Hard-of-hearing children’s sense of identity and belonging

This study explores the process of identity construction for hard-of-hearing (HH) children in Sweden. Twenty-nine children aged 9 16 years who attended special classes for HH students were interviewed. During this longitudinal study, all classes were moved from an oral to a signing school environment. The findings support the position that a bilingual HH identity exists. HH children often construct their identity by widening their reference group to include not just HH but also those who are ‘almost the same’. They can have a sense of belonging either to deaf or hearing children, or both. In the development of identity HH children make distinctions between subgroups within their reference group. There were also children in crisis or with an unclear identity. This needs to be further explored to determine if the crisis is a productive part of identity construction or a problem requiring support. Gender construction also needs to be further explored.


Introduction
The aim of this longitudinal childhood study is to explore hard-of-hearing (HH) identities from the standpoint of adolescents attending HH classes. The research is framed by symbolic interactionism (Mead 1995;Charon 1995;Frønes 1994;Trost and Levin 1999;Owens, Stryker, and Goodman 2001;Jenkins 2004) and an identityand-difference perspective (Woodward 1997). During the course of this study the adolescents attended different school settings for HH children, and switched significant others at school Á from hearing to deaf peers within the majority group of children at school.
One's social identity or identities grow, develop and change throughout life and can be understood as a process that is never final or settled although adolescence is a stage of life central to identity construction: 'Social identity is our understanding of who we are and of who other people are, and, reciprocally other people's understanding of themselves and others (which includes us)' (Jenkins 2004, 5). The foundation is created, confirmed and transformed in interaction with parents and teachers as well as siblings and peers. Theoretically identities can be personal or collective, and are frequently constructed in terms of oppositions such as boy/girl, normal/deviant, able-bodied/ disabled etc., as well as in terms of insiders and outsiders, 'us' and 'them' (Woodward 1997). In internal-external dialectic, memberships in different groups or sub-groups are key emotional factors in bridging between collective identities and personal identities. Jenkins (2004) argues that the individually unique and the collectively shared identities can be similar and related to or entangled with each other. In the search for similarity, a sense of belonging and a feeling of being the same as others or almost the same are important.
In the identity-construction process presented in this article I will focus on how the children's personal identities are related to their collective identities and their sense of belonging to different groups that are 'the same' or subgroups that are 'almost the same'. I will use the concept of belonging from an internal and personal position, and inclusion/exclusion from an external and collective position.

Identity and self-esteem
The HH girls and boys are involved in a struggle with other children for power and status, for friends, for what is right and wrong, etc., a struggle in which they test who they are. Situations of negotiation become central both in relation to adults (vertical relations) and to other children (horizontal relations) (Jansson 1996). Relations between children may, to a large extent, be characterized by mutuality, similar functional prerequisites, and equality in social status, i.e. horizontality. For children with disabilities, however, the relation to peers without a disability could be characterized by verticality; i.e. they can find themselves in a subordinate position in terms of power (Nordströ m 2002). That HH and deaf children indeed are in a subordinate position, and are excluded in numerous ways at school, has been identified by researchers in many different countries (Andersson and Lawenius 1997;Israelite, Ower, and Goldstein 2002;Kent 2003;Nikolaraizi and Hadjikakou 2006). School experience, the social atmosphere and interaction with other children and teachers are significant factors in moulding the identity of a HH or deaf child. In a New Zealand study, the majority (55.8%) of HH children did not identify as having a hearing disability (see Kent 2003). This may reflect a stigma attached to being HH in the mainstream schools. The way they are treated in the school environment thus seems to have a major impact on the children's development of identity and the feeling of 'being similar' becomes the recognition of being an insider in a reference group.
The HH are a large group of persons living all over Sweden, but are not a culturally recognized group in the same way as are the deaf (Ahlströ m and Preisler 1998). Nevertheless, researchers have asserted that there is a HH identity (Andersson and Lawenius 1997), an identity that young people may construct 'based on their position with regard to hearing and deaf peers, and the differentness of both groups' (Israelite, Ower, and Goldstein 2002, 144). A study of the self-esteem of deaf students showed that identification with similar others has a positive impact on the individual's self-esteem, even when the identification is with a devalued minority group (Jambor and Elliot 2005).
There is constant interaction between the outer and inner worlds, between my perception of myself and other people's experience of who I am. The one image is not disconnected from the other, and they continuously influence one another. The conscious self is the identity. According to Ervin and Stryker (2001) identity and selfesteem are different aspects of the self. There is 'transversalism' as regards identity, implying that children may identify themselves with various reference groups and allow different aspects of themselves and their experiences to become visible in different situations (Priestley 1998). Identity may also be modified and/or transformed.
Identity is a cognitive variable, while self-esteem is an affective variable linked to the self (Ervin and Stryker 2001). Ervin and Stryker (2001), who have attempted to theoretically link self-esteem and identity, believe that social behaviour may be a result of the cooperative interaction between cognitive and affective variables in a cyclical process. Creating and maintaining our dignity is a continuously ongoing project in all human lives (Trost and Levin 1999). Children value themselves in relation to people most important to them: i.e. significant others. Not only adults, such as parents and teachers, are included in the group of significant others, but also other children (Demo 2001). The ability to make friends and keep them is crucial to a child's development of self-esteem (Kernberg et al. 1992). For HH children, boys and girls at school are significant others in the individualization process whereby one learns to value one's self, and in the process of identity construction.

Bodily aspects of identity and the importance of language
Children's experiences of their own bodies and those of other children are essential to their development of identity and in their relationships with others (James, Jenks, and Prout 1998). The body is not just a passive phenomenon. It plays an active role in moulding classificatory systems and symbolic schemes, and can be the basis of the construction of social differences (Shilling 1997). Having a hearing aid is an aspect related to bodily functions. The hearing aid may have double implications for HH children. When communicating with other people, the hearing aid is a means of assistance, but it is also a symbol of a disability. The hearing aid is visible and serves as a signal indicating that 'this is a hard-of-hearing person'. Language may also be a central part of the process of bodily identification. Whether the child uses spoken language, sign language, or sign-supported speech (SSS) may be of importance to collective identity.
About 90Á95% of HH children are born into hearing families (Ahlströ m 2000; Lynas 2005). Upon diagnosis, the parents are faced with raising a child who does not match their expectations of a normal child (Allen 2002). The child differs from its parents and often from its brothers and sisters with regard to communication. The family might change its communicative style and become a bilingual family to be able to communicate with and support the child. Furthermore, an HH child often lives in a social setting and attends a school where its hearing disability makes it different from the others. The process of interaction plays a significant role when someone is labelled as different or deviant from other persons in the same setting, and there are few social contexts in which differences between people have no significance. Goffman (1972) uses the concept of stigma to refer to a quality that is deeply discrediting, and he concludes that having a disability stigmatizes an individual.
Physical characteristics may lead to a stigmatizing identity, but they can also be transformed to the individual's advantage if the physical differences are signs of 'similarity' and social belonging to a reference group. Moving the HH children from a mainstream school to a special school is a change of social context, which may change the relevant definitions of what is desirable or undesirable and stigmatizing. The images of the body and the social construction of bodily characteristics can be different in the two school contexts.

Bilingualism
Bilingualism is the knowledge and regular use of two or more languages (Grosjean 2001). In Sweden, Swedish Sign Language (SSL) is a recognized language alongside spoken Swedish. Less than a generation ago, the situation was very different. At that time, only an oral approach was accepted, even at special schools for deaf and HH children. Sign language was thought to impede the capacity of children to learn spoken language. The fact that deaf and severely HH children are given opportunities to become bilingual has been part of the Swedish discourse since 1981, when SSL was officially recognized as the native language of people who are deaf (Preisler 1999). In a 2009 law, Language for all, SSL was accorded the same status as spoken languages officially classified as national minority languages (Prop. 2008/09, 153). For a deaf child, bilingualism means having SSL as one's first language, and the dominant oral language in its written form as a second language (Lynas 2005). The communicative needs of HH children, on the contrary, have not been viewed in the same way as those of deaf children. Linguistically, HH children live in a borderland (Ahlströ m and Preisler 1998). In the school context for HH children, spoken language can be used with environmental and technical support or SSS with environmental and technical support. The children also learn SSL. So for HH children, bilingualism often involves spoken Swedish as a first language and SSL as a second language. Some HH children can switch between spoken Swedish, SSL and SSS without any difficulties (Ahlströ m and Preisler 1998).
A socio-linguistic study in the USA found that the choice of language made by deaf and HH young people was linked to their choice of identity (Kannapell 1993). The language used may be a symbolic expression of similarity, of 'being the same', and of social arenas of belonging and solidarity. The individual can use language in order to show who he/she is, and it can be used by the collective in order to define the boundaries of the group in relation to the outside world. Symbols may have both communicative and existential import (Lalander and Johansson 2002). Bilingual speakers can use language preferences in their identity work (Cashman 2005). Speakers can 'do' social identities by using language alternation and language preference resources to constitute, and not merely reflect, social structure. They can invoke a we-code (in-group) using one language, and a they-code (out-group) using another language. The HH boys and girls in the present study are all bilingual.
Deaf identity in a cultural perspective is strongly linked with a linguistic perspective in contrast with constructions of deaf people as disabled (Obasi 2008). Many deaf people reject the disabled label in favour of the cultural and linguistic minority construction, and a cultural emancipatory discourse has developed and progressed over the past few decades. Obasi (2008) concludes that the power of language in identity formation has been recognized by many researchers as important, and some researchers view identity as an entirely linguistic construction. A HH identity and cultural emancipatory discourse have not been developed in the same way as for the deaf. A new group of children who will construct their identities in possibly new ways are children with Cochlear Implantation (CI). However this group has not been included in this study.
In Sweden bilingualism is a central aspect of caring for deaf and HH children (Ahlströ m 2000; Brunnberg 2005). The special classes for HH students were moved from the mainstream school to the special school because of a need for more space for the hearing children at the mainstream school. However, at the local level there had been a discussion for at least ten years about what would be the best environment for the hard of hearing children. The discussion was centred on concerns about what would provide the best learning environment for HH children and afford them opportunities to become bilingual.

Research design
This study is a qualitative study of HH Children's experiences and ideas, conducted in a Swedish city with approximately 120,000 inhabitants. Since 1937, this city has been a centre of education for HH students (SOU 1998, 66). Beginning in 1976, classes for HH students were located at a mainstream school. However, in 1994 the classes were moved from the mainstream school to the special school. The change of school context gave the HH children a unique experience of what it means to be part of differing realities and they were interviewed before and after this change.
This study consists of two parts. In one part, the empirical data are from interviews with 29 HH children of different ages. All the children were interviewed twice in the form of semi-structured interviews, and at the same time their self-esteem was rated. In the second part of the study, the empirical data are from interviews with four HH children from the sample. All four had a HH identity, were the same age, and 'just' had a hearing disability, rather than multiple disabilities. These were the only four children fulfilling the criteria in the sample.

Participants
The group of HH children (n 29) were all children from the city in question attending special classes for HH students in the mainstream school. Some months later, in the autumn when a new school year started, all six HH classes were moved to a special school for deaf students. The HH children still attended the same classes for HH children as previously, using spoken Swedish as their first language, but the language environment changed from spoken Swedish to Swedish Sign Language (SSL). The children were 7Á14 years old when the study began, and 9Á16 years old when interviewed a second time. It is above all the results from the second interview/ assessment that are presented in this article, though some comparisons between the two interviews are made.
The 29 children all had severe or profound hearing loss and were prescribed hearing aids (not always used). Participants were selected on the basis of the educational setting, not from audiometric evaluations. They were attending the special school for HH and deaf children, and had a hearing loss that had been diagnosed by the public health system to certify the child's need to attend a special class for HH children. In addition to their hearing loss, six children had other disabilities reported by their parents: three had a visual disability, two had Attention Deficit Hyperactivity Disorder (ADHD) and one Minimal Brain Damage (MBD). A few children (n 3) primarily used SSL at home and had a deaf parent. The other children used spoken language or spoken language with sign as a support (SSS) at home and had hearing parents.
The second part of the study concerns four children who all were categorized as having a HH identity. The children whose narratives were investigated in a descriptive way were selected as participants because they were similar in many respects, though they differed from each other with regard to native language and gender. Most Similar Systems Design (MSSD) inspired the selection of children (Denk 2002). The group was small, since no other child at the school fulfilled all three criteria: (1) similar age (11Á12 years old); (2) Swedish origin; and (3) severe hearing loss and no other diagnosed disability. Two children used SSL at home, as they had a deaf parent, and two children used spoken Swedish at home, as they had hearing parents. Two were boys and two girls. The children were all able to communicate by means of both spoken Swedish and SSL. They had all attended schools with both hearing and deaf peers. Accordingly, the selection of the children in this group was guided by similarity in order to obtain more detailed knowledge, of the variation in the construction of an HH identity among boys and girls of the same age in similar situations, but with different native languages.

Research questions
Two questions about the children's identities are posed: (1) Do the HH children construct a hearing identity, deaf identity, HH identity or some other identity?
(2) How do HH children treat similarities and differences with deaf and hearing children if and when they construct a HH identity? The study will focus on the HH children's interactions with other children, especially within the child population at school. This was based on the assumption that such relations, as well as the family, play a central role in the socialization process and the development of identity. Gender construction is highlighted when it is the main focus for the girl or the boy.

Ethics
The study is in line with the United Nations Convention on the Rights of the Child (UN CRC; 1989) and the United Nations Convention on the Rights of Persons with Disabilities (UN RPD; 2006). All HH children in the region attending the special school are considered to be capable of forming their own views and are heard about their identity construction. The study was approved by the ethics committee of the Swedish Council for Social Research (Sfr). Informed consent was obtained from the participating adolescents and from their custodians who also took part in the study. The presentation of the study takes ethical considerations in account.

Data collection and analysis
The interviews were designed to evaluate the children's perceptions of themselves and their relations with family and with peers and friends at school. There were also questions relating to the particular situation of the HH children. An interview guide Á CIPF, Cornell Interview of Children's Perceptions of Friendships and Peer Relations Á was the basis (Kernberg et al. 1992;Engströ m, Kallenberg, and Smedler 1994). The questions in the interview guide were partly structured, with answer alternatives, but there were also several open questions, to which the children responded freely. In the second interview, the questions from the first interview were repeated but were supplemented with questions about their experiences in different school contexts, and their views about the concept of HH (Brunnberg 2003). The interviews were both audio and video-taped.
CIPF includes a rating scale constituting a basis for estimating the child's selfesteem (see Appendix 1). The estimations of the children's self-esteem were assessed by the person who interviewed the child, and this assessment was checked by two independent researchers. Inter-reliability was judged as satisfactory by an outsider (Smedler 1996). In this presentation, only the comparative results for self-esteem are presented, not the scales.
Model for analysis of hard-of-hearing children's identity In the analysis of the interviews a model was created from the results of previous studies about HH children's identity. Identities are fluid and can change over time but are at a point experienced as stable, 'giving the self a sense of continuity across time and location' (Shields 2008, 304). In previous research HH identities were described in terms of a child having a hearing identity, a deaf identity, or a HH identity, or as suffering from an identity crisis (Andersson and Lawenius 1997). The categorization of the child's identity at the time of the interviews in the current study was checked by another researcher. This categorization was based on the children's own perceptions. I searched for the children's answers in the interviews and to specific questions (see Appendix 2) to identify whether they at that time had a hearing, deaf or HH identity. The somewhat rough-and-ready notion of how a child with a hearing, deaf or HH identity would answer the questions was as follows.
A child with a hearing identity would prefer to use spoken language. The child would have mostly hearing friends at home and seek contact with the hearing children at the mainstream school. If the child wanted more friends to associate with in his/her spare time, he/she would prefer hearing children of the same age. The child enjoyed attending the mainstream school, and he/she wanted special classes for HH students to be located at a school with hearing children.
A child with a deaf identity would prefer to use SSL, would primarily have deaf friends at home, and he/she would play with the other deaf children at the special school. If the child wanted more friends, he/she would prefer deaf ones. The child preferred a social context with SSL, and he/she wanted the special classes for HH students to be located at a school for deaf children.
A child with a HH identity would use spoken language, SSS and SSL. The child would try to meet with HH friends during his/her spare time. If the child wanted more friends, he/she would want them to be HH. The child would be able to explain the expression 'hard-of-hearing', and would give the impression of including him/ herself in that category when describing the concept.
A child could be categorized as having a particular identity even if it did not correspond to the notion in every detail. A child could also be categorized as having an unclear identity if the child denied, or was very ambivalent about having a hearing loss, and could be considered to be having an identity crisis if the child was in grief related to its hearing loss.

Variations of HH identity
To gain a deeper understanding of the variations in the construction of HH identity I carried out a descriptive analysis of four children's narratives (MSSD-design). The analysis of the children's narratives was carried out in four essential steps (Giorgi 1988). All the interviews were read several times in order to become familiar with the text. When an overall view had been acquired, the text was read again with the aim of distinguishing 'meaning units' with a focus on identity and interaction. The meaning units were then condensed to express the psychological insight contained in them more directly Á the essence. Finally a structure of the child's experience was described. When the children's narratives had been analyzed in this way, the children's experiences were compared. I tried to be faithful to the children's narratives by focusing on the meaning and significance of the interview text in order to understand the life world of the children as they perceived it and bracket the adult perspective as much as possible. I searched for variations in HH children's identity, despite having taken similarity as a starting point in the selection of children as participants in this sub-group.

Identity
The epithet most often used by others of a child attending classes for HH students, both at school and in other situations, is 'hard-of-hearing'. The words the children in this study used to describe themselves varied, though most of them referred to themselves and identified themselves as 'hard-of hearing' (n 20). None of the children attending HH classes had a deaf identity, and only one child had a hearing identity. More than one in four of the children (n 8) had an unclear identity or were in identity crises.
When children calling themselves HH described what characterized them, they stressed the use of hearing aids and their bilingualism Á that they used both spoken Swedish and Swedish Sign Language. Their bilingualism made them different from both deaf and hearing children and could be included in their identity construction as HH. Most of the children in this study with a HH identity constructed this as a bilingual identity and extended their reference group. This extension could be constructed in different ways. The core difference between the identity types could be whether they extended their reference group beyond 'just HH' to hearing or deaf children, or both. This extension seemed mainly to be based on ability to communicate and on language. In their identity-construction work, the children displayed similarities but also differences between the subgroups within their reference group.
The child with a hearing identity had more than one disability. At the mainstream school, this child was one of the few HH children who often sought social interplay with hearing children but was rejected. The child's self-esteem deteriorated when he moved to the special school.
Identity as hard-of-hearing with extended reference group Within the group of children with a HH identity, many children extended their reference group to include deaf (n 15), a few children extended their reference group to include hearing members (n 3), and a few positioned HH as a bicultural group between the world of the hearing and the world of the deaf (n 2). In the identity construction process the children seemed to change focus and actions in order to strengthen similarities or differences with the extended group.
Identity as hard-of-hearing/deaf (hearing impaired) Within the group of children with a HH identity, many children (n 15) extended their reference group by defining deaf as 'almost the same' and constructed an identity as Hearing impaired. All of them expressed the opinions that HH children should attend a school for deaf children and that HH are bilingual. The children categorized as having a HH/deaf identity seemed to be at different stages in the process of identity construction. Six of the 15 children had a distinct HH identity as well as a distinct extended identity as HH/deaf. Peter, whose construction of identity is described later in this article, is one of them. Some children in the group of children with a HH-identity strongly affirmed their belonging to the group of HH, and others affirmed similarity or difference within the extended reference group of deaf children.
Identity as hard-of-hearing/hearing Three of the 20 students with a HH identity seemed to experience the strongest sense of belonging with hearing children. One of the children chose not to have deaf friends because he found sign language difficult to understand. The other two children had a strong sense of belonging with hearing children, and wanted to attend schools with hearing children. One child did not have any contact with hearing or deaf children at school, but nevertheless said she would rather attend a school with hearing children because the deaf bothered her more. Spoken language was an important part of what linked these three children with hearing children.
Identity as hearing/HH/deaf Á bicultural identity Two students expressed a bilingual and a bicultural HH identity that differed from the HH/deaf or HH/hearing identities. These two students positioned themselves between the deaf and hearing worlds.
The HH are halfway between deaf and hearing. HH people can both sign and talk.
The students wanted both hearing and deaf friends, as well as HH friends. One of the students thought there should be special classes for HH students at mainstream schools as well as at special schools. The students expressed a bilingual HH identity with bicultural influences. Their HH identity was influenced not just by the culture in the HH group, but also by the deaf and hearing cultures. Despite this, the students, like most of the other children with a bilingual HH identity, experienced more of a sense of belonging with deaf children than with hearing children.

Confirming similarities and/or differences with other groups in the identity-construction process
It seemed to be important in the process of HH identity construction to handle the relations with children in the extended group both in terms of similarity and difference, or to affirm one's identity as HH in strengthening one's belonging to the HH group. There were four children who primarily seemed to affirm their identities as HH. Jan, whose construction of identity is described later in this article, is one of them. These children only wanted new friends if they were HH. Another child seemed to strengthen his HH/deaf identity by acquiring a sense of belonging with deaf children. Four children wanted to strengthen their HH/deaf identities by cultivating a sense of belonging with hearing children, and preferred to use spoken language even though they were considered to have a HH/deaf and bilingual identity.
It may seem like a contradiction, but these children experienced a sense of belonging with peers at the special school at the same time as they preferred hearing and HH friends. In the process of their identity construction, they seemed to be in a position where it was important to show the differences between the subgroups in their reference group. To show competence in spoken language was a central symbol of this. Eva, whose construction of identity is described later, is one of these children.
Unclear identity or identity crisis Several children (n 8) described experiences or emotions that were assessed as constituting unclear identity or an identity crisis. The children expressed this in different ways. Some of them (n 5) expressed that they did not want to be HH, nor did they want new HH friends. They were in rebellion against their disability or gave contradictory reports and were assessed as unclear about their identity. There also appeared to be children in a crisis situation and in grief about their hearing loss. This could be because of deteriorating hearing or aspects related to belonging or being an outsider.
A boy with multiple disabilities, who also had poor self-esteem dreamed of being able to hear: This child and one other described a sense of insecurity and were stigmatized at the mainstream school. They did not find deaf children to be patronizing in the same way, though their relationships with deaf children were not without conflict either.
A child with multiple disabilities, and whose hearing capacity had deteriorated sharply, did not want to be described as HH. This student had poor self-esteem in both school contexts, and socially he had not been able to make himself at home at either school. Another child, who did not want to be regarded as HH, was isolated in both schools. This child did not interact socially with hearing, deaf or HH students and described what it was like to be HH as: It's just a lot of trouble. Not nice. (Mats) A girl expressed grief about the consequences of her hearing impairment. She had gained in self-esteem when attending the special school, but remained unhappy about her hearing impairment. Another girl had also gained greater self-esteem since attending the special school; nevertheless, she did not want to be HH but would prefer being able to hear. She wanted to attend a school with hearing peers and thought they would not cause trouble as often as the deaf students. Nevertheless, she did not want more hearing friends, but rather more deaf friends. There are many contradictions in the girl's descriptions, memories and wishes. A boy with social problems described a sense of disorientation and being an outsider. This boy had poor self-esteem and did not feel accepted by hearing or deaf students. He believed it would be better if there were more HH students attending the school. At the same time, he had conflict-laden or distant relationships with several HH students at school and only wanted new friends if they were hearing.
The students assumed to be suffering from an identity crisis or having a vague identity could be in grief or rebellion over their hearing loss. In this group of children there were children with only a hearing disability and children with multiple disabilities, children with high as well as low self-esteem, boys and girls. In the youngest age group (9Á10 years old) no child was assessed as belonging to this group. In the older age groups there were children having with problematic social relationships with HH children, as well as others who were well established within this group. They were all at this time under emotional stress.

Identity crisis versus stable identity
There was a significant difference between the children who were considered to have a stable identity and those who were assessed as suffering from an identity crisis in terms of how many close friends they had. There were, relatively speaking, more children suffering from an identity crisis (n 6 out of 8) who reported complete isolation or only having one close friend, than there were children with a stable identity (n 7 out of 21) (x 2 (2) 04,067, p B0.05). Many of the children in both groups felt that they did not have enough friends. Half of the children in the crisis group and many of the children with a stable identity (80%) wanted more friends.
The self-esteem of 11 of the HH children improved after the change of school. For 13 of the children, their self-esteem remained about the same. The self-esteem of five of the HH children worsened after the change of school. The children assessed as being in a state of crisis were represented in all three groups.

Construction of hard-of-hearing identity
The descriptive analysis of four children's narratives was carried out to find variations in the construction of HH identity between boys and girls of the same age and in similar situations. The participants either spoke Swedish or SSL as their native languages. They all constructed a bilingual HH identity, but there were variations in the way they did this.
Eva, who was 11 years old, had a deaf parent, and SSL was the predominant language at home. She had mastered both spoken language and SSL. As a small child, she attended a pre-school where SSL was used. Eva reflected on the word HH as follows: I think of hearing a bit worse than others, and that it's the same for the deaf. (Eva) Eva felt that there was a similarity between deaf and HH children. They had the same kind of disability and this gave her a sense of belonging to the same reference group. Nevertheless, Eva did not want deaf children as her friends. She preferred to speak, not to use SSL with friends and other children.
Eva's best friend in the home context was a hearing girl, and Eva used spoken language when communicating with her friend. Eva also used spoken language with her best friend in the HH class. She preferred playing with children of the same sex and with the same disability. As her second choice, she might play with children with 'almost the same' disability, but not with children of the opposite sex. The gender difference between boys and girls seemed to give Eva a stronger sense of 'not being the same' than the difference between HH and deaf. In Eva's opinion, special classes for HH students should be located at a school for deaf children, because there is a feeling of solidarity between HH and deaf children.
Where do you think the HH classes should be? Should they be at a school together with hearing children or at a school together with deaf children? Together with deaf children. Why? They fit together better.
In what way do you think that they fit together better? Well, they can both sign and so on . . . they understand each other a bit better . . . it seems to me. . . . Do you feel more at home with the deaf? Yes, I do. We've got almost the same disability, haven't we? (Eva) Eva's responses indicate that she feels an affinity with deaf children because of her disability, yet chooses not to use SSL. There is a difference between HH and deaf, i.e. between the two subgroups in her reference group that is related to language. She wants first and foremost to use spoken language in her relations with other children. Language becomes an important dimension of establishing her own identity. By being acquainted with spoken language and able to talk, she can make a distinction between herself as HH, the deaf, and her deaf mother. The hearing loss, i.e. not having normal hearing, creates a sense of solidarity between Eva, who is HH, and the deaf Á a sense of being 'almost the same'. This is interpreted as meaning that Eva has a HH/deaf identity and is at a stage of her identity construction where it is important to emphasize the difference between herself and the deaf. Eva's responses also indicate an ongoing gender construction.
Peter, who was 12 years old, also used SSL as his mother tongue. However, he used spoken language, SSL or SSS when communicating with other persons. He seemed primarily to make a pragmatic choice of language and communication style depending on whom he wanted to communicate with. Initially, Peter did not have any thoughts about the word HH, but after reflecting for a while he described what is specific to a HH person.
What's special about being HH? That you have an apparatus like a hearing aid, that sort of thing, and that you can talk and sign. (Peter) Peter thought that the special classes for HH students should be located at a school for deaf children. Among the deaf children at school there were children he played with every day. He would like more friends regardless of whether they were HH, deaf or hearing. At the mainstream school, he did not play with hearing children and he had no hearing friends. His sister is hearing, and he spoke and played with her.
Peter identified himself as HH and bilingual. He had a stronger sense of affinity and affiliation with deaf children than with hearing children. Like Eva, he had widened his reference group to include the deaf as 'almost the same'.
In personal relationships with friends, Eva preferred spoken language and had hearing and HH friends. Peter had deaf and HH friends, but not hearing friends. Peter did not use language in the construction of his identity in the same way as Eva did. They both had a HH identity as HH/deaf, and they both had SSL as their native language. Both Eva and Peter had bilingual competence but different language preferences. They mainly communicated with friends using their preferred language, though Peter seemed more pragmatic than Eva. For Eva, language was a central factor when choosing friends and building her sense of identity.
Jan, who was 11 years old, was another child with a HH/deaf identity. He affirmed his HH identity, though he said that he usually did not think about it. When someone called him HH, he usually tried to ignore it. Jan generally used spoken language and communicated by means of signs at school. His family used spoken language. As a young child, Jan attended two pre-schools, one where spoken Swedish was used and, another where SSL was used. He both spoke Swedish and was proficient in SSL. In his relationships with children of the same age, it was of great importance to Jan that they be HH. He did not want hearing or deaf friends, just HH friends. He chose being alone over playing with hearing children in the area where he lived.
Would you like to have more hearing friends? No.
Why not? Because . . . it's not so fun to play with hearing children . . . somehow. Why don't you think it's so fun? Sometimes I like to be alone . . . . But most of the children I know are HH and they're better friends. (Jan) Jan's best friend was HH. The children at school were very important to him and he played with HH peers from various classes. Jan never chose to be by himself at school, but at home he often did so. He distanced himself from both hearing and deaf children. He preferred to associate with children of the same age who belonged to his own reference group, the HH. At the same time, at a collective level Jan experienced a stronger sense of belonging with deaf than with hearing children, and wanted the special classes to be located at a school including deaf children.
Where do you think the HH classes should be? Should they be at a school together with hearing children or at a school together with deaf children? I have mixed feelings about that. But it's better for the deaf to be with the HH. (Jan) Jan thought that the difference between the deaf and the HH is that deaf children cannot talk. For Jan, the difference between himself and hearing children was more distinct than between himself and deaf children, yet he lives in a hearing family. In contrast, Eva, who has a deaf parent, strongly emphasized the difference between herself and deaf children. Jan demonstrated a psychological distance to both deaf and hearing children and a sense of belonging primarily with HH children. However, he perceived a certain similarity with deaf children, and his self-esteem improved when he attended the special school for deaf children. Jan could be regarded as having an identity as HH/deaf, but at the same time he could be regarded as being in the process of creating a strong HH identity.
Jessica is not one of the 29 children, and she attended a HH class in another part of the country when this study began. During her first years at school, she was individually integrated into a class with hearing children, and did not attend a special class for HH students as did Eva, Peter and Jan. Her hearing deteriorated, and she was moved to a special class for HH students. Jessica has hearing parents.
Jessica, who was 12 years old, wanted above all to have more friends Á HH, hearing and maybe also deaf friends. During breaks, Jessica mostly chose to associate with other HH girls. The girls liked to 'stroll around talking', and they mainly used spoken language. Jessica used SSL with one of her closest friends at school.
Why do you mostly choose to be together with your classmates? Is it because they are your classmates or is there some other reason? I suppose it's because they're my classmates or because I can talk with them. But Lena [her best friend], she doesn't hear very well. You have to use sign language with her. (Jessica) Her choice of language was pragmatic, in order to make communication possible. Jessica had a strong sense of being at home with other HH children, and they were her strongest reference group. She thought that there should be a school just for HH children.
Where do you think the HH classes should be Á at a school for hearing children or at a school for deaf children? I don't know. . . . I think there ought to be one school just for the HH, one for the deaf and one for hearing children. Why is that? Then you meet more children who are the same as you. (Jessica) Being alike was important to Jessica and for strengthening her identity as HH. She mostly interacted with other HH girls, though she also had hearing children as friends. She maintained contact with deaf children at school, but was not as close to them as to HH students. In Jessica's reference group of HH children, different languages were used, but SSS was more frequently used than spoken Swedish or SSL. Her sense of affinity was strongest with children of the same sex, but she occasionally played with HH boys. For Jessica, the reference group was HH children, both individually and collectively.
The four children above demonstrated a bilingual HH identity. They were all 11Á12 years old. Language plays a communicative and a symbolic role in the construction of identities. Three of the children widened their reference group to include the deaf. At the same time, these three children also emphasized the difference between the subgroups within their reference group and those hearing children outside it. Jessica did not seem to widen her reference group. She had a HH identity and may keep it this way over time or later widen her reference group.

Discussion
The aim of this longitudinal childhood study was to explore HH identities from the adolescent's perspectives. The label frequently given by others to the children in the HH special classes is 'hard-of-hearing', and a majority of the students (n 20) construct in different ways a HH identity. Only one child identified himself as 'hearing' and none as 'deaf'. However, several children (n 8) were in a state of identity crisis or had an unclear identity and were ill at ease.
The New Zealand study by Kent (2003) of HH children in mainstream schools, found that it was evident that there may be a psychological risk for those students who identify themselves as HH. The current Swedish study found that children who do not self-identify as HH are at greater psychological and social risk than those who self-identify as HH. There may be a variety of reasons for this difference. The children in the current study all attended special classes for HH children, which none of the participants in the New Zealand study did. The Swedish children belonged to an important group in the educational setting where all the members were described as HH by significant adults such as parents and teachers. However, there were also Swedish children who were suffering from an identity crisis (28%), which can be taken as indicating they were in a psychologically risky situation.
The construction of HH identities by the children is a complex process in which age, ability, gender and language seem to be intersectional dimensions. School environment and families are important contexts in the complex reality in which HH children construct their identities. Family background can, as for all children, be related to socio-economic factors and ethnicity but also to languages within the family (spoken languages/sign languages). The children had varying knowledge of Swedish and SSL but were all bilingual. In the process of constructing their HH identity, the children dealt with their position as insiders and outsiders in different ways (see Woodward 1997). When constructing their identities most of the children extended their HH reference group to include those who are 'almost the same' as insiders not just 'the same'. For one child, 'almost the same' could include the deaf, but another child could include hearing children or both groups. Woodward (1997) maintains that identity is most clearly defined by difference, but the HH children in the current study primarily singled out similarities in order to extend their own reference group. A majority extended their reference group to include the deaf as 'almost the same'; so for them hearing children were the outsiders. In constructing the HH identity, the children did not just single out similarities with another group, but also dissimilarities between their extended reference group and the outsiders. They also made additional distinctions about similarities and dissimilarities between the subgroups within their extended reference group. Interaction with peers on the schoolyard and elsewhere played, just as Frønes (1994) argues, an important role in the identity-construction work.
The self-image is not merely a passive product of what we think others think of us. Children are actively involved in the social and psychological processes of creating their self-image. They interact more often with others who think favourably of them and avoid contact with those who think less favourably of them (Rosenberg 1979;Demo 2001). When playing with hearing children the HH children were in a subordinate position Á vertical relations Á and most of them avoided contact with the hearing children. The HH children interacted more often with the deaf children, and most of them thought the deaf children saw them more positively than the hearing children. The change of school setting and significant others was a change of power position related to the majority group of children at school. In the special school the relations between the children were horizontal. This change seemed to influence the HH children's evaluations of themselves, but there were variations.
According to the HH children's descriptions, a HH person is someone with reduced hearing capacity, and is almost the same as a deaf person. The children maintained that the difference between HH and deaf is that the HH are able to use both spoken language and SSL, while the deaf only use SSL and written Swedish. Both groups are bilingual, but in different ways. Language is an important indicator of difference, but language may also, at a symbolic level, be an important indicator of similarity and connection (Lalander and Johansson 2002;Cashman 2005). Sign language signals similarity with the deaf and difference from hearing people, while spoken language signals a difference from the deaf and a similarity with hearing people. The children did use language as a central dimension in their identityconstruction work when describing 'who they are'. The language preferences could be different depending on which type of extended reference group the adolescent belonged to, and at what stage in the identity construction process she/he was. The cases of Eva and Jessica demonstrate the central role of language both in communication and as a symbol when constructing an identity as a girl with a hearing impairment.
The construction of HH identity is a very complex and varied process, and the choice of language seemed to play an important symbolic role in this process. The results of an American socio-linguistic study confirm that the choice of language made by deaf and HH children at the intermediate level is related to their choice of identity, and that it is important to demonstrate attachment to a reference group by means of choice of language (Kannapell 1993).
In this study many children (28%), but not the youngest, experienced discomfort and were in what we assessed as an identity crisis or a state of unclear identity. This group included both boys and girls. Such a crisis could be part of an age-related search for identity, sudden hearing loss or problematic social situation. The children could be grieving their hearing loss or rebelling against not being able-bodied. They could react in a constructive or destructive way. In the identity-construction process it seemed to be important to work through the grief of having a hearing loss and therefore being in a different situation than other children. The HH children suffering from an identity crisis appeared to be significantly more isolated than children with a stable identity when it came to relationships with peers. Some children expressed a deeper sense of disorientation, social problems and an apparent tendency to go astray in their identity-construction work. They might need support to find out who they are and how to relate to peers. In a state of marginal identity they would feel uncomfortable, and not well accepted within either the deaf or the hearing worlds (Nikolaraizi and Hadjikakou 2006). Children suffering from an identity crisis had high as well as low self-esteem, which supports the hypothesis that the crisis can be a constructive and age-related search for identity or an indication of more complex personal and social problems.
The school context that strengthens the identity of HH children seems to be one where they find sameness. This could be different for different children, but for most of the HH children in the current study this happened in the school with deaf peers. Most important, however, was to meet other HH children. HH children are social actors with unique childhood experiences in different countries, and in the same country at different times, and as a consequence they possess individual differences, which develop their identities in different ways. It is of great importance to understand more about how HH children construct their identity and the context in which they are able to develop a strong identity. It is also very important to find out how to support HH children suffering from an identity crisis and children with multiple disabilities.