European Child & Adolescent Psychiatry

, Volume 23, Issue 4, pp 187–196 | Cite as

Behavioral problems in school-aged hearing-impaired children: the influence of sociodemographic, linguistic, and medical factors

  • Stephanie C. P. M. TheunissenEmail author
  • Carolien Rieffe
  • Maartje Kouwenberg
  • Leo J. I. De Raeve
  • Wim Soede
  • Jeroen J. Briaire
  • Johan H. M. Frijns
Original Contribution


The purpose of this study was to examine several behavioral problems in school-aged hearing-impaired children with hearing aids or cochlear implants, compared to normally hearing children. Additionally, we wanted to investigate which sociodemographic, linguistic, and medical factors contributed to the level of behavioral problems, to pinpoint where targeted interventions can take place. This large, retrospective study included a sample of 261 school-aged children (mean age = 11.8 years, SD = 1.6), that consisted of three age- and gender-matched subgroups: 75 with hearing aids, 57 with cochlear implants, and 129 normally hearing controls. Self- and parent-reports concerning reactive and proactive aggression, delinquency, and symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder were used. In addition, several language and intelligence tests were administered. Hearing-impaired children showed significantly more proactive aggression, symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder than their normally hearing peers. More behavioral problems were associated with special schools for the deaf, sign (-supported) language, hearing aids (in contrast to cochlear implants), higher age, male gender, lower socioeconomic status, lower intelligence, and delayed language development. Hearing-impaired children face multiple problems regarding their behavior. The outcomes implicate that professionals should be aware of the higher risk of developing behavioral problems, in order to screen, detect, and treat in time. Furthermore, the associated risk and protective factors emphasize that clinicians must always consider the heterogeneity of the group of hearing-impaired children, in order to help and support the individual patient.


Behavioral problems Children Cochlear implant Hearing impairment 



We thank all children and their parents for their participation in this study. This research was supported by the Innovational Research Incentives Scheme (a VIDI grant) by The Netherlands Organisation for Scientific Research (NWO), no. 452-07-004 to Carolien Rieffe.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Stephanie C. P. M. Theunissen
    • 1
    Email author
  • Carolien Rieffe
    • 2
    • 3
  • Maartje Kouwenberg
    • 2
  • Leo J. I. De Raeve
    • 4
  • Wim Soede
    • 1
  • Jeroen J. Briaire
    • 1
  • Johan H. M. Frijns
    • 1
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryLeiden University Medical CenterLeidenThe Netherlands
  2. 2.Department of Developmental PsychologyLeiden UniversityLeidenThe Netherlands
  3. 3.Dutch Foundation for the Deaf and Hard of Hearing ChildAmsterdamThe Netherlands
  4. 4.KIDS, Royal Institute for the DeafHasseltBelgium

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