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  • 8/12/2019 J. Deaf Stud. Deaf Educ.-2013-G.-deafed_ent052

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    The Author 2013. Published by Oxford University Press. All rights reserved.

    For Permissions, please email: [email protected]

    Theory/Review Manuscript

    Factors Associated With Social Interactions Between

    Deaf Children and Their Hearing Peers: A Systematic

    Literature Review

    Batten, G.*, Oakes, P. M., Alexander, T.

    The University of Hull

    Received February 3, 2013; revisions received August 26, 2013; accepted September 11, 2013

    Research indicates that deaf children can have marked social

    difficulties compared with their hearing peers. Factors that

    influence these social interactions need to be reviewed to

    inform interventions. A systematic search of 5 key databases

    and 3 specialized journals identified 14 papers that met the

    inclusion criteria. Methodological quality of the articles was

    assessed using an adapted checklist. There was a general lack of

    consensus across studies. The main factors investigated were

    the deaf childs communication competency, age, and level of

    mainstreaming, which overall were positively associated with

    peer interactions. Some studies also found that females were

    more likely to have positive social interactions. The majority

    of studies were cross-sectional. Some studies lacked appropri-

    ate control groups and did not recruit an appropriate range ofinformants. A wide range of factors were associated with social

    interactions between deaf and hearing children. The role of

    communication gained the highest consensus across studies.

    Other factors were involved in more complex interactions.

    This review aimed to investigate the factors that are

    associated with and/or directly influence the social

    interactions between deaf children and their hearing

    peers. While individual studies have looked at the vari-

    ous factors that are associated with improved peer rela-

    tionships between deaf children and hearing peers, no

    systematic review of the findings has yet been under-

    taken. By exploring these factors, parents, profession-

    als, and policy makers are best informed to support and

    develop interventions to help deaf children enjoy posi-

    tive social interactions, peer acceptance, and deep and

    meaningful friendships with their hearing peers. These

    relationships are associated with a wide range of posi-

    tive outcomes, for childrens psychological well-being

    and their academic career. This could ultimately reduce

    risk factors in later life and increase resiliency against

    any future challenges.

    Developmental Importance of Friendships

    A key aspect of development for every child, whether

    deaf or hearing, is the ability to interact socially. Social

    interactions and friendships in childhood are associ-

    ated with a wide range of factors related to psychologi-

    cal well-being and can be considered protective factors

    against life stressors and developmental challenges,

    such as those faced by deaf children. Having close

    positive peer relationships is associated with increased

    self-esteem (Bishop & Inderbitzen, 1995), emotion

    regulation (McElwain & Valling, 2005), successful

    adjustment to school transitions, and positive attitudes

    toward school (Tomada et al., 2005). However, peer

    rejection is related to the reverse. Studies have found

    that isolated children display more internalizing prob-lems, such as depression, anxiety, and low self-concept

    (Strauss, Forehand, Smith, & Frame, 1986), while con-

    currently disliking school and performing more poorly

    academically (Flook, Repetti, & Ullman, 2005).

    Peer relationships offer children opportunities

    to practise key competencies related to interpersonal

    interactions, such as helping, sharing, and negotiating

    *Correspondence should be sent to Georgina Batten, Department of

    Clinical Psychology and Psychological Therapies, The University of

    Hull, Hull, HU6 7RX, UK (e-mail: [email protected]).

    doi:10.1093/deafed/ent052

    Journal of Deaf Studies and Deaf Education

    Journal of Deaf Studies and Deaf Education Advance Access published November 12, 2013

    mailto:[email protected]:[email protected]
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    with others (Hartup, 1989). The establishment of posi-

    tive peer relations is crucial for childrens global socioe-

    motional development, advancing emotional regulation

    and expression (Parker & Gottman, 1989), while simul-

    taneously fostering communication skills (Newcomb &

    Bagwell, 1996) and aspects of cognitive development,

    such as perspective taking (McGuire & Weisz, 1982).Friendship building is a developmental goal for children

    (Buysse, Goldman, & Skinner, 2002) and contributes to

    later adjustment and life satisfaction (Brissette, Scheier,

    & Carver, 2002; Ladd, Kochenderfer, & Coleman, 1996;

    Overton & Rausch, 2002). Therefore, peer friend-

    ships could provide deaf children with opportunities to

    develop specific social, emotional, and cognitive skills,

    alongside increasing their overall well-being and self-

    confidence. However, rejection by peers or the absence

    of friendships could lead to increased psychosocial and

    educational difficulties for deaf children, over and above

    the challenges they can already face.

    Deaf Children: The Developmental Challenge

    Deaf children born to hearing families are more vulnera-

    ble to language delays (Moog & Geers, 1985). The poten-

    tial mismatch of communication modalities used between

    deaf children and their families could be linked to this.

    Vulnerability to language delays can affect childrens

    development of communication strategies; understand-ing of the thoughts and feelings of others (Peterson &

    Slaughter, 2006); ability to self-regulate especially in rela-

    tion to attention, impulsivity, and emotions (Mitchell &

    Quittner, 1996; Rieffe, 2011); rate of understanding social

    rules (Rachford & Furth, 1986); and overall social func-

    tioning (Marschark et al., 1993; Stinson & Whitmire,

    2000). Additionally, deaf children have been found to

    be 1.5 to 2 times more vulnerable to mental health dif-

    ficulties (Hindley, 2005) compared with their hearing

    peers. Problems can relate to loneliness (Most, 2007) and

    depression (Theunissen, et al., 2011), along with wider

    behavioral problems (Barker, et al., 2009).

    Social Interaction Between Deaf Children and

    Hearing Peers

    Alongside the communication and psychological dif-

    ficulties that deaf children can face, deaf childrens

    social behavior has been found to be more withdrawn

    and less collaborative than that of their hearing peers

    (Wauters & Knoors, 2007). While there are mixed

    findings in assessing deaf childrens peer acceptance

    (Stinson & Kluwin, 2003), deaf children have been

    found to feel more rejected and neglected than their

    hearing peers (Cappelli, Daniels, Durieux-Smith,McGrath, & Neuss, 1995; Wauters & Knoors, 2007).

    Research indicates that deaf children do not have as

    many close friendships with hearing peers (Wauters

    & Knoors, 2007) and these relationships are more

    sporadic (Lederberg, Rosenblatt, Vandell, & Chapin,

    1987). Deaf children are also more likely to have a

    complete lack of friends in their mainstream class

    than their hearing peers (Nunes, Pretzlik, & Olson,

    2001). Furthermore, compared with mothers of hear-

    ing teenagers, mothers of deaf adolescents have rated

    their childrens friendships as higher in aggression

    and lower in warmth (Henggeler, Watson, & Whelan,

    1990). However, this was not found in the childrens

    self-reports.

    It is also important to consider the attitudes

    and beliefs of hearing children regarding their deaf

    peers and what may mediate this. Most, Weisel, and

    Tur-Kaspa (1999)compared hearing peers who had

    regular contact with deaf children in mainstream

    education compared with those who did not, accord-

    ing to their perceived personal qualities and the stu-dents attitudes of deafness. It was noted that the

    deaf students speech intelligibility was associated

    with more positive perceived personal qualities by

    their hearing peers. Furthermore, the group that had

    contact with their deaf peers associated more posi-

    tive qualities of those with poor speech intelligibility

    compared with students who did not have this con-

    tact. Within this context of familiarity, Lewis (1995)

    found that peer acceptance of children with disabili-

    ties is affected by other childrens understanding of

    a childs special needs. Stinson and Liu (1999)foundthat hearing peers had varying attitudes toward deaf-

    ness, with negative attitudes centred on frustration,

    misinterpretation, communication breakdowns,

    fear, and lack of familiarity with deaf peers and an

    unwillingness to consider children who are differ-

    ent. This demonstrates that it is necessary to con-

    sider both the impact of characteristics associated

    Page 2 of 18 Journal of Deaf Studies and Deaf Education

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    with the deaf child and the attitudes and character-

    istics of their hearing peers on peer interactions and

    relationships.

    Understanding Social Interaction in the

    Context of Research and Child Development

    While social behavior, peer status, and friendships are

    independent and complex social constructs, this review

    recognizes the importance of exploring the range of

    social interactions when considering deaf childrens

    experiences with hearing peers.

    Researchers emphasize the importance of dis-

    tinguishing between the different components of

    social interactionsocial behavior: considering

    social skills and overall social competence; social

    status: including a childs acceptance or rejection by

    their peers; and friendships: considering the quan-tity, quality, and stability of long-term peer rela-

    tionships (Bukowski & Hoza, 1989; Mikami, 2010;

    Stinson & Antia, 1999). The different components

    of social interaction can relate to different devel-

    opmental stages in children, both in formation and

    impact (Mikami, 2010). Typically, social behaviors

    and skills are initially developed in the preschool

    years of early childhood, thereby impacting future

    social interactions and relationships subsequently

    (Engels, Dekovic, & Meeus, 2002). Peer acceptance,

    a construct of social status, is more relevant to mid-

    dle childhood, from around the age of 712 years old

    (Gifford-Smith & Brownell, 2003). The presence of

    a close, reciprocal friendship has been found to be

    more pertinent to older children, during adolescence

    (Buhrmester, 1996). Pederson, Vitaro, Barker, and

    Borges (2007) sequential model of childhood inter-

    nalization problems postulates that young childrens

    interpersonal behavior is associated with social sta-

    tus in middle childhood, laying the foundations for

    friendships in adolescence.

    Current Context for Deaf Children: Moving

    into the Hearing World?

    The health and educational context of deaf children is

    becoming an increasingly pertinent issue to consider

    in relation to social development and friendships with

    hearing peers. Technology has helped develop more

    efficient interventions, with improved hearing aids and

    the use of cochlear implants.

    The Newborn Hearing Screening Programme

    introduced in the United Kingdom in 2002 has

    increased focus on early identification of hearing loss

    in infants, enabling earlier intervention options for

    children and their families. Early diagnosis of hear-ing loss may be associated with better communication

    outcomes (Bat-Chava & Deignan, 2001). Improved oral

    communication skills may facilitate social interactions

    with hearing peers (Bat-Chava, Martin, & Kosciw,

    2005) and improve childrens perceptions of their deaf

    peers (Most et al., 1999), thereby leading to improved

    friendships and increased socioemotional benefits for

    deaf children.

    Alongside the technological and health care

    advancements, inclusion policies are prioritizing

    mainstream education for children with learning and

    sensory disabilities (Department for Education and

    Employment [DfEE], 1998; Disability Rights Task

    Force, 1999). Combined with improved audiological

    interventions, increasing numbers of deaf children

    are entering mainstream education. In such establish-

    ments, the majority of children are not deaf and the

    predominant communication modality is spoken lan-

    guage. The inclusion of deaf children in mainstream

    education has been associated with good academic out-

    comes and greater development of social skills (Geers,1990; Stinson & Antia, 1999). However, deaf children

    can face considerable social challenges with their

    hearing peers.

    The emotional cost for deaf children of increased

    peer rejection, neglect, reduced number of friend-

    ships with hearing peers, and the lack of closeness

    within friendships cannot be ignored. Childrens posi-

    tive mental and emotional health is a priority under

    the governments Every Child Matters (Department

    for Education and Skills [DfES], 2003) initiative.

    Furthermore, Coyner (1993) emphasized the impor-tance of childrens social well-being on academic

    achievement, stating that the best predictor of aca-

    demic success in a mainstream program for hard of

    hearing and deaf students is their acceptance by hear-

    ing peers (p. 90).

    The issue of social interactions and relationships

    between deaf children and hearing peers is clearly an

    Social Interaction of Deaf and Hearing Peers Page 3 of 18

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    important and growing area of concern. However, deaf

    childrens social experiences in mainstream schools can

    vary widely (Christiansen & Leigh, 2002) and thus not

    all deaf children experience rejection and poor-quality

    friendships with hearing peers. The reasons behind

    this are unclear and need to be explored to best support

    all deaf children.The review, therefore, aimed to address the follow-

    ing question:

    - What factors are associated with and/or directly

    influence the social interactions between deaf

    children and their hearing peers?

    Method

    Search Strategy

    A search strategy of the literature up to and includ-

    ing January 2012 was conducted using a wide range

    of electronic databases, covering the disciplines of

    clinical psychology (PsycINFO via Ebsco), edu-

    cation (ERIC), social sciences (IBSS), and health

    (CINAHL). The large multidisciplinary database,

    SCOPUS, was used, which included a search of

    MEDLINE. Individual journals that specifically pub-

    lished research on deaf children were also searched.

    These included The Journal of Deaf Studies and

    Deaf Education, Ear and Hearing, and Deafness andEducation International. There was no start cut-off

    date applied to the searches. To ensure that the rep-

    lication of previous work did not occur, a search for

    existing systematic literature review papers was con-

    ducted. This search did not identify any previously

    published systematic literature reviews investigating

    the factors influencing social interactions between

    deaf children and their hearing peers.

    The terms searched were (deaf* OR hear* impair*

    OR hard of hear* OR hard-of-hear* OR hear*

    difficult* OR hear* disorder*) and (child* OR adoles-cen* OR teen* OR young OR student* OR pupil* OR

    boy* OR girl* OR juvenile*) and (peer* OR group*

    OR friend* OR relation* OR social*OR interact* OR

    integrat* OR bull* OR isolate* OR alone OR lonel*).

    Articles that featured these search terms in their title,

    abstract, or keywords and that met inclusion criteria

    were identified. When possible, a search limit was put

    in place, and subsequent searches were confined to

    peer-reviewed journals in the English language, which

    used child participants. Titles were then used to assess

    relevancy. In cases of uncertainty, the abstracts and

    then the full texts were reviewed. Reference lists and

    citations of identified key articles were also searched.

    Key authors identified from the retrieved articles werecontacted to investigate whether any relevant articles

    were soon to be published and to identify any additional

    relevant articles that had not been identified from the

    existing search.

    Study Selection Criteria

    Selection criteria were refined after reading the

    abstracts and full papers identified in the scoping

    search. Initial searches found that studies used a wide

    range of methodological designs, different sources for

    data collection, and frequently included participants

    who experienced all forms of hearing loss, ranging

    from mild to profound, unilateral, and bilateral. It

    was, therefore, decided that excluding mild or unilat-

    eral hearing loss, when this applied to the minority of

    a studys participants, would restrict the conclusions

    drawn from the review and lead to an unrepresentative

    presentation of research in the area. A wide age range of

    419 years was included to enable consideration of all

    levels of social development, including development insocial skills and social status and how well-established

    childhood friendships were. See Table 1for details on

    selection criteria.

    Search Outcome

    Figure 1illustrates the steps taken in the search process

    for this review. Using the search strategy, 2,428 peer-

    reviewed articles were identified from a wide range of

    search engines and relevant journals. Following assess-

    ment of article titles, 118 articles were selected. Onceduplicates were removed and abstracts of the articles

    were read, 37 articles remained, of which the full arti-

    cles were read. The references sections and electronic

    citations of these articles were manually reviewed, pro-

    ducing a further six articles. Personal communication

    with lead authors led to an additional article being iden-

    tified and reviewed. In total, 44 full articles were read.

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    Thirty articles were removed according to the inclusion

    and exclusion criteria. Over half of these articles were

    removed as they did not specifically explore factors that

    affected or were associated with the social interaction of

    deaf and hearing children, instead exploring descriptivepatterns of interactions. Fourteen articles were conse-

    quently included for the review and are summarized

    in Table 2 (in Supplementary Materials). Only directly

    relevant findings from these studies are reported in this

    review due to the wide range of research questions and

    outcomes explored in many of the studies.

    Data Extraction

    A protocol was specifically developed around the aims

    of the review to record data from each article.

    Data Synthesis

    Due to the diversity of methodologies and outcome

    measures, statistical methods of data synthesis were not

    appropriate. Extracted data were collated and reported

    qualitatively for the review, generating a comprehen-

    sive narrative account of the findings.

    Table 1 Selection criteria

    Inclusion criteria Exclusion criteria

    Studies with participants aged 419 years old with

    hearing loss

    Studies that only describe the pattern of interaction

    between deaf children and their hearing peers, instead of

    investigating the factors that affect this

    Studies including a minority of participants with

    unilateral hearing loss

    Studies that do not directly assess social interaction between

    deaf children and hearing peers

    Longitudinal studies with one time point that doesnot meet age inclusion criteria

    Studies including participants with additional physical,sensory, developmental, or learning difficulties

    Studies with qualitative, quantitative, or mixed

    design

    Studies only investigating social interaction between deaf

    children and their deaf peers

    Methodologies that involve collecting data from

    children and informers other than the child

    Intervention studies

    Literature reviews or other non-empirical papers

    Dissertations

    Studies that have not been peer reviewed

    Studies not printed in English

    Journal of DeafStudies & Deaf

    Education (600)N=12

    Deafness and

    Education

    International(227) N=4

    Total full articles reviewed

    (N=44)

    Participants with

    additional

    disabilities

    (N=3)

    Intervention based

    (N=7)

    Participants not in

    age range

    (N=2)

    Interactions between

    deaf children only

    (N=1)

    Included articles

    (N=14)

    Not specifically

    measuring factors

    affecting social

    interaction (N=17)

    Full Articles reviewed following electronic search

    (N=37)

    Full articles reviewed following manual reference

    list search (N=6)

    Articles reviewed following personal

    communication with key authors (N=1)

    CINAHL(374)

    N=31

    ERIC(27)

    N=14

    PsycInfo(236)

    N=49

    IBSS(103)

    N=3

    Scopus(560)

    N=5

    Ear and

    Hearing(300)

    N=0

    Figure 1 Flowchart of search strategy and study selection

    Social Interaction of Deaf and Hearing Peers Page 5 of 18

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    Study Quality Assessment

    Quality assessment was conducted on all articles included

    in the review. While studies were not excluded on the

    basis of their quality rating, this information informed

    the analysis of the reliability and validity of each studys

    findings and overall conclusions. Furthermore, includ-

    ing studies ranging in quality informed analysis of the

    current research literature in this area and contributed to

    the reviews recommendations for future research.

    A range of quality checklists were available. However,

    none of these were appropriate for all types of systematic lit-

    erature reviews (Moja, Telaro, Moschetti, Coe, & Liberati,

    2005), and it was challenging to identify reliable checklists

    that assess studies with varying methodologies. Therefore,

    a quality control checklist was developed by the researcher

    that could assess studies using mixed designs and quantita-

    tive methodologies. This was important due to the range ofmethodologies represented in the articles selected for the

    review. The devised checklist was a combined adaptation

    of the checklists developed by Downs and Black (1998),

    Law et al. (1999), and the National Institute for Health

    and Clinical Excellence (NICE, 2007). A mixed-methods

    checklist developed by Sirreyeh, Lawton, Gardner, and

    Armitage (2011)was also referenced to ensure all relevant

    assessment questions were considered.

    The checklist (see Table 3 in Supplementary

    Materials) consisted of 43 questions, 32 of which were

    only relevant for quantitative-based methodologies.

    Mixed designbased methodologies would be assessed

    by all 43 questions. A point-scoring system was used to

    compare the quality of different studies. Checklist cri-

    teria were rated as yes (2 points), partial (1 point)

    and either no or dont know (zero points). Quality

    ratings were converted into percentages to allow direct

    comparison across studies. To ensure the reliability of

    quality ratings, an independent researcher rated a ran-

    domized selection of half of the articles under review.

    Using Spearmans correlation, inter-rater reliability

    was scored at .743, at

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    while three considered the social interactions of deaf,

    secondary aged children (1219 years old), and four

    spanned the age groups. Eight studies included partici-

    pants with cochlear implants, with one study includ-

    ing bilateral cochlear implants (Wolters et al., 2011).

    Studies ranged in their inclusion criteria according to

    type and severity of hearing loss. Two studies includedparticipants with unilateral hearing loss. Studies also

    differed widely in their sample size, from 7 (Lederberg,

    Ryan, & Robbins, 1986) to 220 (Stinson, Whitmire, &

    Kluwin, 1996).

    Type of Social Interaction Measured

    The 14 studies varied in their focus and breadth of

    exploration in to social interactions of deaf children

    with hearing peers. Research has emphasized the

    importance of differentiating between varying levelsof social interaction, separating out childrens social

    behaviorincluding social skills and overall social com-

    petence, social statusincluding a childs acceptance or

    rejection by their peers, andfriendshipsconsidering the

    quality and stability of long-term peer relationships

    (Bukowski & Hoza, 1989; Mikami, 2010; Stinson &

    Antia, 1999). Half of the studies focused solely on the

    social behavior or social skills of deaf children with their

    hearing peers (Antia et al., 2011; Bat-Chava et al., 2005;

    Lederberg et al., 1986; Martin, Bat-Chava, Lalwani, &

    Waltzman, 2010; Most, Ingber, & Heled-Ariam, 2011;

    Musselman, Mootilal, & MacKay, 1996; Stinson et al.,

    1996). One study focused solely on the social status

    of deaf children among hearing peers (Cappelli et al.,

    1995), another study focused only on friendships in

    this population (Roberts & Rickards, 1994), and four

    studies included a combination of friendship and

    social status (Bat-Chava & Deignan, 2001; Leigh et al.,

    2008), social status and social behavior (Wolters et al.,

    2011), and friendship and social behavior (Martin &

    Bat-Chava, 2003). Finally, one study considered the

    full range of social interactions, from social behavior,

    status, and friendships between deaf children and their

    hearing peers (Wauters & Knoors, 2007).

    Measures Used

    Due to the different domains of peer social interaction

    being assessed, a wide range of measures were used

    across studies. Two studies used the Social Activity

    Scale, and three studies used the CBCL, and some

    studies used similarly constructed sociometric scales

    of peer ratings and nominations. However, the major-

    ity of studies used differing measures. These instru-

    ments also varied in their construction, as some were

    recognized questionnaires and protocol with stand-ardized scores and established reliability and validity,

    while others were created by the study or were guided

    by their participant responses (Bat-Chava & Deignan,

    2001; Martin & Bat-Chava, 2003; Roberts & Rickards,

    1994).

    Main Themes From the Studies

    The main themes found from the review will be exam-

    ined from the inside-out. First, individual factors

    relating to the deaf child will be explored alongsidethe childs clinical hearingrelated characteristics.

    The review will then begin taking a wider perspective,

    considering first the influence of peer characteristics

    in social interactions and then the context of the social

    interaction.

    Child Characteristics

    Age. Three (Cappelli et al., 1995;Martin & Bat-Chava,

    2003; Roberts & Rickards, 1994) of the five studies

    (Cappelli et al., 1995; Lederberg et al., 1986; Martin& Bat-Chava, 2003; Roberts & Rickards, 1994; Wauters

    & Knoors, 2007) that explored the association between

    age and peer interactions found a relationship. Quality

    ratings for these studies ranged from 61.8% to 80.9%.

    These studies collectively considered social skills, social

    status, and friendship patterns, which were informed

    by parents, deaf children, and hearing peers. Two of

    the three studies (Cappelli et al., 1995; Martin & Bat-

    Chava, 2003) found that age was positively associated

    with social outcome. Older deaf children had higher

    social status and a wider repertoire of coping skills insocial situations with hearing peers. Older children also

    demonstrated more focus on peer relationship goals

    and reported a greater fear of negative evaluation by

    hearing peers (Cappelli et al., 1995).

    When considered together, the studies of Cappelli

    et al. (1995) and Martin and Bat-Chava (2003) had

    methodological strengths, collectively exploring social

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    skills, status, and relationships from the perspectives

    of children and parents and recruiting participants of

    similar age ranges (612 and 511 years old). However,

    females were disproportionately represented in one

    study, and gender was not controlled for in this analy-

    sis (Cappelli et al., 1995). Gender could have been a

    confounding factor in social outcomes for this studyand thereby could have had a biased effect on results.

    Furthermore, neither study controlled for communica-

    tion competence. These factors should be considered

    in light of findings related to the association of gender

    and communication with social interactions later in this

    review.

    Age was identified in one study as a mediating fac-

    tor between friendship patterns and educational set-

    ting (Roberts & Rickards, 1994). Only primary aged

    children with high levels of mainstreaming had more

    hearing friends than those in less integrated educa-

    tional settings. This indicates that younger childrens

    friendships are more influenced by context. While this

    study had a large sample size, age was not controlled for

    across educational settings, and ratings were only gen-

    erated from deaf children, which could have affected

    results. It is, therefore, important to exercise caution

    when generalizing findings.

    Two of the five studies (Lederberg et al., 1986;

    Wauters & Knoors, 2007) did not find an association

    between age and peer interactions. However, there werea number of limitations in the studys methodological

    designs, which could have limited results. Furthermore,

    one study (Wauters & Knoors, 2007) did not control for

    communication competence in children. Although one

    of these studies used a two time point longitudinal

    design, the time points were only separated by 1 year.

    Both these studies had small sample sizes and indi-

    vidually used a relatively smaller age range compared

    with the other studies. Furthermore, both studies only

    included primary aged children. It is possible that the

    most powerful effects of age on social interactions occuracross the transition to secondary school and through

    adolescence, which were not included in these studies.

    Gender. Five studies analyzed the relationship

    between gender and peer social interactions (Martin &

    Bat-Chava, 2003; Martin et al., 2010; Musselman et al.,

    1996; Wauters & Knoors, 2007; Wolters et al., 2011).

    Studies ranged in quality considerably, from 67.7%

    (Martin & Bat-Chava, 2003; Musselman et al., 1996) to

    80.9% (Wauters & Knoors, 2007; Wolters et al., 2011).

    There was variation in sample size, from 10 (Martin

    et al., 2010) to 87 participants (Wolters et al., 2011);

    ratios of male to female participants; and consideration

    of participants communication competence, with threestudies not controlling for this (Martin & Bat-Chava,

    2003; Martin et al., 2010; Wauters, & Knoors, 2007).

    Collectively, studies included the full range of social

    interactions, with all studies including exploration of

    social behaviors, two studies including consideration

    of social status, and two studies exploring associations

    with peer relationships.

    Three studies found a relationship between gender

    and peer interaction (Martin et al., 2010; Musselman

    et al., 1996; Wolters et al., 2011). Two of these (Martin

    et al., 2010; Wolters et al., 2011) found that young deaf

    girls were more likely to demonstrate higher levels of

    social competence, with increased acceptance, proso-

    cial behavior, and agreeableness. While young deaf

    boys demonstrated improvization in conversations,

    they were also found to exhibit more withdrawn and

    antisocial behavior than girls (Wolters et al., 2011).

    More pragmatic skills and ability to monitor conver-

    sations were associated with peer acceptance in girls,

    although not with boys (Wolters et al., 2011). Another

    study (Musselman et al., 1996) found that only girlssocial adjustment was influenced by their educational

    setting, whereby increased integration with hearing

    peers was associated with higher social participation

    and emotional security with hearing peers.

    Of the three studies (Martin et al., 2010;Musselman

    et al., 1996; Wolters et al., 2011), the full range of chil-

    dren, peers, parents, and teachers were recruited. Two

    studies (Martin et al., 2010; Musselman et al., 1996)

    only considered social behaviors and the other (Wolters

    et al., 2011) considered social behaviors and status. The

    ability to generalize findings was, therefore, reduced asnone of these studies explored an association between

    gender and type or quantity of social relationships.

    Concurrently, one study (Martin & Bat-Chava,

    2003) found that gender was not associated with the

    ability to establish relationships with hearing peers or

    with the frequency of strategies developed. However,

    the set of coping strategies most associated with

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    successful peer relationships was mediated by gender.

    For girls, confidence, the ability to play alone, and ask

    for repetitions were associated with better peer rela-

    tionships. High achievement in sport was associated

    with peer success in boys. While this study considered

    a wide age range within primary school aged children,

    it is not possible to generalize findings with regard toolder children. Additionally, due to a relative under-

    representation of male participants, additional coping

    skills associated with male peer success could exist but

    were not identified due to low statistical power.

    One study (Wauters & Knoors, 2007) that consid-

    ered the full range of social interactions, did not find an

    association between gender and peer interactions. This

    study had a longitudinal design and a high quality rat-

    ing of 80.9%. However, it had a small sample size and

    only considered primary school aged children, which

    may have limited results and reduced the ability to gen-

    eralize findings with regard to older children.

    Self-esteem. One study (Martin et al., 2010) considered

    the relationship of self-esteem with peer relationships.

    Deaf girls were found to have higher self-esteem, and when

    gender was controlled for, self-esteem was associated with

    increased peer interaction quality, prosocial behavior, and

    peer group entry. This study had a 72.1% quality rating;

    however, the small sample size of 10 deaf children limited

    the reliability of the results. Furthermore, communicationcompetence was not controlled for, which may have acted

    as a confounding factor.

    Childs ability in academic subjects and sport. Mathe-

    matical ability was negatively associated with the level

    of a deaf childs social impact, whether that impact be

    positive or negative (Wauters & Knoors, 2007). No

    other academic abilities were found to be associated

    with peer interactions. Another study (Martin & Bat-

    Chava, 2003) found that the ability to excel in sport was

    associated with the quality of male peer relationships.These studies had quality ratings of 80.9% and 69.1%,

    respectively. However, neither of the studies controlled

    for childrens communication competence, and both

    had small sample sizes.

    Communication competence. Eight studies considered

    communication use and ability (Antia et al., 2011;

    Bat-Chava & Deignan, 2001; Bat-Chava et al., 2005;

    Lederberg et al., 1986; Leigh et al., 2008; Most et al.,

    2011; Roberts & Rickards, 1994; Wolters et al., 2011).

    These studies ranged in quality ratings from 58.9%

    (Bat-Chava & Deignan, 2001) to 83.8% (Antia et al.,

    2011). All except for one study (Lederberg et al., 1986)

    found that deaf childrens communication was relatedto interactions with peers. This study (Lederberg et al.,

    1986) had one of the lowest quality ratings and had an

    especially small sample size. Furthermore, it only relied

    on data collected through relatively brief observations,

    which may have limited the results found.

    Considering the remaining studies together, oral

    communication, specifically speech intelligibility,

    ability to improvize in conversations, and pragmatic

    language skills, was positively associated with the full

    range of social interactions, social behaviors and com-

    petency, popularity, and relationships (Bat-Chava &

    Deignan, 2001; Bat-Chava et al., 2005; Most et al.,

    2011; Roberts & Rickards, 1994; Wolters et al., 2011).

    Satisfaction with home communication was positively

    related to social competence and self-esteem (Leigh

    et al., 2008), while classroom communication partici-

    pation was positively associated with social skills (Antia

    et al., 2011). These studies collectively explored the

    perspectives of deaf children, hearing peers, parents,

    and teachers. While there were methodological weak-

    nesses in the studies, with one using a small samplesize (Bat-Chava et al., 2005), three not controlling for

    confounding variables, such as type of hearing device

    being used, age of participants, and characteristics of

    the informers (Leigh et al., 2008; Most et al., 2011;

    Roberts & Rickards, 1994), and one using a retrospec-

    tive design (Bat-Chava & Deignan, 2001), the con-

    sensus that communication competency is associated

    with social interactions with hearing peers remained.

    A number of studies explored the impact of cochlear

    implantation on communication competence, a matter

    that is explored later in this review.

    Hearing loss. Five studies considered childrens level

    of hearing (Antia et al., 2011; Bat-Chava & Deignan,

    2001; Cappelli et al., 1995; Martin & Bat-Chava, 2003;

    Roberts & Rickards, 1994). Two of the studies did not

    find an association between the degree of hearing loss

    and deaf to hearing peer interactions (Cappelli et al.,

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    1995; Martin & Bat-Chava, 2003). These studies

    collectively covered childrens, peers, and parental

    perspectives and the full range of social interactions,

    although one study (Cappelli et al., 1995) had a relatively

    small sample size. Another study (Antia et al., 2011),

    which employed an extensive longitudinal design, large

    sample size, and perspectives from teachers and deafchildren, found that functional hearing ratings were

    positively associated with social behaviors. Hearing

    difficulties was also identified as a theme from parental

    narratives (Bat-Chava & Deignan, 2001). Parents

    reported that their childrens compromised ability

    to hear speech and detect subtle cues and idioms in

    conversation negatively affected social interactions

    with hearing peers. However, parents of children with

    positive communication outcomes from their cochlear

    implants may have been more willing to participate.

    This study had a relatively low quality rating of 58.9%,

    which may have affected the reliability of findings.

    Another study (Roberts & Rickards, 1994) found that

    the degree of hearing loss was related to friendship

    patterns, whereby the majority of children with mild

    to moderate hearing loss had mostly hearing friends,

    whereas some children with severe to profound

    hearing loss had a more equal balance of hearing and

    deaf friends. However, this study also found that the

    educational setting was related to friendship patterns,

    which is discussed later in this review. As this was notcontrolled for in analyses, findings may not be reliable.

    One study (Bat-Chava & Deignan, 2001) found

    that the age of children at the time of hearing loss diag-

    nosis was negatively associated with oral communica-

    tion ability. Studies have found a relationship between

    communication and social interaction (Antia et al.,

    2011; Bat-Chava & Deignan, 2001; Bat-Chava et al.,

    2005; Leigh et al., 2008; Most et al., 2011; Roberts &

    Rickards, 1994; Wolters et al., 2011). Therefore, age at

    diagnosis may be indirectly associated with social skills

    in deaf children.

    Impact of cochlear implants. Four studies considered

    the relationship between cochlear implantation and

    peer relationships (Bat-Chava & Deignan, 2001; Bat-

    Chava et al., 2005; Leigh et al., 2008; Martin & Bat-

    Chava, 2003). Two studies (Bat-Chava & Deignan,

    2001; Martin & Bat-Chava, 2003) found that the use

    of a cochlear implant was not directly associated with

    any form of social interaction. One of the studies (Bat-

    Chava & Deignan, 2001) found both improvements

    and limitations in childrens communication skills

    with their cochlear implant. Parents also reported

    their childrens personality became more extroverted

    following cochlear implantation, which indirectlyhelped their childrens peer relationships. The quality

    ratings from these studies were relatively low at 58.9%

    and 69.1%, and there was a lack of multiple informers.

    Furthermore, one study (Bat-Chava & Deignan, 2001)

    was retrospective, thereby reducing reliability. The

    results from both studies (Bat-Chava & Deignan,

    2001; Martin & Bat-Chava, 2003) were generated

    from the same, larger study, and data were likely to

    have overlapped. Conclusions from each study should,

    therefore, not be considered independently.

    Two other studies (Bat-Chava et al., 2005; Leigh

    et al., 2008) found indirect associations between coch-

    lear implant status and the range of peer interactions.

    The quality of both studies was similar at 76.5% (Bat-

    Chava et al., 2005) and 75.0% (Leigh et al., 2008). One

    study (Leigh et al., 2008) found that cochlear implan-

    tation was related to childrens increased hearing

    acculturation, which in turn was positively associated

    with acceptance by hearing peers and other socializa-

    tion skills. This study also found that deaf children

    attending mainstream education are more likely tohave a cochlear implant. Attending mainstream edu-

    cation was also associated with an increased level of

    social competence with hearing peers. Therefore,

    cochlear implantation was proposed to be influenc-

    ing social competency and relationships with hear-

    ing peers indirectly through increased identification

    with the hearing world and increased integration with

    hearing peers in school. However, a confounding fac-

    tor of parental hearing loss was not controlled for.

    There were a disproportionate number of deaf par-

    ents of deaf children attending segregated schools andwho had hearing aids instead of cochlear implants. It

    is possible that the hearing status of the deaf parents

    affected their childrens hearing acculturation, which

    would have affected results.

    The other study had mixed results (Bat-Chava

    et al., 2005). While no relationship between cochlear

    implant status and age of implantation with social

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    behaviors was found, there was a positive relationship

    between duration of cochlear implant use on over-

    all functioning. This effect was moderated by level

    of hearing loss. The cochlear implant was associated

    with increased oral communication skills. Socialization

    improvements in deaf children followed improvements

    in childrens communication skills with their cochlearimplants. It was proposed that increased oral language

    skills allows for increased conversational involvement,

    which in turn can further develop theory of mind skills

    and improve social interactions with hearing peers.

    A positive relationship between time and socialization

    skills was also found.

    Peer Factors

    Three studies considered how the characteristics of

    hearing peers (Bat-Chava & Deignan, 2001;Lederberget al., 1986; Roberts & Rickards, 1994) were associ-

    ated with social behaviors, status, and peer relation-

    ships. These studies had relatively low quality scores

    from 58.9% (Bat-Chava & Deignan, 2001) to 67.6%

    (Lederberg et al., 1986), with number of informants,

    lack of control of confounding variables such as age

    (Roberts & Rickards, 1994) and hearing device used

    (Lederberg et al., 1896; Roberts & Rickards, 1994),

    retrospective accounts, and sample sizes being per-

    tinent issues. One study (Roberts & Rickards, 1994),

    using deaf childrens perspectives, found that the

    clarity of peers speech was positively associated with

    peer relationships. Another (Bat-Chava & Deignan,

    2001) identified themes in parental narratives regard-

    ing peer attitudes. Parents reported that hearing peers

    who invested more effort, patience, and time with

    their deaf child were more likely to have positive peer

    relationships. Parents also reported that the more

    time deaf children and hearing peers spend together,

    the better their peer relationships. The time chil-

    dren had known one another was also highlighted by

    another study (Lederberg et al., 1986), which found,

    through observations, that familiarity played a greater

    role in social behaviors than the general experience of

    hearing peers being with deaf children. Results indi-

    cated that hearing peers could not generalize their

    adapted social behaviors and responses to unfamiliar

    deaf children.

    Contextual Factors

    Education placement. Seven studies considered the

    extent of mainstreaming (Leigh et al., 2008; Most et al.,

    2011; Musselman et al., 1996; Roberts & Rickards,

    1994; Stinson et al., 1996; Wauters & Knoors, 2007;

    Wolters et al., 2011). These studies ranged widely in

    quality from 61.8% (Roberts & Rickards, 1994) to

    80.9% (Wauters & Knoors, 2007; Wolters et al., 2011).

    Two studies found increased educational integration

    with hearing peers was positively associated with

    speech intelligibility, social competence with hearing

    peers and hearing acculturation (Leigh et al., 2008;

    Most et al., 2011). These studies collectively considered

    perspectives of deaf children, teachers, and parents and

    included primary (Most et al., 2011) and secondary

    (Leigh et al., 2008) aged children. However, as

    previously discussed, childrens hearing acculturationmay have been affected by a lack of control over the

    confounding variable of parental hearing status (Leigh

    et al., 2008). Other confounding variables, such as the

    hearing device used, were not controlled for in one

    study (Roberts & Rickards, 1994), which may have

    affected results. Consequently, these positive results

    should be interpreted cautiously.

    Four studies found more complex associations

    (Musselman et al., 1996; Roberts & Rickards, 1994;

    Stinson et al., 1996; Wolters et al., 2011). Two of these

    studies (Roberts & Rickards, 1994; Stinson et al., 1996)

    found that age mediated the relationship between the

    level of mainstreaming and peer interactions. These

    studies found that younger children in high levels

    of integration with hearing peers had more hearing

    friends and higher self-perceived social competence.

    The opposite was true for older children, who had

    lower social competence when in the highest rate of

    integration. While both studies had large sample sizes,

    they only included perspectives of deaf children and

    one did not control for communication competence

    (Stinson et al., 1996) and the other did not control for

    age. Additionally, the sample was not evenly distributed

    across educational settings (Roberts & Rickards, 1994).

    One study (Musselman et al., 1996) found that chil-

    dren in segregated education settings had poorer peer

    adjustment and poorer overall perceived social compe-

    tence compared with partially or fully mainstreamed

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    children. However, fully and partially mainstreamed

    deaf students did not differ on social competence. This

    study only included the perspectives of secondary aged

    deaf children. A final study (Wolters et al., 2011) found

    that deaf 12-year-old children in mainstream schools

    demonstrated lower antisocial and withdrawn behavior

    and more prosocial behavior with peers compared withchildren in segregated education. A large sample was

    used in this study, and perspectives of children, peers,

    parents, and teachers were considered, which increases

    the reliability of the studys findings. However, as only

    12-year-old children were considered, findings are lim-

    ited in how far they can be generalized.

    One study (Wauters & Knoors, 2007) did not find

    an association between level of educational integra-

    tion with hearing peers and peer relationships for pri-

    mary aged deaf children. This study had a longitudinal

    design with a small sample size, which only considered

    the perspectives of deaf children. This may have lim-

    ited findings.

    Additional contextual factors. Participation in com-

    munity activities and extracurricular activities was

    positively associated with social skills for primary aged

    children (Antia et al., 2011). This longitudinal study

    had a high quality rating of 83.3%, considering the

    perspectives of both deaf children and their teachers

    over 5 years. An observational study (Martin et al.,2010) and a mixed-methods study (Bat-Chava &

    Deignan, 2001), with quality ratings of 72.1% (Martin

    et al., 2010) and 58.9% (Bat-Chava & Deignan, 2001),

    found that group interaction was more difficult for deaf

    children with hearing peers. However, both studies did

    not calculate the quantifiable impact of hearing loss on

    group compared with one-to-one peer interactions.

    The observational study (Martin et al., 2010) did not

    include a control group of hearing children interacting

    in a group. Furthermore, while parental narratives

    indicated deaf children faced more difficulties in

    multitalker situations, this additional difficulty was also

    not quantifiable due to the methodological design.

    Summary

    There was a high range of variability in study qual-

    ity, design, participants recruited, and data sources

    used. Many factors were explored in relation to peer

    interactions, covering child and hearing peer charac-

    teristics along with the context of their interactions.

    Results showed a complex picture with a lack of con-

    sensus across studies. The main factors investigated

    were the deaf childs age, communicational compe-

    tency, and level of mainstreaming, which overall werefound to be positively associated with peer interactions.

    However, mediating factors for some of these domains

    were also identified, and some studies found no effect.

    Gender was also explored, and females were more

    associated with positive peer relationships in some

    studies. Differences in successful coping skills reper-

    toires between boys and girls were also found. Cochlear

    implantation, academic ability, and self-esteem may be

    associated with peer interactions. A small number of

    studies found group size, the hearing peers familiarity,

    speech, and attitude toward deaf peers were associated

    with social interactions.

    Discussion

    The aim of this study was to conduct a thorough sys-

    tematic literature review of studies that investigated

    the social interactions between deaf children and

    their hearing peers and to explore the associated fac-

    tors that directly impact interactions between deaf and

    hearing peers.The review highlighted a wide range of factors that

    were associated with deaf childrens social behavior,

    status, and relationships with hearing peers. There was

    considerable diversity in study design and participants

    recruited, with widely varying sample sizes, control

    groups, and participant characteristics. The quality of,

    and conclusions from, the literature is therefore vari-

    able and more limited in terms of generalizing to the

    wider population. However, the breadth of exploration,

    considering the wide range of associated factors related

    to peer interactions, produces a rich source of informa-tion and discussion. The review especially highlighted

    the role of communication, educational placement, the

    deaf childs age, and gender.

    The range of results, within and across variables,

    indicates that highly complex interactions are involved

    between multiple factors in shaping the social interac-

    tions of deaf children with hearing peers. Due to the

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    cross-sectional designs and lack of control of con-

    founding factors, cause and effect could not be estab-

    lished for some variables. It is possible that there is a

    bi-directional relationship between some of these fac-

    tors and peer outcomes.

    Understanding Results Through a Communication

    and Developmental Framework

    The results from the review could be tentatively con-

    sidered within a communication and developmental

    framework, given the prominence of certain findings.

    Communication can be considered as a relational var-

    iable, developed within relationships, which continu-

    ally influences and gets influenced by relationships.

    This was highlighted by the review, whereby high

    levels of consensus were found across studies focus-

    ing on the importance of childrens communication

    in peer relationships (Antia et al., 2011; Bat-Chava

    & Deignan, 2001; Bat-Chava et al., 2005; Leigh

    et al., 2008; Most et al., 2011; Roberts & Rickards,

    1994; Wolters et al., 2011). Furthermore, satisfaction

    with communication at home and the communica-

    tion competency of peers was found to be associated

    with social outcomes (Leigh et al., 2008; Roberts &

    Rickards, 1994). Results indicated that there were a

    number of contributors and mediators to communi-

    cation competency and social outcomes, such as thetype of hearing device used and the age of hearing

    loss diagnosis (Bat-Chava & Deignan, 2001). Gender

    is also associated with the communicational skills

    of deaf children and the value of communication

    in friendships (Martin & Bat-Chava, 2003; Wolters

    et al., 2011).

    While communication and social competency are

    clearly related, it is difficult to establish the way they

    interact and contribute to each others development.

    Bat-Chava et al. (2005)proposed that improvements in

    oral communication can lead to increased exposure tospoken conversations, which in turn can help children

    develop a better understanding of others views and

    feelings, thereby fostering the development of social

    skills and relationships. It is also possible that peer rela-

    tionships can foster social communication skills (Glick

    & Rose, 2011). Wright and Oakes (personal communi-

    cation with Dr Barry Wright, National Deaf Child and

    Adolescent Mental Health Service) proposed that deaf

    children may be delayed in picking up communication

    and social skills due to limited exposure to typical early

    experiences. Without this exposure to communica-

    tion, children may struggle to develop age-appropriate

    theory of mind and social competencies, which in turn

    may negatively impact the development of friendshipsand further opportunities to develop social skills.

    One way of increasing these oral communication

    experiences is through mainstream education, which

    provides high exposure to spoken language and social

    interactions with hearing peers. The nature of the rela-

    tionship between educational placement, communica-

    tion competency, and social outcome is not known, but

    may be bi-directional. Age also appears to play a role

    in this. The highest levels of mainstreaming positively

    influence younger children who are more dependent on

    their surroundings; however, it can be detrimental for

    older deaf children (Roberts & Rickards, 1994; Stinson

    et al., 1996). This may be due to the developmental

    task of identity formation (Erikson, 1968), whereby

    deaf children have the additional task of balancing

    their deaf-hearing identity. To support this, equilib-

    rium between social experiences and friendships with

    deaf and hearing peers may be optimal (Leigh, 1999).

    Alongside educational integration, time also pro-

    vides more scope for increased social and commu-

    nication experiences for deaf children. Time and ageare positively correlated with social interactions (Bat-

    Chava et al., 2005; Cappelli et al., 1995; Martin &

    Bat-Chava, 2003). Time may provide children with a

    greater opportunity to practice repairing communica-

    tion breakdowns, develop social skills and their coping

    repertoire, and increase overall familiarity with hearing

    peers and social resiliency.

    During adolescence, there is more focus and

    importance placed on peer relationships (Wigfield

    et al., 1991). This is confounded by the social stress of

    childrens transition to secondary school (Barone et al.,1991; Pratt & George, 2005). Older deaf children have

    been found to have more positive social interactions

    and a larger social coping skills repertoire (Cappelli

    et al., 1995; Martin & Bat-Chava, 2003). However, they

    are also more anxious of negative peer evaluation dur-

    ing this life stage (Cappelli et al., 1995). Gender may

    act independently and/or, within this developmental

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    frame in differentiating childrens communication

    styles and social skills necessary for peer success.

    Additional factors related to communication styles

    may influence peer interactions, such as the patience

    and enthusiasm of hearing children to interacting with

    their deaf peers (Bat-Chava & Deignan, 2001). The

    personality of the deaf child (Bat-Chava & Deignan,2001), especially in how assertive (Martin & Bat-Chava,

    2003) and confident (Martin et al., 2010) they are in

    communicating and interacting with peers, could also

    be an important factor. This may vary with age and

    development.

    Limitations of the Studies Reviewed

    There were methodological and theoretical limitations

    to the studies considered in this review. In relation to

    methodological design, one of the prominent issues

    was the source of the data. One study found that the

    peer acceptance ratings from parents and deaf children

    poorly correlated (Leigh et al., 2008). Over a third of

    the studies in this review only considered the perspec-

    tives of one type of informant, typically either the par-

    ent or the deaf child. This may have affected reliability

    and validity of findings regarding deaf childrens social

    behavior, social competency, and friendship patterns.

    Without a complete picture of the social interactions

    between deaf children and hearing peers, it is not pos-sible to comprehend the extent of difficulties children

    may face and all areas of support children may need;

    thus, interventions may not be targeted correctly.

    Studies in this review were also limited by a relative

    lack of qualitative methodologies, observational data,

    longitudinal designs, and control of some confound-

    ing variables, such as communication competence.

    Cause and effect was often not possible to establish.

    Furthermore, a number of the studies had small sam-

    ple sizes, and a wide variety of questionnaire formats

    and types were employed. Collectively, this limitedthe results and conclusions that could be drawn from

    within and across studies.

    The articles reviewed also spanned a wide time

    frame, from 1986 to 2011, as there was no single date

    or time period appropriate to set for cut-off criteria. As

    discussed in the introduction, the context of issues for

    deaf children is rapidly changing, due to technological,

    educational, and health advancements. Therefore, the

    profiles of the deaf children in some studies are out

    of date. Some of the earlier studies do not include

    children with cochlear implants, while the majority

    of those that do only include children with unilateral

    cochlear implants. As technology and health policies

    are developing, increasing numbers of deaf children arebeing fitted for bilateral cochlear implants. It is impor-

    tant that research uses representative sample groups

    reflecting this change in device use and considers the

    possible impact of the additional implant on social skill

    and friendship development.

    Alternative factors that may impact deaf childrens

    social interactions were not considered. The attach-

    ment styles and the deaf childrens relationships with

    parents and siblings were not explored. Furthermore,

    childrens emotional literacy or intelligence, attention

    levels, impulsivity, global executive functioning skills,

    and emotion regulation were not considered in any

    of the studies, despite research indicating that deaf

    children can have difficulties in these areas (Mitchell

    & Quittner, 1996; Peterson & Slaughter, 2006; Rieffe,

    2011). Furthermore, it is important to note that stud-

    ies have found relationships among these variables in

    other populations (Hoza, 2007; Mavroveli et al., 2009;

    McDowell et al., 2002; Sroufe et al., 1990; Stocker &

    Dunn, 1990). Additionally, even though gender was

    identified as a possible influencing factor in socialinteractions, friendships were not considered in terms

    of same-sex to opposite-sex peer friendships. It is pos-

    sible that different social and communication skills,

    types of interactions, and possible challenges are asso-

    ciated with opposite-sex deaf to hearing peer relation-

    ships compared with same-sex friendships. If this is

    the case, support and interventions would need to be

    adapted to address the differences.

    A final theoretical issue relates to the links between

    social skills and behavior and social status and peer

    relationships. Only one of the 14 studies reviewed con-sidered social interactions at all three levels and the

    majority that did not, only explored social skills and

    behavior. However, if a deaf child has good social skills

    or a large number of hearing friends, it does not nec-

    essarily mean those friendships are of a high quality.

    Therefore, the true or complete social profiles of the

    children recruited may not have been investigated.

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    Recommendations for Future Studies in the Field

    In line with the discussed limitations of the stud-

    ies reviewed, it is recommended that future research

    includes multiple sources of data, larger sample sizes,

    and longitudinal designs, including observations in nat-

    uralistic settings. When designing studies, major child-

    hood developmental and life stage transitions, such as

    starting secondary school and entering into adolescence

    as well as the type of social interaction explored, should

    be considered and explicitly addressed. It is preferable

    to include the full range of social interactions, from

    development of social skills and behavior to social sta-

    tus to the quantity, stability, and quality of the peer

    relationships, both between same-sex and opposite-sex

    peers. With increasing numbers of children being fit-

    ted with bilateral cochlear implants, more research that

    includes these children also needs to be undertaken.Furthermore, it is crucial to include hearing controls

    in studies in order to establish the typical patterns of

    friendship development among children.

    Future studies should consider and control for

    key confounding factors identified in this review.

    Furthermore, when considering identity issues and

    acculturation, hearing status of the childs family

    should also be considered as a possible confounding

    variable. Finally, consensus on which report measures

    used in this research area would allow for more gener-

    alization and direct comparisons across studies.

    Limitations to this Systematic Literature Review

    There were a number of limitations to this systematic

    literature review. First, due to the limited scope of

    this review, studies that recruited deaf children with

    additional developmental, sensory, or learning diffi-

    culties were not included. As roughly a third of deaf

    children (Fortnum et al., 2002) are diagnosed with an

    additional disability, results from this review cannot be

    directly generalized to these children. Furthermore,deaf-to-deaf peer relationships were not explored. This

    is a highly important area and could greatly increase

    deaf childrens development and resiliency. This was

    demonstrated in one study that found that the oldest

    adolescents were negatively affected by full mainstream

    integration (Stinson et al., 1996). Bicultural accul-

    turation is associated with psychological well-being

    in deaf individuals (Hintermair, 2008) whom experi-

    ence life in both the deaf and hearing world. Research

    into deaf childrens friendships with hearing and deaf

    peers should consequently be reviewed in order to best

    understand and support deaf children so they can sub-

    sequently develop good-quality friendships.

    The review included studies that had a range ofmethodological designs and that had recruited children

    with a wide range of hearing loss severity. This was

    done due to the typical variety of hearing loss presen-

    tations in deaf children. Exclusion of this would have

    severely limited the exploration of the review. However,

    by including children with such a range of hearing loss,

    results may not be as reliable. This is compounded by

    the finding from some studies that the level of hearing

    loss was an influencing factor on social interactions.

    Clinical Implications From the Review

    The review indicates that mainstream school programs

    designed to support the development of deaf childrens

    friendships should begin at a young age, promoting one-

    to-one relationships between deaf and hearing children.

    These programs should have some differentiation accord-

    ing to gender, such as supporting deaf boys to be involved

    in team sports, while helping girls to increase assertive-

    ness in their communication and repetition requests.

    The review also highlighted that deaf children who

    were involved in community activities and extracur-

    ricular activities had more positive social interactions

    (Antia et al., 2011). While the direction of causality is

    not known, increasing childrens social experiences will

    likely increase opportunities to practise and develop

    communication and social skills.

    Finally, research indicated that older adolescents

    may be at a socioemotional disadvantage in fully inte-

    grated educational settings. Further exploration of

    this and more flexible education or time after school

    could be beneficial in order to allow children to

    develop friendships with deaf peers. This is thought

    to be crucial for deaf childrens emotional well-being

    (Musselman et al., 1996).

    Supplementary Material

    Supplementary material is available at http://jdsde.

    oxfordjournals.org/.

    Social Interaction of Deaf and Hearing Peers Page 15 of 18

    http://jdsde.oxfordjournals.org/lookup/suppl/doi:10.1093/deafed/ent052/-/DC1http://jdsde.oxfordjournals.org/lookup/suppl/doi:10.1093/deafed/ent052/-/DC1http://jdsde.oxfordjournals.org/lookup/suppl/doi:10.1093/deafed/ent052/-/DC1http://jdsde.oxfordjournals.org/lookup/suppl/doi:10.1093/deafed/ent052/-/DC1
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    References

    Antia, S. D., Jones, P., Luckner, J., Kreimeyer, K. H., & Reed,

    S. (2011). Social outcomes of students who are deaf and

    hard of hearing in general education classrooms. Exceptional

    Children, 77, 489504, doi:10.2190/DE.41

    Barker, D. H., Quittner, A. L., Fink, N. E., Eisenberg, L. S.,

    Tobey, E. A., & Niparko, J. K. (2009). Predicting behav-

    iour problems in deaf and hearing children: The influencesof language, attention, and parent-child communication.

    Development and Psychopathology, 21, 373392, doi:10.1017/

    S0954579409000212

    Barone, C., Aguire-Deandeis, A. I., & Trickett, E. J. (1991).

    Mean-ends problem solving skills, life stress, and social sup-

    port as mediators of adjustment in the normative transition

    to high school. American Journal of Community Psychology,

    19, 207225. doi:10.1007/BF00937928

    Bat-Chava, Y., & Deignan (2001). Peer relationships of children

    with cochlear implants. Journal of Deaf Studies and Deaf

    Education, 6, 186199. doi:10.1093/deafed/6.3.186

    Bat-Chava, Y., Martin, D., & Kosciw, J. G. (2005). Longitudinal

    improvements in communication and socializationof deaf children with cochlear implants and hear-

    ing aids: Evidence from parental reports. Journal

    of Child Psychology and Psychiatry, 46, 12871296,

    doi:10.1111/j.1469-7610.2005.01426.x

    Bishop, J., & Inderbitzen, H. (1995). Peer acceptance and friend-

    ship: An investigation.Journal of Early Adolescence, 15, 476

    89. doi:10.1177/ 0272431695015004005

    Brissette, I., Scheier, M. F., & Carver, C. S. (2002). The role

    of optimism in social network development, coping,

    and psychological adjustment during a life transition.

    Journal of Personality and Social Psychology, 82, 102111.

    doi:10.1037/0022-3514.82.1.102

    Buhrmester, D. (1996). Need fulfillment, interpersonal com-

    petence, and the developmental contexts of early adoles-cent friendship. In W. M. Bukowski, A. F. Newcomb, &

    W. W. Hartup (Eds.), The company they keep: Friendships

    in childhood and adolescence (pp. 346365). New York, NY:

    Cambridge University Press.

    Bukowski, W. M., & Hoza, B. (1989). Popularity and friendship:

    Issues in theory, measurement, and outcome. In T. J. Berndt

    & G. W. Ladd (Eds.), Peer relationships in child development

    (pp. 1545). New York, NY: Wiley.

    Buysse, V., Goldman, B. D., & Skinner, M. L. (2002). Setting

    effects on friendship formation among young children

    with and without disabilities. Exceptional Children, 68,

    503517.

    Cappelli, M., Daniels, T., Durieux-Smith, A., McGrath, P., &Neuss, D. (1995). Social development of children with hear-

    ing impairments who are integrated into general education

    classrooms. The Volta Review, 97, 197208.

    Christiansen, J. B., & Leigh, I. W. (2002). Cochlear implants in

    children: Ethics and choices. Washington, DC: Gallaudet

    University Press.

    Conrad, R. (1979). The deaf school child. London, UK: Harper

    and Row.

    Coyner, L. S. (1993). Comparison of the relationships of aca-

    demic success to self-concept, social acceptance and per-

    ceived social acceptance for hearing, hard of hearing and

    deaf adolescents in a mainstream setting. Unpublished doc-

    toral dissertation, University of Arizona, Tucson.

    Department for Education and Employment (DfEE). (1998).

    Meeting special educational needsA programme of action.

    London, UK: HMSO.

    Department for Education and Skills (DfES). (2003). Every childmatters green paper. Norwich, UK: HMSO.

    Disability Rights Task Force. (1999). From exclusion to inclusion.

    London, UK: Department for Education and Employment.

    Downs, S. H., & Black, N. (1998). The feasibility of creating a

    checklist for the assessment of the methodological quality

    both of randomised and non-randomised studies of health

    care interventions.Journal of Epidemiological and Community

    Health, 52, 377384. doi:10.1136/jech.52.6.377

    Engels, R. C. M. E., Dekovic, M., & Meeus, W. (2002). Parenting

    practices, social skills and peer relationships in adolescence.

    Social Behaviour and Personality, 30, 318. doi:10.2224/

    sbp.2002.30.1.3

    Erikson, E. H. (1968). Identity: Youth and crisis. New York, NY:Norton.

    Flook, L., Repetti, R. L., & Ullman, J. B. (2005). Classroom

    social experiences as predictors of academic per-

    formance. Developmental Psychology, 41, 319327.

    doi:10.1037/0012-1649.41.2.319

    Fortnum, H. M., Marshall, D. H., & Summerfield, A. Q. (2002).

    Epidemiology of the UK population of hearing-impaired

    children, including characteristics of those with and without

    cochlear implantsaudiology, aetiology, co-morbidity and

    affluence. International Journal of Audiology, 41, 170179.

    doi:10.3109/14992020209077181

    Geers, A. (1990). Performance aspects of mainstreaming. In M.

    Ross (Ed.), Hearing impaired children in the mainstream(pp.

    275297). Parkton, MD: York Press.Gifford-Smith, M. E., & Brownell, C. A. (2003). Childhood

    peer relationships: Social acceptance, friendships, and

    peer networks. Journal of School Psychology, 41, 235284.

    doi:10.1016/S0022-4405(03)00048-7

    Glick, G. C., & Rose, A. J. (2011). Prospective associations between

    friendship adjustment and social strategies: Friendship as a

    context for building social skills. Developmental Psychology,

    47, 11171132. doi:10.1037/a0023277

    Hartup, W. W. (1989). Social relationships and their develop-

    mental significance. American Psychologist, 44, 120126.

    doi:10.1037/0003-066X.44.2.120

    Henggeler, S. W., Watson, S. M., & Whelan, J. P. (1990). Peer rela-

    tions of hearing-impaired adolescents.Journal of PaediatricPsychology, 15, 721731. doi:10.1093/jpepsy/15/6/721

    Hindley, P. (2005). Mental health problems in deaf chil-

    dren. Current Paediatrics, 15, 114119. doi:10.1016/j.

    cupe.2004.12.008

    Hintermair, M. (2008). Self-esteem and satisfaction with life

    of deaf and hard-of-hearing peopleA resource-oriented

    approach to identity work.Journal of Deaf Studies and Deaf

    Education, 13, 278300. doi:10.1093/deafed/enm054

    Page 16 of 18 Journal of Deaf Studies and Deaf Education

  • 8/12/2019 J. Deaf Stud. Deaf Educ.-2013-G.-deafed_ent052

    17/18

    Hoza, B. (2007). Peer functioning in children with ADHD.

    Journal of Paediatric Psychology, 32, 655663. doi:10.1093/

    jpepsy/jsm024

    Ladd, G. W., Kochenderfer, B. J., & Coleman, C. C. (1996).

    Friendship quality as a predictor of young childrens early

    school adjustment. Child Development, 67, 11031118.

    doi:10.2307/1131882

    Law, M., Stewart, D., Letts, L., Pollock, N., Bosch, J., &

    Westmoreland, M. (1999). Critical Review FormQualitativeStudies [Online]. Retrieved from www.musallamusf.com/

    resources/Qualitative-Lit-Analysis-pdf.pdf

    Lederberg, A. R., Ryan, H. B., & Robbins, B. L. (1986). Peer

    interaction in young deaf children: The effects of partner

    hearing status and familiarity. Developmental Psychology, 22,

    691700. doi:10.1037/0012-1649.22.5.691

    Leigh, I. W. (1999). Inclusive education and personal develop-

    ment. Journal of Deaf Studies and Deaf Education, 4, 236

    245. doi:10.1093/deafed/4.3.236

    Leigh, I. W., Maxwell-McCaw, D., Bat-Chava, Y., & Christiansen,

    J. B. (2008). Correlates of psychosocial adjustment in deaf

    adolescents with and without cochlear implants: A pre-

    liminary investigation. Journal of Deaf Studies and DeafEducation, 14, 244259. doi:10.1093/deafed/enn038

    Lewis, A. (1995). Childrens understanding of disability. London,

    UK: Routledge.

    Marschark, M. (1993). Psychological development of deaf children.

    New York, NY: Oxford University Press.

    Martin, D., & Bat-Chava, Y. (2003). Negotiating deaf-hearing

    friendships: Coping strategies of deaf boys and girls in

    mainstream schools. Child: Care, Health & Development, 29,

    511521. doi:10.1046/j.13652214. 2003.00371.x

    Martin, D., Bat-Chava, Y., Lalwani, A., & Waltzman, S. (2010).

    Peer relationships of deaf children with cochlear implants:

    Predictors of peer entry and peer interaction success.

    Journal of Deaf Studies and Deaf Education, 16, 108120.

    doi:10.1093/deafed/enq037Mavroveli, S., Petrides, K.V., Sangareau, Y., & Furnham, A.

    (2009). Exploring the relationships between trait emo-

    tional intelligence and objective socio-emotional outcomes

    in childhood. British Journal of Educational Psychology, 79,

    259272. doi:10.1348/000709908X368848

    McDowell, D. J., Kim, M., ONeil, R., & Parke, R. D. (2002).

    Childrens emotional regulation and social competence in

    middle childhood: The role of maternal and paternal inter-

    active style. Marriage and Family Review, 34, 345364.

    doi:10.1300/J002v34n03_07

    McElwain, N. L., & Valling, B. L. (2005). Preschool chil-

    drens interactions with friends and older siblings:

    Relationship specificity and joint contributions to prob-lem behaviour. Journal of Family Psychology, 19, 486496.

    doi:10.1037/0893-3200.19.4.486

    McGuire, K. D., & Weisz, J. R. (1982). Social cognition and

    behavioral correlates of preadolescent chumship. Child

    Development, 53, 14781484. doi:10.2307/1130074

    Mikami, A. Y. (2010). The importance of friendship for youth

    with attention-deficit/hyperactivity disorder. Clinical Child

    and Family Psychology Review, 13, 181198. doi:10.1007/

    s10567-010-0067-y

    Mitchell, T., & Quittner, A. L. (1996). Multi-method study of

    attention and behavioural problems in hearing-impaired

    children. Journal of Clinical Child Psychology, 25, 83-96.

    doi:10.1207/s15374424jccp2501_10

    Moja, L. P., Telaro, E., Moschetti, I., Coe, L., & Liberati, A.

    (2005). Assessment of methodological quality of primary

    studies by systematic reviews: Results of the metaquality

    cross sectional study. British Medical Journal, 330, 1053

    1060. doi:10.1136/bmj.38414.515938.8FMoog, J., & Geers, A. (1985). EPIC: A program to accelerate aca-

    demic progress in profoundly hearing-impaired children.

    The Volta Review, 87, 259277.

    Most, T. (2007). Speech intelligibility, loneliness, and sense of

    coherence among deaf and hard-of-hearing children in indi-

    vidual inclusion and group inclusion.Journal of Deaf Studies

    and Deaf Education, 12, 495503. doi:10.1093/deafed/

    enm015

    Most, T., Weisel, A., & Tur-Kaspa, H. (1999). Contact with

    students with hearing impairments and the evalu-

    ation of speech intelligibility and personal quali-

    ties. The Journal of Special Education, 33, 103110.

    doi:10.1177/002246699903300204Most, T., Ingber, S., & Heled-Ariam, E. (2011). Social compe-

    tence, sense of loneliness, and speech intelligibility of young

    children with hearing loss in individual inclusion and group

    inclusion. Journal of Deaf Studies and Deaf Education, 12,

    495503. doi:10.1093/deafed/enr049

    Musselman, C., Mootilal, A., & MacKay, S. (1996). The social

    adjustment of deaf adolescents in segregated, partially inte-

    grated and mainstreamed settings. Journal of Deaf Studies

    and Deaf Education, 1, 5263. doi:10.1093/oxfordjournals.

    deafed.a014281

    National Institute for Health and Clinical Excellence (2007). The

    guidelines manual, methodology checklist: Qualitative studies,

    145150. London: NICE.

    Newcomb, A. F., & Bagwell, C. L. (1996). The developmentalsignificance of childrens friendship relations. In W. M.

    Bukowski, A. F. Newcomb, & W. W. Hartup, (Eds.), The

    company they keep(pp. 289321). New York, NY: Cambridge

    University Press.

    Nunes, T., Pretzlik, U., & Olson, J. (2001). Deaf childrens social

    relationships in mainstream schools. Deafness and Education

    International, 3, 123136. doi:10.1002/dei.106

    Overton, S., & Rausch, J. L. (2002). Peer relationships as

    support for children with disabilities: An analysis of

    mothers goals and indicators for friendship. Focus on

    Autism and Other Developmental Disabilities, 17, 1129.

    doi:10.1177/108835760201700102

    Parker, J. G., & Gottman, J. M. (1989). Social and emotionaldevelopment in a relational context: Friendship interactions

    from early childhood to adolescence. In T. J. Berndt & G.

    W. Ladd (Eds.), Peer relationships in child development (pp.

    95131). New York, NY: Wiley.

    Peterson, C. C., & Slaughter, V. P. (2006). Telling the story

    of theory of mind: Deaf and hearing childrens narra-

    tives and mental state understanding. British Journal of

    Developmental Psychology, 24, 151179. doi:10.1348/0261

    51005X60022

    Social Interaction of Deaf and Hearing Peers Page 17 of 18

    http://www.musallamusf.com/resources/Qualitative-Lit-Analysis-pdf.pdfhttp://www.musallamusf.com/resources/Qualitative-Lit-Analysis-pdf.pdfhttp://www.musallamusf.com/resources/Qualitative-Lit-Analysis-pdf.pdfhttp://www.musallamusf.com/resources/Qualitative-Lit-Analysis-pdf.pdf
  • 8/12/2019 J. Deaf Stud. Deaf Educ.-2013-G.-deafed_ent052

    18/18

    Pratt, S., & George, R. (2005). Transferring friendship: Girls and

    boys friendships in the ransition from primary to secondary

    school. Children & Society, 19, 1626. doi:10.1002/chi.830

    Rachford, D., & Furth, H. G. (1986). Understanding friend-

    ship and social rules in deaf and hearing adolescents.

    Journal of Applied Developmental Psychology, 7, 391402.

    doi:10.1061/0193-3973(86)90008-0

    Rieffe, C. (2011). Awareness and regulation of emotions in

    deaf children. British Journal of Developmental Psychology.doi:10.1111/j.2044-835X.2011.02057

    Roberts, S. B., & Rickards, F. W. (1994). A survey of graduates

    of an Australian integrated auditory/oral preschool. Part II:

    Academic achievement, utilization of support services and

    friendship patterns. The Volta Review, 96, 207236.

    Sirreyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2011).

    Reviewing studies with diverse designs: The development

    and evaluation of a new tool.Journal of Evaluation in Clinical

    Practice. doi:10.1111/j.1365-2753.2011.01662.x

    Sroufe, L. A., Egeland, B., & Kreutzer, T. (1990). The fate of early

    experience following developmental change: Longitudinal

    approaches to individual adaptation in childhood. Child

    Development, 61, 13631373. doi:10.1111/j.14678624.1990.tb02867.x

    Stinson, M. S., Whitmire, K., & Kluwin, T. (1996). Self-

    perceptions of social relationships in hearing-impaired

    adolescents.Journal of Educational Psychology, 88, 132143.

    doi:10.1037/0022-0663.88.1.132

    Stinson, M. S., & Antia, S. D. (1999). Considerations in educat-

    ing deaf and hard of hearing students in inclusive schools.

    Journal of Deaf Studies and Deaf Education, 4, 163175.

    doi:10.1037/0022-0663.88.1.132

    Stinson, M., & Liu, Y. (1999). Participation of deaf and hard-of-

    hearing students in classes with hearing students.Journal of

    Deaf Studies and Deaf Education, 4, 191202. doi:10.1093/

    deafed/4.3.191

    Stinson, M. S., & Whitmire, K. A. (2000). Adolescents who aredeaf or hard-of-hearing: A communication perspective on

    educational placement. Topics in Language Disorders, 20,

    5872.