Considerations in Adapting Therapy with Children who are Deaf/Hard of Hearing



Mainstream clinicians who provide trauma-focused therapy with deaf and hard of hearing children should keep in mind that the variation in social-emotional development among deaf children overall is greater than the differences between this group and the hearing population. Thus, a good rule-of-thumb is to be aware of the possible ways that deaf and hard of hearing children may differ from hearing children, while keeping in mind that these differences may or may not be present in every deaf child. The reported differences outlined above suggest that a clinician working with a deaf child may need to consider adapting his/her approach based on an assessment of the client’s level of social-emotional development. Many mainstream clinicians are experienced in working with developmental delays in hearing children from impoverished backgrounds. Similarly, clinicians may want to take into account a deaf child’s opportunities (or lack of opportunities) for acquiring skills such as self-control, emotional awareness, and interpersonal problem solving. Consultation with a specialized therapist familiar with deaf and hard of hearing children may also be useful in identifying and addressing social-emotional developmental differences. Assessing the individual deaf child’s social-emotional functioning will help identify his or her unique strengths and needs as they relate to age-appropriate expectations. A list of core social-emotional competencies, which could be useful in conducting an assessment. It includes the following:



- identifying and labeling feelings,

- expressing feelings,

- assessing the intensity of feelings,

- managing feelings, and

- delaying gratification.



- using self-talk—conducting an "inner dialogue" as a way to cope with a topic or challenge or reinforce one's own behavior;

- reading and interpreting social cues—for example, recognizing social influences on behavior and seeing oneself in the perspective of the larger community;

- using steps for problem solving and decision making—for instance, controlling impulses, setting goals, identifying alternative actions, and anticipating consequences;

- understanding the perspectives of others;

- understanding behavioral norms (what is and is not acceptable behavior);

- having a positive attitude toward life; and

- developing self-awareness—for example, developing realistic expectations about oneself



- using nonverbal skills—communicating through eye contact, facial expressiveness, tone of voice, gestures, etc.; and

- using verbal skills—making clear requests, responding effectively to criticism, resisting negative influences, listening to others, helping others, and participating in positive peer groups.



Adapting Cognitive Behavioral Techniques


Mainstream therapists working with deaf and hard of hearing children should take into account the following considerations in adapting trauma-informed treatment:


- Assess the child’s affective and general vocabulary, regardless of age. How developed is the child’s sign language skills/linguistic competence? Consider that he/she may be unable to recognize the written English or finger spelled word for a specific emotion, but that he/she may know the ASL sign for the emotion.

- Be aware that, in assessing a deaf child’s affect, facial expression and body language are very important. Both are elements used in sign language just as intonation is used in spoken language to convey emotion. When explaining something in sign language, the child’s affect may reflect his or her emotions at the time of the event, not the current emotional state. The therapist should also be aware of his or her own facial expression and body language and what it conveys to the deaf child.

- Use role-play in conjunction with pictures and drawings to teach various emotions relevant to the child’s age. Dolls can be used to role play with younger children.

- Differentiate emotional “feeling” from physical “feeling” using the “Color my Life” technique. Visual techniques and artwork can be helpful in explaining the relationships between situations, thoughts, and feelings.

- Use words and behavioral descriptions that children can understand to describe concepts of cognitions. With younger children, the concept of cognitions can be visually represented by drawing cartoon-like figures representing various types of thoughts in a “thought balloon” above the figure’s head.

- Use balloons to teach visualization. The therapist can have the interpreter interpret guided imagery instructions while the child watches and follows along.

- Adapt written exercises to the child’s reading and writing ability when necessary. Pictures and drawings can be substituted for the written material.

- Use metaphors like cooked vs. uncooked spaghetti to help the child understand relaxation vs. tension in the body.

- Include learning the correct vocabulary for sexual anatomy and sexual terms, as well as identifying trusted people the child can talk to about abuse for safety-skills training.


National Child Traumatic Stress Network (2006). White paper on addressing the trauma treatment needs of children who are deaf or hard of  hearing and the hearing children of deaf parents. Los Angeles, Calif., and Durham, NC: National Child Traumatic Stress Network, 2006,