Unit 1: Psychosocial Aspects and Disability

1.1 Overview of psychosocial development; wellbeing and quality of life

1.2 Implications of hearing impairment on domains of psychosocial development

1.3 Role of family in psychosocial development of children with hearing impairment

1.4 Role of peers and community in psychosocial development of children with hearing impairment

1.5 Challenges and issues in psychosocial development of children with hearing impairment













1.1         Overview of psychosocial development; wellbeing and quality of life


A psychosocial approach to human behavior involves the relation between intrapersonal psychological and environmental aspects. Psychosocial characteristics is commonly described as an individual’s psychological development in relation to his/her social and cultural environment. “Psychosocial” means “pertaining to the influence of social factors on an individual’s mind or behavior, and to the interrelation of behavioral and social factors” (Oxford English Dictionary, 2012). 

Psychological development, the development of human beings’ cognitive, emotional, intellectual, and social capabilities and functioning over the course of a normal life span, from infancy through old age. It is the subject matter of the discipline known as developmental psychology. Child psychology was the traditional focus of research, but since the mid-20th century much has been learned about infancy and adulthood as well.

Now, let’s turn to a less controversial psychodynamic theorist, the father of developmental psychology, Erik Erikson (1902-1994). Erikson was a student of Freud’s and expanded on his theory of psychosexual development by emphasizing the importance of culture in parenting practices and motivations and adding three stages of adult development (Erikson, 1950; 1968).

Erikson believed that we are aware of what motivates us throughout life and that the ego has greater importance in guiding our actions than does the id. We make conscious choices in life, and these choices focus on meeting certain social and cultural needs rather than purely biological ones. Humans are motivated, for instance, by the need to feel that the world is a trustworthy place, that we are capable individuals, that we can make a contribution to society, and that we have lived a meaningful life. These are all psychosocial problems.

Erikson’s Psychosocial Stages of Development


Approximate Age (years)

Virtue: Developmental Task




Hope: Trust vs. Mistrust 

Trust (or mistrust) that basic needs, such as nourishment and affection, will be met



Will: Autonomy vs. Shame 

Sense of independence in many tasks develops



Purpose: Initiative vs. Guilt 

Take initiative on some activities, may develop guilt when success not met or boundaries overstepped



Competence: Industry vs. Inferiority 

Develop self-confidence in abilities when competent or sense of inferiority when not



Fidelity: Identity vs. Role Confusion 

Experiment with and develop identity and roles



Love: Intimacy vs. Isolation 

Establish intimacy and relationships with others



Care: Generativity vs. Stagnation

Contribute to society and be part of a family



Wisdom: Integrity vs. Despair 

Assess and make sense of life and meaning of contributions






Psychosocial well-being is a superordinate construct that includes emotional or psychological well-being, as well as social and collective well-being. The term “quality of life” is similar to psychosocial well-being in that it involves emotional, social and physical components. At the same time, it is often used in healthcare research to specify how the individual’s well-being may be impacted over time by a medical condition, thus muddying its conceptual clarity and specificity.

Psycho-social aspect is a most important factor of children with hearing impairment. Because Psycho-social aspect influence of most important development of children with hearing impairment. These are language, speech, literacy, education, cognitive function and that function can forward in good and quality of life. So good and quality of life is an essential factor of the children with hearing impairment. In the field of special education one of most important issue is Psychosocial aspect.

Well-being is a positive outcome that is meaningful for hearing impairment students for many sectors of society. Because it tells us that hearing impaired student perceive that their lives are going well. Good living conditions (e.g., housing, employment) are fundamental to well-being. Many indicators to measure what hearing impaired students think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life. Well-being generally includes global judgments of life satisfaction and feelings ranging from depression to joy. Another way quality of life is search for good life in a particular place or person or group.

Hearing loss has a negative impact on communication skills and, therefore, creates additional challenges. Audiologists can support successful experiences at each of Erikson’s developmental stages by working with the child and family to:

·       Ensure that a child has the opportunity to fully participate in the environment by providing access to auditory and/or visual environmental cues

·       Inform families about developmental milestones

·       Provide the tools for the child, family, and educators to develop good communication skills, including amplification, assistive devices, and instruction on creating effective listening environments

·       Encourage the development of appropriate social skills

·       Coach caregivers on creating positive and successful experiences when the child attempts new skills



1.2         Implications of hearing impairment on domains of psychosocial development


Hearing Loss Impact on Cognition

In order to integrate information and store it for future use, a person must be able to receive that information through a sensory input channel such as hearing or vision.

Babies first learn about sound by listening to the different sounds in their surroundings, such as people’s voices, music, and those coming from toys like rattles. They also learn to make sounds themselves, like cooing or crying. These aspects help with developing language along with voice and speech, which impact communication, listening to learn, and music appreciation.

Psychosocial development is just a fancy phrase that refers to how a person's individual needs (psycho) mesh with the needs or demands of society (social). Erikson's theory of psychosocial development gives us a way to view the development of a person through an entire lifespan.

But not only language development is dependent on your child’s ability to hear. Their listening skills also influence their ability to learn to both read and write and it greatly influences their social skills as well. To develop spoken language, children must be able to hear speech clearly and also to hear themselves. If your child's hearing loss is left untreated, their basic language development will often be delayed. As your child grows, they face a range of challenges during different stages of their lives, from infancy through the school years and beyond. Their hearing loss will impact their life differently in the transition from being in the security of your home to being on their own in challenging environments such as school, sports and other social activities.

The earlier hearing loss occurs in a child's life, the more serious the effects on the child's development. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact.

There are four major ways in which hearing loss affects children:

1.     It causes delay in the development of receptive and expressive communication skills (speech and language).

2.     The language deficit causes learning problems that result in reduced academic achievement.

3.     Communication difficulties often lead to social isolation and poor self-concept.

4.     It may have an impact on vocational choices.


Sentence structure


Academic achievement

Social functioning

From birth through approximately 3 years of age, Erikson postulates that children experience two distinct stages of psychosocial development. In the first stage, children learn whether they can trust their environment and if their basic needs will be consistently met (Berger, 2003). When caregivers meet children’s basic needs, children learn to trust them and their environment in general. Children with hearing loss may be at a disadvantage in this stage of development because of several factors. For example, their parents may not be able to respond consistently to their needs because they are experiencing grief over their child’s diagnosis. A child may not have access to the auditory cues that signal that a parent’s attention may be diverted (e.g., doorbell or ringing telephone) or not be aware of the auditory stimulation a parent is using to comfort the child or to show affection.

The audiologist can support psychosocial development at this stage by:

·       Working with families toward healthy acceptance of and adaptation to their child’s hearing loss so that the parents are emotionally prepared to meet their child’s needs

·       Reminding parents that children with hearing loss may perceive a situation very differently from a child with normal hearing sensitivity

·       Ensuring that the child has access—either visual or auditory—to the parents’ communication with the child and his/her environment (e.g., consistent use of amplification during waking hours, visual alerting devices for the home) and teaching parents about the characteristics of good listening environments, effective communication strategies, and appropriate attention-getting skills



1.3         Role of family in psychosocial development of children with hearing impairment


Family is the primary unit in the life of an individual. Parents are the pillars of this unit.

Berk (2008), the family styles of upbringing describes as a combination of parent’s behaviour in different life situations based on which the permanent educational climate is created in the family. He emphasises four styles of parent’s education:

·      Authoritarian – Parents want to have everything under control and do not show any signs of love, attachment or warmth, and the consequence of such behaviour is that the children cannot develop high level of pro-social behaviour, but their behaviour is filled with aggression, quarrelsome, bad temper and self-destructiveness (Vasta, Haith & Miller, 1998; Deković & Janssens, 1992)

·      Authoritative – The parents have caring, sensitive relation to the needs of the children with clear limits to the children. The result is the children’s positive image about themselves and often they acquire high academic success (Klarin, 2006; Berk, 2008)

·      Indifferent – The parents are emotionally withdrawn and distant from the children, indifferent towards children’s behaviour, not interested in children’s success. The result is neglect of the children and lack of supervision

·      Indulgent – The parents towards children have warm and caring relation, but with too much pamper so that the children of such parents often are impulsive, irritable, without self-control and spoiled. The result can often be the cause of depression and anti-social behaviour (Susskind, 2005).


Support for language acquisition and speech

The most important function which gets affected due to hearing loss is the natural language acquisition and speech. However language development is vital as it is the basis of communication. It is the most important factor in the all-round development of a child. It is the basis of most learning, not only in the formal aspects of education, but also in the development of character, emotional state and social relationship of the children. The questions are ‘who should develop language and how it should be taught to the children’.

Parents of a hearing impaired child may therefore interact and talk to him as naturally as they would do with hearing children. They should remember

Throughout the day there are plenty of ideal moments to give a hearing impaired child an opportunity to acquire language, these are: getting up, washing, bathing, dressing, undressing, cooking time, meal time, going out to the market garden or zoo, visiting friends, playing, going to bed etc.. These are the times when the phrases used have real meaning and so the parents could help develop vocabulary, meaningful language structures and communication skills in the hearing impaired child.

Toys and books are the most interesting things which would help parents to initiate conversation and also to provide language to the gestures the child uses while playing and browsing through the books.

Other enabling actions

While these activities are continuously going around at home parents should pay sufficient attention to the following:


Parents and family need to fulfill certain responsibilities in order to function. A family must generate income, protect and maintain its members and home, nurture and love one another and see to it that children are taught social norms and educated. When a child is handicapped, these responsibilities become more crucial. There is the expense, the time, the energy needed to care for the disabled member and his/her safety. Besides this there is the difficulty of helping the disabled member develop a good self-image and social skills, and the problems of seeing to it that the disabled member receives an appropriate education. Every ordinary task becomes more difficult and more stressful.


When you bring your child home for the first time, your family will become their social group. Parents are the first teachers for children.

What your child learns through the interactions between you and them is what they will carry for the rest of their life in regards to how to treat others. Through this socialization with family, your child will learn how to trustseek friendships from others, and find comfort with others as well.

Generally, we have to learn how to make and sustain relationships. These skills are started and strengthened with the family. Additionally, giving your child the tools for interpersonal development before they learn the skills of technology is vital. These skills can ultimately help your child avoid some of the common effects of technology on children.

Learning how to have face-to-face interactions is critical in a child’s development. Face-to-face interactions require immediate responses, facial expressions, cues, certain tones of voice, and much more that we do not receive through texting or other online message systems. This is exactly what your child is looking to you and their family to learn.


We generally understand values to mean an understanding between what is right and what is wrong. As a society, we have norms and values, and these function in conjunction with personal values and norms.

One way to see what a society values is to look at whom a society respects. Usually, people show more respect to people and to things that they value highly. Whenever you treat people with disrespect, your child will certainly notice. Children are sponges that soak up everything around them, and many times we forget that they are watching us.

However, as a whole, many of us agree and desire to share with our children values of respect, compassion, fairness, and responsibility to name a few.

A good way to teach your child values is to discuss with them the importance of healthy and unhealthy values. Even when your child is little, giving them some responsibilities, such as cleaning the table or helping to cheer up a friend or sibling when they’re sick, will begin to teach them the importance of these values. Additionally, explaining the importance of values will help your child understand consequences.


Once your child is born, they start learning motor skills, language skills, cognitive skills, and emotional skills.

Regarding motor skills, it is largely the family’s responsibility for teaching these skills. Even if your child is in daycare, the work that parents put in at home to teach these skills is much more effective than in the few hours your child is under someone else’s care. Your child will learn how to sit up, walk, run, climb, hold a spoon, and so on. These seem so natural to us as adults, but they are skills that have to be fine-tuned at a very young age, and they also reinforce your child’s independence which is essential for their development.


Your child gets their primary sense of security from their family. They rely on you to make sure their basic needs, such as shelter, food, and clothing, are met.

More than that, there is emotional security at home that your child will not find in any other place. Once your child goes to school, they will learn more of public and social skills. But, when they are at home is when your child really learns how to be themselves and express themselves fully. Creating a safe, open home environment is vital so that they can grow.

As a parent, giving your child consistency and structure helps them to develop feelings of security. This can be achieved through schedules. Your child will know that everyday around a certain time, they will eat, bathe, sleep, etc. Therefore, with a schedule, your child will be able to feel comfort knowing their needs will be met.


How to help your child learn to talk

"That is a dog... It says, Bow-Bow". He will enjoy watching your facial expression and hearing your voice as you imitate the sound.

Ask the child "What does the dog say?"

"He may try to answer by saying ‘bu-bu’ or-------. Encourage this vocalization by imitating it and repeating the imitations." (A smile, touch or caress will encourage him to imitate once more)

Similarly you can show him a cow, a cat or a crow and tell him to imitate that particular animal’s cries and action…. e.g.

A cow says: amma….

A cat says: Meow… meow….

A crow says: Kaa…. Kaa..

Most children enjoy playing this miming game and it also helps to bring their attention to your face & an opportunity to listen to your voice.

More than anything, remember that he is your child and like any other child needs your love and affection.

With the above in view parents of the disabled take on multiple roles, which are not separate and distinct from one another, nor do they fall into distinct chronological periods. Rather, they often overlap and share common elements.

Parents as Implementers of Professional Advice

A widely held assumption during 1970s was that parents should conscientiously implement decisions made by the professionals. If a child was not making satisfactory progress in the special education program, it was often assumed that the parents were not assuming their responsibility for implementing the program at home. The "myth of professional omnipotence" or the assumption that professionals, by virtue of their specialized training and technical expertise, have the ability to make wise decisions about other people's lives has slowly disintegrated. The recent age therapists and educators have accepted the potential of parents. Parents are now active partners in not only implementing of professional advice but also plan out and carry out the same at home.

Parents as Service Providers

Parents' groups serve as a mechanism through which parents give each other mutual support and share information. Parents' initiated and supported efforts often at great personal expense has won the legal right to free and appropriate public education in the least restrictive environment, better conditions in residential facilities and integrated vocational, residential and recreational services in the community, provisions for better financial security.

Parents as Teachers

As mentioned earlier since 1970s a great emphasis has been placed on the role of parents as teachers and members of the multidisciplinary team. Here parents are provided training to make them more resourceful and for better involvement.

Parents as Political Advocates

The development of parents' organisations evolved from small, local support groups of parents to national professional organisations. The primary function of many parent organisations has changed from providing direct services to advocating for political, legal, economic and social change.

Parents as Family Members

Professionals are becoming more aware of the necessity to consider the needs and roles played by all members of the family with a child with disabilities. It has been recognized that family has a value in developing and implementing programs for the disabled member. It is also realized that family members have much to offer professionals. They often have unique insights gleaned from their day-to-day experiences living with the member with disability.


Throughout history and across culture the family has been the primary agency for survival. Although the forms of families vary, the tasks are universal. Parents or parent surrogates cross all cultures assured the responsibility for transmitting to their offspring their competencies required by the social, economic and political forces of their society or social group. The family constitutes the parents but also the siblings, grandparents, uncles and aunts and other extended family. Hence, the major responsibilities of families can be listed as follows

1.     The economic responsibilities to generate income and provide financial support for living costs and related payments.

2.     The domestic and health care responsibility, to meet the daily needs of food, clothes, health and medical care and safety.

3.     The recreational responsibility to provide leisure environment and activities.

4.     The responsibility for self-identity to increase each family member's sense of belonging.

5.     The affectionate responsibility to show and share love, care, emotional feelings and companionship.

6.     The responsibility for socialization to develop social skills and enhance interpersonal relationships.

7.     The educational and vocational responsibility to assist and support schooling and career & selection and preparation.


1.4         Role of peers and community in psychosocial development of children with hearing impairment


Any young children building relationships with peers it is at the core of development. Because with the help of building relationships in young children can get acquire skills, knowledge and interacting with another peers. That is why Peer interaction is the social exchange of some duration between/among individuals, which refers to dynamic behaviors of the participants' actions and the sections are communication (non-linguistic and linguistic), behaviour (positive and negative) and lastly social play with peers. So positive peer interactions and relationships in early childhood play a vital role child with hearing impairment. Because interactions can make on the quality of life, verbal relationships, social adjustment and successful emotion regulation in the future. That is why role of peer to children with hearing impairment it is the ability to interact effectively communication which help for cognitive development and school success about the children with hearing impairment.

Language and Speech Ability

Children with hearing impairment often have some degree of language and/or speech delay, which is a major factor affecting their interaction with hearing peers. Its noted that children with hearing impairment in great delay normal language and speech development and that delay created in great barriers for them in establishing and sustaining social relationships. Children with hearing impairment have into high, medium and low language ability at the level of hearing loss and most of the severe/profound hearing loss cannot communicated by the speech in our hearing world so he/she withdrawing from interaction with peer of linguistic ability thereby they had limited opportunities to practice interaction skills and adapted to sign language.

Social Cognition

Human is a talkative animal and language is conveying the idea about one end to another. So language and speech impairment is associated with deficits in social cognition or emotional competence that might undermine social interaction. It could be sensibly incidental that children with hearing impairment generally have poorer language and speech ability than hearing children, their opportunities in interaction with others are not sufficient to learn and practice social skills. So children with hearing impairment had deficits in social cognition and emotional competence thus resulting in less success in their interaction with peers.

Peers' Hearing Status

In our hearing sense is special sense and that sense we acquire in naturally. It is called knowledge of sense about sound. But problem is who cannot perceive the sound in naturally that's call hearing problem. So hearing status means both children with and without hearing impairment. But it has been noted that most of the hearing impaired children interact about those who are hearing impairment or who use in sign language and hearing children interact only hearing peers. So role of peer about hearing impairment it should be both a higher quantity and quality of social interaction and it is feasible that children with hearing impairment prefer to interact with peers who are normal peer and also additionally, they use different interaction strategies based on oral/verbal communication. For example, deaf children use more visual and less object-based strategies when interacting with deaf playmates but when normal peers they used object-based and language orient interacting with hearing playmates.

Peers' Familiarity

Peers' familiarity plays a great role in interaction between children with hearing impairment and hearing peers. In pre-school level deaf children in dyadic (two-way communication) play with familiar and unfamiliar peers and deaf children had more successful initiations with familiar than with unfamiliar hearing partners. Interestingly, hearing children used more visual communication with a familiar deaf peer than an unfamiliar deaf child. Apparently, hearing children and children with hearing impairment who are familiar with one another may find non-linguistic means of communication to partially overcome language and mode-ofcommunication barriers. This is a positive effect of peer familiarity could be seen in the co-enrollment program, which was beneficial for social interactions between children with hearing impairment with hearing peers and that manifest to contribute children with hearing impairment to become more and more familiar with their hearing peers through participating together in all classroom activities, thus enhancing peer interaction between them.

The peers groups are defined as social groups that are made of people with similar age, education or social status and which are primarily consisted of persons that share similar or same status and mostly they are almost the same age. (Lackovi –Grgin, 2006). Based on the researches of peers groups many scientists (Meada, Freud, Erikson, Piaget J), imply to important the peer influence on the social development (Ladd, 1999). The researches of the peer groups show how peer game has very important role in the socialisation (Cowen 1973 & Roff and Sell, 1967), but also that bad peer relation in the childhood results to later social unacceptable behaviours. Bukowski and Hoze (1989) develop a model of the peer relations through two basic dimensions of social functioning of persons that are in a way a mirror of children’s social competences: popularity and friendship. The popularity represents a perception of the person from the environment with high stage of acceptance, and the friendship as a two-way relation between two people filled with warmth and trust. With the friendship, a person satisfies the need for belonging through acceptance or desirability in the group, as well as the need for closeness that satisfies through friendly relations (Asher, 1996). In the literature, we can find several divisions of acceptance/rejection of children considering stage of preferences, and Coie (1984, according to Klarin, 2006) differ: popular, rejected, neglected, controversy and average child. Categories of rejected, isolated and neglected child belong to the category of unpopular children. The unpopular children are often more hyperactive, aggressive, egoistic and focused on themselves, overestimate their capabilities, neglecting the needs of others, lonely, shy, and rejection often appears as an important predictor of satisfaction with school, social self-respect, school achievements and perception of social support (Klarin, 2006). The pedagogy, all aforementioned connotations and labelling of children, does not accept. It considers them more as SOS signals of the children that cry for help, care and concern, but also for love, and an opportunity for an educational action. The category of the popular child and the child “a star” belong to the category of the popular children that are characterised with friendliness, communicativeness, sense of humour, high self-respect and cheerful mood. Simel, Špoljarić & Buljubašić-Kuzmanić (2010) allege that popular children more often have close friend then the children that are not popular because they have more opportunities to make friendships. In addition, they allege that there is at least partial connection between popularity and friendship apropos how a weak peer acceptance does not necessarily result inadequate friendships. All mentioned speaks in favour of importance of peer groups, and especially in the age of middle childhood when the first friendship starts. In this period, the children are ready for cooperation and agreement, the friendship is observed as the relation of tolerance, trust and cooperation, and intimacy between the friends becomes an important feature of friendly relations.

Community role in psychosocial development of children with hearing impairment is very important factor about learn language and communication skills. At first it is most important factor in children with hearing impairment is that how to learn language and how develop communication skills with other and it is challenging for children at early age and he/she to trouble and they go to specialist services. But role of community in psychosocial development of children with hearing impairment may be delivered as part a Community Based Rehabilitation (CBR) programme. In this sense community based support takes the services to the family in their community or home and community provide in proper rehabilitation which is ensure that specific support to deaf learner and develop of psychosocial aspect because deaf children have the right to be included in their community and to be supported to develop communication and language skills and specialist staff help the hearing impairment child in his/her particular impairments aspect.

No Discrimination

Discrimination can mean that deaf children and young deaf people are often cut off from traditional support structures within communities. Sometimes families are excluded because of their deaf child. So no discrimination and community help to raise awareness of deaf children's rights and provide the opportunities as peer the general normal hearing children.


Training and support is not always easily available also training and support service cannot easily available those who are living in rural areas. It can be very difficult to find time and resources to travel to areas where training is available. So community will arrange the programme and it can make it easier available for parents to attend training or support about the resources. The community role in balancing are:

·      Provide in basic need in psychosocial development.

·      Arrange for meeting do to support in the families.

·      Mapping daily activities, the geography of the area and location of services.

Range of Support

·      Give information in carry available in hearing aids, health services, groups and associations, schools and self-help activities.

·      Training and ideas on developing communication and language skills in the early years and managing behaviour and teaching children basic skills for independence.

·      Support in decision-making about education and plans for the future and finding employment or getting involved in other self-help activities.

·      Opportunities to meet parents and deaf people who have a range of different experiences.

·      Information about children's rights and how to keep children safe from neglect, and abuse.


·      Learning sign language including total communication and helps to decrease communication barriers between children and their families as well as outer side of the home.

·      Learning to communicate has a positive impact on children's behaviour.

·      Parents need much more than information - they need practical demonstrations, advice and teaching.

·      Resources for teaching communication and language are essential tools for psychosocial development of children with hearing impairment.

·      Families are more likely to understand the value of educating their deaf child when they are able to communicate well with their children and community support them.

Lessons Learnt

Community should prepare training programme and give the training to parent which help for deaf children.

·      Trainers can make home visits.

·      Teaching from experience, using real examples, can help others understand.

·      Parents can learn a lot from sharing experience in groups.

·      Training in small local groups helps avoid the need to travel long distances.

·      Trainers can work with regular schools to give deaf children in those school's access to sign language/ total communication and parents, teachers, head teachers, and local authorities should work together as a team.

·      Trainers need to be prepared to challenge negative attitudes, such as "deaf children unable to communicate", or that "cutting underneath the tongue enables children to talk".

·      Trainers should build up a plan (I.E.P.) of activities and good teaching materials.

Partnership Working in Parents& Community

Both parents and community work together for psychosocial development in deaf child. These are

·      Received hands-on experience in working with parents and children.

·      Gained an understanding of how parents felt and what their priorities were.

·      Learned to have empathy when they talked to parents

·      Improved their skills and confidence

·      To move from teaching speech sounds to teaching the language.

·      Realized that it is possible to teach a child without a hearing aid

·      Realised the need for visual learning aids and learned to make them



1.5         Challenges and issues in psychosocial development of children with hearing impairment


Hearing sounds and words helps children learn to talk and understand. A child with hearing loss misses out on these sounds. This can cause problems with speaking, reading, school success, and social skills. It is important to have your child tested if you think they have trouble hearing.

Common difficulties often (but not always) experienced by the child with a hearing impairment

·       Language delay/disorder

·       Speech delay/disorder

·       Sensory processing

·       Attention and listening difficulties

·       Behavioural difficulties

·       Gross motor difficulties due to middle ear dysfunction affecting balance.

·       Difficulties with reading and spelling.

Hearing is an important aspect to speech and language development, communication, and learning. Due to hearing loss or auditory processing problems it should be listening difficulties and that's effect in child's development. There are four challenges which affect hearing loss children. These are:

1. Delay in the development of receptive and expressive communication skills (speech and language).

2. Due to deficit of language hearing impaired Lerner can face learning problems that result in reduced academic achievement and difficulties in verbal communication.

3. Due to verbal communication difficulties often lead to social isolation and poor self-concept.

4. Due to lack of self-concept it may have an impact on vocational choices and cannot access proper vocational.

Challenges in psychosocial development of children with hearing impairment

·       Following instructions within the home, kindergarten or school environment.

·       Vocabulary whereby a child cannot clearly get their message across due to limited word knowledge.

·       Learning to talk, speech intelligibility and clarity.

·       Self esteem and confidence when they realise their skills do not match their peers.

·       Bullying when others become more aware of the child’s difficulties.

·       Self regulation and behaviour as the child is unable to regulate themselves appropriately to settle and attend to a task for extended periods of time.

·       Accessing the curriculum because they are unable to attend to tasks long enough to complete assessment criteria.

·       Anxiety and stress in a variety of situations leading to difficulty reaching their academic potential.

·       Academic performance: Developing literacy skills such as reading and writing and coping in the academic environment.

·       Academic assessment: Completing tests, exams and academic tasks in higher education.

More specific implications of not seeking treatment will be influenced by the common difficulties that are most influencing your individual child.

With the introduction of inclusive society, children with hearing impairment are placed in general schools with normal children and it promotes to our oral/verbal community. So the role of parents, peers and community is a most important factor in psychosocial development of children with hearing impairment.