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((114 11"1'1113'111211; ~‘11["11‘ 1| '1" h!“ h N11111- '111 ‘11111111 “1'I111'11‘11JII‘11J1'1J1111‘1'L LIBRARY L M‘chj 339 State university % This is to certify that the dissertation entitled A GDMMUNICATION PROGRAM FOR ENHANCING INI‘ERACI‘ION IN FAMILIES WITH A HEARING IMPAIRED CHIID presented by Beth Schoenmld—Ooerbeck has been accepted towards fulfillment of the requirements for _PILD._ degree in kachology Date 141M 8 ?/1 QB MS U i: an Afl'irmaiiw Action/Equal Opportunity Institution 0-12771 RETURNING MATERIALS: fl— FMSU 1 Place in book drop to “**aup +hiq rhorbnuf Fw’* A COMMUNICATION PROGRAM FOR ENHANCING INTERACTION IN FAMILIES WITH A HEARING IMPAIRED CHILD By Beth Schoenwald—Oberbeck A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling and Educational Psvcholouv and Special Education 1983 ©1983 BETH CINDY SCHOENNALD-OBERBE CK All Rights Reserved ABSTRACT A COMMUNICATION PROGRAM FOR ENHANCING INTERACTION IN FAMILIES WITH A HEARING IMPAIRED CHILD BY Beth Schoenwald Oberbeck Research on problems associated with the hearing impaired child's socialization processes are reviewed. The influence of communication within the family and it's effects on the hearing impaired child's social development is discussed. A communication program for families with a hearing impaired child (FWHIC) was developed and used with four families. A matched Comparison group participated in loosely structured discussions. The program activities integrated positive com- municative dimensions with issues related to this population. The program was derived from the Human Development Program by Bessel (1972). Videotaped ratings of communication skills, the Moos Fam- ily Environment Scale, interviews and written comments were used to measure the programs' effectiveness. Findings indi- cate that the FWHIC program did have beneficial effects for parents and/or children. Some of the major findings include improved awareness skills, the ability to label feelings and skills, in- .cmeased.perceptions of family cohesiveness, and decreased perceptions of family conflict. The Comparison families participated in loosely struc- tured discussions actually perceived some deterioration in their perceptions of family environment, and a decrease in their awareness and social interaction skills. A follow up analysis 3-4 weeks after the program indicated several long term effects, although the majority of children and families perceived no changes. To my family, Gary, Mom, Dad, David, Robin, Marna, Clare, Fritz, Sessue, Neuvo and Beezus; And to the Vill- age School which provided me with the motivation and perception of learning which helped me through all of my doubts about educational institutions. ii ACKNOWLEDGMENTS I would like to thank my advisor Dr. Walter Hapkiewicz for his continuous support and direction, and my committee Dr. Chris Clark, Dr. Vivian Stevenson, and Dr. Gary sufllak for their assistance in making this project possible. In addition thanks are due to Dr. Dave Dalby for his support and assistance in working with the data, Dr. Robert Fernie for his consultation and to Ms. Carol Grubbs for the TLC with which she typed this document. Last but not least I would like to thank llr.Jay Farman, the Director and Mr. Alan '" Lblxmd, the Assistant Director at the Phoenix Day School for the Deaf for their help and cooperation. iii .- TABLE OF CONTENTS Page(s) LIST OF TABLES 00000000000000oeoooo00000000000000000000000000... V111 LIST OF FIGURES ................................................ CHAPTER 1: INTRODUCTION ....................................... Theoretical Framework ..................................... Problem ................................................... Purpose ................................................... Conceptual Hypotheses ..................................... CHAPTER 2: REVIEW OF LITERATURE ............................... Family Socialization Practices ............................ Families With Hearing Impaired Children Improving Communications .................................. Summary of Literature Review .............................. CHAPTER 3: DESIGN OF THE STUDY ................................ Sample .................................................... Conceptual Hypotheses ..................................... Experimental Treatment..................................... Measures .................................................. TABLE 1 Family Environment Scale Subscale Descriptions ... TABLE 2 Internal Consistencies, Average Item-Subscale Correlations and Test-Retest Reliabilities for PBS Form R Subscales ............................. Procedure ................................................. Alterations in the HDP for the FNHIC ...................... Sequence of Meetings With the Families .................... Summary of Procedures ..................................... CHAPTER 4: ANALYSIS OF RESULTS ................................ Introduction .............................................. Case Study of Each Family and Comparison Family ........... Figure 1: Communication Skills of Family Units 1A and 1 .. Figure 2: Communication Skills for Experimental and Comparison Family Members in Units 1A and 1 .... Figure 3: Pre-Post Test Profiles for Experimental Family 1A ...................................... Figure 4: Pre-Post Test FES Profiles for Comparison Family 1 ....................................... Figure 5: Communication Skills of Family Units 2A and 2 .. Communication Skills for Experimental and Comparison Family Members in Units 2A and 2 .... : Pre-Post Profiles for Experimental Family 2A ... Pre-Post Test Profiles for Comparison Familyz 0.0000000000000000000000.0.0.0....0.... : Communication Skills of Family Unit 3A ......... Figure 6: Figure 7 Figure 8: 9 Figure iv ix 1-7 1-2 2-6 6 6-7 8-35 8-13 13-17 17-34 34-35 36-54 36-37 37-38 38 39-43 40 41 43-46 46-52 52-53 53-54 55-121 55-56 56-71 57 58 59 6O 61 62 63 64 65 Page(s) Figure 10: Communication Skills for Experimental Family Members in Unit 3A ..................... 66 Figure 11: Pre-Post Test Profiles for Experimental Family 3A ..................................... 67 Figure 12: Communication Skills of Family Units 4A and 4 ...................................... 68 Figure 13: Communication Skills for Experimental and Comparison Family Members in Units 4A and 4 ... 69 Figure 14: Pre-Post Test Profiles for Experimental Family 4A ..................................... 70 Figure 15: Pre-Post Test Profiles for Comparison Family 4 ...................................... 71A No. 1A Parent's Written Comments for the Sessions ......... 71-72 Interview with Family No. 1A .............................. 72 Family Environment Scale No. 1A ........................... 72-73 Matched Comparison Family No. 1 (Two Parent Family) ....... 73 Ratings of Family Communication Skills .................... 73 No. l Parent's Written Comments of the Sessions ........... 73-74 Interview with Family No. 1 ............................... 74 Family Environment Scale No. 1 ............................ 74-75 Discussion of Experimental Family No. 1A and Comparison Family No. 1 .............................................. 75-76 Experimental Family 2A (2 Parent Family) .................. 76 Ratings of Family Communication Skills .................... 76-77 No. 2A Parent's Written Comments of the Sessions .......... 77 Interview with Family No. 2A .............................. 78-79 Family Environment Scale No. 2A ........................... 79 Matched Comparison Family No. 2 (Single Parent Family) .... 80 Ratings of Family Communication Skills .................... 80 No. 2 Parent's Written Comments of the Sessions ........... 80 Interview with Family No. 2 ............................... 81 Family Environment Scale No. 2 ............................ 81-82 Discussion of Experimental Family No. 2A and Comparison Family No. 2 .............................................. 82-83 Experimental Family No. 3A (2 Parent Family) ............. 83 Ratings of Family Communication Skills .................... 83-84 No. 3A Parent's Written Comments of the Sessions .......... 84-85 Interview With Family No. 3A .............................. 85-86 Family Environment Scale No. 3A ........................... 86 Matched Comparison Family No. 3 ........................... 86-87 Discussion of Experimental Family No. 3A .................. 87 Experimental Family 4A (2 Parent Family) ................. 87 Ratings for Family Communication Skills ................... 87-88 No. 4A Parent's Written Comments of the Sessions .......... 88-89 Interview With Family No. 4A .............................. 89 Family Environment Scale No. 4A ........................... 9O Matched Comparison Family No. 4 (Two Parent Family) ...... 90 Ratings of Family Communication Skills .................... 90-91 No. 4 Parent's Written Comments for the Sessions .......... 91 Interview With Family No. 4 ............................... 91-92 Family Environment Scale No. 4 ............................ 92-93 Discussion of Experimental Family 4A and Comparison Family No. 4 .............................................. 93-94 V Family Environment, Summary and Conclusions ................ TABLE 3 - Summary of changes in FES for Families ........... TABLE 3 - (cont.) .......................................... TABLE 4 - Summary of Changes in FES for Child .............. TABLE 4 - (cont.) .......................................... Cohesion ..................................... . ..... ........ Expressiveness ............... . ....... . ....... ... ..... ...... Conflict ...................................... . ....... ..... Independence ........................... .... ...... .......... Intellectual Cultural Orientation . ........... . ........... .. Active Recreational Orientation .... ......... . .............. Moral Religious Emphasis ........ ........... ..... ........... Organization .......................... . .................. .. Control ................................... ................. Family lncongruence Scores ............................... .. Post Test - Follow Up Testing ......... ...... ............. .. Cohesion ............................ ....... ............... . Figure 16: Follow Up FES Profiles for Experimental and Comparison Family Units 1A and 1 ............... Figure 17: Follow Up FES Profiles for Experimental and Comparison Family Units 2A and 2 ............ ... Figure 18: Follow Up FES Profile for Family Unit 3A ....... Figure 19: Follow Up FES Profile for Experimental and Comparison Family Units 4A and 4 ............... Expressiveness ......................................... .... Conflict ............................................... .... Independence .............................. . ................ Achievement Orientation .................... . ............ ... Intellectual Cultural Orientation ........................ .. Active Recreational Orientation ................ . . . . . . Moral Religious Emphasis ....................... . ........... Organization. ............................................... Control .................... ..... ........................... Family Incongruence Score for Post-Follow Up Testing ....... Family Communication Skills, Summary and Conclusions ....... TABLE 5 - Summary of Changes in Communication Skills ....... TABLE 5 - (cont.) . ............. ... ......... ....... ....... .. Awareness ........... ............. .. ..... ............ ..... .. Mastery ...... ......... ...... .......... ........... .......... Social Interaction .... .......... .............. ......... .... CHAPTER 5: CONCLUSIONS AND DISCUSSION ................ ...... .... Limitations .................................. ..... ......... Videotapes ................................................. Population ................................. ....... ......... Implications for Future Research ........................... APPENDIX A - Demographics of Phoenix Day School for the Deaf March 8, 1982 ........................ ..... ......... APPENDIX B - Topics Used For Discussion When Filming Pre- and ' Post-Tests ......................................... APPENDIX C - Suggestions For the Professionsl When Facilitating Use Of Program For Families With A Hearing Impaired Child .......... ................. .......... Page(s) 94—99 95 96 97 98 99 99—100 100 100—101 100-102 102 102-103 103-104 104 104-105 105 105-110 106 107 108 109 110 110—111 111—112 112 113 113-114 114 114 115 115-116 116—119 117 118 119 119-120 120—121 122—135 131 131—132 132 132—135 136—139 140 141 Page(s) APPENDIX D - For Your Family: A Family Education Program for families with a hearing impaired child ........ 142-162 APPENDIX E - Topics Used For Discussion In Comparison Group .... 163 APPENDIX F - Examples of Scoring Pre- and Post-Video Tapes ..... 164-165 APPENDIX C - Written Comments by Parents ....................... 166-175 LIST OF REFERENCES ............................................. 176-181 vii TABLE TABLE 2 TABLE TABLE TABLE D LIST OF TABLES Page(s) Family Environment Scale Subscale Descriptions .. ..... 40 Internal Consistencies, Average Item-Subscale Correlations and Test-Retest Reliabilities for FES Form R Subscales . ......................... . ...... 41 Summary of Changes in FES for Families ............... 95-96 Summary of Changes in FES for Child .... ..... . ..... ... 97-98 Summary of Changes in Communication Skills ........... 117—118 viii LIST OF FIGURES Figure 1: Communication Skills of Family Units 1A and 1 ..... .. 57 Figure 2: Communication Skills for Experimental and Comparison Family Members in Units 1A and 1 ......... 58 Figure 3: Pre-Post Test Profiles for Experimental Family 1A ............. 0.... ...... ......O............ 59 Figure 4: Pre-Post Test FES Profiles for Comparison Family 1 .0... ......OOOOOOICCOOO 000000000000 60 U“ Figure Communication Skills of Family Units 2A and 2 ....... 61 Figure 6: Communication Skills for Experimental and Comparison Family Members in Units 2A and 2 ......... 62 Figure Pre-Post Profiles for Experimental Family 2A ........ 63 Figure 8: Pre-Post Test Profiles for Comparison Family 2 ............................................ 64 Figure 9: Communication Skills of Family Unit 3A............... 65 Figure 10: Communication Skills for Experimental Family Members in Unit 3A ........................... 66 Figure 11: Pre-Post Test Profiles for Experimental Family 3A ..... ...... ...................... ....... ... 67 Figure 12: Communication Skills of Family Units 4A and 4 ............................................ 68 Figure 13: Communication Skills for Experimental and Comparison Family Members in Units 4A and 4 ......... 69 Figure 14: Pre-Post Test Profiles for Experimental Family 4A ... ...... .................................. 70 Figure 15: Pre-Post Test Profiles for Comparison Family 4 ............................................ 71 Figure 16: Follow Up FES Profiles for Experimental and Comparison Family Units 1A and 1 .................... 106 Figure 17: Follow Up FES Profiles for Experimental and Comparison Family Units 2A and 2 .................... 107 Figure 18: Follow Up FES Profiles for Experimental Family 3A ... 108 Figure 19: Follow Up FES Profiles for Experimental and Comparison Family Units 4A and 4 .................... 109 \J ix CHAPTER I: INTRODUCTION Theoretical Framework It is quite clear that the family plays a critical role in the socialization of the child. The parents' methods of discipline, their attitudes towards their child, and their relationship with each other all have an effect on the child's development. The child's behavior and constitu- tional predisposition also play an important role in how the family system operates. Variations in pamnnal behavior have been found to re- late in systematic ways to differences in social and cogni- tive development in their children. Baumrind's research suggests that "authoritative" parenting is most effective in developing a child's competence. Baumrind suggests that "authoritative" parents give their children an opportunity to explore the environment and gain interpersonal competence without the experience of anxiety. A child's anxiety is often associated with restrictive, power assertive discipline practices; or with the complete permissiveness resulting in a child's inexperience in conforming to the demands and needs of others (Baumrind 1967). Similarly, consistency in child rearing is important in the socialization of the child. Parental conflict and in- consistency are associated with maladjusted behavior in children, particularly in the form of aggression (Glueck & Glueck, 1950; Heatherington, Cox & Cox, 1978; Garmezy, 1975; l 2 McCord, McCord & Zola, 1959; Martin & Heatherington, 1971; Patterson, 1977, 1978). The parent socializes the child by serving as a model to imitate. Kagan (1964) suggests that the child gains a sense of mastery over the environment by imitating the res- ponses of a warm, competent and powerful parent. Evidence from imitation studies supports this position (Bandura & Huston, 1961; Bandura, Ross & Ross, 1963; Heatherington, 1965; Heatherington & Frankie, 1967; Mischel & Grusec, 1966; Mussen & Parker, 1965). Husbands and wives serve as a mutual support system for each other. Positive mother-infant interaction has been found when fathers are supportive of mothers (Pederson, 1975; Pederson, Anderson & Cain, 1977; Feiring & Taylor, 1977). There is a tremendous amount of literature which pertains to how a marriage is affected by the birth of a handicapped child. Frequently, stages or phases are used to describe the process of reacting to and accepting their child's handicap. Anger or blame are emotions often used to describe husband- wife attitudes towards each other, and are often considered coping strategies (Ulrey & Rogers, 1982). High conflict be- tween parents is associated with negative feelings toward children (Pederson et al, 1977). Problem Social interaction is necessary for learning appropriate behaviors and values. The transition from an egocentric 3 perspective to a decentered perspective requires exposure to other's positions and orientations. A hearing impaired child is rarely exposed to enough appropriate role models, or to the quantity and quality of communication necessary for social maturity. Altshuler, a psychiatrist who works with the hearing impaired population, observed that certain unique person- ality features were present among deaf persons. His obser- vations were made in a preventative mental health clinic for hearing impaired persons. They often showed a poorly deve- loped ability to understand and care about the feelings of others, and had inadequate insight into the impact of their own behavior on others. They held a generally egocentric View of the world, and their inability to handle tension seemed to be reflected in impulsive behavior and the absence of much thoughtful introspection (Rainer 8: Altshuler &Kallman 1969). The research of Schlesinger and Meadow (1972), Barker (1953), Mindel and Vernon (1971), all report similar findings regarding the social immaturity of a hearing im- paired person. A study of deaf adolescents conducted by Evans (1975) indicated that ninety percent of the surveyed population of hearing impaired children who have hearing parents have no system of communication other than primitive iconic homemade gestures. The communication barrier for a deaf child is heightened even more when we consider what is "missed" in addition to direct communicative exchanges. 4 The difficulties faced by parents of hearing impaired children as a result of this barrier might well be expected to cause difficulties in management, play, and discipline. This is confirmed by videotapes of parents and preschool hearing impaired children at play. Parenting practices often fluctuated between overindulgence and excessive demand, indicating the lack of understanding of the dynamics of deaf- ness, [er the child's use of acting-out behaviors as a mode of communication (Schlesinger and Meadow, 1972);] In addi- tion, they found that parents of deaf children are likely to overprotect their deaf children, thus reducing their range of experiences and objects available for manipulation. As the hearing impaired child's life continues, and language development does not occur normally, family-child communication becomes increasingly frustrating and stressful. The adult-child communication patterns tend to be more di- dactic and less mutual. The deep semantic aspects of com- munication tend to be distorted or lost by attention to the surface features of the communication exchange (Liben, 1980, p. 202). The issue of communication is integrated into almost all the literature on family socialization. Communication is an integral part of discipline, modeling, identification, and mutual support systems within the family. Thus we can assume that'improved communication within a family with a hearing impaired child would facilitate remediation of some of the difficulties cited above. We assume that improved 5 communication would improve the family environment. There are numerous therapy techniques and educational programs which are aimed at improving one's ability to commu- nicate with others in groups. Group size (Psathas, 1960), group attractiveness (Cartwright and Zanders, 1968) and group expectations (Bradford and Mial, 1963) all contribute to the group's effectiveness. Current research on communicative competence (Larson, Blacklund, Redmond and Barber, 1978) have demonstrated ways in which communication skills can be measured. Dimensions of communicative competence serve as operational definitions of competence and may be used when testing, measuring and instruction communication strategies (Weiman, 1980). Although different researchers maintain different views on what dimen- sions of communicative competence are important, Weimann and Blacklund (1980), authors of a comprehensive review, state that there is a surprising degree of consensus on what be- haviors constitute competence. The Human Development Program (HDP) developed bylkmsell (1972) and Palorrares (1980)is aprogram which provides opportun- ities for learning and practicing effective communication skills. It is often referred to as a "high quality communi- cation experience". The HDP learning strategies encourage people to utilize themselves and others as resources for gaining useful ideas and information about experience. The dimensions of communication that Bessell and Palomares use are derived from huge body of theoretical literature 6 including behavioristic, humanistic and psychoanalytic orien- tations. Their objectives for the program parallel the vari- ous dimensions described in communicative competence models fairly closely. Purpose This study attempts to provide an intervention program for families with a hearing impaired child. The program is designed to have a positive effect on family communication and the family environment. The program process will be an adapted version of the Human Development Program. The con- tent, or activities will relate to research on individual and family development in families with a hearing impaired child, in contrast to "normal" families. There have been relatively few empirical studies con- ducted with families having a hearing impaired child, al- though they have been appearing more frequently within the last decade. Most of the literature written on the social development of the hearing impaired child and his family has been descriptive in nature. This study attempts to contri- bute to the limited amount of empirical literature in this area . Conceptual Hypotheses The study will be organized around two conceptual hypo- theses: a) Family environment will change following the treatment program; b) Family communication will change 7 following the treatment program. A pilot study will be con— ducted prior to the actual research study. This procedure should minimize difficulties with the practical aspects of the program as well as determine that program instructions are clear. CHAPTER 2: REVIEW OF LITERATURE The review of literature includes three related topics: 1) Family Socialization Practices; 2) Families with Hearing Impaired Children; 3) Improving Communication. Each topic will be reviewed separately and subsequently tied together in a summary section. Family Socialization Practices Socialization is a process whereby an individual ac- quires behavior patterns, beliefs, standards, and motives, all of which are valued by, and appropriate in, his own cultural group and family. The range of possible character- istics which may become adopted by an individual is enormous; and yet a person ordinarily adopts characteristics and be- haviors which are considered appropriate to his own parents. Baumrind (1967) was concerned with the types of parent- child relationships which enhance a child's competence. Com- petence was defined as self-reliance, social responsibility, independence, achievement orientation, and vitality. In order to investigate this, a group of 3 and 4 year olds were observed in nursery school and at home, and rated on their levels of competency. Three groups of children were then selected on the basis of their competency ratings: Group One (most competent) were the most mature, content, independent, realistic, self-reliant, self controlled, explorative, affil- iative, and self-assertive. Group Two children were rated as 9 moderately self—reliant and self controlled, but relatively discontented, insecure and apprehensive. Group Three child— ren were the most immature, highly dependent, less self con- trolled, less self-reliant, and more withdrawn, tending to retreat from novel or stressful experiences. The child rearing practices of the parents in the 3 groups were investigated with home visits, observations in structured situations, and parental interviews. Four aspects of their rearing practices were evaluated: 1) Control (influencing the child's activities, modifying his express— ion of behaviors, and promoting internalization of parental standards); 2) Maturity demands (pressures on the child to perform up to his ability level intellectually, socially and emotionally); 3) Clarity of parent-child communication (use of reason to obtain compliance, asking for the child's opin- ions and feelings); and 4) Parental nurturance (love, care- taking, compassion, praise and pleasure from the child's accomplishments). Results of Baumrind's study indicate that the parents of the most mature, competent children scored uniformly high on all four dimensions. They were described as warm, com- municated well with their children, and at the same time controlled and demanded mature behavior. Baumrind used the label "authoritative” to describe these parents and their methods of interaction. Group Two parents were rated as lower on use of rational control and were more coercive. They were less warm, used their power freely, and did not 10 encourage their children to express themselves when they disagreed. This type of interaction was described as "authoritarian”. Group Three parents were not well organ- ized or effective in running their household. They were lax in their discipline and rewards; they made few demands and paid little attention to training for independence and self- reliance. These parents were labelled "permissive”. Further studies by Baumrind confirmed these findings (Baumrind, 1971). Kagan (1964) suggests that a child gains a sense of mastery over the environment by imitating the responses of a warm, competent and powerful parent. Most theorists agree that identification is a process whereby the child, through imitation, modeling or introjection acquires traits, charac- teristics and values similar to their parents. Heatherington and Frankie (1967) investigated the effects of parental dominance, warmth and conflict on imita- tion of parents by boys and girls. Eighty male and eighty female nursery and kindergarten children and their parents were randomly selected from a small, middle class town in Wisconsin. Parental measures on warmth, hostility, conflict, and dominance were obtained on the Family Interaction Task. The subjects were classified as coming from high conflict homes or coming from low conflict homes. -Each child was observed on an imitation task in which each parent alternately was instructed to play with the child in a specific way. The instructions involved postural, motor 11 and verbal responses. The child was then observed playing by himself in order to measure imitative behaviors. Results suggest that maternal warmth facilitates imitation of the mother more than paternal warmth facilitates imitation of the father. Parental dominance has more important effects on boys than for girls. Maternal warmth interacts significantly with sex of the subject while paternal warmth facilitates imitation to an equal degree for boys and girls. It was seen that under high conflict, with both parents low in warmth, there is a significant tendency for boys and girls to imitate the dominant, aggressive parent regardless of the parent's sex. The authors suggest this might be the result of a sense of extreme helplessness on the part of the child. Heatherington and Frankie's results seem to be con- gruent with those of past studies which have found that par- ental dominance is important in the identification of boys (Bandura & Huston, 1961; Bandura, Ross & Ross, 1963; Heather- ington, 1965; Mischel & Grusec, 1966: Mussen & Parker, 1965). Punishment, used as a form of disciplinary interaction can have undesirable side effects which limit its usefulness. This may be illustrated in a recent study by Redd, Morris and Martin (1975). Five-year old children were asked to complete a sorting task with three different types of adults. One adult behaved positively, smiled, and made positive comments while the child performed the task. A second adult used mild verbal reprimands whenever the child deviated from the task. A third adult was present but made no comments 12 whilc the child completed the task. Results indicated that the punitive adult was most eff- ective in keeping the children on task; however, the child— ren tended to prefer the positive and neutral adults. The children always chose the positive adult when asked who they preferred to work a little more with; and similarly avoided the punitive adult as a partner. Thus, while punishment may have been effective it had undesirable side effects. Parents who use punishment may also be inadvertently providing an aggressive model for the child (Bandura, 1967;1kmhyfingUX1& Parke. 1979). A large body of research mostly done in the 19503 and 19608 focused upon correlations between types of discipline and moral indices such as feeling guilty over violating a moral norm, or resisting temptation. Hoffman reviewed the literature (1977) in this area and summarized the results. Moral internalization is fostered by: 1) the parent's fre- quent use of inductive disciplinary techniques which empha— size harmful consequences of the child's behavior for others; and 2) the parent's frequent expression of affection outside the disciplinary encounter. We use the term "democratic parent” to describe the parent who is warm, accepting, encouraging of autonomy, and low in intrusive psychological control (Kagan, 1962; McCord, McCord 8: Zola,1969; Hetherington 8c Parke, 1979), This type of child- rearing has been.nore recently described as ” authoritative " parent- ing and is currently the popular stereotype of the most positive child- 13 rearing techniques. The child of such parents is likely to be seen as outgoing, independent, friendly, creative and lacking in hostility. Thus the democratic parent is apt to socialize his children in such a way as to incorporate the appropriate behavior patterns, beliefs, standards and motives which are appropriate in their cultural group and family. Families With Hearing Impaired Children Many experts in the field of hearing impairments such as Mindel, Jabaley, Furth, Liben, Levine and Altshuler have described what it must be like to be born with the major sensory deficit of an auditory impairment. Edna Levine, the author of The Psychology 9: Deafness, describes what normal hearing children experience as infants. In so doing she im- plies some of what must be lacking for the hearing impaired infant: "Because he can hear himself, he realizes that he can give the world a self created product in his own vocal utterances. Consciously produced vocal- izations are among the earliest creations the baby can give or withhold." (Levine, 1960, p. 22). The result of a communication deficit and its effects on a hearing impaired individual's social development has been discussed and studied by many researchers. Furth sugg- ests that some of the results may be positive: "They are not handed down a rigid tradition of verbal mores .... Just as a deaf child must invent their first conventional signs for communication, they also 'invent social norms for playing and living together. This setting creates a social and affective indepen- dence, a sense of relying on themselves ...." (Furth, 1973, p. 44-45). 14 Unfortunately there is also evidence to the contrary. For example, between 1955 and 1963 Altshuler and a group of mental health professionals operated a pilot clinic for the purpose of diagnosis, treatment and preventative health care for the deaf population. His observation of the social de- velopment of hearing impaired individuals was quite differ- ent than that suggested by Furth. During the course of the project, he noted the following personality features as be- ing present among deaf persons: 1) Poorly developed ability to understand and care about the feelings of others; 2) In- adequate insight into the impact of their own behaviors; 3) An egocentric view of the world; 4) Inability to handle ten- sion, resulting in impulsive behavior (Rainer & Altshuler, REE). Schlesinger and Meadow did a survey designed to identify deaf children at a state residential school who were con- sidered by their teachers or dormitory counselors to be emotionally disturbed and in need of treatment. The ques- tions used were in the same format as those used previously in a mental health survey conducted in Los Angeles, thus providing a comparative base. Results of the survey showed that of the 516 students in the school, 11.6 percent were considered to be severely disturbed and in need of psychiatric treatment; and 19.6% were,considered to have behavioral problems which resulted in disproportionate demands on the teachers' and counselors' time. In contrast, 2.4 % of unimpaired students in Los 15 Angeles county were considered to be severely disturbed: and 7.3% were described as in need of extra time from teachers. This survey indicated that deaf students showed behavioral problems 3-5 times larger than for other children in the county. Several other studies investigating the prevalence of behavior problems among deaf children have shown similar results ( Schien, 1975; Vernon, 1969; Freeman, et a1, 1975; Schlesinger 8; Meadow, 1972). Tests with the Vineland Social Maturity Scale consist- ently reveal that deaf persons are less mature than hearing persons (Barker, 1953; D011, 1965; Streng & Kirk, 1938; Avery, 1948; Burchard & Mylebust, 1942; Schlesinger and Meadow, 1972). Similar results have been found using Rorschach testing as well as other projective instruments (Levine, 1956; Rainer 8; Altshuler, 1966). _ Exactly when and how do these maladaptive social behav- iors develop? Obviously there is not one answer to this question. For example, there are physiological problems in which high fevers accompany a disease, such as meningitis, or incompatible blood types in parents, or Rubella (Vernon, 1969; Mindel & Vernon, 1971). However, the interaction of psychological and physiological factors often described as minimal brain dysfunction or hyperkinesis is not fully under- stood. The personality characteristics reflecting social immaturity described above could be the result of a variety of causative factors and thus one must take precaution in ascribing the label or diagnosis of brain damage to these 16 children. Some researchers have investigated the cognitive as- pects of development to search for answers. Nass (1964) suggests that young deaf children have less adequate reason- ing abilities than hearing children. He found that 8-10 year old hearing impaired children gave more primitive ex- planations than did hearing children on more complex ques- tions; e.g., “How does snow come?" "How is it that stars shine?" However, a different explanation has been offered by Liben for this phenonnmenon. She suggests that it is equal- ly plausible that Nass's findings simply result from in- adequate information obtained by the children. Many of the complex questions are precisely the types of questions nor- mally asked during the incessant "whys" of early childhood. The hearing impaired child often does not have the communica- tion skills needed to ask these questions, nor to comprehend the explanations when they are given (Liben, 1978, p. 205). Edna Levine explains the cause for the hearing impaired child's immaturity in a similar fashion: "The pupil's need for life enlightenment begin to outstrip the store of language he is so painstaking- ly learning. There comes a time when he needs to know more of the customs and taboos of society, more of the reasons and motives of human behavior, the why and how of emotions, more of moral and ethical values. But the problem is how to get such infor- mation across to him when he has not yet mastered venough language for understanding and explanations. And so a lag arises between what the deaf pupil does know and has experienced and what he should know and ought to have experienced for his age. It is this lag that forms the core of the handicap of l7 deafness. Language impoverishment is its kernel. (Levine, 1956, p. 11). Schlesinger and Meadow (1960), Mindel and Vernon (1971) agree that the core problem which causes social immaturity lies in the absence of gratifying reciprocal communication within the family during the deaf child's early years. They suggest that a major reason for these problems stems from the fact that most deaf children (89%) are born to hearing parents who have no previous knowledge about or experience with profound congenital deafness. The Family The concept of the family as a system is helpful for understanding the impact of having a handicapped child on members of the family. When a handicapped child is born or when the handicap is discovered, severe stress may be exper- ienced by family members (Pederson, Anderson 8: Cain, 1977; Hether- ington &Parke 1979). How a family copes with these stresses affects the child's development as well as the functioning of the family unit. Ulrey &.Rogers (1982) describe clinically how a marraige is affected by the birth of a handicapped child. Anger and blame are emotions often used to describe husband—wife attitudes towards each other, and are considered coping strategies: "This kind of strategy may threaten the marital relationship because one spouse harbors negative feelings toward the other. One parent may blame 18 the other for their child's handicap. Blame may be expressed as, "If only you hadn't drank during your pregnancy." "I didn't want another baby, only you did," and so on.... Conversely, the marital relationship may also be threatened if one spouse feels guilty about perhaps causing the handicap, internalizes the blame and withdraws from the other" (Ulrey 8: Rogers, 1982). ' Although parental reactions vary tremendously with re- gards to their handicapped child, it is important to note that their ability to support one another will have an impor- tant influence on child rearing (Pederson, 1975). Thus if their negative reactions are not resolved, the conflict be- tween parents is likely to be associated with negative feelings towards the child as well (Pederson, et al, 1977). Changes in lifestyle necessitated by demands of a handicapped child can also be a source of disruption in the patterns of relating that the parents had established. These disruptions cause additional stress within the family. Stu- dies have shown consistently that divorce and marital diff— iculties are much more frequent among parents of handicapped children than among parents of nonhandicapped children (Heatherington & Parke, 1979). Communication is necessary for the socialization of a child within the family. Most parents of a hearing impair- ed child know almost nothing of the multitude of difficult- ies faced by a hearing impaired child. "Until the reality of deafness is known, parents ,and child cannot cope constructively. Consequent- ly, there is a huge discrepancy between parents' expectations and the child's achievements, which creates intense frustration for them both. The frustration leads to an underlying stress and 19 anger for which parents have no constructive outlets. As a result, they begin to avoid interacting with the child, and he begins to avoid interacting with them. Further attempts at child-parent communication becomes so stress- ful and frustrating that both the child and the parents understandably want to escape. Thus, the deaf child is often isolated in his own home, losing the emotional and educational bene- fits he needs and should get from close parental contact. The parents, in turn, lose the satis- faction of child—raising that they have a right to expect” (Vernon, 1974, p. 97). Vernon points out that the deaf child cannot respond as readily to the interaction which is initiated by his parents. Similarly the child does not receive the gratification he needs from his efforts to communicate. In order to study these communication patterns, Schlesinger and Meadow (1972) did an investigation of parent-child interaction which is discussed in depth in the chapter entitled, "Developmental Process in Deaf Preschool Children: Communicative Competence and Socialization", 1972. Forty preschool deaf children and their parents were subjects in the study. The children were enrolled in 8 preschool programs for the deaf in the San Francisco Bay area. They all met the following criteria: 1) Hearing level no better than an 80 decible average (in the speech range 500-1000-2000 cycles per second) in the better ear; 2) Between 2; and 4 years of age; 3) Onset of deafness no later than 12 months; 4) Caucasions with English as their primary language; 5) No additional handicaps; 6) No twins; 7) No children with deaf parents. A control group of 20 20 hearing children of hearing parents matched for age and sex were selected from local nursery schools in San Francisco. Twenty minute videotaped "scenarios" of semistructured mother-child play sessions were collected for each pair of subjects. A set of rating scales were developed including ten dimensions of the mother's behavior, ten dimensions of the children's behavior, four dimensions descriptive of the children's attributes exclusively related to deafness, and four dimensions of the reciprocal mother-child interaction. A manual was written which defined these dimensions. Raters were trained to rate the dimensions and interjudge relia- bility ranged from .90 to .65, with a mean of .83. In addition to taped interviews with the parents, the California Psychological Inventory (Gough, 1957) and several different measures of the child's communicative competence were also obtained (Mecham Language Development Scale, 1958; information from mothers; and teacher's ratings of express- ive communication, receptive communication, speech and lip- reading). The results obtained indicated that mothers of hearing children received more positive ratings for all nine of the dimensions, which implied a positive or negative evaluation. Six of these dimensions were found to be significantly diff- erent: permissiveness, nonintrusiveness, nondidactic behav- ior,_creativity, flexibility, and approval of the child. No significant differences were found between the two groups for: enjoyment of the child, effectiveness in achieving his 21 cooperation, and the degree to which the mothers seemed to be relaxed and comfortable in the studio situation. It is interesting to note that although all 40 of the children were considered severely to profoundly deaf, their receptive and expressive communication skills varied greatly. This could be explained by several factors: 1) Time of diag- nosis followed by earlier or later use of hearing aids; 2) Difficulties with audiological testing; 3) Differences in training to utilize residual hearing: 4) Lip reading effi- ciency which may vary with stress ; 5) The variation or range of sound frequencies to which children could respond; 6) The parents' and teachers' use of sign-language and finger spell- ing to provide an avenue of communication. The children were divided into high and low groups on the basis of the index of communicative competence. When the child's level of communicative competence was controlled, the mothers of hearing children continued to be rated sig- nificantly higher than mothers of either the "high” or "low" groups of deaf children in the dimensions of: flexibility, nondidatic behavior, nonintrusiveness, and approval of the child. Mothers of more competent deaf children ranked sec- ond and mothers of less competent deaf children ranked low- est, but rated higher on "permissive" behavior than mothers of more competent deaf children. -During the interaction sequence, hearing children were rated higher on all five dimensions including: compliance vs. resistance; creativity vs. lack of imagination; enjoyment 22 of interaction with mothers; absence of apparent enjoyment; buoyancy, happiness vs. apparent sadness, unhappiness; and pride in mastery vs. absence of pride in accomplishments. Examination of the intercorrelations between ratings for mothers and children revealed that the child's curiosity, creativity and independence were not particularly related to the mother's behavior, whereas the child's enjoyment of the interaction with his mother is significantly related to each dimension of positively defined behavior on the part of the mother. A comparison of the child-rearing responses during the interviews revealed some interesting differences between parents of hearing children and parents of hearing impaired children. Responses to questions regarding "socialization for safety" indicated that mothers of deaf children utilize some other method in addition to verbal warnings, such as visual/tactile methods, in a greater proportion than do mo- thers of hearing children. Almost two-thirds of the mothers with hearing impaired children vs. one-quarter of the mothers with hearing children used control of the environment to protect their children. The authors note that it is diffi- cult to separate necessary protectiveness from unnecessary overcontrol when a child suffers a profound hearing loss. Responses to questions regarding punitive methods of socialization revealed that almost 3 times as many mothers of deaf children felt comfortable using physical punishment than did mothers of hearing children. Some of the mothers 23 of hearing impaired children stated that spanking was the only thing the deaf child understands. Five percent of the mothers with deaf children and twenty-five percent of the mothers with hearing children reported 23333 spanking their child. In addition, mothers with deaf children more fre- quently reported spanking the subject child less than his siblings and they were less likely to report variations in spanking dependent upon the age of the child vs. mothers of hearing children. In summary, mothers of deaf children behaved radically different than mothers of hearing children. This was par- ticularly true when the deaf children were poor communica- tors. The mothers were seen as inflexible, controlling, di- dactic, intrusive and disapproving. The deaf children with fewer communication skills appeared less happy, enjoyed interaction less, were less compliant, less creative and showed less pride in mastery than their deaf peers or hear— ing peers. The child-rearing practices of mothers with hear- ing impaired children included more supervision of the child in order to protect him from accidents, a narrower range of disciplinary techniques, and feelings of frustration regard- ing communication with their child. The authors note that: "The data comparing behavior of mothers and child- ren when deafness is present and not present would seem to provide powerful support for the notion that children's capabilities and behavior exert tremen- .dous influence on the interactional style exhibited by the mother. This effect is both reciprocal and cumulative, with communicative deficit leaving its mark on every major area of child-rearing practices, and on the expressive and instrumental styles of 24 both mothers and children” (Schlesinger & Meadow, p. 110). Although it is important for parents to reinforce what happens in school, too much focus on providing formal in- struction can interfere with normal parenting functions. Levine sees parents assuming the "teacher role" quite early: "After they learn that he is deaf, they often tend to look upon him as an organ of speech that must be made to talk as soom as possible. They still do not see the child himself. It is his disability that fills the foreground of their thoughts" (Levine, 1956, p.9). Schlesinger and Meadow confirm Levine's description with the results of their study on parent-child interaction. Videotapes of hearing impaired children and their mothers reveals that many mothers use potentially playful situations as opportunities for language instruction. These "teaching” situations are often encouraged by the child's teacher or speech therapist. For example, a mother may withold a snack until the child speaks or signs the word for the desired food (Schlesinger & Meadow, 1972). It is interesting to note that between deaf children and their deaf parents, the quantity and quality of inter- action is greater than between deaf children and their hearing parents. The quantity and quality of interaction is greater because they share sign language as a mode of inter- action. The Office of Demographic Studies at Gallaudet College did an annual survey of hearing impaired children and youth. Of the 18,748 children in the sample, only 5% were reported having emotional/behavioral problems when both 25 parents are deaf, and 9.2% when one or both parents were hearing parents (ODS, 1975). The use of early manual comm- unication has been repeatedly shown to positively effect achievement and IQ scores as well (Brill, 1960; Vernon and Koh, 1970, 1971; Quigley and Frisina, 1961). Although hearing children often complain of being unable to communicate with their parents, hearing impaired adoles- cents often have no method (literally) with which to inter- act with their hearing parents. Data collected by Evans (1975) indicated that ninety percent of the hearing impaired children who have hearing parents have no system of communi- cation. These communication barriers continue throughout adolescence. In his survey 49% reported poor communication with their parents; 37% said their parents had difficulty explaining their recent experiences to them; 41% reported difficulty telling their parents of their recent experiences. Similarly a survey conducted by Schlesinger and Meadow show- ed that of the 34 deaf families who had children enrolled in California School for the Deaf (Berkeley) in 1966, 33 repor- ted they had used manual communication with their children from infancy on, vs. none of the 34 hearing families, who made no early use of manual communication. Siblings in a family with a hearing impaired child may also feel the effects of various adjustments that must be maden Patricia Schwirian studied the presence of a pre— school hearing impaired child on his older siblings. Old- er normal siblings were found to have greater childcare 26 responsibilities and lower levels of social activities than their counterparts, in addition, the older the sibling was, the more his responsibilities, independence, and social act- ivity level increased. However, the effects found were mini- mal and Schwirian suggests that social impairment of the hearing impaired child would increase with age and become more difficult for the family in later years (Schwirian, 1976). Much of the difficulty experienced by families with a hearing impaired child points to a weakened communication system between the child and others in his environment. This communication breakdown is seen time and time again through- out the literature. There seems to be no doubt that improv- ing communication within the family would assist in facilita- ting a healthier socialization process. Improving Communication There are numerous therapy techniques and educational programs which are aimed at improving one's ability to comm- unicate with others. These programs range in focus from a complete academic orientation to psychoanalytic therapy. The concept of group experience is a recent phenomenon that has become more popular and widespread in its uses. Within the category of experiential groups falls T-groups, encounter groups, sensitivity groups, Gestalt groups and a host of other groups. There has been some research which focuses upon 27 variables which effect all of these groups including group size, attractiveness of group, and expectations of the group. Psathas' (1960) review of the literature on group size indicated that with increased group size, members experience less direct involvement and participation. As the group gets larger, instead of interacting with each other, the members tend to direct their communications to the highest-ranking initiator, who in turn responds to them as a group rather than as individuals. From their review of the research Cartwright and Zanders (1968) conclude that a group is attractive when: "1) Its members are valued and accepted (Dittes, 1959); 2) Its members are similar (Newcomb, 1953); 3) It is small enough to enable members to comm- unicate and relate effectively (Porter & Lawler, 1965); 4) It provides opportunities for social life and close personal associations (Hagstrom & Selvin, 1965); 5) It provides at least two of these three sources of satisfaction: personal attraction, task attraction (attractive goals), and prestige from membership (Back, 1951)." (Ohlsen, 1977, p. 61). A group must agree to its expectations on the following topics: 1) It knows why it exists; 2) Its members have estab- lished an atmosphere in which its work can be done; 3) Its members realize how decisions are made; 4) Each member is encouraged to make his own unique con- tributions; 5) Its members have learned how to re- quest, accept, and give help; 6) Its members have learned how to diagnose problems and improve its functioning; and 7) Its members have learned to cope with conflict. (Bradford and Mial, 1963, p. 64; 'Ohlsen). How can we determine whether an intervention program 28 actually effects the group members ability to communicate effectively? Current theory and research in communicative competence focuses upon this issue: "Communication competence, unlike linguistic com- petence, involves awareness of the transactions that occur between people. Competence in this perspective is tied to actual performance of the language in social situations" (Allen and Brown, 1976). Larson, Backlund, Redmond and Barber (1978) all have similar definitions of communicative competence: ”The abil- ity of an individual to demonstrate knowledge of the appro- priate communicative behavior in a given situation“. The behavioral view of competence, in contrast to the cognitive view, not only seeks an idealized set of rules, it focuses on a repertoire of skills appropriate to a variety of rela— tionships and contests. The main implication for theory and research is that an analysis of communicative behavior should lead to inferences about underlying knowledge structure and the evaluation of the appropriateness and effectiveness of various skills in specific contests. The dimensions of comm- unicative competence serve as operational definitions of com- petence and may be used for testing, measurement and instruc— tional strategies (Weimann, 1980). The choice of the dimensions of communicative competence are important. By labeling a behavioral dimension, the re- searcher, educator, or theorist is saying that variations in behavior with regard to a dimension is crucial to one's jud- gements of communicative competence. Conceptions of comm- unicative competence are provided by many sources. 29 Weinstein (1969) lists the following skills when he dis- cussed interpersonal competence: "Skills at establishing and maintaining desired identities both for one's self and for others, is pivotal in being interpersonally competent. This skill is dependent in turn on three var- iables. First, the individual must be able to correctly predict the impact that various lines of action will have on others' difinition of the situation. This is what is meant by empathy if we strip the concept of its affective overtones. Second, the individual must posses the intra- personal resources to be capable of employing effective tactics in situations where they are appropriate." (p. 757-758) Wang, Rose and Maxwell (1963) describe similar dimen- sions of communicative competence: "Differences found in young children's verbal communication skills are attributed to more than just differences in such linguistic qualities as syntactic structure, vocabulary and intelligibi- lity. The differences in communication skills are strongly influenced by such factors as the child's ability to take the listener's role, his ability to order and classify relevant information, the nature and amount of feedback information supplied by the listener, and the appropriateness of the response of the speaker to feedback" (p. 1). Wiemann and Backlund (1980), authors of a comprehensive review of communicative competence note that as a concept it is still in its developmental stages: "Many dimensions of competence have been proposed, discovered, and/or named; these spring from vari- ous types of research efforts. A review of this work illustrates both the diversity of thinking in the area and a suprising degree of empirical con- sensus on what behaviors constitute communicative competence" (p. 193). -In 1967 the newly formed Human Development Training Institute developed the Human Development Program (HDP) and the magic circle process. One might call the HDP's three 30 objectives (awareness, social interaction, and mastery) di— mensions of communicative competence. The three—fold HDP theory covers the concepts of awareness, social interaction and mastery (Bessel, 1972). The program's learning strategies are experimental and engage both emotional and intellectual involvement. HDP learning strategies encourage people to utilize themselves and others as resources for gaining use- ful ideas and information about experience. At the same time the strategies provide opportunities for practicing effective communication skills. It is often referred to as a "high quality communication experience". The dimensions Bessel and Palomares chose were derived from a huge body of theoretical literature. Specifically they selected a number of theorists from the behavioristic, humanistic, and psychoanalytic orientations to develop their program. However, their objectives parallel the various dimensions described in the communicative competence models fairly closely. The Human Development Program is chosen as the inter- vention model for this study for several reasons: 1) Previous training by an official HDP trainer in Manhasset, Long Island: 2) Previous experience using this program with children of all ages at Phoenix Day Schood for the Deaf; 3) Its focus on being a "quality communication experience", which is relevent to this study; 4) A review of research which indicated its relatively more frequent use with hear- ing impaired children than other programs of its type. 31 A brief description of the HDP sessions is necessary in order to understand the studies which use this program. The program consists of seven curriculum books, one for each elementary school grade. The leader and the circle members sit together and discuss issues suggested in the activity guides. There are certain ground rules set for the discuss- ion process which promote "quality communication". The act- vities are designed so that the "what”, or content, and the ”how”, or process, are both in keeping with the objectives. Josephine Newton, a social worker, used the HDP in the Florida School for the Deaf and Blind in 1975. The rationale for her project stemmed from her belief that using the HDP with deaf children would assist them in making changes in their self-concept and relationship with others. Thirty-six residential schools for the deaf were canvassed to find out whether a program of this type was used. Thirty-six respon- ses were returned and no school indicated that they had a program of this type in progress. There were 9 students in the study, 7 girls and 2 boys; four were 8 years of age, and five were 9 years of age. The program was used for one year. Observations were made by the school social worker, the teacher involved, and the children involved. The social worker saw the program as interesting and challenging, and notes: "They are beginning to Show pleasure when someone reflects what they have been saying correctly. It's like they are thinking, 'Wow, people really do care and know what I'm saying'." 32 The primary problem noted was the limited vocabulary, partic- ularly around words used to express feelings and emotions. A continuous log of descriptions such as this one were kept throughout the year. The teacher kept a similar log of descriptions which basically stated that she saw "carry over” into the class- room. She noted for example that the students were begin- ning to do less interrupting of each other, and the children reminded each other of the circle rules and expected them to be just as valid in the classroom. It is evident that the Newton study lacks rigorous re- search techniques. There was no comparison group, no stan- dardized measures and no rating of behaviors. Some reference to this effect was made at the end of the article. The author suggested that the program be further investigated the following year and concluded by saying: "I am convinced more than ever now, that processes that are being used to assist hearing students grow and have new experiences in the affective domain can and should be used with those who have physical disabilities". At the Montreal Oral School for the Deaf, Sheila Becker a psychologist, utilized an adaptation of the HDP (1978). A group of nine 14 year old hearing impaired children met weekly for six months. Each pupil in this group was main- streamed in the public schools as much as possible, with tutorial support. The pupils met during lunchtime. Rather than discussing things in a circle, the pupils sat around a 33 blackboard and their feelings and ideas were written down on a blackboard, thus combining cognitive and affective develop- ment. Again, the program was not followed systematically; however, the teachers and "other professionals involved” noted the following results: The pupils were able to 1) express affective themes; 2) appreciate individual differ- ences; 3) listen to their peers' contributions for both content and feeling; and 4) look for similarities of theme or need expressed by group members. They concluded by say- ing: "There seems to be no apparent reason why the techni- ques proposed could not be modified for use with all hearing impaired school aged children" (Becker, 1980). In 1979-80 the writer implemented an adapted version of the HDP with the students at Phoenix Day School for the Deaf. Although no formal results of the program's effects were assessed, the writer found the program to be meaningful and useful. The children appeared to develop better listen- ing skills and the ability to communicate events or feelings on a personal level. The teachers involved were enthusias- tic and eager to participate, thus carrying on the program themselves after they became confortable. This study is an attempt to provide scientific evidence for an intervention program for families with a hearing impaired child. The program is expected to have a positive effect on family communication and family environment. The program's process will be an adapted version of the HDP. The content, or activities will be related to research on the 34 individual and family development mentioned above and delin- eated in the description of the program's content. Summagy of Literature Review Current research on socialization and child-rearing indicate that "authoritative" or democratic parenting is most effective. Positive child-rearing facilitates indepen- dence, warmth, social responsibility, assertiveness and creativity. In order to facilitate the development of these characteristics, a parent must be warm, democratic, communi- cate clearly, demand mature behavior, and maintain consistent behavior. Physical punishment, total permissiveness and intrusive control are ineffective child-rearing practices. An effec- tive parent must explain his reasons for his punitive be- havior as often and consistently as possible. The limited amount of research on the child-rearing practices of parents with a hearing impaired child indicate that they have more difficulty using authoritative or demo- cratic rearing techniques. Studies of parent-child inter- action for this population have shown that parents are often over-controlling, or at the other expreme overly permissive, avoiding frequent interaction with the child. The core problem with regards to interaction between a parent and his deaf,child stems from a breakdown in communication. Both the child's lack of communicative competence and the par- ent's lack of any formal system of communiCation contribute 35 this breakdown. The hearing impaired child has been frequently des- cribed and measured as being socially immature, egocentric, impulsive and unable to handle tension. These characteris— tics are similar to what Baumrind describes as less compe- tent children with either authoritarian or permissive par- ents. Families with a hearing impaired child would benefit from an improved communication system. An improved system could improve the family envirorment, and perhaps alter some of the negative child-rearing practices such as frequent spankings and a lack of disciplinary explanations. Better communication would facilitate the sharing of ideas, reasons, information, feelings, questions, and concepts. The Human Development Program (HDP) emphasizes quality communication, and regulates the group process with the use of various ground rules. This program has been used with hearing impaired children in school settings. It is one of the programs used frequently with handicapped children. How- ever, very little empirical research has been conducted using this program with the hearing impaired. This study will attempt to implement the HDP in family settings. In chapter three, the procedures for developing an adapted version of the program will be discussed. The design and procedures for the program's implementation and an evaluation of the program's effectiveness will also be explained. CHAPTER 3: DESIGN OF THE STUDY Sample Fourteen families with one hearing impaired child age 11-14 attending Phoenix Day School for the Deaf (P.D.S.D.) volunteered for the study during the 1982 Fall registration period. (Appendix A included a recent demographic survey of the student population at P.D.S.D.). From this sample 4 families had to be eliminated: Two children were diagnosed to have severe learning disabilities, 1 family had no home or work phone, and 1 family lived beyond a reasonable travel- ing distance. Two of the remaining ten families were inclu- ded in a pilot study; 8 families were included in the formal study. The eight families were matched as closely as possible on: Age of child at onset of deafness. IQ. SES. Age of child. Method of communication used in the home (total communication or oral communication.) 011$me The 4 pairs of families were then randomly assigned to the experimental or comparison group. Six of the 8 families included two parents (married), and two of the families included mothers but no fathers. Siblings were invited to participate during the study and offer comments and questions but no formal measures were made for them. Five of the 8 hearing impaired children were congenitally deaf, 2 of the children became deaf at 36 37 22 months and 1 at 18 months. There were 3 children age 11 years, two age 13 years, and one age 14 years. All of the families were classified as middle class with the exception of one low-middle class family. All of the families reported using Total Communication in the home. Each child had a severe-to-profound hearing loss and IQ scores within the average range, with the excep- tion of 1 child who scored slightly below the average range. There were 4 male and 4 female children. Design Pre-test Post-test X1 X2 X1 X2 E X3 X4 X3 X4 X5 X6 X5 X6 C X7 X8 X7 X8 Figure 1: A Visual Diagram of the Research X1-X8 = Families E = Experimental group using program C = Comparison group Conceptual Hypotheses Due to the small number of subjects, no statistical hypothesis was investigated. The results will be reported descriptively with the inclusion of graphic representations. 38 However, the study was organized around two conceptual hypotheses: A) Family environment will change following the treatment program; B) Family communication will change following the treatment program. Experimental Treatment An altered version of HDP (see procedures) was used as the treatment in the study. It was used for 10 nights in the families' homes. In order to verify that the treatment was being used, a phone interview was conducted every third night with each family. During each session a form was used to check off: 1) The session number; 2) The day and time of session; 3) Any additional comments the family chose to make. A more indepth interview was obtained from each family mem- ber at the end of the program along with the formal measures being used. A comparison group, matched for the aforementioned characteristics was asked to spend time for 6 or 10 nights discussing a neutral topic while following loosely structured directions. Appendix E includes the list of 10 neutral top- ics and directions chosen for the program. Interviews were conducted just as they were in the experimental group. The comparison group was asked to participate in these discuss- ions in order to control for the possible confounding vari- ables of spending time with family on a regularly scheduled basis. 39 Measures All of the families in both groups took the same pre- test and post-test. Two different measures were included: A) The Family Environment Scale (FES); B) Rating of video taped discussions. A. Family Environment Scale (FES) — the FES developed by Moos (1974) was used in order to detect any change which may have occured after completing the program. Table 1, (p. 40) describes the subscales included in the instrument. As you can see, some of the subscales are more applicable to studying a family communication program than are others. Subscale number 8, “Moral-Religious Emphasis" was least relevant. However, the Moos' FES was deemed, or, selected as the most appropriate standardized measure available for this study. The FES long form (Form R) was standardized on 285 families which were described as "normative" i.e., a fairly evenly distributed number of siblings, upper, middle, and lower classes (although more upper and middle classes). Table 2 (p. 41) shows the subscale internal consistencies, the average item to subscale correlations and eight week individual test-retest reliabilities for Form B. A family incongruence score was also obtained. The score assesses the extent to which the family members disagree about their family climate. These scores were obtained for each pair of family members. The average of these incongruence scores yields a family incongruence score. 10. 40 TABLE 1 Family Environment Scale Subscale Descriptions Cohesion Expressiveness Conflict Independence Achievement Orientation Intellectual- Cultural Orientation Active Recreational Orientation Moral- Religious Emphasis Organization Control Relationship Dimensions The extent to which family members are concerned and committed to the family and the degree to which family members are helpful and supportive of each other. The extent to which family members are allowed and encouraged to act openly and to express their feel- ings directly. The extent to which the open expression of anger and aggression and generally conflictual inter- actions are characteristic of the family. Personal Growth Dimensions The extent to which family members are encouraged to be assertive, self-sufficient, to make their own decisions and to think things out for them- selves. The extent to which different types of activities (i.e., school and work) are cast into an achieve- ment oriented or competitive framework. The extent to which family is concerned about political, social, intellectral and cultural activities. The extent to which the family participates actively in various kinds of recreational and sporting activities. The extent to which the family actively discusses and emphasizes ethical and religious issues and values. System Maintenance Dimensions Measures how important order and organization is in the family in terms of structuring the family activities, financial planning, and explicitness and clarity in regards to family rules and respon- sibilities. Assesses the extent to which the family is organ- ized in a hierarchical manner, and the rigidity of family rules and procedures and the extent to which family members order each other around. 41 TABLE 2 Internal Consistencies, Average Item-Subscale Correlations and Test-Retest Reliabilities for FES Form R Subscales Average Eight Week Internal Item-Subscale Test—Retest Consistency Correlation Reliability Subscales (N2814) (N:814) (N247) Cohesion .78 .58 .86 Expressiveness .71 .48 .73 Conflict .75 .56 .85 Independence .64 .45 .68 Achievement Orientation .65 .49 .74 Intellectual-Cultural Orientation .78 .54 .82 Active Recreational Orientation .68 .48 .77 Moral-Religious Emphasis .79 .55 .80 Organization .78 .52 .76 Control .70 .51 .77 In this study the 40 item short form (Form S) was used for convenience purposes. Preliminary data (Moos', 1974) indicated that the use of Form S results in a family profile which is highly similar to that obtained using Form R (at least for relatively large families). A family profile and incongruence score was obtained before and after the program. A follow up testing session was administered one month later to note any further effects. A profile obtained only for the hearing impaired child will be reported in order to obtain additional information which may reveal important findings. it should be noted that the FES was administered indi- vidually and manually to the hearing impaired child. Thus, the lack of standardization procedures and the necessity to 42 translate complex words into simpler ones must be considered when analyzing the results. This administration difficulty is not uncommon when testing hearing impaired individuals (Schoenwald, 1980; Zlezula, 1982). B. Ratings 9f Video Taped Discussions - A group dis- cussion in the home, using the ground rules (process rules for discussion during program) was rated for the frequency of 3 different communicative dimensions. These dimensions were 1) Awareness; 2) Mastery; 3) Social Interaction; the 3 objectives of the HDP. These objectives are operationally defined below: Awareness - the ability to repeat what another has said. Mastery - the ability to label ones feelings or skills. Social Interaction - the ability to follow the ground rules including: attending to the speaker, no interrup- tions, and no put downs. Appendix F includes examples of these objectives and their ratings. It is important to note that the ground rules suggest that each person take a turn in making a statement as well as a turn reflecting another person's statement. Thus, the measures were able to be made systematically if the rules were followed. The only change made in the ground rules, made during the ratings, was in rule number four (see section on rule alterations). One observer was present to tape the discussions and 2 trained raters rated each tape. Patterson (1975) observed families at home while being videotaped and noted that al- though obtrusive, they habituated quickly to the presence of 43 an observer. Specifically, 3 pre-test group discussions and 3 post- test group discussions were rated for every family in each group. Results are reported in the form of a bar graph which diagrams the frequency of the 3 dimensions for each family member and for the family as a whole unit. Procedure The procedure section is divided into the following categories: A) The Creation of the Experimental Treatment Program; B) The Pilot Study; C) Sequence of Contacts with the Family; and D) Summary of the Procedures. A. The Creation pf the Experimental Treatment Program - the name of the program is Families With A Hearigg Impaired Child (FWHIC). The program was presented in book form. It was used with families in their home and without direct guid- ance from a professional. However, clear directions were included, and an initial discussion with the program director was conducted previous to the program's commencement. The book was written at the 3rd-4th grade reading level. Barlow, Fulton and Peplow (1971) assessed reading comprehen- sion skills in 157 deaf adolescents (14-21) and found a mean equivalence score ranging from 4.5 to 6.1. The program's level was assessed with the Graph for Estimating Readibility, by Edward Fry, Rutgers University Reading Center, New Jersey. Original illustrations were prepared by the program director. They were used to enhance understanding of the activity, and 44 for enjoyment. The objectives described in the HDP program were incor- porated into the FWHIC. They included: Awareness - Accurate perception, understanding and insight; i.e., to know what one is actually seeing, hearing, thinking, feeling, and doing. (An example of a topic in the HDP which focuses on this issue is: ”Something that makes me feel good.") Social Interaction - Interacting with others to fulfill basic interpersonal needs. (An example of a topic in the HDP which focuses on this issue is: "Cooperation, approval and disapproval.") Mastery — A feeling of efficacy demonstrated by the knowledge of one's own feelings, or the ability to feel adequate about one's skills and feelings; i.e., to gain control over one's surroundings. (An exam- ple of an HDP topic that focuses on this issue is: "I did it myself.") The ground rules or process of HDP was used in an adap- ted form for the FWHIC. The rules of the HDP are listed below: 1. Bring yourself to the circle and nothing else. (This is required in order to eliminate distractions.) 2. Everyone gets a turn to share, including the leader. (This is to assure everyone of a turn to speak and establishes equality among members.) 45 3. You can skip your turn if you wish. (Privacy is to be respected. If one doesn't choose to respond, just their presence is accepted.) 4. Listen to the person who is sharing. (The circle members listen without making evalua- tive statements.) 5. The time is shared equally. (This prevents only one person dominating the circle, and prevents restlessness.) 6. There are no interruptions, probing, put- downs, or gossip. (This provides safety for the circle members. Unacceptable behaviors may be discussed prior to the Magic Circle and periodically thereafter.) 7. Stay in your space. (This prevents distractions.) The leader's role was adopted from the HDP program with some adaptions. The leader for HDP is generally a teacher or school counselor. In the FWHIC, parents each took the role as leader and group member. If there were two parents in the family, they alternated as leader for each successive activity presented in the book. (Prior to the commencement of the program a professional educator, psychologist, school psychologist or counselor should clarify to the parents the program instructions and objectives. Appendix C includes suggestions for what the professional might say.) The leader's role was to explain and enforce the ground 46 rules. After the rules had been explained, the leader was asked to provide a 1 to 2 minute elaboration of the topic to be discussed. Then the circle discussion began with volun- teers. If the members were hesitant, the leader was instruc- ted to begin by discussing his/her thoughts. The leader was instructed to perform a dual role of both leader and partici- pant. In the HDP program, when the discussion has been com— pleted, the leader may suggest a summary of the discussion. Members restate what other members have discussed, thus everyone who spoke has been given feedback and has been reviewed by another member. Lastly, a cognitive summary is conducted. This phase allows members to reflect on learning gained from the session. The leader encourages members to consider the similarities and differences found regarding the topic dis- cussed. The leader thanks the members for participating and may add a word about the next topic to be discussed. Alterations in the HDP for the FWHIC. As previously mentioned, the FWHIC process included the same ground rules and procedures used for the HDP with sev- eral alterations. The alterations were made in hopes that they would be more easily adapted by a hearing impaired child and his/her family. The ground rules and procedures were explained in printed form at the beginning of the book for the program leaders; the objectives of the program were 47 also included in simple terms. The original ground rules and their alterations are listed below. (Note that only the rules selected for alter- ation are included.) Rule 3 - "You can skip your turn if you wish.” Alteration - Although skipping a turn was still per- mitted, he/she was to be asked a second time, after others had taken their turn. (This was to assure that the content and process was shared and experienced if at all possible; and because of the relatively small number of participants involved within each family.) Rule 4 - ”Listen to the person who is sharing." Alteration - This rule was crucial. Accurate comm- unication was an important aspect of the program. A member was asked to repeat or rephrase what another member had said each time a turn was completed. If that member could not repeat or rephrase the response, the original speaker was asked to offer his/her res- ponse again. (This step was included during the testing sessions in order to measure listening abilities, for "Awareness”). This was to be done "tactfully", as the response may have had to be given several times for the hearing impaired child before the process was com- pleted. This is normally done in the HDP program only 'at the end during the review session. This alteration was most beneficial when the program was conducted at Phoenix Day School for the Deaf. Initially the 48 children were unable to repeat or rephrase what others had said. This may have been due to poor listening, comprehension difficulties, or expressive difficulties. However, they appeared to improve significantly with more experience. Rainer and Altshuler (1966) also note that in their group sessions the hearing impaired persons directed all their attention to the leader and did not communicate well with other members. Rule 5 - "The time is equally shared.” Alteration - Time was not an important issue. As long as attention continued each member was instructed to take as much time as needed. This was due to the small number in the groups, and the potential need for one person to express more on a given topic. Rule 7 - ”Stay in your own space." Alteration - This did not seem relevant in a home en- vironment, although some semblance of a circle in which all members face each other was suggested. In addition to these rule alterations, added emphasis in the procedure was placed on the summary review. Due to the poor, abstract reasoning abilities of the hearing impaired children documented in the literature review, it was consid- ered important that the similarities and differences regard- ing what was said be brought to attention by the leaders. Thus, at least in the beginning, the leaders were to take this responsibility completely. 49 The rules or processes were followed during each session activity. The leaders were asked to remind the family of the rules before each session began. The family was instructed to follow the rules in order to meet the objectives of the program. The activities or content of the program differed from that of HDP. The activities were focused upon issues which have been documented or described in the literature review. Due to the nature of the literature, which is frequently descriptive, a one-to-one correspondence between issue, or research finding, and activity could not be made. However, an attempt was made to directly and/or indirectly include issues which have been portrayed as reasons for individual or family difficulties. These issues were the basis for each of the activities and are enumerated below. In addition, FWHIC activities were approached in a more formal structure vs. the HDP which is based soley on dis- cussion. Thus, lists, photographs, and games were included as part of the book. This was done for the following rea— sons: 1) Due to the language difficulties experienced by the hearing impaired learner, activities based soley on verbal interaction may be less valuable. 2) Due to the lack of formal training as facilitators, the additional structure was hoped to aid the parents with their role as leader. 3) Due to the difficulties experienced when trying to manually or orally communicate in families with hearing impaired children, a written program was developed to facilitate 50 clarity of the issues. Ten activities were chosen for the program. Each activ- ity was to take one evening. Each activity was presented on a separate page and included one illustration. The activ- ities which were selected and the issues and themes described in the program are listed below: Page of Program Issue being addressed 1 (Introduction) Identifying the presence of the hearing impaired child and accepting that he/she experiences things differently. 2 This activity involves watching T.V. without sound. The focus is upon what it is like to see and hear, and to better under- stand the T.V. experience of a hearing impaired child. 3 This activity involves making a list of things that make sounds. It is a continuation of activity 2, using more examples of things we normally hear and take for granted. 4 This activity involves talking about why we feel proud of our- selves. The purpose is to comm- unicate affective feelings about oneself to other family members. Communicating this kind of infor- mation may be a new experience for many families. 5 This activity involves communicat- ing a sentence without systematic language. This brings awareness of the difficulties encountered by the hearing impaired child when making an exchange with someone who cannot sign or make themselves clear; and the frustrations involved with trying to communicate 10 (Summary-Conclusion) 51 with someone who doesn't under- stand. This activity involves talking about a relative who had an im- portant experience. The focus is on the importance of communi- cating personal family events and the possible misinterpreta- tions that are commonly made by the hearing impaired family member. This activity involves talking about what you do during a work- ing day. The purpose is to in- form other family members about what one's daily responsibilities and experiences are like. This activity involves sharing an experience with all but one fam- ily member. The focus is upon what it feels like to be isolated from a group due to the inability to hear what is being said by others. This activity involves talking about how one worries about other family members. The focus is upon how family members may worry and become overprotective. It may point out how this differs for the hearing impaired member. This last activity is a summary of what has been learned and/or experienced, and a suggestion to develop new activities on your own. Appendix D includes a black and white copy of the FWHIC Program. The original book is printed on color pages, and is spiral bound. B. The Pilot Study — In order to maximize the practical aspects of the procedure, as well as to determine if the 52 program instructions were clear, a pilot study was conducted. Two families were used. One was considered to be highly co- operative; the other was considered to be uncooperative. Alterations were made according to the information obtained during the pilot study. The alterations which were made were in regards to scheduling activity sessions. The amount of time (10 days for 10 sessions) was found to be too short. Thus, 2-3 weeks were allotted for the program's completion. The sequence of meetings with the family (described below) were found to be successful during the pilot program and thus were used during the course of the study. C. Sequence of Meetings With the Families - Meetinngumber One: The first meeting consisted of meeting the family, ex- plaining the procedures to be used during the study, adminis- tering the FES, and obtaining consent forms. The families were not assigned to an experimental or comparison group un- til the second meeting. The FES was administered with total communication to the hearing impaired child and given to the parents to complete by themselves. A second meeting was scheduled at this time. Meeting Number Two: The second meeting consisted of taping the family dur- ing their discussion of three topics while using the ground rules. Appendix B includes the topics used when taping the family. The families were then randomly assigned to a group and directed as to how to use their respective programs. In 53 addition, the scheduling of times for convenient phone inter- views were discussed and decided upon and the instructions for record keeping during the program were explained. Meeting Number Three: This meeting took place after the family had completed their program. A second videotape was made of the family during their discussion of three topics while using the ground rules. The FES was administered again in the same manner as previously described, and interviews were conduct- ed. A meeting was scheduled for the final follow-up FES testing. Meeting Number Four: This meeting consisted of administering the final FES measure. In addition, those families who did not belong to the experimantal group were offered the experimental treat- ment, that is the FWHIC Program. Lastly, the families were thanked for their participation and cooperation and they were informed that the results would be made available to them upon the completion of the study if requested. D. Summary 9f the Procedures - The experimental and comparison groups were matched as closely as possible on their entering characteristics and randomly assigned to either the experimental (E) group or the pomparison (C) group. The experimental group participa- ted in the adapted version of the HDP. Adaptions were based on the specific needs of this population as previously 54 described. The FES and video tapings were used for both groups prior to and following the experimental and compar- ison treatments. The FES was administered one month after the completion of the program, for follow up purposes. Com- parisons are presented visually in profiles and histograms and summarized. The interviews provide feedback and identify specific activities which may have been more useful than others. CHAPTER 4: ANALYSIS OF RESULTS Introduction The conceptual hypotheses which were analyzed were: A) Family environment will change following the treatment pro- gram: B) Family communication will change following the treatment program. The families were investigated in match- ed pairs. The experimental families are presented in the figures by a number with an "A” beside it (IA-4A), and the compairson families will have a corresponding number without an ”A” beside it (1-4). Each group was investigated to determine which, if any, outstanding changes occurred in the video measures, which measures communication skills, and the Family Environment Scale (FES), which measures family enwhrm- went, (Appendix F includes a copy of the FES). The 'Case Study' section reviews each family's results including excerpts from their comments and interviews (Appendix G includes the written comments in their entirety). In this section a discussion of each family pair is included and focuses on the major contrasts observed and recorded. Lastly a summary of the results were analyzed in order to determine any overall patterns in the findings. Interrater reliability for the videotapes was very high (r = .99). When a disagreement occured with regards to an individual score, the second raters score was used in order to eliminate any possible biases. Family Incongruence scores are reported in raw score 55 56 form. This is due to the lack of standardized scores avail- able for the short form of this measure used in the study. It is important to consider the dependency among measures of communication when considering the results. Each individual member of the family affects another member's score. For example, if one member has a very high Mastery score, he or she is giving another member an opportunity to have a similar- ly high Awareness score; i.e., the more a person says, the more another person has available to repeat. The same dependency must be considered when observing the scores of the FES for the family unit. The family score could remain the same from pre- to post-testing, whereas each member's score could have changed. This is due to the fact that the family unit scores are an average of all the family members' responses. The changes could be compliment- ary, whereby no total changes were visible without a closer look at the various influences from each member. The figures that follow include the communication skill graphs (pre—post) and the FES profiles (pre-post and follow-up) for each family in the study. Case Study of Each Family and Comparison Family Experimental Family 1A (Single Parent Family): Ratiggs of FamilyCommunicatioQ_Skills -As can be seen in Figure 1, the family unit increased their Awareness Skills by 20 points; decreased their Mastery Skills by 5 points, and showed no change in their Social 57 No. IA VIDEOTAPE “UNLES N°_ 1 saw - ms M tery Sl-Sociol Hamish E'— Fomily Funny )s " 8 - S g .. ..- "MW 3 i M W500 Skill Figure 1: Communication skills of Family Units 1A and 1 58 NM VIDEOTAPE RATINGS No, He 4mm mm“: + Sl-Sotiol ion ;.,_ Chad .1. Child SO .- :- >~ g 001— g I s 1: .5 E 1.2 fiLLl— fig? Cai‘vnaicution Skill Cam-unication Skill N1 1 . . . Cbnnnhmbnsmfl (kmmwmamnnShH Frequency 8 [I I I F'WMY r—f—H—t-H—r—H—P F—I—r—r—r—r—f‘f‘f‘f-f. ‘ :1”? 'V r f i‘ 1“ 1:: i mecr I me: i fi‘ I M 51" 7x 101 s: . , , Cmicalion Skill Comm-mum Skull Figure 2: Communication Skills for Experimental and Comparison Family Members in Units 1A and 1 59 PR ETEST FES PROFILE: Fornin No.lAlnccngn.uer~ce Score: 9 mu ‘ IOU Hor- « 'Ml NHr— - Ml 7” -1 ——f"—-~———u———dl-—d-——r———1l——-J———Il-J 7“ .‘ Ml“ 0“ b E H)»- /\ \ /\/ -1 1.“ g- ; so ‘ "we” / .4". so: 5 \// \f r ’5 .10»— 4 40: M) —« ——4r—-—-1 ———1--—- u———
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