The Authors propose a multifactorial pattern for the understanding of the psychological development of the child with impaired hearing. 
According to this pattern the psychological development is determined by a variety of factors that can be regrouped intothree categories:
• family features
• aspects concerning the rehabilitation and the acoustic prosthesis
• social and socio-environmental factors.
In order to apply an effective action it is necessary to consider the interaction of the different factors and to adapt the therapeutic plan to that particular situation

MAGGIO M

MAGGIO O.

MARTINES, Francesco

MUCIA M

Archivio istituzionale della ricerca - Università di Palermo

SUMMARYThe Authors propose a multifactorial pattern for theunderstanding of the psychological development of the childwith impaired hearing. According to this pattern the psychological developmentis determined by a variety of factors that can be regrouped intothree categories:• family features• aspects concerning the rehabilitation and the acousticprosthesis• social and socio-environmental factors.In order to apply an effective action it is necessary toconsider the interaction of the different factors and to adapt thetherapeutic plan to that particular situation.Key words:Child deafness, psychological developmentRIASSUNTOGli Autori propongono un modello multifattoriale per lacomprensione dello sviluppo psicologico del bambino con defi-cit uditivo. Secondo tale modello lo sviluppo psicologico è determi-nato da una molteplicità di fattori, raggruppabili in tre categorie:• caratteristiche familiari• aspetti riabilitativi e protesici• fattori sociali e socio-ambientali.Per un intervento riabilitativo efficace occorr valutarel’interazione fra i vari fattori e adattare il progetto terapeuticoa quella particolare situazione.Parole chiave:Sordità infantile, sviluppo psicologicoActa Pediatrica Mediterranea, 2006, 22: 41AMULTIFACTORIAL PATTERN FOR THE UNDERSTANDING OF THE PSYCHOLOGICALDEVE-LOPMENTOF THE CHILD WITH IMPAIRED HEARING AND ITS CLINICAL-THERAPEUTIC IMPLI-CATIONSMARIA MAGGIO - FRANCESCOMARTINES- MARIANNA MUCIA - ORESTEMAGGIOUniversity of Palermo- Department of Medical Biotechnologies and Forensic Medicine- Audiology Section (Head: Prof. E. Martines)[Un modello multifattoriale per la comprensione dello sviluppo psicologico del bambino con deficit uditivo e sue implicazioni clinico-terapeutiche]IntroductionIn the past, many people thought that deafnesswas one of the causes for cognitive developmentretard (Pintner and Patterson, 1917)( 1 ) and for psy-chological-emotional problems (Brunschwig,1936)(2).The individual with a serious impaired hearingwas, in this way, stigmatised and described as“dependent” “suspicious”, “aggressive”.To d a y, luckily, many stereotypes have beendropped also thanks to a fitter use and evaluation ofthe intelligence tests and to deeper studies about thepersonality of deaf subjects.In this way it was possible to carry out theshift from an epistemological pattern of linearcasualness, according to which there is a direct rela-tion cause-effect between deafness and psycho-pathology, to a pattern of complexity that takes intoconsideration deafness as one of the possible riskfactors for the outbreak of psychopathologies.This statement involves important consequen-ces ot only on the social plan (common belief), butalso on the clinic-therapeutic plan.In fact, since the child’s behaviour is the lastexpression and manifestation of the interactionmong several factors and of the peculiar and origi-nal way with whom a subject reacts to them, it isn’tpossible to think about a“ pre constituted pattern ofa deaf child”.C o n s e q u e n t l y, he medical specialists, theexperts in the schools and in the rehabilitation the-rapy that want to plan effective educational and the-rap utic activities must take into consideration thevariety of the factors influencing the behaviour and“ hinking” in an attitude of col-operation amongthem and with the family of the impaired child. DiscussionIn case of unfavourable simultaneous situa-tions for the normal psycho-emotional develop-ment, it is possible that deaf children may developtypical features of maladjustment personality. Inp a r t i c u l a r, it is possible to distinguish three maintypologies of personality (Bacchini and Va l e r i o ,2000)(3):• An obsessive kind of personality, that ismainly visible in the subject attitude controlling thesurrounding environment in a constant and carefulway.• An impulsive kind of personality (Va c ca r iand Marschark, 1977)( 4 ) in order to face and com-pensate the poor capacity of inner observation.• Adepressive kind of personality, caused bythe state of social isolation in which the deaf childcan be.Let’s consider the multifactorial pattern propo-sed by the Authors in a detailed way, to betterunderstand the child’s behaviour. Bronfenbrenner (1988)(5) refers to the psycho-logical development of an individual as a processthat takes place in the mind and that, since it can’tbe observed directly, is inferred from the typicaland personal way through which each person liveshis or her own experiences subjectively and getsinvolved in the surrounding world. In this wayevery subject contributes to his/her own develop-ment.On the other side, even the environment direc-tly influences the personal developing process boththrough the features of the immediate contextwhere the subject is placed (family) and throughmore distal contextual features (for instance thegroup of peers and the school context) that mayamplify or reduce the effects of the immediate con-text.In order to give a full explanation, let’s consi-der three main factorial categories that influence thechild’s individual mental processes:a) family relational features;b) aspects regarding the rehabilitation and theacoustic prosthesis;c) social and socio-environmental factors.A) Family relational featuresRubin, et al., (1990)( 6 ) take into considerationthree variables that may influence the family andthe relational environment:u the social-economic conditions in which thefamily lives;u the personal and social conditions, that isthe psychological maturity and the parents’h e a l t hcondition, the family union and the social supportprovided to the family;u the belief becomes mature to their child.The last aspect is particularly important for thedevelopment of the impaired child that, even morethan his ordinary classmates, needs answers abouthis/her own competences and limits from his/herparents.Therefore, the advice given by the experts tothe parents about the possibilities and the limits oftheir impaired child becomes a strongly therapeuticintervention, able to modify the more or less wrongbeliefs and, consequently, the expectations ofparents and the image that the child has of himself,indirectly from the way the parents consider him.Also the child’s temperamental features areinv lved in determining the quality of the relation-ship parents-child (Belsky, 1984)( 7 ), as they canmake it easier or, on the contrary, more difficult theeducational task of the parents.A “ d i ficult” child, aggressive, avoiding, is abit gratifying for the parents who, in the course oftime, acquire a less careful and less welcoming atti-tude towards their child. In this way they structurean unsatisfactory relation between parents and childith some consequences for the child’s develop-ment.The family’s relational style is also  influencedby the way with which the parents react to thesituation of their impaired child. The elaborationprocess of the diagnosis and of the acceptance ofthe problem is often long and complex and it needsmutual emotional support and adaptability byparents.Meadow (1968)(8), in particular, identifies threedistinguished phases in the elaboration process ofthe diagnosis about the deafness of a child:• phases of the diagnostic funnel, characteri-zed by the research from the parents about the datathat can avert the feared diagnosis;• phases of the diagnostic trauma that beginswhen doctors confirm the diagnosis of deafness;• phases of the therapeutic alliance that allowsthe parents to get actively involved in the therapy oftheir child and to co-operate with the experts.Not always,but the family is able to react tothe diagnostic trauma with a balanced and activeco-operative attitude with the experts (Maggio M.e  al., 1995)(9).42 M. Maggio - F Martines et AlIn fact they can show attitudes of refusal withconsequent inability to respond to their child’sneeds in an adequate way and running the risk todetermine and encourage the rising of damages inthe in the child, in the psychological, cognitive andsocial development (Sacks, 1993)( 1 0 ), or hyperpro-tective attitudes or, still, hypo affective or ambiva-lent behaviours. The last ones,particularly damagethe child’s self-esteem seriously because, in thisway, he doesn’t feel worthy of his parents’love.The audiologist, in col-operation with thespeech therapist, and if possible, with other expertson impaired children rehabilitation, must think alltogether about the family relational features inorder to plan appropriate and fit activities for a par-ticular child living in a given family.In this way it will be possible to involve theparents in the therapeutic project actively and makethem aware of the program to carry out, avoiding,in this way, interventions that often reveal to beineffective because not shared by the family. B) Aspects regarding the rehabilitation andthe acoustic prosthesisThe diagnostic and acoustic prosthesis preco-city (Maggio O. et al., 1986)( 11 ), together with thestrictly clinical data such as the age of the outbreakof the disease and its seriousness, are important ele-ments that can amplify the effectiveness of therehabilitative interventions.In fact, an immediate intervention can reducethe negative influence of impaired child’s develop-ment significantly (Hasenstab et al., 1978)(12) and itis likewise indicative of an adequate and immediatereaction from the parents.The speech therapist takes over a basic role forthe psychological and relational growth of theimpaired subject with whom he establishes anintense and long affective cooperation term.First of all he has the task to motivate the childto the listening and to the communication, notwith-standing the impaired hearing situation and the dif-ficulties that come from this. By offering apt instru-ments for the communication, he allows the child toestablish satisfactory relations with children of thesame age, avoiding, in this way, the isolation andthe sense of inadequacy that derive from it.It is likewise important that the parents areinvolved by the speech therapist in the therapeuticproject, in order to let them know their child’spotentialities as well as to stimulate the psychologi-cal, the affective-relational growth and the lingui-stic competence in an aware and suitable way.Our experience of work with impaired chil-dren has given us the possibility to confirm thisconcept, in fact, whereas the speech therapist hastaken into consideration the aff e c t i v e - r e l a t i o n a ldimension of the patient and has established a trust-ful relation as well as the sharing and the exchangewith the parents and other experts involved in therehabilitation, the therapeutic process has been car-ried out with more serenity and has given profitableoutcomes.C) Social and socio-environmental factorsThe contact with people not belonging to thef mily unit has a positive influence on the psycho-logical and relational development of the child. Asi  offers cognitive and social stimuli, it promotesi ferent activities from those already known, itintroduces the child in environments rich of newphysical stimuli and exposes him to interactive,behavioural and linguistic modalities different fromthose he has experienced at home (Bandura,1969)(13).Moreover, through the social contact, the childd velops the capability of the mutual exchange, afundamental condition in human relationships. Inthe case of an impaired child, in addition to whathas already been said, the possibility to stay withther people, above all with children of the sameage, stimulates the linguistic learning and the capa-bility to assume and to structure the informationcoming from the external world (Bacchini andValerio, 2000) (Trozzi et al., 2000) (Carmuco et al.,2002)(3)(14)(15).Having the possibility to spend part of the freetime together with friends and ordinary schoolma-tes is a chance to be on an equal footing, withoutthe mediation of adults,that are always too busy inavoiding any difficult or frustrating situations tohim, preventing him, in this way, from experiencinghis own potentialities.Obviously, and this is one of the project goalsregarding the school integration, it’s necessary toprepare the impaired child to the integration, bygiving him the suitable instruments of communica-tion and reading and comprehension of the messa-ges coming from outside, in order to avoid the riskof isolation or refusal from his schoolmates.We have to consider another aspect thatregards the socio-environmental factors, that is thequality and the variety of the territorial services, thesocio-economic and family status and the socialAmultifactorial pattern for the understanding... 43representation of deafness that the environmentgives back to the family.ConclusionsAccording to the pattern of the complexity, theindividual is considered in his dynamic and mutualinteraction with the surrounding environment andwith the changes described so far. The development is a process that involves thec o g n i t i v e - a ffective and biological factors of theindividual and the proximal and distal factors of theenvironment where they belong in a constant andreciprocal interaction. Such interactive process is influenced andinfluences the subject as a whole (Magnusson andBergman, 1984)(16).Therefore, it is necessary to delineate a paththat involves all the medical and educational opera-tors and the family with the purpose to “invent”together personalized instruments of interventionthat guarantee a unitary therapeutic plan which isshared and takes into consideration the complexityof the individual.References1) Pintner R., Patterson D.G., A comparision of deaf andhearing children in visual memory for digits,in JournalExp. Psychol., 2, 76-88, 1917.2) Brunschwig L., A study of some personality aspects ofdeaf children, in Contributions of education, n. 687,Teachers College, New York, Columbs University,1936.3) Bacchini D., Valerio P., Le parole del silenzio,E d .scientifiche Magi, Roma, 2000.4) Vaccari C., Marschark M. “Il controllo dell’impulsivitànei bambini sord i ”, in Psicologia clinica dello svilup-po, 1, 2, 173-187, 1997.5) Bronfenbrenner U., Interacting system in human deve-lopment. Research paradigms: present and future. InBolger N., Caspi A., Downey G., Moorehouse M..Persons in context: Developmental processes.Cambridge University Press., 1988.6) Rubin K.H., Mills R., Rose-Krasnor L., M a t e r n a lBeliefs And Children’s Competence. In Schneider B.H.,Attili G., Nadel J., Weissberg R.P. ( a cura di). SocialCompetence In Developmental Perspective,K u w e r,1990.7) Belsky J. The determinants of parenting: a pro c e s smodel, Child development, vol. 55, 83-96, 1984.8) Meadow K.P., Pa rental Response To The MedicalAmbiguites Of Congenital Deafness, i  Journal ofSocial Behaviour, 9, 2 9-304, 1968.9) Maggio M., Maggio O., Pepi A., Puccio R., Gli aspettidella sordità infantile: proposta di un questionario,Acta Pediatrica Mediterranea, vol. 11, n. 1-2, 1995.10) Sacks O., Seeing Voices. A Journey Into The World OfThe Deaf, Ed. Adelphi, Milano, 1993.11) Maggio O., Puccio R., Rizzo C., Indagine statistica sulS e rvizio di audiologia Infantile dell’Università diPalermo (confronto fra gli anni 1977 e 1982),A c t aPediatrica Mediterranea, 2, 75, 1986.12) Hasenstab M. S., Horner J.S., Comprehensive interven-tion with hearing-impaired infantis and preschool chil-d ren, Unpublished Ph. D. dissertation, University ofVirginia,, by Nowell R.C. 1978.13) Bandura A., Social learning theory and identificationprocesses.In D.A. Goslin (Ed.), Handbook of sociali-zation theory and research. Chicago: Rand McNally,1969.14) Trozzi M., Azzarà V., Turchetta R., Brenna E., MaioloA:, Cianfrone G., Alcuni spunti sul profilo psicologicodel bambino sord . Riv. ORL:, Aud., Fon: 3-4,65-70,2000.15) Carmuco A:, Maggio M., Maggio O., Martines E.,Puccio R:., Lo sviluppo cognitivo, linguistico, emozio-nale, comportamentale del bambino audioleso, A c t aPediatrica Mediterranea, 18, 143-45, 2002.16) Magnusson D., Bergman L.R., Individual and variable-based approaches to longitudinal research on early riskfactors. In Studies of psychosocial risk.Rutter M.(Eds.), Cambridge University press, Cambridge, 1984.Contribution at “ XXIX National Meeting of the Italian Societyof Audiology”, Isle of Capo Rizzuto (Kr), September 24th-27th,2003. _________Request reprints from Dott. ssa MARIA MAGGIOC/o Sezione di Audiologiadel Dipartimento di Biotecnologie Mediche e Med. LegaleVia del Vespro, 12990138 Palermo(Italy)44 M. Maggio - F Martines et Al

A Multifactorial pattern for the understanding of the psychological development of the child with impaired hearing and its clinical-therapeutic implications

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A Multifactorial pattern for the understanding of the psychological development of the child with impaired hearing and its clinical-therapeutic implications

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