Article summary with Children who are deaf or hard of hearing in inclusive educational settings: a literature review on interactions with peers by Xie a.o. - 2014

Hard-hearing (HH) or deaf (D) children face various challenges when interacting with typically hearing children. Fortunately, social interaction in inclusive settings can be improved through adequate intervention programs. The reviewed literature suggests that deaf and hard-hearing children struggle with communication, initiating, entering and maintaining interactions in inclusive settings. Social skills training and co-enrollment programs are deemed effective interventions. Key aspects of social interactions are social skills, communicative skills, the responses of typically hearing children and environmental effects.

In the last 20 years, inclusive education (children with disabilities attending regular schools) has become increasingly popular. While the literature mentions several benefits of inclusive education, it is also argued that placing D- or HH-children in a classroom with TH-children does not necessarily result into more social interaction, positive inclusion, peer acceptance or better social communication skills. Research shows that children with hearing problems are at greater risk of being ignored by typically hearing children in regular schools in comparison to special schools. Even those with no speech impairments and hearing aids struggle in noisy environments and group situations.

What is the definition of interaction?

Interaction concerns the social exchange between at least two individuals, with their actions being interdependent.

What was the focus of previous reviews?

The number of literature reviews regarding this topic in inclusive settings is limited. One review was focused on the affective and social effects on D- or HH-children. Another also assessed the interactions between HH- or D-children and typically hearing children in segregated and inclusive settings, but this review was based on studies who were not up-to-date. A more recent review concerned the factors that affect the social interaction between both groups of children. How they interact and how their interaction can be improved needs to be further investigated.

What is the purpose of this study?

21 studies published between 2000-2013 were reviewed in order to provide more accessible information to researchers and teachers. Three research questions were formulated:

1. How do D- and HH-children interact with hearing peers in inclusive settings?
2. What challenges do D- and HH-children face regarding social interactions with hearing peers in inclusive educational settings?
3. What interventions improve social interactions between D- and HH-children and their hearing peers in inclusive education?

What method was used?

The themes of the papers were divided into two broad themes (processes and outcomes of interactions between D- and HH-children and their hearing peers) and several major themes (communication, entering, initiating and maintaining interactions).

What were the findings regarding communication?

Communication is essential for D- and HH-children in establishing and maintaining relationships and interactions with typically hearing children. One study found that there was no symbolic communication between deaf or hard-hearing children and hearing peers at preschool ages. A study concerning children that attended elementary school found that deaf or hard-hearing children tried to initiate interactions with their hearing peers, but were frequently ignored by them. When peers were responsive, most interactions were non-linguistic and had a short duration. The findings of this study demonstrates that D- or HH-children are at risk of social isolation in regular schools.

The results of another study regarding 42 to 65-month-olds who were observed during play sessions suggest that D- or HH-children procedure less verbal initiations compared to children with normal hearing. They had, however, a greater rate of play and verbal turns.

Studies concerning children with cochlear implants found that these implants are beneficial in terms of social communication with hearing peers in inclusive settings. The communication skills of those children progressed significantly. However, individual differences were observed: some children showed no improved communication skills. Other findings show that D- or HH-children found it easier to communicate with hearing peers in one-on-one interactions. Group conversations were challenging, even for children with implants and sufficient language skills.

In another study participants (aged 11-19 years) were asked to form pairs and describe sets of pictures. They could use requests for clarification. The D- or HH-participants requested more clarifications in comparison to hearing peers, but no differences were found in the production of nonspecific and specific requests nor with regard to the responses to the requests. This suggests that D- or HH-students have similar conversation skills in comparison to their hearing peers.

One study concerned children aged 7-12 years and their ability to receive, ask questions and to response. All children attended regular schools. They formed mixed pairs and were asked to play a trivia game. The results demonstrate D- or HH-children found it more challenging to repeat trivia questions verbatim, but they provided more right answers and requested a greater amount of general clarifications (‘Sorry?, ‘What?’).

Summarized, in comparison to the social interactions between children with normal hearing, it was found that fewer interactions occur between D- or HH-children and their hearing peers. With age and increased experience, some levels of communication skills became similar. D- or HH-children understand their hearing peers better in quiet environments, but found it challenging to express complex linguistic content.

What were the findings regarding entering and initiating interactions?

One study focused on the initiation of social interactions by 2-3 year old D- and HH-children. The results indicate that these children attempted to initiate interaction with hearing children more often than with other D- or HH-children. However, the attempts were less successful compared to the attempts to interact with other D- or HH-infants.

Other studies found no differences in response and initiation skills between D- or HH-children and hearing children aged 37-62 months. However, D- or HH-children received less responses over time. One study, concerning 49-63-month-olds, found that children from both groups were equally successful in engaging in play situations, but D- or HH-children had significantly less success with entering non-play activities.

A study regarding D- or HH-children with cochlear implants and hearing children (aged 6 -14 years) entering play situations, found that D- and HH-children took longer to enter into plays with others, had fewer continuous interactions, had more failed attempts at entering into play, were less cooperative and verbal. Children who used the cochlear implants longer than 2 years, exhibited no significant improvements compared to the children who used them for a shorter period.

What were the findings regarding maintaining interactions?

One study focused on social attention skills, social engagement and social competence of D- or HH-children and normal hearing children (aged 49-64 months). The findings showed no difference in their ability to acknowledge, notice, initiate, follow and respond to other children. However, the quality of the communicating skills of D- or HH-children was poorer. They were also more easily distracted and showed less focused and continuous attention during social interaction. This indicates that D- or HH-children are less capable of maintaining interactions with peers.

Another study found gender differences in D- or HH-children aged 5-11 years regarding the maintenance of relationships and interactions with hearing peers in inclusive educational settings. Girls used strategies like advocating needs, requesting repetition and assertiveness, while boys also used excelling in sports as an strategy to bond with peers.

What were the findings regarding intervention programs?

Several intervention programs are aimed at promoting interactions of D- and HH-children with hearing peers in inclusive educational settings. Examples are the social skills training program and the co-enrollment program.

In the co-enrollment program, D- and HH-students received education with normal hearing peers in the same classroom were special and general teachers worked together. The social interactions and educational performance were assessed through informal interviews and observations.  The findings demonstrated an increase in interactions between D- or HH-students and their hearing peers.

One study examined social behavior, participation and communication in a co-enrolled classroom program. The children were aged between 9 and 12 years. No differences emerged regarding classroom communication and social behavior. However, D- or HH-children with extra difficulties found it more challenging to engage in interactions.

Another study found that the co-enrollment program was not merely beneficial to deaf and hard hearing students, but had a positive influence on everyone involved in the program.

Social skills are necessary in order to interacts with other people and build friendships. One study examined the social skills training program. D- or HH-children and hearing children aged between 9 and 13 years participated. Part one of the program included interpersonal problem-solving training and was targeted at only the D- and HH-children. Part two of the program concerned a social skills training, taught to all children. This included negotiating, apologizing, avoiding issues, recognizing and dealing with group influence, sharing and cooperating in a group. The findings show that this program helps to improve the emotional and social adjustment, social problem-solving abilities and assertive behaviors in all participants.

What are the conclusions?

Regarding research question 1 and research question 2, it is found that D- and HH-children experience difficulties in communicating, initiating and entering in social group and in the maintenance of social interactions with hearing peers. Some studies show that children with hearing aids do well in inclusive settings, especially in one-on-one situations.

Regarding research question 3, the social skills training and co-enrollment programs have shown their value.

What should future research focus on?

Future research should focus on:

• Examining communication skills in more natural or informal settings,
• Interactions between D- and HH-children and hearing peers during different periods in school life,
• The improvement of social interactions between deaf or hard hearing children and hearing peers in inclusive educational settings;
• Examining classroom climate and its influence on the social development of students.