title: Reading the signs: impact of signed versus written questionnaires on the prevalence of psychopathology among deaf adolescents.
abstract: OBJECTIVE
  There are no empirically validated measures of psychopathology that can be easily understood by signing deaf children and little reliable data on the prevalence of psychiatric disturbance in this population. The aim was to meet this need by developing an Australian Sign Language (Auslan) version of a widely used measure (the Youth Self-Report; YSR) which could be administered in an interactive CD-ROM format, to assess its reliability, and to compare the prevalence of clinically significant psychopathology in deaf adolescents when using the Auslan questionnaire versus the standard written version. This would also allow examining the validity of written questionnaires in this population.
  
  
  METHODS
  Twenty-nine male and 25 female adolescents with severe or profound hearing loss from public and private schools in the Australian States of Tasmania (n = 11) and New South Wales (n = 43) agreed to participate and completed the written and the interactive Auslan versions of the YSR. Parallel forms were completed by parents (Child Behaviour Checklist) and teachers (Teacher's Report Form).
  
  
  RESULTS
  The Auslan version showed comparable reliability to that reported for the standard YSR: internal consistency (alpha) ranging from 0.77 to 0.97 and test-retest agreement (r) from 0.49 to 0.78. The interactive Auslan version yielded a prevalence of clinically significant emotional and behavioural problems in deaf adolescents of 42.6% compared with 21.4% when using the standard English version. Prevalence for the wider Australian adolescent population (18.9%) was similar to that obtained among deaf adolescents when using the standard YSR (21.4%). However, it was higher among deaf adolescents (42.6%) when using the Auslan version (OR = 3.2, 95% CI = 1.83-5.58). According to the Auslan version, the syndromes Withdrawn/Depressed (OR = 6.5, 95% CI = 2.96-14.25), Somatic Complaints (OR = 4.8, 95% CI = 2.53-9.22), Social Problems (OR = 8.3, 95% CI = 4.16-16.47) and Thought Problems (OR = 5.7, 95% CI = 2.50-12.80) were much more prevalent among deaf adolescents than in the wider adolescent population, while Attention Problems (OR = 1.1, 95% CI = 0.39-3.17) and Rule-Breaking Behaviour (OR = 1.5, 95% CI = 0.73-3.17) were not.
  
  
  CONCLUSIONS
  An interactive Auslan version of the YSR is reliable, better accepted and yields higher rates of disturbance than the standard written questionnaire. Clinicians should be aware that using written instruments to assess psychopathology in deaf adolescents may produce invalid results or may underestimate the level of disturbance, particularly emotional problems.
authors.affiliation: Child and Adolescent Mental Health Service (CAMHS), Alder Hey Hospital, Royal Liverpool Children's NHS Trust, c/o St. Theresa's Catholic Junior School, Utting Avenue East, Liverpool L11 1DD, UK. andrew.cornes@liverpool.gov.uk
authors.forename: Andy
authors.initials: A
authors.lastname: Cornes
authors.forename: Meg J
authors.initials: MJ
authors.lastname: Rohan
authors.forename: Jemina
authors.initials: J
authors.lastname: Napier
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Rey
mesh_terms: D000293:Adolescent; D016251:CD-ROM; D002648:Child; D003430:Cross-Sectional Studies; D003638:Deafness / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D009517:New South Wales; D010552:Personality Assessment / Q000706:statistics & numerical data; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D011932:Reading; D015203:Reproducibility of Results; D012813:Sign Language; D011795:Surveys and Questionnaires; D013577:Syndrome; D013648:Tasmania; D014743:Videotape Recording