Social, Behavioral, & Emotional Issues related to Deaf and Hard of Hearing Student Assessment and Intervention Bryan D. Miller, Ph.D., NCSP Associate Professor Department of Psychology Gallaudet University Culturally and Linguistically Sensitive Behavioral Assessment Knowledge of the social context, including the family, the language, and the effects of specific cultural values and beliefs, needs to be taken into account among the deaf and hard of hearing (DHH) population similar to other culturally and linguistically diverse populations. Assessment of DHH children as a culturally and linguistically diverse population for academic problems as well as behavioral/emotional problems needs to be carefully planned the same way. Culturally and Linguistically Sensitive Behavioral Assessment Gopaul-McNicol and Thomas-Presswood (1998) provide an excellent account of innovative educational approaches when assessing and providing intervention for culturally and linguistically diverse children. Kamphaus and Frick (2002) also provide important guidelines for assessing children from diverse backgrounds and for assessing acculturation as part of evaluating child and adolescent personality and behavior. Culturally and Linguistically Sensitive Behavioral Assessment Assessment of DHH children needs to pay careful attention to exclusionary factors when diagnosing Emotional Disturbance (ED). Professionals need to attempt to rule out behavioral characteristics possibly related to deaf cognition and/or the cultural/linguistic environment instead of ED characteristics. Culturally and Linguistically Sensitive Behavioral Assessment Assessment that includes, not only standardized testing, but also includes Response to Intervention (RTI) approaches will be valuable in the future to comprehensively address exclusionary factors. Best practices for DHH will include monitoring students’ progress as a result of evidence-based interventions to appropriately rule out cultural/linguistic environmental and deaf cognitive biological influences before making an ED diagnosis. Social, Behavioral, and Emotional Assessment with Deaf and Hard of Hearing Children “Behavior rating scales and computerized assessments are of immense value, but the information that they provide must be interpreted in the context of an understanding of the effects of deafness on children’s social and emotional development” (Hindley & Kroll, 1998) Social, Behavioral, and Emotional Assessment with Deaf and Hard of Hearing Children The following recommendations should be taken into consideration when assessing students: Basic understanding of behavioral differences of DHH children. Test adaptation must be made cautiously. It is important to use informal assessment and to observe interactions with children due to the lack of assessment tools designed for DHH children. Interpret test results according to what the test measures and how it applies to DHH children. Attention Deficit Hyperactivity Disorder (ADHD) Assessment with Deaf and Hard of Hearing Students Problems with DHH children’s development due to language, communication, and the environment make the diagnosis difficult. A number of conditions that can appear like ADHD or occur in association with ADHD make it difficult to diagnose ADHD in DHH children, such as learning disorders, emotional and behavioral disorders, medical disorders, and environmental factors. Attention Characteristics in DHH Children It is important for adults working with DHH students to learn how to work with them within their visually oriented world (Marschark & Walters, in Marschark & Hauser, 2008). Deaf individuals have a wider field of view and are sensitive to motion in the periphery (Bavelier, Dye, & Hauser, 2006) which most likely helps them attend to more of what is going on around them (Dye, Hauser, & Bavelier, in press). Attention Characteristics in DHH Children Differences exist between deaf and hearing parents and teachers in how they regulate visual attention and adult/child communication. Deaf parents and deaf teachers appear to have knowledge on how to work within DHH students’ zone of proximal development and provide the appropriate amount of scaffolding, but research has also shown that hearing mothers who are able to develop appropriate sign language competency can communicate with their deaf children similarly to that of hearing mothers with hearing children (Moeller & Schick, 2006). Attention Characteristics in DHH Children DHH children have been shown to be distracted by events in their peripheral vision. Peripheral input draws their attention away from the task at hand similar to how hearing children cannot help but be distracted by central events. Research has shown that visual attention getting and use of visual communication strategies can be learned (Mohay, 2000). Attention Characteristics in DHH Children Teachers could possibly use computerized training of attention skills as a part of the students’ classroom activities. Klenberg et al. (2001) found that using computerized visual spatial working memory tasks, while adjusting the difficulty level as performance increased, significantly improved performance on working memory tasks and general reasoning tasks in hearing children with ADHD. In addition, their parents reported decreases in attention difficulties. Computerized training could be successful for DHH students who may be struggling with attention. Attention Characteristics in DHH Children Changing the learning environment to counteract visual distraction needs to be sensitive to the psychological and cultural needs of the DHH child. Change observed in their attention allows them to adapt to their environment due to the lack of an auditory sense to inform them about the environment and to guide their attention. Attention Characteristics in DHH Children DHH children at the front of the classroom with their classmates behind them or where they cannot see out of windows or through the classroom door may increase difficulties they encounters in school. This may counter the adaptation in their visual system and could lead to greater distraction. This is due to the enhancement in their attentional peripheral vision which is more evident when the timing and location of events in the periphery is unknown. Attention Characteristics in DHH Children One approach could be to allow the DHH child to learn his visual environment. Small class sizes with semicircular arrangement of seats and the same seats for each student during the year could create a more predictable learning environment in which the DHH student can learn to ignore novel stimuli in their peripheral vision. Unpredictable events could also be minimized by decreasing movement in the classroom. Attention Characteristics in DHH Children Research including the participation of deaf children, deaf adults, and deaf teachers should occur in the future to help determine how to arrange the physical layout of classrooms and thus maximize the ability of the DHH child to attend. Research on visual attention in DHH children and adults suggests that the best practices will be those that support a visually predictable environment in which DHH students can learn to predict and ignore task irrelevant stimuli that may distract them from attending to instruction. Social and Emotional Characteristics in DHH Children Theory of Mind: Deaf and Hearing Children’s Comprehension of Picture Stories and Judgments of Social Situations (Rhys-Jones & Ellis, 2000) The results from this study did not provide evidence for the hypothesis that deaf adolescents possess significantly poorer knowledge about social reasoning than age-matched hearing peers, but it did present further additional support for Peterson and Siegal’s (1995) conversational hypothesis: a proposal that a deprivation in conversation about mental states leads to an impairment in the development of an awareness of mental states in the younger deaf children. Social and Emotional Characteristics in DHH Children PATHS: Promoting Alternative Thinking Strategies (Greenberg & Kusche, 1998) PATHS is a comprehensive program that promotes emotional and social competencies and reduces aggression and behavior problems in elementary school-aged children. This program is implemented in the school setting with the understanding that it should be integrated with the natural educational process of the classroom. Designed to be used by educators, counselors, and parents. Originally developed for used with DHH children but has subsequently been used with other populations. PATHS enables students to learn to act and react appropriately with peers and adults and to control their own behavior. Social and Emotional Characteristics in DHH Children PATHS is a classroom wide prevention curriculum that includes many aspects of supporting social and emotional development. Authors first developed the curriculum with the objectives to teach DHH children effective interpersonal problem solving skills. Their purpose was that the means to achievement of effective interpersonal problem solving skills is to build emotional awareness and emotional regulation skills so that the DHH child uses inner speech to guide behavioral self control. Social and Emotional Characteristics in DHH Children PATHS is based on cognitive behavioral principles, including the elements of cognition, behavior, and affect. The five domains that the PATH curriculum addresses are self control, emotional understanding, interpersonal problem solving skills, positive self esteem, and peer communication and relationships. The lessons are taught three times a week for 20 to 30 minutes for most of the school year (Greenberg & Kusche, 2006). Social and Emotional Characteristics in DHH Children PATHS curriculum has shown long term effectiveness with regular education classes (Kelly, Longbottom, Potts, & Williamson, 2004), special education (Kam, Greenberg, & Kusche, 2004), and DHH classrooms (Greenberg & Kusche, 1998). In a follow up to their 1994 study, Greenberg and Kusche (1998) found that 1 and 2 year post intervention assessments showed that the deaf children who had participated in the PATHS program exhibited better problem solving skills, better social emotional adjustment, and improvements in cognitive functioning, including less impulsive responding as well as verbal self direction and planning. Teachers have commented that the program promoted language development (Curtis & Norgate, 2007). All of these positive outcomes are clearly related to social and emotional development. Social and Emotional Characteristics in DHH Children Executive function (EF) includes the higher order cognitive processes responsible for metacognition and behavior regulation, including the control of attention and impulses. Brain development related to EF begins before birth and continues until early adulthood. Research has shown EF is influenced by environmental factors such as language use at home and in school. DHH children’s EF appears to follow expected developmental milestones if they receive appropriate access to language during the first few years of life and are trained how to use their eyes more effectively than hearing children to learn from their environment. Social and Emotional Characteristics in DHH Children Sociocultural approaches to instruction (Rogoff, 1990, 2003; Vygotsky, 1978) provide theory-based teaching methods that are also evidence-based and shown to be successful for hearing children. Sociocultural approaches emphasize ways social interactions and language use shape students to become independent learners and facilitate their cognitive development. Sociocultural approaches that focus on each child’s development as social and cultural learners and thinkers is needed for social and emotional development. Social and Emotional Characteristics in DHH Children Teacher communication patterns are influenced by their social and cultural upbringing. These sociocultural behaviors have a role in the classroom because social and communication interactions shape students on how to develop learning and thinking skills (Borkowski & Muthukrishna, 1998; Singleton & Morgan, 2006). Research suggests such language and environmental factors shape EF development. Social and Emotional Characteristics in DHH Children DHH children regardless of the level of their aided hearing loss depend on visual learning more than hearing children. DHH children’s development of visual attention control as part of EF development is important to increase their access to language and incidental learning. Social and Emotional Characteristics in DHH Children Hearing parents could be taught to use visual attention strategies used in deaf mother deaf child dyads (Mohay, 2000). Training could be developed for all teachers of the deaf from infant toddler programs to college programs for DHH students. Training could include strategies demonstrating how to moderate a classroom of visual learners. Example of a DHH Classroom Behavior Management System The behavior system uses a timer, cups on the students’ desks, pennies, and the traffic light poster on the board. Set the timer for 15 minutes when the students are all in the room in the morning. Tell the students you are starting the timer and press the start/stop button. If a student is not working, not paying attention, not sitting appropriately, calling out, etc. during the 15 minute time period, move his/her car to yellow. If the behavior continues or the student settles down and then starts behaving inappropriately again, move the car to red. You can quickly/casually mention the problem, but don’t let the student argue or delay the class time because of your explanation. When the timer rings, give each student that is on green or yellow a penny. Example of a DHH Classroom Behavior Management System Re-start the timer, and return all cars to green. Continue this throughout the entire school day. At the end of the day, students count their pennies. If the student has more than 5 pennies and has had a good day behavior-wise, he/she can pick a prize from the prize box on the counter. Do not give pennies to students who are not in the room (out for mainstream classes). When students return from the mainstream, ask the interpreters if they followed the expected behavior. If yes, put a penny in their cup. If no, no penny. Suggestions for Improvement based on DHH Characteristics Example of a DHH Social Story School can be a fun place. When I go to school I get to see my friends and go to gym class. I can also learn new things. We follow rules to keep us safe and to help us learn (such as Pay Attention and Keep Your Hands and Feet to Yourself). When we follow the rules, we can get a prize. I like prizes! If we follow the rules our names are on the green check. If we do not follow the rules our names are moved to the red check. Example of a DHH Social Story Sometimes I get mad when my name is moved to the red check or when the teacher asks me to do something that I do not want to do. Then I can keep trying hard to follow the rules and earn a green check (such as Pay Attention and Keep Your Hands and Feet to Yourself). It is important that I am quiet and I try to relax. When this happens I will try to keep working and pay attention to the teacher. I can take deep breaths to help me relax. But if I am too upset to keep working the teacher will ask me to take a break. When I take a break I can go to the “time out chair”. When I go there I can take deep breaths. And count to 10 in my mind. I also need to draw a picture of what happened. And then I draw a picture of what I could have done better. Suggestions for Improvement based on DHH Characteristics Example of a DHH Crisis Management Plan The following crisis management procedures will be used when A is engaged or about to engage in aggressive behavior that has the potential of injuring others and/or when he is engaged or about to engage in destructive behavior that has the potential of doing substantial property damage. A will be directed to a designated seclusion/timeout area and required to remain in this area without positive reinforcement and without other reinforcing activities until he is calm. A staff member must make visual contact with A every 2 minutes. Include a release contingency—additional period of time for calm behavior (between 10 seconds and 5 minutes) before release from seclusion/timeout. Do not exceed 15 minutes for the total duration of the procedure. Example of a DHH Crisis Management Plan After 5 minutes of refusing to do work or complying with other demands, prompt A to sit in “time out” chair and complete a yellow form. A should be seated with his back to the class until he has completed the yellow form and calmed himself. Set ‘time out’ timer to 5 minutes. Tell him that after the timer rings, if he is filling out his sheet and sitting quietly, he will be able to return to the group and his name will be moved to the ‘yellow’ area. Continue teaching other students and encourage them to ignore the behaviors. If A continues to become too distracting and/or leaves his chair and begins to throw things, hit himself, pound his fists, etc., then after 5 minutes have the Para remove the other children from the room and have them work on their “packets.” After the students leave, set the ‘time out’ timer for another 5 minute period. For the duration of his behavior, up to 15 minutes, continue to reset the timer and let him know that he has another chance to calm himself and comply with the expectation(s). Example of a DHH Crisis Management Plan Call designated related services personnel to report that the behaviors are occurring and to see if she is able to offer any support and/or can come to process the incident with A once behaviors have diminished. Teacher stays in the room with A and encourages him to sit in the time-out chair and clearly and simply states expectations “sit down and take 10 deep breaths” (or whatever the request is at the moment) as opposed to having him attempt to engage teacher’s attention. If A ignores teacher’s prompts then teacher should ignore student behavior and work on an alternate activity, resetting the timer for 5 minute intervals, as needed, until 15 minutes have elapsed. After a few minutes teacher should again clearly and simply state expectation (e.g., “sit down and take 10 deep breaths”). (This continues until A complies or for no longer than 15 minutes.) The only contact between teacher and student should be teacher clearly and simply stating expectation (e.g., “sit down and take 10 deep breaths”). Example of a DHH Crisis Management Plan If A complies and is seated, he returns to his desk and teacher presents him with the activity he missed/refused to complete, then informs him that the timer will start again and now, if he has positive behavior, he can earn a green check. After A complies for 5 minutes in his seat, the other students can return to the classroom. However, if A does not comply and 15 minutes have elapsed, then seek assistance from the building principal, counselor, school psychologist, or other related services personnel. Ask principal to remove student to office. Do not give A any attention while in office until negative behaviors have decreased. Principal/teacher can call parent to discuss situation. Return A to classroom and have him fill in a yellow form (what I did and what I should have done) and process event and possible (+) reactions with teacher/ social worker. Suggestions for Improvement based on DHH Characteristics DHH Case Study The IU 13 school psychologist observed A’s classroom on 9/15/08 from 11:15 a.m. to 12:45 p.m. to assist with identifying target behaviors and behavioral functions. Using a 1 minute time sampling procedure for all observations, A demonstrated 80% on-task behavior in a small group reading class (3 students) for 10 minutes, with 2 intervals of passive and motor off-task behavior exhibited as A looked at the floor and touched another student sitting next to him on the carpet (attention function), which was followed by the student moving away from him with no further off-task behavior exhibited by A. Specific academic behavior included A counting his reading cards he collected after correctly identifying words. After a 20 minute period of 1-1 reading instruction, A transitioned to a 10 minute independent writing activity and demonstrated 90% on-task behavior, with 1 interval of motor off-task behavior as A rolled up the paper he was supposed to be writing words on (attention function), although he stopped with signed redirection. When A’s speech and language therapist arrived to take A for speech and language therapy, A originally said that he did not have his speech folder in an apparent attention function, although the speech and language therapist found it. A then stood by the door and did not initially move to leave the classroom (attention function), needing a signed and physical prompt (hand on back) to walk. After returning to the classroom in 30 minutes, A transitioned to another small group (4 students) activity involving writing and presenting. A demonstrated 88% on-task behavior for the 25 minute activity, with 3 intervals of motor off-task behavior as he looked at this examiner and poked his pencil into his belly in an apparent attention function. Again, he stopped with a signed redirection to continue writing. Additional on-task behaviors noted during this activity included participating in the lesson by describing what he had included in a poster he made, and following teacher directions to begin writing. A did also demonstrate restless, squirmy behavior during 1 separate interval, but this behavior did not escalate into increasingly off-task behavior or aggressive non-compliance. DHH Case Study The school psychologist used a Structured ABC Analysis Form on 9/15/08 to further identify locations, antecedents, and consequences of 5 separate observed problem behaviors. Touching another student included an antecedent of the student sitting next to A and included the consequence of the student moving away, which discontinued the behavior. Sniffing his book and pointing to something in the book (which occurred during 1-1 reading instruction) included demand antecedents of the teacher questioning him about a story, with redirection effectively being used as a consequence to stop the behavior. Rolling his paper also included demand antecedents, again with an effective redirection consequence. Standing still instead of walking to speech and language therapy included an antecedent of receiving attention for misplacing his folder and included the consequence of attention for his standing still behavior. In all, 4/5 behaviors included a 1-1 interaction between teacher/therapist and student, with 1/5 taking place in small group. 3/5 involved demands as antecedents and 2/5 involved approach/attention. Redirection was identified as an effective consequence, with ignoring also effective in stopping the behavior, but attention/approach less successful in reducing attention-seeking behavior for A. DHH Case Study A’s teacher completed the FAST throughout 9/08 to identify primary functions of behaviors following problem behavioral incidents which occurred on 9/9, 9/10, 9/12, and 9/29. The target behavior identified included aggression, specifically screaming, stomping, clenching fists, and rolling back his eyes in his head. The frequency of these behaviors was identified to be daily, with severity noted as mild as it was disruptive but involved little risk to property or health. Identified times that problem behavior was most likely to occur included 11:00 to 12:30, while settings/activities problem behavior was least likely to occur included specials and recess. Before the problem behavior occurs, A reportedly usually refuses to follow a direction that is either challenging for him or something he doesn’t want to do. After the problem behavior occurs, A reportedly usually rejoins the activity. The FAST revealed a mixture of social positive (attention/preferred items) and negative (escape from tasks/activities) reinforcement as primary functions of A’s behaviors, but further interpretation revealed a stronger attention function as compared to escape due to his tendency to return to work on his own time if ignored (withdrawal of attention) and his tendency to act silly and rowdy during down time when he is not required to do anything (absence of demands). DHH Case Study Target Behaviors: DHH Case Study Immediate Triggers: DHH Case Study Function of Behavior: DHH Case Study Description of Behavior: DHH Case Study Alternative Skills to be Taught: DHH Case Study Consequence Strategies: To reinforce the alternative skills: DHH Case Study Consequence Strategies: To decrease target behaviors: DHH Case Study Classroom Interventions to Reinforce Skills: DHH Case Study Monitoring/Evaluation: Social Processes and Outcomes of In-School Contact Between Deaf and Hearing Peers (Kluwin, Stinson, & Colarossi, 2002) Social Skills/Social Maturity: In regard to the question of whether deaf students demonstrate age-appropriate social behavior, the studies suggest that middle school hearing peers may be more socially mature than deaf peers, but differences between the peer groups are apparent only when teacher evaluations of social maturity are used. In addition, one study indicated that adolescent mainstreamed deaf students are more socially mature than self-contained deaf students, but deaf students are selected for mainstream classes on the basis of their social maturity. The difference in the age range of the participants may also have affected the results. Social Processes… Social Interaction: For observational studies, there appear to be fairly consistent patterns in the interactions between deaf and hearing peers. Deaf students tend to interact more frequently with deaf classmates than with hearing ones. In addition, exposure of deaf and hearing peers to each other over time may increase interactions. Studies also indicate that specially designed interventions, such as certain types of cooperative learning, can increase interaction. Social Processes… These social interaction studies have collectively employed a variety of age groups, observational systems, settings, and experimental manipulations. Results regarding self-reports of participations, conducted primarily with adolescents, are in some respects similar to those for the observational studies, conducted primarily with young children. Deaf students generally report themselves as interacting more often with like peers, in line with the findings for observational studies. Self-report studies have also shown, as have observational studies, that deaf students’ participation in social activities with hearing classmates may increase when these groups have greater contact with each other. Social Processes… Social Acceptance: Studies with measures of peer rated acceptance, conducted with a variety of age groups, have yielded mixed findings. Results for three studies indicated that hearing peers accepted deaf students in mainstream classes, although factors such as extent of contact and gender may have an effect. In a fourth study, however, the deaf students were not as accepted as the hearing students and an intervention had no effect. Social Processes… The social acceptance studies of self-perceptions of relatedness suggest a different perspective on acceptance. Even though in the above studies hearing peers often showed acceptance in their ratings, the deaf students may have viewed their relationships with hearing peers as less than fully satisfying. The Musselman et al. (1996), Stinson and Whitmire (1991), and Stinson et al. (1996) studies suggest that, in general, deaf students report greater relatedness with deaf peers than with hearing ones. Adolescents were the participants in these studies and a qualification here is that perceptions may vary as a function of extent of mainstreaming and characteristics of the sample. Social Processes… Social acceptance results for perceptions of relatedness also differed from those for perceptions of participation. Although reported participation increased with greater contact between deaf and hearing peers, relatedness often seemed to be independent of participation. The relationship might be summarized by the adolescents most often studied this way as “I like them alright, but I’d prefer my own kind if I have a choice.” Some of this may be an effect of studying adolescents who place so much emphasis on personal discovery and definition through peer interaction and thus would prefer a like group as a benchmark; or it may be a more general human phenomenon paralleling the preferences of the preschoolers who would rather interact with someone of the same race, sex, age, and hearing status. Finally, the pattern of results may also reflect the effect of the frequent difficulties deaf and hearing students have in communicating with each other and establishing close relationships. Social Processes… Affective Functioning: The studies reviewed indicate no general difference in selfperceived self-image, or self-esteem, as a function of segregated versus mainstream classes. A qualification here is that rated self-image may vary with the setting when the child’s language skills are taken into consideration as well. A change in the setting, such as from a school with only deaf students to one with both deaf and hearing students, may also affect self image. Perceived social competence may also vary with the setting, except in this case, age needs to be taken into consideration as well. An additional consideration is the age of the participants, as the studies used primarily adolescents for their sample. Implications of Social Processes… Social measures are of direct relevance to educators working with deaf and hard-of-hearing students in classes with hearing peers. Measures are needed to help determine, from a social perspective, appropriate placement for the individual student. Measures can also monitor the social development of that student in the placement. Measures can additionally assess the effectiveness of interventions designed to facilitate the social integration of the student. Promoting Social Competence in Deaf Students: The Effect of an Intervention Program (Suarez, 2000) The aim of this study was to determine the effects of a social skills training program on the social skills and social behaviors of deaf children in a mainstream setting. The study used a pretest/posttest design. The participants consisted of 18 severely and profoundly hearingimpaired children (ages ranged from 9-1 to 13-6) who were enrolled in three elementary schools in the Canary Islands. Results indicated that the intervention succeeded in improving students’ social problem-solving skills, especially in making comprehensible the steps implied in the solution of interpersonal problems; the intervention also led to significant improvement of deaf students’ assertive behavior as rated by their teachers and by themselves. Significant differences in social or academic integration as judged by companions in a sociometric questionnaire were not found. Promoting Social Competence… The format for teaching social skills followed in each session was derived from the literature in this field (Goldstein, Sprafkin, Gershaw, & Klein, 1980; Michelson, Sugay, Wood, & Kazdin, 1983) and consisted of the following: Introduction to the skill and instructions. Modeling. Role-playing. Feedback and reinforcement. Discussion. Home activities. Generalization. Promoting Social Competence… The following three types of measures were obtained: ratings made by teachers, sociometric measures, and self-ratings completed by the deaf students. The Meadow/Kendall Social-Emotional Assessment Inventory for Deaf Students (MKSEAI; Meadow, 1983). The teacher ratings: Children’s Assertive Behavior Scale (CABS; Michelson et al., 1983). The Sociometric Questionnaire (Gosalbez, 1980). The deaf student’ self-ratings: Children’s Assertive Behavior Scale (Self-CABS). Hearing Mothers and Their Deaf Children: The Relationship between Early, Ongoing Mode Match and Subsequent Mental Health Functioning in Adolescence (Wallis, Musselman, and MacKay, 2004) In the few studies that have been conducted, researchers have typically found that deaf adolescents have more mental health difficulties than their hearing peers and that, within the deaf groups, those who use spoken language have better mental health functioning than those who use sign language. This study investigated the hypotheses that mental health functioning in adolescence is related to an early and consistent mode match between mother and child rather than to the child’s use of speech or sign itself. Using a large existing 15-year longitudinal database on children and adolescents with severe and profound deafness, 57 adolescents of hearing parents were identified for whom data on language experience (the child’s and the mother’s) and mental health functioning (from a culturally and linguistically adapted form of the Achenbach Youth Self Report) was available. Hearing Mothers… Three groups were identified: auditory/oral (A/O), sign match (SM), and sign mismatch (SMM). As hypothesized, no significant difference was found favoring a combined A/O and SM groups, but a significant difference was found favoring a combined A/O and SM group over the SMM group. These results support the notion of the importance of an early and consistent mode match between deaf children and hearing mothers, regardless of communication modality. Parenting Stress and Social Support in Hearing Mothers of Deaf and Hearing Children: A Longitudinal Study (Lederburg & Goldbach, 2002) This longitudinal study investigated the impact of child deafness on mothers’ stress, size of social networks, and satisfaction with social support. 23 hearing mothers of deaf children and 23 hearing mothers of hearing children completed a series of self report questionnaires when their children were 22 months, 3, and 4 years old. When children were 22 months, more mothers of deaf children reported pessimism about their children’s achieving self-sufficiency and concerns about their children’s communication abilities than did mothers of hearing children. When their children were 3 and 4 years old, mothers of deaf and hearing children did not differ in their reports of general parenting stress, as measured by the Parenting Stress Index (PSI). Likewise, mothers’ ratings of satisfaction with social support were not affected by child deafness, nor did they change developmentally. Parenting Stress… Mothers of deaf and hearing children did differ in the types of support networks utilized. Mothers of deaf 22-month-olds reported significantly larger professional support networks, while mothers of hearing children reported significantly larger general support networks across all child ages. Mothers’ feelings of stress and satisfaction with social support were very stable across the 2 years examined. The results suggest that most mothers of deaf children do not feel a high level of general parenting stress or dissatisfaction with their lives and support networks. However, mothers of deaf children are likely to feel stress in areas specific to deafness. In addition, because parenting stress was highly stable, special efforts should be made to intervene when mothers of deaf children are expressing high levels of stress.