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167 11 Mental Health Problems in Deaf Children and Adolescents: Part II—Aspects of Psychopathology Tiejo van Gent According to most studies, the incidence of psychopathology is greater in deaf children than in the general population, although the majority of these children do not have a mental disorder (Hindley, 1997). However, several mechanisms are likely to contribute to variations in the reported prevalence. Methods of assessment and the choice of informants have varied from singlerating responses to questionnaires given to parents (Vostanis, Hayes, Du Feu, & Warren, 1997; van Eldik, Treffers, Veerman, & Verhulst, 2004; Hintermair, 2007) and teachers (Schlesinger & Meadow, 1972; Fundudis, Kolvin, & Garside, 1979; Aplin, 1985, 1987; Sinkkonen, 1994), self-reports (van Eldik, 2005; Cornes, Rohan, Napier, & Del Rey, 2006), ratings based on parental interviews (Fellinger, Holzinger, Sattel, Laucht, & Goldberg, 2009), two-stage designs combining information from parents and teachers with interview responses of deaf participants (Rutter, Graham, & Yule, 1970; Freeman, Malkin, & Hastings, 1975; Hindley, Hill, McGuigan, & Kitson, 1994) to one-stage, multiple-informant approaches incorporating relevant information from parents, teachers, deaf participants, clinicians, and medical files (van Gent, Goedhart, Hindley, & Treffers, 2007). Variations of This chapter and the previous chapter by van Gent 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_11_ch11.indd 167 ara86542_11_ch11.indd 167 13/10/15 4:39 PM 13/10/15 4:39 PM Tiejo van Gent 168 findings in studies using similar instruments and methods of calculating prevalence rates suggest that differences in the composition of the study samples contribute to differences in outcome. For instance, data from a small number of hearing impaired participants (N = 13) in the whole population study by Rutter et al. (1970) may lead to a relatively less reliable outcome. Furthermore, while most studies concentrated on both children and adolescents, some focused either on adolescents (Hindley et al., 1994; van Eldik, 2005; Cornes et al., 2006; van Gent et al., 2007) or on children (Fundudis et al., 1979), a factor that may have influenced the distribution of disorders. For example, in one study more internalizing problems were found among adolescents than among younger children (van Eldik et al., 2004), but in other studies no significant age-related differences were found (Aplin, 1985, 1987). Study samples also varied in two other characteristics: the degree of hearing loss in the participants (table 1) and the type of school. Degree of hearing loss has been associated with rate of psychopathology (Fundudis et al., 1979), but later studies do not confirm this (Fellinger et al., 2009; Hintermair, 2007; van Eldik et al., 2004; van Gent et al., 2007). The type of school may be more relevant to psychopathology than degree of hearing loss (Hindley et al., 1994), as indicated in studies of students who attended special schools for deaf children and adolescents (Aplin, 1985; Hintermair, 2007; Sinkkonen, 1994; van Eldik et al., 2004; Vostanis et al., 1997), ordinary school only (Aplin, 1987) or more than one type of school (Fundudis et al., 1979; Hindley et al., 1994; van Eldik, 2005; Cornes et al., 2006; van Gent et al., 2007). Although some studies (Aplin, 1987; van Eldik, 2005) show that children in mainstream schools display lower levels of mental health problems than do those attending special schools, other factors (e.g., IQ, communication mode, physical health) (van Gent et al., 2007) and referral bias (Hindley et al., 1994; van Gent et al., 2007) may influence such conclusions. Findings are inconclusive as to whether disorders are more common among deaf children in mainstream or special schools. Both deaf children in mainstream schools (Smith & Sharp, 1994) and deaf children in special schools (Kouwenberg, Rieffe, Theunissen & de Rooij, 2012) were found to be particularly at risk of being bullied. On the other hand, deaf children in residential schools may be more vulnerable to abuse (Sullivan, Brookhouser, & Scanlan, 2000). Finally, discrepancies in findings may be related to the extent to which instruments and assessment procedures have been adapted for use with deaf people. Recent studies with such adaptations (Youth Self-Report [YSR...


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