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Research in Developmental Disabilities
journal homepage: www.elsevier.com/locate/redevdis
Research Paper
Differences in self-advocacy among hard of hearing and typical
hearing students
Rinat Michael
⁎
, Haya Maroon Zidan
School of Education, Tel Aviv University, Ramat Aviv 6997801, Israel
A R T I C L E I N F O
Number of reviews completed is 2.
Keyword:
Self-advocacy
Hearing loss
Hard of hearing
Mainstream
A B S T R A C T
Background: Self-advocacy is considered a protective factor of psychosocial and academic problems
among students with special needs.
Aims: To asses self-advocacy among students with hearing loss and compare it to that of typical
hearing students.
Methods and procedure: The current study examined 27 hard of hearing (hh) students and 27
typical hearing students, all studying in mainstream classes. They completed the Hope Scale, a
self-esteem scale, a self-efficacy scale, and a measure of self-advocacy statements. Data regarding
the hh participants’ spoken language abilities were collected through their itinerant teachers.
Outcomes and results: HH students reported lower levels of self-esteem than the typical hearing
students. Emotional self-efficacy was positively correlated with age among the hh students, and
hope and effort were negatively correlated with age among typical hearing students. Some significant
positive correlations emerged among the hh participants between their syntactic and
pragmatic abilities and several self-advocacy indicators.
Conclusions and implications: Interventions aimed at enhancing self-advocacy among hh students
should focus on intensifying their self-esteem as well as their syntactic and pragmatic abilities.
1. Introduction
Self-advocacy is speaking up or taking action for oneself. It includes defending one’s rights and fighting for appropriate services
(Williams & Shoultz, 1982). Thus, the acquisition of effective communication skills is paramount for successful self-advocacy
(Schoffstall, Cawthon, Tarantolo-Leppo, & Wendel, 2015). Students with hearing loss who are mainstreamed may encounter various
challenges during their school years (e.g., Marschark & Albertini, 2004). Good self-advocacy skills may assist them in handling such
challenges. However, since many of them face acute communication barriers, their ability to express their needs and preferences to
others may be impaired (e.g., Eriks-Brophy et al., 2006).
Only few studies have examined self-advocacy among students with hearing loss in general and mainstreamed students in particular
and most of them focused on self-advocacy interventions and not on children's skills per se (e.g., Luckner & Muir, 2002). In
addition, most of these studies related to self-advocacy as a one-dimensional construct and not as a complex one, as suggested by
leading scholars in this domain (e.g., Kozminsky, 2004; Test, Fowler, Wood, Brewer, & Eddy, 2005). Furthermore, no comparison was
made with individuals with typical communication skills. Consequently, the knowledge about the ability of students with hearing loss
to advocate for themselves is limited. The current study adopted a broad conceptualization of self-advocacy (Kozminsky, 2004) and
examined various aspects of self-advocacy among hard of hearing (hh) students in comparison with typical hearing students studying
https://doi.org/10.1016/j.ridd.2017.11.005
Received 2 February 2017; Received in revised form 31 October 2017; Accepted 7 November 2017
⁎
Corresponding author.
E-mail addresses: freskori@post.tau.ac.il (R. Michael), haiahrdf@gmail.com (H.M. Zidan).
Research in Developmental Disabilities 72 (2018) 118–127
Available online 10 November 2017
0891-4222/ © 2017 Elsevier Ltd. All rights reserved.
T
in Arabic-speaking schools in Israel.
1.1. Self-Advocacy
Self-advocacy is considered a developmental process in which the individual gradually gains confidence in expressing ambitions
and emotions, taking responsibility over his or her life (Kozminsky, 2004). In general, there are two types of self-advocacy: group selfadvocacy
and personal self-advocacy. Group self-advocacy includes joint activities of people with similar needs which are aimed at
promoting social justice for the whole group. In contrast, personal self-advocacy includes actions of an individual, such as expressing
thoughts or emotions in an assertive way, developing the ability to choose and decide, acknowledging formal and informal rights, and
making changes in the environment. In this type of self-advocacy, the individual is not part of a group and the advocacy act is
perceived as a natural and obvious action based on the assumption that a person is responsible for his or her own choices in life
(Kozminsky, 2004; Zegar & Baumann, 2012). The current study focused on personal self-advocacy.
Different scholars have addressed the issue of self-advocacy with most of them tending to focus on only one specific aspect.
Weiner (1985), for example, described the motivation for self-advocating. He suggested that people tend to look for the causes of
their successes and failures. Individuals who perceive their successes and failures as processes which are related to their own planning
and efforts, have stronger motivation to engage in activities which will help them attain future success. Ellis (1962) emphasized the
diverse ways in which people respond to the same or similar events. This diversity is largely the result of differences in cognition or
belief systems and may impact individual behavior, including the action of self-advocacy. Yuan (1994) focused on the actual action of
self-advocacy. He proposed a structured way of verbalizing self-advocacy statements. First he suggested using a positive statement
aimed at attracting the listener's attention and expressing a readiness to progress, then a statement describing the individual's difficulties
and problems and the way in which they affect his or her behavior, and finally a statement suggesting a solution which takes
into account personal and environmental resources and difficulties. For example, if a hh student in a mainstream class finds it difficult
to follow an assignment's instructions which are given orally, he or she may approach the teacher and phrase a request accordingly: “I
want to be sure I will do the assignment according to your instructions (a positive statement), but I find it difficult to follow and
remember them when they are given orally (difficulty description). Could you please write them down (a suggested solution)?”.
More recently, Test and colleagues (Test et al., 2005) proposed a model of self-advocacy involving four components: two related
to knowledge (knowledge of self and knowledge of rights) and two related to skills (communication and leadership). According to this
model, in order to self-advocate individuals should first know and understand themselves; then, they need to communicate this
knowledge effectively to others; and finally, by developing leadership skills, they can move from individual self-advocacy to advocating
for a group of individuals with common concerns.
Another model put forth by Kozminsky’s (2004) suggests three components that are essential in order for individual self-advocacy
to occur: knowledge, motivational features, and skills. The knowledge component includes personal knowledge (of one’s special needs,
difficulties, and strengths), as well as environmental knowledge (regarding one’s rights, duties, and existing facilities which may help
a person to advocate himself or herself). The motivational features component includes characteristics essential for self-advocacy
such as self-determination, self-efficacy, self-esteem, and internal locus of control. The skills component includes skills that ensure the
efficiency of the self-advocacy act such as goal setting, decision- making, self-control, problem solving, working with others, assertive
communication, and the use of self-advocacy statements. Since Kozminsky’s model was more comprehensive in nature, including not
only components of knowledge and skills but also motivational features which are considered the fuel of self-advocacy (Kozminsky,
2004), and since understanding of the relationships between these three components is limited, the current study adopted Kozminsky’s
conceptualization of self-advocacy. Specifically, we examined the knowledge component through awareness of strengths,
the motivational features component through self-esteem and self-efficacy, and the skills component through the usage of selfadvocacy
statements.
Self-advocacy is especially important when considering students with special needs in general and those attending mainstream
classes in particular, since it is considered one of the most efficient ways to promote and encourage the social integration of these
students (Pitlyk, 2007). Additionally, most teachers in general settings are usually less trained to work with students with special
needs and have more difficulty including them. Indeed, a number of studies reported teachers' concerns regarding their own professional
competence and knowledge for the successful inclusion of students with disabilities in their classrooms (Forlin, 2001;
McLeskey & Waldron, 2002; Sharma, Forlin, Loreman, & Earle, 2006). Consequently, students with disabilities in mainstreamed
classes may have a greater need for self-advocacy than students in special education classes. The current study focused on hard of
hearing (hh) students attending mainstream classes.
1.2. Self-advocacy among HH students
Although there are audiological criteria for being hh, the current study adopted a more functional and social definition of this
concept in which a person with hearing loss who prefers to communicate through spoken language and places more importance on
blending into the hearing world then being part of the Deaf community is perceived as hh (e.g., Michael, Cinamon, & Most, 2015).
Indeed, students who are hh tend to study in mainstream classes and to use spoken language as their main mode of communication
(e.g., Allen, 1992; Mitchell & Karchmer, 2011).
Studying in a mainstream school can be quite challenging for students with hearing loss if only because of the mere fact that they
are often the only children with hearing loss in the entire school (Pitlyk, 2007). Although integration of students with hearing loss in
mainstream classes may contribute to them academically as well as socially (e.g., Antia, Jones, Luckner, Kreimeyer, & Reed, 2011), it
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
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may also be accompanied by emotional distress. For example, environmental conditions such as group instruction, background
noises, students whispering, and lack of consideration of hh students' special needs may isolate these students from their peers (Kent
& Smith, 2006). Several strategies have been proposed by scholars in order to facilitate the integration of hh students in mainstream
classes such as programs for communication skills development (e.g., Suarez, 2000) and joint activities for students with and without
hearing loss (Cambra, 2002). A leading strategy for supporting these students is the implementation of self-advocacy interventions.
In general, regardless of strategy type, better coping was found among older students (Martin & Bat-Chava, 2003). This may be
related to greater life experience and/or increased demands in the classroom. According to Foster (1998), for example, children who
have experience in encountering challenges and successfully coping with them will gradually learn to adapt to changes more easily.
Zegar & Baumann (2012) claim that students with hearing loss must learn to act for themselves so they will not miss academic and
social information. Teaching children with hearing loss self-advocacy skills is extremely important and thus should be done as early
as possible. They suggested encouraging young children to draw their teacher’s attention to situations in which they have difficulty
following what is said in class, such as when they cannot see the teacher’s face or when their hearing device is malfunctioning.
However, one should also take into consideration environmental factors which may impact children's sense of efficacy to selfadvocate
such as parental perceptions and cultural norms and values. For example, Crabtree (2007) found that Arab fathers of hh
children reported feelings of shame to the point where they did not want to be seen in public with their child. This tendency may
cause Arab hh children to feel less confident in their ability to express their needs and preferences
Indeed, the few studies which examined self-advocacy skills among students with hearing loss in mainstream classes suggested
that these skills are largely influenced by the students' environment, including their relationships with their parents, teachers, and
other authority figures. It seems that through proper guidance these children are able to develop good self-advocacy skills and realize
their rights (Luckner & Muir, 2001; Test et al., 2005). However, not much is known regarding their initial ability to self-advocate and
whether there are specific aspects of self-advocacy in which they may encounter difficulties.
Self-advocacy is expressed through verbal communication and is based on pragmatic skills (Kozminsky, 2004). Thus, when
examining self-advocacy, it is important to take into account the difficulties that many students with hearing loss tend to have in
spoken language such as relatively poor vocabulary (Bishop & Mogford-Bevan, 1993) and phonological and grammatical skills
(Delage & Tuller 2007). These difficulties may impact their development, their general knowledge, and their learning processes
(Moores & Meadow-Orlans, 1990; Marschark, Lang, & Spencer, 2011), as well as their emotional health and social integration
(Fellinger, Holzinger, Beitel, Laucht & Goldberg, 2009).
The current study examined self-advocacy among Israeli Arab students with and without hearing loss who were mainstreamed in
general education classes. It should be noted that children with hearing loss who are Arabic speakers are subject to an even more
complicated linguistic condition due to the diglossia of the Arabic language (i.e., the gap between the spoken and the literary
language). This condition causes the need to cope with two completely different languages (Ibrahim, 2009).
Following studies on better coping and communicative skills among older students (Martin & Bat-Chava, 2003), age differences
were also examined. In addition, the spoken language abilities of the hh students was taken into account in light of the importance of
verbal communication in self-advocacy acts (Kozminsky, 2004).
Based on Kozminsky’s (2004) model which proposed three components of self-advocacy (knowledge, motivational features, and
skills), the first research hypothesis was that aspects of these components will be inter-related. Specifically, we assumed that
awareness of strengths, self-esteem and self-efficacy, and mastery in self-advocacy statements will be positively correlated both
among hh students and typical hearing students. In light of their possible difficulties, the second research hypothesis was that hh
students will report lower levels of self-advocacy on all components compared to their hearing peers: they will be less aware of their
strengths, will have lower self-esteem and self-efficacy, and will exhibit lower levels of mastery in statements promoting self-advocacy.
A third hypothesis was that older hh student will report higher levels of self-advocacy, and a fourth hypothesis was that hh
students with better functioning in spoken language will report higher levels of self-advocacy.
2. Materials and method
2.1. Participants
Participants were 54 Israeli Arab students aged 11–15 (M = 12.59, SD = 1.37) in grades 5–9. Twenty-seven were hh and 27 had
typical hearing. In each group there were 17 boys and 10 girls and they were equally distributed across grades. All participants
attended general education classes in Arabic speaking schools in Israel and did not participate in any self-advocacy intervention. The
hh students used only spoken language as their mode of communication. They received additional support once or twice a week from
an itinerant teacher, whose specialty was deaf and hh education, in order for them to keep at pace with the general curriculum. This
support had been provided for them for at least five years and typically focused on relevant vocabulary and world knowledge which
these children often lacked due to their hearing loss. Table 1 presents additional data concerning the hh group.
2.2. Measures
2.2.1. Measures of self-advocacy
2.2.1.1. Awareness of strengths.. Awareness of strengths was measured by the Hope Scale (Snyder, 2002), a questionnaire aimed at
assessing personal strengths and resources that serve as a basis for investing effort for the realization of goals. The original
questionnaire includes six items divided into two factors: pathways thinking (i.e., perceived capacity to find routes to goals) and
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
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agency thinking (i.e., the motivation to use those routes) and has been used among students with and without disabilities (e.g.,
Lackaye, Margalit, Ziv, & Ziman, 2006). Meltzer and colleagues (Meltzer, Reddy, Pollica, Roditi, Sayer, & Theokas, 2004) added four
items measuring effort and examined this measure among students with disabilities. The response scale of each item ranges between
one (“never”) and six (“always”). Due to relatively low reliability scores of the pathways thinking and agency thinking factors in this
study (α = 0.47 and α = 0.57 respectively), factor analysis was conducted. The analysis yielded two factors with one item with
similar loadings on both factors. Consequently, this item was deleted. Based on item content, the two factors were considered as
measuring awareness of two abilities (or strengths): academic effort and problem solving. Alphas coefficients for these factors were 0.75
and 0.64, respectively. Internal consistency for the whole scale was 0.78.
2.2.1.2. Self-Esteem.. Self-esteem was assessed through the Rosenberg’s Self-Esteem Scale (1965), which was found to be suitable for
participants with hearing loss (e.g., Lu et al., 2015). This scale includes 10 items which are rated on a four-point Likert scale from
“Strongly disagree” to “Strongly agree” with higher scores indicating better self-esteem. The original internal consistency was 0.88. In
the current study internal consistency was 0.68.
2.2.1.3. Self-Efficacy.. The Self-Efficacy Questionnaire for Children (SEQ-C; Muris, 2001) was used in order to measure participants'
self-efficacy. Although not previously administered to individuals with hearing loss, this measure was reported suitable for diverse
samples including minorities and children from low SES background who may also face language difficulties (e.g., Suldo & Shaffer,
2007). It is a 24-item scale divided into three factors: social self-efficacy (the perceived capability for peer relationships and
assertiveness), academic self-efficacy (the perceived capability to manage one’s own learning behavior, to master academic subjects,
and to fulfill academic expectations), and emotional self-efficacy (the perceived capability of coping with negative emotions). Each
item is scored on a 5-point scale with 1 = not at all and 5 = very well. Muris reported Cronbach's alphas of 0.88 for the whole
questionnaire and between 0.85 and 0.88 for each of the sub-scales. In the current study, alphas were 0.86 for the whole
questionnaire and between 0.74 and 0.78 for the different sub-scales.
2.2.1.4. Mastery in self-advocacy statements.. In order to examine participants' ability to phrase self-advocacy statements, six scenarios
were written by the second author who is an experienced teacher of hh students. These scenarios are partly based on the contents of a
virtual self-advocacy course for hh students who study in mainstream classes (https://sites.google.com/a/lakash.tzafonet.org.il/
main/singur). Three of the scenarios focus on academic situations and three focus on social situations (Appendix A).
For each scenario participants were requested to answer two questions: (a) “In your opinion, what should the student do in order
to solve the situation?" and (b) “Tell me exactly: What should the student say?" Answers to the first question received either 0 (when
there was no mentioning of self-advocacy) or 1 (when participants included in their answers actions of self-advocacy, i.e., speaking up
or taking action for themselves). Scores of answers to the second question ranged between 0, when statements did not include any
aspect of self-advocacy, and 3, when statements included all three types of statements that are part of Yuan’s (1994) model of efficient
self-advocacy statements (a positive statement, a statement which describes the problem, and a suggested solution). Thus, the
minimum overall score was 0 and the maximum score was 4.
For inter-rater reliability purposes, a third of the scenarios were coded separately by three coders: the two authors and an
additional expert in deaf education. After the coding process was over, the level of agreement between evaluators was calculated.
Disagreement was apparent only in relation to 3.3% of the coding. A discussion among the evaluators determined the final coding of
the few cases in which there was disagreement. An internal reliability analysis revealed an internal consistency of 0.62 for the entire
measure and 0.64 and 0.79 for advocacy in academic situations and in social situations, respectively.
2.2.2. Demographics
Data regarding participants' characteristics such as age and gender were collected through their parents. Parents of students with
hearing loss also provided information about the severity of hearing loss, use of hearing device, main mode of communication, the
existence of other family members with hearing loss, type of mainstreaming, and subjects in which the students received additional
Table 1
Demographics of the HH Group (n = 27).
Variable Value Frequency %
Degree of hearing loss Mild 6 22.2
Mild-Moderate 2 7.4
Moderate 9 33.3
Moderate-Severe 2 7.4
Severe 5 18.5
Profound 3 11.1
Hearing loss onset Pre-lingual 18 66.7
Post-lingual 9 33.3
Hearing device Hearing aid 17 63.0
Cochlear implant 4 14.8
None 6 22.2
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
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support.
2.2.3. Spoken language abilities
The language level of the hh participants was assessed by their itinerant teachers. The teachers graded their students' overall
abilities in vocabulary, syntax, pragmatics, and speech intelligibility on a scale between 1 (“not good at all”) and 6 (“excellent”).
These domains were chosen since they were considered as most relevant for self-advocacy by an external expert in deaf education.
The self-advocacy literature also mentions language abilities as important for good self-advocacy such as pragmatics and other verbal
behaviors necessary for good communication (e.g., Lock & Layton, 2001; Van Reusen, 1996).
2.3. Procedure
After receiving approval from the Ministry of Education, students with hearing loss were approached through the treatment center
for students with hearing loss in the city of Tiberias which is responsible for all deaf and hh students living in northern Israel. Out of
80 students between the ages of 11 and 15 enrolled in this center, 27 students and their parents agreed to participate. Thus the return
rate was about 34%. The students with typical hearing also lived in northern Israel and were chosen through personal acquaintance
and the use of snowball sampling. All of them were reported as having typical development. They were matched by age and gender
with the hh participants. All participants and their parents assured they had not previously taken part in a self-advocacy intervention.
Both parental and child consent was obtained before the study began.
Students and their parents received explanations about the questionnaires by the second author who administered the research
questionnaires. The students completed the measures of self-advocacy indicators (awareness of strengths, self-esteem, self-efficacy,
and mastery in self-advocacy statements) and the parents completed a background questionnaire on their child. Research questionnaires
were administered individually in a quiet place in the participants' homes. The students and their parents were assured that
they could drop out from the study at any time. Each encounter lasted between 30 and 45 min. A form for the general assessment of
the hh students' spoken linguistic functioning in the four domains mentioned above was sent to their specialist teacher in deaf
education. All teachers completed the form.
2.4. Data analysis
Statistical analysis was conducted using the Statistical Package for the Social Sciences Version 21.0 (SPSS Inc., Chicago, IL, USA).
The baseline demographics were compared by descriptive analysis. Pearson correlations were used to calculate relationships between
aspects of self-advocacy (awareness of strengths, self-esteem and self-efficacy, and mastery in self-advocacy statements) and to
examine the relationships between students' age and self-advocacy. Independent samples t-tests were applied to compare differences
between the hh group and the typical hearing group on the indicators of self-advocacy. Spearman correlations were used to examine
relationships between students' language levels in the four domains (vocabulary, syntax, pragmatics, and speech intelligibility) and
the different self-advocacy variables.
3. Results
The first study goal was to examine the relationships between aspects of self-advocacy: awareness of strengths, self-esteem and
self-efficacy, and mastery in self-advocacy statements. Correlations which were calculated for each of the two study groups (students
with and without hearing loss), revealed some significant results (see Table 2).
As hypothesized, significant correlations between the different self-advocacy indicators were found within each study group.
Among the hh group significant positive correlations were found between most of the awareness of strength variables and most of the
self-efficacy variables; between self-esteem and the awareness of strength variables; and between self-esteem and most of the selfefficacy
variables. Among the typical hearing group similar significant correlations were found except for self-esteem, which was
positively correlated only with one self-efficacy variable (academic self-efficacy) and with two of the three awareness of strength
variables. Mastery of self-advocacy statements were not significantly correlated with the other indicators in either group.
Comparisons between correlations among the two study groups revealed only one significant difference which was between
problem solving and emotional self-efficacy (Z = −1.99, p < 0.05). As can be seen in Table 2, a higher correlation between these
two variables was found among the typical hearing group.
The second research goal was to explore differences between the hh group and the typical hearing group on the indicators of selfadvocacy.
A significant difference was found in self-esteem [t(52) = 4.61, p < 0.001]. As presented in Table 2, student with hearing
loss reported lower self-esteem than students with typical hearing.
The third goal of the study was to examine the relationships between students' age and self-advocacy. Indeed, some significant
correlations were found within each of the study groups. Among the hh students, significant positive correlations were found between
participants' age and their emotional self-efficacy (r = 0.46, p < 0.05) and general mastery in self-advocacy statements (r = 38,
p < 0.05). Among the typical hearing students, significant negative correlations were found between their age and their general
awareness of strengths (r = −0.39, p < 0.05) and academic effort (r = −0.43, p < 0.05). Comparisons between correlations
among the two groups revealed significant differences in the correlation between age and emotional self-efficacy (Z = −3.03,
p < 0.01) and between age and general awareness of strengths (Z = −2.09, p < 0.05). Whereas a stronger correlation was found
between age and emotional self-efficacy among the hh students, a stronger correlation was found between age and general awareness
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
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of strengths among the typical hearing students.
The fourth study goal was to explore the relationships between hh students' language abilities in four domains (vocabulary,
syntax, pragmatics, and speech intelligibility) and their self-advocacy. Analyses showed significant positive correlations between
syntactic abilities and emotional self-efficacy (r = 0.43, p < 0.05), between pragmatic abilities and general mastery in self-advocacy
statements (r = 0.56, p < 0.001), and between pragmatic abilities and mastery in self-advocacy statements in academic situations
(r = 0.59, p < 0.01).
4. Discussion
The present study examined self-advocacy among hh and typical hearing Israeli Arab students who studied in general education
classes. The selection of indicators of self-advocacy was based on Kozminsky’s (2004) model which proposes three main components:
knowledge, motivational features, and skills. This study examined specific aspects of each component: awareness of strengths in the
knowledge component, self-esteem and self-efficacy in the motivational features component, and mastery in self-advocacy statements
in the skills component.
4.1. Relationships between self-advocacy components
As hypothesized, significant positive correlations were found for each of the study groups between most of the self-advocacy
measures. However, there were no significant correlations between mastery in self-advocacy statements and the other variables.
These findings partly support Kozminsky’s (2004) model since they imply that at least certain aspects of the knowledge component of
self-advocacy (i.e., awareness of strengths) are related to certain aspects of the motivational features component (i.e., self-esteem and
self-efficacy). They are also in accordance with Di Giunta et al. (2013) who claimed that students who evaluate themselves better
show higher levels of self-efficacy and tend to persist in their efforts to achieve the goals that have been set for them as long as they
feel that they are able to cope with the challenges imposed by these goals.
A possible explanation for the lack of correlations between the ability to phrase self-advocacy statements and the other study
variables may be due to an essential difference between them. Whereas mastery in self-advocacy statements is an ability which is
Table 2
Means, Standard Deviations, and Inter-Correlations between the Self-Advocacy Variables among the Hard of Hearing (n = 27) and the Typical Hearing (n = 27)
Participants.
Variable Group M SD 2 3 4 5 6 7 8 9 10 11
1. General awareness of strengths HH 4.75 0.60 0.82***
0.81***
0.69***
0.53**
0.62**
0.42*
0.23 0.14 0.13 0.19
TH 4.83 0.76 0.70***
0.88***
0.45*
0.73***
0.57**
0.59**
0.61**
0.05 0.05 0.07
2. Academic effort HH 5.04 0.75 0.34 0.57**
0.51**
0.51**
0.50**
0.21 0.21 0.06 0.29
TH 5.13 0.85 0.28 0.31 0.46*
0.21 0.64***
0.29 0.16 −0.15 0.13
3. Problem solving HH 4.55 0.67 0.51**
0.32 0.47*
0.15 0.15 0.01 0.20 0.02
TH 4.59 0.96 0.40*
0.67***
0.61**
0.37 0.62**
−0.08 0.19 −0.02
4. Self-esteem HH 3.31 0.32 0.46*
0.46*
0.46*
0.14 0.05 0.10 0.10
TH 3.66 0.24 0.37 0.21 0.40*
0.24 −0.27 0.19 −0.20
5. General self-efficacy HH 3.79 0.58 0.84***
0.89***
0.72***
0.09 0.35 −0.11
TH 3.89 0.49 0.87***
0.74***
0.82***
−0.02 0.05 −0.09
Total 3.84 0.53 0.85***
0.82***
0.77***
0.04 0.18 −0.10
6. Social self-efficacy HH 3.84 0.77 0.68***
0.32 0.02 −0.22 0.19
TH 3.94 0.61 0.46*
0.62**
−0.02 0.14 0.05
7. Academic self-efficacy HH 4.06 0.64 0.52**
0.01 −0.35 0.34
TH 4.04 0.50 0.41*
0.04 0.03 0.06
8. Emotional self-efficacy HH 3.52 0.83 0.17 0.02 0.37
TH 3.69 0.78 0.05 0.07 0.07
9. General mastery in self-advocacy
statements
HH 2.54 0.56 0.63***
0.63***
TH 2.58 0.67 0.45*
0.96***
10. Academic self-advocacy HH 2.53 0.35 −0.08
TH 2.58 0.63
Total 2.56 0.64 0.48***
11. Social self-advocacy HH 2.57 0.56
TH 2.54 0.72
Note. HH = hard of hearing; TH = typical hearing.
* p < 0.05.
** p < 0.01.
*** p < 0.001.
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
123
expressed in real-life situations, the other variables reflect feelings, beliefs, and personal perceptions. There may be a gap between
what individuals think or feel about themselves and their ability to act. As previously suggested (e.g., Eriks-Brophy et al., 2006), since
many students with hearing loss face acute communication barriers, their ability to express their needs and preferences to others may
be impaired. Thus, it may be that even if such students are aware of their strengths and feel confident and able, they may still suffer
from difficulties in acting as their own advocates.
4.2. Differences in self-advocacy
In accordance with the research hypothesis, the hh students reported lower levels of self-esteem as compared with the typical
hearing students. However, there were no significant differences between the two groups in the other self-advocacy indicators. The
lack of significant differences may be explained by the fact that all hh participants studied in mainstream classes. Previous studies
(e.g., Ingber & Beni-Noked, 2010) have emphasized the contribution of mainstreaming to the ability of students with hearing loss to
cope with various academic and social tasks. For example, these students are more exposed to spoken language than students in
special education settings. This exposure may lead to better literacy skills and better academic and social performance (Cambra,
2002; Luckner & Muir, 2001). In addition, their speech may be more coherent enabling them to express themselves better in a hearing
environment than students who use mainly sign language as their mode of communication. Indeed, positive associations have been
found in other studies between the use of spoken language and the functioning of students with hearing loss who are enrolled in
general education, including their learning processes, general knowledge, and social-emotional and cognitive development (Moores &
Meadow-Orlans, 1990; Marschark et al., 2011). An intervening factor may be the type of communication hh students have with their
parents. For example, studies have found that Deaf children who have Deaf parents and use sign language as their main mode of
communication tend to have relatively good social-emotional adjustment as well as behavioral, academic, and communicative
functioning (Polat, 2003; Weisel, 1988). This population was not examined in this study.
Mainstreaming also may expose children with hearing loss to different challenges which may be less apparent in special education
settings, such as studying in large classes and communicating in spoken language. These challenges may enhance their awareness of
their difficulties, as well as their awareness of their strengths.
Another factor which may explain the lack of differences found between the two study groups in awareness of strengths, selfefficacy,
and mastery in self-advocacy statements is the fact that all hh participants received support from an itinerant teacher once or
twice a week. Studies have found that such adjunct teachers may help develop students' learning strategies, social skills, and selfadvocacy
(Antia, Kreimeyer, Metz, & Spolsky, 2010; Luckner & Muir, 2001). Thus, it is possible that the hh participants were similar
to the typical hearing ones on most of the self-advocacy indicators in the current study, despite possible communication and language
difficulties, due to the support they received from their special teacher.
Despite the potential contribution of mainstreaming to students with hearing loss, it may also be accompanied by emotional
distress since these students may feel different from their peers with typical hearing, express feelings of isolation (Leigh, 1999;
Stinson, Whitmire, & Kluwin, 1996), social problems (Wolters, Knoors, Cillessen, & Verhoeven, 2011), and encounter difficulties in
affective interaction (Weisel & Bar-Lev, 1992). Consequently, even if they feel efficient and are aware of their strengths, their selfvalue
as compared to their typical hearing peers may be relatively low, as found in the current study. Since no comparisons were
made in this study between hh students from different educational settings (general vs. special), it is recommended that future studies
examine in a more direct manner the contribution of mainstreaming to various aspects of hh student's self-advocacy.
In general, the difference which was found between participants with and without hearing loss in self-esteem is in accordance
with previous studies (e.g., Zmiro, Kurtz, & Reiter, 2007) and emphasizes the potential impact that hearing loss may have on
individuals' self-esteem. According to Eichngreen and Hofain (2009), children may perceive having a hearing loss as a central trait,
which colors their whole personality to a point that other characteristics do not receive sufficient attention. Lebel-Hagai (2011)
claimed that persons who grow up having a hearing loss may develop stereotypic perceptions in relation to their situation and
consequently suffer from poor self-image and frustration. In contrast, Kemmery & Compton (2014) who examined perspectives of
identity related to perceptions of hearing loss among students with hearing loss and their caregivers/parents found self-determined
identity types, the notion of identity as a fluid concept, and a sense of management as well as a sense of perseverance. It seems that
having a hearing loss may be a possible but not a necessary condition for low self-esteem. Indeed, studies which examined self-esteem
among students with hearing loss have reported that self-esteem was associated with the students' personality and not with their
degree of hearing loss (Kemmery & Compton, 2014; Warner-Czyz, Loy, Evans, Wetsel, & Tobey, 2015). In fact, Jambor & Elliott
(2005) found that students with more severe hearing loss had higher self-esteem. They suggested that among these students hearing
loss is perceived as part of their personality and they tend to accept themselves more easily as compared with students with less
severe hearing loss.
The lower levels of self-esteem among hh participants may be also explained by cultural factors. As noted above, Crabtree (2007)
found that Arab fathers of hh children reported feelings of shame to the point where they did not want to be seen in public with their
child. Such behavior may largely influence hh children's self-esteem. Thus, one of the main conclusions from the current study's
findings may be that although students with hearing loss are aware that their success depends on their motivation and efforts, and
despite relatively high levels of self-efficacy, they still consider themselves inferior to students with typical hearing. In any case, the
lower levels of self-esteem found in this study suggest that professionals working with students with hearing loss should pay attention
to their inner world and enable them to process emotional issues so they could set aside limited self-perceptions.
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
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4.3. Relationships between age and self-advocacy
Some correlations emerged within the study groups between participants' age and their self-advocacy. Among students with
typical hearing, older children reported lower levels of awareness of strengths in general and academic effort in particular. A possible
explanation may be related to students' understanding that the older they get the tougher their studies become. Indeed, many
students report that during the transition from elementary to junior high there is a decrease in their academic functioning, and
specifically in their internal motivation, more stress, greater academic competitiveness, and a sense of losing personal control and
competence (e.g., Forgan & Vaughn, 2000). The fact that these correlations were not reported among students with hearing loss may
be due to the increasing amount of accommodations they receive as academic demands rise.
Among students with hearing loss, a significant positive correlation was found between age and emotional self-efficacy, a correlation
which was significantly stronger in this group than in the typical hearing group. This finding may be explained by the fact
that students with hearing loss who study in mainstream classes (as was the case in this study) often receive emotional support and
positive reinforcements from professionals working with them (such as their specialist teacher or speech therapist). This support may
enable them to process their feelings particularly during sensitive periods such as the transition from elementary to junior high.
Another possible explanation for the correlation which was found between hh students' age and their emotional self-efficacy is
also related to the fact that they studied in mainstream classes with typical hearing students. It may be that in order to overcome
obstacles imposed by their hearing loss, these students use personal control skills on a daily basis. Consequently, they may develop
stronger emotional immunity then their typical hearing peers who do not have to go through the same negative experiences.
According to Galla and Wood (2012), strong emotional self-efficacy suggests previous success in monitoring negative emotions,
which may explain why students with hearing loss exhibit higher levels of emotional efficacy as they grow older.
4.4. Spoken language abilities and self-advocacy among HH participants
As hypothesized, the hh students' language abilities were related to some of the self-advocacy components. Specifically, significant
positive correlations were found between their syntactic abilities and emotional self-efficacy, between their pragmatic
abilities and their general mastery in self-advocacy statements, and between their pragmatic abilities and their mastery in selfadvocacy
statements in academic situations. These findings follow previous studies which emphasized the importance of language for
different types of functioning, including social-emotional and cognitive development, general knowledge acquisition, and learning
processes (Moores & Meadow-Orlans, 1990; Marschark et al., 2011). These findings do not come as a surprise since self-advocacy is
expressed through verbal communication and is based on the use of language in a social-communicative context (Kozminsky, 2004).
In addition, studies have reported an association between higher language abilities and better social-emotional skills (e.g., Nelson,
Welsh, Vance Trup, & Greenberg, 2010) which may include emotional efficacy as well.
5. Conclusions
In sum, the research findings suggest that although knowledge and motivational features of self-advocacy may be inter-related,
the actual ability to phrase self-advocacy statements is more related to variables such as language abilities, at least when examining
hh students. The study's results also imply that in order for hh students in mainstreamed oral educational settings to reach at least
equivalent self-advocacy skills as children with typical hearing, interventions aimed at enhancing self-advocacy among hh students
should focus on intensifying their self-esteem as well as their syntactic and pragmatic abilities.
The current study has some limitations which should be addressed. First, the sample size was relatively small since it was difficult
to locate students with hearing loss who did not participate in self-advocacy interventions. Second, although relevant to a large
proportion of hh students, the study's findings are limited to hh students from mainstream classes and are not necessarily salient for
students in special education settings or in settings where sign language is the primary modality of communication and not spoken
language. In addition, the sample included a specific sub-group within Israeli society, i.e., Arab speaking children. Since different
social groups may have different attitudes towards individuals with special needs and different perceptions of their abilities (e.g.,
Crabtree, 2007), a cross-cultural study on self-advocacy seems essential. Finally, this study included the development of a preliminary
self-advocacy skills measure which contained academic and social scenarios. Future studies should further examine this measure and
maybe develop a complementary measure with closed items.
Despite the study's limitations its findings are of importance. First of all, in contrast to previous studies which mainly examined
the contribution of different self-advocacy interventions to their participants, this study examined the self-advocacy skills of an
under-studied group, that is students with hearing loss who had not received any formal guidance in self-advocacy skills. This enabled
an evaluation of their basic abilities in self-advocacy that have developed naturally (e.g., Portman & Portman, 2002). Secondly, the
current study employed a comprehensive approach to self-advocacy by referring to three of its components (knowledge, motivational
features, and skills) rather than addressing only one aspect (mainly skills) as done in most previous studies (Roberts, Ju, & Zhang,
2016). Thirdly, the comparisons between participants with and without hearing loss enabled a better understanding not only of the
self-advocacy skills of individuals with special needs, but also of individuals with typical development. Fourth, this study examined
students' self-reports. Although they may be influenced by social desirability, they also enable these students to speak out and express
themselves. Thus, the study's findings shed light on the way hh students feel, think, and assess themselves in situations which require
self-advocacy. The fact that participants were similar in their background (e.g., cultural affiliation, main mode of communication,
and type of educational institution) strengthens the ability to conclude that the differences and similarities which were found
R. Michael, H.M. Zidan Research in Developmental Disabilities 72 (2018) 118–127
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between the hh study group and the typical hearing group are probably related to hearing status and associated factors rather than to
other social and educational variables.
Appendix A
Scenarios for Measuring Mastery in Self-Advocacy Statements
Academic Situations
1. Yousef had a history test. A few days prior to the test, his teacher explained about the test in class, but Yousef did not hear the
whole explanation and consequently went over only part of the material for the test. When the teacher returned his test, she said
in front of the whole class: “You got a low grade because you didn’t study for the test. Too bad that you don’t listen in class.”
2. During English class the teacher dictates and spells a lot of words. Since he has difficulties hearing, Rammy has to watch the
teacher’s lips while she speaks. The problem is that he has difficulties watching her lips and writing down what she says at the
same time.
3. Nadin has difficulties in assignments which require her to express herself orally, such as participating in classroom discussions.
She tries to avoid looking at the teacher so she won’t ask her to talk. She claims that when she starts talking, she hears her
classmates giggle because her speech is not very clear.
Social Situations
1. Yesterday, at the end of the last lesson and after the teacher went out of the class, one of the students invited all of the students to
her birthday party which was supposed to be held that day at 5:00 pm. Ahmed did not hear what she said and missed the birthday
party. This is not the first time that he has missed a social event and the other guys in class are offended by him. The next day, the
students asked him why he didn’t come and he didn’t know what to answer them.
2. Samira’s big sister is ashamed to be seen with her because of her hearing aid. When they go out together, she asks her to have her
hair down. Samira is very offended by her,
3. Nisim loves gym class. However, when he participates in group games he doesn’t hear the teacher’s instructions and his team
mates calling him. Since Nisim sweats a lot during games, he has to take off his hearing aids.
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