**1.1 Families of children with hearing loss**

People with communication disorders caused by hearing loss may present complex manifestations involving linguistic, cognitive, behavioral, psychological and social alterations. The causes can be isolated or associated to clinical aspects of different neurological or genetic problems. Children with hearing loss (HL) may be considered as a high risk population due to the presence of indicators such as: language delay, which involve communication skills, low academic progress and social emotional level (Calderon, 2000). The presence of such impairments may cause some difficulties concerning the development of the children and the relationship with their parents.

Some preventive measures should be taken more actively including the primary ones which reduce the birth incidence of children with hearing loss and secondary ones that help in its early detection. (Gatto & Tochetto, 2007).

In addition to hearing screening programs researchers emphasize the importance of training health professionals to guide parents on how to communicate with their children. The need to decide beforehand (without having enough knowledge of their benefits) the communication form that is to be used with their children possibly is a stress trigger which may influence the quality of the interaction between parents and children. (Gravel & O´Gara, 2003). Early identification of hearing loss and the consequent counseling services available in the community may help parents establish effective relationships with their children (Marchesi, 1996), and if followed by intervention allows fast access to available technologies (Smith, 2008). If this happens before six months of age, the life of the child will be positively affected, increasing the prognosis of better school performance (Smith, 2008; Marscharck, 2001; Yoshinaga-Itano & Sedey, 2000).

In the Brazilian culture parents emphatically employ verbal behavior to interact with the children from an early age. This type of behavior provides no positive effect for children

Families of Children with Hearing Loss and Parental Educational Practices 97

assumption that children with hearing loss have a lack of social skills and more behavior

A review of Brazilian papers published between 1995 and 2005 has identified the relationship between parents and children with hearing loss (Bisol, Simioni & Sperb, 2008). However there are no reports comparing positive and negative practices of parents. There

One study compared parental educational practices of hearing families with deaf children, and hearing families with hearing children. The results obtained showed that parents of children with hearing loss (HL) expressed less feelings and opinions, and did not play very much with their children. The positive practices were most frequent among parents of hearing children. Nonetheless, the study did not control other important variables as the

Behavioral evaluation of children and parental educational practices are important and necessary to identify the difficulties and the resources they present. It permits the elaboration of behavioral diagnosis and effective interventions with the children or with their parents/caretakers. Evaluation procedures include: spontaneous report during the interview, oriented instruments (scales, inventory) and direct observation in a natural or structured environment. However, it is important to investigate parental practices and behavior of children through validated instruments. In this study a validated inventory Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P) (Interview Guide of Parental Educational Social Skills - Bolsoni-Silva, Loureiro & Marturano, 2011)1 was used. It evaluates positive and negative parental educational practices, as well as

Behavior problems are classified as internalizing (isolation, depression, anxiety and somatic complaints) and externalizing behaviors (impulsiveness, aggression, agitation, challenging and anti-social characteristics) (Achenbach & Edelbrock, 1979). In any of the situations if they occur for at least six months they can be considered as emotional disorders (internalizing) or as disruptive behavior (externalizing) according to DSM-IV (APA, 2006). The externalizing behaviors are characterized by improper expression usually towards other people, with a tendency to harm them (Kazdin & Weisz, 2003). On the other hand, internalizing behaviors refer to harmful actions towards the person himself. However, in

Infantile social skills have been reviewed by Calderella (Caldarella & Merrell, 1997). They identified a diversity of infantile social skills, as follows: 1) *peers relationship skills (*greeting, praising, helping, negotiating, inviting friends to play*); 2*) *self-control skills* (controlling humor, dealing with criticism); 3) *academic skills* (removing doubts, following teacher's instructions, working independently); 4) *adaptability skills* (following rules and instructions,

1 This study kept the original denomination for RE-HSE-P. The corresponding name in English is

are no studies comparing those conducted in clinical and nonclinical groups.

presence or absence of behavior problems in the children (Rodrigues et al. 2010).

**1.2 Parental educational practices of mothers of children with hearing loss** 

behavior problems and social skills of children reported by the mothers.

both cases they are considered inadequate for infantile social skills.

Interview Guide of Parental Educational Social Skills.

problems, as compared to hearing children.

with hearing loss. Parents tend to reduce this and other types of communicative behaviors towards their deaf children as soon as they find out their children cannot hear them. A study was conducted with 19 parents in order to check feelings and expectations towards children with hearing loss. The results showed communication problems because the parents took a long time to make use of other communication means to facilitate the relationship between them (Boscolo & Santos, 2005).

In a literature review about family relationships and presence of children with hearing loss, it was observed that mothers were less equalitarian and spontaneous with deaf children than with the other children. They were also more restricting and controlling (Brito & Dessen, 1999). The relationship of the fathers with the children with hearing loss tended to be somewhat absent. The mothers assumed the care of the children and, consequently, their education (Brito, 1997). Fathers participated less intensively on the development of the children using more rational justifications, culturally more accepted, as the necessity of being absent due to work. However, fathers tend to present the same anguish and anxiety feelings reported by mothers (Canho, Neme & Yamada, 2006). The authors suggest intervention procedures geared towards the fathers in order to make them active participants in the upbringing of the children. In the Brazilian culture, the mother is responsible for taking care of the house, raising the children, including the ones with no disorder (Oliveira, Simionato, Negrelli & Marcon, 2004; Guarinello, 2004; Dias, Rocha, Pedroso & Caporali, 2005).

The authors above focus on the important role familiar interactions have for the development of deaf children. They represent opportunities for both of them to learn how to communicate with each other.

The early use of bimodal communication (oral and gestures), may prevent problems and promote mutually satisfactory interactions between parents and deaf children (Oliveira, Simionato, Negrelli & Marcon, 2004; Guarinello, 2004; Dias, Rocha, Pedroso & Caporali, 2005). Thus, interventions with children with hearing loss must also focus on their families. The use of sign language by the family helps these children to interact with the surrounding world, favoring satisfactory and appropriate relationships (Negrelli & Marcon, 2006; Lacerda, 2003).

Deaf children with deaf parents who learned the sign language during childhood had better school performance than deaf children with hearing parents. Deaf children learned to read and write two years before those with hearing parents (Marscharck, 1993). Nevertheless, 90% of the children with hearing loss have hearing parents. This fact may lead to super protective practices due to communication problems (Gargiulo, 2003).

Hearing parents expect their children to speak. They take longer to understand that other forms of communication are possible. Such communication difficulties between them may cause social skills deficits in the children (Boscolo & Santos, 2005).

Social skill may lead to a better development and help preventing behavioral problems. They may also aid the children to interact positively with people, increasing the possibility of social support as well as being able to solve problems.

Apart from hearing loss, studies have reported an inverse relation between social skills repertoire and behavior problems (Cia & Barham, 2009). Nevertheless, there is an

with hearing loss. Parents tend to reduce this and other types of communicative behaviors towards their deaf children as soon as they find out their children cannot hear them. A study was conducted with 19 parents in order to check feelings and expectations towards children with hearing loss. The results showed communication problems because the parents took a long time to make use of other communication means to facilitate the

In a literature review about family relationships and presence of children with hearing loss, it was observed that mothers were less equalitarian and spontaneous with deaf children than with the other children. They were also more restricting and controlling (Brito & Dessen, 1999). The relationship of the fathers with the children with hearing loss tended to be somewhat absent. The mothers assumed the care of the children and, consequently, their education (Brito, 1997). Fathers participated less intensively on the development of the children using more rational justifications, culturally more accepted, as the necessity of being absent due to work. However, fathers tend to present the same anguish and anxiety feelings reported by mothers (Canho, Neme & Yamada, 2006). The authors suggest intervention procedures geared towards the fathers in order to make them active participants in the upbringing of the children. In the Brazilian culture, the mother is responsible for taking care of the house, raising the children, including the ones with no disorder (Oliveira, Simionato, Negrelli & Marcon, 2004; Guarinello, 2004; Dias, Rocha,

The authors above focus on the important role familiar interactions have for the development of deaf children. They represent opportunities for both of them to learn how to

The early use of bimodal communication (oral and gestures), may prevent problems and promote mutually satisfactory interactions between parents and deaf children (Oliveira, Simionato, Negrelli & Marcon, 2004; Guarinello, 2004; Dias, Rocha, Pedroso & Caporali, 2005). Thus, interventions with children with hearing loss must also focus on their families. The use of sign language by the family helps these children to interact with the surrounding world, favoring satisfactory and appropriate relationships (Negrelli & Marcon, 2006;

Deaf children with deaf parents who learned the sign language during childhood had better school performance than deaf children with hearing parents. Deaf children learned to read and write two years before those with hearing parents (Marscharck, 1993). Nevertheless, 90% of the children with hearing loss have hearing parents. This fact may lead to super

Hearing parents expect their children to speak. They take longer to understand that other forms of communication are possible. Such communication difficulties between them may

Social skill may lead to a better development and help preventing behavioral problems. They may also aid the children to interact positively with people, increasing the possibility

Apart from hearing loss, studies have reported an inverse relation between social skills repertoire and behavior problems (Cia & Barham, 2009). Nevertheless, there is an

protective practices due to communication problems (Gargiulo, 2003).

cause social skills deficits in the children (Boscolo & Santos, 2005).

of social support as well as being able to solve problems.

relationship between them (Boscolo & Santos, 2005).

Pedroso & Caporali, 2005).

communicate with each other.

Lacerda, 2003).

assumption that children with hearing loss have a lack of social skills and more behavior problems, as compared to hearing children.

A review of Brazilian papers published between 1995 and 2005 has identified the relationship between parents and children with hearing loss (Bisol, Simioni & Sperb, 2008). However there are no reports comparing positive and negative practices of parents. There are no studies comparing those conducted in clinical and nonclinical groups.

One study compared parental educational practices of hearing families with deaf children, and hearing families with hearing children. The results obtained showed that parents of children with hearing loss (HL) expressed less feelings and opinions, and did not play very much with their children. The positive practices were most frequent among parents of hearing children. Nonetheless, the study did not control other important variables as the presence or absence of behavior problems in the children (Rodrigues et al. 2010).
