Decker, K. B., Vallotton, C. D., & Johnson, H. A. (2012). Parents' communication decision for children with hearingloss: Sources of information and inñuence. American Annals of the Deaf 157{4), 326-339.

PARENTS' COMMUNICATION DECISION FOR

CHILDREN WITH HEARING LOSS: SOURCES OF

INFORMATION AND INFLUENCE

KALLI B . DECKER, CLAIRE D .

VALLOTTON, AND KLVROLD A.

JOHNSON

ALL THREE AUTHORS ARE AFFILIATED WITH

MICHIGAN STATE UNIVERSITY, EAST LANSING.

DECKER IS A DOCTORAL STUDENT, DEPARTMENT

OF HUMAN DEVELOPMENT AND FAMILY

STUDIES. VALLOTTON IS AN ASSISTANT

PROFESSOR, DEPARTMENT OF HUMAN

DEVELOPMENT AND FAMILY STUDIES.

JOHNSON IS A PROFESSOR, DEPARTMENT OF

COUNSELING, EDUCATIONAL PSYCHOLOGY,

AND SPECIAL EDUCATION.

HoosiNG A METHOD of Communication for a child with hearing loss isa complex process that must occur early to prevent developmental con-sequences. Research shows that parents' decisions are influenced byprofessionals; parental attitudes and knowledge also may be influen-tial. The present study investigated additional influences on parents'choices; data were collected via an online survey (A'̂ = 36). Results in-dicated no effects of parents' knowledge of development on their com-munication choices, but did indicate an effect of parents' values andpriorities for their children. Further, parents who chose speech only re-ceived information from education or speech/audiology professionalsmore often. However, there were no group differences in sources par-ents cited as influential; all parents relied on their own judgment. Re-sults suggest that parents internalize the opinions of professionals.Thus, accurate information from professionals is necessary for parentsto make informed decisions about their children's communication.

Keywords: communication,communication choice, deaf, hearingloss, parenting knowledge, parentingvalues, sign language

The ability to communicate effectivelyis critical to the healthy developmentof children. Effective communicationsupports cognitive development aswell as social development, includingthe ability to develop positive relation-ships with others. Therefore, it is im-portant that children with hearing lossobtain the opportunity to experiencehealthy development by learning andusing an elaborated system of commu-nication that best fits their own needs

and the needs of those with whomthey must develop relationships. In or-der for this to occur, it is necessarythat parents of these children makechoices regarding their child's methodof communication early in the child'slife so that healthy language develop-ment is not disrupted.

The present study examines theinternal and external influences onparents' choice of a method of com-munication for their children who aredeaf and hard of hearing. The focus ofthe study is on the relationship be-tween the child's parents and the indi-viduals and other sources from whichthey received advice, as well as par-

VOLUME 157, No. 4, 2012 AMERICAN ANNALS OF THE DEAF

ents' knowledge about and values re-lated to children's communication.The theory of social constructionism(Gergen, 1985) is used to investigatewhether parents' choices vary basedon where they received advice andwhat advice they viewed as influential.Social constructionism posits that so-cial interchange is the basis of peo-ple's knowledge of the world and howthey construct meaning (Gergen,1985). In particular, interactions be-tween people over time can lead toshared agreements which are thenregarded as "truth" or "fact" eventhough they do not stem from an ob-jective view of the world, but, rather,arise from the interaction between in-dividuals (Burr, 1995; Gergen, 1985;Lock & Strong, 2010). Therefore, theway in which individuals make mean-ing of the world does not necessarilycome from their own attempts at un-derstanding, but from their interac-tions with others (Lock & Strong,2010). Furthermore, the knowledgeand meaning that individuals gain fromsocial interaction often determine howthey choose to act (Burr, 1995).

Most parents who have a child withhearing loss have typical hearing abili-ties (Gallaudet Research Institute[GRI] 2007; Mitchell & Karchmer,2004a). This means that in order tomake choices related to their child'scommunication, these parents eitherrely on their limited knowledge andexperiences related to hearing loss orseek information or advice elsewhere.From the perspective of social con-structionism, it seems possible thattheir interactions with those sourcesfrom which they received advice in-fluence their views and subsequentchoices. Gathering information aboutthe types of individuals from whomparents seek advice, as well as thosethey feel have influence on their com-munication decisions, can result in abetter understanding of parents' ac-

tions (i.e., the communication choicethey make for their child).

Early identificationand interventionIn the last decade, there has been a sig-nificant increase in the number of in-fants screened for hearing loss. Beforewidespread infant hearing screeningwas in place, children would com-monly be identified with hearing lossbetween ages 2 and 3 years (NationalInstitutes of Health [NIH], 1993).Thanks to recommendations of NIHand the subsequent success of univer-sal newborn hearing screening pro-grams, some areas of the United Statesnow identify children with hearing lossat an average age of 2 months (Yoshi-naga-Itano, 2003).

Although the early identification ofhearing loss is highly important, it isjust the first step in making sure chil-dren have access to services that willhelp them develop communicationskills. Children with hearing loss andtheir families also need to have appro-priate support and intervention assoon as possible. The benefits of earlydetection and intervention have beenconsistently demonstrated by re-search. In particular, one study foundthat the language comprehension andexpressive language skills of childrenwho were identified with hearing lossbefore the age of 6 months were sig-nificantly better than those of chil-dren who were identified after thatage (Yoshinaga-Itano, Sedey, Coulter,& Mehl, 1998). It has also been deter-mined that the earlier a child is identi-fied with hearing loss, the better thatchild's language skills will be later inlife (Apuzzo & Yoshinaga-Itano, 1995;Robinshaw, 1997; S. J. White & R. E. C.White, 1987). Furthermore, it wasfound that children who began receiv-ing intervention services before theage of 11 months had language abili-ties at 5 years of age that were compa-

rable to those of 5-year-olds with typi-cal hearing (Moeller, 2000). Recently,researchers have demonstrated that in-tervention before the age of 3 monthsis even more effective in supportinglanguage, as measured by how manywords children are able to produceand understand, as well as their ges-ture use between 12 and 16 months ofage(Vbhretal.,2008).

Compiications Reiatedto intervention andCommunication OptionsBased on the benefits of early hearingloss identification and coinciding in-tervention, parents are being encour-aged to make decisions about theirchild's method of communicationvery early in their chud's life, ideallybefore he or she is 6 months old(Joint Committee on Infant Hearing,2007). Therefore, parents are encour-aged by professionals to choose amethod of communication for theirchild very quickly. Early hearing detec-tion and intervention programs pro-vide intervention that is intended tobegin as early as possible in an infant'slife, and that focuses primarily on thedevelopment of communication skills,as well as additional supports for par-ents and children (Seaver, 2010).Some of the most important aspectsof this intervention are based on themethod of communication the childwill use (Centers for Disease Controland Prevention, 2011; Seaver, 2010).There are a number of communica-tion methods that parents can choosefrom, including a spoken or visual lan-guage (e.g., either spoken English orAmerican Sign Language [ASL]), an al-ternate form of a spoken or visual lan-guage (e.g.. Cued Speech or SignedEnglish), or a combination of both aspoken and a visual language (e.g.,both spoken English and ASL; Gravel& O'Gara, 2003; Marschark, 2007;Seaver, 2010). This communication

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PARENTS' COMMUNICATION DECISION

choice is most beneficial when it ismade early in the child's life; however,it can often be complex, overwhelm-ing, and controversial (Seaver, 2010).

Because of the narrow window oftime between hearing loss identifica-tion and the ideal time to enroU aninfant in intervention services, par-ents often feel unprepared to make adecision about their child's methodof communication, especially sincethey often do not have the time tofully understand the implications ofthe different communication options(Young et al., 2006). This decisionmay also be overwhelming becausethe majority of children with hear-ing loss are born to two parents withtypical hearing abilities (GRI, 2007;Mitchell & Karchmer, 2004a) whomust make choices about their child'smethod of communication withoutmuch experience related to hearingloss (Kurtzer-White & Luterman, 2003).This decision is further complicatedby the fact that they have a number ofcommunication options to choosefrom, some of which have become in-creasingly controversial.

Choosing a method of communica-tion for a chUd can be controversialbecause different methods are com-monly associated with different viewsof hearing loss. There are two distinctways in which deafness is commonlyviewed—on the basis of either a socio-cultural or an audiological model(Senghas & Monaghan, 2002). Indi-viduals who believe that hearing losscan become a part of the cultural as-pect of the individual's life (through,for example, involvement in the Deafcommunity) are likely to adhere to asociocultural model of deafness (Seng-has & Monaghan, 2002). On the otherhand, those who have an audiologicalview of deafness see it as a medical de-fect to be repaired, and are thus morelikely to support interventions thathelp the child with hearing loss fit in

with mainstream society (Senghas &Monaghan, 2002). These differingviews of deafness are commonly asso-ciated with a specific method of com-munication, with a sociocultural viewof deafness aligning with the use ofASL and an audiological view aligningwith the use of the family's spokenlanguage.

Overall, these two models of deaf-ness commonly dominate the way inwhich individuals view hearing loss.There is a scarcity of research relatedto hearing parents' knowledge of andalignment with these views of deafness, and whether these views influ-ence parents' decisions regardingtheir child's method of communi-cation. In particular, it is unclear ifparents are consciously aware oftheir perceptions of hearing loss andtheir subsequent desires for theirchild to "fit" one model, and subse-quent lifestyle, or another. There isalso a need to understand where theseviews originate, so that parents caneventually be provided with knowl-edge and support in a way that givesthem useful and appropriate informa-tion on which to base their decision.

Influential FactorsRelated to Parents'Communication ChoicesThere are few studies of parents' com-munication choices for their childrenwith hearing loss, none of which arebased on representative samples. De-spite this paucity of research, thesestudies do find some common charac-teristics regarding influential factorsin parents' communication choices.The factor most often found to influ-ence parents' decisions is contactwith medical or education personneland the information or advice parentshave received from those individuals(Eleweke & Rodda, 2000; Kluwin &Stewart, 2000). Similarly, Li, Bain, andSteinberg (2003) found that there

were no significant differences be-tween groups of parents who choseoral only, sign only, or both oral andsign in regard to the factors that influ-enced their communication decisionfor their child. Approximately 90% ofall parents said they were influencedby a professional; however, informa-tion was not provided about the typeof professionals these parents werereferring to. Cost and availability ofservices corresponding with differentcommunication methods are alsonoted as influential factors (Eleweke& Rodda, 2000; Kluwin & Stewart,2000; Li et al, 2003). There are a num-ber of other influences related to par-ents' decisions that are noted lessoften; they include parents' percep-tions of assistive listening devices(Eleweke & Rodda, 2000), the atti-tudes of education and service profes-sionals (Eleweke & Rodda, 2000),suggestions from a friend (Li et al,2003), and the hope of having a childwho is able to communicate in a waysimilar to that of individuals with typi-cal hearing (Kluwin & Stewart, 2000).

Since information and guidancethat parents receive from medical oreducational personnel is the most fre-quently cited factor influencing par-ents' decisions about their child'smethod of communication, this guid-ance must be examined more closely.In one study, it was reported that lessthan half of parents surveyed hadbeen provided with informationabout more than one method of com-munication (Prendergast, Lartz, &Fiedler, 2002). In regard to the audio-logical and sociocultural models ofdeafness, it is common that onemodel of deafness dominates the waya professional views hearing loss,even though these views actually liealong a continuum (Marschark, 2007;Young et al, 2006). Such views—whether conscious or unconscious—could easily lead professionals to

VOLUME 157, No. 4, 2012 AMERICAN ANNALS OF THE DEAF

provide parents with partial or con-flicting information regarding differ-ent methods of communication. It iscommon that after parents have madea decision about a method of commu-nication, they realize that they werenot provided with adequate informa-tion at the time they were making theirchoice because of the strong one-sidedbeliefs of the professional (s) they hadapproached for advice (Young, 2002).Eurthermore, parents often fee! thatthey could not make a fully informeddecision because professionals en-couraged certain methods of commu-nication more than others, and thatmany of these professionals had suchstrong beliefs about certain methodsthat they were not able to provide par-ents with information related to all thepossibilities (Young, 2002).

Different views of deafness, as wellas the common result of profession-als' one-sided beliefs, play an impor-tant role in the information thatparents receive about methods ofcommunication, and in their subse-quent decisions. However, there havebeen debates spanning the last twocenturies regarding the benefits ofone communication method over an-other (Senghas & Monaghan, 2002).Research on the effectiveness or bene-fits of different communication meth-ods is inconclusive; although certainmethods of communication may bebeneficial to children with specificcharacteristics, there is not a singleapproach to communication that isbetter than all others for all children(Gravel & O'Gara, 2003; Marschark,2001; Spencer & Marschark, 2010).Since the limited studies to date haveconcluded that parents' communica-tion choices are commonly influ-enced by professionals, and that theseprofessionals often provide partial in-formation despite the fact that nomethod of communication has beenfound to be better than another, this

leads us to question where parents re-ceive information and how this relatesto the communication method theychoose for their child.

Another aspect of the communica-tion decision process that should beconsidered is the attitudes about deaf-ness and communication methodsthat parents themselves have. Li et al.(2003) studied parental beliefs and at-titudes because "in the absence ofconclusive medical evidence [aboutthe best method of communication],parents may rely instead on their be-liefs, values, and goals, which areoften polarized among people whotake opposite stances" (p. 163). Li etal. found that compared to parentswhose child used oral and sign or signonly for communication, parentswhose child used only oral communi-cation were significantly more likelyto indicate feelings that were consis-tent with an audiological or medicalmodel of deafness, such as the valuingof speech over sign.

There are a number of demo-graphic characteristics that could alsorelate to parents' communicationchoices. Eor example, Li et al. (2003)observed that parents' choice abouttheir child's method of communica-tion was most influenced by theirchild's degree of hearing loss, a find-ing that is related to the finding byothers that the way in which motherscommunicate with their child is influ-enced by the child's degree of hearingloss (Kluwin & Gaustad, 1991,1994). Ithas also been found that parents' owndegree of hearing loss is related totheir communication choice for theirchild (Mitchell & Karchmer, 2004b,2005). Other factors that should be ex-amined include the age at which thechild was identified with hearing lossand the child's current age. It is possi-ble that parents' choices could be bi-ased toward speech alone if the childwas identified with hearing loss at an

older age, since older children's meth-ods of communication may reflect op-tions available in their schools ratherthan parents' original choices.

Judging from the limited availableliterature, it appears that parents'communication choices for their childwith hearing loss are based on severalfactors—the most important being theinformation they receive from profes-sionals. Because most parents of chil-dren with hearing loss have typicalhearing (GRI, 2007; Mitchell & Karch-mer, 2004a), it is likely that they do nothave adequate information regardinghearing loss, yet they are likely to re-ceive only partial information fromprofessionals regarding options forcommunication methods (Young,2002) even though none of thesemethods are proven to be better forall children with hearing loss (Gravel& O'Gara, 2003; Marschark, 2001;Spencer & Marschark, 2010). There-fore, the present study investigates theinfluential sources from which parentsreceive advice and parents' ownknowledge and beliefs.

The Present StudyTo extend the limited research on par-ents' attitudes and beliefs that influ-ence their choices for communication,in the present study we examine par-ents' views about their relationshipwith their child, as well as their desiresregarding their child's place in societythat related to audiological or socio-cultural views of deafness. The studyalso considers parents' knowledge ofcommunication development, since itcould possibly relate to different com-munication options parents choosefor their children.

The present study addresses thegap in the current literature regardingwho or what influences parents' com-munication decision for their child.Specifically, the study addresses fourquestions:

VOLUME 157, No. 4, 2012 AMERICAN ANNALS OF THE DEAE

PARENTS' COMMUMCATION DECISION

1. From whom did parents receiveinformation about communica-tion options for their child whowas deaf or hard of hearing?

2. Who did parents feel was most in-fluential to their decision about acommunication method?

3. Are there differences in sourcesof information and sources ofinfluence between parents whochose speech only versus com-munication that included signsfor their children?

4. Did parents' values and knowl-edge influence the method ofcommunication they chose fortheir child?

Design and ProcedureParents or guardians of children withhearing loss who were under 7 yearsof age were asked to participate in asurvey; however, if parents indicatedthat they had children who were over7 years of age, they were not excludedfrom analyses. Information about thesurvey was distributed through Hands& Voices, a nonprofit organizationthat provides nonbiased emotionaland communication-focused supportfor families of children with hearingloss. Participants learned about thesurvey via Hands & Voices Hstservsand an advertisement in a quarterlynewsletter, as well as websites for par-ents. A web link placed in the paperand online newsletters took partici-pants to an introductory web page onSurveyMonkey, a secure online surveysite. Participants were informed of thenature of the study and their rights asparticipants, per the informed con-sent procedures of Michigan StateUniversity. Participants had to ac-knowledge and agree to each sectionof the online informed consent formin order to proceed to the survey. Forthose who requested a paper copy ofthe survey, a paper consent form wassent, which the parents returned with

the survey. After giving their consentto participate in research by indicatingthat they knew their rights as partici-pants, participants completed thesurvey either online (n = 34) or onpaper (ri = 2). Participants received a$15 gift certificate for completing thesurvey.

The portion of the survey that is an-alyzed for the present study focusedon how parents' communicationchoice related to the information theyreceived and felt was influential. Datawere analyzed that were relevant toparents' values related to their child'sdevelopment and their knowledge ofcommunication development.

ParticipantsA total of 36 participants who had achild who was deaf or hard of hearingparticipated in the present study. Only1 participant failed to complete thesurvey in its entirety. All participantswho completed the demographic por-tion of the survey were Caucasian {n= 35); 33 were mothers and 2 were fa-thers. Their 2008 mean household in-come was $54,403 {SD = $32,828;range = $0-1100,000). The partici-pants' average age was 37.65 years {SD= 5.15 years; range = 23.38-46.53years). The parents had a range of ed-ucational backgrounds: Two had pro-fessional degrees, 9 had master'sdegrees, 2 had post-baccalaureate ed-ucation, 10 had bachelor's degrees,and 4 had associate's degrees; 7 hadsome college training, and 1 had ahigh school diploma or GED. Partici-pants recruited for the survey hadchildren who were, on average, A.AAyears old {SD = 2.18 years; range =0.32-9.29 years). The children (16male, 19 female) had various degreesof hearing loss, which was identified atan average age of 9.87 months (SD =19.9 months, range = 0-77 months).Additional demographic informationcan be found in Table 1.

MeasureA single survey was created to gatherinformation on all concepts used inthe present study. Participants an-swered questions regarding theirknowledge and beliefs about commu-nication development in children,where they received informationregarding choices for their child'smethod of communication, and whoor what they felt influenced their sub-sequent decision. Participants werethen asked what method of communi-cation their child used to communi-cate with others.

Child Communication MethodParents were asked about their child'sprimary method of communicatingwith others, and were given the fol-lowing response options: "speak,""sign," "speak and sign," "I don'tknow yet," and "he/she does not com-municate." This item was used to cre-ate a dummy variable called ChildCommunication Method which speci-fied whether a child used speech onlyor a method of communication thatincluded signs. If participants indi-cated that they did not know yet orthat their child did not communicate,they were not included in analysesthat used this variable.

Sources of Informationand InfluenceA list of possible sources of informa-tion and influence on parents' com-munication choices for their childrenwas generated through a contentanalysis of current research literature,as well as books and websites de-signed for parents of children withhearing loss.

Parents were asked to indicatewhere they went for informationabout communication options whentheir child was first identified withhearing loss; they were asked to selectall sources that applied. A series of

VOLUME 157, No. 4, 2012 AMERICAN ANNALS OF THE DEAF

Table 1

Demographic Information on the Study Participants

Variable

Parental hearing status (W = 36)

Hearing

rDeaf and hard of hearing

Primary cultural identity of parents who were deaf and

hard of hearing {n = 6)

jj^Deaf culture

Deaf culture and hearing culture

Hearing culture

Primary method of communication of parents who were

deaf and hard of hearing (n = 6)

spoken language

A signed language

5oth spoken and signed language

Child's degree of hearing loss (A/= 35)

(26-40 dB)

Moderate (41-55 dB)

p/loderately severe (56-70 dB)

Severe (71-90 dB)

Profound (>90 dB)

Child's method of communication with parent (A/= 35)

•Speech

Sign

ISpeech and sign

Child's method of communication with others (N= 35)

iSpeech

Sign

Speech and sign

I don't know yet.

le/she does not communicate.

Child's use of hearing devices (N = 35)^

|Hearing aid in one ear

Hearing aids in both ears

Other

None

3 Because participants were allowed to mark more than one choice, the percentage column totalsmore than 100.0%.

dummy variables for each source ofinformation was created using partici-pants' responses to indicate whetheror not they had received informationfrom 13 specified sources. (See Table2 for the list of these sources.)

Parents were also asked to indicatewho or what they felt had primarily in-fluenced their communication deci-sion for their child; they were asked toselect only those options that had had

the most influence on their decision.Participants could choose among 14specified influences; these includedall of the items listed as sources of in-formation (see Table 2) other than "Ididn't seek additional information,"but also included the option of indi-cating "my own judgment" and "mychild's other parent/my spouse orpartner." Another series of dummyvariables was created for each of the

sources of influence to represent par-ticipants' responses.

Parental Values -A content analysis of current researchliterature, as well as books and web-sites designed for parents of childrenwith hearing loss, was used to gener-ate items that reflected parents' atti-tudes and beliefs related to their childthat more closely adhered to an audi-ological or sociocultural view of deaf-ness (Senghas & Monaghan, 2002).Five forced-choice questions weregenerated for the present study to as-sess parents' values in regard to theirchild, and were combined to create a"Parental Values Scale." Response op-tions that were in line with an audio-logical view of deafness were given ascore of 0; response options that werein line with a sociocultural view ofdeafness were given a score of 1. All ofthe responses were summed together,resulting in a scale in which thosewith lower scores had views that weremore in line with an audiological viewof deafness, and those with higherscores had views that were more inline with a sociocultural view of deaf-ness. The questions used to create theParental Values Scale are listed in theAppendix.

Knowledge of CommunicationDevelopmentBased on a subset of questions takenfrom the Knowledge of Infant Devel-opment Inventory (KIDI; MacPhee,1983), a "Knowledge of Communica-tion Development Scale" was createdto determine if parents' communica-tion choice could be explained by howmuch they knew about the develop-ment of early communication. TheKIDI is a survey that was created toevaluate an individual's knowledgeabout parenting practices, as well as in-fant development and typical behavior.(See the Appendix for the questions

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PARENTS' COMMUNICATION DECISION

Table 2Sources of Information for Parents {N = 35)

Source

Medical professionals

Community agency professionals or personnel

FamHy members/close friends

Other parents I know

Teachers/school personnel

M

t value

(two-tailed)

4.964**

-0.193

--3.113'

-2.448*

A school/educational program for the Deaf

l̂ diologist/speech pathologist ^ ' f H H H H H H H iPeople 1 know who are deaf/hard of hearing or have

a chiid who is deaf/hard of hearing

The InterneJIIIIIIIIIIIIIHIIIIIIII^^Books or magazines

1 didn't seek additional inform^i^^^^||g||||||||||||||||[|||||

i don't know/don't remember.

lilher ' •*p< .05. "p< .01.

.4000

WÊÊÊÊÊÊm.2571

.3714

•1.0286.0000

0.837 1• • • •-0.968

0.504

-10.538**

•^3.947**^.

used, the original categories in whichthey were included, and the correct re-sponses.) Participants could answereach question by choosing "agree,""disagree," or "not sure." For the pur-pose of creating a single score fromthese items, correct responses were as-signed a value of 1, and incorrect and"not sure" responses were assigned avalue of 0. All responses were summedto create a Knowledge of Communica-tion Development score. Cronbach'salpha for the entire KIDI measure hasbeen reported as .82 for parents(MacPhee, 1983). The present studyused a subset of the KIDI questions re-lated to early communication develop-ment; there are no reports of reliabilityfor this subset of questions.

ResuitsParents' Sources ofInformationTo determine whether there were sig-nificant differences in the frequencieswith which the total sample of partici-pants endorsed a particular source ofinformation, a one-sample t test wasused to compare the frequency withwhich each source of information was

endorsed to the average number oftimes any source of information wasendorsed.

The most common sources of infor-mation for parents included medicalprofessionals, audiologists or speechpathologists, and the Internet: 71% ofthe participants received informationfrom medical professionals and audiol-ogists or speech pathologists, and 63%sought or received information fromthe Internet. The next most commonsources of information were teachersor school personnel, schools or educa-tional programs for the deaf and hardof hearing, and books or magazines(see Table 2).

Parents reported seeking informa-tion from about 4 sources on average(M = 4.28, range = 1-10). On average,each information source was selectedby 14 participants (41%); however,there were significant differences be-tween sources in the frequency of par-ticipants' responses. A one-sample ttest (two-tailed) indicated that familiesreceived information about communi-cation options for their child frommedical professionals, audiologists orspeech pathologists, and the Internet

significantly more than other sources(see Table 2). On the other hand, asseen in Table 2, family members orclose friends and other parents werenot sources of information that par-ents commonly used. Furthermore,most parents indicated that they hadreceived information from the listedsources, as demonstrated by the factthat "I didn't seek additional informa-tion" and "I don't know/I don't re-member" were chosen significantlyless often than the listed options.

Influential Factors in Parents'Communication DecisionSources of influence were analyzed inthe same way as sources of informa-tion. Figure 1 shows that parents indi-cated that their own judgment was themost common factor that influencedthe method of communication theychose to use with their child, with 8696of parents' responses including thisfactor. The child's other parent or theparticipants' spouse or partner werethe next most common source of in-fluence, cited by 40% of parents.

Parents reported that their choicefor their child's method of communi-cation was influenced by an average ofabout 2.5 sources (range = 1-6). Eachinfluential source was selected by anaverage of 6 participants (18%). AsTable 3 shows, a one-sample t test(two-tailed) indicated that the influ-ential sources that were chosen sig-nificantly more often than otherswere parents' own judgment and thechild's other parent or the parent'sspouse or partner. Table 3 also showsthat factors that were not influential inthis decision were other parents andbooks or magazines.

Comparisons BetweenGroups: Sources ofInformation and InfluenceA two-tailed independent samples ttest was conducted to determine

VOLUME 157, No. 4, 2012 AMERICAN ANNALS OF THE DEAF

Figure 1

Frequency of Citation of Sources of Information That Parents Viewed as Influential

My own judgment

My child's other parent/my spouse or partner

Medical professionals

Community agency professionals or personnel

Family members /close friends

Other parents I know

Teachers /school personnel

A school/educational program for the Deaf

Audiologist /speech pathologist

People I know who are deaf/hard of hearing orhave a child who is deaf/hard of hearing

Websites on the Internet

Books or magazines

I don't know/don't remember.

. Other

0 5 10 15 20 25Number of Participants

30

whether there were differences in tbesources from which parents receivedinformation, as well as those that theyfelt were most influential, based onthe method of communication their

child used. Findings indicate that par-ticipants whose children use speechonly received information about com-munication options from teachers orschool personnel and audiologists or

Table 3

Sources of Information That Parents Reported to Have Been Influential on TheirCommunication Decision for Their Child (A/=35)

Source Mt value

(two-tailed)

The child's other parent/my spouse or partner

: Medical professionals or personnel

Community agency professionais or personnel

h_Family members/close friends

[Other parents i know

^lachers/school persoil

A school/educationai program for the Deaf

Audiologists/speech pathologists

Peopie i know who are deaf or have a chiid who is deaf

tebsites on the Internet

Books or magazines

I don't know/don't remefl

Other

.8571

.4000

.0857

.1143

.0857

.0571

.0857

.1429

.1429

.1143

.1143

.0286

.0000

.2000

11.307"

2.636*• •-1.178

-1.934-3.050**-1.934-0.595-0.595-1.178-1.178

-5.250**

0.312

*p< .05. **p< .01.

speech pathologists more often (seeTable 4).

The independent samples t test(two-tailed) indicated that, in regardto sources that parents viewed as in-fluential when they were decidingwhat method of communication theirchild would use, there were no signifi-cant differences between parents whochose speech only and parents whochose communication that includedsigns.

Comparisons BetweenGroups: Parental ValuesIn an independent samples t test(two-tailed), there was a statisticallysignificant difference in the scores onthe Parental Values Scale between par-ents of children who used speechonly and parents whose children usedcommunication that included signs,i(31) = -4.99, p < .001. Parents whochose speech only had lower scoreson average on the Parental ValuesScale (M = 2.11, SD = 0.90), wbicb in-dicated that they had views that fitmore closely with an audiologicalview of deafness. Those whose com-munication choice included the useof signs had higher scores (M = 3.73,SD = 0.96), which indicated that theyhad views that were more in line witha sociocultural view of deafness.

Comparisons BetweenGroups: Knowledge of .Communication DevelopmentFindings from an independent sam-ples t test (two-tailed) indicated thatparticipants whose children usedspeech only and those whose chil-dren used signs did not have signi-ficantly different scores on theKnowledge of Communication De-velopment Scale, t(51) = 0.903, ̂ =ns. This finding indicates that eachgroup of parents had similar knowl-edge about infants' communicationdevelopment.

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PARENTS' COMMUNICATION DECISION

Table 4Sources of Information for Parents in Relation to Their Child's Method ofCommunication (A/= 33)

Method of communication

Source

Speech

only

M

(SD)

Communication that

includes signs

M Mean

(SD) difference

Medical professionals

Community agency

professionals or personnel

Family members/

close friends

Other parents 1 know

personnel

A school/educational

program for the Deaf

Audiologist/speech

pathologist

People I know who are

deaf/hard of hearing or

have a child who is

deaf/hard of hearing

Websites on the

Internet

Books or magazines

I didn't seek additional

information.

I don't know/don't

remember.

Other

- p = .05. * p < .05.

Í value

(two-tailed)

Effects of Parental Values onCommunication DecisionsLogistic regression models were alsoused to determine if parents' valuescould accurately predict their com-munication choice when child char-acteristics were controlled for. We firstconsidered a model with control vari-ables only (Table 5, Model 1), thenadded our focal variable: parents' val-ues (Model 2).

Model 1 is a control variables-only

model that includes the child's degreeof hearing loss, the age at which thechild was identified with hearing loss,the child's current age, and parents'knowledge of communication devel-opment. Although parents' degreeof hearing loss has been shown to re-late to their child's communicationmethod (Mitchell & Karchmer, 2004b,2005), this variable was not includedas a control since only six parents indi-cated that they had hearing loss, and

only two of those identified with Deafculture. The results of Model 1 showthat none of the controls were statisti-cally significant predictors of parents'communication choice for their child;however, we choose to retain each ofthe variables in our subsequent modelin order to test the effects of parentalvalues with all other variables con-trolled for.

Model 2 includes the controls andthe parental values scores. After chil-dren's characteristics and parents'knowledge of communication devel-opment were controlled for, parents'values significantly predicted theircommunication choice. In particular,the odds ratio of 9.53 shows that whenparents answered one additional ques-tion in the Parental Values Scale thatwas more in line with a socioculturalview of deafness, rather than an audi-ological view, they were 9.53 timesmore likely to have chosen for theirchild to use signs.

The Relationship BetweenParents' Sources ofInformation and Their ValuesBased on the preceding results, a posthoc analysis was completed to investi-gate whether the sources from whichparents received information were re-lated to the parents' scores on theParental Values Scale. Results of theparametric Spearman correlations be-tween the parents' sources of informa-tion and their values score are shownin Table 6. The only significant correla-tion was between parents receiving in-formation from audiologists or speechpathologists and their values. Thisnegative correlation shows that par-ents who received information fromaudiologists or speech pathologistshad a lower score on the Parental Val-ues Scale, which means that they hadviews that were more in line with anaudiological view of deafness.

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Table 5

Logistic Regression Results for Parent Comnnunication Choices Based onDemographics and Parents' Knowledge and Values

Factor

Child's degree of hearing loss

Age at which child was identified

with hearing loss

Child's current age

Parent's knowledge of

communication development

Parents' values

Model fit (chi-square)

*p<.05. ***p< .001.Notes. OR refers to odds ratio, which

Model 1 (n = 30)

OR 95% CI

••1Í2ÍT37^0.97 [.90, 1.05]

" 0.6Í ^^'^•IIH1.17 [.35,3.90]

7.99 23.03*"

Model 2 (n = 30)

ORilmfi'B..

1.03

[ 0.47

0.56

9.53"

is the multiplicative effect of an additional

95% CI

[0.10.1.59][0.93, 1.13]

[0.05, 5.73]

11.62. 56.02]

unit of the predictoron the likelihood of using signs relative to speech. For example, the odds ratio of 0.61 for age indi-cates that for every additional month of age, parents are 0.61 times as likely to use signs. CI refersto confidence interval; 95% CI is the 95% confidence interval around the odds ratio. Confidence in-tervals containing 1 indicate a nonsignificant predictor.

DiscussionThe present study explores influentialfactors related to parents' decisionsabout their child's method of com-munication. In particular, the studyfocuses on influential sources of infor-mation, as well as parents' own valuesand knowledge.

Table 6

Correlations Between Parents' Sources of Information and Values (A/ = 35)

Sources of Informationand InfluenceThe findings of the present study indi-cate that parents most often receivedinformation from medical profession-als and audiologists or speech pathol-ogists. This finding is consistent withprevious research indicating that par-

Source .U

Méifcál profesÄ>nai&

Community agency professionals or peisonnel

Family members/close friends

Other parents 1 know

Teachers/school personnel ™*" HH^HHHHl

A school/educational program for the Deaf

Audiologist/speech pathologist

People 1 know who are deaf/hard of hearing or have a child

who is deaf/hard of hearing

The Internet

Books or magazines

1 didn't seek additional information.

i don't know/don't remember.

**p<.01

Correlation with soore

on Parental Values

Scale

-.206

.107

'~4lHliHMK''"-.093

-.036

-.444'*

.000

-.181-.138

.175

ents commonly receive informationfrom medical professionals (Eleweke& Rodda, 2000; Kluwin & Stewart,2000; Li et al., 2003). Further, our re-sults show that parents who chose amethod of communication that in-cluded signs had received informa-tion from different sources than thoseparents who chose speech only. Al-though audiologists or speech pathol-ogists were a common source ofinformation for all parents, those whochose speech only for their childspecified that they had received in-formation from these individuals sig-nificantly more often. Furthermore,these parents also indicated more of-ten that they had received informationfrom teachers or school personnel.These findings are consistent withthose of prior studies showing that par-ents commonly receive advice or infor-mation from professionals (Eleweke &Rodda, 2000; Kluwin & Stewart, 2000;Li et al., 2003), and show that receivinginformation from particular types ofprofessionals is associated with par-ents' choices. In light of previous re-search showing that parents felt thatthey received incomplete informationon communication options from pro-fessionals (Young, 2002), it is possiblethat these professionals—audiologistsor speech pathologists, and teachersor educational personnel in particu-lar—are the information sourcesthat commonly have strong beliefsthat favor an oral method of commu-nication.

Although parents reported receiv-ing information from an average offour sources, they reported an averageof only two sources of informationthat were influential. Interestingly thetwo most common sources of infor-mation that were cited as influentialwere not the professionals they spoketo, but instead the parents' own judg-ment and the opinion of the child's

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PARENTS' COMMUNICATION DECISION

other parent or the parents' spouse orpartner. Even though medical profes-sionals and audiologists or speechpathologists were the most commonsources of information, they werecited as influential by a much smallerpercentage of parents: Medical profes-sionals and audiologists or speechpathologists were each cited assources of information by 71% of par-ents, but medical professionals wereonly cited as influential by 9%, and au-diologists or speech pathologists wereeach cited as influential by 14%. Thesefindings appear to contradict previousresearch indicating that parents' deci-sions are influenced by the opinionsof professionals (Eleweke & Rodda,2000; Kluwin & Stewart, 2000; Li et al.,2003); however, previous studies didnot specifically ask parents to differen-tiate between sources of informationand sources of influence, as was donein the present study. Therefore, thepresent study examines a more nu-anced picture of decision making andmay demonstrate a difference be-tween parents' actual sources of infor-mation and the sources that they feltwere influential. Overall, there wereno significant differences between theparents who chose speech only andthose who chose communication thatincluded sign in regard to the sourcesof information they indicated as beinginfluential.

The theory of social construction-ism can provide a frame for under-standing why parents did notcommonly indicate outside sourcesof information as influential, eventhough they had received informationfrom a number of sources. From theperspective of social constructionism,which states that individuals' knowl-edge is the product of their interac-tions with other individuals (Gergen,1985), the findings of the presentstudy can be seen in another light.While there are clear differences in

sources of information received byparents who chose speech only, bothgroups of parents reported that theyrelied on their own opinions andthose of the child's other parent. Thismay indicate that they had internal-ized the information they receivedfrom sources of information and hadaccepted it as their own beliefs. In par-ticular, parents who chose speechonly received information signifi-cantly more often from audiologistsor speech pathologists and teachersor school personnel, yet there was nodifference in sources that were citedas influential between this group ofparents and those who had chose amethod of communication that in-cluded signs. These findings are con-sistent with a social constructionistinterpretation of how decisions aremade—the knowledge that individu-als gain from interacting with othersinfluences their actions (Burr, 1995).If parents internalized the views ofthese professionals, they would thenfeel that their own judgment was themost influential factor related to thedecision they made rather than someoutside source. It is also possible thatif the child's other parent or the par-ent's partner also received informa-tion from the same sources, then theytoo internalized that information. Thiswould explain why these individualswere second most commonly cited asinfluential sources of information forparents. Therefore, based on the ideasof social constructionism, it is possiblethat parents had internalized the viewsof audiologists or speech pathologistsand teachers or school personnel,who are professionals who may havestrong one-sided beliefs toward theuse of a method of communicationthat includes speech by itself. Conse-quently, it would be understandablethat those parents then chose to usespeech only but felt that the choicecame from their own opinion.

Parents' Knowledgeand ValuesThere were no significant differencesin parents' knowledge of communi-cation development between thegroups of parents, even though therewas variance in parents' scores (rang-ing from 29% to 100% correct). Thelack of differences between thegroups of parents may mean that theirdecisions were not based on differ-ences in knowledge but on other in-fluential factors already discussedabove. However, this sample was rela-tively well educated, and there waslimited variation in parents' knowl-edge of communication develop-ment. Thus, a more diverse sample ofparents may yet reveal a role forknowledge of communication devel-opment in parents' decisions.

Parents who chose speech only fortheir child had views that were in linewith an audiological view of deaf-ness. This finding is consistent withthose of previous research (Kluwin &Stewart, 2000; Li et al, 2003) thatshowed that parents who had audio-logical views of deafness typicallychose speech as their child's primarymethod of communication. Parentswho chose a method of communica-tion that included signs had views thatwere in line with a sociocultural viewof deafness.

Further, based on the results of thepost hoc analysis associating parentalvalues with sources of information,only the receipt of information fromaudiologists or speech pathologistswas significantly related to parents' val-ues. Parents who received informationfrom audiologists or speech patholo-gists had views that were in line with anaudiological view of deafness. This isinteresting, given that our findings in-dicate that parents who chose speechonly received information from theseprofessionals significantly more oftenthan parents whose child used signs.

VOLUME 157, No. 4, 2012 AMERICAN ANNALS OF THE DEAF

Based on the way in which the datafor the present study were collected(i.e., after a communication choicehad been made), the path of influencebetween sources of information, par-ents' values, and their choices is un-clear. One explanation for theseresults is that parents whose valueswere in line with either an audiologi-cal or sociocultural view of deafnesssought information from specificsources. However, since most parentsof children with hearing loss are hear-ing (GRI, 2007; Mitchell & Karchmer,2004a), and most hearing adults havelittle experience of deafness (Kurtzer-White & Luterman, 2003), we cannotassume that the parents who partici-pated in the present study had alreadyadopted strong one-sided beliefs foror against using signs or speech and,based on those beliefs, decided whattypes of professionals they would goto for advice. Instead, it is possiblethat specific types of professionals,audiologists and speech pathologistsin this case, provided parents with in-formation that influenced their viewsof deafness and their communicationchoice for their child. Another possi-bility is that the parents' communica-tion choices, and their subsequentexperiences of their children, maythen have influenced the values theseparents endorsed.

Strengths and Limitationsof the StudyOne strength of the present study wasthe recruitment of participants from anonbiased organization in order to in-corporate diversity within the sourcesof information and influence for par-ents, and variance in parental beliefs,values, and knowledge. Anotherstrength was the different methods ofcommunication that were used by theparticipants' children. Although therecruitment strategy was intended toinclude demographically diverse par-

ticipants, the study has limited gen-eralizability due to the fact that allparticipants were drawn from onesource, and the information providedby parents was for children in a broadrange of ages. The study is also limitedbecause all parents were Caucasianand had moderate incomes and highlevels of education on average; there-fore, the results of the study cannotbe assumed to be representative of allparents of children with hearing loss.Furthermore, the size of the samplelimited the analyses that could bedone with the data and the power ofsuch analysis. These challenges arecommon for researchers who workwith parents of children with hearingloss, given that this is such a low-inci-dence population.

Future DirectionsDue to the many factors related tochildhood hearing loss and the com-plications that parents face whentrying to make a communication de-cision for their child, future researchon this topic should prioritize thegathering of a much larger and morediverse sample, specifically includingindividuals who participate in Deafculture and others who have an addi-tional minority status besides hearingloss. Increasing the size and diversityof the sample could also enable a testof the scales used in the present studyas part of a consideration of thebroader factors that influence parents'decisions. Also, based on events andchanges that occur over time that mayinfluence how parents make commu-nication choices for a child with hear-ing loss, the children's age rangeshould be more restricted. Additionaldemographic data should also begathered on factors that may influ-ence the method of communicationthat parents choose for their child,such as the child's birth order, if he orshe has additional siblings with hear-

ing loss, and if so, whether they areolder or younger. Furthermore, in or-der to tease apart the complex rela-tionship between parents' values andtheir sources of information and influ-ence, future studies should incorpo-rate longitudinal designs so as toenable a better understanding of par-ents' values before they begin receiv-ing information about their choices fortheir child's communication, what typeof information they receive from spe-cific sources, and if their values changeover time in response to such informa-tion or as a result of the choices theymake. Finally, future research shouldalso include randomly assigned follow-up interviews with parents to gain amore comprehensive report of the fac-tors that influenced their communica-tion choice, and member checking tovalidate the findings and interpreta-tions of the study A focus group ap-proach should also be considered forfuture research since it could providean opportunity for parents to sharemore detailed information about howtheir choices were influenced andwhat they valued the most.

Also, given that there are a numberof books and other printed materialsavailable for parents related to commu-nication options and the experiencesof other parents, parents' infrequentuse of these materials should be inves-tigated. It may be useful to study howthese materials, or parents' access tothem, could be improved.

Conclusion and ImplicationsFindings of the present study indicatethat, in the present sample, the methodof communication that the parentschose was influenced by the sourcesof information they received duringthe decision-making process. Specif-ically, parents who chose to usespeech received information fromteachers or school personnel andaudiologists or speech pathologists

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PARENTS' COMMUNICATION DECISION

more often than those who chose touse a method that included signs.However, there were no significantdifferences in the sources of informa-tion that parents cited as having thegreatest infiuence on their decision.Instead, there is one common sourceof information that parents cited asbeing infiuential—their own judg-ment, followed by the infiuence oftheir child's other parent or theirspouse or partner. It is possible thatparents who chose speech only inter-nalized the views and opinions of theprofessionals from whom they had re-ceived information significantly moreoften, and then accepted these viewsas their own. This acceptance couldbave led them to believe that theirjudgment, as well as the judgment oftheir child's other parent or their part-ner or spouse, actually had the most in-fiuence on their decision, rather thanthe individuals from which it originallycame. These findings have implicationsfor the sources from which parents re-ceive advice. It is of utmost importancethat these sources of informationprovide parents with current, accu-rate information so they can makewell-informed decisions about theirchild's communication, and, if neces-sary, refine tbose decisions over time.

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Appendix

Survey Variables Created for Analysis

Parental Values Scaleitem Score assigned

^ . V\fliëffiny cnlraisorscndol age, it is most important that my child ¡s able to fit in with his/her peers.

B. When my child is of school age, it is most important that I have a good relationship with my child.

A. It is important to me that my child lives a normal life, a life like everyone else.

B. It is important to me that my child lives the kind of life that is right for him/her.

A. It is important to me that my child has all of the opportunities and experiences that other children hav

B. It is important to me that my child has opportunities that fit his/her own unique talents and limitations.

^ . The language that my child learns early ¡n life should prepare him/her to more easily fit in with

B. The language that my child learns early in life should help him/her and me communicate earlier in his/her life.

A. When my child is of school age, it will be very important for him/her to fit in with his/her hearing peers and

communicate effectively with those peers.

B. When my child is of school age, it will be very important for him/her to fit in with his/her deaf peers and"

communicate effectively with those peers.

Knowledge of Communication Development Scale items

Item

Children often will keep using the wrong word for awhile, even when they are told tfi

to say it (like "feet" not "footses").

Babies understand only words they can say

KIDI

categoryCorrect

response

A child is using rules of speech even when he/she says words and sentences in an unu

or different way (like "I goed to town" or "What the dolly have?").

Children learn all of their language by copying what they have heard adults say

The more you comfort your crying baby by holding and talking to it. the more you spoil him/hed

The parent just needs to feed, clean, and clothe the baby for it to turn out fine.

Talking to the baby about things he/she is doing helps the baby's development and later competence.

The two-year-old who says "no" to everything and tries to boss you around means it is just trying

to get you upset.

l ^b ies do some things just to make trouble for the parent (like crying a long time or soiling their diape.Total possible correct

Principle-LanguagePrinciple-Language

Principle-Language

Principle-Language

1 ParentiJWPPPParenting

Parenting

Agreel

Disagree

Agree ̂

Disagree

1 Disagre|

Disagree

Agree >

Parenting Disagree

Note. KIDI, Knowledge of Infant Development Inventory.

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