Li Yuelin, Bain Lisa, Steinberg Annie G
Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market St, Suite 1029, Philadelphia, PA 19104, USA.
Arch Pediatr Adolesc Med. 2003 Feb;157(2):162-8. doi: 10.1001/archpedi.157.2.162.
Early intervention decisions for a deaf or hard of hearing child are difficult to make, partly because of the lack of definitive proof of the superiority of any particular communication approach.
To compare the relative importance of the child's hearing loss and parental attitudes, beliefs, values, and aspirations in the decision process.
Eighty-three parents were surveyed about decision factors that may have affected their choice of communication modality, including resource availability, attitudes and beliefs about hearing loss, values, trade-offs, and goals. Parental preference ratings on hypothetical outcomes were also collected in 4 domains: communication, academic performance, social functioning, and emotional well-being.
The child's extent of hearing loss was the most influential decision factor (P<.001). Beyond the extent of hearing loss, logistic regression further showed that parental cognitive-attitudinal factors were important in the inclination to favor an oral approach-if they believed that deafness can and should be corrected and if they desired the child to be able to speak (P =.03 and.04, respectively). Technology that aims at improving the child's ability to speak (eg, cochlear implants) had no significant impact on the decision to choose oral only training.
Professionals who work with deaf children and their parents should recognize the presence of many relevant issues beyond the extent of the child's hearing loss. Interventions may be most effective if aimed at balancing parental beliefs and aspirations and audiologic considerations.
对于失聪或听力障碍儿童，早期干预决策很难做出，部分原因是缺乏确凿证据证明任何一种特定沟通方式具有优越性。
比较儿童听力损失以及父母的态度、信念、价值观和期望在决策过程中的相对重要性。
对83位家长进行调查，询问可能影响其沟通方式选择的决策因素，包括资源可用性、对听力损失的态度和信念、价值观、权衡因素及目标。还收集了家长对4个领域假设结果的偏好评分：沟通、学业成绩、社会功能和情绪健康。
儿童听力损失程度是最具影响力的决策因素（P<0.001）。除听力损失程度外，逻辑回归进一步显示，家长的认知态度因素在倾向于支持口语方法方面很重要——如果他们认为失聪能够且应该得到矫正，以及如果他们希望孩子能够说话（分别为P = 0.03和0.04）。旨在提高儿童说话能力的技术（如人工耳蜗）对仅选择口语训练的决策没有显著影响。
与失聪儿童及其家长打交道的专业人员应认识到，除了儿童听力损失程度之外，还存在许多相关问题。如果干预旨在平衡家长的信念和期望以及听力学方面的考虑，可能会最有效。
