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  • Writer's pictureStacy Crouse

Theory of Mind Development in Children with Hearing Loss

Theory of Mind development and how it is impacted in children with hearing loss is a fascinating topic. While more obvious auditory, speech, language skills tend to be the focus for DHH children, Theory of Mind is a crucial skills for parents and professionals to foster throughout the childhood of kids with hearing loss.

What is Theory of Mind?

Theory of mind is the understanding that another person's mental states– beliefs, desires, thoughts, and emotions– may be different than one's own. It's the internal recognition that the actions of others are motivated by their thoughts.

Theory of Mind Development

Theory of Mind develops throughout childhood as children have real-world experiences. Prerequisite skills begin developing during infancy. Around four years of age, children realize that other people have their own unique thoughts, which are based on what they themselves know and have experienced.

False Belief

In early childhood, the concept of false belief emerges. This allows a child to recognize that not only are others’ perceptions based on their set of knowledge and experiences, but also that others’ beliefs might not align with what is true.

Examples of false beliefs are everywhere, including in popular (and simple) stories and tales. In the story of Little Red Riding Hood, the reader knows that the grandmother is actually the wolf.

An open children's book working on theory of mind development with children with hearing loss

A child with a mature Theory of Mind will understand that Little Red Riding Hood is questioning the size of the wolf’s ears, eyes, and teeth because she does not know the truth (that the wolf is acting as her grandmother). From that perspective, it makes sense that she is confused by the facial features of who she thinks is her grandmother.

Theory of Mind in Deaf Children

Children with hearing loss frequently experience delayed Theory of Mind development for multiple reasons.

Fewer Incidental Learning Opportunities

One reason that Theory of Mind development may be delayed for children with hearing loss is a decrease in incidental learning. Perspective taking often develops incidentally by overhearing situations that occur around you. For people with hearing loss, overhearing does not happen nearly as often as it does in those with normal hearing.

Children with hearing loss are less likely to be able to listen in on people using language to describe their state of mind. For example, they might not hear their sibling tell a parent how they felt in a certain situation and why.

Simplified Language Models

Secondly, children with hearing loss often have decreased exposure to more complex language. When speaking to a child with hearing loss, people may use simpler sentences in order to help them better comprehend. Their language models are more likely to be devoid of abstract concepts that describe others' mental states.

For example, rather than saying, “I doubt that the mail already came, but let's go check the mailbox anyway,“ a parent might try to make their language easier for the child to understand by saying, "Let's go look in the mailbox." While their intentions may be good, using simpler language can contribute to an underdeveloped Theory of Mind in deaf children.

Impacts of Delayed Theory of Mind

The impacts of an underdeveloped theory of mind can effect a child in their home, school, and community environments.

Language Skills

Children that have not developed Theory of Mind may have difficulty understanding narratives. When reading (or listening to) a story, they may have trouble considering how a character's unique experiences impact their beliefs and perspectives. This can impact their ability to follow or comprehend stories as well as apply them to other situations and activities.

Deficits in perspective taking also impact the ability to successfully tell a multidimensional narrative. A child with an underdeveloped Theory of mind may not be able to go beyond telling a very simple sequence of events. Their story could lack insight into the motivation, beliefs, and reasoning of the people involved.

Social Skills

Additionally, Theory of Mind has a huge impact on a child’s understanding of social situations. To successfully interact with and respond to others, we infer others' thoughts and feelings. For example, a child must understand the perspective of their parents when trying to persuade them to buy candy at the store.

When communicating socially, we also must consider the shared knowledge base so that we aren’t providing too much or too little information. If a child misses conversational nuances, their ability to successfully identify and take the perspective of others in social scenarios is likely impacted.

Theory of Mind Activities

There are many natural and developmentally appropriate activities that can foster Theory of Mind throughout childhood.

Pretend Play

Pretend play is a great way to break down Theory of Mind in a slower and more controlled way than real life situations allow for. It teaches children to utilize flexible thinking, which helps lay the foundation for Theory of Mind development.

Structured activities, including role play conversations for older students, give the child time to understand the thoughts of an imaginary person in a situation. The teacher, parent, or therapist is able to interject cues in real time to help the child make connections between the thoughts and actions of people involved in the scenario.

Reading Books

Reading books is a very important activity to challenge children to understand the perspectives of characters. Even very simple stories can provide the opportunity to discuss the characters’ thoughts and feelings surrounding the events of the story. There is nothing wrong (and in fact, there are a lot of things right) with reading the same set of books regularly with young children to help them develop this skill.

A group of children's books that foster theory of mind for young children with hearing loss.

Guessing Games

Another way to promote Theory of Mind is by playing guessing games. They allow the child to observe two people having different perspectives during the same activity, as one person knows a piece of information while the other person doesn’t.

A simple form of this concept may be choosing an object to place in a bag or box and giving hints for the child to guess what the object is.

A bag and several toys and figurines being used as a guessing game in speech therapy

For older children, more structured (and linguistically complex) guessing games provide great opportunities to model use of vocabulary related to mental states and practice taking another person's perspective.

Animals guessing game used in speech therapy with child with hearing loss

Modeling in Conversation

Probably the easiest and most natural way to foster Theory of Mind is to use words to describe mental states in day-to-day activities. Real-life scenarios provide meaningful opportunities for a child with hearing loss to understand the words and how they relate to the perspectives of others involved.

A handout showing words that describe mental state that can help develop theory of mind

Available for free to email subscribers, this handout provides several words to describe mental states. Use the words in grammatically correct sentences such as...

  • "I think that..."

  • "She feels like..."

  • "We wonder if..."

  • "I really hope that..."

  • "He expects to..."

Additional Theory of Mind Resources for Children with Hearing Loss

Hearing First has a fantastic downloadable resource for supporting Theory of Mind with DHH children. It shares a timeline of specific Theory of Mind skills as well as activities and strategies to help children acquire each one.

Central Institute for the Deaf shares this article about Theory of Mind, including how to foster theory of mind in various subjects and areas.

Carol Westby writes this article in The ASHA Leader about hearing loss' impact on Theory of Mind in children, especially in terms of interpersonal and intrapersonal deficits.

I know what you're thinking– it all makes so much sense, yet is completely mind blowing, right? Theory of Mind in deaf and hard-of-hearing children is often an overlooked topic, but it's extremely important to keep top of mind throughout childhood.

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Chilton, Helen. (2019, May 1). Theory of Mind and Deaf Children. ENT & Audiology News, 28(2).

Hearing First. (2017, September 21). Theory of Mind: What It Is and How Your Child Can Develop It. [Blog Post]/ Retrieved from

Schick, Brenda; de Villiers, Jill; de Villiers, Peter; and Hoffmeister, Bob. (2002, December 1). Theory of Mind: Language and Cognition in Deaf Children. The ASHA Leader, 7 (22). p. 6-14.

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