Did you know that deaf and hard of hearing children are 2-3 times more likely to struggle with challenging behavior compared with their hearing peers (Bigler et al, 2018)? That’s roughly 30-40% of all deaf children, over 100,000 in the U.S. alone! Worldwide, there are over 32 million deaf and hard of hearing children in countries all over the world. How many of this often neglected population receive the services that they need? Learn about more behavioral risk factors for deaf and hard of hearing children experiencing challenging behavior.

What does “challenging behavior” mean?

According to the Centers for Disease Control (CDC), “challenging behavior” can be either internalized or externalized. Internalized behavior is “aimed toward the self” and may be subtle or difficult to detect. Nonetheless, these are associated with negative mental health outcomes and deaf children are at a high risk at developing internalized challenging behavior. Some examples of internalized behavior include anxiety, depression, emotional symptoms (like sadness, fear, guilt, shame, etc.), eating disorders, social withdrawal or even self-harm.

Externalized challenging behavior is more apparent to others because it is “aimed towards other people”. Often, externalized behaviors are aimed at family members or related service providers (such as behavior analysts, Speech Language Pathologists, Special Education teachers etc.). Deaf children are often at an increased risk for externalized challenging behaviors. These may severely impact their quality of life, mental health, physical health and opportunities to grow, learn and explore. Externalized challenging behavior may include physical aggression towards others, property destruction, verbal aggression (or arguing), impulsivity or elopement (running away).

What is the cause of challenging behavior in deaf and hard of hearing children?

No, it’s not hearing loss. Hearing loss — or deafness — itself does not cause challenging behavior. Deafness does not cause mental health issues or chronic diseases. Many studies have attempted to address finding the etiology — or cause — of challenging behavior in this population. Some of these are:

• Poor integration of cognitive function
• Visual attention difficulties
• Sensory overload
• Sensory deprivation
• Language deprivation

What are the risk factors?

One of the largest risk factors for challenging behavior in this population is Language Deprivation (or lack of access to language). This is a huge behavioral risk factor among this population. Research indicates a severely increased risk in mental health issues among those who have experienced language deprivation. Language deprivation “occurs due to a chronic lack of full access to a natural language during the critical period of language acquisition (when there is an elevated neurological sensitivity for language development), approximately the first five years of a child’s life” (Hall et al, 2017).

Other risk factors include poor parent-child relationships (high family stress is often reported in this population and may present a health risk), poverty, prejudice and lack of access to health care or education.

Behavioral risk factors for challenging behavior with Deaf and Hard of Hearing children

Did you know that deaf and hard of hearing children are 2-3 times more likely to struggle with challenging behavior compared with their hearing peers (Bigler et al, 2018)? That’s roughly 30-40% of all deaf children, over 100,000 in the U.S. alone! Worldwide, there are over 32 million deaf and hard of hearing children in countries all over the world. How many of this often neglected population receive the services that they need?

What does “challenging behavior” mean?

According to the Centers for Disease Control (CDC), “challenging behavior” can be either internalized or externalized. Internalized behavior is “aimed toward the self” and may be subtle or difficult to detect. Nonetheless, these are associated with negative mental health outcomes and deaf children are at a high risk at developing internalized challenging behavior. Some examples of internalized behavior include anxiety, depression, emotional symptoms (like sadness, fear, guilt, shame, etc.), eating disorders, social withdrawal or even self-harm.

Externalized challenging behavior is more apparent to others because it is “aimed towards other people”. Often, externalized behaviors are aimed at family members or related service providers (such as behavior analysts, Speech Language Pathologists, Special Education teachers etc.). Deaf children are often at an increased risk for externalized challenging behaviors. These may severely impact their quality of life, mental health, physical health and opportunities to grow, learn and explore. Externalized challenging behavior may include physical aggression towards others, property destruction, verbal aggression (or arguing), impulsivity or elopement (running away).

What is the cause of challenging behavior in deaf and hard of hearing children?

No, it’s not hearing loss. Hearing loss — or deafness — itself does not cause challenging behavior. Deafness does not cause mental health issues or chronic diseases. Many studies have attempted to address finding the etiology — or cause — of challenging behavior in this population. Some of these are:

• Poor integration of cognitive function
• Visual attention difficulties
• Sensory overload
• Sensory deprivation
• Language deprivation

What are the risk factors?

One of the largest risk factors for challenging behavior in this population is Language Deprivation (or lack of access to language). This is a huge behavioral risk factor among this population. Research indicates a severely increased risk in mental health issues among those who have experienced language deprivation. Language deprivation “occurs due to a chronic lack of full access to a natural language during the critical period of language acquisition (when there is an elevated neurological sensitivity for language development), approximately the first five years of a child’s life” (Hall et al, 2017).

Other risk factors include poor parent-child relationships (high family stress is often reported in this population and may present a health risk), poverty, prejudice and lack of access to health care or education. 

In summary, behavioral risk factors for challenging behavior in deaf and hard of hearing children include language deprivation as a primary factor, poor integration of cognitive function, visual attention difficulties, sensory overload, sensory deprivation and poor parent-child relationships. While many of these risk factors may be difficult to address at the individual level, increasing access to education and healthcare services, reducing poverty and prejudice in deaf communities, and improving parent-child relationships can help reduce the risk of challenging behavior in this population. Ultimately, these behavioral risk factors underscore the critical importance of early intervention and support for deaf children worldwide.

What can we do?

There are a number of strategies we can use to address challenging behavior in deaf and hard of hearing children, including:

1. Early intervention services, such as developmental therapies (speech therapy, occupational therapy, applied behavior analysis, etc.), language therapy and educational support.

2. Parent education and support programs that help parents build positive parent-child relationships and address parenting strategies for challenging behavior.

3. Support programs for teachers, clinicians, and related service providers to help them better understand and respond to behavioral risks in this population.

4. Advocacy efforts to improve access to education and healthcare services, as well as reduce poverty and prejudice in deaf communities.

Overall, addressing the risk factors associated with challenging behavior in deaf and hard of hearing children is critical to improving these children’s quality of life, mental health, physical health, and overall development. By supporting early intervention services, parent education programs, teacher support initiatives, and advocacy efforts targeting the root causes of behavioral issues in this population, we can help ensure that all deaf children have the opportunity to thrive.

Behavioral risk factors for challenging behavior among deaf and hard of hearing children are wide-ranging and often difficult to address. However, early intervention services, parent education programs, teacher support initiatives, and advocacy efforts can help reduce the impact of these risks on a child’s development. At Signs of Communication, LLC, we use Applied Behavior Analysis (ABA) in addressing language deprivation as well as other risk factors for challenging behavior in deaf and hard of hearing children. ABA is an evidence based intervention that is supported by decades of research. By providing ABA services to deaf and hard of hearing children, we can help them develop critical communication skills, improve their behavior and overall quality of life.