Theory of Mind Development in Children with Hearing Loss
Theory of Mind is a topic that brings out my inner #SLPnerd like few others do. Typical development of Theory of Mind, as well as how it’s often impacted in children with hearing loss, is completely fascinating to me.
While prerequisite skills for a mature Theory of Mind begin developing during infancy, at around four years of age children realize that other people have their own unique thoughts, which are based on what they know and have experienced. The concept of false belief emerges, which enables 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 belief are everywhere, including popular stories. In the story of Little Red Riding Hood, the reader knows that the grandmother is actually the wolf. A child with a Theory if 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 that it is the wolf, but rather is confused by the facial features of who she thinks is her grandmother.
Children with hearing loss frequently experience delayed Theory of Mind development. First, understanding others' perspectives develops in part by experiencing and overhearing situations in everyday life. When a hearing loss is present, learning by overhearing does not happen nearly as often as typically hearing children. Additionally, people may often speak to a child with hearing loss using simple sentences 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,“ a parent might attempt to make their language easier for the child to understand by saying, "Let's look in the mailbox." While intentions may be good, in actuality, using simpler language may also contribute to an underdeveloped Theory of Mind in deaf children.
Difficulty achieving Theory of Mind can impact a child in several ways, including understanding and creating narratives. When reading (or listening to) stories, a reader considers the beliefs and perspectives of the characters in the book by considering the unique experiences of each character. Deficits in perspective taking also impact the ability to successfully tell a multidimensional narrative that goes beyond simply stating a sequence of events and instead provide insight into motivation, beliefs, and reasoning of the people involved.
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 must infer their 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 with others, 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.
Now that you’ve jumped on the Theory of Mind bandwagon with me, let's explore some ways to promote the development of these skills in children with hearing loss. Hearing First has a fantastic PDF download HERE with ideas on how to naturally facilitate Theory of Mind development from birth. Reading books is a very important activity to challenge children to understand the perspectives of characters. Even very simple stories often 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.
Pretend play (or role-playing for older children) is a great way to break down Theory of Mind in a slower and more controlled way than real life situations allow for. Structured activities, such as this one, 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.
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. Playing a game such as this animals guessing game (below) provides a more linguistically complex way for the child to take the other person's perspective.
Probably the best and most natural way to foster a Theory of Mind is to use language that is rich in words describing mental states. Using words such as think, feel, wonder, doubt, hope, remember, and expect during real-life scenarios will provide everyday opportunities for a child with hearing loss to understand the meanings of these words and how they relate to the perspectives of others involved. Secondly, using these words in grammatically correct sentences provides a model for how to use them appropriately.
I know what you're thinking-- it all makes so much sense, yet is completely mind blowing, right? Admittedly, few topics get me to read beyond the summary of research articles like this one. And because I love my email subscribers just as much as this intriguing subject, I’ve added the above printable graphic to my exclusive freebie library here! I “hope” (ha, get it?) you check it out!
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 https://hearingfirst.org/en/blog/2017/09/21/Theory-of-Mind
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.