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Family contributions in treatment of the hearing-handicapped child of school age : an exploratory survey… Brown, Joanne Victoria 1960

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FAMILY CONTRIBUTIONS IN TREATMENT OF THE HEARING-HANDICAFFED CHILD OF SCHOOL AGE An e x p l o r a t o r y s u r v e y o f p a r e n t s o f J e r i c h o H i l l S c h o o l p u p i l s , Vancouver, 1959 - I960  by  JOANNE VICTORIA BROWN  T h e s i s Submitted i n P a r t i a l F u l f i l m e n t o f t h e Requirements f o r t h e Degree o f ••: MASTER OF SOCIAL WORK i n t h e S c h o o l o f S o c i a l Work  A c c e p t e d a s conforming t o t h e s t a n d a r d r e q u i r e d f o r t h e degree ofMaster o f S o c i a l Work  S c h o o l o f S o c i a l Work  i960 The  University ofB r i t i s h  Columbia  In presenting  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of  the requirements f o r an advanced degree at the  University  of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. agree that permission f o r extensive f o r s c h o l a r l y purposes may  I further  copying of t h i s t h e s i s  be granted by the Head of  Department or by h i s r e p r e s e n t a t i v e .  my  I t i s understood  that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission.  DepS&^nt  of  /^T^^  S-r^^  The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada. Date 'iTY^n^  / f ^ g  A B S T R A C T  Improved t e c h n i q u e s ( p a r t i c u l a r l y e l e c t r i c a l apparatus) make i t p o s s i b l e t o t e a c h hearing-handicapped c h i l d r e n t h e use o f language a t an age when t h e i r m o t i v a t i o n and t h e i r c a p a b i l i t i e s f o r t h i s l e a r n i n g are a t t h e i r peak. The r e s u l t has been t o e a s e , c o n s i d e r a b l y , t h e burden o f b a s i c e d u c a t i o n a l t r a i n i n g , and a l s o t o permit t h e b a l a n c i n g o f t h i s w i t h t h e broader s o c i a l i z a t i o n o f t h e c h i l d . T h i s makes e a r l y d i a g n o s i s more important t h a n e v e r ; but i t a l s o makes f a m i l y p a r t i c i p a t i o n a v i t a l i n g r e d i e n t . Two companion s t u d i e s - one c o n c e n t r a t i n g on t h e p r e - s c h o o l c h i l d , and t h e o t h e r on t h e school-aged c h i l d - have been undertaken t o sharpen t h i s p a r t o f t h e f o c u s - t h e f a m i l y , p a r e n t a l , and r e l a t e d i n f l u e n c e s which b e a r on t h e p r o g r e s s i n h i s . e a r l y y e a r s now p o s s i b l e f o r t h e hearing-handicapped child. W i t h the- c o - o p e r a t i o n o f t h e P a r e n t - T e a c h e r s A s s o c i a t i o n o f t h e J e r i c h o H i l l S c h o o l , and t h e S c h o o l p e r s o n n e l , i n f o r m a t i o n was o b t a i n e d from some e i g h t y p a r e n t s o f c h i l d r e n o f s c h o o l age r e s i d i n g i n B r i t i s h Columbia, who responded t o a q u e s t i o n n a i r e e n q u i r y . T h i s was f o l l o w e d by i n t e r v i e w s w i t h f a m i l i e s l i v i n g w i t h i n GreatWvancouver. The a r e a o f e n q u i r y i n c l u d e d a) t h e i m p l i c a t i o n s o f t h e handicap, and b ) t h e c o n t r i b u t i o n s made by p a r e n t s i n t h e treatment o f t h e c h i l d ; an assessment b e i n g made o f more h e l p f u l and l e s s h e l p f u l f a m i l y s i t u a t i o n s , , r e s p e c t i v e l y . I n f o r m a t i o n and i n t e r p r e t a t i o n r i s an e v i d e n t need, f o r b o t h c h i l d r e n and p a r e n t s , and a s t r a i n i n g p o t e n t i a l a s w e l l as b e h a v i o u r consequences. A t t r i b u t e s which d i s t i n g u i s h t h e more h e l p f u l f a m i l y f r o m t h e l e s s h e l p f u l a r e i n d i c a t e d . Some g e n e r a l f i n d i n g s r e l a t e t o (a) community a t t i t u d e s and (b) s e r v i c e s f o r t h e hearing-handicapped child. Because o f i t s e x p l o r a t o r y n a t u r e , t h i s study must l e a v e s e v e r a l q u e s t i o n s unanswered; b u t t h e importance o f e a r l y d i a g n o s i s and c o - o p e r a t i v e r e l a t i o n s h i p s between c l i n i c s , p a r e n t s , and s c h o o l , a r e c l e a r l y i n d i c a t e d . S o c i a l Work S e r v i c e s a r e p a r t i c u l a r l y r e l e v a n t i f t h e d i f f e r e n t i a l needs o f c h i l d r e n ( i n f a m i l y terms a s w e l l a s degrees o f h e a r i n g l o s s ) a r e t o be met.  i  TABLE OF CONTENTS ' page Chapter I.  The Deaf C h i l d and. H i s  Problems  Concepts o f d e a f n e s s - f r o m e v i l s p i r i t s t o a u d i o l o g y . Some q u e s t i o n s from a s o c i a l work p o i n t o f view. Scope and method o f s t u d y . I n c i d e n c e o f d e a f n e s s i n B r i t i s h Columbia. Deafness d e f i n e d C h a p t e r 2.  The S c h o o l C h i l d ;  I m p l i c a t i o n s o f Hearing Impairment  I n t e l l i g e n c e and p e r s o n a l i t y . The c h i l d as he grows. The p a r e n t s * p o i n t o f view. The c h i l d i n r e l a t i o n t o other children. The c h i l d i n r e l a t i o n t o s c h o o l C h a p t e r 3.  1  9  The S c h o o l C h i l d and H i s F a m i l y  Acceptance o f t h e h a n d i c a p . Knowledge o f the h a n d i c a p . View o f t h e problems. Mutual support between p a r e n t s . Breadth of i n t e r e s t . The more h e l p f u l f a m i l y . The l e s s helpful family C h a p t e r 4.  S e r v i c e s f o r t h e School-Aped  20  Child  The meaning o f the h a n d i c a p . The c o n t r i b u t i o n s o f t h e f a m i l y . The s c h o o l and t h e c h i l d . The community and the c h i l d . The l o c a l scene  33  Appendices: A. Sample q u e s t i o n n a i r e . B. , B i b l i o g r a p h y .  TABLES IN THE T a b l e A.  T a b l e B.  TEXT  C l a s s i f i c a t i o n A c c o r d i n g t o Degree o f H e a r i n g Loss e s t a b l i s h e d Age o f R e a l i z a t i o n and P r o g r e s s i n H p - R e a d i n g .......  7 26  ACKNOWLEDGEMENTS  S p e c i a l t h a n k s a r e due t o D r . & Mrs. J.L. Robinson and t h e i r daughter Jo-Anne f o r i n v a l u a b l e i n f o r m a t i o n and even more i n v a l u a b l e i n s p i r a t i o n ; t o t h e e i g h t y parents o f hearing-handicapped c h i l d r e n f o r t h e i r eager and t h o u g h t f u l r e s p o n s e s t o q u e s t i o n n a i r e s , and i n t e r v i e w s ; t o Dr. Reba W i l l e t s , D i r e c t o r , Vancouver  School  H e a l t h S e r v i c e s f o r h e r i n t e r e s t and u n d e r s t a n d i n g , and t o D r . Leonard Marsh f o r h i s sound a d v i c e and s t e a d y encouragement.  FAMILY CONTRIBUTIONS IN TREATMENT OF THE HEARING-HA.NDICAPPED CHILD OF SCHOOL AGE  CHAPTER  THE  ONE  DEAF CHILD AND  HIS PROBLEM  I n a n c i e n t t i m e s , i t would have been a simple m a t t e r t o d i s c u s s t h e problem o f h e a r i n g impairment.  Without knowledge o f t h e p h y s i o l o g y o f  t h e e a r . o r o f t h e p h y s i c s o f sound, s u p e r s t i t i o n r e i g n e d supreme, and t h e of deafness  was  b e l i e v e d t o be e v i l s p i r i t s . , ' What was  p o i n t o f view, t h e d e a f p e r s o n was consigned  t o a sub-human l i f e .  c e n t u r y was  social  c o n s i d e r e d i n c a p a b l e o f l e a r n i n g , and  was  I t appears t h a t not u n t i l t h e s i x t e e n t h  any attempt made t o educate deaf  c e n t u r i e s such e d u c a t i o n was  f a r worse from a  cause  c h i l d r e n ; and f o r t h e next  two  a v a i l a b l e o n l y t o t h e c h i l d r e n o f t h e wealthy.  W i t h t h e development o f p u b l i c s c h o o l s f o r t h e d e a f , which t o o k p l a c e almost c o n c u r r e n t l y i n F r a n c e , Germany and E n g l a n d d u r i n g t h e  eighteenth  c e n t u r y , t h e r e arose a c o n f l i c t which, even t o d a y , has not c o m p l e t e l y appeared.  There are p r o t a g o n i s t s b o t h f o r t h e  ' O r a l System, u s i n g speech and 1  l i p - r e a d i n g as t h e c h i e f means o f i n s t r u c t i o n , and f o r t h e u s i n g s i g n s and the manual a l p h a b e t .  The  'deaf-mute '. 1  s t u d e n t s who  can make  g r e a t e r s t r e s s on t e a c h i n g speech has,  contributed t o the obsolescence, and  'Manual' System,  The t r e n d , however, appears t o be toward  an i n c r e a s i n g use o f the O r a l System f o r t h o s e p r o g r e s s b y t h i s method.  dis-  any happily,  i n r e c e n t y e a r s , o f t h e terms 'deaf and dumb*  O b v i o u s l y , when t h e d e a f are capable o f speech t h e s e  terms  are no l o n g e r a p p l i c a b l e . The  spread o f e d u c a t i o n a l o p p o r t u n i t i e s f o r t h e d e a f  was  f o l l o w e d by advances i n knowledge o f t h e e a r , and o f h e a r i n g d i s o r d e r s . and  s u r g i c a l treatment,  Medical  as w e l l as p r e v e n t i v e measures, have g r a d u a l l y become  - 2available.  I n t h e e a r l y p a r t o f the t w e n t i e t h c e n t u r y , a b i g s t e p forward  ,  c o u l d be t a k e n w i t h t h e development o f t h e e l e c t r i c a l h e a r i n g a i d , and e l e c t r i c a l t e s t i n g methods.  L a t e r s t i l l came a n i n t e r e s t i n t h e p e r s o n a l i t y  o f t h e d e a f , and a number o f p s y c h o l o g i c a l i n v e s t i g a t i o n s were F o l l o w i n g World War I I , w i t h t h e e s t a b l i s h m e n t  undertaken.  of aural  r e h a b i l i t a t i o n c e n t r e s b y t h e U n i t e d S t a t e s armed f o r c e s , t h e p r o f e s s i o n o f a u d i o l o g y was b o r n .  An a u d i o l o g i s t has been d e s c r i b e d a s "the  individual  whose p r i m a r y i n t e r e s t i s i n t h e measurement o f h e a r i n g l o s s and t h e t a t i o n o f those with hearing impairment".  rehabili-  A l t h o u g h the. t e r m i s l e s s w i d e l y  1  used i n o t h e r c o u n t r i e s > t h e r e are s i m i l a r t r e n d s toward u t i l i z a t i o n o f nonm e d i c a l p e r s o n n e l i n c l i n i c s e s t a b l i s h e d f o r t h e purposes o f t h e measurement, and treatment  o f hearing  impairment.  These developments i n t h e m e d i c a l and a u d i o l o g i c a l f i e l d s have, i n e v i t a b l y , a f f e c t e d e d u c a t i o n a l methods, and, undoubtedly, c o n t r i b u t e d t o t h e p r e s e n t ascendance o f t h e o r a l method.. Irene and A.W.G. E w i n g ^ have o u t l i n e d f o u r t r e n d s i n the t w e n t i e t h century education o f the deaf c h i l d .  These  are summarized a s . f o l l o w s : 1.  The development o f a s s o c i a t i o n s o f t h e p a r e n t s o f deaf  c h i l d r e n s e e k i n g t o obtain.improvements i n t h e p r o v i s i o n f o r t h e i r c h i l d r e n ' s v  education.  An i n c r e a s i n g number o f p a r e n t s are l e a r n i n g about p r i n c i p l e s and  methods o f o r a l e d u c a t i o n i n o r d e r t h a t t h e y may p r o v i d e t h e i r c h i l d r e n w i t h " t a l k i n g environments" f r o m a n e a r l y 2.  age.  E a r l i e r d e t e c t i o n o f d e a f n e s s which has been f o l l o w e d b y  an a c c e l e r a t i o n i n t h e e s t a b l i s h m e n t o f n u r s e r y and i n f a n t  New  schools.  * Newby, Hayes A., A u d i o l o g y . A p p l e t o n - C e n t u r y - C r o f t s York, N.Y., 1956, p . 1. 2  "Nursery  Inc.,  Ewing, Irene and A.W.G.. Speech and t h e Deaf C h i l d . Manchester  U n i v e r s i t y P r e s s , Manchester, 1954, p . 56 - 6 l .  - 3 and p r e s c h o o l s a r e i n e x i s t e n c e t o a s s i s t t h e c h i l d i n a d j u s t i n g t o h i s w o r l d , t o h e l p him d e v e l o p a concept o f the w o r l d about him t h r o u g h  worth-while  e x p e r i e n c e s , and t h u s t o l e a d him t o t h e p o i n t where he has a d e s i r e f o r o r a l communication.  To do t h i s t h e r e must be a f o u n d a t i o n o f r e a l  e x p e r i e n c e s i n o r d e r t h a t he may ;3..  have, a b a s i s f o r language  life-like  and o r a l  Growing r e c o g n i t i o n o f need f o r s p e c i a l i z e d  communication.  training,  knowledge, and s k i l l , as w e l l as p e r s o n a l q u a l i t i e s , i n t e a c h e r s o f t h e d e a f . 4. the deaf.  S y s t e m a t i c i n v e s t i g a t i o n o f problems i n o r a l e d u c a t i o n o f  T h i s p o i n t i s r e - i n f o r c e d by B a r k e r at a l who  state that:  "Probably  r e s e a r c h w i l l show t h a t t h e r e s i d e n t i a l s c h o o l , t h e day s c h o o l , and t h e  regular  p u b l i c s c h o o l are each s u p e r i o r i n meeting t h e e m o t i o n a l and e d u c a t i o n a l needs o f d i f f e r e n t groups o f c h i l d r e n .  The t a s k o f r e s e a r c h i s t o f o r m u l a t e  p r i n c i p l e s f o r t h e guidance o f e d u c a t o r s so t h a t c h i l d r e n can be p l a c e d p r o p e r l y b e f o r e t h e y l a n g u i s h i n u n f a v o u r a b l e s c h o o l environments."^ I t can be seen t h a t p r o g r e s s has been made i n meeting e d u c a t i o n a l and p h y s i c a l needs o f t h e h e a r i n g - h a n d i c a p p e d  child.  The  the literature  i s l e s s c l e a r about r e s o u r c e s t o meet t h e e m o t i o n a l and s o c i a l needs; and i t i s p r e c i s e l y y t h e s e needs t h a t are o f p a r t i c u l a r concern t o t h e s o c i a l worker. number o f q u e s t i o n s are l i k e l y t o come t o h i s mind.  Do t h e e m o t i o n a l and  s o c i a l needs o f t h e h e a r i n g - h a n d i c a p p e d d i f f e r i n any way of the hearing c h i l d ? How  f r o m s i m i l a r needs  What are some o f t h e problems as seen by t h e f a m i l y ?  i s t h e f a m i l y meeting t h e problems?  successful than others?  Are t h e r e some f a m i l i e s who  are more  In what ways do t h e s c h o o l and t h e community co-operate  w i t h t h e f a m i l y i n p r o v i d i n g f o r the c h i l d ' s needs?  1  Washington, D.C.,  A  MJlIe;r,&^ November, 1952,  V o l t a Review. p.421.'  B a r k e r a t a l Adjustment t o P h y s i c a l Handicap and I l l n e s s : A Survey, o f t h e S o c i a l P s y c h o l o ^ y ~ o f Physique and D i s a b i l i t y . S o c i a l Research C o u n c i l , New York, N.Y., 1953, . 31 2  p  2  1,1  -4Scope and Method of Study The obvious way i n which to find answers to these questions i s to approach families with hearing-handicapped children.  With this i n mind a  questionnaire was formulated, a sample of which may be found i n Appendix A. These were forwarded to the families of children attending Jericho H i l l School for the Deaf. At that time there were 177 such children. It was decided to make contact only with those families living within the Province of British Columbia, of whom there were 148 with 154 hearing-handicapped children.  1  Gf these, 92 families lived within the Greater  Vancouver area and 56 i n other parts of the province.2 Excluded, i n addition to the children whose parents l i v e outside, the province, were the Indian children, and the wards of the Superintendent of Child Welfare, and of the Children's Aid Societies.3  Of the 154 questionnaires sent out, 82 were  returned, of which 79 were usable (2 were marked 'not known at this address" and 1 was  uncompleted). :  Following the examination of the completed questionnaires,  interviews were held with seven families i n the Greater Vancouver area. These were chosen on the basis of indications of helpfulness to the child.  Four  ^ Six of the families had two children with hearing impairment. 2 For the purposes of this study, Greater Vancouver includes Vancouver, North Vancouver, West Vancouver, Burnaby, New Westminster, Richmond and Sea Island. . . . " 3 Consideration was given to including the wards i n the study, but the idea was discarded after perusal of five of the ten case records. In only one of these five cases was the 'child removed from his own family as a direct result of his hearing handicap. The situation, i n the one case, was so complex as to be considered atypical of situations i n which hearing impairment i s a problem. M h i s cursory review of the cases gave rise to at least two questions which might well merit further study: (1) how does the incidence of handicaps among wards compare with that among the general population of children; (2) what i s the effect upon the ward of the double handicap, i.e., removal . . from his own family, and physical impairment? '  - 5families who appeared .to be particularly well-informed and understanding, . and three who appeared minimally so, were interviewed.  In five cases the  hearing-handicapped children were present and i n three cases both parents were interviewed. The interviews were unstructured, with the parents being free to discuss their particular'problems and remedies with respect to the hearing-handicapped  child.  Apparent-Incidence of Hearing Handicaps The numbers of children i n British Columbia suffering from hearing impairment are not, at present, available.  Jericho H i l l School  for the Deaf and Blind, serving the Province of British Columbia, accepts children from five years of age who have a.hearing loss of 35 decibels or more.  The children are eighteen or nineteen years of age when they graduate.  As of January, I960, there were 177 pupils.  By comparison, the number of  blind children i n the school was 79. The Registry for Handicapped Children i s another source of information on the incidence of hearing impairment among children i n British Columbia.  Their figures, however, may not.present a complete census. They  are dependent upon the reporting of :doctors, public health nurses and hospitals throughout the province, and of the Children's Health Centre i n Vancouver.  In January, I960, the Registry showed children between the ages  of 5 and 14 years, who were deaf, numbered 59> and those with hearing impairment numbered 353.  Those considered deaf had a hearing loss of 70  decibels or more, but no definite criteria were set to describe hearing impairment. The discrepancy i n numbers between Jericho H i l l School and the Registry can be accounted for by the children with defective hearing,  - 6 attending the public school system.  Each individual school has a record  of the children -with defective hearing i n that particular school, but . nowhere- are these centrally compiled. ' In the Vancouver schools, a l l children, undergo hearing tests i n Grade 2 and Grade 4. If hearing loss i s 10 decibels or more, various steps may be taken according to the. degree of the loss. A simple re-arrangement of seating i n the classroom may suffice; parents are notified; referral may be made to the family doctor; a temporary transfer to Jericho H i l l School may be arranged to provide extra tutoring i n speech and language; or a permanent transfer may be necessary.  It i s considered  that a child with a loss up to 50 decibels can manage satisfactorily i n hearing classes, i f intellectual or emotional d i f f i c u l t i e s do not complicate the situation.  The total number $£ these children at present i n the public  school system is. not known. Deafness Defined :  -  Widely used definitions of the terms used i n speaking of  the deaf are those established by the Committee on Nomenclature of the Conference of Executives of. the American Schools for the Deaf. These are as follows: "The deaf:  those i n whom the sense of hearing i s non-functional for the  ordinary purposes of l i f e .  This general group i s made up of two distinct  classes based entirely on the time of the loss of hearing: (a) the congenitally deaf - those who were bom deaf; (b) the adventitiously deaf - those who were born with normal hearing but i n whom the sense of hearing became nonfunctional .later through, illness or accident. The hard-of-hearing: those i n whom the sense of. hearing, although defective i s functional with or without a hearing a i d "  1  •^-Barker. Roger G. et al.' Adjustment to Physical Handicapped Illness: A Survey of the Social Psychology of Physique and Disability. Social Science Research Council, New York, N.Y., 1953, p. 190.  - 7An increasing use i s being made of the classification according to hearing loss established through audiometric testing.  Table  A presents this classification. T ble A a  Classification According to Degree of Hearing Loss Established by Audiometric Testing Extent of Disability  Amount of Loss,decibels  Submarginal  15-25  Marginal  25 - 35  Moderate  35 - 50  Severe  50-70  Profound  over 70  Source.: Adapted from Levine, EriMS., Youth i n a Soundless World . Mew York University Press, 1956, p. 34 It i s not possible to state at exactly what point i n this scale the deaf and the hard-of-hearing, according to the definitions, can be differentiated.  The reason for this appears to. be that factors other  than degree.of hearing loss enter into determining at what point hearing becomes non-functional. For instance, the physical, intellectual, and emotional capacity of the individual w i l l affect the degree to which he u t i l i z e s residual hearing. Because, i n general,schools for the deaf make use of the classification according to degree of hearing loss, and the subject of this study i s hearing-handicapped  children of school age, the terms used w i l l be  related to this classification.  It i s recognized that differences exist  between the deaf and the hard-of-hearing,, but the distinction need not be rigorous, i n this study, because i t s area of concern i s children with hearing impairment, without reference to the degree or cause of the impairment, or to the age at which hearing i s lost.  • •'  . -.8 - '; Defective hearing i s not always, the sole handicap borne by. some children.  A l l too frequently there are further complications such as  cerebral palsy, mentai retardation, and impaired sight.  But here again,  i t , i s not intended to consider, i n this study, the special problems inherent i n these situations.  Nor [will there be any attempt made to present material "  on the specialized subject of the education of deaf children, except insofar as'schooling affects the emotional and social development of the hearinghandicapped child.  CHAPTER TWO .' THE SCHOOL CHILD: IMPLICATIONS OF HEARING IMPAIRMENT  Psychological studies, designed to measure the, intelligence and personality of deaf children, have been undertaken since the beginning of this century. One of the earliest of these compared, by means of physical and psychological tests, a deaf group and a hearing group of nine-year-old children.  The results showed "the deaf as good as or better than the hearing  i n physical measurements, manual dexterity and athletic s k i l l s . memory and observation, the deaf were.found markedly superior".  In tests of 1  Subsequent  studies have produced a variety of results, some concluding deaf children have normal intelligence, others that they are mentally retarded.  The reason  for the wide divergence i n results i s considered to l i e i n the failure, to date, to devise intelligence tests suitable for use with the deaf. A comparative study done i n 1941 "gives further evidence to support the conclusion that the deaf child i s normal mentally i f his ability i s measured on a test that does not involve the use of language for direction or response."2 i t stands to reason that, so long as language i s a part of the testing process, the deaf child i s immediately at a disadvantage.  Until more acuurate tests  are devised, the present consensus of opinion appears to be that deaf children have normal intelligance, with the same wide variations among individuals as may be seen i n the general population.  Levine, Edna S., Youth i n a Soundless World. New York University Press; New York; 1956, p. 57. 1  Ibid, p. 65.  - 10 Personality tests'are-a more recent development. Levine, in testing teenage g i r l s i n a residential school for the deaf, made careful preparations to avoid the effects of the language barrier.  She states that:  "The personality pattern of.the deaf subjects was found to be characterized by: l ) pronounced underdevelopment i n conceptual forms of mental activity; 2) emotional underdevelopment;. 3) a substantial lag i n understanding the dynamics of interpersonal relationships as well as the world about; 4) a highly egocentric l i f e perspective; 5) a markedly constricted l i f e area; and 6) a rigid adherence to the book-of-etiquette coderather than inner sensibility as standards for behaving and even for feeling."  1  The study does not indicate  to what degree anyone of these t r a i t s may be a result of the social restrictions of l i f e i n a residential school rather than solely the result of the hearing handicap.  The girls i n the study group were between the ages  of fifteen and eighteen and had been i n residence i n a school for the deaf from the ages of five to seven.  Thus, for more than half of their lives they  had been, to a large extent, segregated from the hearing community. Although, when reviewing a number of personality tests on deaf children, Levine does not draw attention to this fact, nevertheless, i t i s apparent that the results of the tests are closer to those obtained on hearing children where the deaf subjects are day rather than residential pupils. It would appear that residential living for lengthy periods has an effect on personality but that this effect has not been accurately measured noir has i t been separated from the effects of defective hearing. There should be one further warning i n respect to personality ., tests.  The individuals i n a study group do not exhibit a l l of the t r a i t s to  1  2  op. c i t . p. 146  op. c i t . pp. 6 5 - 6 8  2  - l i the same degree; and some may not exhibit any of them to any appreciable degree.  There i s danger,, then, i n assuming that a particular child with  a hearing defect w i l l , as a result of this defect, develop certain personality traits.  Knowledge of personality patterns can be helpful i n increasing the  understanding of the possible effects of the handicap on the personality, but i t should be recognized that the pattern i s a general picture, a trend, and cannot be applied i n total, to each individual deaf child.  "Although there  i s evidence that there are certain common reactions to, as well as common problems i n , hearing lossf i t i s also true that vastly different reactions occur, depending on the dynamic forces within each individual personality."! It appears that, despite historical attitudes, there i s no proof of marked differences between the deaf child and the hearing child i n intelligence or i n personality. "The deaf child differs from the hearing child only i n that he cannot hear, and, not hearing, i s unable to communicate i n the ordinary way.  His handicap i s very great because of his lack of words  to express his thoughts, needs and desires."2 What does this handicap meani, i n day-to-day l i f e , to thechild and to those around him? From both the questionnaires and the interviews with the parents of deaf children, i t was possible to pick out a number of d i f f i c u l t i e s arising directly from hearing impairment. under five.headings:  These w i l l be discussed  effects upon the child as he grows; effects upon the  parents; effects upon other children in.the family; the deaf child i n relation  1 Fibush, Esther W., "The Problem of Hearing Loss", Social Casework, Volume XXXVI Number 3, March 1955, p. 124. (F.S.A.A., N.Y.) •2 Groht, Mildred A., - Natural Language for Deaf Children, Alexander Graham Bell Association for the Deaf, Inc., Washington, D.C., 1958, p. 5.  to peer groups; and the deaf child i n relations to school. The Child as He Grows  „•  The most frequently mentioned d i f f i c u l t y from the child s 1  point of view i s his inability to understand what i s said to him, and the reverse of this, his inability to make himself understood to others.  It i s  l i k e l y that hie greatest hardship i n this respect w i l l occur i n his early years, when his a b i l i t y to lip-read and to speak i s less well developed.  A little  of what this means w i l l be recognized by parents of hearing children, when they recall that time when their children were between the ages of one and three years. The child i s not able to understand, or be understood, through the medium of speech, but is.highly mobile and fast developing a w i l l of his own. Most parents pray for the time to come when they can "reason with the child", realizing that, when more adequate communication i s established between them, l i f e i s easier both for themselves and for the child.  For the  hearing-handicapped child, this period of tension and frustration i s an extended one and i s only gradually l e f t behind as he arduously learns to make use of language. A number of parents wrote about their c h i l d s tendency to 1  selfishness and a wariness of possessions.  It i s possible that this may be  a result of the unsatisfactory nature of their contact with people, who demand so much i n the way of understanding, and who f a i l , i n turn, to understand.  Material objects, by contrast, make no demands, do not change, and  are. altogether much more comfortable to be with.  The value to' them of their  possessions i s l i k e l y to increase as their satisfaction i n personal contacts decreases. It i s probably for similar reasons that some children with  hearing loss stay more to themselves, withdraw, or become on-lookers rather than participants^  It i s almost as though the satisfactions they might derive  from personal contact are not as'yet •worth the immense effort i t requires for these children to obtain them. Some;parents reported their children reacting i n the opposite direction, being overly impatient, demanding, dominating, and displaying a tendency to show-off.  Could this, perhaps, be a substitution  of action for mutual interchange' of thoughts and ideas, which i s so much more d i f f i c u l t for them? This leads.right into the d i f f i c u l t i e s the hearing-handicapped child encounters i n participating i n groups.  Since his "hearing" depends to  varying degrees on lip-reading, he must have, a clear view of the face of the person who i s speaking, and this i s not always a possibility i f members:>of the group are moving around, or i f the light i s poor.  The child may discover  who i s speaking just when the conversation passes on to another member of the group.  He can only "listen to" one person at a time, and he i s lost when  there are interruptions, or. a quick interchange. The heading person, too, can become confused i n a large group where many people are talking at the same time, but he i s able, relatively easily, to follow a single conversation even when i t moves quickly from one member of the group to another. This the hearing-handicapped person cannot do, so that, as the size of the group increases, so does his discomfort. It can be seen that there are many ways i n which the inability to understand and to be understood serve to build up tension and frustration i n hearing-handicapped children.  Not infrequently, these are expressed  through tantrums and sleep disturbances.  In most cases these are outgrown  but i t i s the opinion-of some of the parents that this i s at the price of a rather rigid control of feelings.  It i s their contention that many of these  - 14 children appear cooler, calmer, and quieter than their hearing contemporaries, because to express any degree of feeling might open the floodgates on the intense feelings they have carefully learned to control. A second major d i f f i c u l t y (and one reported on many of the questionnaires) pertains to the attitudes of hearing people toward the hearinghandicapped.  These were variously described as indifferent, impatient,  superstitious, and ignorant. Such attitudes would not l i k e l y affect the child u n t i l he reaches approximately school age, the time when he i s beginning to seek companionship outside the family group.  Some parents find their children  becoming sensitive, timid, and shy i n response to these attitudes.  There i s  a tendency for a few to give i n more easily to their hearing playmates i n ; order to retain their friendship.  Most children, at some stages, experience  embarrassment when evidence of their deafness.is displayed i n public, such as the use of signs or gestures. Gradually he begins to see himself as "different".  Up until this time he has known he could not "hear" the way  other people could but now he begins to understand more nearly the f u l l meaning of the handicap.  In a sense, he6.1earns what hearing means!  Certainly/to take on some of.the public's valuation of- him as a hearinghandicapped person: but, unfortunately, i n many cases this valuation i s based on lack of knowledge.  It i s hard for him to understand why he must suffer  this handicap which, i n addition to the many d i f f i c u l t i e s . i t raises for him, also devaluates him i n the eyes of the world.  He thus forms certain  attitudes about himself and about other people.  He accepts, at least to a  degree, the public's evaluation of him, but, at the same time, he i s resentful of i t , and turn's this resentment against the public. A third major area of concern for the hearing-handicapped child i s i n relation to a career. This begins to take on serious aspects  toward the latter part of the child's schooling.  Because of the d i f f i c u l t i e s  i n communication and the consequent need to spend more time on language development, the child with hearing loss w i l l have less general education than the hearing child at a comparable age.  In addition, f a c i l i t i e s for  higher education and for vocational training are few.  However, even i f he  should enter- the employment market as well equipped, vocationally, as the .hearing person, he' meets a further.obstacle i n the form of misconceptions and misunderstandings on the.part of employers.  For the hearing-handicapped ;  person, preparation for,and placement i n , suitable employment have been largely neglected subjects.  It is-not proposed to go into i t further here,  since i t i s beyond the scope of this study, but i t must be noted as a major problem for the child as he nears-the end of his schooling. The Parents' Point of View "'. The earliest and perhaps the most d i f f i c u l t hurdle the parents of the hearing-handicapped child must overcome i s their own feelings about the child.  This was not indicated so much on the completed questionnaire,  perhaps because of i t s emphasis on the child, but i t became quite clear i n the interviews with parents.  The manner i n which feelings are handled vary,  of course, wLth each individual but some of the feelings themselves are common, not only to parents of children with.hearing impairment, but to parents of a l l handicapped children. The fact of having given birth to an imperfect child i s a blow to self-esteem, whatever the cause may have been.  Even i f the child  loses his hearing later i n l i f e through illness, there i s a tendency again for the parents i n some degree to blame themselves. The reaction may be to deny or minimize the handicap, so that steps to lessen i t are not taken. In other instances, the parents may reject the child himself because of his  - 16 handicap.  If this arouses too much guilt, they might t r y to disprove the  rejection, even to themselves, by over-solicitous care of the child, thus retarding his growth toward independence.  Whatever the reaction, there i s  no doubt that the emotions can often come close to being overwhelming.. Calm appraisal of facts helps to allay these emotions i n the f i r s t place facts about the handicap, and what can be done to mitigate i t .  There should  also be an opportunity for parents to discuss their feelings and to recognize that a l l parents have negative, as well as positive, feelings toward their children.  An awareness of the new feelings clears the way for the acceptance  of the facts, and the ability to face them constructively. Many of the day-to-day d i f f i c u l t i e s mentioned by the parents relate to the child-*s inability.tb understand or to make himself understood. This poses problems for the parents i n the child's management and training. How do you explain the rules he must abide by, or the plans to have a picnic next Sunday, or what i t w i l l be like for him when he goes to school? How do you c a l l him i n from play? Because there are so many frustrations for him, he has a tendency to anger, stubbornness, and tantrums.  How do you  reassure him i n these instances; or when he i s frightened? Some of the parents were understandably concerned about spoiling the child i n an attempt to avoid upsets as much as possible. Sleep disturbances which seem to.occur more frequently for the hearing-handicapped child are another d i f f i c u l t y faced by parents. Earlier, i t was suggested that these disturbances might be caused by excessive tension.  There i s another possible cause.  The child who cannot hear i s i n  contact with the world around him mainly through his eyes; so that when he i s i n the dark, or closes his eyes, he i s cut off from the world - isolated.  He  does not hear the comforting noises of the home which assure him a l l i s normal.  - 17 Many parents reported that the children seemed to need nothing more than reassurance that someone was close by.  As the child becomes older, some  parents find d i f f i c u l t y i n imparting such things as sex information and social niceties.  Employment prospects for the child are of deep concern  to the parents;even earlier than to the. child, because parents are more aware of the obstacles the child must overcome, and of the paucity of resources to help him. The Child in Relation to Other Children There are two important ways i n which other children affect the development of the deaf child. ,The f i r s t --which applies, of course, only to children who have brothers: and sisters within reasonable reach of their own age - i s the influence of siblings.. The other - basic for a"n children, almost without exception - i s his relation with his playmates. His. peers (as socialogical terminology has now made them familiar) affect . him i n communication, education, play  i n a l l that makes up "socialization"!  .The importance of siblings, obviously,.could  be a subject  of special study*, This was not possible i n the limits of the present study. Neither on the questionnaire, nor.in interviews has there been any attempt to study the effects of hearing impairment i n one child upon other children In the family.  However, a few of the parents spontaneously; mentioned that  their hearing children, particularly i n younger years, tended to be jealous of the child with hearing loss.  This, they believe, i s a result of the extra  time and attention that, of necessity, i s spent i n communication with the hearing-handicapped child.  It i s possible, on the other hand, that hearing  brothers and sisters may be a real asset to a deaf child because he learns other methods of communication more continuously.  Much of what will.be  discussed i n the next paragraphs i n relation to peer groups w i l l also be  - 18 applicable to other children within the family. As far as peer groups are concerned, when children are very young, they play alongMde each other, rather than with each other, and at this, stage the hearing-handicapped  child, apparently, has l i t t l e d i f f i c u l t y .  Even i n the early action games he i s quite at home. But when the rules of the.game become more complicated, or when "pretending" or "make-believe" games are initiated, lack of speech and hearing becomes a barrier to play. It takes time and patience to help the child understand rules, or to explain the kind of make-believe necessary, arid by that time the hearing children w i l l probably have lost interest:-;. Team games were also' reported as a problem, especially when speech i s a necessary part of the game. The d i f f i c u l t i e s are much the same as are posed by participation i n groups, which was discussed earlier.  This  holds truej too, for the teen-age "mixer". Many of the children with hearing loss tend to t i r e more easily than the hearing-child, possibly because of the intense 'concentration required on their part, i n order to catch with their eyes what their ears cannot hear.' Some of the children were reported to have been subjected' to teasing by playmates, with the result that they prefer'the company of similarly handicapped children . They are cautious and careful, tending to approach hearing children with reserve and suspicion. Most of them, however, had one or two hearing friends, whom they had known for some time, and with whom they were comfortable and intimate. The Child i n Relation to School • • " ' . The child, whose hearing loss necessitates his attending the School for the Deaf, and who must leave homei to do so, sometimes finds i t hard to understand why he i s sent away to school when other children are not. Even  - 19 i f he could "hear" an explanation he i s frequently too young to grasp i t , since many of the children start school at five years of age.  A l l too often he  sees i t as a rejection by his parents - a banishment from his home. Those parents who recognize this feeling i n their child are at a loss to know how to combat i t .  For those children who are day pupils at the school, there are  often long distances to travel, resulting i n a lengthened school day. leaves*little time for him to play with neighbourhood children.  This  And, of  course, the very fact that he attends a different school helps to separate him from these children. Some of the parents are convinced that the hard-of-hearing child, i n particular, benefits from the stimulation he receives when attending a hearing school. On the other hand, many of the children are not happy i n these schools because they are l e f t out of activities and, not infrequently, teased by the hearing children.  There i s need for more study on this question.  Indeed, this applies to much of what has been opened up by this exploratory study. The parents who have taken part i n this enquiry have listed a wide variety of problems affecting many aspects of the child's l i f e . It i s probable that the l i s t i s far from exhaustive} but the f i r s t purpose . achieved i s that of giving a helpful picture of the implications of hearing impairment. .  CHAPTER THREE  THE SCHOOL CHILD AND HIS FAMILY  How can the deaf child be helped by his parents? There seem to be almost as many different ways of handling d i f f i c u l t i e s arising out of hearing impairment as there were parents who took part i n the study. At least this seems to be the only conclusion, on f i r s t examination. However, i t i s possible, from the information provided, to detect certain elements i n the family situations .which seem to bear upon the degree of help and understanding available to the hearing-handicapped child within his family. ' The elements which can be identified have been treated as separate entities for the sake of ease of discussions, but i t w i l l be obvious that they are closely inter-related; frequently, they merge and overlap. Acceptance of the Handicap ...  In the previous chapter, mention was made of the feelings  aroused i n parents by the knowledge of their child's handicap. Sometimes these feelings can be allayed, to some extent, by factual information about the impairment and the steps that can be taken to overcome i t to the greatest possible degree.  At other times, however, the emotions, themselves, may stand  i n the way of facing the facts, with unhappy results for the child.  Acceptance  of the handicap refers to the ability of the parents to face the facts realistically. - .  . .  Cough]in,, who studied attitudes of parents of orthopedically crippled children, arrived at some interesting results which might well be  - 21 - . applicable to parents of children with different handicaps.  Four "categories  of parental attitudes" were identified on the basis of interviews and case history material, as follows: "1.  Complete emotional acceptance of the child (providing  him with security "and protecting him from feelings of inferiority) together with a r e a l i s t i c intellectual insight into his physical condition and medical and educational requirements. 2.  Complete emotional acceptance • of the child without, f u l l  intellectual realization of the situation facing him. 3.  Unfavourable emotional attitudes (oversolicitude, rejection,  or pushing beyond capacity) with adequate understanding of the child's physical state and the educational and medical requirements. 4.  Extreme ignorance of the physical requirements of the  child together with destructive emotional attitudes."1 Varying de'grees/of acceptance were indicated by the parents participating i n the present study. For some there was long delay i n acknowledging the child's impairment.  More often than not, this was caused  by a lack, of resources i n the.community making i t d i f f i c u l t to obtain a firm diagnosis; or, i f this was made, f a i l i n g to provide the parents with guidance . In handling the problem.  Whatever the cause of the delay, for the child i t  meant the irrevocable loss of months, and sometimes years, i n providing the help he needed. . \ . Some, of the more troubled parents found the extra burden of a handicapped child more than they' could bear; and he was consigned to an  Barker, Roger G. et a l , Adjustment to Physical Handicap and Illness: A Survey of the Social Psychology of Physique and Disability; Social Science Research Council, New York, N.Y.,1953, p. 68  • - 22 institution at as. early an age as possible.  At the other extreme, there  were parents who seemed to embrace the idea of the handicap too wholeheartedly. Each and every d i f f i c u l t y with the child was blamed upon his defective hearing. The handicap loomed so large i t was d i f f i c u l t to see the child behind i t . A l l other needs, except the need to overcome the hearing loss, were, forgotten, with the result that no.time was l e f t for parents or child to relax and enjoy each other. Perhaps these are the conditions which produce the so-called "drilled personality" which i s sometimes attributed:to the deaf.;  v  Those parents who seemed to be most helpful to their hearing(  handicapped child had achieved a fine balance i n accepting the handicap r e a l i s t i c a l l y , but at the same time reserving greatest, concern for the child, rather than the hearing impairment.  This attitude on the part of the parents  appeared to provide the child, i n turn, with greater ease i n accepting his own handicap. Knowledge of the Handicap From comment's on the questionnaire, i t was clear that many parents f e l t keenly'the lack.of sources of information about  hearing-impairment.  A very few/had been able,to attend the John Tracy Clinic i n Los Angeles, and found this experience'invaluable. '.Considerably more, but less than half those completing the questionnaires, had made use of the correspondence course from this same c l i n i c .  One or two of these found the instructions too  complicated to be useful to them. Schools for the deaf were the most frequently used sources of information, followed by the Pre-School Hearing Project i n the Speech and Hearing Clinic at the Health Centre for Children i n Vancouver. The latter, which was. f i r s t established i n 1954> w i l l , no doubt, have a wider range of use as time goes on.  A few. of the parents subscribed to the Volta  Review, a magazine directed to parents of deaf, children and published i n the  - 23 United States. Other sources of. information were individuals - doctors, teachers, and other parents of deaf.children. There was considerable contrast i n the attitudes of parents to knowledge about hearing loss.  Some had searched diligently and learned a  great deal, while others had picked up what knowledge they could, casually, and frequently from less well-informed sources.  It i s axiomatic that those  parents with greater and more accurate knowledge were able to be more helpful to their child. In addition to general knowledge, there was also a contrast among parents i n the amount of specific knowledge possessed about their child. Although most parents were well aware of the child's condition, his progress, and his particular d i f f i c u l t i e s , there were some who did not know what range of hearing loss the child had, or, other than i n very general terms, how he got along i n school and with other children. Without this knowledge they could be of l i t t l e real help to their child. View of the Problems Another characteristic which distinguished the more helpful parents from the less helpful was the point of view taken i n facing the problems raised by the hearing impairment.  The two extremes were represented by those  parents who saw only the problems posed for their child, and those who only the problems posed for themselves.  saw  There were few, i f any, parents at  either extreme, but i n the families where the greater stress was laid on the problem faced by the child, rather than those faced by the parents, the atmosphere was more" l i k e l y to be one of understanding and helpfulness toward the child. An illustration df this point can be seen i n the different approaches taken by two mothers to their child's tantrums.  To both these  mothers, the tantrums were, to say the least, an inconvenience and ah  - 24 embarrassment. The one mother, however, looked beyond the (to her) troublesome behaviour and attempted to find the causes.  Recognizing that the child  was reacting to, from his point of viewy unwarranted and inexplicable deprivations,' she took the time and energy to explain the situation to him. Parenthetically, i t should be stated, that this time and energyis considerably magnified, as compared with similar situations which also, arise with hearing children.  The second mother was unable to see beyond her own perception of  the behaviour as being troublesome to her. gave up the tantrums.  She punished the' child until he  In the f i r s t instance, the experience for the child  was one of growth and learning; i n the second, one of inhibition and isolation. Mutual Support Between Parents Many of the comments on the questionnaires highlighted the need for parents to "work together" and to "share equally" i n respect to the hearing-handicapped child:  One mother pointed out that she f e l t very  strongly on this point because "there are many times when the mother i s too close to the problem to be wisely objective". Another mother stressed the necessity for "the love of parents for each other and for the child".  On  the other side of the picture, there were a few replies stating that the father was "not much help", or a help only "to pay b i l l s " . A similar variety of responses could be seen i n the interviews. In most cases, i t was important to the mother that her husband be present at the discussion.  It was obvious that this was their pattern, i n facing most of  their responsibilities.  On the other hand, i n one case, i t was impossible to  gain a picture of the father's role i n the family, even after direct questioning. It was apparent, i n this instance, that the mother's over-protection of the child was exaggerated to the point that she found i t necessary to exclude even the influence of the father. Where mutual support between parents i s lacking, not only w i l l  - 25 there be less likelihood of beneficial treatment for the child, within the family, but there i s a strong possibility thai damage may be done to him. Incompatibility of the parents w i l l lead, at best, to inconsistency of treatment, and, at worst, to a more or less complete withdrawal of attention from the child, as the thought and concern of the" parents centre, upon the marital difficulties.  This situation can only be harmful to the child.  Breadth of Interest .. .~ 'A final:characteristic^ common to those, families which appeared to be most helpful to their hearing-handicapped child, was the a b i l i t y of the parents to extend their interest and concern beyond their own child to a l l children with hearing impairment.  These are the families who  have sought and gained a great deal of information, and who have shared i t with other parents.  Many of them have taken an active part i n the community  i n an attempt to improve and increase f a c i l i t i e s for children with defective hearing. There are, undoubtedly, other characteristics which affect the contributions families can make i n the treatment of their hearinghandicapped child.  Those. discussed here are the ones indicated most clearly  i n the responses to the questionnaires, and i n the interviews, which formed the basis of this exploratory study. It was not the primary objective of the questionnaire enquiry to attempt s t a t i s t i c a l correlations, but some illustration of the data w i l l be of interest.  For instance, they provided sufficient information to permit a  comparison to be made between the more helpful and the less helpful families . i n relation to such important matters as a) early discovery of defective hearing, and b) progress i n lip-reading.  (See Table B). The f a i r l y wide  scatter of these phenomena i s notiotblej but there i s also some evidence that  - 26 -  hearing loss i s detectable between 6 months and 2 years i f the parents are alert to the possibility*  (The special eases of hearing 1©0S directly  attributable to a disease such as meningitis, which may not strike until 4 or 5, would have to be separated In a more detailed examination.) -  TABU! B:  Age of Realization aai.Frogress i n Lip ReacJing. ,  Lip  Discovered  R e a d i n g  learning  or Confirmed  i  II ;  Good  Pair  Total  i  11  t  II  I  AH  Birth to 6 nios»  1  3  X  0  2  0  4  7 r. 17 raps.  5  1  5  1  10  0  20  y?*ll  2  4  4  1  .. 3  4  9  9  18  2 « 2 yr.ll  , 3  3  4  0  5  1  12  4  16  1  1  2  1  2  5  5  7  12  0  O  1  0  0  3  1  3  12  12  17  3  22  13  51  28  18-1  3-5  yrs.  30Lder than 5  Total  3  7 22  79  - 27 Group I distinguishes as far as possible the more helpful ' families from the less helpful families (Group II). In Group I, 33. out of 51 or approximately 2/3 discovered the hearing impairment when the child was under 2 years of age. l i p read.  Only 12 out of 51, or roughly l/4 are just learning to  In Group II, i . e . the less helpful families, 14 out of 28, or only  l/2 discovered the hearing impairment when the child was under 2 years of age. As many as 12 out of 28, or nearly l/2 are. just learning to lip-read.. In order to illustrate further the characteristics distinguishing more helpful and less helpful families, details of five interviews may now be presented, the f i r s t three depicting helpful families, and the last two less helpful families. I  The More Helpful Families 1.  .: [  Fred i s a well- built, good-looking boy of fourteen, who  has been profoundly deaf'since birth.  For the past four years, he has been  attending a hearing school where he i s i n a class of ten other children with hearing impairment. Since attending this school, he discovered that deaf children are behind the hearing children i n their work, and this has increased his "urge to learn". His self-confidence has increased and he has improved i n manners , and dress.  He has belonged to hearing groups of cubs and scouts,  and he has hearing friends i n the neighbourhood.  He has some d i f f i c u l t y l i p -  reading strangers, and making his speech understood to themj but he i s able to communicate well with people he knows. Fred's father i s a skilled labourer and the finanicfel circumstances are quite comfortable. education.  The parents have had partial high-school  There, i s one other child i n the family,- a younger daughter. There was considerable delay i n learning of Fred's defective  hearing, although the parents had taken him to many doctors.  He was almost,  four years old before the medical decision was made that he was deaf.  The  - 28 parents were told, at this time, that nothing could be done u n t i l the child was old enough to go to a school for the dqaf. but not the defeatism.  They accepted the diagnosis,  Through further enquiries, they learned the child  could attend pre-school classes at the School for.the Deaf; and they, themselves,'. enrolled i n the John Tracy clinic correspondence  course.  Both parents were present during the interview, and i t was obvious that they shared i n their concern for the child.  The father had  helped with the Gubs when Fred f i r s t joined, i n order to pave the way for him, 'and to find -out the sort of d i f f i c u l t i e s that might arise, with which the parents could help him. . They both thought they tended to over-protect Fred, but tried to guard against this.  There were two major d i f f i c u l t i e s  which the parents believed adversely affected,, not only Fred, but a l l hearing-handicapped  children - a lack'of understanding and patience on the  part of hearing people i n relation to the deaf, and a lack of training and employment opportunities for the deaf. 2.  George, who i s now ten years of age,, lost his hearing  as a result of meningitis when he was five years of age.  Although he i s  profoundly deaf, he.speaks exceptionally well because he had acquired some language before losing his hearing. reading.  He has also proven to be adept at l i p  He attends a hearing school where he.is i n a class with ten other  .children with hearing impairment.  His progress there i s good. George has  lived i n the same neighbourhood for a number of years, and he has acquired quite a few hearing friends.  On the whole, however, he prefers deaf children  for playmates and, at the time of the interview, he had a friend from Jericho H i l l School staying with him.  He does not belong, to any organized hearing  groups. George's father i s manager of a store department, and financial  - 29 circumstances are comfortable.  Both parents completed high school. There  i s one other child i n the family, an older boy. . Although George's father was not present at the interview, the mother's references to him, and her frequent use of the term "we" indicated a sharing of responsibilities.  There had been no delay i n learning of the  child's handicap,, and the parents had taken immediate remedial steps. George had been enrolled at Jericho H i l l School two weeks after leaving hospital, and the parents had applied to the John;Tracy Clinic.  The couple subscribe  to the Volta, Review. There i s perhaps a slight tendency to over-stress the child's scholastic attainment to the detriment of his social adjustment. 1  In discussing some of the problems arising out of hearing impairment, the mother showed considerable awareness of the child's feelings. Since the loss of hearing had been sudden, his reactions had been rather violent, particularly i n the early stages. hearing, and;often talks about i t .  He apparently s t i i l remembers  The parents.have been active i n  disseminating knowledge to other parents, and i n community efforts to improve conditions for hearing-handicapped 3.  children.  Gordon, who i s twelve years old, has a hearing loss of  between seventy and eighty decibels as a result of an attack of meningitis. when he was eighteen months old. He i s attending a. hearing school i n a class with seven other hearing-handicapped progress i s satisfactory.  children.  He has a number of• hearing friends i n the neighbour-  hood, and at the community centre near-by. scouts.  He likes school, and his  He attends a hearing group of  His mother calls him an "extrovert" and he certainly demonstrated  a cheerful and friendly disposition, as well as an a b i l i t y to hold a conversation with strangers. He l i p reads well and is' f a i r l y easily understood. Gordon's father i s a master mariner earning a comfortable  • .-..*" '.'">';•''  • - 30 - •'  income for his family. The mother has one year of university education. There i s one other child i n the family, an older g i r l . Again, only the mother was present at this interview, but there was every indication of a good relationship between the parents. The mother believed her husband had greater d i f f i c u l t y i n accepting the disability •in his only son; and she showed considerable understanding of his feelings. She stressed the need to face the facts, and to avoid blaming a l l d i f f i c u l t i e s on the hearing impairment.  The couple sought information from the John Tracy  Clinic, and from teachers of the deaf.  They subscribe to the Volta Review.  Gordon's parents consider treatment of the  hearing-handicapped  child to be much the same as treatment of the hearing child, except that the hearing impairment presents d i f f i c u l t i e s i n communication.  Treatment should  be differentiated according to the particular child's needs, with recognition being granted to the problems posed for him by his handicap.  The parents  have taken part, with others, i n community efforts to assess.the educational and employment opportunities for hearing-handicapped  children.  II The Less Helpful Families 1.  Mary i s eleven years of age.  Her mother does not know the  extent of the hearing loss, but believes the child can hear the telephone ring. Mary has been.in three different residential schools for the deaf since she was five years of age.  Her progress i s f a i r .  During this past year, her  mother l e f t her employment so that the child could become a day pupil. Her mother described her as being a "lone wolf" but believe she i s mixing better with other,children now. The child, to date, has no hearing playmates. Mary's mother, who has been a' widow for the past six years, had been doing shift work, which did not allow her to give much attention to the children.  There i s one other child, an older boy.  A modest income permits  -31 the mother to give up her work, which she had done i n order to encourage the child to mix with hearing children. Discovery of Mary's impairment occurred when she was almost two.  The parents were i n touch with the John Tracy Clinic at that time, but  after the child's enrollment-in a school for the deaf no further efforts were made to acquire information.  Perhaps because the mother had no-one with whom  she. could share her problem, she stressed the d i f f i c u l t i e s from her own point of view and mentioned "the going had been tough for her". She recognized she had lacked patience with Mary, but hoped that she would, not be able to devote more time to the child. .. .2.  Bob and Jane are ten and six years of- age.  Their mother  believes Bob i s t o t a l l y deaf, but i s not sure about Jane because the child seems to make more use of her hearing aid than Bob.  Both children are  residential pupils i n the School for the Deaf, Bob for five years, and Jane for one.  The children come home for weekends, where Jane has one or two  hearing playmates, but Bob tends to associate mainly with another deaf child i n the neighbourhood. Neither child belongs to an organized group of hearing children.  The children are making f a i r progress i n school.  The Speech and  Hearing Clinic believes that Jane, has sufficient hearing to enable her to manage satisfactorily i n a hearing school, but her mother i s unable to admit this. Bob and Jane's father was killed four years ago and their mother remarried, two years ago.  The financial situation i s insecure and the  mother does shift work to augment the family income. daughter i n the family.  There i s an older  The indications are that the mother attempts to  shie.ld her husband from too many responsibilities for these, children of her firsts marriage.  - 32 Bob's hearing loss was discovered when he was eighteen months old.  Shortly after this the mother took the correspondence course from the  John Tracy Clinic, but saw i t only.as a means to/prepare the. child for entry into a school for the deaf.  Jane was much younger whert her loss was discovered,  since the mother was, i n a sense, expecting i t .  It i s apparent that she  exaggerates the degree of Jane's loss; and tends to leave major responsibilities for both children to the school;  Behaviour of the children which i s bothersome  to her, such as tantrums, has.been-met with "lickings".  She sees a l l of the  d i f f i c u l t i e s inherent i n hearing impairment as having been a tremendous burden to her.  This mother, with so many personal problems of her own, has been able  to contribute very l i t t l e to her children and has, i n fact, where possible, shifted responsibility for them to others.  CHAPTER FOUR  SERVICES FOR THE SCHOOL-AGED CHILD  . Gesell has said that "handicaps vary enormously with respect to origin, severity, and effects upon the personality of the growing child; Inheritance, disease, and injury may damage or distort the.normal course of development i n four different areas: sense,perception, motor performance, intelligence, and conduct. self-same c h i l d . "  1  Sometimes more than one area i s affected i n the  Defective functioning i n any one of these areas may have  tragic implications for the child,.as well as for his family. It i s doubtful whether the four areas are. given equal importance, either.by. individuals, particular families, or i n the culture at.large.  This study, of course, i s  concerned with the f i r s t of these areas -r with only one defect of special importance.  But i t may help to preserve; balance' i f this fourfold  classification i s kept i n mind. It takes imagination - or hard parental experience - to understand the significance of deafness, for a growing child. k  Contact with  -  the external world i s the source of knowledge.; and this contact i s effectuated through the senses - touch, taste, smell, sight and hearing. Because of their greater distance-receptivity, the senses of sight and hearing are considered to have the most important possibilities for "intelligence" development; Of the two, hearing i s , perhaps, of greater importance because i t i s  Gesell, Arnold, Studies i n Child Development, Harpers. New York and London, 1948, p. 170.  - 34 fundamental to communication.  "Men become human through communication with  , their fellows; they may also become incomplete personalities i f that communication i s cut down sharply.  Social groups - ranging from the close-knit  and intimate family to the formal and impersonal lecture association - exist by virtue of the fact that their members can,communicate with one another." ^ Fortunately for the deaf child, not a l l communication i s through the spoken word. Communication may be verbal, non-verbal, or, as i n most instances, a combination of both.. Facial expressions, bodily positions, and gestures are non-verbal - and frequently eloquent - means of communication. They are universally used, although more so, perhaps,' by. some national groups, such as the French and Italian, than by others.  Verbal communication, however,  i s basically dependent upon language; and i t i s the acquisition of language that becomes, for the hearing-handicapped, child, the c r i t i c a l and challenging task. It i s well-known that the deaf child, makes the first.babbling sounds that a l l babies make, but, because he cannot hear, the sounds have no meaning to him, so that his babbling does not develop into speech as i t does with the hearing child.  "The hearing child Is exposed to spoken language for  . months before he begins to. talk, i n spite of being i n the fortunate position of having normal hearing. It takes him a l l that time to learn to understand ^ what people are talking about and to discoverkthat speech i s a desirable tool for him.  The deaf child must be given the same opportunity to understand  •2 spoken language."  Rose, Arnold M., Sociology, the Study of Human Relations. Alfred A. Knopt, New Xorkj N.Y., 1956, p.3 Lassman, Grace, Harris, Language for the Preschool Deaf Child Greene and Stratton, New York, N.Y.,1950, p. 3. 2  - 35 For the deaf child, exposure to spoken language is, only the beginning.  There must also be intensive concentration on sense-training -  particularly for sight., auditory training, l i p reading, and encouragement and training i n the use of the voice.  It i s not within the scope of this study  to outline details of the methods and techniques i n accustoming deaf children to the use of language, and teaching them progressively thereafter.  Fortunately,  there are now many excellent books covering this topic. But, their importance and d i f f i c u l t y - cannot be minimized. It i s upon the family that the major responsibility rests for preparing the hearing-handicapped child to learn to speak. This, of course, i s over and above their f i r s t responsibility to him as a child.  Bossard states  that: "The importance of family situations i n the formation of personality i s emphasized today by a l l the sciences which are participating i n the study of human behaviour.  Much of the recent advances i n the fields of psychology,  psychiatry,- pschoanalysis, sociology, criminology, education, and social work reveals with, striking clarity the early and pervasive role of the family i n conditioning the behaviour of i t s child members. The family i s a society, the f i r s t i n which the child lives, and the most powerful i n changing original nature into the socialized personality.  11  Later on, he speaks more  specifically of the contributions of the family i n the child's development. "In the constant interplay between family members, the child's personality takes form.  Common contributions'of the interactive process to the child are  (a) satisfaction of the desire for intimate response, (b)- a stage for the development of the child's ability, (c) the approval of one's kind, (d) the f i r s t lessons i n living with other persons, (e) determination of personal attitudes, (f) tools for the acquisition of an education, and (g) living habits."  Bossard, James H.S., The Sociology of Child Development. Harper and Brothers, New York, N.Y., 1954, p. 52. 2  ibid, p. 95  2  - 36 This i s a large and v i t a l budget of work.  It i s perhaps necessary to remember  that a l l parents have to undertake these tasks i n part, i n co-operation (sometimes i n competition!) with the school, the child's playmates, and other "socialization"agents. Under normal circumstances, "bringing up a child" i s no small task; but the parents of hearing-handicapped children have the added responsibility of assisting their children i n the struggle to achieve language. This requires an understanding of the importance of (and some of the techniques in) preparing the child for speech.  Mrs. Lassman, In reference to sight  training, states: "The child's a b i l i t y to observe, to match, to imitate, to experiment, leads.to a proficiency i n matching l i p movements and speech patterns, i n learning to recognize similarities and differences i n printed forms, and i n feeling free to express himself orally, physically, and creatively." The importance of early attention to auditory training even for the profoundly deaf i s discussed in.an article by D. Fry and Edith whitndJ. i n the Lancet.  2  Nor i s lip-reading an easily won accomplishment, as anyone soon learns who attempts to lip-read the actors on television with the sound turned off! A l l this, then, constitutes an added and heavy responsibility for parents of hearing-handicapped children; and with this addition comes the delicate question of balancing the needs of the child with the needs imposed by the handicap.  .  Lassman, Grace Harris, op. c i t . , p. 59.  Fry, D. and Whitnell, Edith, "The Auditory Approach i n the Training of Deaf Children", The Lancet. Vol. 1 No. XII, March 20th, 1954, p. 583. 2  Fortunately, schools for the deaf have had a great deal of experience, and can, and do give much help and guidance to parents.  But.  :  schools, i n turn, pose further problems for both child and parent.  Some of  the problems for the child hold true not only for hearing-handicapped children, of course, but for a l l children. Entering school for every child i s the f i r s t major step away from the family.  Bossard makes the statement:  "Transfer from the family world to the school and gang or peer world involves revolutionary changes and major problems for the child, such as: (a) the passage from protected to unprotected competition, (b) the changed responses expected,, (c) differences between the culture of the family and that of the peer world, and (d) conflicts with parental attitudes."  1  Without doubt there  i s a tremendous adjustment for a.child to make i n his f i r s t months i n school. "As the five-year-old goes to school, he looks back toward home and he hesitates.  This glorious day for which he has waited so long carries also  i t s measure of heartbreak." 2 The d i f f i c u l t i e s on entering school are l i k e l y to be magnified for the hearing-handicapped; child - particularly i f he must'be a.residential pupil.  Under ordinary circumstances, a child i s able to return to the comfort  of his home, each day, to recoup his strength, as i t were, so that he i s able to test himself again i n the new and different setting of the school.  For  the.child who becomes a resident in-school, the change from the familiar to the unknown i s sudden and complete; and one which the child must face without the support of his family.  This i s not to say that there are no compensating  features for the child attending.a residential school.  For one thing, when  op. c i t , p. 46I Lane, Howard and Beauchamp, Mary, Understanding Human Development. Prentice - Hall, Inc., Englewood C l i f f s , New Jersey, 1959, p. 244  - 38 he i s among children with a similar handicap, he i s less l i k e l y to be . regarded as being."different"; and for another, he w i l l have the advantage of special equipment, staff, and instruction.  Nevertheless, the abrupt and  complete separation from his family at the time of his admission to the school sometimes has lasting and damaging effects. A l l this means that schooling raises many questions for the parents of the hearing-handicapped  child.  Does this particular school offer  the sort of programme most suitable for my child?  Would the more concentrated  learning atmosphere of the residential plan be of greater benefit to my child, at this time, than the maintenance of close family contact?  Sometimes a  question comes i n this form: i f there i s no school for the deaf i n the .. community, should the family move to the vicinity of a school so that the ,child may attend as a day pupil? The school, too, faces a continuing challenge i n the need for constant re-appraisal of methods i n order to maintain and improve educational standards.  Levine calls attention to this when she states: "This appeal  poses a serious problem to the educator; for the question now before him i s whether his specialty, which has already done so much to develop the "deaf" mind, can do even more under present circumstances".  Current information,  according to her i s that: "the outstanding weaknesses of the deaf pupils are i n such areas as conceptual thinking, alertness to and understanding of the world about, a b i l i t y to profit from past experiences and incorporate the gains into patterns of increasing maturity, a b i l i t y to reason logically, not only i n arithmetic problems but especially i n real-life situations." " A l l these weaknesses represent potential threats to adjustment;  She sumssup: a l l can be  strengthened through.broader educational objectives." • 1  Levine, Edna S., Youth i n a Soundless World. A Search for Personality, New York University Press, N.Y., 1956, p. 194. .  - 39 . The child i s said to be a physical, mental, emotional and social being.  Historically, parents took f u l l responsibility for the child's  development i n a l l areas.  With the growth i n the complexity of society, the  sheer size of the task necessitated the community's sharing a part of the burden. F i r s t , the schools assumed some of the responsibility i n the area of mental development. This, was followed by public health programmes to oversee physical development; child guidance clinics and family counselling to assist i n emotional development, and recreational programmes.geared to the social development of the child. . A similar evolution has occurred i n resourcesfor the hearinghandicapped child - but with a considerable delay i n time.  The schools for  the deaf were, for many years, a towering, but lonely, source of help to hearing-handicapped  children and their parents.  More recently speech and  hearing clinics have been set up, with programmes to provide for early diagnosis, assessment, guidance, and counselling to parents, both i n respect to the physical and to the emotional development of the child. Largely neglected to date, has been the participation of the community at large i n sharing responsibility for the social development of children with defective hearing.  The importance of this break i n the treatment  chain can hardly be overemphasized.  This i s an area i n which specific efforts  need to be made because the very nature of the handicap, by virtue of i t s raising a barrier to communication, tends to separate these children from their fellow beings.  Individual parents have arranged for this children to become  members of scout and guide clubs but there has been no organized effort to help these associations i n understanding the special needs of.the child with . impaired hearing.  By contrast, the Canadian National Institute for the Blind  has a specific and wide-ranging programme designed to encourage the acceptance  •  - 40 -  of blind children i n a l l kinds of sighted groups within the community. ! The Local Scene The present study has attempted to pinpoint some of the contributions which families can make i n the treatment of hearing-handicapped children.  In the process of gathering material, something more than specific  information was obtained.  In part this was the result of requesting general  comments on the questionnaires, and of keeping the interviews unstructured. Three general impressions come very clearly from this: (1<) a" plea for public ;  understanding of deaf children; (2) a concern about the insufficiency of community resources f o r the deaf; and. (3) a sense of conflict among existing agencies, with resulting confusion and uncertainty on the part of parents. The causes, the extent, and possible steps require to ameliorate these conditions would certainly provide opportunities for.further study. Attitudes on the'part of the general public toward people with handicaps, ieave; much to. be desired.  Inmost instances, the cause appears to  be ignorance, compounded,by fear and pity.  Unlike most handicaps, defective  hearing has no outward and visible signs - the deaf child has no cane and ho crutch.  Whether of. not this contributes to the feeling that "deaf people  could really do much better i f they would try", i s a matter for speculation. Certainly, this attitude may well be reinforced by the very, real fact that some deaf people do hear certain frequencies better than others. The varieties of deafness are not well understood.  In any case, i n communicating with the  hearing-handicapped person, the hearing person often must share the burden of the handicap and extend himself i n order to ensure mutual understanding.• Some  See Eileen Scott, "The Blind Child i n the Sighted Nursery School". The New Outlook for the Blind. New York, N.Y., November, 1957. A Second article by Miss Scott entitled "The Integration of Blind Children into 1  Community Recreational Activities" has- been accepted for publication by The New Outlook for the Blind.  but not a l l of this problem i s educational.  Knowledge leads to understanding  and could do much to overcome many of these attitudes.  "Since the real  handicap i s a social one, education of the public to an understanding of handicapped individuals i s an essential part of any programme to help them. Each parent of a child with a physical handicap can do his share of this type of educating by being direct and unashamed i n explaining his child's d i f f i c u l t i e s to people who must meet him." 1  Although individual parents  can do much, the f u l l task of keeping the public informed should not be l e f t to them, alone. Resources serving the hearing-handicapped children i n British Columbia include the Speech and Hearing Cllnicj, and the Jericho H ^ l l School; the latter has an active Parent/Teacher Association, a well-informed group which has done much to disseminate knowledge and stimulate improvement i n f a c i l i t i e s for the care of their children.  There i s also a nursery school  serving the Vancouver area. p  In 1954, a section known as the Pre-School.Hearing Programme was set up within the Speech and Hearing Clinic, providing free investigation and treatment of children with suspected hearing impairment.  Parents throughout  the province may bring their children to the clinic for a two-week period. Although this project i s child-centred, guidance and counselling are provided to the parents at this time.  If '-.sustained counselling i s required, referral  Fiedler, Miriam Forster, Deaf Children i n a Hearing World. The Ronald Press Company, New lork, N.I., 1952, p. 197. 1  This Programme i s the source of the comparison study to the present one. It i s by Mrs. Renate Varwig and entitled "Family Contributions i n the Pre-School Treatment of the Hearing-Handicapped Child. An analytical survey of children i n the Speech and Hearing Clinic, Health Centre for Children, Vancouver General Hospital, 1955-59". Master of Social Work thesis, University of British Columbia, i960. 2  _ 42 may be made either to the local public health office or to the local social, welfare department; but continuing services, particularly i n respect to the latter, dependsupon a presently precarious staff situation. Jericho H i l l School accepts both day and residential pupils; the teaching u t i l i z e s both the oral and manual systems, depending upon the capacity of the individual child.  In line with current thought, classes have  been set up within three of the local hearing schools.  It i s possible that,  with the present f a c i l i t i e s for earlier diagnosis'and treatment of the hearing-handicapped  child, more and more pupils w i l l be able to take their  place within hearing classes; i.e. the ordinary classes of the local school system, rather than In separate classes within the hearing school. There are, however, two important gaps i n service - insufficient opportunity for vocation.:.a l and higher education, and insufficient opportunity for employment. Most notable, i n surveying present resources, i s the paucity of agencies that meet the social and emotional needs of the child.  hearing-handicapped  This might well be interpreted as a failure on the part of the social  work profession to contribute to the welfare of this special group of children. There are three general areas i n which such contributions could be made by social workers: individual counselling with families; provision of information to the community; and organization and integration of existing agencies, serving children with hearing impairment. With training i n the three methods of social casework, social group work and community organization, the social worker i s equipped to provide services i n these areas. The third general impression pertains to conflicts or disagreements about methods and resources.  This appears to have been an  attribute of services to the hearing-handicapped  almost from the beginning.  The original divergence of opinions as to the relative merits of the oral and  - 43 and manual systems, which was at one time acute, has been largely resolved; but there are s t i l l some residuals. There are those who deprecate the use of any form of manual communication; and there are others who advocate i t s use, i n combination with the oral system, i n order to expedite the teaching of this child.  The adult deaf are particularly reluctant to see the abandonment  of manual forms of communication, since i t would further restrict their social contacts.  Two other serious points of conflict exist: (;a) the relative  advantage of day over residential care, and (b) the relative importance of "education" (formally interpreted) over "socialization" (broadly interpreted). In this instance, education i s construed as the inculcation of knowledge; and socialization as the broader aspects of learning to live i n a hearing community. A series of studies could be developed to probe further these highly influential matters. Conflict and debate,of themselves, need not be destructive. They are indicative of interest and concern; and the energy they produce can be harnessed for constructive use.  Unless this i s done, however, the parents  who receive conflicting advice become doubtful and uncertain. inevitably reflected i n their care of the child.  This i s  The answer may be i n some  means of co-ordination which would allow for differences of opinion and experimentation, but which also could bring about consensus of opinion i n many areas.  In this way parents, school and community could give impetus to  the increasing improvement of services for the hearing-handicapped child. This i s a community organization task.  It has been taken up by comparable  groups - such as Committees or Councils for the Handicapped, and Associations _for Retarded Children - which have made remarkable gains i n recent years. Perhaps the most promising next stage for the hearing-handicapped child would be a new organization to enlist and extend parental co-operation; to  - 44 consolidate gains i n social information and clinical'knowledge; and to promote public knowledge and understanding.  -45APPENDIX " t A * Sample Questionnaire  THE UNIVERSITY OF BRITISH COLUMBIA SURVEY OF SOCIAL ADJUSTMENT OF HEARING HANDICAPPED CHILDREN BETWEEN AGES 5 AND 12 A.  The Handicap 1.  How did you f i r s t discover your child had a hearing difficulty? .......  2. 3.  How old was the child at this time? After-discovering his hearing loss, from whom did you seek advice? ....  4. 5.  Did you continue to make use of any of these sources of information? .. What sources of information (such as radio, talks, articles, books, • magazines, educational classes) have you found most helpful?  6. 7. 8.  Does your child l i p read? ..... Well? Poorly ..... Just learning ... Does your child use speech: ....... Is i t understandable to the family only?.. Does the child f u l l y recognize the meaning of the handicap?  . B.  Relationship with Other Children  1. Are there other children i n your family? 2. Does your child have hearing playmates? • : 3. Does he talk normally to them? talk plus gestures? only gestures? 4. What differences, i f any, do you see i n the way i n which the hard-ofhearing child associates with other children (compared with the child with normal hearing)? • 5. Have you noticed any changes i n the.way i n which your child associates with other children since he started school? 6. Does your child have any hard-of-hearing playmates (a) at school? (b) i n the neighbourhood? C.  Relationships with Adults 1. In what ways has your husband helped you i n giving special attention to the hard-of-hearing child? 2. Are there things which he particularly can do for the child? 3. What other adults would you say are important to this child (besides his teachers at school? . 4. To what adults or children does he turn when he feels i n trouble with his deafness? '..  - 46 D.  Development and Health Factors 1.  Has the child had eating difficulties? (a) age 1 - 5 ?  2.  Have there been any particular bladder or bowel difficulties? (a) age 1 - 5? (b) since school? Is he a light or sound sleeper? sleep disturbances such as nightmares? What serious illnesses or injuries has the child had? Have you noticed behaviour change during or after illness?  3. 4. 5. E.  (b)since school?.  Are there  School Life 1. 2. 3. 4.  F.  What schools, camps or kindergartens has yourchild attended (other than Jericho Hill)? Was he particularly troubled by being away from home? What i s his present attitude towards school? How would you described his progress i n school?  General Behaviour L. 2.  Does he generally play quietly? Does he like reading? help instruction?  or noisily? Can you. use reading to In what kind of things?  3. Under what circumstances does the child become more easily upset or  concerned? Does i t happen occasionally? Frequently? Seldom? 4. How does he behave (what does he do) when he i s upset 0 2 * afraid? When angry? 5. What helps to reassure him and make him feel comfortable again?  Social Data (for statistical classification only) Size of Family Sex  Age  Education Occupation of Father  Elem. High (incomplete] High (complete) University  M  Income Group under $2400 , 2400-4800 ... 4800-6000 "... over 6000 ..,  t  - 47 BIBLIOGRAPHY  General: Barker, Roger G. et a l , Adjustment to Physical Handicap and Illness: A Survey of the Social Psychology of Physique and Disability. Social Science Research Council, New York, N.Y., 1953. Bossard, James H.S,, The Sociology of Child Development. Brothers, New York., N.Y., 1954.  Harper and  Breckenridge, Marian E. & Vincent, E. Lee, Child Development, Physical and Psychological Growth Through the School Years. W.B. Saunders Company, Philadelphia & London, 1943. Ewing, A.W.G., Educational Guidance and the Deaf Child. University Press, Manchester, 1957.  Manchester  Ewing, I.R. & Ewing, A.W.G., Speech and the Deaf Child. Manchester University Press, Manchester, 1954. Fiedler, Miriam Forster, Deaf Children i n a Hearing World. Press Company, New York, 1952. Gesell, Arnold, Studies i n Child Development. New York and London, 1948.  The Ronald  Harper and Brothers,  Groht, Mildred A., Nata&aal Language for Deaf Children. Alexander Graham Bell Association for the Deaf, Inc., Washington, D.C., 1958. Hodgson, Kenneth W., The Deaf and Their Problems, a Study i n Special Education; Watts & Co., London, 1953. Lane, Howard & Beauchamp, Mary, Understanding Human Development. Hall, Inc., Englewood C l i f f s , New Jersey, 1959.  Prentice  Levine, Edna S., Youth i n a Soundless World, A Search for Personality. New York University Press, New York, 1956. Rose, Arnold M., Sociology, the Study of Human Relations. Knopf, New York, 1956.  Alfred A.  Special: Black, Martha & Eastman, Milton, The Illinois Plan for Special Education of Education- of Exceptional Children; The Speech Defective. Issued by Superintendent of Public Instruction, State of I l l i n o i s , Revised  1957.  - 48 Special: continued Board of Education, London, Children with Defective Hearing, Report of the Committee of Inquiry into Problems relating to. H.M. Stationery Office, London, 1938. Bureau of School and Community Services, A Guide to Better Hearing. Connecticut State Department of Education, Hartford, 1957. Illinois Annual School for Mothers of Deaf Children, If You Have A Deaf Child. University of Illinois Press, Urbaha, 1953. Perry, M. Eugene, Two Hundred and Fifty Thousand Strong. A Survey of the Deaf and Hard of Hearing Organizations i n Canada. Privately printed, 1943 ( ? ) .  

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