Effect of Hearing Loss on Peer Victimization in School-Age Children

Abstract

Nearly one third of school-age children report being bullied, primarily enduring teasing or rumors. Children with hearing loss (HL) are at increased risk of victimization due to being “different” from the general population. This project assesses effects of auditory status on bullying by comparing incidence and type of bullying in 87 youth and adolescents with HL (7–18 years) to published national data from peers in the general population. All participants wore auditory technology (i.e., hearing aids or cochlear implants), communicated orally, and participated in mainstream education. Each participant completed the 2009 National Crime Victimization Survey’s School Crime Supplement. Adolescents with HL endured significantly higher incidence of bullying versus the general population (50.0% vs. 28.0%), particularly for exclusion (26.3% vs. 4.7%) and coercion (17.5% vs. 3.6%). Children younger than 12 years with HL report lower rates of bullying (38.7%) than adolescents with HL, but rates did not differ significantly. Future research should explore risk and protective factors for peer victimization in youth and adolescents with HL to reduce long-term consequences on quality of life.

The Centers for Disease Control and Prevention define bullying as unwanted aggressive behavior(s) by another youth or group of youth that involves an observed or perceived power imbalance and is repeated or likely to be repeated multiple times (Gladden, Vivolo-Kantor, Hamburger, & Lumpkin, 2014). In 2016, the U.S. Department of Education estimates 21.5% of school-age children (12–18 years) experience traditional peer victimization, but rates across studies span from 8% to over 70% (DeVoe & Murphy, 2011; Modecki, Minchin, Harbaugh, Guerra, & Runions, 2014; Zhang, Musu-Gillette, & Oudekerk, 2016). The range in prevalence estimates may reflect differences based on demographic factors, study focus, and researcher definitions (Casper, Meter, & Card, 2015). A recent meta-analysis of 80 studies by Modecki et al. (2014) reports a sample-size-weighted mean of 36% for traditional victimization self-reported by 12- to 18-year-olds. Several factors are associated with increased victimization rates. For example, children with health issues and disabilities endure higher rates of bullying (Griffith, Wolke, Page, Horwood, & ALSPAC Study Team, 2005; Rose, Monda-Amaya, & Espelage, 2011; Swearer, Wang, Maag, Siebecker, & Frerichs, 2012; Van Cleave & Davis, 2006). Thus, children with hearing loss (HL) have increased risk of being bullied, but few researchers have explored victimization in this population. This study fills that gap by examining the prevalence and type of bullying experienced by children and adolescents with HL using auditory technology (e.g., hearing aids or cochlear implants) versus peers in the general population.

Peer Victimization in Adolescents in the General Population

Approximately one third of school-age children and adolescents experience bullying (DeVoe & Murphy, 2011; Modecki et al., 2014). The most common types of bullying in the general student population include being teased (e.g., being made fun of, called names, or insulted; 19%), having rumors spread about oneself (17%), and enduring physical harm (e.g., being pushed, shoved, tripped, or spit on; 9%) (DeVoe & Murphy, 2011). DeVoe and Murphy (2011) define four other possible types of peer victimization: being threatened with harm, being forced to do something one does not want to do, purposeful exclusion from activities, and property destruction.

The seven types of traditional peer victimization defined by DeVoe and Murphy (2011) can merge into four basic categories: (a) physical victimization, which includes physical harm; (b) verbal victimization, which involves name-calling and teasing in a hurtful way, threatening with harm, and coercion; (c) indirect bullying, which aims to damage relationships through relational, reputational, or psychological means, such as social exclusion and spreading rumors; and (d) damage to property, which refers to defacing or damaging personal property (Olweus, 2007).

Several variables contribute to the likelihood of peer victimization. The social ecological model (Hong & Espelage, 2012) frames these variables based on the six system levels of Bronfenbrenner’s (1979) ecological theory. The six levels affecting bullying experiences include (a) youth characteristics, including but not limited to sociodemographic variables, mental health status, and learning or developmental disabilities; (b) microsystem, an interrelationship between an individual and groups within immediate settings, such as the home or school; (c) mesosystem, the interrelations between two microsystems; (d) exosystem, the environment beyond an individual, such as exposure to media violence or neighborhood effects; (e) macrosystem, social and ideological influences (e.g., cultural or religious norms); and (f) chronosystem, change or stability in systems over the lifespan. This article focuses on youth characteristics, particularly, sociodemographic variables, communication and social competence, and presence of disabilities associated with victimization in children and adolescents.

Sociodemographic characteristics, such as age and gender, affect rate and type of bullying. Rates of victimization in middle school exceed those in high school (Espelage & Horne, 2008; Nansel et al., 2001). Types of bullying often differ by gender, but overall, males tend to experience higher rates of peer victimization (Nansel et al., 2001; Peguero, 2008; Salmon, James, Cassidy, & Javaloyes, 2000). Boys typically endure direct or physical bullying (Espelage, Hong, Rao, & Thornberg, 2015; Nansel et al., 2001). Multiple studies report girls more commonly experience indirect bullying, but a meta-analysis suggests trivial gender differences in indirect victimization rates (Card, Stucky, Sawalani, & Little, 2008). Verbal bullying does not differ by gender (Bevans, Bradshaw, & Waasdorp, 2013; Brito & Oliveira, 2013).

Social competence also affects rate of victimization. Children with inadequate social skills, apparent in having fewer friends, more peer problems, or poor peer relationships, report peer victimization more than those with larger support systems (Nansel et al., 2001; Wiener & Mak, 2009). Participation in activities, especially interscholastic sports, decreases the likelihood of bullying, but this protection does not extend to academic clubs or intramural sports (Peguero, 2008).

Children perceived as weak or different also tend to be bullied more often (Tresh, 2004). Children can diverge from the mainstream via cognitive, developmental, emotional, physical, motor, or sensory differences. Children with special needs experience peer victimization 2 to 3 times more frequently than the general population, and the rate of bullying increases for those with observable disabilities (e.g., cerebral palsy, blindness, HL that includes wearing auditory technology or using sign language) and chronic conditions (Bourke & Burgman, 2010; Carter & Spencer, 2006; Dawkins, 1996; Rose, Espelage, Monda-Amaya, Shogren, & Aragon, 2015; Swearer et al., 2012; Van Cleave & Davis, 2006). For instance, children and adolescents with visible external differences report higher rates of victimization occurring at least once (50% vs. 21%) or regularly (30% vs. 13%) relative to a group without visible medical conditions (Dawkins, 1996).

Children with disabilities differ in not only rate, but also type, of peer victimization. Children with and without disabilities both endure teasing, but teasing children with special needs often focuses on the disability itself (Bourke & Burgman, 2010; Dawkins, 1996). Such disability-based bullying not only constitutes a personal violation but also may represent a federal civil rights violation (Yell, Katsiyannis, Rose, & Houchins, 2016). Children with special needs often experience verbal and indirect bullying (i.e., teasing, exclusion), possibly due to poorer communication and social skills relative to peers without special needs (Carter & Spencer, 2006; Dawkins, 1996). Additionally, children with disabilities frequently are less popular, have fewer friends, and struggle with loneliness, factors associated with higher rates of bullying in the general population (Carter & Spencer, 2006; Dawkins, 1996; Sullivan, 2006).

Peer Victimization in Youth and Adolescents With HL

Youth and adolescents with HL may have unique experiences with peer victimization versus a general group of children with special needs. First, visibility of hearing aids and cochlear implants marks a physical difference from hearing age-mates, and children with observable disabilities have higher rates of getting bullied (Carter & Spencer, 2006; Swearer et al., 2012). Second, communication difficulties hinder peer interactions. Children with HL may not hear a peer speaking, particularly in noisy situations, such as a classroom or cafeteria. Children with HL may acquire vocabulary akin to hearing peers but miss subtler aspects of language, such as puns, humor, and sarcasm (Nicholas & Geers, 2003; O’Reilly, Peterson, & Wellman, 2014), and language deficits increase the rate of peer victimization (e.g., Knox & Conti-Ramsden, 2007). Third, immature social skills, such as unequal turn taking or discomfort entering a social conversation, occur more often in children with HL versus hearing peers (Kouwenberg, Rieffe, Theunissen, & de Rooij, 2012; Nicholas & Geers, 2003; Punch & Hyde, 2011).

Children with HL report more peer problems than hearing peers (e.g., more difficulty making and maintaining friendships, lower acceptance or popularity; Brown & Cornes, 2015; Huber et al., 2015; Kouwenberg et al., 2012), but the effect of HL on prevalence of victimization in youth and adolescents is unclear. Some studies report higher rates of victimization in children with HL (17% to 67%; Weiner, Day, & Galvan, 2013; Weiner & Miller, 2006; Wheeler, Archbold, Gregory, & Skipp, 2007). For example, Weiner et al. (2013) found students with HL in residential and large day schools report victimization more than twice as often as hearing students (33% vs. 14%). Other studies describe no difference in rate of traditional victimization based on auditory status (Bauman & Pero, 2011; Kent, 2003; Kouwenberg et al., 2012; Kusche, Garfield, & Greenberg, 1983; Mejstad, Heiling, & Svedin, 2009; Percy-Smith, Caye-Thomasen, Gudman, Jensen, & Thomsen, 2008). Studies may differ in the assessment of prevalence of peer victimization in children and adolescents with HL, but they agree that auditory status affects victimization type. Contrary to the prevalence of teasing, rumors, and physical harm in the general population, those with HL frequently experience teasing and social exclusion (e.g., fewer invitations to parties, being ignored more). This suggests children with HL experience bullying differently than hearing peers (Dalton, 2011; Kouwenberg et al., 2012; Punch & Hyde, 2011) and more like children with other special needs.

Children with HL experience bullying differently than hearing peers and more like children with other special needs.

Rates of bullying in children with HL may vary due to participant characteristics or methodology. Some studies have subjects with various degrees of HL (mild or moderate through profound) who may or may not use hearing aids or cochlear implants (Bauman & Pero, 2011; Brown & Cornes, 2015; Kouwenberg et al., 2012; Mejstad et al., 2009; Weiner et al., 2013). Others report only on those with profound HL using cochlear implants (Huber et al., 2015; Percy-Smith et al., 2008; Wheeler et al., 2007). All but one study (Kouwenberg et al., 2012) focus on subjects using sign or sign support versus spoken language only for communication. Moreover, most students across studies attend special schools for deaf and hard-of-hearing students versus mainstream schools.

Methodology also may contribute to outcome disparities in children with HL. First, some studies use parent proxy versus self-report of victimization in children with HL (Percy-Smith et al., 2008). Self-report provides a more valid source of victimization because parents overestimate subjective aspects (e.g., peer relationships), and only one third of adolescents report bullying to any adult, including a parent (DeVoe & Murphy, 2011; Eiser, 1997; Sweeting & West, 2001). Second, many studies use ad hoc measures or a limited set of items (often one item) focused on bullying (Bauman & Pero, 2011; Kent et al., 2003; Kouwenberg et al., 2012; Percy-Smith et al., 2008), which reduces validity and generalizability of results. Third, some studies provide a mean rating of bullying occurrence on a Likert scale, precluding analysis of prevalence (Kouwenberg et al., 2012). Fourth, studies use the word bullying, which may invoke negative connotations, versus describing specific situations (e.g., “Other children are mean to me”). Swearer and colleagues (2012) found that students reporting no victimization changed their answer to at least once or twice when presented with specific situations. Only one study thus far used a standardized, validated measure of bullying, the Olweus Bullying Questionnaire (Olweus, 2007), in adolescents with HL (Weiner et al., 2013). Weiner et al.’s (2013) large sample includes students with HL in residential and large day schools for the deaf, many of whom used sign language, reducing applicability to mainstreamed youth and adolescents with HL who typically communicate orally and use hearing aids or cochlear implants.

Purpose of This Study

Peer victimization has emerged center stage due to its negative immediate and long-term effects on mental and physical health, including reduced life satisfaction, lower self-esteem, depression, and poorer quality of life (Sullivan, 2006). The variance in participant characteristics paired with inadequacies in measurement of peer victimization in the published literature creates difficulties articulating the effect of HL on victimization in children and adolescents. To address these issues, we report outcomes via an established, validated survey about experience(s) with bullying to afford a broader understanding of prevalence and type of peer victimization experienced by youth and adolescents with HL who use hearing aids or cochlear implants via five research questions:

Does auditory status (HL vs. general population) affect prevalence or type of peer victimization experienced by adolescents? We predict adolescents with HL will report a higher rate of victimization, particularly for exclusion, due to poorer communication and social skills, compared to peers in the general population.

Does developmental age (youth vs. adolescents) affect prevalence or type of peer victimization in children with HL? We anticipate higher rate of reported peer victimization in youth (7–11 years) versus adolescents (12–18 years) with HL based on age effects shown in the general population.

Does gender affect prevalence or type of peer victimization in adolescents in the general population, adolescents with HL, or youth with HL? We expect higher rates of victimization and physical bullying in boys versus girls but no effect of auditory status by gender on rate of peer victimization.

Does type of auditory technology (hearing aids or cochlear implants) affect prevalence or type of peer victimization in youth and adolescents with HL? We expect no differences by type of auditory technology.

Do demographic factors (e.g., audiologic variables, communication competence, social competence, temperament) differ for bullied versus nonbullied adolescents with HL? We anticipate the bullied group will have poorer communication and social skills relative to the nonbullied group, as shown in studies of other children with special needs.

Method

Participants

Participants included 87 English-speaking children and adolescents (36 boys, 51 girls) with sensorineural HL who met the following inclusion criteria: bilateral HL of at least moderate degree (≥40 dB hearing level), consistent use of auditory technology (i.e., hearing aid or cochlear implant), age 7 to 18 years, and oral communication mode. Individuals with diagnosed or suspected cognitive, developmental, or visual delay and those who could not complete the survey were excluded. We stratified participants by age: (a) youth with HL (n = 31), whose age ranged from 7 to 11 years (M = 9.8 years, SD = 1.3) and (b) adolescents with HL (n = 56), whose age ranged from 12 to 18 years (M = 14.1 years, SD = 1.8). This stratification by chronologic age allowed comparison of prevalence and type of bullying by (a) auditory status via comparison of our adolescents with HL to adolescents in the general population (n = 4,326) as reported by DeVoe and Murphy (2011) and (b) age group via comparison of outcomes in youth versus adolescents with HL (Table 1).

Table 1.

Demographic Characteristics of Participants With Hearing Loss (HL).

	Youth with HL (n = 31)		Adolescents with HL (n = 56)		Adolescents in the general population (n = 4,326)
Variable	n	%	n	%	n	%
Gender
Female	20	64.5	31	55.4	2,135	49.3
Male	11	35.5	25	44.6	2,191	50.7
Ethnicity
Hispanic or Latino	3	9.7	8	14.0	809	18.7
Non-Hispanic/non-Latino	28	90.3	48	86.0	3,517	81.3
Race
White or Caucasian	24	77.4	39	69.6	2,589	59.8
Black or African American	0	0.0	4	7.1	650	15.0
Asian	1	3.2	3	5.4	174	4.0
Unknown or not reported	3	9.7	6	10.7	809	18.7
Other	3	9.7	4	7.1	104	2.4

Note. Descriptive characteristics of adolescents in the general population come from DeVoe and Murphy (2011). The other category includes all other races not previously listed, including Native Hawaiians or other Pacific Islanders, American Indians, and respondents of two or more races. Data from participants with HL include separate reporting of ethnicity and race. DeVoe and Murphy classified race by categories that coincided with non-Hispanic/non-Latino ethnicity (e.g., White or Caucasian, non-Hispanic). For those self-reporting as Hispanic or Latino, ethnicity superseded any report of race. Therefore, the unknown or not reported category for adolescents in the general population includes only those who identified as coming from Hispanic or Latino origin.

Most participants had severe to profound HL and wore at least one cochlear implant (90.3% and 76.8% in the youth and adolescent groups with HL, respectively). Over 80% wore binaural devices: 66.0% wore bilateral cochlear implants, 17.4% wore binaural hearing aids, and 10.5% used a cochlear implant plus a contralateral hearing aid. The remaining participants used either a unilateral cochlear implant (12.8%) or unilateral hearing aid (1.1%). Youth with HL had a mean age at identification of HL of 15.6 months (SD = 15.6 months; range: 0–60), mean age at device fitting of 40.8 months (SD = 31.2 months; range: 12–108), and mean duration of experience of 6.5 years (SD = 2.6 years; range: 2–10). Mean age at identification for the adolescent group was 22.7 months (SD = 27.6 months; range: 0–132), mean age at device fitting was 40.0 months (SD = 28.1 months; range: 8–134), and mean duration of device experience was 10.8 years (SD = 2.3 years; range: 4–14.3). Participants using hearing aid(s) had a younger age at fitting (M = 25.8 months, SD = 11.8 months) than those using cochlear implant(s) (M = 43.9 months, SD = 30.1 months), presumably due to recommendations of a hearing aid trial prior to cochlear implantation.

Data for the adolescents in the general population reflect estimates generated by administration of the 2009 School Crime Supplement to the National Crime Victimization Survey to all eligible respondents. Eligibility required chronologic age between 12 and 18 years and enrollment in Grades 6 to 12 in an educational program (i.e., not homeschooled). Per DeVoe and Murphy (2011), 5,023 completed the survey and 4,326 (86.1%) met the criteria for inclusion in the analysis (please see Table 1 for demographic characteristics of adolescents who compose the general population group).

Participant recruitment involved face-to-face interaction, printed and electronic flyers, word of mouth, and snowball sampling directed to a range of clinical centers and summer camps in Texas and Colorado as well as online community listservs and social media. This project compiled data from protocols approved by the institutional review board at the university of the first author.

Materials

Communication competence

Participants subjectively appraised communication skills via a 10-point Likert scale, with 1 representing poor abilities and 10 reflecting excellent skills. Items assessed speech perception (e.g., “How well do you understand others talking when it is noisy?”) and speech intelligibility (i.e., “How well do you speak so that others can understand you?”). Subjective and objective measures of communication skills correlate highly in individuals with HL (Kirk, Pisoni, & Miyamoto, 1997).

Social competence

Social competence included self-report of number of friends and activities. Quantity of friends was assessed via a 4-point scale (I have no friends, I have one close friend, I have several friends, I have lots of friends). Social engagement reflected number of activities (e.g., athletic teams, fine arts groups, academic clubs, community service) in which a child partook within the past year. Participants also could select I do not participate in activities either in or out of school.

Temperament and behavior

The Early Adolescent Temperament Questionnaire–Revised (EATQ-R) assessed temperament and behavior for 9- to 15-year-olds (Capaldi & Rothbart, 1992; Ellis & Rothbart, 2001). Our sample included two youth and seven adolescents with HL (10.3%) whose age fell outside the intended age range for this measure. Our study included 28 items across four temperament domains (i.e., affiliation, attention, shyness, frustration) and one behavior domain (depressive mood) most likely related to HL and peer victimization. Affiliation (five items) referred to desire for warmth and closeness with others. Attention (six items) marked the capacity to focus and shift attention. Frustration (seven items) represented negative affect related to interruption of ongoing tasks or goals. Shyness (four items) indicated behavioral inhibition to challenge, especially socially. Depressive mood (six items) denoted lowered overall enjoyment and less interest in activities.

Participants rated each statement on a 5-point Likert scale, ranging from almost always untrue to almost always true. Scoring mirrored protocols in Ellis and Rothbart (2001). Domain scores signified a grand mean of all responses across all items within a domain to equalize scores across areas regardless of items per domain. Higher scores denoted more positive outcomes. The EATQ-R has good to excellent internal consistency (Cronbach’s α =.69–.80 across domains).

Peer victimization

The School Crime Supplement to the National Crime Victimization Survey assesses occurrence and frequency of peer victimization biannually (U.S. Department of Justice, 2011). Participants completed the 2009 School Crime Supplement, the most recent version available with published outcomes at the onset of data collection. Each child indicated if he or she experienced teasing (being made fun of, called names, insulted), rumors spread about him or her, threats with harm, physical harm (being pushed, shoved, tripped, spit on), coercion (being forced to do something he or she did not want to do), purposeful exclusion from activities, or property destruction. Items described situations versus using the word bullying to attain an accurate measure of occurrence without coloring results with negative connotation of the word bullying. If participants indicated peer victimization occurred, the online survey generated a set of follow-up items regarding the frequency of occurrence of each type of peer victimization and report of the occurrence to an adult.

Procedure

This project exists as part of a larger study exploring quality of life in children and adolescents with cochlear implants. Participants completed all questionnaires via Qualtrics, an online survey generator, between January 2013 and August 2014. If a participant expressed difficulty reading or understanding items on the survey, the first author or a graduate student in speech-language pathology or audiology read the item to him or her and used clinical judgment to determine the need for further explanation. Study personnel were trained to enact standard communication strategies used with individuals with HL, including repeating or rephrasing a statement to enable understanding of items. Fewer than 20% of participants in the youth group—mostly the youngest participants—and fewer than 5% of participants in the adolescent group requested assistance in understanding items on the survey.

Statistical Analyses

To examine the effect of auditory status on proportion of adolescents experiencing peer victimization, we compared proportion means and calculated 95% confidence intervals around the sample population’s proportions to show if adolescents with HL represent a different population than adolescents in the general population (Newcombe, 1998). No overlap between the 95% confidence intervals of the two populations indicated statistically significant differences between the proportions of the two groups (Carlin & Doyle, 2001).

Peer victimization differed by auditory status such that a significantly higher percentage of adolescents with HL (50.0%) experience bullying versus adolescents in the general population (28%).

Additionally, Z tests afforded group comparison by specific types of peer victimization by comparing the proportion of adolescents with HL who experience bullying to the proportion of adolescents in the general population who experience bullying. Finally, an independent-samples t test allowed comparison of bullied and nonbullied adolescents as a function of demographic variables (e.g., communication competence, social engagement, temperament). We evaluated the effect of bullied status on these variables with an alpha value of 0.05 using IBM SPSS Statistics Version 24 (IBM Corp.; Armonk, NY).

Results

Peer Victimization in Adolescents With Hearing Loss Versus General Population

The first research question investigated the effect of auditory status on prevalence and type of peer victimization in adolescents. Participants indicated if another student made them feel badly during the school year via seven types of victimization. A yes response to at least one item constituted presence of bullying. Peer victimization differed by auditory status such that a significantly higher percentage of adolescents with HL (50.0%, 95% confidence interval [36.9%, 63.1%]) experience bullying versus adolescents in the general population (28%, 95% confidence interval [26.4%, 29.6%]), z = 3.63, p = .0003 (Table 2). The lack of overlap between the 95% confidence interval of the sample of adolescents with HL and adolescents in the general population suggested these two groups represent different populations of adolescents.

Table 2.

Percentages of Self-Reported Peer Victimization in Youth and Adolescents With and Without Hearing Loss (HL).

Type of bullying	Youth with HL (n = 31)	Adolescents with HL (n = 56)	Adolescents in the general population (n = 4,326)
At least one type of peer victimization	38.7 [21.6, 55.8]	50.0 [36.9, 63.1]	28 [26.4, 29.6]
Being made fun of, called names, or insulted	25.8 [10.4, 41.2]	26.3 [14.8, 37.8]	18.8 [17.5, 20.1]
Having rumors spread about him or her	9.7 [0.0, 20.1]	21.1 [10.4, 31.8]	16.5 [15.2, 17.8]
Being threatened with harm	9.7 [0.0, 20.1]	7.0 [0.3, 13.7]	5.7 [5.0, 6.4]
Being pushed, shoved, tripped, or spit on	3.2 [0.0, 9.4]	15.8 [6.2, 25.4]	9.0 [8.1, 9.9]
Being made to do things he or she did not want to do	6.5 [0.0, 15.2]	17.5 [7.5, 27.5]	3.6 [3.1, 4.1]
Exclusion from activities on purpose	16.1 [3.2, 29.0]	26.3 [14.8, 37.8]	4.7 [4.0, 5.4]
Property destroyed on purpose	3.2 [0.0, 9.4]	5.0 [0, 11.2]	3.3 [2.8, 3.8]

Note. Description of types of peer victimization come from the 2009 School Crime Supplement to the National Crime Victimization Survey (U.S. Department of Justice, 2011). Values for adolescents in the general population come from DeVoe and Murphy (2011). A 95% confidence interval (in brackets) was calculated for each proportion according to two methods described by Newcombe (1998) without correction for continuity. Values in bold indicate a significant difference between adolescents with HL and those in the general population.

The groups also differed by type of victimization (Table 2). The most frequently reported types of victimization in the general population include teasing (18.8%), having rumors spread about them (16.5%), and physical harm (9.0%) (DeVoe & Murphy, 2011). Adolescents with HL most often identified teasing, exclusion, having rumors spread about them, and coercion as ways they felt picked on. Comparison of confidence intervals revealed a significantly higher proportion of victimization in adolescents with HL for two types of bullying: coercion (HL, 17.5%, 95% confidence interval [7.5%, 27.5%]; general population, 3.6%, 95% confidence interval [3.1%, 4.1%]), z = 5.42, p < .00001, and exclusion (HL, 26.3%, 95% confidence interval [14.8%, 37.8%]; general population 4.7%, 95% confidence interval [4.0%, 5.4%]), z = 7.39, p < .00001.

Peer Victimization in Youth With HL Versus Adolescents With HL

The second research question evaluated the effect of age group (youth vs. adolescents) on rate of victimization in children with HL. Youth with HL reported a lower but nonsignificant prevalence of bullying compared to adolescents with HL (38.7% vs. 50.0%, respectively; Table 2).

Adolescents and youth with HL reported similar prevalence (≤5% difference) of being teased, being threatened with harm, and having property destroyed. Adolescents with HL more often experienced rumor spreading (21.1% vs. 9.7%), physical harm (15.8% vs. 3.2%), coercion (17.5% vs. 6.5%), and exclusion (26.3% vs. 16.1%). However, overlap between the 95% confidence intervals suggested no significant differences based on age group. We collapsed victimization type across broader categories to examine age-related differences in experiences. Adolescents with HL reported higher rates of direct (16.7% vs. 3.2%) and indirect (38.9% vs. 22.6%) victimization but similar rates of verbal (35.2% vs. 32.3%) and property damage (5.6% vs. 3.2%) relative to youth with HL.

Youth and adolescents with HL varied in how many ways they were bullied. Most experienced one (youth, 41.7%; adolescents, 35.7%) or two types of bullying (youth, 33.3%; adolescents, 32.1%).

If a participant with HL reported victimization, Qualtrics automatically generated two follow-up questions: (a) Why did the youth [adolescent] think he or she was bullied? and (b) Did the youth [adolescent] notify an adult about the incident? Nearly half (45%) of the sample indicated they did not know the reason for victimization. One fifth believed they were bullied because of their HL. Other reasons included how they look (10%) or act (10%). A few participants described why they were bullied: “[I was] not around,” “How I dress,” “Because I am different,” and “Jealousy.” Half of participants in each age group indicated they reported the incident to an adult.

Effect of Gender on Peer Victimization Across Groups

The third research question examined the relationship between gender and victimization (see Table 3). Nearly one third of adolescent males (26.6%) and females (29.5%) in the general population reported at least one type of peer victimization within the past year, suggesting gender does not affect rates of being bullied (DeVoe & Murphy, 2011). The same held true for youth and adolescents with HL, albeit with higher prevalence than for adolescents in the general population (48.0% and 51.0% for males and females, respectively). For youth with HL, females reported higher prevalence of overall bullying relative to males (45.0% vs. 27.3%). Comparison of victimization by gender in adolescents with HL to the two other groups revealed no significant group differences.

Table 3.

Proportions of Self-Reported Peer Victimization by Gender, Age Group, and Auditory Status (in percentages).

Type of peer victimization	Males			Females
Type of peer victimization	Youth with HL (n = 11)	Adolescents with HL (n = 25)	Adolescents, general population (n = 2,135)	Youth with HL (n = 20)	Adolescents with HL (n = 31)	Adolescents, general population (n = 2,191)
At least one type of peer victimization	27.3 [1.0, 53.6]	48.0 [28.4, 67.6]	26.6 [24.6, 28.3]	45.0 [23.2, 66.8]	51.0 [33.4, 68.6]	29.5 [27.4, 31.6]
Being made fun of, called names, or insulted	9.1 [0, 26.1]	28.0 [10.4, 45.6]	18.4 [16.7, 20.1]	35.0 [14.1, 55.9]	26.0 [10.6, 41.4]	19.2 [17.3, 21.1]
Having rumors spread about him or her	9.1 [0, 26.1]	20.0 [4.3, 35.7]	12.8 [11.3, 14.3]	10.0 [0, 23.1]	23.0 [8.2, 37.8]	20.3 [18.5, 22.1]
Being threatened with harm	9.1 [0, 26.1]	4.0 [0, 11.7]	5.6 [4.6, 6.6]	10.0 [0, 23.1]	10.0 [0, 20.6]	5.8 [4.8, 6.8]
Being pushed, shoved, tripped, or spit on	0.0	20.0 [4.3, 35.7]	10.1 [9.3, 10.9]	5.0 [0, 14.6]	13.0 [1.2, 24.8]	7.9 [6.6, 9.2]
Being made to do things he or she did not want to do	9.1 [0, 26.1]	20.0 [4.3, 35.7]	4.0 [3.2, 4.8]	5.0 [0, 14.6]	16.1 [3.1, 28.9]	3.2 [2.5, 3.9]
Exclusion from activities on purpose	9.1 [0, 26.1]	24.0 [7.3, 40.7]	3.8 [3.0, 4.6]	20.0 [2.5, 37.5]	29.0 [13.0, 45.0]	5.7 [4.7, 6.7]
Property destroyed on purpose	0.0	8.0 [0, 18.6]	3.4 [2.6, 4.2]	5.0 [0, 14.6]	3.0 [0, 9.0]	3.2 [2.4, 4.0]

Note. HL = hearing loss. Data represent participants who self-reported peer victimization on the 2009 School Crime Supplement to the National Crime Victimization Survey (United States Department of Justice, 2011). Values in brackets indicate 95% confidence interval for proportions. Data for adolescents in the general population come from DeVoe and Murphy (2011). Participants could report the presence of multiple types of bullying, so group sums may exceed 100%. Values in bold indicate a significant difference between adolescents with HL and those in the general population.

Boys and girls differed in manifestation of victimization. Boys in the general population reported teasing (18.4%), rumor spreading (12.8%), and physical bullying (10.1%) as the most frequent types of bullying (DeVoe & Murphy, 2011). In contrast, male adolescents with HL reported nearly equal occurrence (20%–28%) of teasing, exclusion, rumor spreading, physical harm, and coercion. Two types of bullying in adolescent males significantly differed by auditory status: coercion (HL, 20.0%, 95% confidence interval [4.3%, 35.7%]; general population, 4.0%, 95% confidence interval [3.2%, 4.8%]), z = 3.98, p < .00001, and social exclusion (HL, 24.0%, 95% confidence interval [7.3%, 40.7%]; general population, 3.8%, 95% confidence interval [3.0%, 4.6%]), z = 5.11, p < .00001. Male youth with HL reported lower rates of victimization but did not differ significantly from adolescents with HL on any type of bullying.

Girls differed from boys relative to types of peer victimization experienced. Adolescent girls with and without HL reported teasing (HL, 26.0%; general population, 19.2%) and having rumors spread about them (HL, 23.0%; general population, 20.3%) as common ways in which they got bullied. However, female adolescents with HL also reported social exclusion at significantly higher rates than hearing peers (HL, 29.0%, 95% confidence interval [13.0%, 45.0%]; general population, 5.7%, 95% confidence interval [4.7%, 6.7%]), z = 5.41, p < .00001. Female youth with HL also reported teasing (35%) and exclusion (20%) as occurring most frequently, and no significant differences emerged between the two groups of females with HL.

Effect of Auditory Technology on Peer Victimization in Children and Adolescents With HL

Comparison by auditory technology did not differ by more than 10% for most types of bullying. Adolescent cochlear implant users reported at least one type of victimization more often than hearing aid users (53.5% vs. 38.5%). However, an opposite trend emerged by type of victimization, with higher rates in the hearing aid versus cochlear implant group for exclusion (38.5% vs. 23.8%), coercion (30.8% vs. 14.3%), and being threatened with harm (23.1% vs. 2.4%). Limited sample size in youth with hearing aids (n = 3) precludes statistical comparison by auditory technology in the younger group with HL.

Effect of Personal Variables on Peer Victimization in Children With HL

The fifth research question explored effects of personal variables on peer victimization in children with HL via four areas: auditory factors, communication competence, social competence, and temperament or behavior. We collapsed data across age groups due to the lack of significant differences by prevalence or type of victimization between youth and adolescents with HL. The nonbullied group (n = 47, 55.3% female) had a mean age of 12.6 years (SD = 2.6). The bullied group (n = 40, 62.5% female) had a mean age of 12.6 years (SD = 2.8).

The bullied group had a younger age at identification of HL (M = 15.2 months, SD = 16.0) compared to the nonbullied group (M = 24.1 months, SD = 28.5). The bullied group also had younger age at device fitting (M = 36.7 months, SD = 25.0) versus the nonbullied group (M = 44.1 months, SD = 32.7). The two groups had similar duration of device use (bullied, M = 9.3 years, SD = 3.3; nonbullied, M = 9.1 years, SD = 3.0). The groups did not differ significantly by age at identification, age at device fitting, or duration of device use (Table 4).

Table 4.

T Test and Descriptive Statistics for Effect of Personal Variables on Bullying in Children With Hearing Loss.

Variable	Bullied			Not bullied			95% CI for mean difference	t	df	p (two-tailed)
Variable	M	SD	n	M	SD	n	95% CI for mean difference	t	df	p (two-tailed)
Age at HL identification (months)	15.2	16.0	22	24.1	28.5	22	[−22.92, 5.19]	−1.27	42	.21
Age at device fitting (months)	36.7	25.0	34	44.1	32.7	32	[−21.69, 6.85]	−1.04	64	.30
Duration of device use (years)	9.3	3.3	34	9.1	3.0	32	[−1.31, 1.81]	0.32	64	.75
Understanding in quiet	8.5	1.8	36	8.2	1.9	44	[−0.54, 1.12]	0.70	78	.49
Understanding in noise	5.4	2.7	37	5.6	2.2	44	[−1.32, 0.84]	0.44	79	.66
Intelligibility	8.0	2.4	37	8.2	2.2	44	[−1.31, 0.74]	−0.55	79	.59
Number of activities	3.0	1.2	38	3.1	1.7	47	[−0.78, 0.51]	−0.41	83	.68
Affiliation	3.8	0.7	24	3.9	0.5	31	[−0.47, 0.15]	−1.03	53	.31
Attention	3.7	0.5	39	3.8	0.6	47	[−0.34, 0.12]	−0.93	84	.36
Depressive mood	2.5	0.8	39	2.3	0.6	47	[−0.03, 0.58]	1.81	84	.07
Frustration	3.1	0.7	39	2.9	0.6	47	[−0.09, 0.44]	1.29	84	.20
Shyness	2.8	0.9	39	2.6	1.1	47	[−0.28, 0.57]	0.67	84	.50

Note. CI = confidence interval; HL = hearing loss.

The groups rated speech perception in quiet similarly (bullied, M = 8.5, SD = 1.8; nonbullied, M = 8.2, SD = 1.9). Both groups appraised listening in noise as more challenging than quiet environments (bullied, M = 5.4, SD = 2.7; nonbullied, M = 5.6, SD = 2.2). The nonbullied group rated speech intelligibility more positively (M = 8.2, SD = 2.2) than the bullied group (M = 8.0, SD = 2.4), but the differences did not reach statistical significance (Table 4).

The bullied and nonbullied groups reported nearly identical distributions for number of friends. Most participants cited having several (42.5% and 36.2% in the bullied and nonbullied groups, respectively) or lots of friends (37.5% and 42.6% in the bullied and nonbullied groups, respectively). Nearly 10% per group specified having only one close friend. One member per group indicated having no friends. The groups showed no significant difference in social engagement (bullied, M = 3.0 activities, SD = 1.2; nonbullied, M = 3.1 activities, SD = 1.7; Table 4).

No significant differences emerged between bullied and nonbullied groups of youth and adolescents with HL for temperament and behavior (Table 4). Both groups rated affiliation most positively (bullied, M = 3.8, SD = 0.7; nonbullied, M = 3.9, SD = 0.5). Attention represented the second most positive domain (bullied, M = 3.7, SD = 0.5; nonbullied, M = 3.8, SD = 0.6). The frustration domain garnered a mean rating of 3.1 (SD = 0.7) in the bullied group and 2.9 (SD = 0.6) in the nonbullied group. Both groups rated the shyness domain similarly (bullied, M = 2.8, SD = 0.9; nonbullied, M = 2.6, SD = 1.1). Experiencing peer victimization did not vary with ratings of depressive mood behaviors (bullied, M = 2.5, SD = 0.8; nonbullied, M = 2.3, SD = 0.6). Also, EATQ-R ratings by both bullied and nonbullied groups with HL approximated ratings from typically developing children (for comparison, see Ellis & Rothbart, 2001).

Discussion

Peer victimization of adolescents with HL occurred with significantly higher prevalence versus the general population. The predominance of teasing and rumors persisted across groups, but rates of coercion and social exclusion occurred more frequently in adolescents with HL than the general population. Youth and adolescents with HL expressed similar rates and types of victimization. Bullied youth and adolescents with HL did not differ from nonbullied participants on personal variables, such as auditory history, social engagement, temperament, and behavior.

The predominance of teasing and rumors persisted across groups, but rates of coercion and social exclusion occurred more frequently in adolescents with HL than the general population.

Our finding that adolescents with HL experience peer victimization at rates nearly twice that of peers in the general population converges with relative proportions reported by Weiner et al. (2013). Weiner et al. report students with HL enrolled in residential and day schools for the deaf report higher levels of victimization (32.5%) than hearing peers in a national comparison group (14.4%). Differences in absolute proportion of peer victimization likely reflects each study’s definition of bullying. In the current project, if participants indicated a victimization situation occurred (e.g., teasing, exclusion)—even once in the past year—that response constituted bullying, in accordance with nationwide administration of the School Crime Supplement (DeVoe & Murphy, 2011; U.S. Department of Justice, 2011). In contrast, Weiner et al. focused on “serious bullying” issues occurring at least twice in the past few months. Alternatively, children with significant HL who attend deaf residential or day schools may have deaf peers or greater access to visual communication, which could lower the prevalence of victimization.

Disparities in our findings versus the literature may reflect methodological differences. First, children with HL completed our survey versus parental proxies (Percy-Smith et al., 2008). Self-report may be a more valid and accurate estimate of bullying because only 30% to 50% of adolescents report bullying to adults, and parents often misjudge quantity and quality of a child’s peer relationships (Bauman & Pero, 2010; DeVoe & Murphy, 2011; Eiser, 1997).

Second, participant selection differs between our project and previous studies. Our study included children with HL who use auditory technology, communicate orally, and participate in mainstream education. Other studies primarily included participants using sign language or sign support (Bauman & Pero, 2010; Percy-Smith et al., 2008; Weiner et al., 2013) or enrollment at residential, day, or charter schools for the deaf or hard of hearing (Bauman & Pero, 2010; Mejstad et al., 2009; Weiner et al., 2013). Mainstream education may create a setting in which youth or adolescents with HL have no peers with HL in the classroom, grade level, or school. This could exacerbate differences between the child with HL and hearing peers at a developmental stage that favors conformity over differences, potentially leading to higher likelihood of peer victimization (Bourke & Burgman, 2010; Sweeting & West, 2001).

Third, and perhaps most importantly, instruments assessing rates of victimization vary widely. Most studies reporting no significant difference in prevalence base findings on one item about bullying (e.g., “Other children or young people pick on me or bully me”; Kouwenberg et al., 2012; Mejstad et al., 2009; Percy-Smith et al., 2008; Weiner et al., 2013). Our validated survey asks if another student made them feel badly in a certain way (e.g., “Have you been hit, pushed, shoved, or spit on in the past year?”), without specifically using the word bullying, to allow focus on the action, not the terminology. Doing so may have increased the proportion of bullying in our sample with HL relative to previous studies (Swearer et al., 2012). However, it mirrors administration of the School Crime Supplement to adolescents in the general population (DeVoe & Murphy, 2011).

The type of bullying experienced by youth and adolescents with HL mimics patterns in children with other special needs, with higher rates of exclusion and coercion. These findings parallel published reports of fewer invitations to social events, lower quantity and quality of friendships, and higher loneliness in children and adolescents with HL (Bauman & Pero, 2011; Brown & Cornes, 2015; Huber et al., 2015; Kouwenberg et al., 2012; Percy-Smith et al., 2008).

Surprisingly, no personal factors, such as auditory history, communication competence, temperament, or behavior, differed between the bullied and nonbullied groups. The only factor that trended toward significance was depressive mood, such that the bullied group had more depressive symptoms than the nonbullied group. This finding echoes findings by Theunissen et al. (2011), who reported higher rates of depression in children with HL. The potential bidirectionality of the association between depressive symptoms and victimization should be highlighted.

From Youth Characteristics to the Home and School Microsystem

Surveying the prevalence and type of victimization in youth and adolescents with HL provides a first step to addressing the issue. Next steps involve identification of risk or protective factors that influence probability of occurrence to create effective antibullying programs. These factors may go beyond individual youth characteristics to include a microsystem of school and home settings, as posited by a social ecological perspective (Hong & Espelage, 2012).

Social skills may affect victimization in this population. Adolescents with HL often have difficulties of peer acceptance, making and maintaining friends, and entering conversations with peers, echoing social deficiencies in bullied youth (Dalton, 2011; Kent, 2003; Kouwenberg et al., 2012; Mejstad et al., 2009; Punch & Hyde, 2011). Peer problems may reflect communication difficulties related to auditory skills. Difficulty hearing a conversation may lead to imbalanced turn taking (e.g., manipulation of a discussion to control the topic or withdrawal from dialogue). Alternatively, peer problems may indicate a broader issue of not recognizing social cues from conversation or distinguishing true friendship from acquaintances. Most children with HL cited several or lots of friends, but anecdotal reports from parents and clinicians working with this population question the veracity of these friendships. If children with HL do not develop skills to interact successfully with peers in high-quality relationships (e.g., equal turn taking, reading social cues, sharing personal thoughts), and if they do not learn to transform social skills within developmental societal norms, they have a higher risk of experiencing victimization, particularly in the social arena. No studies have explored this association explicitly.

Social competence can act as a protective factor against bullying. Adolescents, especially females, with at least one high-quality supportive friend tend not to report victimization, a phenomenon called the “friendship protection hypothesis” (Bollmer, Milich, Harris, & Maras, 2005; Kendrick, Jutengren, & Stattin, 2012). Maintaining a high-quality friendship conveys a person’s value and social-emotional proficiency to navigate teenage society. Engagement in activities also guards against bullying, especially for interscholastic sports, which generate a higher social status than intramural sports or academic activities (Peguero, 2008). Future studies should delve into friendship quality or activity type, which could shield adolescents with HL from bullying.

Family dynamics (e.g., parenting style, home environment) represents another factor in the microsystem that can influence the likelihood of being bullied. Risk factors for victimization include lower socioeconomic status and negative parenting styles, such as abuse, neglect, overprotection, or excessive control (Duncan, 2004; Espelage et al., 2015), but no studies to date explore these issues in adolescents with HL. On the upside, high-quality family relationships (e.g., parental support, time spent with parents, intergenerational closure) protect against bullying (Hansen, Steenberg, Palic, & Elklit, 2012; Mann, Kristjansson, Sigfusdottir, & Smith, 2015; Salmon et al., 2000). Kouwenberg et al. (2012) found similar outcomes in adolescents with HL: Teens whose parents showed sensitivity and challenged them to develop competence and independence reported lower levels of bullying.

Study Limitations

Our study is not without limitations. Sample homogeneity, potential selection bias, and exclusion of children with additional disabilities may signify a best-case scenario, potentially underestimating prevalence of bullying in adolescents with HL. Contrastingly, we assumed the comparison group included a representative sample of adolescents, but DeVoe and Murphy (2011) did not report the disability status of participants, leading to the possible inclusion of youth and adolescents with HL or other disabilities in the comparison sample. Another limitation of this study is that the 2009 version of the School Crime Supplement asked about presence of victimization but did not have follow-up items on imbalance of power or repeated nature of the offense. Thus, responses by our sample may reflect a single incident and overestimate victimization in this population. However, use of the same measure and procedure should equalize our interpretation with DeVoe and Murphy. Finally, measurement of some variables could be confounded by a limited array of items (number of friends), subjectivity of response (communication competence), language skill (communication competence), or self-awareness (number of friends, communication competence).

Future Studies, Clinical Implications, and Conclusion

Despite its limitations, this study is the first examination of prevalence and type of peer victimization in youth and adolescents with HL using hearing aids or cochlear implants enrolled in mainstream education. Our administration of a valid established measure affords a direct comparison of responses from adolescents with HL to a representative group of peers in the general population. Finally, our study compared prevalence and type of peer victimization in youth and adolescents with HL to afford a first look at age-related differences in this population.

Future studies of peer victimization in youth and adolescents with HL should expand in both sample size and test measures. A larger sample would afford analysis by degree of hearing loss, use of auditory technology, and mode of communication, among other factors. Future studies should also explore additional factors associated with victimization in youth and adolescents, including youth-related characteristics, such as social skills (e.g., friendship quality, loneliness, social participation, affect cue processing); psychological and temperament variables (e.g., depression, anxiety, and self-esteem); and microsystem-level variables, such as school participation, family involvement, and the parent–child relationship.

This project has clinical and educational implications. Clinicians and educators can contribute to awareness and therapeutic strategies in youth and adolescents who experience bullying. The presence of indicators of victimization (e.g., psychosomatic symptoms, depression or anxiety, decreased school motivation or performance) should prompt follow-up questions about peer relationships and school functioning (Analitis et al., 2009; Squires, Spangler, DeConde Johnson, & English, 2013). Clinicians can routinely screen for involvement in victimization using straightforward, direct questions (see Squires et al., 2013). Victimization also can be included on individualized education plans or 504 plans (e.g., safe environment statement, focus on social and pragmatic skills; see Massachusetts Advocates for Children, 2011, for ideas). These strategies afford a starting point to tackle victimization in children and adolescents with HL, but one needs to understand prevalence, risk and protective factors, and underlying issues before delving into clinical intervention.

Parents and professionals working with children and adolescents need a more complete understanding of the prevalence of peer victimization in children and adolescents with HL to develop appropriate and effective therapeutic intervention programs to maximize quality of life in this population.

In conclusion, children and adolescents with HL experience peer victimization at higher rates than peers in the general population and on par with counterparts with special needs. Social exclusion and coercion occur with greater prevalence in adolescents with HL. Parents and professionals working with children and adolescents need a more complete understanding of the prevalence of peer victimization in children and adolescents with HL to develop appropriate and effective therapeutic intervention programs to maximize quality of life in this population.

Footnotes

Acknowledgements

Thank you to friends and colleagues who referred participants, and to the adolescents who participated.

Authors’ Note

This research was supported in part by a grant from the E. Rhodes and Leona B. Carpenter Foundation. We appreciate feedback from colleagues on previous versions of this article.

ORCID iD

Andrea D. Warner-Czyz

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