In sum, our results demonstrate that youth who perceived that they understood all or most of their parent’s expressive communication, report a higher perceived quality of life related to their sense of self, their relationships and their environment as well as better quality of life related to being DHH. Within the YQoL-DHH module for youth quality of life instrument, the youth's perception of full understanding of parent's communication is important for high participation–related quality of life. Youth who understood most or all of what their parents say were likely to report higher quality of life related to self-acceptance and advocacy and also lower perceived stigma related to being DHH. These perceptions did not differ by degree of hearing loss but rather were consistent across the range of loss from mild to severe as well as among youth with CIs. Preferred communication modality was not related to the youth’s evaluation of how much she or he understood the parent, perceived quality of life associated with participation and self-acceptance/advocacy, or the youth’s report of depressive symptoms. Perceived stigma associated with being DHH, however, was significantly associated with mode of communication. Specifically, youths who reported strong preference for speech were much more likely to report greater stigma associated with being DHH than youths who reported preference for combination of sign language and speech. The addition of sign language to the DHH youth’s daily communication appears to carry a beneficial effect in reducing youth perceived stigma associated with hearing loss. Finally, the relationship found between youth’s perceived ability to understand what their parents said and generic quality of life is consistent with previous research that suggest a link between communicative competence (as opposed to preferred mode of communication) and socioemotional development among youth who are DHH (Hintermair, 2006
Our finding of the association between perceived quality of life and youths’ perceptions of their ability to understand what their parents say underscores the importance of the quality of communication at home. Conversely, the parent’s perception of the DHH youth’s communication may be equally important in shaping developmental outcomes. In other words, the outcomes of the DHH child's early experience are influenced by a combination of factors intrinsic to the child and environmental modifications (Marschark, 2007
). Closer examination of this bidirectional relationship, rather than the youth or parent’s characteristics, is necessary in order to adequately understand the impact that basic parent–youth communication would have on DHH-specific quality of life outcomes.
Research has shown that better problem solving skills among parents are associated with better academic and socioemotional development in their deaf children (see Calderon & Greenberg, 2003
, for a review). Lower parental stress and depression are associated with better socioemotional development in children who are DHH (Hintermair, 2006
; Kushalnagar et al., 2007
). These studies point to the same conclusion: early communication difficulties appear to be associated with parental stress and socioemotional difficulties among children who are DHH. As we tie in these data with current study findings, it may be logical to conclude that the quality of communication at home is not only just related to the child’s early socioemotional and language development but also related to later quality of life issues in adolescence. It emphasizes the need to consider home communication across the age span as a malleable factor that deserves attention for its proximal role in satisfaction with school and life.
The relatively small percentage of youth who reported less than optimal understanding of parent’s expressive communication also reported more depressive symptoms than youth who reported that they understood most or all of what their parents said. The association between perceived level of ability to understand what parents said and depressive symptoms remained moderately strong after taking in consideration the youth’s preferred mode of communication, age, parent’s hearing status, and the youth’s level of hearing loss. If the depressed youth does not perceive communication with hearing parents to be accessible, this youth may sense a loss of belonging, thus negatively impacting his or her perceive quality of life related to life at home. This can potentially place the youth at increased risk for engaging in health-risk behaviors such as tobacco use, alcohol use, illicit drug use, and high-risk sexual behavior, which has also previously been shown to be associated with a poor quality of life (Topolski et al., 2001
). These health-risk behaviors also have been shown to be associated with depression and anxiety that emerge during adolescence (see DiClemente, Santelli, & Crosby, 2009
, for a review), and depression and hopelessness have been shown to be associated with lower perceived quality of life (Moore, Hofer, McGee, & Ring, 2005
For the general youth population without disabilities, parental involvement and parent–youth communication have been shown to be influential on various youth outcomes such as reduction in sexual risk behaviors (DeVore & Ginsburg, 2005
; Stoiber & McIntyre, 2006
), better academic achievement (Hill et al., 2004
), and overall adolescent adjustment (see Proctor, Linley, & Malthy, 2009
, for a review). Parent monitoring has been found to significantly reduce adolescent risk behaviors, including tobacco, marijuana, and illicit drug usage (Robertson, Baird-Thomas, & Stein, 2008
; Stanton et al., 2004
). In these parent–youth communication studies that involve hearing youth and hearing parents, parent–youth communication is typically high level and focuses on what messages are sent, what messages are heard, and what messages are understood. For deaf youth who do not have accessible communication at home, we must first address the basic issue of whether they felt that they understood how much their parents said before we can move on to higher level parent–youth communication. Another issue to consider is the degree of language proficiency that may differ between the parent and youth. For example, the parent may not be as proficient in sign language as the youth or the youth not as proficient in spoken English as the parent. This may add yet another layer of complexity in understanding each other’s basic communication and create stress within the parent–youth relationship. Within this context, both the parent and the youth’s ability to be flexible, recognize, and problem solve in communication breakdowns can serve to improve the relationship and maintain healthy parent–youth connection as well as promote positive youth perceived quality of life. These issues further emphasize the importance of making entire families the participants or consumers of communication interventions with DHH children and youth; the goal of most early intervention programs (see Sass-Lehrer & Bodner-Johnson, 2003
; Stredler-Brown, 2010
). Future mental health and family communication intervention studies with DHH youth are needed to discern the causal relationships among depressive symptoms, perceived ability to understand parent's communication, and perceived quality of life.
One study limitation is the nature of convenience sampling. A large percentage of youth participants were recruited through schools, listserves, and camps. Written consents from the parents were required prior to surveying youth participants. The self-selection process associated with parental consent may be reflective of educated and literate parents who are already involved in their children’s lives, which may explain the higher number of positive perception of parent expressive communication and associated quality of life. Better sampling methods to include hard-to-recruit participants are needed to provide a wider representation of the young population and their perception of quality of life in general and as DHH individuals.