Risks for deaf and hard of hearing children’s Theory-of-Mind development
Empirical findings and data
With hearing impairment, there is a particular risk of developmental delays in Theory of Mind.
In hearing children, Theory of Mind typically emerges between 3 and 5 years of age across a variety of languages and cultures (Wellman, Fang, & Peterson, 2011). Research has shown that deaf and hard of hearing children proceed through the same stages in their Theory of Mind development just as hearing peers. However, the rate of development among deaf and hard of hearing children is slower in many cases but not in all (Wellman, 2011; Antonopoulou et al., 2016; Becker et al. 2018).
The development of emotional knowledge can also be delayed in the case of hearing impairment.
- Deaf and hard of hearing children can face difficulties compared to their hearing peers in identifying emotions correctly, labeling them accurately, understanding and regulating them (Aviner 2009).
- Hosie et al. (1998) argued that deaf and hearing children share a common conceptual understanding of basic emotions (happiness, sadness, anger and surprise) as expressed on the face. However, deaf and hard of hearing children were better than hearing children in labeling fear but worse in labeling disgust.
- Hosie et al. (2000) showed that the concealment of emotions to protect the feelings of others was especially difficult for deaf and hard of hearing children, relating this to problems with Theory of Mind.
- Wiefferink et al. (2012) compared emotion regulation in deaf and hard of hearing children. Despite early cochlear implantation, deaf children proved to have less adequate emotion regulation abilities and less social competence than their hearing peers. Additionally, the deaf and hard of hearing children’s language skills did not predict emotion regulation. Researchers attributed this to the fact that their parents did not sufficiently engage in emotion identification and regulation during informal conversations.
The development of Theory of Mind in deaf and hard of hearing children is related to the mode, the quantity and quality of language exposure at home during infancy and childhood.
- Deaf and hard of hearing children with hearing parents show a delay in social understanding development (Schick et al., 2002). Deaf and hard of hearing children of deaf parents, who acquire sign language very early in life and have natural access, develop Theory of Mind on the same early timetable as hearing children (Peterson & Siegal, 1999; Peterson et al., 2005; Schick et al., 2007), and achieve remarkably better results on Theory of Mind tasks than deaf and hard of hearing children of hearing parents. However, deaf and hard of hearing children who sign with their hearing parents do better than those who use only spoken language (Courtin, 2000; Courtin & Melot, 1998). In principle, children who communicate with their parents using spoken language can develop Theory of Mind appropriate for their age. However, the decisive factor is whether or not the children can perceive the language their parents use well.
- Researchers have revealed that the development of Theory of Mind in deaf and hard of hearing children is related to the quantity and quality of language exposure at home during infancy and childhood (Peterson, Wellman, & Slaughter, 2012). Research has shown that even orally communicating children with cochlear implants do not outperform hearing children in Theory of Mind tasks (Peterson, 2004; Moeller & Schick, 2006; Ketelaar et al., 2012). Knoors & Marschark (2014, see also Lecciso et al., 2012) suggest that this may be interpreted by the fact that communication between parents and children with implants to some extent lacks conversations about mental states, or, alternatively, these conversations may lack specific mental verbs or syntactic complements.
General language competence, the development of vocabulary and certain syntactic competences can influence Theory of Mind acquisition in deaf and hard of hearing children.
- Some studies have shown a relationship between general language proficiency and Theory of Mind skills among deaf and hard of hearing children (e.g., Hao, Su, & Chan, 2010).
- Especially the ability to process complex sentences with verbs of saying, thinking and wishing is a predictor of performance on the false belief tasks (Schick et al., 2007; Becker et al, 2018). Children who are not able to understand these complex syntactic forms have difficulty understanding how their own thoughts and beliefs may differ from those around them. For instance, if a child can understand sentences such as “The mother thought her cake was in the cupboard,” he/she is more likely to understand and predict behavior premised on a false belief.
- Some other studies have shown that deaf and hard of hearing children’s exposure to mental verbs (i.e. thinking, knowing, believing, etc.) contributes to the enhancement of Theory of Mind among deaf and hard of hearing children (Remmel & Peters, 2009; Becker et al., 2018).
Evidence-based training methods for Theory of Mind
The ability to put oneself in other people’s shoes is a central prerequisite, for example, for self-regulation and the ability to resolve conflicts. Therefore, it can be assumed that deficits in Theory of Mind can limit social participation.
For these reasons, it is of enormous importance to integrate prevention and intervention measures for these social-cognitive skills in early intervention, at kindergarten and school.
Fortunately, research has shown that properly designed intervention programs may result in dramatic improvements in Theory of Mind among deaf and hard of hearing children.
Research has proven that the following methods are especially helpful – mixed or alone:
- Reading stories with mental-state vocabulary and asking questions about the content in (group) discussions.
- Sociodramatic /role play
- Thought-bubble-stories with visual representation of what people are thinking.
- Language exercises for labeling emotions and syntactical structures.
- Informing and preparing teachers for promoting Theory of Mind.
In our training program THE MIND READERS, we have therefore combined the various methods that have proven successful in research.
Astington, J.W. & Baird, J.A. (Eds./2005): Why language matters for theory of mind. New York: Oxford University Press.
Hofmann, S. G.; Doan, S. N.; Sprung, M.; Wilson, A.; Ebesutani, C.; Andrews, L. A. & Harris, P.L. (2016): Training children’s theory-of-mind: A meta-analysis of controlled studies. Cognition, 150, 200-212.
Ketelaar, L.; Rieffe, C.; Wiefferink, C.H. & Frijns, J.H.M. (2012): Does Hearing Lead to Understanding? Theory of Mind in Toddlers and Preschoolers With Cochlear Implants. Journal of Pediatric Psychology, 37 (9), 1041–1050; DOI: 10.1093/jpepsy/jss086.
Peterson, C.C. & Wellman, H.M. (2009): From fancy to reason. Scaling deaf and hearing children’s understanding of theory of mind and pretence. British Journal of Developmental Psychology, 27 (2), 297–310; DOI: 10.1348/026151008X299728.
Sprung, M., Münch, H. M., Harris, P. L., Ebesutani, C. & Hofmann, S. G. (2015): Children’s emotion understanding: A meta-analysis of training studies. Developmental Review, 37, 41-65.