title: Psychopathology and its risk and protective factors in hearing-impaired children and adolescents: a systematic review.
abstract: OBJECTIVE
  Pediatric hearing impairment is a chronic handicap that can potentially lead to the development of psychopathology. Yet, for hearing-impaired children and adolescents, the exact occurrence of various forms of psychopathology and its causes are unclear, while this knowledge is essential to enable targeted screenings and interventions.
  
  
  OBJECTIVE
  To investigate the level of psychopathological symptoms in hearing-impaired children and adolescents as compared with normally hearing peers. Second, the influence of type of hearing device and possible risk and protective factors on psychopathology were examined.
  
  
  METHODS
  A systematic literature search was performed covering relevant databases, including PubMed, Embase, and Web of Science. Two independent researchers identified the relevant articles. The final search was performed on May 2, 2013, and resulted in a total of 35 articles.
  
  
  RESULTS
  Literature consistently demonstrated that hearing-impaired children and adolescents were more prone to developing depression, aggression, oppositional defiant disorder, conduct disorder, and psychopathy than their normally hearing peers. Levels of anxiety, somatization, and delinquency were elevated in some, but not all, hearing-impaired participants, for reasons related to sex, age, and type of school. Divergent results were obtained for the level of attention-deficit/hyperactivity disorder and the influence of type of hearing device on psychopathology. Possible risk and protective factors were identified, including age at detection and intervention of hearing loss, additional disabilities, communication skills, intelligence, type of school, and number of siblings.
  
  
  CONCLUSIONS
  Literature on psychopathology in hearing-impaired children and adolescents is scarce and sometimes inconsistent. To define a more precise occurrence of psychopathology, more studies are needed. These studies should have a longitudinal design to draw firmer conclusions on causality. Hopefully, this will lead to more knowledge in the future to help and support each hearing-impaired individual.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Stephanie C P M
authors.initials: SC
authors.lastname: Theunissen
authors.affiliation: Department of Developmental Psychology, Leiden University, Leiden, the Netherlands3Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, the Netherlands.
authors.forename: Carolien
authors.initials: C
authors.lastname: Rieffe
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Anouk P
authors.initials: AP
authors.lastname: Netten
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Briaire
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Soede
authors.affiliation: Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jan W
authors.initials: JW
authors.lastname: Schoones
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands5Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
authors.forename: Johan H M
authors.initials: JH
authors.lastname: Frijns
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006310:Hearing Aids / Q000523:psychology*; D006312:Hearing Loss, Bilateral / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D010372:Pediatrics; D011599:Psychopathology; D012307:Risk Factors