Deaf and hard of hearing children are at risk of showing a significant delay in Theory of Mind development compared to hearing children. The reason is that these children have fewer opportunities for language interactions with other people. Training deaf and hard of hearing children in Theory of Mind can prevent delays and can promote and improve children’s social understanding and behaviour.
The connection between language development and Theory of Mind
The development of Theory of Mind interacts with language acquisition. Important drivers for the acquisition of Theory of Mind skills are the mastery of words and/or signs for mental concepts and feelings and of complex syntactic structures. An important prerequisite is also the opportunity to participate in diverse conversations with different people. This requires general language competence and good quality communication in the family, at kindergarten or at home. This includes, for example, parents and teachers talking to the children about the inner worlds and feelings of other people.
Risks for deaf and hard of hearing children’s Theory-of-Mind development
Deaf and hard of hearing children are at particular risk of being many years behind in the development of Theory of Mind skills compared to hearing peers. This is true for both spoken and sign language communicating children. One reason for this is that this development is closely linked to language acquisition (spoken language and/or sign language) and passive and active participation in linguistic interactions. Both may be impeded due to hearing loss or deafness.
Research has identified several risks in Theory of Mind development in the context of hearing loss or deafness.
Empirical findings and data
With hearing loss, there is a particular risk of developmental delays in Theory of Mind.
In many countries, research has shown, that hearing children typically develop Theory of Mind skills between the ages of three and nine (Wellman 2018). The 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, 2018; Antonopoulou et al., 2016; Becker et al. 2018).
The development of emotional knowledge can also be delayed in the case of hearing loss/deafness.
- Deaf and hard of hearing children can face difficulties compared to their hearing peers in identifying emotions correctly, labelling them accurately, understanding and regulating them (Most & Aviner 2009).
- Hosie et al. (1998) argued that deaf and hard of 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 labelling fear but worse in labelling 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 behaviour 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 and critical thinking. 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 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 labelling 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.
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