mental health of deaf and hard-of-hearing adolescents in mental health services in Norway - a pilot study

Object: The main aim of this study was to gain a better understanding of Quality of Life, family functioning and mental health for Norwegian deaf and hard-of-hearing children and adolescents. Method: We used the Inventory of Life Quality for Children (ILC), McMaster Family Assessment Device (GFS) and the Strengths and Difficulties Questionnaire (SDQ). These instruments were used to assess Quality of Life, family functioning, emotional and behavioural problems in deaf and hard-of-hearing (n= 20) and hearing Child and Adolescent Psychiatry (CAP) patients (n = 717) as well as in a hearing normative sample (n= 1032). Results: We found that Quality of Life and family functioning of deaf and hard-of-hearing (DHH) CAP patients were comparable to those of their hearing CAP peers. DHH CAP patients showed a non-significant tendency to report more emotional and behavioural difficulties than hearing CAP patients. Conclusion: Based on these results, Norwegian deaf and hard-of-hearing CAP patients score similarly to their hearing peers in CAP on measures of Quality of Life and family function, whereas there may be a tendency for DHH CAP patients to report more emotional and behavioural problems than hearing CAP patients. Due to the very small sample size more research is needed on the subject

Psychometric properties of the Inventory of Life Quality in children and adolescents in Norwegian Sign Language

Background: Several studies have assessed the Quality of Life (QoL) in Deaf and hard-of-hearing (DHH) children and adolescents. The findings from these studies, however, vary from DHH children reporting lower QoL than their typically hearing (TH) peers to similar QoL and even higher QoL. These differences have been attributed to contextual and individual factors such as degree of access to communication, the participants’ age as well as measurement error. Using written instead of sign language measures has been shown to underestimate mental health symptoms in DHH children and adolescents. It is expected that translating generic QoL measures into sign language will help gain more accurate reports from DHH children and adolescents, thus eliminating one of the sources for the observed differences in research conclusions. Hence, the aim of the current study is to translate the Inventory of Life Quality in Children and Adolescents into Norwegian Sign Language (ILC-NSL) and to evaluate the psychometric properties of the self-report of the ILC-NSL and the written Norwegian version (ILC-NOR) for DHH children and adolescents. The parent report was included for comparison. Associations between child self-report and parent-report are also provided. Methods: Fifty-six DHH children completed the ILC-NSL and ILC-NOR in randomized order while their parents completed the parent-report of the ILC-NOR and a questionnaire on hearing- and language-related information. Internal consistency was examined using Dillon-Goldstein’s rho and Cronbach’s alpha, ILC-NSL and ILC-NOR were compared using intraclass correlation coefficients. Construct validity was examined by partial least squares structural equation modeling (PLS-SEM). Results: Regarding reliability, the internal consistency was established as acceptable to good, whereas the comparison of the ILC-NSL with the ILC-NOR demonstrated closer correspondence for the adolescent version of the ILC than for the child version. The construct validity, as evaluated by PLS-SEM, resulted in an acceptable fit for the proposed one-factor model for both language versions for adolescents as well as the complete sample. Conclusion: The reliability and validity of the ILC-NSL seem promising, especially for the adolescent version, even though the validation was based on a small sample of DHH children and adolescents

Psychometric properties of the Inventory of Life Quality in children and adolescents in Norwegian Sign Language

Background Several studies have assessed the Quality of Life (QoL) in Deaf and hard-of-hearing (DHH) children and adolescents. The findings from these studies, however, vary from DHH children reporting lower QoL than their typically hearing (TH) peers to similar QoL and even higher QoL. These differences have been attributed to contextual and individual factors such as degree of access to communication, the participants’ age as well as measurement error. Using written instead of sign language measures has been shown to underestimate mental health symptoms in DHH children and adolescents. It is expected that translating generic QoL measures into sign language will help gain more accurate reports from DHH children and adolescents, thus eliminating one of the sources for the observed differences in research conclusions. Hence, the aim of the current study is to translate the Inventory of Life Quality in Children and Adolescents into Norwegian Sign Language (ILC-NSL) and to evaluate the psychometric properties of the self-report of the ILC-NSL and the written Norwegian version (ILC-NOR) for DHH children and adolescents. The parent report was included for comparison. Associations between child self-report and parent-report are also provided. Methods Fifty-six DHH children completed the ILC-NSL and ILC-NOR in randomized order while their parents completed the parent-report of the ILC-NOR and a questionnaire on hearing- and language-related information. Internal consistency was examined using Dillon-Goldstein’s rho and Cronbach’s alpha, ILC-NSL and ILC-NOR were compared using intraclass correlation coefficients. Construct validity was examined by partial least squares structural equation modeling (PLS-SEM). Results Regarding reliability, the internal consistency was established as acceptable to good, whereas the comparison of the ILC-NSL with the ILC-NOR demonstrated closer correspondence for the adolescent version of the ILC than for the child version. The construct validity, as evaluated by PLS-SEM, resulted in an acceptable fit for the proposed one-factor model for both language versions for adolescents as well as the complete sample. Conclusion The reliability and validity of the ILC-NSL seem promising, especially for the adolescent version, even though the validation was based on a small sample of DHH children and adolescents

Deaf and hard-of-hearing children and adolescents’ mental health, Quality of Life and communication

Abstract Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing – (D)HH – children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication

Measuring childhood maltreatment: Psychometric properties of the Norwegian version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale

Purpose Adverse childhood experiences in sensitive periods of the developing brain render the individual at a life-long risk for a broad spectrum of aberrant health outcomes. However, there is a lack of scales for the comprehensive assessment of adverse childhood experiences providing information of various types and the age of occurrence. Based on the complete, experimental version of the Maltreatment and abuse chronology of exposure (MACE-X) scale, the present study aimed to develop and psychometrically test a Norwegian version of MACE. Methods The 75-item MACE-X was translated from German to Norwegian and administered as a self-report measure to 90 outpatients and 145 employees at a Division of specialized mental health care in South-Eastern Norway. The outpatients also completed the Childhood trauma questionnaire (CTQ) and the Symptom checklist 90 (SCL-90) to investigate convergent and predictive validity. To investigate test-retest reliability, outpatients completed MACE once more two weeks later. Results Rasch analysis and Anderson likelihood ratio tests on the combined outpatient and employee data resulted in a 55 item version of the Norwegian MACE. In the outpatient group, test-retest reliability of the MACE-55 was excellent for total scores (ICC ≥ 0.94) and good to excellent for 10 subscale scores (ICC ≥ 0.82). Convergent validity with the CTQ was moderate to high for both total scores (0.63 ≥ r ≥ 0.86) and subscale scores (0.56 ≥ r ≥ 0.82). As compared to CTQ total scores, a MACE total score that combined severity and duration of exposure was numerically more strongly associated with overall psychiatric symptoms and each of nine symptom domains on the SCL-90. Conclusions The newly developed Norwegian MACE comprehensively assesses past exposure to adverse childhood experiences with high psychometric properties. This scale is a useful tool for research questions addressing sensitive periods for childhood adversities and associated health phenotypes

Measuring childhood maltreatment: Psychometric properties of the Norwegian version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale.

PURPOSE:Adverse childhood experiences in sensitive periods of the developing brain render the individual at a life-long risk for a broad spectrum of aberrant health outcomes. However, there is a lack of scales for the comprehensive assessment of adverse childhood experiences providing information of various types and the age of occurrence. Based on the complete, experimental version of the Maltreatment and abuse chronology of exposure (MACE-X) scale, the present study aimed to develop and psychometrically test a Norwegian version of MACE. METHODS:The 75-item MACE-X was translated from German to Norwegian and administered as a self-report measure to 90 outpatients and 145 employees at a Division of specialized mental health care in South-Eastern Norway. The outpatients also completed the Childhood trauma questionnaire (CTQ) and the Symptom checklist 90 (SCL-90) to investigate convergent and predictive validity. To investigate test-retest reliability, outpatients completed MACE once more two weeks later. RESULTS:Rasch analysis and Anderson likelihood ratio tests on the combined outpatient and employee data resulted in a 55 item version of the Norwegian MACE. In the outpatient group, test-retest reliability of the MACE-55 was excellent for total scores (ICC ≥ 0.94) and good to excellent for 10 subscale scores (ICC ≥ 0.82). Convergent validity with the CTQ was moderate to high for both total scores (0.63 ≥ r ≥ 0.86) and subscale scores (0.56 ≥ r ≥ 0.82). As compared to CTQ total scores, a MACE total score that combined severity and duration of exposure was numerically more strongly associated with overall psychiatric symptoms and each of nine symptom domains on the SCL-90. CONCLUSIONS:The newly developed Norwegian MACE comprehensively assesses past exposure to adverse childhood experiences with high psychometric properties. This scale is a useful tool for research questions addressing sensitive periods for childhood adversities and associated health phenotypes