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Yuelin Li, PhD; Lisa Bain, MA; Annie G. Steinberg, MD

Arch Pediatr Adolesc Med. 2003;157:162-168.

Background  Early intervention decisions for a deaf or hard of hearing child are difficult to make, partly because of the lack of definitive proof of the superiority of any particular communication approach.

Objective  To compare the relative importance of the child's hearing loss and parental attitudes, beliefs, values, and aspirations in the decision process.

Methods  Eighty-three parents were surveyed about decision factors that may have affected their choice of communication modality, including resource availability, attitudes and beliefs about hearing loss, values, trade-offs, and goals. Parental preference ratings on hypothetical outcomes were also collected in 4 domains: communication, academic performance, social functioning, and emotional well-being.

Results  The child's extent of hearing loss was the most influential decision factor (P<.001). Beyond the extent of hearing loss, logistic regression further showed that parental cognitive-attitudinal factors were important in the inclination to favor an oral approach—if they believed that deafness can and should be corrected and if they desired the child to be able to speak (P = .03 and .04, respectively). Technology that aims at improving the child's ability to speak (eg, cochlear implants) had no significant impact on the decision to choose oral only training.

Conclusions  Professionals who work with deaf children and their parents should recognize the presence of many relevant issues beyond the extent of the child's hearing loss. Interventions may be most effective if aimed at balancing parental beliefs and aspirations and audiologic considerations.

From the Department of Anesthesia, School of Medicine, University of Pennsylvania (Dr Li), and the Center for Outcomes Research (Dr Li) and the Deafness and Family Communication Center, Children's Seashore House (Ms Bain and Dr Steinberg), The Children's Hospital of Philadelphia, Philadelphia, Pa.

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