Can You Hear What I Think? Theory of Mind in Young Children With Moderate Hearing Loss

Objectives: The first aim of this study was to examine various aspects
of Theory of Mind (ToM) development in young children with moderate
hearing loss (MHL) compared with hearing peers. The second aim
was to examine the relation between language abilities and ToM in both
groups. The third aim was to compare the sequence of ToM development
between children with MHL and hearing peers.
Design: Forty-four children between 3 and 5 years old with MHL (35 to
70 dB HL) who preferred to use spoken language were identified from
a nationwide study on hearing loss in young children. These children
were compared with 101 hearing peers. Children were observed during
several tasks to measure intention understanding, the acknowledgement
of the other’s desires, and belief understanding. Parents completed two
scales of the child development inventory to assess expressive language
and language comprehension in all participants. Objective language test
scores were available from the medical files of children with MHL.
Results: Children with MHL showed comparable levels of intention
understanding but lower levels of both desire and belief understanding
than hearing peers. Parents reported lower language abilities in children
with MHL compared with hearing peers. Yet, the language levels
of children with MHL were within the average range compared with test
normative samples. A stronger relation between language and ToM was
found in the hearing children than in children with MHL. The expected
developmental sequence of ToM skills was divergent in approximately
one-fourth of children with MHL, when compared with hearing children.
Conclusion: Children with MHL have more difficulty in their ToM reasoning
than hearing peers, despite the fact that their language abilities lie
within the average range compared with test normative samples.