How Mental Health Issues Cause Further Breakdown in Communication with Deaf and Hard of Hearing Individuals Jaime A.B. Wilson, Ph.D.
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1 How Mental Health Issues Cause Further Breakdown in Communication with Deaf and Hard of Hearing Individuals Jaime A.B. Wilson, Ph.D. Licensed Clinical Psychologist
2 Meeting the Deaf Client Deaf, HH, and Deaf-Blind (D/HH/DB) individuals referred for services may have language dysfluency. Dysfluency: [communication] that is not smoothly delivered or grammatically well formed (Nordquist, 2011).
3 The Traditionally Underserved Possesses limited communication abilities In addition to any or all of the following: Cannot maintain employment without support. Demonstrates poor social / emotional skills. Cannot live independently without transitional assistance.
4 The Challenge of Working with the Traditionally Underserved Must parse out whether the language patterns of dysfluent patients reflects mental illness, language deprivation, or some neurological disorder. Knowing the source of the deficit will help to determine the Individualized Plan for Employment! Can be a predictor of success in a vocational endeavor.
5 A Word of Caution Cannot draw conclusions about mental illness on the basis of the spoken (signed) or written language skills of the deaf person. Language deprivation can be confused with, or confounded by, mental illness that develops later.
6 Disorganized Thinking, Language, & Behavior Defined as a frequent inability to sort, interpret and respond to perceptual phenomena.
7 Conclusions? It is customary for a general provider to interpret such observed symptoms as evidence of psychosis. Evidence of language deprivation warrants extra caution! More often than not, there are misdiagnoses.
8 Final Diagnosis? Does the evidence of the confused sign order and missing grammatical features indicate unstructured thinking? Does this language problem mean that the individual is psychotic?
9 A Differential Diagnosis How do we determine whether a Deaf individual has language dysfluency related to thought disorder vs. language dysfluency related to language deprivation?
10 Analyzing Language Skills Vocabulary: Impoverished vocabulary, with many signs used incorrectly. Does not appear to understand abstract concepts. Overgeneralizes the use of a sign
11 Analyzing Language Skills (cont.) Time: Uses almost no time indicators. Does not seem to understand the days of the week or months of the year. Does not use ASL # incorporation like THREE-WEEKS-FROM-NOW or TWO-YEARS.
12 Analyzing Language Skills (cont.) Spatial Organization: Does not make correct use of the visual field, organizing information spatially. Attempted to list family members on fingers, but repeated the same finger for different people. Never referred back to a previous established sign.
13 Analyzing Language Skills (cont.) Spelling: Incorrectly spells words.
14 Results of Psychological Evaluation - WAIS-III PIQ: 69, %ile = 2 WJ-R Reading Comprehension: 6 years, 3 months Basic Math Skills: 6 years, 6 months Written Expression: 6 years, 6 months Prior evaluation results from grade school showed an IQ of 65.
15 Overall Conclusions Results from psychological evaluation suggest difficulties with putting things in order by time or space. Sign language use suggests trouble telling a story sequentially and in manipulating the signing spatial field. Such brain pathology likely contributes to language difficulties. Language problem also appears to be developmental.
16 Overall Conclusions Appears to represent a series of pictures. Seems to be organized loosely as a kind of collage.
17 Analyzing Language Skills (cont.) Organized narrative or story given. Can be quite difficult to understand, even for fluent signers, until one gets to know and learn of limited repertoire of topics. Also notice that there is a mixture of sign with gesture and pantomime.
18 Take Home Messages Language deprived deaf individuals have signing that is often mixed with gesture and pantomime. A comprehensive psychological or neuropsychogical evaluation can help to shed light on what is happening with the individual.
19 Need to Recognize the Issue Visual-Gestural & Home Signs Lots of Vocabulary & Grammatical Features Most Severe Deprivation Severe Deprivation Less Severe Deprivation Reflection of Inadequate Learning
20 What a Difficult Case! The real diagnostic dilemmas will occur with deaf persons who are language deprived and may also have a thought disorder. Some symptoms such as concreteness and poverty of content are clearly related to both causes.
21 Psychological Evaluations of Deaf Individuals are Complex! More complex than with hearing individuals! (Glickman, 2007). Reasons: Language Minorities AND Cultural Minorities WITH the possibility of language deprivation! Culturally informed assessments need to occur! The opportunities for misjudgments about deaf patients are many.
22 Misdiagnoses are Common! Without proper training and experience working with the D/HH/DB population, it is natural to overlook vital cultural and linguistic variables. Consider that deaf individuals may espouse beliefs from a Deaf culture frame of reference that deafness is good, having a deaf child is preferable over a hearing one, hearing aids and cochlear implants might be a form of cultural genocide, and speaking is unnecessary and oppressive.
23 References Denmark, J. (1994) Deafness and mental health. London: Jessica Kingsley. Dew, D.W.E. (1999). Serving individuals who are low-functioning deaf. Washington, DC: The George Washington University Regional Rehabilitation Continuing Education Program. Glickman, N. (2007). Do you hear voices? Problems in assessment of mental status in deaf persons with severe language deprivation. Journal of Deaf Studies and Deaf Education, 12 (2), pp ). Glickman, N., & Harvey, M. (Eds.). (1996). Culturally affirmative psychotherapy with deaf persons. Mahwah, NJ: Lawrence Erlbaum Associates. Gulati, S. (2003). Psychiatric care of culturally deaf people. In N. Glickman & S. Gulati (Eds.), Mental health care of deaf people: A culturally affirmative approach. Mahwah, NJ: Lawrence Erlbaum Associates. Evans, J.W. & Elliott, H. (1987). The mental status examination. In H. Elliott, L. Glass, & J.W. Evans (Eds.), Mental health assessment of deaf clients: A practical manual (pp ). Boston, MA: College Hill Press. Long, N., Ouellette, S., Long, G., & Dolan, K. (1993). Service provision issues with traditionally underserved person who are deaf. In O.M. Welch (ed.), Research and practice in deafness: Issues and questions in education, psychology and vocational service provision (pp ). Springfield, IL: Charles C. Thomas. Nordquist, R. (2011). Grammar and Composition. Retrieved from: Pollard, R. (1998). Psychopathology. In M. Marschark & M.D. Clark (Eds.), Psychological perspectiveson deafness (pp ). Mahwah, NJ: Lawrence Erlbaum Associates. Thacker, A. (1994). Formal communication disorder: Sign language ind eaf people with schizophrenia. British Journal of Psychiatry, 165, Thacker, A. (1998). The manifestation of schizoprhenic communication disorder in sign language. Unpublished doctoral dissertation, St. George Hospital Medical School. Torrey, E.F. (2001). Surviving schizophrenia. New York: Quill. Vernon, M. & Daigle-King, B. (1999). Historical overview of inpatient care of mental patients who are deaf. American Annals of the Deaf, 144,
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