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

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 and social skills of children reported by the mothers.

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 both cases they are considered inadequate for infantile social skills.

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 Interview Guide of Parental Educational Social Skills.

Families of Children with Hearing Loss and Parental Educational Practices 99

The term functional analysis contains different definitions (Meyer, Oshiro, Mayer, & Starling, 2008) and it was elaborated from the Experimental Analysis of Behavior. For the clinical context it reinforces the relevance of evaluating several behaviors and multiple causes, considering antecedent variables (environment), response (reported or observed behavior) and consequent (events which occur after the answers). Considering parentschildren interactions the consequent variables constitute the children's behaviors towards

In order to compare the parental educational social skills of two groups of mothers (one of children with hearing loss, and the other with hearing children without any behavior

Differences were found between the clinical and nonclinical population, in relation to parental educational social skills (ESS-P), the infantile social skills, and the contextual variables. There were no differences between the groups in relation to negative practices and behavior problems. However, there were no evaluations for the sub-categories of the following behaviors: communication, expressiveness and the establishment of limits (Bolsoni-Silva, Loureiro & Marturano, 2011). Describing them may help in the identification of behavior which can be focus of rapid interventions without neglecting other needs of the studied population. Therefore, additional analyses must be performed comparing the interactions established between parents and children from the hearing loss (HL) group and

The present study aims at comparing the quality of interactions established between parents and children, considering two groups: Clinical Group x Nonclinical Group (normative). Specific objectives were to describe and compare behaviors denominated as positive parental practices (Parental Educational Social Skills - ESS-P), negative parental practices

A total of 52 mothers took part in this study whose children presented hearing loss (n = 27) (HL Group) or children who were part of a normative/nonclinical sample (n = 26) (Normative Group). The children with hearing loss (HL) used Hearing Aids (HA - AASI Aparelho de Amplificação Sonora Individual) and had hearing parents. They were identified at CEDALVI/HRAC/USP (Center of Hearing, Language and Vision Disorders, in the Hospital for the Rehabilitation of Craniofacial Anomalies, at University of São Paulo, Bauru, São Paulo, Brazil). The normative/nonclinical sample (n = 26) comprised two studies: the first evaluated the effectiveness of an intervention procedure (Bolsoni-Silva, Salina, Versuti & Rosin-Pinola, 2008) and the other evaluated the parental practices of

The Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (Interview Guide of Parental Educational Social Skills) - (RE-HSE-P - Bolsoni-Silva, Loureiro & Marturano, 2011)

(aggressiveness and no assertiveness), infantile social skills, and behavior problems.

the parents' behavior and vice-versa (Goldiamond, 1974/2002).

problems or other disorder) the RE-HSE-P was employed.

separated/divorced mothers (Boas & Bolsoni-Silva, 2010).

from the nonclinical group.

**2. Method** 

**2.1 Participants** 

**2.2 Inventory** 

using free time properly, answering requests); 5) *assertive skills* (starting conversation, accepting invitations, replying greetings). Nonetheless, other components of the children social skills may be present, such as: emotional expressiveness, civility, empathy, interpersonal problems solution, ability to make friends and social academic skills (Del Prette & Del Prette, 2006).

In a study with 48 preschoolers (24 with behavioral problem and 24 without), behavioral categories for the infantile social skills were suggested from evaluations of mothers and teachers. They were classified as: (a) **Social availability and cooperation**: Child makes requests, tries to help, asks questions, greets people, praises people, takes initiatives; (b) **Expression of feelings and coping**: expresses properly: thoughts, concerns and needs, shows distress, gives opinions, claims personal rights, is usually in a good mood and negotiates; (c) **Positive social interaction**: communicates in a positive manner, makes friends, plays with them, has nonverbal interaction (Bolsoni-Silva, Marturano, Pereira & Manfrinato, 2006).

Positive parental practices may avoid the appearance and/or the maintenance of difficulties in interactions established between parents and children. On the other hand, negative practices may increase the probability of their occurrences (Patterson, Reid & Dishion, 2002).

Positive educational practices include positive monitoring and moral behavior. Positive monitoring comprises the appropriate employment of attention and to grant privileges. Moral behavior implies promoting favorable conditions to the development of virtues and cultural values (empathy, notion of justice, responsibility, and work). Negative educational practices comprise negligence, permissiveness, negative monitoring, inconsistent punishment and physical abuse (Gomide, 2006).

Parental social educational skills constitute important behaviors to guarantee a positive parental practice. In order to study the parents-children interaction as parental educational social skills (ESS-P); such skills were classified as: communication (talking, asking) expression of feelings and coping (expressing positive and negative feelings, opinions, demonstrating concern, playing) and establishing limits (identifying and reinforcing socially skilful and nonskilful behaviors, setting rules, being consistent, agreeing with the spouse, fulfilling promises, identifying mistakes and apologizing) (Bolsoni-Silva, Loureiro & Marturano, 2011).

The interview guide (RE-HSE-P) was elaborated based on the propositions of authors involved in the social skills field (Del Prette & Del Prette, 1999; Caballo, 1991) and researchers involved in the study of parental practices (Patterson, Reid & Dishion, 2002; Reid, Webster-Stratton & Hammond, 2003). Authors of the Behavior Analysis field were consulted especially concerning the application of functional analyses in clinical practice (Goldiamond, 1974/2002; Meyer, Oshiro, Mayer, & Starling, 2008). The RE-HSE-P was validated and it has been employed in characterization studies (Bolsoni-Silva & Marturano, 2008) and as a pre and post-test measure at interventions (Bolsoni-Silva & Marturano, 2010) being effective in differentiating groups with and without problems. It has also being used in the identification of behavioral patterns of parents and children after intervention, by functional analysis.

The term functional analysis contains different definitions (Meyer, Oshiro, Mayer, & Starling, 2008) and it was elaborated from the Experimental Analysis of Behavior. For the clinical context it reinforces the relevance of evaluating several behaviors and multiple causes, considering antecedent variables (environment), response (reported or observed behavior) and consequent (events which occur after the answers). Considering parentschildren interactions the consequent variables constitute the children's behaviors towards the parents' behavior and vice-versa (Goldiamond, 1974/2002).

In order to compare the parental educational social skills of two groups of mothers (one of children with hearing loss, and the other with hearing children without any behavior problems or other disorder) the RE-HSE-P was employed.

Differences were found between the clinical and nonclinical population, in relation to parental educational social skills (ESS-P), the infantile social skills, and the contextual variables. There were no differences between the groups in relation to negative practices and behavior problems. However, there were no evaluations for the sub-categories of the following behaviors: communication, expressiveness and the establishment of limits (Bolsoni-Silva, Loureiro & Marturano, 2011). Describing them may help in the identification of behavior which can be focus of rapid interventions without neglecting other needs of the studied population. Therefore, additional analyses must be performed comparing the interactions established between parents and children from the hearing loss (HL) group and from the nonclinical group.

The present study aims at comparing the quality of interactions established between parents and children, considering two groups: Clinical Group x Nonclinical Group (normative). Specific objectives were to describe and compare behaviors denominated as positive parental practices (Parental Educational Social Skills - ESS-P), negative parental practices (aggressiveness and no assertiveness), infantile social skills, and behavior problems.
