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143 Mental Health Problems in Deaf Children and Adolescents: Part I—Epidemiology, Etiology, and Cultural, Linguistic, and Developmental Aspects Tiejo van Gent Being deaf in a world oriented to the needs of hearing people increases a child’s vulnerability to mental health problems. Understanding why this is and how it happens helps explain both normal development and psychopathology (Hindley & van Gent, 2002). Of all deaf children, 90–95% are born into hearing families; thus the views of their parents is very important. One of the major challenges faced by deaf children (i.e., children with bilateral, severe-to-profound hearing impairment ) is obtaining access to meaningful communication through a visuospatial signed and/or spoken language. Health professionals have to take into account the fact that many deaf people do not view themselves as having an impairment or a handicap but rather as having their own language and culture. In this chapter “deaf” children refers to those with permanent, bilateral, severe-to-profound hearing impairment. In addition, we briefly discuss the effects of otitis media with 10 Author’s note: This chapter and the following chapter are updated and extended versions of T. van Gent, (2012), Mental health problems in deaf children and adolescents. In T. van Gent, Mental health problems in deaf and severely hard of hearing children and adolescents. Findings on prevalence, pathogenesis and clinical complexities, and implications for prevention, diagnosis and intervention (pp. 23–80), PhD thesis, Leiden University, Netherlands. The dissertation itself concerns a broadly renewed and adapted revision of P. A. Hindley & T. van Gent, (2002), Psychiatric aspects of specific hearing impairments, in M. Rutter & E. Taylor (Eds.), Child and adolescent psychiatry (4th ed.) (pp. 842–857). Oxford: Blackwell Science. ara86542_10_ch10.indd 143 ara86542_10_ch10.indd 143 12/10/15 6:56 PM 12/10/15 6:56 PM Tiejo van Gent 144 effusion (OME), as well as the mental health of hearing children of deaf parents and of children with a combination of a hearing and a visual impairment (i.e., deaf-blindness). EPIDEMIOLOGY OF DEAFNESS A bilateral hearing impairment (HI) is usually described quantitatively in terms of the unaided, averaged, pure-tone decibel (dB) hearing threshold for noise in the better hearing ear. Degrees of impairment may be categorized as mild, moderate, severe, and profound, but parameters for decibel thresholds may vary. For example , Stephens (2001) defines mild impairment as 20–40 dB, moderate as 41–70 dB, severe as 71–95, and profound as ≥ 96 dB, whereas Walch, Anderhuber, Köle, and Berghold (2000) describe mild as 15–30 dB, moderate as 31–60 dB, severe as 61–90 dB, and profound as ≥ 91 dB. In European countries, more than 1 in 1,000 children are likely to have permanent, bilateral congenital HI of moderate or greater severity (Davis & Parving, 1994; Fortnum & Davis, 1997). The prevalence of HI rises to 50–90% among children 9 years of age and older (Fortnum, Summerfield, Marshall, Davis, & Bamford, 2001). The postnatal rise in the prevalence of HI can be explained by genetic progressive HI and, to a lesser extent, by acquired HI (approximately 4–9% of overall prevalence) or delayed confirmation of congenital HI (Fortnum et al., 2001). The prevalence of HI has not changed over time (De Graaf, Knippers, & Bijl, 1997; Fortnum et al., 2001). A systematic review of population-based studies in developed countries on reported distributions of causes of permanent bilateral childhood HI in children with a loss of ≥ 40 dB (Korver et al., 2011) shows weighted means of 30.4% for HI of hereditary origin (syndromic and nonsyndromic), 19.2% for pre-, peri-, or postnatally acquired HI, and 48.3% for unknown causes. However, over time the relative distribution of etiologies changes. Findings from a large population study in the UK suggests that cases of syndromic and perinatal origin (including severe prematurity) have increased, and HI of unknown, prenatal (e.g., rubella) and postnatal (e.g., meningitis) etiologies have decreased (Fortnum et al., 2002). Reported rates of etiologies vary across the included categories of hearing level and also with the inclusion of unknown etiologies (ibid.). It is highly likely that technological improvements in diagnosis will reduce the number of cases of unknown etiology in favor of cases with known origins , including recessive hereditary causes, single gene mutations, subclinical viral infections (e.g., cytomegalovirus), and inner-ear malformations (Walch et al., 2000). Nine out of 10 cases of hearing impairment are sensorineural, most commonly related to sensory dysfunction in the inner ear. Less often, the hearing loss involves the...


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