Early Child Development and Care

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Psychosocial difficulties and quality of life in

children with hearing impairment and their
association with parenting styles

Damla Eyuboglu, Gul Caner Mercan & Murat Eyuboglu

To cite this article: Damla Eyuboglu, Gul Caner Mercan & Murat Eyuboglu (2021)
Psychosocial difficulties and quality of life in children with hearing impairment and their
association with parenting styles, Early Child Development and Care, 191:6, 952-962, DOI:
10.1080/03004430.2019.1652171

To link to this article: https://doi.org/10.1080/03004430.2019.1652171

Published online: 06 Aug 2019.

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EARLY CHILD DEVELOPMENT AND CARE
2021, VOL. 191, NO. 6, 952–962
https://doi.org/10.1080/03004430.2019.1652171

Psychosocial difficulties and quality of life in children with hearing

impairment and their association with parenting styles
a b a
Damla Eyuboglu , Gul Caner Mercan and Murat Eyuboglu
a
Department of Child and Adolescent Psychiatry, Osmangazi University, Eskisehir, Turkey; bDepartment of
Otorhinolaringology, Tepecik Training and Research Hospital, Izmir, Turkey

ABSTRACT ARTICLE HISTORY

The aim of this study was to investigate the relationship between the Received 2 July 2019
psychosocial problems, quality of life and parenting styles in children Accepted 1 August 2019
with hearing impairment. A total of 84 children (42 children with
KEYWORDS
hearing impairment and 42 healthy children) and their parents were Children with hearing
included. The emotional, behavioural, peer and school-related problems impairment; psychosocial
were significantly higher, and self-esteem levels were significantly lower difficulties; quality of life;
in the case group compared to the healthy children. We also parenting styles; parental
determined that the parents of children with hearing impairment had attitudes
overprotective and authoritarian parenting styles compared. The
findings showed that there was a significant correlation between the
emotional problems of children and the overprotective and authoritarian
parenting style. These findings indicated that the intervention should
not focus solely on the existing disabilities of these children. It also
pointed at the importance of the parental attitudes in both the
treatment and protection of mental health.

Introduction
Hearing is an important sense that enables individuals to interpret their environment and commu-
nicate with other people. Hearing impairment is a disability that has a significant impact on the cog-
nitive, emotional and social development/socialization of children. As a result, it impacts affected
children’s entire lives (Fellinger, Holzinger, & Pollard, 2012; Hindley, 1997; Schlumberger, Narbona,
& Manrique, 2004; Sunal & Cam, 2005). The ratio of infants born with hearing impairment is approxi-
mately 1–3:1,000. The addition of acquired hearing impairment due to other factors increases this
incidence up to 5:1,000 (Boulet, Boyle, & Schieve, 2009; Centers for Disease Control and Prevention,
2009). The occurrence rate its consequences emphasize the importance of early diagnosis and treat-
ment. Therefore, hearing screenings are a common practice worldwide; a direct result of this is the
newborn hearing screening programme in our country, enacted in 2005.
Currently, hearing impairment can be treated with hearing aids or cochlear implants. The earlier
the condition is diagnosed and treated with a hearing aid or cochlear implant, the better developed
the receptive and expressive language skills of children (Kirk, Miyamoto, Ying, Perdew, & Zuganelis,
2000; Meyer, Svirsky, Kirk, & Miyamoto, 1998).
The rate of mental health problems is higher among children with hearing impairment compared
to the general population (Bigler et al., 2019; Brown & Cornes, 2015; van Gent, Goedhart, Hindley, &
Treffers, 2007). The studies consistently showed that hearing-impaired children and adolescents were
more prone to developing internalizing and externalizing problems than their normally hearing peers
(Stevenson, Kreppner, Pimperton, Worsfold, & Kennedy, 2015; Theunissen et al., 2014a). In studies

CONTACT Damla Eyuboglu damlakarakaslar@hotmail.com

© 2019 Informa UK Limited, trading as Taylor & Francis Group
 EARLY CHILD DEVELOPMENT AND CARE 953

that focused on the community samples, the prevalence of the mental health problems was 40%
among deaf children (Hindley, 2000). In children with hearing impairment, the risk of the autism spec-
trum, attention deficit and hyperactivity disorders are also high, along with the risk of emotional and
behavioural problems (Fellinger, Holzinger, Sattel, Laucht, & Goldberg, 2009; Hindley, 2005; Remmel,
Better, & Weinberg, 2003).
Some studies of the mental health of hearing impaired children and adolescents have investigated
associations between such problems and other factors. Various risk and protective factors, such as
communication skills, intellectual impairments, age at detection and intervention, additional disabil-
ities, etc., affecting the level of psychopathology have been identified (Theunissen et al., 2014b).
Quality of life is a concept that is assessed subjectively and is under influence of the surrounding
cultural, social and environmental factors (Harper & Power, 1998). According to the definition pro-
vided by the WHO, quality of life is ‘a state of complete physical, mental and social well-being,
and not merely the absence of disease and infirmity’ (WHO, 2006). Hearing impairment does not
only impair the quality of life for children but also their parents (Looi, Lee, & Loo, 2016a). With the
implementation of cochlear implants or hearing aids, the child’s social communication skills, sociali-
zation and quality of life improve (Davis et al., 2006; Morettin et al., 2013).
There is a consensus that parents have a critical role in the emotional and behavioural well-being
of their children (Antonopoulou, Hadjikakou, Stampoltzis, & Nicolaou, 2012). In addition, it is also well
known that the parenting styles are important, considering the personality and moral development,
development of social skills and academic success. In this context, the attitudes within the frame of
the mother-father–child triangle have a critical importance for being a role model to children and the
regulation of the relationship between the siblings. Parents with a positive parenting style exhibit a
tolerant, sensitive, warm and supportive behaviour. They respond properly to the needs of their chil-
dren and simultaneously encourage the development of autonomy (Kawabata, Alink, Tseng, van
Ijzendoorn, & Crick, 2011; Stack, Serbin, Enns, Ruttle, & Indsey, 2010). It was reported that the
social and emotional adaptations of children grown up with this type of parenting style are signifi-
cantly better (Kawabata et al., 2011). Overprotective parenting styles have a prohibitive and repres-
sive characteristic and are associated with underarm inhibition of children’s development (Barber,
1996). Children growing up in families with this type of attitude become more dependent and
often develop emotional disturbances (Yavuzer, 1990). In other words, their social development is
inhibited (Yavuzer, 2003).
The main features of children that have grown up with authoritarian parents are the absence of
the right of speech, prevention of participation and strict implementation of rules without taking into
consideration the needs and requests of children (Antonopoulou et al., 2012). Children, who are
exposed to these type of attitudes, which do not allow discussions and flexibility, suffer from retarded
social and emotional development (Kawabata et al., 2011; Stack et al., 2010).
Quittner et al. (2013) determined that the sensitivity of mothers with healthy children was more
developed depending on the positive parenting style compared to mothers of children with hearing
impairment. Although there are studies showing that authoritarian and strict parenting style is more
common in families with children with hearing impairment, there are also studies suggesting that
there is no difference between the parenting styles (Antonopoulou et al., 2012; Ketelaar, Wiefferink,
Frijns, & Rieffe, 2016).
In summary, previous studies have showed that the adolescents and children have suffered more
from psychosocial difficulties than their normally hearing peers and have described the strong associ-
ations between mental health problems of hearing impaired children and various factors above men-
tioned. Very few studies have examined parenting styles of hearing-impaired children and their
effects on psychosocial aspects of these children. The present study aimed to reinforce and
expand the existing evidence by addressing three research questions:

(1) Do children with hearing loss grow up with different parenting styles than normal hearing
children?
954 D. EYUBOGLU ET AL.

(2) Are there any associations between the emotional and behavioural difficulties of hearing-
impaired children and parenting styles they exposed to?
(3) Are there any associations between the quality of life of hearing-impaired children and parenting
styles they exposed to?

Method
Participants and procedures
Participants in the current study included 42 children who were using a hearing aid and/or cochlear
implant and their parents (28 mothers, 14 fathers). All of these were followed up in otorhinolaryngol-
ogy outpatient clinic. Researchers recruited the samples in the process of monitoring. In addition, 42
healthy children without any chronic disease, as well as their parents (26 mothers, 16 fathers), were
included as the control group. Children diagnosed with a significant physical, cognitive and/or devel-
opmental delay and/or with a significant/major acute medical condition were excluded.
The participants and their families were informed about the study, and written and/or verbal
consent was obtained from the children; written consent was obtained from the parents. The socio-
demographic data was recorded by the otolaryngologist during the examination. The parents fulfilled
the Strengths and Difficulties Questionnaire (SDQ), KINDL Quality of Life Questionnaire and Parental
Attitude Research Instrument (PARI) for their children. The Child Psychiatrists interpretated the scales
and reported the results. Ethics committee approval was obtained for the study.
Degrees of hearing loss in children were classified in accordance with the American Speech and
Hearing Association (ASHA) criteria: 16–25 dB = slight hearing loss, 26–40 dB = mild hearing loss, 41–
55 dB = moderate hearing loss, 56–70 dB = moderately severe hearing loss, 71–90 dB = severe
hearing loss and profound hearing loss = 91+ dB (American Speech- Language-Hearing Association
(ASHA), 2010).

Measures
Sociodemographic data form
This form was created by the investigators based on the literature for the collection of the sociode-
mographic characteristics. The form contained questions about the age and educational status of the
children, as well as the age, educational, economic and occupational status of their parents.

The strengths and difficulties questionnaire (SDQ)

The SDQ was developed for the screening of the mental disturbances in children and consists of 25
questions (Goodman, 1997). These questions are grouped in 5 dimensions: behavioural problems,
attention deficit and hyperactivity, emotional problems, peer problems and social behaviours.
While high scores in social behaviour reflects the strengths of the individual in the social field,
high scores in the other subgroups reflects the severity of the related problems. The questionnaire
was adapted into Turkish and its reliability and validity were confirmed (Guvenir et al., 2008).

Parental attitude research instrument (PARI)

This questionnaire was developed by Schaffer and Bell (1958). The validity and reliability study for the
Turkish language was done in 1978. It is used for the evaluation of parental attitudes during child
rearing and is designed to be filled out by parents (LeCompte, LeCompte, & Ozer, 1978). The internal
consistency of the questionnaire is 0.91. PARI is used for the evaluation of 5 different dimensions, like
the overprotective parenting, equalitarian/democratic attitude, denial of housewife roles, parental
discord on child-rearing and strict discipline. Increased scores in the dimensions, except for ‘equali-
tarian/democratic attitude’, indicate unfavourable parenting.
 EARLY CHILD DEVELOPMENT AND CARE 955

KINDL quality of life questionnaires family form

The questions of the KINDL (KINDer Lebensqualitätsfragebogen: Children Quality of Life Question-
naire), a pediatric quality-of-life questionnaire for general purposes, have a 5-point Likert scale (1
= never, 5 = always). The questions are divided into 6 subgroups: Physical well-being, emotional
well-being, self-esteem, family, friends, everyday functioning in the past week and perception of
chronic diseases (Ravens-Sieberer & Bullinger, 1998). The mean scores were calculated for each sub-
group and converted to a value between 0 and 100. High scores indicated a high quality of life (www.
kindl.org). The validity and reliability study of the questionnaires for the Turkish language was per-
formed by Baydur et al (Baydur, Saatli, Eser, & Yuksel, 2007).

Data analysis
Data analyses were performed using the Statistical Package for Social Science (SPSS 23.0 for
Windows). The measured variables were expressed as median ± standard deviation, and the categoric
variables were defined as percentages and numbers. The distribution of numeric variables were eval-
uated using the Kolmogorov–Smirnov test and by evaluating histograms. The comparison of the
normal distribution of numeric variables was evaluated using Student’s t tests, and non-normally dis-
tributed numeric variables were evaluated using the Mann- Whitney U test. Chi-square analyses and
Fisher’s exact tests were performed for dichotomous variables. Spearman’s Correlations were run to
determine associations between the PARI, SDQ and KINDL subscales. The value of statistical signifi-
cance was determined as p < 0.05. The effect size was measured with Cohen’s d. Cohen’s d-values
of 0.2 or below reflected a small effect size, around 0.50 reflected a moderate effect size and 0.80
and above reflected a large effect size (Cohen, 1992).

Results
A total of 84 children (42 cases with hearing impairment and 42 healthy controls) were included in
our study. The mean ages of patients and controls were 6.8 ± 1.5 years (4–10 years) and 6.2 ± 1.3 years
(4–10 years), respectively. There were 21 (%50) females and 21 (%50) males in the patient group and
22 (%52.4) females and 20 (%47.6) males in the control group. In the case group, 3 (7.1%) children
were not attending school, 18 (42.9%) of them were attending kindergarten and 21 (50%) of them
were attending primary school. In the control group, 1 (2.4%) child was not attending school, 20
(47.6) of them were attending kindergarten and 21 (50%) of them were attending primary school.
There was no statistically significant difference between the groups regarding the age, sex and edu-
cation statuses of the children.
When the educational status of the parents was examined, the most of them were primary and
high school graduates. There was no statistically significant difference between the groups regarding
the education statuses of the parents. Additionally, all couples in the present study were living
together.
Regarding the hearing impairment, 19% of the children (n = 8) had moderate (41–55 dB), 26.2% (n
= 11) had moderately severe (56–70 dB), 45.2% (n = 19) had severe (71–80 dB) and 9.5% (n = 4) had
profound (91+ dB) hearing impairment. Thirty-one of them were using hearing aids and 11 were
using cochlear implants. Twenty-nine children visited normal schools and 13 of them received
additional private training.

Psychosocial difficulties
We used the Strengths and Difficulties Questionnaire to assess psychosocial difficulties. There was a
significant difference between the two groups in all dimensions except for the prosocial behaviour
score (Table 1). We determined that children with hearing impairment suffered more emotional,
956 D. EYUBOGLU ET AL.

Table 1. The comparison of the scores of the Strengths and Difficulties Questionnaire between case and control groups.
Case group Mean ± SD Control Group Mean ± SD Effect size (Cohen’s d) p*
Total Difficulty Score 13.4 ± 7.1 8.4 ± 3.4 0.89 <0.001
Emotional Symptom Score 3.2 ± 2.3 1.5 ± 1.4 0.89 <0.001
Behavioral Problems Score 2.4 ± 1.9 1.1 ± 0.8 0.89 <0.001
HA/AD Score ** 4.5 ± 2.2 3.4 ± 1.8 0.54 0.02
Peer Problems Score 3.4 ± 2.3 2.8 ± 1.6 0.30 0.02
Prosocial Behavior Score 7.4 ± 2.1 8.0 ± 1.4 - 0.1
*Student’s t test **Hyperactivity and attention deficiency scores.

behavioural and peer problems, and attention deficit and hyperactivity disturbances than healthy
controls.

Quality of life
The comparison of the quality of life questionnaire scores between the two groups showed that chil-
dren with hearing impairment suffered more from disturbances related to the physical and emotional
status, self-esteem and school relations (Table 2).

Parenting Style
The comparison of the groups for the PARI sub-questionnaire scores revealed that the levels of
the overprotective and authoritarian parental attitudes were statistically higher in the case group
(Table 3).

Correlations
Bivariate analyses were used to examine possible relations between psychosocial difficulties, quality
of life and parenting style in the case group. The results indicated that overprotective parenting and
strict discipline parenting style were shown to be associated with psychosocial difficulties in children
with hearing impairment (Table 4). Furthermore, a significant relationship was also found between

Table 2. The comparison of the KINDL quality of life questionnaire scores between the case and control groups.
Case group Control Group
Mean ± SD Mean ± SD Effect size (Cohen’s d) P
Physical well-being 69.3 ± 19.5 80.3 ± 3.12 0.67 0.01*
Emotional well-being 70.4 ± 11.9 83.4 ± 12.6 1.06 <0.001**
Self-esteem 60.8 ± 2.19 75.0 ± 10.1 0.92 <0.001**
School 70.2 ± 18.9 82.2 ± 11.8 0.76 <0.001**
Family 74.1 ± 13.3 78.5 ± 12.4 - 0.15**
Social relationships 77.2 ± 15.9 75.2 ± 13.1 - 0.47*
*Mann-Whitney U test, **Student’s t test.

Table 3. The comparison of the case and control groups for parental attitudes.
Case group Control Group
Mean ± SD Mean ± SD p
Overprotective parenting 48.3 ± 5.7 37.4 ± 12.6 <0.001*
Strict discipline 41.5 ± 7.5 31.7 ± 8.9 <0.001**
Equalitarian/Democratic 26.8 ± 3.6 27.0 ± 4.1 0.84**
Denial of housewife roles 30.2 ± 6.2 27.6 ± 6.4 0.075**
Marital conflict 13.8 ± 4.3 12.8 ± 3.3 0.52*
*Mann-Whitney U test, **Student’s t test.
 EARLY CHILD DEVELOPMENT AND CARE 957

Table 4. The correlations between the PARI sub-dimensions and SDQ subscale scores.
1 2 3 4 5 6 7
1. Total difficulty 1
2. Emotional symptom 0.85** 1
3. Behavioural problems 0.71** 0.48** 1
4. HA/AD 0.70** 0.38** 0.46** 1
5. Peer problems 0.74** 0.61** 0.31** 0.25* 1
6.Overprotective parenting 0.31** 0.30** 0.15 0.18 0.27* 1
7. Strict discipline 0.27* 0.33** 0.08 0.12 0.17 0.81** 1
**p < 0.01. *p < 0.05, SDQ:Strengths and difficulties questionnaire; PARI: Parenting attitudes research instrument; HA/AD: Hyper-
activity and attention deficiency.

Table 5. The correlation between the quality of life subscale scores and PARI family dimensions.
1 2 3 4 5 6
1. Physical well-being 1
2. Emotional well-being 0.30* 1
3. Self-esteem 0.31** 0.36** 1
4. Social relationships −0.05 0.30* 0.27* 1
5.Overprotective parenting −0.13 −0.42** −0.13 −0.12 1
6. Strict discipline −0.25* −0.48** −0.16 0.02 0.81** 1
**p < 0.01. *p < 0.05; PARI: Parenting attitudes research instrument.

emotional well-being of these children with overprotective parenting and strict discipline parenting
style (Table 5).
We also performed a correlation analysis in order to evaluate the relationship between the SDQ
and KINDL subscale scores and the severity of the hearing impairment, but we did not find any sig-
nificant correlation.

Discussion
In the present study, we investigated the emotional, behavioural disturbances, quality of life and par-
enting styles of children with hearing impairment, and we determined significant differences.
Consistent with the studies reporting that hearing impaired children have more internalizing and
externalizing problems than healthy children, our findings suggest that these children have more
emotional and behavioural problems (Edwards, Khan, Broxholme, & Langdon, 2006; Fellinger et al.,
2012; Theunissen et al., 2011; Theunissen et al., 2012; Theunissen et al., 2014b). Children with
hearing impairment may have difficulties expressing their feelings and exhibiting emotional literacy
skills (Stevenson et al., 2015). This finding contributed to the interpretation of the emotional problems
of children with hearing impairment. In addition, the communication problems with the family and
peers pave the way for the development of these emotional and behavioural disturbances (Barker
et al., 2009).
In our study, the SDQ hyperactivity subscale scores were higher in children with hearing impair-
ment. Although there are some studies reporting a significant correlation between hearing impair-
ment and ADHD, this relationship is still under debate. It was suggested that the ADHD
encountered in children with hearing impairment might be related to low IQ levels (Hindley &
Kroll, 1998; Huber et al., 2015; van Eldik, Treffers, Veerman, & Verhulst, 2004).
It might be suggested that children with hearing impairment can have difficulties in peer
relationships because of existing communication disabilities. In our study, the parents of children
with hearing impairment stated that their children experienced significantly more difficulties in
peer relationships. It was also emphasized in the related literature that children with hearing
impairment suffered more from social isolations and difficulties with peers because they do not
participate in the social activities (Vostanis, Hayes, Du Feu, & Warren, 1997). Moreover, their
different appearances, due to the cochlear implants or hearing aids, exposes them more frequently
958 D. EYUBOGLU ET AL.

to peer victimization (Kouwenberg, Rieffe, Theunissen, & de Rooij, 2012; Wolters, Knoors, Cillessen,
& Verhoeven, 2011).
In our study, we investigated the quality of life of children with hearing impairment and deter-
mined that it was significantly limited compared to healthy children, except for family and social
relationship subscales. There are other studies reporting that the quality of life was impaired in chil-
dren with hearing impairment compared to healthy children (Aras et al., 2014; Edwards, Hill, & Mahon,
2012). In our study, the quality of life of children with hearing impairment was significantly impaired
in the physical, emotional, school and self-esteem dimensions. Self-esteem and school success of
these children may be negatively affected due to the limitations in the receptive and expressive
language and this can pave the way for the emotional and behavioural problems. In addition,
high hyperactivity subscale scores in the SDQ – as in our study – may have a negative effect on
the quality of life (Looi, Lee, & Loo, 2016b; Meinzen-Derr, Wiley, Grether, & Choo, 2011).
In our study, we also evaluated the parenting styles of the parents of children with hearing impair-
ment. The results showed that parents of children with hearing impairment had more overprotective
and authoritarian parental attitudes. Families of children with hearing impairment may have difficul-
ties to communicate and interact with their children (Freeman, Dieterich, & Rak, 2002). The parents
may be inexperienced and there could be a lack of role models in raising children with hearing
impairment (Antonopoulou et al., 2012). Therefore, parenthood may be different in these families
compared to families with healthy children.
A children with hearing impairment in a family may affect the family in all fields (Antonopoulou
et al., 2012), and these parents may become overprotective and interfering (Calderon & Greenberg,
1999). In a study conducted by Antonopoulou et al., it was reported that mothers of children with
hearing impairment had a more authoritarian and strict parenting style and exhibited more
emotional and verbal hostility to their children. Having a disabled child may lead to more stress
and difficult emotions to cope with, and these may unfavourably affect the parenting style. The rela-
tively higher energy, which these parents have to spend due to the limited autonomy of their chil-
dren during daily activities, and the increased need for parental support, may also be one of the
factors affecting the parenting style (Woolfson & Grant, 2006).
In our study, we determined strong correlations between the overprotective parenting and strict
discipline attitudes and the emotional symptom scores of SDQ and emotional well-being subscales of
the quality of life questionnaires. These findings pointed to the critical role of the parental attitude in
the psychosocial development of their children. Previous studies confirmed that overprotective and
authoritarian parental attitudes paved the way for the development of dependent personalities with
emotional and social disturbances (Barber, 1996; Kawabata et al., 2011).
While hearing impairment independently increases the risk of emotional and behavioural pro-
blems, additional exposure to overprotective parenting and strict discipline attitudes may worsen
the psychosocial development. One of the surprising findings of our study was that children with
hearing impairment experienced emotional and behavioural problems and suffered from low
quality of life independently from the severity of the hearing impairment. It is usually expected
that the problems increase with the increase in the severity of the existing disability. However, this
finding may indicate the relationship between the psychosocial problems of children with hearing
impairment and parenting style. In this context, interventions that are only directed to the treatment
of the hearing impairment may remain insufficient. Therefore, special focus on parents, evaluation of
the parental attitudes and training to overcome negative parenting styles may contribute to the
treatment of the emotional problems of children with hearing impairment. Newborn hearing screen-
ing programmes were already implemented in several countries, which enabled early diagnosis and
adaptation of the children with hearing impairment. In regards to preventive mental health, these
findings show that parent programmes, which will be organized with the families of the early diag-
nosed children and enable healthy communications and relationships between the children and
parents, will contribute to the efforts to raise healthy children.
 EARLY CHILD DEVELOPMENT AND CARE 959

Limitations
This study had certain limitations. The study data was only obtained from parents. The self-evaluation
of children and observations of the teachers were not be taken into consideration. In addition, only
one of the parents participated in the study for each child, and differences between mothers and
fathers could not be investigated. The sample size was rather small in respect to the number of
people with hearing impairment in the general population. As the study was conducted in one
centre, we were not able to investigate different cultures.

Conclusion
Several studies demonstrated that the existing disabilities of children with hearing impairment had a
negative impact on their psychosocial development, and the emotional and behavioural disturb-
ances were more common in this group when compared to healthy children. On the other hand,
there are only a limited number of studies that focus on parenting styles and their consequences
in children with hearing impairment. Unlike previous studies, our study showed that the existing dis-
ability was not the only factor that affected negatively the quality of life and mental status of children
with hearing impairment. Instead, their problems might also be significantly related to inappropriate
parenting styles compared to healthy children. The results of this study emphasized the importance
of simultaneous handling both children and parents and that only such a comprehensive approach
will enable a healthy development of these children.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This study received no specific grant from any funding agency in the public, commercial or non-profit organizations.

Notes on contributors
Damla Eyuboglu is an assistant professor in the Department of Child and Adolescent Psychiatry at Osmangazi University,
Eskisehir-Turkey. Her research interests focus on infants and their learning enviroments and on psychotherapy.
Gul Caner Mercan is an associated professor in the Department of otorhinolaringoloy at Tepecik Training and Research
Hospital, Izmir-Turkey. Her research interest focus on children with hearing impairment.
Murat Eyuboglu is an assistant professor in the Department of Child and Adolescent Psychiatry at Osmangazi University,
Eskisehir-Turkey. His research interests include autism spectrum disorder, early childhood development and social
interactions.

ORCID
Damla Eyuboglu http://orcid.org/0000-0001-6042-7768
Gul Caner Mercan http://orcid.org/0000-0002-0968-9305
Murat Eyuboglu http://orcid.org/0000-0003-3278-0374

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