Psychosocial Aspects of Deafness: Implications for ...

JADARA JADARA

Volume 43 Number 1 Article 6

November 2019

Psychosocial Aspects of Deafness: Implications for Rehabilitation Psychosocial Aspects of Deafness: Implications for Rehabilitation

Counselors Counselors

Diana M. Eraser The University of Texas-Pan American

Sandra Hansmann

Shawn P. Saladin

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PSYCHOSOCIAL ASPECTS OF DEAFNESS; IMPLICATIONS

FOR REHABILITATION COUNSELORS

Diana M. Eraser, M.S.

Sandra Hansmann, Ph.D.

Shawn P. Saladin, Ph.D.

The University of Texas-Pan American

Abstract

Negative societal attitudes toward people with hearing loss can be handicapping. Becauseof their deafness, people face a multitude of external barriers which become theirhandicap. The primary barriers or handicaps to this underserved population are two fold,inaccessibility to appropriate services during important milestones in their lives and amisunderstanding of Deaf culture. Rehabilitation counselors are advised to become awareof the types of interventions their Deaf consumers had as children through their educationand socialization for insight to appropriate services. Also discussed is the importance ofcommunication and employer involvement in reducing societal stereotypes.

Keywords: rehabilitation, deaf, employment, development

Introduction

It is unclear how many people in the United Sates are Deaf or hard ofhearing because discrepancies exist in major sources of information suchas the National Center for Health Statistics and the Survey of Income andProgram Participation (Access to Disability Data, n.d.). Mitchell (2006)suggests these types of surveys rarely provided the same results becauseof the way the questions are phrased and the definitions of hearing lossand deafness across surveys are not consistent or uniform. Accordingto the National Center for Health Statistics (U.S. Department of Healthand Human Services, n.d.), there are an estimated 20 million peoplewith reported hearing problems which include the Deaf and hard-of-hearing over the age of three. While an additional 6.2 million people areprelingually or congenitally deaf (e.g. acquiring deafness prior to a firstlanguage acquisition which includes deafness at birth through three years).The 2000 census (U.S. Department of Commerce Economics and StatisticsAdministration, 2002) indicated that roughly 9.3% of the US population

fits in the US Department of Health and Human Services definition ofprelingually or congenitally deaf. However, the 2008 Survey of Income

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Eraser et al.: Psychosocial Aspects of Deafness: Implications for Rehabilitation

Published by WestCollections: digitalcommons@wcsu, 2009

and Program Participation (SIPP) identified the American population ofpersons with hearing loss or deafness fewer than one in twenty Americans,5.0% or approximately 14 million, are currently Deaf or hard of hearing.The SIPP also estimates more than half of all persons with hearing lossor deafness are 65 years of age or older while less than 4% are less than18 years of age. Additionally, Senghas and Monaghan (2002) stated thatprevocational deafness or deafness prior to the age of 19 years occurs attwice the rate of prelingual deafness. Considering the different sourcesand different methods for counting it can be difficult to determine howmany people in the United States are deaf or hard of hearing. Regardless ofwhich statistic one chooses to follow it is reasonably clear there is a largepopulation of people in the United States who are deaf or hard of hearing.Many of them will need vocational rehabilitation services from peoplewho may not understand deaf culture (Allen, 1994; Capella, 2003; Lucas,Schiller & Benson, 2004; Saladin, 2008). This paper attempts to educaterehabilitation counselors, who may be misinformed and unwittinglyadhere to negative societal attitudes regarding people who are deaf, thusimpairing this population from reaching their full potential in languagedevelopmental, educational, socialization, and employment domains.Implications for rehabilitation counselors are addressed in this article.

Developmental

Deafness is not about the level of hearing as much as it is about languageand communication access. Many people who are deaf use sign languageas their means of communication. American Sign Language (ASL) isrecognized as a foreign language, although there is no written or spoken formof the language (Senghas & Monaghan, 2002). ASL is a distinct languagewhich uses the hands and body, including the face, to encode lexical formsand grammatical relationships. The use of these visible, rather than audible,articulators allows signers to use three-dimensional space in complexlinguistic ways and gives sign languages a unique quality not shared withspoken languages (Senghas & Monaghan, 2002). Just as spoken languagesvary around the world, sign languages also vary and have distinct regionalaspects. Signers often learn to read and write a spoken language (Senghas& Monaghan, 2002). For example, ASL signers often learn to read andwrite English while Nicaraguan signers will often learn to read and writeSpanish. ASL has all the linguistic properties of other natural languages. Itpossesses the equivalents of phonology, morphology, and syntax that are just

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as complex as those used in spoken languages (Boutla, Supalla, Newport,& Ravelier, 2004). For example, phonology in ASL refers to signs that arecomposed of independent visual-gestural features of hand shape and palmorientation and location in space and motion (Boutla, Supalla, Newport,& Ravelier). These are analogous to features such as voicing, manner andplace of articulation in spoken language (Boutla, Supalla, Newport, &Ravelier). Another linguistic property of ASL is it has its own grammar,rules, and capability for subtle communication (Ruccione, 2004). Peoplewho hear rely on temporal encoding during signing whereas people whoare deaf rely on spatial encoding (Boutla, Supalla, Newport, & Ravelier).

People who are deaf are especially at risk of having difficulty duringwhat is known as the critical language acquisition period. This is the timein human development when learning language takes the least amount ofeffort. If early childhood interventions do not occur during the optimalbrain growth spurt for learning language, the child may have difficultymastering any language (Mayberry, 1993; Ruccione, 2004; Tallal, 2004).Moreover, Folven and Bonvillian (1991) examined the modality of earlylanguage acquisition and found infants who were deaf and signed beforethey spoke achieved milestones in early language. Similarly, Ladd (2005)stated evidence of communicating with non-deaf babies through signingcan enhance their cognitive development and speed up the acquisitionof their spoken language. Storbeck and Calvert-Evers (2008) furthersupport evidence that undetected hearing loss can have a profound effecton a child's holistic development, including communicative, languageand cognitive development. Intervention before the age of 6 months hassignificant positive impacts in the overall later development while failureto detect hearing loss can have far-reaching negative social and economicramifications. These negative social and economic ramifications can posea threat in such areas as education, employment, and societal integrationwhich all have the potential to impact quality of life (Storbeck & Calvert-Evers). Also, as part of early childhood intervention, hearing parents needto be educated regarding deafness as their own responses to deafness affectshow the child will view him or herself. Atkin, Ahmad, and Jones (2002)found having a deaf child has social and psychological consequences forhearing parents of which include: feelings of guilt, frustration, anxiety,helplessness, isolation, notions of unfairness and resentment. If parents arenot educated regarding deafness, their deaf child may be excluded fromconversations and other important aspects of family life thus creating

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isolation and limited communication at home. Consequently, this situationmay contribute to lower self-esteem for the child (Atkin, Ahmad, &Jones).

Disability threatens more than just health, but it also threatens theindividual's abilities to integrate socially through employment, healthcare, and other social activities that promote physical and mental health(Harrison & Kahn, 2004). Most people incurring a disability such asdeafness at an older age have already experienced life's diversity andachievements but still have to make adjustments to restore functioning.However, with the prevalence of hearing loss among older persons, thereare psychosocial considerations relevant to the loss. On an intrapersonallevel, acquiring a hearing loss at an older age may affect the individualin such a way in which they may respond by going through stages of lossanalogous to stages of grief (Kampfe & Smith, 1998). People experiencinglatten deafness may feel a sense of detachment from oneself and from theworld thus feeling isolated and depressed. They may also feel frustration,anger, resentment, and helplessness in their lack of ability to understandspeech or communicate fully with others as they may have in the past(Kampfe & Smith). Negative societal attitudes towards deafness willalso have psychosocial implications for late-deafened adults. Deaf adultsface discrimination because of their disability and this discrimination cannegatively affect their longevity (Ladd, 2005). Having a disability such asdeafness could very well affect longevity if a person cannot access healthcare or social services to integrate them in areas which promote physicaland mental health. Limited communication may also contribute it serves todeny access to employment and other social services. All of this can have adomino effect on the members of the Deaf community, leading to a lack ofself-confidence, identity crisis, self-hatred, and/or mental illness in whichlongevity can eventually be affected (Ladd).

Education

Laws promulgated after the Civil War made education mandatory forall United States citizens and these laws firmly established English asthe majority language (Seamans, 1996). Consequently, American SignLanguage, having roots in French Sign Language, was viewed as a foreignlanguage. This may have created attitudes in which people who signedwere viewed as in need of "restoration" to integrate in an American society

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of English speakers. The educational system for the deaf focused on speechdevelopment and oral communication, and the results were generallycharacterized as failure and frustration for deaf children. This is especiallyproblematic as the best lip readers usually can only accurately understandabout 20% of spoken English (Seamans, 1996).

Because of their hearing loss and inability or difficulty differentiatingvarious sounds which form words and sentences, spoken languageacquisition is one of the greatest challenges for people who are deaf. Dueto strong probability of isolation from other people who are deaf or peoplewho sign, they are also at risk of not becoming fluent in ASL. When oneis not fluent in a first language it is often extremely difficult to master asecond language (Seamans, 1996; Shantie & Hoffmeister, 2000). Studentswho are deaf, in general, have not improved their fluency in English as asecond language when participating in mainstreaming programs (Goldin-Meadow & Mayberry, 2001). Language is not the only academic areaaffected as studies indicate the average English reading level of deaf highschool graduates was 4"' grade and the average math level was 6"^ grade(Goldin-Meadow & Mayberry).

This bilingual-bicultural (Bi-Bi) system, another education approachdeveloped in the 1940s, focused on using teaching principles related toEnglish second language learners and recognized ASL as the primarylanguage. Attention was focused on mastering the first language, and thenEnglish was introduced as a second language. The second aspect of thisapproach focused on the distinct cultural differences between the cultureof the deaf and that of the general society. Education using both ASL andEnglish, with an emphasis on positive attributes of both cultures, maycontribute to the ease of which the graduates of such programs appear tointegrate into both cultures (Goldin-Meadow & Mayberry, 2001). In onestudy, students educated in this system graduated from high school with a10'** grade reading level and some continued their educational pursuits incollege (Goldin-Meadow & Mayberry).

Social and Emotional Adjustment

There are few instruments to measure the psychosocial developmentof children with deafness. However, the Meadow-Kendall Social andEmotional Assessment Inventory (SEAI) is one such instrument (Meadow,

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1983). Polat (2003) investigated the impact of environmental factors onthe psychosocial development of deaf children and studied variables suchas: 1) student-related background and experiential characteristics, 2)parent-related variables, 3) school-related factors, and 4) teacher-relatedvariables. Polat used the SEAI school-age version which is one of the fewinstruments specifically designed for use with students who are deaf andhas cross-cultural validity. SEAI is reported as a reliable and valid measurein the assessment of the psychosocial adjustment of students who aredeaf (Polat). Four models were constructed using an ecological approach.The first model viewed the change in social and emotional adjustmentof Deaf students as a result of primary background variables (i.e. degreeof hearing loss, age, and gender). The second model included family-related variables (i.e. familial deafness and mode of communication usedat home). The third and fourth models viewed school-and teacher-related

variables, respectively, to determine the interaction of different systemsand their relation with regard to the social and emotional adjustmentof the person. The results suggest there is a positive correlation amongpsychosocial adjustment and the following factors: a) use of hearing aids,b) speech intelligibility, c) academic achievement, d) parental hearingstatus, e) use of total and oral communication at school, and f) use of totalcommunication at home. Furthermore, the findings of Polat's researchindicated that students with hearing losses of 40 dB or less have lowerrates of psychosocial difficulties and thus have a better social adjustment,self-image, and emotional adjustment.

Socialization

While methods of educating people who are deaf are important, anotherdevelopmental aspect, socialization, is often overlooked. Society stilladheres to negative attitudes regarding people who are deaf thus inhibitingthem from reaching their full potential. For minority languages to flourish,they must maintain a cultural base of shared needs and beliefs. Havinga shared language symbolizes more than an ability to communicate; itsignifies a shared identity, a collective heritage, and facilitates the imaginingof ties (Atkin, Ahmad, & Jones, 2002). People who are deaf comprise oneof these communities and function as a cultural group. Because they sharea language and express similar beliefs. Deaf people identify themselves ashaving a "Deaf culture. Kyle and Pullen (1988) found that many peoplewho are deaf identify themselves as members of the Deaf culture because

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they share a common language, heritage and experiences of oppression.Many people who are deaf feel misunderstood by hearing people andfeel they lack meaningful representation and leadership in the majoreducational, professional, and political institutions that affect their lives(Kyle & Pullen). Charles and Thomas (2007) further support the notion ofa lack of meaningful representation for people who are deaf. They indicatedpeople in this group are not supported by organizations in terms of beingsought out as members. Furthermore, members of organizations do notsign so communication among deaf and hearing members is hindered. Thiscan be compared to the exclusion many people who are deaf have facedfrom childhood (Charles & Thomas). Furthermore, people who are deafoften struggle for a positive identity. A re-framing of the disadvantage theyexperience may be necessary to achieve a positive identity. The disadvantageresults from the negative attitudes of a hearing society. This society failsto communicate effectively with people who are deaf in either sign orspoken language resulting in the general society displaying paternalisticbehaviors. In addition this population, because of their differences, is oftenmarginalized (Atkin, Ahmad, & Jones, 2002).

The concept of Deaf culture emerged in 1965 and gained acceptance by1980 with an emphasis on the use of Deaf correlating with a strong stanceon the sociopolitical nature of an inability to hear (Senghas & Monaghan,2002). The term "Deaf refers to both audiological and cultural situations.People who lose their hearing later in life may be audiologically deaf butnot necessarily culturally Deaf. Many hearing parents of Deaf childrenhave reservations regarding Deaf culture and its language due to delays inachieving language milestones in spoken language (Petitto & Kovelman,2003; Ruccione, 2004). Furthermore, Luckner and Stewart (2003) foundpositive correlations amongst a deaf person's success and self esteemas an adult and the familial as well as educators support of Deaf culturereceived as a child. Finally, it was found adolescents with hearing lossstruggle with questions regarding whether to identify primarily with Deaf,hearing, or both cultures (Cornell & Lyness, 2004). Adolescents withhearing loss often feel frustrated in their interactions with hearing peers asthey struggle for communication, understanding, and solid relationships.In their research on adolescents with hearing loss, Cornell and Lyness(2004) identified four types of Deaf identity based on the Cultural andRacial Identity Development model (C/RID model). These four typesof Deaf identity included: (a) culturally hearing in which the individual

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identifies with the hearing culture only and defines deafness as a medicalpathology or disability, (b) culturally marginal in which the individual doesnot identify with either the hearing culture or Deaf culture, (c) immersionin which the individual is immersed in Deaf culture and has a negativeview of the hearing culture, and (d) bicultural in which the individual iscomfortable in and identifies with both. Those individuals who identify asbicultural are basically well adjusted; they have a high overall self-conceptand social self-concept (Cornell & Lyness).

Goldin-Meadow and Mayberry (2001) reported that 90% of deafchildren in the U.S. are bom to hearing parents. Meadow (2005) found Deafchildren of Deaf parents compared to deaf children of hearing parents aremore likely to show a higher level of intellectual functioning, a higher levelof social functioning, and demonstrate a higher level of communicativecompetence including competence in written and spoken, expressive andreceptive language. This is a result of Deaf parents exposing their Deafchildren at an early age to both oral and manual training (Meadow, 2005).It could be argued that the higher level of functioning could have an impacton potential employment opportunities for this population.

Employment

Even though people who are deaf may be subjected to inappropriatesocial and educational interventions during their developmental years, thesituation becomes more confounded in their desire to seek employment orsecure a career. With the enactment of The Rehabilitation Act of 1973 and

the passage of the 1998 Workforce Investment Act (WIA), misinformationabounds regarding employing people who are deaf (Winn, 2006). Employersmay still adhere to negative societal attitudes about individuals who aredeaf as workers and thus contribute to inhibiting them from employmentopportunities. Winn found the primary factors having a negative impacton job opportunities for people who are deaf included: (a) Communicationbarriers, (b) employer attitude, and 3) telephone difficulties. Althoughprogress is seemingly slow in assisting them in acquiring gainfulemployment, there is still a need for public awareness regarding deafnessand the benefits of employing this population.

Even though laws enacted to provide employers with mandatesrelated to employment of people with disabilities, employers continue

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to have misconceptions regarding employing people who are deaf.These misconceptions create unnecessary barriers to employment. Someemployers believe people with disabilities including severe to profoundhearing loss or deafness are handicapped, cannot function productively onthe job, and will have excessive absences from work (Anderson, Boone, &Watson, 2003). To the contrary, people with disabilities, including peoplewith deafness, can function productively on the job and absenteeism forpeople with disabilities is below that of the average worker (Anderson,Boone, & Watson).

People who are deaf may find it ever more difficult to obtain employmentas the unemployment rate continues to rise in the United States. As thenational unemployment rate can fluctuate from 4% to 6% for the generalpublic, the national unemployment rate for people who are deaf issubstantially higher. The unemployment rate for individuals who are deafhas been reported to be approximately 60% (Stensland, 2007). People whoare deaf experience higher rates of unemployment and underemploymentand earn lifetime wages between $356,000 and $609,000 less than theircomparably educated hearing counterparts (Lufl, 2000). Additionally,some young adults with disabilities may begin to think of themselves aspeople of lower worth and less capable of securing good jobs resulting inlower career expectations (Cinamon, Most, & Michael, 2007).

One barrier to employment of people with disabilities is communicationof any sort, i.e., reading, writing, speech, speech reading, signs, or gestures(Wheeler-Scruggs, 2002). A second barrier these individuals encounterwhen seeking employment is negative employer attitudes towards hiringpeople who are deaf. However, Stensland (2007) indicated the populationof people who are deaf have generally demonstrated they are loyal andreliable in their employment.

While negative societal attitudes regarding people who are deaf are amajor barrier to employment, another barrier is fear of financial burden onthe part of employers. The employers may be afraid of spending excessiveamounts of resources providing assistive technology and other services forthe employee who is deaf (Stensland, 2007). However, 73% of employerssurveyed reported their employees with disabilities do not requireaccommodation at all (Stensland). Additionally, employers are eligible toreceive tax credit of up to $5,000 when providing accommodations fortheir employees with hearing loss (Stensland).

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While employment may continue to be a challenge for professionalsworking with this underserved population, supported employment forpeople who are deaf may help employers gain a better understanding ofissues related to deafness. Supported employment programs for peoplewho are deaf utilize a more holistic approach to meet their vocationalneeds. Hansen (1999) found supported employment to be one of themost effective ways of educating employers on how to work with theemployees who are deaf. Employers gain knowledge about deafness suchas an understanding that deaf employees need to rely primarily on visionto gain new information and more attention is given to body languageand facial expressions. Regarding the training of employees who aredeaf, it was also found it is important to give a demonstration of the taskcombined with signed or gestured instructions (Hansen). Other effectiveways for employers to communicate with deaf employees is through theuse of adaptive visual aids such as copied sign language pictures pairedwith English words (Hansen). Other examples of effective communicationbetween an employer and an employee who is deaf include time-charts,simple translations of lists using the individual's sight word recognition,color coding, and bar graphs. Finally, in supported employment, Hansen(1999) recommended rehabilitation counselors stay abreast of technologicalresources, adaptive equipment advances, and provide training for employersand co-workers regarding the issues related to the employment of peoplewith hearing loss.

Implications for Rehabilitation Counselors

While negative societal attitudes have historically inhibited peoplewho are deaf from reaching their full potential in important psychosocialaspects of their lives, it is important for rehabilitation counselors to beable to work effectively with people who are deaf by having an attitudeof equality and mutual respect. Understanding people who are deaf as aseparate culture with a rich and complex language is important to alleviatingnegative attitudes. However, people should be careful to not make deafnessthe salient characteristic of these individuals (Luckner & Stewart, 2003).Rehabilitation Counselors working with this population need to becomeknowledgeable about both the cultural model and the medical model ofdeafness. The latter stresses the only way for people who are deaf to attainfull humanity is to integrate them with the majority population (Ladd,2005).

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Rehabilitation counselors should be aware of the developmentalexperiences and language acquisition processes previously discussed.Communication issues are paramount when working with the deaf population.Rehabilitation counselors need to be sensitive to their unique needs and beaware of the issues that present themselves within the context of deafnessand hearing loss (Cornell & Lyness, 2004). In addition, rehabilitationcounselors may consider establishing open lines of communication withparents and other interested parities. They may provide valuable insight tothe types of successful interventions the consumer used in the past.

It is understood the ultimate goal of vocational rehabilitation services isemployment of the consumer. In order to reach this goal the rehabilitationcounselor needs to work effectively with deaf consumers as well asother personnel trained to work with this population. This may includepersonnel needed for assessment and/or job placement. For example, whenpurchasing a vocational assessment it is important for the rehabilitationcounselor to ensure appropriate and sensitive assessment instruments wereused by vendors competent in working with deaf clients and fluent in ASL(Hansen, 1999; Saladin, 2008).

Improved service delivery may increase the chance of success for theindividual with hearing loss. Services such as college and universitytraining, business and vocational training, and job-placement servicesaffect levels of employment and income (Moore, 2002). It is not surprisingindividuals provided with these training services are employed at a higherrate due to the acquisition of entry level skills for professional careers.Even so, Boutin and Wilson (2009) found people who are deaf and havethe professional training needed to enter into a particular field do not doso at the same rate of pay as people in other disability groups. One mightconclude there is still bias on behalf of the employers against people whoare deaf.

Rehabilitation counselors can be instrumental in helping employersovercome attitudinal, perceptual, and procedural barriers that limit theability of people who are deaf in attaining quality employment outcomes(Gilbride, Stensrud, Ehlers, Evans & Peterson, 1997). By educatingemployers regarding Deaf culture, legislation, the cost of accommodationsand the benefits to hiring people who are deaf, negative employer attitudesmay be ameliorated.

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In closing, not only will employers benefit from an enhancedunderstanding of Deaf culture, society at large will as well. Contact theorystates the more positive encounters people have with different groups themore likely those groups will meet again (Pettigrew & Tropp, 2006). Onecan argue the same is true with the people who are deaf. The more contactthis population and the general society have with each other, the more thenegative stereotypes and attitudes will be alleviated for both sides; thusallowing for greater opportunities to educate each other and for people whoare deaf to reach their potential. Working cooperatively, the rehabilitationcounselor, employers, society at large and, most importantly, the consumerswho are deaf may reach their maximum potential.

Shawn P. Saladin

HSHW 1.126

UTPA Dept. of Rehab.1201 W. University Dr.Edinburg, TX 78539ssaladin@panam. edu

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CORRECTION

Steve Sligar, Ed.D

With apologies in the author note (p. 197) in Sligar, S. R., Boykin, R.B., and Kavin, D. (2008). What were we thinking? ADARA's constructionof knowledge: 1976-2005. JADARA, 41(3), 187-206 the correct tenurefor Glenn Lloyd, Editor Emeritus of JADARA, was 1969-1987 with nointerruptions in service. He also served as editor for several PRWAD andADARA publications during this time.

JADARA 69 Vol. 43, No. 1, 200918

JADARA, Vol. 43, No. 1 [2009], Art. 6


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