Trauma Exposure and Traumatic Symptoms in Deaf Adults

Abstract

While existing research suggests vulnerability of the deaf community to trauma, very little data exists on prevalence, symptom manifestation, and/or unique characteristics of the response of deaf adults and children to traumatic events. In this research, 79 deaf adults were interviewed with the Clinician Administered PTSD Scale, the Life Event Checklist, the Trauma Symptom Inventory, the Peritraumatic Distress Scale, and the Somatoform Dissociation Questionnaire. The average number of unique trauma types experienced per participant was high, averaging 6.18 (SD = 2.65). Findings supported the dose-response model for trauma. Vulnerability factors included number of traumatic events, race/ethnicity, sexual orientation, additional disabilities, prior substance abuse, and low social support. Higher levels of trauma exposure were associated with more depression, anger, irritability, sexual concerns, tension reduction behaviors, and substance abuse problems. The unique trauma symptoms of deaf trauma survivors, including higher levels of dissociation, are discussed. A concept relevant to the deaf trauma community—information deprivation trauma—is introduced. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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Trauma Exposure and Traumatic Symptoms in Deaf Adults
Sven Schild and Constance J. Dalenberg
Alliant International University
While existing research suggests vulnerability of the deaf community to trauma, very little data exists on
prevalence, symptom manifestation, and/or unique characteristics of the response of deaf adults and
children to traumatic events. In this research, 79 deaf adults were interviewed with the Clinician
Administered PTSD Scale, the Life Event Checklist, the Trauma Symptom Inventory, the Peritraumatic
Distress Scale, and the Somatoform Dissociation Questionnaire. The average number of unique trauma
types experienced per participant was high, averaging 6.18 (SD ⫽2.65). Findings supported the
dose-response model for trauma. Vulnerability factors included number of traumatic events, race/
ethnicity, sexual orientation, additional disabilities, prior substance abuse, and low social support. Higher
levels of trauma exposure were associated with more depression, anger, irritability, sexual concerns,
tension reduction behaviors, and substance abuse problems. The unique trauma symptoms of deaf trauma
survivors, including higher levels of dissociation, are discussed. A concept relevant to the deaf trauma
community—information deprivation trauma—is introduced.
Keywords: trauma symptoms, Post-Traumatic Stress Disorder, dissociation, trauma exposure, deafness,
Information Deprivation Trauma
Research findings of core, secondary, and associated symptoms
of trauma (Carlson & Dalenberg, 2000) have led to the formulation
and inclusion of trauma-related diagnoses such as Post-Traumatic
Stress Disorder (PTSD) and Acute Stress Disorder (ASD) in the
Diagnostic and Statistical Manual (DSM; American Psychiatric
Association, 2000). While trauma responses are relatively well
understood among individuals in mainstream society (Briere,
2004; Briere & Scott, 2006; Carlson, 1997), especially among
white, middle- and upper-middle class Americans (Carlson &
Dalenberg, 2000), very little is known about the consequences of
trauma within the Deaf community. According to the National
Center for Health Statistics, approximately 37 million adults in the
United States have some type of hearing loss. Of this group, 3.3%
(i.e., ⬃1.2 million) of adults 18 years and older are deaf or have
significant difficulties understanding speech (Schoenborn & Hey-
man, 2008).
This community, as pointed out by Schein (1989), represents a
remarkably diverse group which varies greatly with regard to
general demographics (e.g., race, ethnicity, country of origin,
religion, family background, gender, and sexual orientation) and
deafness-related variables (e.g., degree of hearing loss, type, age at
onset, and causes of hearing loss) (Padden & Humphries, 2005;
Schein, 1989). Furthermore, a substantial number of deaf people
have disabilities primary or secondary to their hearing loss (Gal-
laudet Research Institute, 2010). The most commonly used lan-
guage among deaf people in the United States and Canada is
American Sign Language or ASL (Gulati, 2003). Within the deaf
community, a large number of people (particularly people who are
prelingually deaf) view their hearing loss not necessarily as a
disability, but rather as a unique cultural identity. To denote this
distinction, differences in spelling are frequently used, which will
also be used throughout this article. The term deaf (lower case) is
generally used to refer to the audiological condition of not being
able to perceive sound, while uppercase Deaf, is used to refer “to
a particular group of people who share a language and a culture”
(Padden & Humphries, 1988, p. 2).
Carlson (1997) cautioned that research findings from main-
stream America may not generalize to individuals from other
cultures or distinct American subcultures. This problem is partic-
ularly severe in the Deaf community, where the validity and
reliability of diagnosed disorders are highly questionable (Black &
Glickman, 2006). This problem is due to a variety of different
factors: (a) the extreme heterogeneity of deaf individuals, (b) a
virtual absence of valid and reliable measures, (c) a general lack of
research with Deaf individuals, and (d) a shortage of qualified,
culturally and linguistically competent mental health professionals
who provide services to this community. When working with
culturally Deaf individuals, clinicians and researchers not only
have to have an in-depth understanding of mental health issues and
sign language fluency, but also, as pointed out by Glickman (2003)
and Pollard (1996), knowledge of the biological, developmental,
educational, vocational, legal, social, and cultural aspects of deaf-
ness.
Although definitive statements cannot be made at this time,
some factors that increase a person’s vulnerability to trauma ap-
pear to be especially prevalent among deaf individuals (Gallaudet
Research Institute, 2001; Gulati, 2003; Sullivan et al., 1987). For
example, it has been well established in the scientific literature that
deaf people are exposed to interpersonal traumas at a much higher
rate than hearing people (Sullivan & Knutson, 1998; Sullivan,
This article was published Online First March 7, 2011.
Sven Schild and Constance J. Dalenberg, Trauma Research Institute,
Alliant International University.
Correspondence concerning this article should be addressed to Sven Schild,
PhD., & Constance Dalenberg, PhD., Alliant International University, 10455
Pomerado Rd, San Diego, CA 92131. E-mail: Dr.Schild@gmail.com
Psychological Trauma: Theory, Research, Practice, and Policy © 2011 American Psychological Association
2012, Vol. 4, No. 1, 117–127 1942-9681/11/$12.00 DOI: 10.1037/a0021578
117

Vernon, & Scanlan, 1987; Vernon & Miller, 2002). Sexual abuse
history has been identified in as many as 50% of deaf children as
compared to 10% to 25% of hearing children (Sullivan et al., 1987;
Vernon & Miller, 2002).
Other than a small number of studies that have examined trauma
responses in deaf people (e.g., Dobosh, 1999; Sullivan & Knutson,
1998), most of the findings thus far are anecdotal in nature. No
identifiable research exists that examines the core symptoms of
psychological trauma or the appropriateness of the current criteria
for the diagnosis of PTSD with people who are deaf. A review of
the literature only located two studies on PTSD prevalence rate
within the deaf adult population. Black and Glickman (2006)
reviewed the hospital records of 64 deaf individuals who were
psychiatrically institutionalized, finding a higher rate of PTSD in
the deaf as opposed to the hearing community (29.7% vs. 6.6%,
respectively) when clinical interview was used as the means for
diagnosis. Dobosh (1999), in her unpublished dissertation evalu-
ating 81 deaf individuals, 33 without and 48 with a sexual abuse
history, reported greater severity of symptoms within the trauma-
exposed deaf adults compared to published scale norms on the
Trauma Symptom Inventory. Neither study provided a thorough
investigation of trauma prevalence in general. Dobosh (1999)
inquired solely about sexual trauma, while Black and Glickman
(2006) were limited in their capacity to compare trauma histories
by the lack of routine trauma assessment within their deaf sample.
Therefore, while there is reason to suspect that both trauma prev-
alence and severity of traumatic symptoms might be higher in the
deaf community, no research to date has specifically tested the
exposure-symptom relationships.
Differences may exist in the manifestation of signs and symp-
toms of psychopathology in hearing and deaf individuals, as Pol-
lard (1998) and Vernon and Andrews (1990) cautioned. Gulati
(2003) has observed that many deaf trauma survivors display a
range of unusual and bizarre symptoms, and the current diagnostic
criteria for PTSD may not fully capture the symptoms displayed by
deaf individuals. Thus, despite higher trauma exposure, it is pos-
sible that traditional PTSD scales, normed entirely on hearing
adults, will underestimate traumatic symptoms in deaf individuals,
leading to fewer total PTSD positive scores.
The role of dissociation in the deaf traumatized population has
been entirely neglected as an area of study. Dissociation in hearing
populations is highly correlated with PTSD (Carlson et al., 2001).
Further, there is reason to believe theoretically that the deaf pop-
ulation might be at particular risk for dissociative symptoms. If
information cannot be shared and must remain private, Freyd
(1994) proposes that it is less likely to become represented and
organized into more conscious, discrete, and readily accessible
units. Thus, the person who lacks social confidants and expressive
language skills, or who is incapable of accessing other social
resources—all more likely to be descriptive of deaf adults relative
to hearing adults—is at greater risk for developing dissociative
symptoms (Freyd, 1994).
It was hypothesized that the current deaf adult sample would
show more dissociative symptoms, but less PTSD as defined by
traditional measures than would hearing samples. However, par-
allel to hearing samples, it was predicted that PTSD scales would
show convergent validity and would relate to trauma exposure.
Relationship among the PTSD clusters also was examined, with a
prediction of the positive contribution of each cluster to the full
diagnosis.
Method
Translation Procedure
All written questions were translated according to established
guidelines (Mason, 2005; Montoya et al., 2004). A glossed version
of all written items was created. Subsequently, the ASL transla-
tions were videotaped and a bilingual research assistant, who was
a native ASL user and unfamiliar with the original written mea-
sures, translated the videotaped version back into English. Since
most test items conveyed simple concepts (e.g., nightmares and not
feeling happy), the first back-translations revealed that most items
were translated accurately. The few items that were either misun-
derstood or not clearly signed were revised. At the conclusion of
this process, a second bilingual research assistant, who was also a
native ASL user, translated the improved ASL translations back
into English until both versions were semantically equivalent.
The translations were conducted to ensure that deaf research
participants with poor reading abilities were able to comprehend
each test item. Before responding to a test item, participants were
asked to look at the standardized ASL translation, which was
signed by the first author and investigator, who was a doctoral
level clinician, with the option of looking at the original English
sentence. The live ASL translation provided to the participants of
this study may have also had additional benefits, including: (a)
allowing participants to ask for clarifications if needed; (b) allow-
ing the researcher to better adjust to the participants’ language
level; (c) quicker response speed, thus allowing for a shorter test
administration times; and (d) reduction in the likelihood that
participants skipped or left test items unanswered.
Recruitment. This study was advertised in the Deaf commu-
nity as a validation study for a new psychological measure. In
order to obtain an unbiased population sample, the type of measure
to be validated was disclosed and explained to participants after
they expressed interest in the study. There were no dropouts after
disclosure of the trauma focus of the study. Recruitment occurred
in Southern and Central California at various Deaf organizations,
college campuses, Deaf social events, and other establishments
where deaf individuals were known to congregate. Each partici-
pant received $20 for his or her participation.
Testing procedures. After obtaining informed consent, par-
ticipants’ sign language comprehension was evaluated. Partici-
pants who reported little or no signing ability or who were ob-
served to struggle to comprehend the Informed Consent
Agreement were dismissed from the study without losing the study
incentive. Participants completed the Life Event Checklist (LEC),
the Clinician Administered PTSD Scale (CAPS), the Peritraumatic
Distress Scale (PDST), the Trauma Symptom Inventory (TSI), the
Somatoform Dissociation Questionnaire (SDQ), Peabody Individ-
ual Achievement Test—Revised (PIAT–R), the Interpersonal Sup-
port Evaluation List (ISEL) and a Socio-Demographic Question-
naire. Adjustments to these measures to accommodate deaf adults
are listed below. Testing required between 2 关1/2兴and 5 hours. The
low trauma group in this research was defined as those who
reported no DSM–IV criteria A1 traumas as measured by the LEC
and the PDST (see later section).
118 SCHILD AND DALENBERG

Measures
The Life Events Checklist (LEC). The LEC is a 17-item
self-report checklist that assesses direct and indirect exposure to a
variety of potentially traumatizing events (Blake et al., 2000). For
the purpose of this study, minor changes were made to the LEC.
First, the 5-point nominal scale (1 ⫽happened to me, 2 ⫽
witnessed it, 3 ⫽learned about it, 4 ⫽not sure, and 5 ⫽doesn’t
apply) was changed to a 4-point nominal scale (1 ⫽happened to
me, 2 ⫽saw it happening to someone else, 3 ⫽learned that it
happened to someone else, 4 ⫽didn’t happen). This change was
implemented to avoid confusion. Second, participants were also
asked to report the number of times each event occurred and his or
her age at the time of the event.
Clinician Administered PTSD-Scale (CAPS). The CAPS is
a structured clinical interview, which assesses the 17 PTSD symp-
toms as outlined in the DSM–IV–TR, in addition to 8 associated
trauma features (Blake et al., 2000). Over the years, the CAPS has
become the “gold standard” for PTSD assessment (Briere & Scott,
2006). Interrater reliability was assessed for 10 individuals by the
first author and a licensed clinical psychologist—both of whom
were fluent in American Sign Language. Reliability coefficients
were .99 for the three PTSD clusters (B, C, and D) and the PTSD
total score.
Translation procedures for the CAPS were similar to the other
written measures. CAPS items were translated into ASL and a
glossed ASL version was created. Each item was translated as
closely as possible to the English meaning in an effort to remain
faithful to the original item. However, it became clear that many
deaf individuals, especially those unfamiliar with psychological
concepts, would have difficulty with item comprehension. There-
fore, several real life examples were added to the already existing
examples to further increase comprehension.
Peritraumatic Distress Scale (PDST). The PDST is part of
the Detailed Assessment of Posttraumatic Stress (DAPS), which is
designed to evaluate trauma exposure and posttraumatic response
in adults (Briere, 2001). The eight-item PDST scale was specifi-
cally developed to evaluate detailed information about emotional
distress during (or soon after) a traumatic event. Three test items
consistent with DSM–IV PTSD criteria A2 were simplified to
allow for clear and accurate ASL translations. Item 1 originally
asked: “At the worst point, how much fear did you feel during this
experience?” This question was simplified to “How much fear did
you experience?” Item three, which evaluates horror, was elimi-
nated because the concepts of “fear” and “horror” in ASL cannot
be clearly distinguished. The PDST scale was completed for the
three most distressing events identified on the LEC. In order to
meet DSM–IV criteria for this study, an event must have received
a score of 4 or above on one of the PDST A2 scale items.
Trauma Symptom Inventory (TSI). The TSI is a 100-item
self-report measure, which assesses acute and chronic trauma
symptoms in adults. The TSI consists of 10 clinical and three
validity scales. The clinical scales are Anxious Arousal (AA),
Depression (D), Anger/Irritability (AI), Intrusive Experiences (IE),
Defensive Avoidance (DA), Dissociation (DIS), Sexual Concerns
(SC), Dysfunctional Sexual Behaviors (DSB), Impaired Self-
Reference (ISR), and Tension Reduction Behavior (TRB) scales.
The three validity scales assess denial of symptoms (Response
Level; RL), unusual or bizarre symptoms (Atypical Response; AR)
and inconsistent or random response patterns (Inconsistent Re-
sponse; INC) (Briere, 1995). The reliability coefficients for the
clinical scales range from .74 to .94 for the hearing norm sample
(Briere, 1995), and from .70 to .89 for deaf individuals (Dobosh,
1999). Both Briere (1995) and Dobosh (1999) report strong evi-
dence for construct validity.
Somatoform Dissociation Questionnaire (SDQ). The SDQ
is a 20-item self-report measure that assesses the dimensional
construct of somatoform dissociation (Nijenhuis, 2004). Somato-
form dissociation refers to disturbances of sensations, movement,
and other bodily functions. Reliability coefficients are excellent,
ranging from .95 to .96 (Nijenhuis, 2004). The convergent validity
between the SDQ–20 and other measures of psychological disso-
ciation has been found to be adequate.
For the purpose of this study, one SDQ–20 item was reworded
and two items were completely eliminated in order to avoid any
hearing biases. No. 18, “I cannot speak (or only with great effort)
or I can only whisper,” was changed to “I cannot sign (or only with
great effort).” Item No. 3, “I hear sounds from nearby as if they
were coming from far away,” and No. 11,“I cannot hear for a while
(as if I am deaf),” were completely eliminated. The SDQ–20 rating
scale and the assessed time frame were changed in order to
maintain consistency with the TSI. Specifically, the new response
format was changed from 1 (not at all) to 5 (extremely) to a scale
ranging from 0 (Never) to 3 (Often). In addition, the assessed time
frame was shortened from “in the past year” to “in the past 6
months.”
Peabody Individual Achievement Test—Revised (PIAT–R).
The PIAT–R is an 82 item individually administered achievement
test (Markwardt, 1992). For the purpose of this study, only the
reading comprehension subtest was administered. Testing is dis-
continued once a participant scores 5 errors within 7 consecutive
responses. This discontinue rule and the multiple-choice format
make this reading comprehension test ideal for individuals with
limited language and expressive skills (Markwardt, 1992).
Socio-Demographic Questionnaire (SoDe–Q). The
SoDe–Q was used to collect information about each participant’s
background. The SoDe–Q was developed to assess three main
areas: (a) general demographic information, (b) deaf specific in-
formation (e.g., degree of hearing loss), and (c) use of alcohol and
illicit drugs.
Interpersonal Support Evaluation List (ISEL). From the
40 items of the ISEL (Cohen, Mermelstein, Kamarck, & Hober-
man, 1985), two appraisal, two tangible support, and two belong-
ing support items were selected. Several items were simplified and
reworded to ensure better reading comprehension. In addition, the
response format was changed from a dichotomy (i.e., probably true
and probably false) to a 5-point Likert scale ranging from
“strongly disagree” to “strongly agree.” The 6-item and original
version was administered to a sample of 17 traumatized adults (7
males and 10 females, Mean age 40.47, SD ⫽15.20) who were
involved in group therapy for their past traumas. The correlation
between the two measures was .93.
Results
Description of Sample
The sample consisted of 79 participants, 45 women and 34
men. The mean age for the entire sample was 40.8 years (SD ⫽
119
TRAUMA EXPOSURE AND TRAUMATIC SYMPTOMS IN DEAF ADULTS

16). The majority of the participants were White (58.2%) and
heterosexual (82.3%). The non-Caucasian participants were
Hispanics (19%), Blacks (11.4%), and other races (11.4%).
Approximately half of the sample (53.2%) was currently in a
relationship. Over 30% of the sample also reported additional
disabilities, with ADHD/ADD and learning disability being
most common. Over 94% of the participants grew up in hearing
families where spoken language was the main mode of com-
munication. As is typical for deaf samples, the median income
was low ($15,000 to $30,000), with 38% of the sample being
employed, and an additional 17.7% on disability. About a third
of the sample (34.2%) reported a high school education or less.
Descriptive details about deafness-related variables are in Table
1. The 22 low-trauma and 57 high trauma individuals did not
differ on any of the demographic variables.
All participants reported at least one LEC event. The most
commonly reported experienced negative events were transporta-
tion accidents (75.9%), unexpected death of someone close
(74.7%), physical assault (72.2%), and natural disaster (67.1%).
The most commonly witnessed adverse events were physical as-
sault (62%), life threatening illness or injury (60.8%), transporta-
tion accident (54.4%), and fire or explosion (48.1%). The low and
high trauma groups were significantly different on the number of
types of negative events experienced on the LEC (M⫽4.55 and
M⫽6.81, SD’s ⫽2.50 and 2.34; t⫽3.66, p⬍.001).
Trauma exposure and trauma symptoms. Hearing loss and
age of hearing loss were not related to trauma symptoms. As
predicted, there was a significant positive correlation between
number of personal adverse events experienced, as measured by
the LEC, and trauma symptoms, as measured by the CAPS, r⫽
.42, p⬍.01, and the TSI, r⫽.40, p⬍.01. Number of adverse
events experienced also correlated with both dissociation mea-
sures: SDQ, r⫽.40, p⬍.01, and TSI Dissociation, r⫽.23, p⬍
.05.
Comparison of rates of PTSD in deaf and hearing samples.
Using the original CAPS scoring rule, 19.5% were classified as
meeting diagnostic criteria for PTSD. PTSD in the hearing popu-
lation occurs in approximately 25% to 30% of traumatized indi-
viduals (Carlson, 1997). Since this deaf sample was multitrauma-
tized, the 19.5% was compared to the upper bound of the PTSD
rates reported by Carlson (1997), that is, 30%. Using zfor the
binominal, results indicated that the prevalence of PTSD in this
deaf sample was significantly lower than prevalence rates among
hearing individuals (z⫽2.02, p⬍.05).
Among the PTSD positive subjects, over half were male
(53.3%), nonwhite (60%), between ages 31 and 50 (53.3%), and
had an additional disability (60%). In addition, one third (33.3%)
were also nonheterosexual. Chi-square indicated significant PTSD
versus no PTSD differences for disability status, ␹2 (1, N⫽77) ⫽
7.22, p⬍.01, and sexual orientation (i.e., heterosexual, homosex-
ual, and bisexual/questioning), ␹2 (2, N⫽79) ⫽11.06, p⬍.005.
There was also a marginally significant difference for race (i.e.,
White vs. Black and Hispanic) ␹2 (1, N⫽68) ⫽2.88, p⬍.09.
PTSD was present for 18.5% of heterosexuals (n⫽63), 11.1% of
homosexuals (n⫽9), and 80% of those who were bisexual or
questioning of their sexual orientation (n⫽5).
Group differences. The high trauma group had significantly
more symptoms of reexperiencing, avoidance/numbing, and hy-
perarousal than did the low trauma group, as measured by the
CAPS (t’s⬎4.43, p⬍.001;see Table 2). The low and high
trauma group also differed on most subscales of the TSI, including
the Intrusive Experiences, Defensive Avoidance, and Anxious
Arousal subscales of the TSI. In addition, 32% of the high trauma
group and 4% of the low trauma group reported a history of
substance abuse (␹
2
⫽6.53, p⬍.001).
Table 1
Frequencies and Percentages for Deafness Variables by Group
Demographic variables
Entire sample
n(%)
Low-trauma
n(%)
High-trauma
n(%) ␹
2
Degree of hearing loss ns
Moderate-severe (61–70db) 12 (15.2%) 3 (25%) 9 (75%)
Severe (71–89db) 23 (29.1%) 6 (26.1%) 17 (73.9%)
Profound (90 ⫹db) 44 (55.7%) 13 (29.5%) 31 (70.5%)
Age at onset of HL loss
a
Birth 19 (24.7%) 4 (21.1%) 15 (78.9%) ns
1st & 2nd year (1–24 months) 39 (50.6%) 12 (30.8%) 27 (69.2%)
3rd–8th year (25–96 months) 19 (24.7%) 5 (26.3%) 14 (73.7%)
Cause of hearing loss ns
Genetic 11 (13.9%) 0 (0%) 11 (100%)
Childhood disease/illness 34 (43%) 10 (29.4%) 24 (70.6%)
Other
a
16 (20.3%) 5 (31.3%) 11 (68.7%)
Unknown 18 (22.8%) 7 (38.9%) 11 (61.1%)
Preferred mode of communication used currently
Signing
b
75 (94.9%) 22 (29.3%) 53 (70.7%) ns
Orally & Lipreading English 4 (5.1%) 0 (0%) 4 (100%)
Hearing status of parent ns
Hearing 75 (94.9%) 21 (28%) 54 (72%)
Deaf 4 (5.1%) 1 (25%) 3 (75%)
a
Other included head trauma, medication, and maternal illness.
b
Signing included ASL, Pidgin Sign English,
and Total Communication.
120 SCHILD AND DALENBERG

Internal structure of the PTSD diagnosis. Using a logistic
regression, the three PTSD clusters were entered as the predictors
with the presence of PTSD, as defined by the CAPS original
scoring rule, the criterion. The Nagelkerke R
2
was .74 and cor-
rectly classified 92.2% of all PTSD cases. Both hyper-arousal
symptoms (CAPS cluster D; ␤⫽.32, p⬍.002) and avoidance and
numbing symptoms (CAPS cluster C; ␤⫽.19, p⬍.01) signifi-
cantly contributed to the prediction of PTSD. The reexperiencing
cluster (CAPS cluster B) did not uniquely contribute. The reexpe-
riencing cluster correlated with the avoidance cluster (r⫽.66, p⬍
.001), and the hyperarousal cluster (r⫽.69, p⬍.001). The
avoidance cluster correlated with the hyperarousal cluster (r⫽.59,
p⬍.001).
Table 3 presents the correlations between the five reexperienc-
ing symptoms, the seven avoidance symptoms, and the five hyper-
arousal symptoms with the cluster totals and PTSD (as defined by
the CAPS original scoring rule). The base rate of each item for
individuals who met and did not meet full criteria is presented.
Each symptom correlated with the respective subtotals and PTSD,
with the exception of C3 (the inability to recall an important aspect
of the trauma).
To match the age groups reported by Briere (1995), subjects
were divided according to age (above and below 55) and gender.
The data is presented in Table 4 for men and women who were 54
years of age or younger. This sample contained an inadequate
number of older male and female participants to allow analysis.
Two of the three validity scores on the TSI (i.e., ATR and INC)
were significantly higher for the deaf sample. Both females and
male deaf samples scored higher than hearing norms on most
scales.
TSI validity scale scores are considered invalid for ATR T
scores at or above 90, RL Tscores at or above 73, and INC T
scores at or above 75 (Briere, 1995). Approximately one third (i.e.,
32.4%) of the deaf male participants and 8.9% of the deaf female
participants scored in the range that would invalidate their profiles.
Further, there was an inverse relationship between English lan-
guage skills, as defined by the PIAT–R Reading Comprehension
score, and atypical symptoms (ATR; r⫽⫺.30, p⬍.01), incon-
sistency (INC; r⫽⫺.27, p⬍.05), and denial of common
symptoms (RL; r⫽⫺.23, p⬍.05) scales.
Convergent validity correlations. The CAPS subscales cor-
related quite significantly with the comparable TSI subscales.
CAPS cluster B correlated with TSI intrusive experiences (r⫽.64,
p⬍.01), CAPS cluster C correlated with TSI defensive avoidance
(r⫽.64, p⬍.01), and CAPS cluster D correlated with the TSI
anxious arousal (r⫽.70, p⬍.01). All TSI scores and all CAPS
clusters had acceptable internal consistency (alphas ⬎.69). How-
ever, as predicted, the overall alpha coefficient for the 17 CAPS
symptoms (␣⫽.87) was significantly lower (z⫽⫺2.31, p⬍.05)
than the published alpha coefficient of .94 to .95 for hearing
individuals (Blake et al., 1995; Hyer, Summers, Boyd, Litaker, &
Boudewyns, 1996). To assess the discriminant validity of the
CAPS, the individual CAPS clusters and the CAPS total score
were correlated with each participant’s reading score on the
PIAT–R, with nonsignificant results (r’s ⬍.10, ns).
Supplemental Analyses
Using the CAPS versus the TSI to determine PTSD. Using
the clinically significant cut-off score of 65, only 6.7% (n⫽1) of
all people who had PTSD according to the CAPS were correctly
classified as having PTSD according to the TSI, although the TSI
made no false positive diagnoses. The percentage of correctly
classified individuals increased to 66.7% (n⫽10) when the cut-off
Table 2
Differences Between High and Low Trauma Individuals on the CAPS, TSI, & SDQ
Low trauma
Mean (SD)
High trauma
Mean (SD)t
CAPS
Cluster B 1.00 (2.00) 7.98 (6.96) 6.79
ⴱⴱⴱ
Cluster C 2.90 (5.13) 11.00 (9.10) 4.90
ⴱⴱⴱ
Cluster D 2.05 (4.19) 8.09 (7.57) 4.43
ⴱⴱⴱ
Total 5.95 (8.90) 27.07 (20.32) 6.33
ⴱⴱⴱ
TSI
Atypical Response 53.23 (11.22) 62.47 (17.67) 2.76
ⴱ
Response Level 52.09 (8.38) 47.44 (6.42) 2.64
ⴱⴱ
Inconsistent Response 54.14 (11.07) 59.82 (13.90) 1.72
∧
Anxious Arousal 46.18 (6.80) 52.19 (9.16) 2.79
ⴱⴱ
Depression 47.68 (7.57) 54.60 (10.98) 3.18
ⴱⴱ
Anger/Irritability 46.77 (8.42) 54.30 (11.88) 2.71
ⴱⴱ
Intrusive Experiences 47.55 (8.43) 55.51 (9.77) 3.37
ⴱⴱⴱ
Defensive Avoidance 47.73 (7.27) 57.12 (10.02) 4.00
ⴱⴱⴱ
Dissociation 52.64 (7.27) 56.54 (12.19) 1.75
∧
Sexual Concerns 47.05 (7.27) 53.09 (11.14) 2.83
ⴱⴱ
Dysfunctional Sexual Behavior 54.18 (10.06) 58.39 (12.79) ns
Impaired Self-Reference 52.68 (8.41) 57.40 (12.78) 1.91
∧
Tension Reduction Behavior 53.73 (9.63) 61.11 (15.79) 2.52
ⴱⴱ
IE, DA, & AA Total 141.45 (19.47) 164.82 (24.18) 4.05
ⴱⴱⴱ
SDQ
Total 1.10 (2.14) 3.24 (3.77) 3.09
ⴱⴱ
∧
p⬍.10.
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
121
TRAUMA EXPOSURE AND TRAUMATIC SYMPTOMS IN DEAF ADULTS

score was lowered to a Tscore of 50. However, 14% of the sample
was identified by this cutoff as positive for PTSD when the CAPS
score was negative.
Discussion
The purpose of this research was to validate the CAPS for the
use with deaf individuals and to explore trauma symptoms in this
highly underserved population. As the results revealed, all partic-
ipants endorsed events that were potentially traumatizing. There
was no gender difference on type or amount of traumatic events
experienced. The high incidence rate is consistent with other
reports of elevated rates of trauma among people with physical or
mental disabilities or ethnic minority groups, including Hallam,
Ashton, Sherbourne, and Gailey’s (2006) sample of participants
with acquired hearing loss, Nosek, Foley, Hughes, and Howland’s
(2001) sample of women with physical disabilities, and Manson,
Beals, Klein and Croy’s (2005) sample of Native Americans. As
these studies have shown, minority status may increase vulnera-
bility and likelihood of trauma exposure and traumatization.
Specific Traumas in the Lives of Deaf People
Within this sample, 76.6% of men and 64.4% of women had
experienced a natural disaster in their lifetime. In addition, 23% of
individuals endorsed the occurrence of a natural disaster as one of
Table 3
Correlations Between the PTSD Symptoms and the Total Cluster Scores
B-Total C-Total D-Total PTSD
Base-rate (n⫽77)
Criteria met
a
n(%)
Criteria not met
n(%)
B1 .84
ⴱⴱ
.66
ⴱⴱ
.56
ⴱⴱ
.47
ⴱⴱ
23 (29.9%) 13 (16.9%)
B2 .52
ⴱⴱ
.28
ⴱ
.41
ⴱⴱ
.35
ⴱⴱ
22 (28.6%) 4 (5.19%)
B3 .73
ⴱⴱ
.50
ⴱⴱ
.47
ⴱⴱ
.39
ⴱⴱ
13 (16.9%) 4 (5.19%)
B4 .77
ⴱⴱ
.48
ⴱⴱ
.54
ⴱⴱ
.45
ⴱⴱ
25 (32.5%) 6 (7.79%)
B5 .67
ⴱⴱ
.39
ⴱⴱ
.49
ⴱⴱ
.34
ⴱⴱ
9 (11.7%) 4 (5.19%)
C1 .64
ⴱⴱ
.73
ⴱⴱ
.48
ⴱⴱ
.55
ⴱⴱ
31 (40.3%) 37 (48.1%)
C2 .40
ⴱⴱ
.69
ⴱⴱ
.55
ⴱⴱ
.56
ⴱⴱ
22 (28.6%) 29 (37.7%)
C3 .17 .37
ⴱⴱ
.04 .06 15 (19.5%) 16 (20.8%)
C4 .63
ⴱⴱ
.64
ⴱⴱ
.51
ⴱⴱ
.38
ⴱⴱ
17 (22.1%) 24 (31.2%)
C5 .27
ⴱⴱ
.63
ⴱⴱ
.33
ⴱⴱ
.23
ⴱ
18 (23.4%) 24 (31.2%)
C6 .41
ⴱⴱ
.76
ⴱⴱ
.31
ⴱⴱ
.42
ⴱⴱ
14 (18.2%) 18 (23.4%)
C7 .39
ⴱⴱ
.50
ⴱⴱ
.28
ⴱ
.25
ⴱ
8 (10.4%) 8 (10.4%)
D1 .31
ⴱⴱ
.32
ⴱⴱ
.61
ⴱⴱ
.38
ⴱⴱ
22 (28.6%) 26 (33.8%)
D2 .54
ⴱⴱ
.45
ⴱⴱ
.85
ⴱⴱ
.71
ⴱⴱ
20 (26%) 21 (27.3%)
D3 .52
ⴱⴱ
.45
ⴱⴱ
.59
ⴱⴱ
.48
ⴱⴱ
19 (24.7%) 21 (27.3%)
D4 .53
ⴱⴱ
.44
ⴱⴱ
.64
ⴱⴱ
.29
ⴱ
16 (20.8%) 27 (35.1%)
D5 .48
ⴱⴱ
.34
ⴱⴱ
.70
ⴱⴱ
.57
ⴱⴱ
11 (14.5%) 13 (16.9%)
Note.a⫽Number of participants with each symptom who met full criteria for the cluster (i.e., Frequency ⫽1;
Intensity ⫽2).
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
Table 4
Mean Scores Differences Between Deaf and Hearing Participants (Ages 18 to 54)
Deaf females (n⫽34) Deaf males (n⫽29)
MSD t MSD t
ATR 3.97 4.14 3.28
ⴱⴱ
4.76 4.92 3.92
ⴱⴱⴱ
RL 1.47 1.40 ⫺1.75
∧
2.14 1.88 ⫺.26
ns
INC 5.71 3.07 3.54
ⴱⴱⴱ
6.24 4.14 3.78
ⴱⴱⴱ
AA 7.47 3.94 ⫺.31
ns
6.52 4.23 .19
ns
D 7.59 6.14 .46
ns
7.34 5.23 2.41
ⴱ
AI 9.65 6.51 1.20
ns
8.45 6.83 .60
ns
IE 7.12 4.93 1.28
ns
6.69 5.76 2.32
ⴱ
DA 10.53 6.17 3.18
ⴱⴱ
7.55 5.77 1.80
∧
DIS 7.79 5.71 2.38
ⴱ
7.62 4.54 3.74
ⴱⴱⴱ
SC 4.56 5.79 .50
ns
5.90 6.11 1.41
ns
DSB 4.59 6.00 2.23
ⴱ
7.59 6.42 4.42
ⴱⴱⴱ
ISR 9.76 6.86 2.81
ⴱⴱ
8.72 5.88 3.41
ⴱⴱ
TRB 5.18 4.91 3.00
ⴱⴱ
5.90 4.65 4.07
ⴱⴱⴱ
∧
p⬍.10.
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
122 SCHILD AND DALENBERG

their three worst life events. These findings are substantially higher
than the findings by Kessler, Sonnega, Bromet, and Hughes (1995)
and Norris (1992), who found that between 10.1% and 18.9% of
men and between 11.9% and 15.2% of women had experienced
similar natural disasters. Given that hearing losses are most prev-
alent in low income families and among individuals in rural areas
(Holt et al., 1994), it is possible that deaf people are more likely to
reside in areas with a higher likelihood of natural disasters. Lan-
guage limitations and the inability to perceive auditory warning
signals about imminent natural disasters may also render deaf
people more likely to experience these events.
Sexual assault was reported by 20.6% of men and by 37.8% of
women, in addition to the 38.2% of men and 42.2% of women who
reported “other unwanted sexual experiences.” Overall, 44.1% of
men and 53.3% of women reported some kind of sexual abuse.
These findings are substantially higher than reports of sexual abuse
among the general hearing population. They are, however, consis-
tent with the sexual abuse rates reported by Sullivan et al. (1987)
for deaf children. It is possible the deaf population may be oppor-
tunistically exploited by perpetrators who may feel protected by a
child’s language limitations (Benedict, White, Wulff, & Hall,
1990). Further, limitations in language are often compensated in
deaf children by enhanced use of touch, which may again render
deaf children more vulnerable to exploitation. In addition, deaf
children may also have limited access to information on appropri-
ate sexual behaviors, abuse, and general safety measures (Ridge-
way, 1993). Sadly, as pointed out by Ridgeway (1993), “many
deaf children believe that abuse is part of being deaf” (p. 166).
Three-fourths of the sample also experienced physical assault
(73.5% of men and 71.1% of women), which included being hit,
slapped, beaten up, or kicked. Given that the majority of the
sample (i.e., 64.2%) reported household incomes of less than
$30,000 annually, participants in this study may live in neighbor-
hoods where exposure to assault is more common. Low income
and neighborhood poverty are generally associated with increased
risk for domestic and community violence, as well as with harsher
child rearing practices (Field & Caetano, 2004).
Sixty-two percent of this sample endorsed events on the LEC in
the “other” category. While detailed information about many of
these events was not available, findings were consistent with
Carlson (1997), who cautioned that many events associated with
PTSD do not qualify as traumatic by current definitions. For
example, two individuals (13.33%) who otherwise did meet diag-
nostic criteria for PTSD reported a stressor that fell outside the
specified criteria in the DSM–IV. One of these events included the
termination of a long-term relationship and one included severe
financial struggles. This study therefore adds to previous research
(e.g., Scott & Stradling, 1994) that questions the necessity of
PTSD criteria A1.
It is likely that the deaf experience lowers the threshold for
perceiving an event as traumatic. For example, the anticipated
death of a loved one may be experienced as “traumatic” if the
deceased was the primary source of social support and only means
of communication with the world. This is consistent with Vernon
and Andrews (1990), who observed that many deaf adults are
likely to suffer from PTSD if they lose a parent or caregiver on
whom they depend.
Information Deprivation Trauma (IDT)
Although no formal analysis of this data was conducted, a theme
emerged from this study that has not been adequately addressed in
previous research: Information Deprivation Trauma or IDT. IDT is
defined here as an event that is experienced as traumatic or more
traumatic because information or knowledge about the event is
limited or not available. The lack of information increases factors
that have been found in the trauma literature to relate to trauma-
tization, such as suddenness, unpredictability, and uncontrollabil-
ity (Carlson, 1997; Carlson & Dalenberg, 2000). For instance,
many deaf people in this study reported their first earthquake,
which in most cases was a minor incident without any injuries or
destruction, as one of their three worst life experiences. The lack
of information or knowledge about this naturally occurring event
made it less predictable and less controllable. The deaf individual
may be unable to glean information from the radio about the extent
of the disaster and maybe was unable to obtain information about
the well-being of family members. This is consistent with other
studies that found that prior knowledge about a trauma had a
desensitization effect and was an important part of the recovery
process (Kalayjian, Kanazi, Aberson, & Feygin, 2002; Norris &
Murrell, 1988).
Several participants expressed that they were uninformed, in
some cases for years, about the tragic death of a close relative.
Once informed about the event, their emotional responses were
overwhelming. Other people reported being traumatized because
people withheld information about an imminent brushfire, which
threatened their home. Discussing these instances of IDT fre-
quently elicited strong emotional reactions during the clinical
interview. Further studies are needed to explore the potential
influence of IDT on traumatization.
Vulnerability Factors
In this study, trauma symptoms were associated with amount of
trauma exposure, race/ethnicity, sexual orientation, additional dis-
ability, prior substance abuse, social support, and language defi-
cits. In this sample, 60% of all people who met PTSD criteria were
non-White. These findings are consistent with other research sug-
gesting an increased vulnerability to PTSD among ethnic minori-
ties (Allen, 1996; Hough, Canino, Abueg, & Gusman, 1996).
Further, although only 6.5% of the sample did not identify as
homosexual or heterosexual, this group constituted one quarter
(26.7%) of all PTSD positive individuals. The increased vulnera-
bility among sexual minorities within the deaf community may be
due a lack of education and understanding about sexuality and
sexual identity (Gannon, 1998; Robinson, 1979).
Sixty percent of all PTSD positive individuals had an additional
disability such as ADHD/ADD and learning disabilities, as com-
pared to 21% of PTSD negative individuals. Thus, this study is
consistent with other research that found that psychological or
psychiatric disorders increase a person’s vulnerability to develop-
ing trauma-related symptoms (Adler, Kunz, Chua, Rotrosen, and
Resnick, 2004; Ozer, Best, Lipsey, and Weiss, 2003). Consistent
with other studies, PTSD positive individuals were also more
likely to report a previous drug or alcohol problem (Najavits,
Weiss, and Shaw, 1997) and lack a social support system (Ozer et
al., 2003). Surprisingly, slightly more men (53.3%) than women
123
TRAUMA EXPOSURE AND TRAUMATIC SYMPTOMS IN DEAF ADULTS

met criteria for PTSD, which is in stark contrast to research with
hearing samples (Breslau et al., 1998; Kessler et al., 1995). In
hearing samples, variance in PTSD rates is frequently accounted
for by the types of trauma experienced. Among deaf people,
however, there was no gender difference for any of the traumatic
events. For example, sexual abuse, which is frequently credited
with increased rates of PTSD among women, occurred relatively
equally among men (44.1%) and women (53.3%).
Trauma Symptoms
Comparing the TSI results of this study to the TSI standardiza-
tion scores, several significant differences were found favoring
higher trauma symptoms in the deaf sample. These higher scores
are likely the reflection of more trauma symptoms among this
multitraumatized deaf sample; however, other explanations cannot
be completely dismissed. It is possible that the elevated scores may
be due to: (a) a cultural difference in labeling affective or behav-
ioral states, (b) an artifact of the test and/or testing procedure
(Dobosh, 1999), or (c) potential translation errors. The last expla-
nation is rendered less likely since strict translation procedures
were followed. In addition, these elevations were found regardless
of whether the test was administered in ASL (as in this study) or
in English as in Dobosh’s (1999) study.
Deaf individuals who were between ages 18 and 54 also re-
ported significantly more symptoms of dissociation, as measured
by the TSI dissociation scale, than hearing people from the stan-
dardization sample. These findings are consistent with Dobosh
(1999), who examined a sample of deaf sexual abuse survivors.
Interestingly, there were only marginally significant differences
between the low and high trauma group and a nonsignificant
correlation between the amount of trauma experienced and disso-
ciation. In other words, deaf people in general, regardless of
trauma exposure and level of traumatization, were more likely to
dissociate than hearing people. In this sample, only 1.8% of the
variance in dissociation was explained by the amount of trauma
exposure alone, which is slightly lower than the 4.4% reported by
Briere, Scott, and Weathers (2005). It is possible that early lan-
guage deprivation and social isolation may have increased a deaf
individual’s overall vulnerability for dissociation.
Although definite statements about their potential influence on
dissociative symptoms cannot be made at this time, Freyd’s (1994)
shareability theory provides some support for this assumption. As
the theory proposes, it is necessary to share traumatic experiences
in order to organize them into more readily accessible units. One
frequently voiced frustration of parents of deaf children is the ease
with which they may refuse to know (by looking away and
refusing to see). Such behavior may be a precursor to dissociation
(Stern, 1997).
TSI dissociation in this sample was also significantly correlated
with somatoform dissociation as measured by the SDQ. Thus, this
study provides the first empirical evidence that deaf people who
are more likely to dissociate are also more likely to experience
unexplained physical symptoms. The SDQ was also significantly
correlated with trauma exposure.
Posttraumatic Stress Disorder
PTSD appears to be manifested differently among the deaf
population as reflected by the lower prevalence rates, different
predictors for the disorder, lower alpha coefficients, and different
symptom constellation. In this multitraumatized sample, only
19.5% of all participants met the diagnostic criteria for PTSD,
which was substantially lower than what would be expected (Carl-
son, 1997). The prevalence rates remained significantly lower even
when less stringent inclusion criteria were used.
One possible explanation is that trauma symptoms in deaf
people manifest in a different symptom constellation. This expla-
nation seems likely given the relatively high base rates for some
symptoms and the fact that some participants did not meet criteria
for PTSD despite elevated CAPS scores. Another possible expla-
nation is that people simply fell short of the full diagnostic criteria
for PTSD because they were experiencing chronic, as opposed to
acute, symptoms. One participant, for example, expressed that he
had been diagnosed with PTSD in the past (which was also
reflected in his elevated scores on all three TSI subscales), but he
did not experience any reexperiencing symptoms in the past
month, and thus fell short of the full PTSD criteria. This is
consistent with findings from McFarlane (1988), who found that
reexperiencing symptoms are generally the first symptoms to
disappear during the course of the disorder. In this study, only
avoidance/numbing and hyperarousal symptoms significantly con-
tributed to predicting the presence of PTSD—reexperiencing
symptoms did not. In other words, using reexperiencing symptoms
as indicators of PTSD alone would likely misdiagnose deaf indi-
viduals and significantly underestimate the presence of the disor-
der among this population.
Preliminary findings also suggest that certain items with the
PTSD criteria might not be predictive within the deaf population.
Reactivity to internal and external cues (B5) and feelings of
detachment from others (C5) certainly may be more common in
the overall deaf population than the hearing population. For ex-
ample, exaggerated startle response is most commonly triggered
by noise (Wilson, 2004). Hearing, which is a relatively passive
process (Braden, 1994), may trigger startle reactions much easier
than visual cues, which are also easier to avoid. In other words,
deaf people may simply avoid situations that could provide a
visual reminder of their trauma, and therefore report fewer trauma-
related startle reactions. Other triggers, such as tactile stimulation,
temperature, pain, and aversive or conditioned odors (van der
Kolk, 1996) may also be easier avoided than auditory cues, or they
may simply be less common among deaf people.
Clinical Implications
Selection of a PTSD measure. Findings from this study
suggest that the CAPS is a more sensitive measure of PTSD in deaf
people than is the TSI. Although the convergent validity for the
two tests was in the expected range, differences emerged when
each measure was used to determine the presence of PTSD. Ac-
cording to the CAPS, 19.5% of this sample met PTSD criteria.
According to the TSI, using the suggested cut-off score of 65
(Briere, 1995), only 2.5% of the sample (n⫽2) was classified as
having PTSD. The TSI cut-off score had to be lowered to the mean
of 50 in order to allow for two thirds (66.7%) of the CAPS PTSD
positive individuals to be classified correctly. This finding reem-
phasizes Carlson’s (1997) point regarding the importance of using
self-report measures solely as screens for a clinical diagnosis
followed up by clinical interview.
124 SCHILD AND DALENBERG

A further problem with the self-report measure was that the
majority of the deaf male participants (i.e., 64.7%) and a third of
all deaf female participants (i.e., 35.6%) had elevated validity
scores at or above a Tscore of 65, often in the invalid range.
Potentially invalid scores, however, were only obtained for un-
usual or bizarre symptoms (ATR) and for inconsistent or random
response patterns (INC). Elevated scores on the RL scale, which
are generally indicative of defensive, avoidant, and oppositional
test taking behaviors (Briere, 1995), were not observed. Further,
there was an inverse relationship between English language skills
and the three validity scales. Importantly, Briere (1995) states that
elevated INC scores are frequently due to poor attention/
concentration and/or dissociation, as reflected in the significant
correlation between dissociation and INC in this study. Since the
TSI standardization sample did not include any deaf individuals
(Briere, 1995), it is currently impossible to determine whether the
elevated ATR and INC scores reflect invalid TSI profiles or more
severe posttraumatic symptoms.
Limitations of the Study
This study was limited to traumatized deaf individuals with
chronic trauma symptoms that were experienced for many months,
and in some cases, even years. Chronic trauma symptoms are
frequently not captured by the construct of PTSD (Herman, 1992),
and PTSD symptoms are known to wax and wane over the course
of the disorder (American Psychiatric Association, 2000). These
reasons may account for the lower observed PTSD rates.
Another shortcoming that might limit the interpretation of some
findings is that this study did not contain a no-trauma control
group. Overall, this study found that the more traumatized a person
was, the more trauma symptoms he or she reported. However, the
nonsignificant (e.g., dysfunctional sexual behavior) and marginally
significant (e.g., dissociation and impaired self-references) find-
ings between the low and high trauma group are difficult to
interpret because the low-trauma group may have already reached
a threshold for traumatization.
Despite the great diversity of this sample, another limitation was
that certain subgroups within this sample were either underrepre-
sented or not included. For example, certain ethnic groups (e.g.,
Asian Americans, Native Americans, Multiethnic individuals),
individuals over 54, postlingually deaf individuals, and deaf peo-
ple from Deaf families were underrepresented.
In addition, there was a restriction of range with regard to
language. This study was limited to individuals with at least
functional language abilities (in both English and/or ASL). There-
fore no statements can be made about the effects of trauma in deaf
adults with limited or no language skills. Given the general diffi-
culties in clinical assessment with high-functioning deaf adults
(Glickman & Gulati, 2003), deaf individuals with limited language
skills present a particular challenge and require a different type of
assessment approach. In this study, there was an inverse relation-
ship between reading skills and capacity to complete a valid TSI,
suggesting possible language-based limitations in interpretation of
trauma items even in ASL. Alternatively, reading level, on its own
or as a proxy for intelligence, may be a buffering factor in trauma
symptom development.
Conclusion and Directions for Future Research
Using qualitative approaches, such as semistructured interviews
(Mitchell, Clegg, and Furniss, 2006) or metaphors, visual aids, or
stories (Glickman, 2003) may be especially useful with this pop-
ulation and would allow a deeper understanding of their posttrau-
matic experiences. Even when assessed by a culturally and lin-
guistically competent clinician, limited language skills and
knowledge about psychological concepts is a major limitation in
trauma assessment with deaf people. Therefore, future trauma
studies may use psycho-physiological measures, such as increase
in heart rate, skin conductance, and blood pressure, which have
shown promising results and may be conducted with minimal use
of language (Kaloupek & Bremner, 1996; Pole, 2007).
Close attention should also be given to the dissociative phenom-
ena in deaf people. The work of Wright, Loftus, and Hall (2001),
for instance, has shown in hearing populations that memory loss (a
typical sign of dissociation) is greater in populations who are
prevented from communicating about the trauma. In addition,
future studies may examine factors suggested by Briere (2006),
such as insecure attachment relationships, emotional neglect, panic
attacks, and substance abuse, which may be especially prevalent
among the deaf population.
Several studies employed prospective designs to study PTSD in
hearing people (e.g., McFarlane, 1988). As Mezzich, Jorge, and
Salloum (1994) pointed out, such designs “allow the possibility of
investigating the unfolding of psychopathologic processes and
testing etiologic hypotheses, pathogenic pathways of interest,
prognostic considerations, lasting treatment effectiveness, patient
trajectories, and outcomes of illness” (p. 137). The field of trauma
and deafness would also benefit from such designs, since currently
no information exists on the progression of the disorder in deaf
people.
While there has been some evidence that deaf children display
behavioral manifestation of their trauma (Sullivan & Knutson,
1998), to the best of the authors’ knowledge, the construct of
PTSD has not been closely scrutinized on an individual symptom
level. Anecdotal evidence, however, suggests that PTSD prior to
the acquisition of language may manifest in an array of bizarre or
unusual symptoms (Gulati, 2003). Studies that use PTSD specific
measures for deaf children are therefore urgently needed.
Despite the difficulties in collecting data with this population,
this study highlighted the importance of conducting trauma re-
search in general with this underserved population, as deaf people
may not only experience more traumatic events than hearing
people, but also may have additional symptoms. Much remains to
be learned about incidence rates of trauma, vulnerability factors,
general trauma symptoms, and PTSD among deaf people.
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Received June 27, 2010
Revision received August 28, 2010
Accepted September 13, 2010 䡲
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