Supporting Mental Health in DHH Students in the School

Understanding Mental Health in DHH Students

Mental health in DHH students includes emotional, behavioral, and social well-being. Schools play an important role by recognizing concerns early, providing accessible communication, collaborating with families, and connecting students with appropriate mental health supports. Early intervention helps students build resilience, confidence, and long-term success.

Every student deserves to feel safe, connected, and supported at school. Deaf and hard-of-hearing (DHH) students may experience unique communication, social, and educational challenges that can influence their emotional well-being. Understanding the difference between expected responses to hearing loss and signs of a developing mental health concern helps educators provide timely, appropriate support while creating an inclusive learning environment.

With the current pandemic and world events, there has been an increase in issues impacting children’s mental health,^1, and studies indicate that deaf and hard-of-hearing (D/HH) children are at higher risk for emotional and behavioral issues². Teachers and other professionals working with D/HH children are often the first to recognize when a student may be experiencing mental health concerns. Knowing the indicators of mental health issues, what to do next, and how to support students and their families is critical. This article will share this information.

What Does Current Research Tell Us About Mental Health in DHH Students?

Contributing factors to the increased rate of social-emotional difficulties in deaf children include being isolated, bullied, or abused⁴, experiencing feelings of loneliness or depression⁵, and experiencing difficulties in school.⁶

Also, language deprivation during the critical period (e.g., birth to 5 years of age) can have permanent consequences for long-term neurological development, which, in turn, directly affects the D/HH child’s mental health development.⁷  Language deprivation puts deaf children at risk for cognitive difficulties, mental health challenges, lower quality of life, higher levels of trauma, and restricted health literacy.⁸

When mental health services are sought, additional issues often arise. Since D/HH children are a low-incidence population, mental health providers frequently lack the specific training to work with this population and are typically unaware of the specialized needs and training required to provide effective services. This can result in the incorrect diagnosis of cognitive impairments or thought disorders.^{9, 10}  In addition, assessment tools are not modified to take into account the linguistic characteristics of this population or cultural norms and values.

What This Research Means for Schools

This research is a reminder that many emotional or behavioral problems are not directly caused by hearing loss. Instead, children often face challenges when they have communication hurdles, social isolation, limited language access, or fewer opportunities to feel included. Knowing these variables helps school teams to respond with appropriate supports rather than assumptions.

When Further Investigation and Support May Be Needed

• A teacher is asked by a student to frequently go to the nurse or to call her parents to ask to go home as she does not feel well, but there seems to be no underlying health conditions.
• A teacher receives a report from the educational interpreter that a student has not been watching the interpreter during the school day as he had been previously, even though the IEP team has determined the student needs the visual interpreted access to spoken information.
• A teacher observes an elementary student’s behavior change from being friendly and outgoing to being quiet and withdrawn with their D/HH and/or hearing peers.
• A teacher has a student share that she often feels ignored and neglected at home and that no one in her family is able to communicate with her. She mentions wanting to live with a different family.
• A student who self-identifies as Deaf expresses concerns to her teacher that she is being bullied by two other students in her integrated class; the Deaf student states that one of the students asked her if she is deaf, and she replies, “No, I’m hearing.”

Indicators of Concern – Further investigation and support may be needed if you notice the following:

Communication

• Not wanting to wear/use listening devices
• Not watching/working with an educational interpreter
• No longer advocating for one’s own communication needs
• Suppressing communication needs so as not to be perceived as being different

Academic

• Difficulty with abstract thinking
• Difficulty with the construct of cause and effect
• Declining academic performance
• Not completing assignments
• Not participating in class or group activities

Social

• Isolation, lack of friends, loneliness
• Avoiding activities or people, especially those previously enjoyed

Behaviors

• Missing several days of school or sessions without reason
• Complaining of physical aches that do not seem to have a medical reason
• Acting out in class
• Falling asleep in class
• Perseverating on certain thoughts, activities, or actions
• Sudden gain or loss of weight
• Describing hearing or seeing things that are not real

Emotions

• Sharing sad and hopeless feelings without good reason that do not go away
• Expressing unusual fears or worries
• Exhibiting fits of frustration or anger

Image Credit: Nagy-bagoly Ilona / 123RF

What to Consider Before Referring a Student

• Discuss your concerns with a school counselor, school social worker, school psychologist, supervisor, or administrator.
• Gather additional information from the student’s team about their observations and concerns.
• Review with the team, who will contact the family and student about concerns and discuss next steps.

Before Making  a Referral

Before you refer, ask yourself if communication access, language development, hearing technology, classroom accommodations, or social inclusion have been effectively addressed. Difficulties in these areas can have an impact on behavior and emotional well-being and should be evaluated alongside any other mental health difficulties.

Responding to Mental Health Emergencies

If suicide is a concern, it is essential to ask a child if they have thought about harming themselves and if they have a plan. Asking these questions will not cause a child to consider taking action, but it will provide more information about what steps need to be taken next. If a child has a detailed plan, it is important to remain calm and respond in a nonjudgmental manner. Express appreciation that they shared with you and request backup support without leaving the student on their own, if possible. If immediate help is needed, it may be necessary to bring the D/HH child to the emergency room at the local hospital. Interpreters can be requested at the hospital as needed.

Supporting Families in Finding a Mental Health Provider

Ideally, the provider seeing the student should be fluent in the communication that the child is most comfortable using and have experience working with children who are D/HH. Seek referrals from other families who have D/HH children, schools for the deaf, and staff working with students who are D/HH to find qualified providers in your community. If an interpreter is needed, this should not be done by a family member but by a certified interpreter. Request the interpreter from the medical provider; the medical provider needs to cover the cost of the interpreter at no additional cost to the family.

Partnering with Families to Access Mental Health Services

Families are critical components of the support team. Schools can foster trust by sharing observations in a respectful manner, listening to family concerns, providing culturally relevant resources, and assisting families in locating providers that have experience dealing with deaf and hard-of-hearing students.

Working Together to Support Students

Here are additional examples to support an IEP or the creation or additions to a 504 that are appropriate.

Additions to an IEP

• Socialization goals
• Self-advocacy goals

Additions to a 504 and/or IEP

• Additional time to take tests and/or complete assignments
• Taking breaks during the school day as needed
• Assignment of an emotional support teacher for the student to work with during the day to obtain support and take a break from the stressors of school

School-Based Strategies That Support Mental Health in DHH Students

• Partner with mental health professionals in the school to discuss students’ potential mental health issues, indicators of symptoms, and outcomes when support is received. These discussions lead to overall assimilation of the value of mental health services and children becoming more comfortable discussing mental health as they would other medical issues.
• Create opportunities for peer support with D/HH students to discuss concerns with others and validate their experiences.
• Develop social skills as needed, so children develop a peer group and have daily positive interactions with others.
• Create opportunities for students to interact with D/HH adults so they can envision a future for themselves.
• Be aware of cultural influences or misunderstandings creating the perception of mental health concerns; examples include strong facial expressions, heavy use of eye contact, and use of touch to gain attention.
• Communicate with families when concerning indicators are observed and share information about available resources they can explore.
• When possible, offer outreach to families experiencing stress. Family and sibling support groups can bolster the resilience of families who have D/HH children.

Building Protective Factors

Schools can strengthen student mental health by creating accessible communication environments, encouraging peer relationships, supporting self-advocacy, promoting belonging, celebrating strengths, and providing opportunities for meaningful participation in school activities.

Final Thoughts on Mental Health in DHH Students

As a teacher, your consistent contact with your students allows you to notice changes in behavior and academics. If you notice any of the concerning indicators listed above, discuss them with your supervisor, administrator, or mental health school professional. You do not need to make the decision if treatment is needed. Instead, focus on working with the educational team, family, and other members of the child’s community, such as their pediatrician, to develop a supportive plan.

Image Credit: wavebreakmedia / Shutterstock

Supporting mental health in DHH students is a shared responsibility among educators, families, school mental health professionals, and community providers. When communication access, emotional support, and strong relationships work together, students are more likely to thrive academically, socially, and emotionally.

There are many supports that can be put in place to address a student’s mental health; the earlier they are engaged, the sooner the student can continue to reach their academic potential. In some cases, when severe mental health symptoms are present, community mental health resources should be explored at the discretion of the family. Ideally, the mental health provider would be able to communicate directly in the shared language of the D/HH child; if these resources are unavailable, encourage families to request reasonable accommodations for the child.

Ultimately, by supporting students’ mental health,
teachers facilitate students’ overall academic growth.

Mental Health in DHH Students: Key Takeaways

✔️ Mental health concerns are not caused by hearing loss alone.
✔️ Communication access is essential for emotional well-being.
✔️ Early identification leads to better outcomes.
✔️ Collaboration between schools and families improves support.
✔️ Inclusive environments strengthen resilience.
✔️ Every student deserves access to appropriate mental health services.

Frequently Asked Questions About Supporting Mental Health in DHH Students

Why are deaf and hard-of-hearing students at a greater risk for mental health concerns?
A variety of systemic factors can impact mental health in DHH students. Overt communication barriers, quiet relational social isolation, a history of peer bullying, and varying degrees of language deprivation all place immense strain on a child’s emotional baseline. Furthermore, a lack of specialized mental health professionals who understand deaf culture or audiological school dynamics can leave students without adequate, accessible support.

What behavioral signs indicate a DHH student needs additional mental health support?
Because DHH students often deal with heavy listening fatigue, emotional distress can look like simple physical exhaustion. School teams should watch closely for these specific changes in a student’s daily baseline:

How does communication access directly influence emotional well-being?
When a student has seamless, reliable access to all communication in the classroom, they feel valued, safe, and fully included. Conversely, constant communication breakdowns create a background hum of anxiety and frustration. Ensuring full communication access is not just an academic accommodation; it is a foundational pillar for protecting a student’s confidence and overall mental health.

How can teaching self-advocacy serve as a proactive mental health intervention?
Self-advocacy is the single most effective tool for building long-term psychological resilience. When a student learns to speak up for their needs rather than quietly giving up, they shift from a state of learned helplessness to one of confidence. This direct correlation makes self-advocacy an essential part of an independence plan that serves them well past high school graduation.

What practical self-advocacy actions can students take to reduce daily classroom anxiety?
Rather than expecting kids to figure it out on their own, educators should explicitly model and practice these real-world communication check-ins with their students:

• Manage Physical Seating and Audio Equipment:
  • Immediate Learning Environment.
  • Teach the student to independently check that their assistive technology is powered on, report a malfunctioning microphone right away, and choose a seating location that optimizes their line of sight.
• Request Real-Time Adjustments and Accommodations:
  • Navigating Lessons.
  • Equip the student with simple phrases to ask teachers to repeat instructions, speak clearly, or verify that accurate closed-captioning is running on all video materials.
• Flag Overlooked Communication Gaps and Breakdowns:
  • Collaborative Problem-Solving.
  • Encourage the child to confidently voice when a comment from a peer was missed during fast-moving group work, ensuring they remain an active participant in their own education.

When should a school formally refer a DHH student for specialized mental health services?
A formal referral should be made whenever a student’s behavioral or emotional struggles persist across several weeks, interfere with their learning and social relationships, or differ significantly from typical developmental expectations. When initiating this process, schools should partner closely with families to connect the student with providers who understand the specific language, culture, and social dynamics of growing up with a hearing loss.

Additional Mental Health Resources:

National Suicide Prevention Lifeline
Voice: 1-800-273-TALK (8255)
Deaf callers use VideoPhone Relay Services, e.g., P3, Sorenson, Convo, ZVRS, and then give the voice phone number above. Website: suicidepreventionlifeline.org

National Suicide Prevention Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone dealing with a suicidal crisis or emotional distress. The call will be directed to the nearest crisis center in the national network of over 150 crisis centers. As there is no ASL hotline for suicide prevention available, this is the best option for Deaf emergency services related to suicide.

Crisis Text Line
Text: Type HOME to 741741 in the US. Website: CrisisTextLine.org
Crisis Text Line is a free, 24/7 text support line for anyone in a mental health crisis. To chat with a trained crisis counselor, text HOME to 741741 from anywhere in the US. This service is free and available all day and night to anyone who is experiencing any type of crisis. Texting is a way to get mental health support and information about mental health services quickly, and it is very useful for D/HH people.

Additional Resources for Supporting Mental Health in DHH Students:
Bullying and Students with Hearing Loss: What Parents and Educators Need to Know
Self-Concept Assessment Strategies for Adolescents with Hearing Loss
How They See Themselves: Self-Concept in Children with Hearing Loss
Self-Concept in Early Childhood: Infants, Toddlers, & Preschoolers with Hearing Loss
Supporting Self-Concept in Students with Hearing Loss: 3 Go-To Ideas
Understanding Self-Identity and Hearing Loss in Children and Teens
Self-Concept in School-Age Children with Hearing Loss
Addressing Self-Esteem and Issues of Fitting In
Teens and the Price to Pass as ‘Normal’
Reducing Stigma and Peer Victimization for Students with Hearing Loss
Bullying and Teasing: Protecting Students with Hearing Loss
What I Wish My Educators Had Known: 20 Tips from Mainstream Deaf and Hard-of-Hearing (DHH) Individuals

Mental Health in DHH Students: References

1. “Children’s Mental Health Is in Crisis.” American Psychological Association, 1 Jan. 2022, apa.org/monitor/2022/01/special-childrens-mental-health.
2. Stevenson, J., Kreppner, J., Pimperton, H., Worsfold, S., & Kennedy, C. (2015). Emotional and behavioral difficulties in children and adolescents with hearing impairment: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 24(5), 477–496.
3. Hintermair, M. (2007). Prevalence of socioemotional problems in deaf and hard-of-hearing children in Germany. Am Ann, Deaf, Summer; 152(3):320-30.
4. Wolters N, Knoors HE, Cillessen AH, Verhoeven L. (2011). Predicting acceptance and popularity in early adolescence as a function of hearing status, gender, and educational setting. Research in Developmental Disabilities. Nov-Dec;32(6):2553-65.
5. Glickman, N. (Spring 2007). Do You Hear Voices? Problems in Assessment of Mental Status in Deaf Persons With Severe Language Deprivation, The Journal of Deaf Studies and Deaf Education, Volume 12, Issue 2, 127–147.
6. Fellinger & Pollard. (2012).  Mental health of deaf people. https://pubmed.ncbi.nlm.nih.gov/22423884/
7. Hall WC, Levin LL, Anderson ML. “Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins. “Social psychiatry and psychiatric epidemiology. 2017 Jun 0; 52(6): 761-776. Epub 2017 Feb 16.
8. Gulati, S. (2014). Language deprivation syndrome. ASL Lecture Series.
9. Morgan, A. & Vernon, M. (1994). A guide in the diagnosis of learning disabilities in deaf and hard-of-hearing children and adults. American Annals of the Deaf, 139(3), 358-370.
10. Hindley, P. A., Hill, P. D., McGuigan, S., & Kitson, N. (1994). Psychiatric disorder in deaf and hearing-impaired children and young people: A prevalence study. Child Psychology & Psychiatry & Allied Disciplines, 35(5), 917–934.

Authors: Roberta Rossman, MEd, MSW, LSW & Polly Brekke, EdD, PsyS.

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Originally published: May 2022
Last update: June 2026