It is well documented that both ethnic/cultural differences as well as language differences complicate a satisfying and effective doctor-patient relationship. Although these differences are... Show moreIt is well documented that both ethnic/cultural differences as well as language differences complicate a satisfying and effective doctor-patient relationship. Although these differences are also present during communication between Deaf patients and their hearing physicians, the volume and quality of research on healthcare facilities for deaf and hard of hearing (DHH) people has not kept up with research on hearing people. This thesis studied the barriers experienced by this patient group, their nature and impact, and possible (cost-effective) solutions to tackle these barriers. The theoretical background, development and use of a guideline to translate and validate standardized questionnaires into sign language is described. The barriers in providing healthcare for severely DHH patients can be classed as follows: 1) communication barriers, 2) barriers due to limited health knowledge and 3) barriers due to deaf cultural features. The results of these studies indicate that DHH people in the Netherlands experience a significantly lower physical, and often also psychological quality of life compared to the rest of the population. Several countries provide specialized facilities to improve healthcare access for this patient group. Though most of these services are likely to be cost-effective, no scientific data are available to support this assumption. Show less
Experiencing shame and guilt is painful but these emotions have an important social function. They prevent socially inappropriate behaviors as they make us aware of norms and values that are... Show moreExperiencing shame and guilt is painful but these emotions have an important social function. They prevent socially inappropriate behaviors as they make us aware of norms and values that are necessary for creating and maintaining social harmony. Participation in the social world is crucial for the development of shame and guilt, and less access to the social world could therefore be detrimental to this development. In this thesis, the influence of access to the social world on the development of self-conscious emotions is examined in two groups with less access to the social world: adolescents with an autism spectrum disorder (ASD) and adolescents with hearing loss. In addition, this thesis aimed to unravel the longitudinal contributions of shame and guilt on the development of adolescent aggression. Adolescents with diminished access to the social world reported lower levels of shame and guilt. The longitudinal relationships applied to both adolescent with diminished access and typically developing adolescents. It was demonstrated that shame is a risk factor for the development of reactive aggression, and that guilt is an inhibiting force on the development of bullying and proactive aggression Show less
In comparison to hearing children, children with hearing loss more often experience social-emotional problems. This thesis aimed to assess whether this was also true for 1-to-5-year-old children... Show moreIn comparison to hearing children, children with hearing loss more often experience social-emotional problems. This thesis aimed to assess whether this was also true for 1-to-5-year-old children who had received a cochlear implant (CI) to remediate their hearing loss. In comparison to hearing peers, children with CI were found to be delayed on some but not all aspects of social-emotional functioning. No delays were found regarding social behavior or empathy. However, children with CI did show delays on theory of mind understanding and on the development of moral emotions. Against expectations, language skills did not have a major influence on children's social-emotional development. Parents in both groups had adopted similar parenting styles. Positive parenting was associated with better social-emotional functioning in children, whereas negative or uninvolved parenting were associated with lower social-emotional functioning. Based on this thesis we can conclude that a CI is beneficial for the social-emotional development of children with a hearing loss. However, these children are still at risk of developing delays in some areas of social-emotional functioning. Furthermore, we should not assume that children with CI who have a strong language development will also show a healthy social-emotional development. Show less
The goal of this dissertation was to enhance our understanding about internalizing problems and peer relations in DHH youth (aged around 11 years). This was done along principles of the... Show moreThe goal of this dissertation was to enhance our understanding about internalizing problems and peer relations in DHH youth (aged around 11 years). This was done along principles of the developmental psychopathology framework in which DHH children were compared to their hearing counterparts and in which multiple (underlying) social-emotional factors were examined. Results showed that DHH youth reported equal levels of somatic complaints, but more depressive symptoms, lower friendship quality and some forms of victimization more than their hearing peers. Throughout the dissertation a recurring DHH-related characteristic causing variability within the DHH sample was type of education; DHH children in special education reported poorer outcomes than their DHH peers in mainstream education. Concerning the underlying factors, a key finding was that emotional functioning underlies the development of internalizing problems and peer relations in both DHH and hearing youth, while the influence of social factors caused a discrepancy between the two groups. For example, poor social understanding is related to depressive symptoms in DHH youth, while this relation is absent in the hearing sample. Peer relations and social understanding should receive focal attention in practice and future research with DHH youth. Show less
The aim of this thesis is to expand the knowledge of mental health problems with deaf and severely hard of hearing children and adolescents in the following domains: 1. The prevalence of mental... Show moreThe aim of this thesis is to expand the knowledge of mental health problems with deaf and severely hard of hearing children and adolescents in the following domains: 1. The prevalence of mental health problems; 2. Specific intra- and interpersonal aspects of pathogenesis; 3. characteristics of the hearing impaired population with severe mental health problems. The rate of mental health problems, especially of emotional problems, was increased in deaf adolescents of normal intelligence compared with the general population. However, findings from the studies described in this thesis support the view that it is not deafness in itself which contributes to mental health problems but rather deafness in conjunction with physical health problems, communication problems, and adverse living conditions. For example, stress-inducing deafness-related characteristics such as an acquired cause of deafness moderated the associati on between low self-esteem and emotional disorder in deaf adolescents. Comparing hearing and hearing impaired children referred to a mental health service over a period of 15 years, more disabling physical health conditions, more intellectual impairment and more environmental distress were found with hearing impaired children. The findings argue for the importance of early detection of problems and a multi-informant approach to the assessment of disorder. Show less
