**3. Results**

The results were synthesized according to three broad categories of RE-HSE-P: *Communication, Expressiveness and Limits Establishment.* 

Figures 1 and 2 present, respectively, the results of the participant's mothers behavior of "talking" and "asking" which are part of the *communication* category. Asterisks in the figures correspond to the items with *statistically significant differences.* The bars identify the clinical group and the lines the nonclinical group.

Analyzing the answers to the question "*Do you talk to your child?",* "*What subjects do you discuss?"* (Figures 1 and 2*),* it was observed that both groups talked to their children in order to teach them what is correct or incorrect, mainly concerning externalizing behaviors (especially disobedience and aggressiveness). Notwithstanding, the nonclinical group more frequently than the clinical group talked about different subjects (clinical average 0.63, SD = 0.88; nonclinical average= 1.42, SD = 1,.5; p = 0.029), and in different periods of the day (clinical average = 0.26, SD = 0.45; nonclinical average = 0.70, SD = 2.11; p = 0.002). The children without hearing loss acted positively during these periods. They demonstrated socially skilful behaviors, such as: talking, keeping eye contact, giving attention to the mothers (nonclinical average = 1.81, SD = 1.09). The clinical group also demonstrated social skills (clinical average = 0.89, SD = 0.95), but with a statistically significant difference in inferiority (p = 0.001). Both groups sometimes answered with nonskilful behaviors (problems concerning externalizing or internalizing behaviors) during conversations,, with no statistical difference between the groups.

clinical

nonclinical

100 Hearing Loss

was used. It evaluates the occurrence and the quality of social skills applicable to educational practices and behavior of children, contingent to: starting conversation, asking questions in general (*Communication*), expressing positive and negative feelings and opinions (*Expressiveness*), affection, situations and strategies used to establish limits, identify children's behavior, what he/she likes and dislikes, accomplish promises (*Limits Establishment*). In total the inventory comprises 70 items and comprehends alpha of 0.846. They are organized into two factors: positive and negative interaction characteristics. The positive interactions are: educational social skills and infantile social skills. The negative

Data from HL and normative groups were collected in the clinics. For the normative group the data were collected in their houses and/or at the children's schools. After the consent of the respondent the mothers signed an Informed Consent. The interviews were conducted according to a specific set of procedures. The answers were recorded for further

Data were computed according to the given information and organized into previously reported categories. Comparisons were made between hearing loss and normative groups (*t* 

The results were synthesized according to three broad categories of RE-HSE-P:

Figures 1 and 2 present, respectively, the results of the participant's mothers behavior of "talking" and "asking" which are part of the *communication* category. Asterisks in the figures correspond to the items with *statistically significant differences.* The bars identify the clinical

Analyzing the answers to the question "*Do you talk to your child?",* "*What subjects do you discuss?"* (Figures 1 and 2*),* it was observed that both groups talked to their children in order to teach them what is correct or incorrect, mainly concerning externalizing behaviors (especially disobedience and aggressiveness). Notwithstanding, the nonclinical group more frequently than the clinical group talked about different subjects (clinical average 0.63, SD = 0.88; nonclinical average= 1.42, SD = 1,.5; p = 0.029), and in different periods of the day (clinical average = 0.26, SD = 0.45; nonclinical average = 0.70, SD = 2.11; p = 0.002). The children without hearing loss acted positively during these periods. They demonstrated socially skilful behaviors, such as: talking, keeping eye contact, giving attention to the mothers (nonclinical average = 1.81, SD = 1.09). The clinical group also demonstrated social skills (clinical average = 0.89, SD = 0.95), but with a statistically significant difference in inferiority (p = 0.001). Both groups sometimes answered with nonskilful behaviors (problems concerning externalizing or internalizing behaviors) during conversations,, with

ones are: negative practices and behavior problems.

**2.4 Treatment procedures and data analysis** 

*Communication, Expressiveness and Limits Establishment.* 

group and the lines the nonclinical group.

no statistical difference between the groups.

**2.3 Data collection procedures** 

categorization.

*Student Test*).

**3. Results** 

y average frequenc

Fig. 1. Average frequency of antecedent variables and behavior of children when the mother talks to them.2

<sup>2</sup> The legends for every figure correspond to the ones from Figure 1.

child.

Figure 3.

a socially skilful manner, and sometimes not.

Families of Children with Hearing Loss and Parental Educational Practices 103

When the answer included "different periods of the day" to the question "When", the mothers reported the following: on the way to school, at night, after arriving from school, during the day, during hygiene care, in all the situations, on vacation, on weekends, late afternoon, at time to get up, during meal times, during homework time, on the traffic, arriving from a trip, arriving from work, when they were together, when going to bed.

As an answer to the question "Which subject?" mothers reported "different subjects" as follows: everyday life, leisure time, usefulness of objects (for instance: pans, brooms), meaning of concepts and objects, something that the child saw, a party, food, animals, plays, cars, father-mother relationship (marriage and separation), drugs, private events involving the mother and the child, personal hygiene, their own body, infantile books, soap operas/ cartoons/television programs, the mother's job, wishes and interest of the child, the future of the family and/or the child, offer help to the child, dangers facing the world, members of the family, which clothes to wear, religion, health, violence and other questions asked by the

About the interactions established for the mothers' questions the groups did not present differences. Both talked during different situations and sometimes the children answered in

*Expressiveness* corresponds to a category of parental educational practice and behavior of the children corresponding to four questions of the RE-HSE-P: "Do you express positive feelings towards your child?", "Do you express negative feelings towards your child?", Do you express your opinions to your child?", "Do you caress your child?". After each of these questions the respondent was required to talk about the quality of the interventions established between parents and children. The answers to these questions were analyzed and according to the occasions in which they occurred, were denominated as *context variables.* The obtained categories were as follows: in several situations, the mother's personal problems, treating the environment carelessly, after calling the attention of the child, due to his/her behavior, before something interesting that the child has done, during leisure time and when the child was not feeling well. Another set of categories refers to *features of mothers' behavior,* present in two classifications of ESSP-P: 1. Communicates and expresses feelings and coping and, 2. Negative educational practice (beating, shouting). The last set of categories refers to *features of the children's behavior* contingent to the mother's, described as skilful behavior and behavior problem (internalizing and externalizing). The results of the questions about "positive feelings" are demonstrated in

The ESS-P "Communication to express positive feelings" refers to the parents' behavior of expressing tenderness in relation to the child or the child's appropriate behavior. The ESS-P "Expresses feelings and coping" refers to: touches the child, plays, hugs and kisses. The comparison between groups shows that the clinical group expresses feelings less in a "communicating" way than the nonclinical group (clinical = 1.15, SD = 0.71; nonclinical average = 2.31, SD = 1.59; p = 0.002). The groups equally "express feelings and coping".

Figure 4 presents "Tenderness expression" for each group. It can be observed that the groups express tenderness towards good behaviors equally in leisure situations and when the child is not feeling well, specially the nonclinical group (clinical average = 0.04, SD =

Fig. 2. Average frequency of antecedent variables and behavior of children when a mother questions them.

Fig. 2. Average frequency of antecedent variables and behavior of children when a mother

2,00

**average frequency**

3,00

antecedent

consequent

4,00

,00

diverse subjects

social skills behavior problem

**Ask**

1,00

questions them.

When the answer included "different periods of the day" to the question "When", the mothers reported the following: on the way to school, at night, after arriving from school, during the day, during hygiene care, in all the situations, on vacation, on weekends, late afternoon, at time to get up, during meal times, during homework time, on the traffic, arriving from a trip, arriving from work, when they were together, when going to bed.

As an answer to the question "Which subject?" mothers reported "different subjects" as follows: everyday life, leisure time, usefulness of objects (for instance: pans, brooms), meaning of concepts and objects, something that the child saw, a party, food, animals, plays, cars, father-mother relationship (marriage and separation), drugs, private events involving the mother and the child, personal hygiene, their own body, infantile books, soap operas/ cartoons/television programs, the mother's job, wishes and interest of the child, the future of the family and/or the child, offer help to the child, dangers facing the world, members of the family, which clothes to wear, religion, health, violence and other questions asked by the child.

About the interactions established for the mothers' questions the groups did not present differences. Both talked during different situations and sometimes the children answered in a socially skilful manner, and sometimes not.

*Expressiveness* corresponds to a category of parental educational practice and behavior of the children corresponding to four questions of the RE-HSE-P: "Do you express positive feelings towards your child?", "Do you express negative feelings towards your child?", Do you express your opinions to your child?", "Do you caress your child?". After each of these questions the respondent was required to talk about the quality of the interventions established between parents and children. The answers to these questions were analyzed and according to the occasions in which they occurred, were denominated as *context variables.* The obtained categories were as follows: in several situations, the mother's personal problems, treating the environment carelessly, after calling the attention of the child, due to his/her behavior, before something interesting that the child has done, during leisure time and when the child was not feeling well. Another set of categories refers to *features of mothers' behavior,* present in two classifications of ESSP-P: 1. Communicates and expresses feelings and coping and, 2. Negative educational practice (beating, shouting). The last set of categories refers to *features of the children's behavior* contingent to the mother's, described as skilful behavior and behavior problem (internalizing and externalizing). The results of the questions about "positive feelings" are demonstrated in Figure 3.

The ESS-P "Communication to express positive feelings" refers to the parents' behavior of expressing tenderness in relation to the child or the child's appropriate behavior. The ESS-P "Expresses feelings and coping" refers to: touches the child, plays, hugs and kisses. The comparison between groups shows that the clinical group expresses feelings less in a "communicating" way than the nonclinical group (clinical = 1.15, SD = 0.71; nonclinical average = 2.31, SD = 1.59; p = 0.002). The groups equally "express feelings and coping".

Figure 4 presents "Tenderness expression" for each group. It can be observed that the groups express tenderness towards good behaviors equally in leisure situations and when the child is not feeling well, specially the nonclinical group (clinical average = 0.04, SD =

Families of Children with Hearing Loss and Parental Educational Practices 105

Fig. 4. Mean frequency of antecedent variables when mothers cuddled and behaviors of

2

**average frequency**

1

0

good

behavior

leisure

children not

feel well\*

ESS-P -

express

affection \*

**Snuggles**

social skills

\*

behavior

problem

children in these interactions.

4

3

Antecedent

parent behavior

consequent

0.19; nonclinical average = 0.35, SD = 0.63; p = 0.023). In these situations, the mothers of children without any deficiency are significantly more dedicated (clinical average = 0.04, SD = 0.19; nonclinical average = 0.35, SD = 0.63; p = 0.023) and as consequence, their children correspond more intensely to the expression of tenderness (clinical average = 0.04, SD = 0.19; nonclinical average = 0.35, SD = 0.63; p = 0.003).

Fig. 3. Average frequency of how mothers express positive feelings to the children.

Figure 5 shows that both groups express opinions about different subjects. Nonetheless, the children from the nonclinical group behaved more frequently according to the category "Expression of feelings and coping" (clinical average = 0.48, SD = 0.51; nonclinical average = 1.15, SD = 1.00; p = 0.004). Some examples of how the child behaves are: hugs, accept the adults' opinion, thanks, gives support to parents when they are sad, gives his/her opinion, and explain his/herself.

Figure 6 presents the context and the mothers' and children's behaviors when mothers expressed negative feelings. Both groups expressed these feelings when they had personal problems, when were in dangerous environments, faced optimal behaviors of children, discussed several subjects and also after reprimands. Nonetheless, the nonclinical group used more negative educational practices (clinical average = 0.30, SD = 0.54; nonclinical average = 1.50, SD = 1.53; p = 0.004) in addition, these children expressed affection in these moments more frequently (clinical average = 1.11, SD = 0.89; nonclinical average = 2.08, SD = 1.62; p = 0.004).

The following examples can be considered as negative practices: verbal and/or non verbal threatening (deprive of privileges, beating), punishment (grounding), tightening the arm of the child, beating, shouting, fighting, getting nervous, calling names, talking a lot, saying "no" without explaining the reason, saying that will exchange the children for other ones, accusing/criticizing the spouse's behavior, cheating, imitating the incorrect behavior of the child and depriving the child from something he/she likes.

0.19; nonclinical average = 0.35, SD = 0.63; p = 0.023). In these situations, the mothers of children without any deficiency are significantly more dedicated (clinical average = 0.04, SD = 0.19; nonclinical average = 0.35, SD = 0.63; p = 0.023) and as consequence, their children correspond more intensely to the expression of tenderness (clinical average = 0.04, SD = 0.19;

Fig. 3. Average frequency of how mothers express positive feelings to the children.

parent behavior

Figure 5 shows that both groups express opinions about different subjects. Nonetheless, the children from the nonclinical group behaved more frequently according to the category "Expression of feelings and coping" (clinical average = 0.48, SD = 0.51; nonclinical average = 1.15, SD = 1.00; p = 0.004). Some examples of how the child behaves are: hugs, accept the adults' opinion, thanks, gives support to parents when they are sad, gives his/her opinion,

ESS-P communicating \* ESS-P feelings and coping **Positive feelings**

Figure 6 presents the context and the mothers' and children's behaviors when mothers expressed negative feelings. Both groups expressed these feelings when they had personal problems, when were in dangerous environments, faced optimal behaviors of children, discussed several subjects and also after reprimands. Nonetheless, the nonclinical group used more negative educational practices (clinical average = 0.30, SD = 0.54; nonclinical average = 1.50, SD = 1.53; p = 0.004) in addition, these children expressed affection in these moments more frequently (clinical average = 1.11, SD = 0.89; nonclinical average = 2.08, SD

The following examples can be considered as negative practices: verbal and/or non verbal threatening (deprive of privileges, beating), punishment (grounding), tightening the arm of the child, beating, shouting, fighting, getting nervous, calling names, talking a lot, saying "no" without explaining the reason, saying that will exchange the children for other ones, accusing/criticizing the spouse's behavior, cheating, imitating the incorrect behavior of the

child and depriving the child from something he/she likes.

nonclinical average = 0.35, SD = 0.63; p = 0.003).

and explain his/herself.

,00

1,00

2,00

**average frequency**

3,00

4,00

= 1.62; p = 0.004).

Fig. 4. Mean frequency of antecedent variables when mothers cuddled and behaviors of children in these interactions.

Families of Children with Hearing Loss and Parental Educational Practices 107

Fig. 6. Mean frequency of antecedent variables when mothers expressed negative feelings

1

0

personal problems

carelessness with the environment

various topics

good behavior

after scolding

**Negative fellings**

negative practice aggressive \*

express affection \*

meets and / or express rights

talk

2

**average frequency**

and children behaviors in these interactions.

4

3

antecedent

parent behavior

consequent

Fig. 5. Mean frequency of antecedent variables when mothers expressed opinions and behaviors of children in these interactions.

*Establishment of limits* consisted in another category of educational practices and children's behaviors corresponding to four questions of the RE-HSE-P: "*Why does it become important to establish limits?", "What do you do to establish them*?", "*Does your child do things that you like?", "Does your child do things that you do not like?"* After each of these questions the respondent is required to talk about the quality of the interactions established regarding the occasions in which they occurred, the type of the mother's behavior, and the child's behavior in relation to the mother's. The answers from the analyses of content according to RE-HSE-P, were classified into three subcategories: (a) context variables: facing the obedience of the child, teaching what is correct and incorrect, having control of the behavior of the child, protecting the health of the child, and in leisure environment; (b) mother's behaviors: b1) communicates and expresses feelings and coping and, b2) makes uses of negative practices (beating, shouting, being quiet/not doing anything) and, (c) children's behavior: skilful and behavior problems (internalizing and externalizing).

Figure 7 describes the results of the identification of appropriate behaviors and motherschildren interactions in these situations. Both groups consider as appropriate the obedience of the children, but the nonclinical group statistically highlights the expression of affection of the children (clinical average = 0.41, SD = 0.50; nonclinical average = 0.88, SD = 0.86; p = 0.019). Both groups use few negative practices, but do not report positive practices. Possibly in these situations even if the mothers identify the proper behavior they do not reinforce it. The children from both groups demonstrate behaviors corresponding to "expressing feelings and coping".

Figure 8 presents the interactions involved when the child demonstrates behaviors that mothers disapprove. Both groups do not like it when children are disobedient or when they are aggressive. Equally, in these occasions, the groups show behaviors considered as negative practices and, mothers also report that they are feeling bad (sad, angry,

Fig. 5. Mean frequency of antecedent variables when mothers expressed opinions and

**Opinions**

various topics internalizing expressed

Antecedent consequent

*Establishment of limits* consisted in another category of educational practices and children's behaviors corresponding to four questions of the RE-HSE-P: "*Why does it become important to establish limits?", "What do you do to establish them*?", "*Does your child do things that you like?", "Does your child do things that you do not like?"* After each of these questions the respondent is required to talk about the quality of the interactions established regarding the occasions in which they occurred, the type of the mother's behavior, and the child's behavior in relation to the mother's. The answers from the analyses of content according to RE-HSE-P, were classified into three subcategories: (a) context variables: facing the obedience of the child, teaching what is correct and incorrect, having control of the behavior of the child, protecting the health of the child, and in leisure environment; (b) mother's behaviors: b1) communicates and expresses feelings and coping and, b2) makes uses of negative practices (beating, shouting, being quiet/not doing anything) and, (c) children's behavior: skilful and

feeling/coping\*

Figure 7 describes the results of the identification of appropriate behaviors and motherschildren interactions in these situations. Both groups consider as appropriate the obedience of the children, but the nonclinical group statistically highlights the expression of affection of the children (clinical average = 0.41, SD = 0.50; nonclinical average = 0.88, SD = 0.86; p = 0.019). Both groups use few negative practices, but do not report positive practices. Possibly in these situations even if the mothers identify the proper behavior they do not reinforce it. The children from both groups demonstrate behaviors corresponding to "expressing

Figure 8 presents the interactions involved when the child demonstrates behaviors that mothers disapprove. Both groups do not like it when children are disobedient or when they are aggressive. Equally, in these occasions, the groups show behaviors considered as negative practices and, mothers also report that they are feeling bad (sad, angry,

behaviors of children in these interactions.

0

1

**average frequency**

2

3

4

behavior problems (internalizing and externalizing).

feelings and coping".

Fig. 6. Mean frequency of antecedent variables when mothers expressed negative feelings and children behaviors in these interactions.

Families of Children with Hearing Loss and Parental Educational Practices 109

Fig. 8. Children's behaviors that mothers disapprove, maternal behaviors, and children's

0

disobeys, attacks

negative practices

behaviors that mothers disapprove


feels bad\*

obeys

apologizes, explains\*

internalizing

externaliz ni

g

reactions

4

3

y e frequenc

antecedent

parent behavior

consequent

2

g avera

1

Fig. 7. Behaviors that mothers approve, maternal behaviors, and children's reactions.

disappointed), especially the clinical group (clinical average = 2.04, SD = 0.59; nonclinical average = 1.38, SD = 1.10; p = 0.011). Children from both groups obey in the same degree , present internalizing or externalizing behaviors, though, the children with deficiency apologize or give explanations more frequently (clinical average = 0.15, SD = 0.36; nonclinical average = 0.81, SD = 1.02; p = 0.004).

Figure 9 describes the reasons given by the mothers to establish limits, their behaviors and the behaviors of their children. It can be observed that mothers from both groups consider important the use of limits establishment to teach children how to behave correctly and safely according to social standards during meals and plays.

However, the nonclinical group, more than the hearing loss group, emphasizes intensely that it is important to establish limits in order to have control over the child's behavior (clinical average = 0.22, SD = 0.42; nonclinical average = 1.35, SD = 1.32; p = 0.000), to teach social relationship rules (clinical average = 0.07, SD = 0.27; nonclinical average = 0.46, SD = 0.86; p = 0.036) and when the child treats their belongings and the environment carelessly (clinical average = 0.37, SD = 0.63; nonclinical average = 0.92, SD = 1.16; p = 0.039).

Mothers of both groups reported that they demonstrated behaviors denominated as positive and negative educational practices, and informed that they felt fine behaving this way. Likewise, in these situations, the children demonstrated behaviors considered as problems, such as disobedience and aggressiveness.

Figure 10 shows global results comparing both groups. In Figure 10 it can be observed that mothers of the nonclinical group reported that they behaved in a social skilful way (clinical average = 6.07, SD = 2.05; nonclinical average = 10.31, SD = 3.78; p = 0.000) as did their children (clinical average = 5.70, SD = 2.30; nonclinical average = 11.00, SD = 4.72; p = 0.000).

Fig. 7. Behaviors that mothers approve, maternal behaviors, and children's reactions.

nonclinical average = 0.81, SD = 1.02; p = 0.004).

such as disobedience and aggressiveness.

= 0.000).

safely according to social standards during meals and plays.

disappointed), especially the clinical group (clinical average = 2.04, SD = 0.59; nonclinical average = 1.38, SD = 1.10; p = 0.011). Children from both groups obey in the same degree , present internalizing or externalizing behaviors, though, the children with deficiency apologize or give explanations more frequently (clinical average = 0.15, SD = 0.36;

Figure 9 describes the reasons given by the mothers to establish limits, their behaviors and the behaviors of their children. It can be observed that mothers from both groups consider important the use of limits establishment to teach children how to behave correctly and

However, the nonclinical group, more than the hearing loss group, emphasizes intensely that it is important to establish limits in order to have control over the child's behavior (clinical average = 0.22, SD = 0.42; nonclinical average = 1.35, SD = 1.32; p = 0.000), to teach social relationship rules (clinical average = 0.07, SD = 0.27; nonclinical average = 0.46, SD = 0.86; p = 0.036) and when the child treats their belongings and the environment carelessly

Mothers of both groups reported that they demonstrated behaviors denominated as positive and negative educational practices, and informed that they felt fine behaving this way. Likewise, in these situations, the children demonstrated behaviors considered as problems,

Figure 10 shows global results comparing both groups. In Figure 10 it can be observed that mothers of the nonclinical group reported that they behaved in a social skilful way (clinical average = 6.07, SD = 2.05; nonclinical average = 10.31, SD = 3.78; p = 0.000) as did their children (clinical average = 5.70, SD = 2.30; nonclinical average = 11.00, SD = 4.72; p

(clinical average = 0.37, SD = 0.63; nonclinical average = 0.92, SD = 1.16; p = 0.039).

Fig. 8. Children's behaviors that mothers disapprove, maternal behaviors, and children's reactions

Families of Children with Hearing Loss and Parental Educational Practices 111

The quality of interactions established between mothers and children with hearing loss were positively correlated with the social skills of the children and with the context variables. The results indicated that the interactions established between mothers and children favor the acquisition and maintenance of the social skills repertoire. For the hearing loss group both mothers and children presented a poor social skills repertoire in comparison to the

ESS-P\* negative practice social skills\* behavior problem context

**Total**

As for *Communication*, the HL group, when compared to the normative group reported talking to their children less frequently about subjects of their interests and in fewer social

Regarding *Expressiveness*, it was observed that the mothers of the normative group expressed affection and praised more frequently than those from the HL group. The children who belonged to the normative group again presented more social skills than HL group. On the other hand, mothers from the HL group used less punishing strategies for

For *Limits Establishment,* it was observed that mothers of children with hearing loss identified fewer approved behaviors when compared to the normative group, and children

When parents establish limits children of the normative group apologize and/or offer

contexts. In these occasions the HL children presented poor social skills behavior.

Fig. 10. Categories totals of RE-HSE-P.

education when compared to the normative group.

explanations (social skills) more frequently than children with HL.

**4. Conclusion** 

0

2

4

**avera g e fre q uenc y**

6

8

10

12

normative group.

were less obedient.

Fig. 9. Frequency of previous situations, maternal behaviors, and reactions of children before setting limits.

Fig. 10. Categories totals of RE-HSE-P.
