Theory-of-Mind Development in Young Deaf Children With Early Hearing Provisions

Abstract

Deaf and hard-of-hearing (DHH) children born to hearing parents have profound theory-of-mind (ToM) delays, yet little is known about how providing hearing assistance early in life, through cochlear implants and hearing aids, influences their ToM development. We thus addressed (a) whether young DHH children with early hearing provision developed ToM differently than older children did in previous research and (b) what ToM understandings characterize this understudied population. Findings from 84 three- to six-year-old DHH children primarily acquiring spoken language demonstrated that accumulated hearing experience influenced their ToM, as measured by a five-step ToM scale. Moreover, language abilities mediated this developmental relationship: Children with more advanced language abilities, because of more time using cochlear implants and hearing aids, had better ToM growth. These findings demonstrate the crucial relationships among hearing, language, and ToM for DHH children acquiring spoken language, thereby addressing theoretical and practical questions about ToM development.

False Belief Understanding in Deaf Children With Cochlear Implants

“…This study demonstrates that earlier implantation might foster social development in children who are DHH by providing (via auditory stimulation) the opportunity to experience more verbal interactions with their hearing caregivers. This is in line with the novel longitudinal study of Yu and collaborators ( Yu et al., 2021 ), which showed that children who are DoH with more advanced language abilities had better ToM growth. It is an important study on ToM development in DHH because, in contrast to previous studies, the authors examined a sizable sample ( n = 84) of young DoH children (ages 3–6) with relatively early use of CIs or hearing aids (mean age at provision of hearing aids or cochlear implants = 1.7 years).…”

“…Moreover, participants varied considerably in terms of communication modality options chosen by families (ranging from exclusively auditory, through bilingual/bicultural to exclusively visual). In a number of studies (see for example, Peterson et al., 2016 ; Yu et al., 2021 ), children with CIs used both spoken language as well as sign language, which makes it possible that their early communication experiences were qualitatively different from those of children who used only one mode of communication.…”

Theory of Mind Development in Deaf Children With Cochlear Implants: Literature Review

“…There are a number of studies demonstrating this relationship (e.g. [14,43,71,73]). For example, Yu et al [71] showed in a longitudinal study that deaf children with CIs who had more advanced language ability had better ToM growth.…”

“…She found that deaf children with CIs performed worse on the FBT in comparison to preschoolers with typical hearing and suggested that deaf children with CIs could have delayed ToM reasoning. Even though CIs improve development in terms of communication and socialization [66], other researchers have also found that deaf children with CIs exhibit delayed ToM development, in particular false belief understanding, in comparison to their peers with typical hearing [67][68][69][70][71]. For example, Yu et al [71] reported that only 3% of deaf preschoolers with CIs (aged 3-6) succeeded in the false belief task, a dramatically low success rate since the majority of hearing preschoolers pass the false belief task around the age of 5 [6].…”

“…[14,43,71,73]). For example, Yu et al [71] showed in a longitudinal study that deaf children with CIs who had more advanced language ability had better ToM growth. However, in the previously mentioned study by Ketelaar et al [67], the authors demonstrated that despite having the same level of spoken language skills, deaf children with CIs still lagged behind their peers with typical hearing in false belief understanding.…”