Theory of mind and language in children with cochlear implants

False belief understanding in deaf children: what are the difficulties?

Children with cochlear implants (CIs) demonstrate proficiency in verbal-story elicited-response (VS-ER) false-belief tasks, such as the Sally & Ann task, at a similar age as typically developing hearing children. However, they face challenges in non-verbal spontaneous-response (NV-SR) false-belief tasks, measured via looking times, which hearing infants typically pass by around 2 years of age, or earlier. The purpose of the present study was to examine whether these difficulties remain in a non-verbal-story elicited-response (NVS-ER) false-belief task, in which children are offered the opportunity to provide an elicited response to a non-verbal-story task. A total of thirty 4- to 8-year-old children with CI-s and hearing children completed three different kinds of false-belief tasks. The results showed that children with CI-s performed above chance level on the verbal task (i.e., VS-ER task), but not on the two non-verbal tasks, (i.e., NVS-ER and NV-SR tasks). The control group of typically developing hearing children performed above chance on all three kinds of tasks (one-tailed significance level). Our findings highlight the importance of external narrative support for children with CIs in tasks that involve mental perspective-taking, and specifically predicting actions based on false beliefs.

Development of Social-Pragmatic Understanding in Children With Congenital Hearing Loss and Typical Hearing Between the Ages of 4 and 6 Years

PURPOSE

This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH.

METHOD

The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years.

RESULTS

The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context.

CONCLUSIONS

Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.

Theory of mind in children with cochlear implants: Comparison with age- and sex-matched children with normal hearing

OBJECTIVES/HYPOTHESIS

Theory of mind (ToM) is a crucial ability for maintaining normal social interaction and is directly related to language ability. This study was performed to compare ToM between children with congenital hearing loss who have received cochlear implantation (CI) and those with normal hearing (NH).

STUDY DESIGN

Case-control study design.

METHODS

One hundred children, aged 2-12 years, participated: 50 children who received CI before 36 months of age (CI group) and one-to-one age- and sex-matched children with normal hearing (NH group). All children underwent tests to examine receptive language ability and ToM. Receptive language was measured using the Receptive and Expressive Vocabulary Test, and ToM was measured using the Theory of Mind Task Battery (ToM-TB). The scores of the two tests were compared between the CI and NH groups.

RESULTS

The ToM-TB score in the CI group correlated positively with age and receptive language score. ToM-TB scores did not differ significantly between children in the CI group who achieved normal receptive language and the NH group. However, these children in the CI group scored lower than those in the NH group on some advanced ToM tasks that require the ability to understand second-order emotion, message-desire discrepancy, or second-order false belief.

CONCLUSIONS

This case-control study found that children with CI who achieve normal receptive language ability have ToM that is similar to that in children with NH. However, these children exhibited weakness in advanced ToM skills. Interventions to facilitate the development of advanced ToM are needed for children with CI.

Complex Language Use in Children With Hearing Loss: A Scoping Review

PURPOSE

Understanding what is known about the language profiles of children with hearing loss (CHL) is vital so that researchers and teachers can identify the specific complex syntactic structures that CHL may struggle to master. An understanding of which aspects of complex syntax pose difficulties for CHL is necessary to inform the kind of intervention that will facilitate learning complex syntax for this cohort of children. This scoping review aims to identify what is currently known about the complex syntax use of CHL who communicate through spoken language, and uncover gaps in the literature to guide further research.

METHOD

Ascoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The Covidence software was utilized to manage the initial and full-text screening process for the search.

RESULTS

From a total of 304 studies, 42 studies were identified that met the eligibility criteria. The review highlights the use of broad-based language assessments and limited use of specific descriptions of the types of complex syntactic structures and skills.

CONCLUSIONS

Findings highlight the need for assessment protocols and analysis methods that better support the description of complex syntax profiles for CHL. School-age CHL continue to display challenges with complex syntax development. The review highlighted the need for further research to improve understanding of the complex syntax strengths and vulnerabilities of CHL. Further investigation is needed to better understand their ability to combine ideas and build complexity in their language use, which in turn can inform teaching in schools and interventions for children who require support.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21980177.

False Belief Understanding in Deaf Children With Cochlear Implants

Theory of mind (ToM) is crucial for social interactions. Previous research has indicated that deaf and hard-of-hearing children born into hearing families (DoH) are at risk of delayed ToM development. However, it is unclear whether this is the case for DoH children who receive cochlear implants (CIs) before and around the second year of life. The present study aimed to investigate false belief understanding (FBU) in DoH children with CIs. The relationships between false belief task (FBT) performance, sentence comprehension, age at implantation, duration of CI use, and Speech Recognition Threshold were explored. A total of 94 children with typical levels of hearing (TH) and 45 DoH children (age range: 3-8), who received their first CI between 6 and 27 months of age, were tested on the FBT and a sentence comprehension test. Results showed that 4- and 5-year-old children with CIs performed significantly worse than their peers with TH on the FBT; 6- to 8-year-old children with CIs performed similarly to age-matched children with TH. Age at implantation and duration of CI use were correlated with sentence comprehension but not with the FBT. The results indicated that FBU was delayed until the age of 6 years in most of children with CIs.

Irony Comprehension in Children With Cochlear Implants: The Role of Language Competence, Theory of Mind, and Prosody Recognition

Purpose Aims of this research were (a) to investigate higher order linguistic and cognitive skills of Italian children with cochlear implants (CIs); (b) to correlate them with the comprehension of irony, which has never been systematically studied in this population; and (c) to identify the factors that facilitate the development of this competence. Method We tested 28 Italian children with CI (mean chronological age = 101 [SD = 25.60] months, age range: 60-144 months), and two control groups of normal-hearing (NH) peers matched for chronological age and for hearing age, on a series of tests assessing their cognitive abilities (nonverbal intelligence and theory of mind), linguistic skills (morphosyntax and prosody recognition), and irony comprehension. Results Despite having grammatical abilities in line with the group of NH children matched for hearing age, children with CI lag behind both groups of NH peers on the recognition of emotions through prosody and on the comprehension of ironic stories, even if these two abilities were not related. Conclusions This is the first study that targeted irony comprehension in children with CI, and we found that this competence, which is crucial for maintaining good social relationships with peers, is impaired in this population. In line with other studies, we found a correlation between this ability and advanced theory of mind skills, but at the same time, a deeper investigation is needed, to account for the high variability of performance in children with CI.

Lies and Irony Understanding in Deaf and Hearing Adolescents

Lies and irony are paradigmatic examples of nonliteral communication; many deaf children and even adults have difficulty in understanding them. The present study assessed the understanding of lies and irony in 96 adolescents living in Spain in urban settings (58 deaf participants, 38 hearing participants; 10-19 years old). We investigated whether deaf and hearing participants differ in their performance, and the effects of age, theory of mind (ToM), and language on the understanding of these nonliteral meanings in deaf participants. The results show that deaf participants do not find it difficult to detect nonliteral statements, but they experience difficulty in attributing the real motivation to the speaker. ToM and language explained performance in the understanding of nonliteral communication in the deaf group. The results suggest the need to focus on promoting the ability to attribute real motivations to speakers. We propose an assessment sequence that differs from those used in other studies. In the proposed sequence, ToM skills would be combined with other skills that influence the understanding of lies and irony and would be sequenced according to the observed performance in deaf adolescents.

Reading and Theory of Mind in Adolescents with Cochlear Implant

Previous research has shown a possible link between reading comprehension and theory of mind (ToM), but these findings are unclear in adolescents with cochlear implants (CI). In the present study, reading comprehension and ToM were assessed in adolescents with CI and the relation between both skills was also studied. Two sessions were performed on two groups of adolescents aged between 12 and 16 years of age (36 adolescents with CI and 54 participants with typical hearing, TH). They were evaluated by means of a standardized reading battery, a false belief task, and Faux Pas stories. The results indicated that reading and cognitive ToM were more developed in the TH group than in adolescents with CI. However, early-CI and binaural group performance were close to the TH group in narrative and expository comprehension and cognitive ToM. The results also indicated that cognitive ToM and reading comprehension appear to be related in deaf adolescents.

Effects of Age at Cochlear Implantation on Learning and Cognition: A Critical Assessment

Purpose Age at cochlear implantation frequently is assumed to be a key predictor of pediatric implantation benefits, but outcomes related to learning and cognition appear inconsistent. This critical assessment examines relevant literature in an effort to evaluate the impact of age at implantation in those domains for individuals who received their devices as children. Method We examined 44 peer-reviewed articles from 2003 to 2018 considering age at implantation and conducted statistical analyses regarding its impact on several domains, including literacy, academic achievement, memory, and theory of mind. Results Across 167 assessments in various experiments and conditions, only 21% of the analyses related to age at implantation yielded evidence in favor of earlier implantation, providing greater benefits to academic achievement, learning, or cognition compared to implantation later in childhood. Among studies that considered cognitive processing (e.g., executive function, memory, visual-spatial functioning), over twice as many analyses indicated significant benefits of earlier implantation when it was considered as a discrete rather than a continuous variable. Conclusion Findings raise methodological, practical, and theoretical questions concerning how "early" is defined in studies concerning early cochlear implantation, the impact of confounding factors, and the use of nonstandard outcome measures. The present results and convergent findings from other studies are discussed in terms of the larger range of variables that need to be considered in evaluating the benefits of cochlear implantation and question the utility of considering age at implantation as a "gold standard" with regard to evaluating long-term outcomes of the procedure as a medical treatment/intervention for hearing loss. Supplemental Material https://doi.org/10.23641/asha.8323625.

The Understanding of Communicative Intentions in Children with Severe-to-Profound Hearing Loss

The ability to distinguish lies from sincere false statements requires understanding a speaker's communicative intentions and is argued to develop through linguistic interaction. We tested whether this ability was delayed in 26 children with severe-to-profound hearing loss who, based on vocabulary size, were thought to have relatively limited access to linguistic exchanges compared to typically hearing peers (n = 93). Children were presented with toy bears who either lied or made a false statement sincerely. Despite identifying speakers' knowledge/ignorance, deaf or hard of hearing (DHH) children were delayed in identifying lies and sincere false statements when matched for chronological age. When matched for receptive vocabulary, observed discrepancies diminished. Deaf children who experienced early access to conversations with their deaf parents demonstrated no delay. Findings suggest limited access to linguistic exchanges delays the development of a key pragmatic skill.

Deaf Children as ‘English Learners’: The Psycholinguistic Turn in Deaf Education

The purpose of this literature review is to present the arguments in support of conceptualizing deaf children as ‘English Learners’, to explore the educational implications of such conceptualizations, and to suggest directions for future inquiry. Three ways of interpreting the label ‘English Learner’ in relationship to deaf children are explored: (1) as applied to deaf children whose native language is American Sign Language; (2) as applied to deaf children whose parents speak a language other than English; and (3) as applied to deaf children who have limited access to the spoken English used by their parents. Recent research from the fields of linguistics and neuroscience on the effects of language deprivation is presented and conceptualized within a framework that we refer to as the psycholinguistic turn in deaf education. The implications for developing the literacy skills of signing deaf children are explored, particularly around the theoretical construct of a ‘bridge’ between sign language proficiency and print-based literacy. Finally, promising directions for future inquiry are presented.

Evidence of Theory of Mind in the Written Language of Deaf Children

The link between Theory of Mind (ToM) and literacy is increasingly being recognized in the literature. However, the focus to date has concentrated on the connections between reading and ToM, with an emphasis on the ways in which ToM is implicated in making inferences from text and suggestions that engaging in reading fiction can support the development of ToM. The exploratory study presented in this paper is unique in its approach as it widens the focus to consider the relationship between ToM and writing. Using a developmental framework based on the work of Westby and Robinson (Westby, C. & Robinson L. (2014). A developmental perspective for promoting theory of mind. Topics in Language Disorders 34 (4), 362-382 doi: 10.1097/TLD.0000000000000035), the written narratives of 43 deaf children (aged 7.2 years to 11.11 years) were examined for evidence of ToM. Evidence of ToM was found in the writing of 86% of the participants (n = 37) with children demonstrating abilities across the spectrum of development. Implications for both research and pedagogical practice are discussed.

The relationships among verbal ability, executive function, and theory of mind in young children with cochlear implants

This study aims to examine the complex relationships among verbal ability (VA), executive function (EF), and theory of mind (ToM) in young Chinese children with cochlear implants (CCI). All participants were tested using a set of nine measures: one VA, one non-VA, three EF, and four ToM. Our study cohort comprised 82 children aged from 3.8 to 6.9 years, including 36 CCI and 46 children with normal hearing (CNH). CNH outperformed CCI on measures of VA, EF, and ToM. One of the EF tasks, inhibitory control, was significantly associated with ToM after controlling for VA. VA was the primary predictor of EF, while inhibitory control significantly predicted ToM. Our findings suggest that inhibitory control explains the association between EF and ToM, thereby supporting the hypothesis that EF may be a prerequisite for ToM.

Comparing Parent and Teacher Ratings of Emotional and Behavioural Difficulties in 5-year old Children who are Deaf or Hard-of-Hearing

Children who are deaf or hard of hearing (DHH) are at higher risk of developing mental health problems. This study reports on the parent and teacher ratings of emotional and behavioural difficulties (EBD) in 5-year old DHH children. It explores the similarities and differences between informants, and the risk and protective factors associated with parent and teacher-ratings of EBD. Parents and teachers of 224 DHH children completed questionnaires on children's EBD and functional auditory behaviour. Children completed standardised assessments of non-verbal cognitive and language abilities. On average, parent- and teacher-rated EBD were 0.42 and 0.20 standard deviations higher than typically developing children. Parents reported more behavioural problems (hyperactivity and conduct), whereas teachers reported poorer prosocial behaviour. Inter-rater correlations were generally low to moderate (0.29 to 0.50). Overall, children with additional disabilities, lower non-verbal cognitive ability, and poor functional auditory behaviour were at higher risk of EBD. Language ability was only a significant predictor of teacher-rated EBD for children with hearing aids but not cochlear implants. Differences in informant-ratings emphasize the need for a multi-informant approach to get a global perspective on the psychopathology of DHH children. The findings indicate that parents may need assistance with managing behavioural problems at home, and teachers should facilitate more opportunities to practice prosocial behaviour at school. Intervention efforts should focus on facilitating good functional listening skills, as this may in turn, improve the mental health of young DHH children.

Psychosocial Development in 5-Year-Old Children With Hearing Loss Using Hearing Aids or Cochlear Implants

This article reports on the psychosocial development and factors influencing outcomes of 5-year-old children with cochlear implants (CIs) or hearing aids (HAs). It further examines differences between children with CIs and HAs with similar levels of hearing loss. Data were collected as part of the Longitudinal Outcomes of Children with Hearing Impairment study-a prospective, population-based study. Parents/caregivers of children completed the Strengths and Difficulties Questionnaire ( n = 333), the Social Skills subscale from the Child Development Inventory ( n = 317), and questionnaires on functional auditory behavior (Parents' Evaluation of Aural/oral performance of Children), and demographics. Children completed assessments of nonverbal cognitive ability (Wechsler Non-verbal Scale of Ability) and language (Preschool Language Scale - fourth edition). On average, parent-rated Strengths and Difficulties Questionnaire scores on emotional or behavioral difficulties were within 1 SD of the normative mean; however, Child Development Inventory scores on social skills were more than 1 SD below the norm. Children with severe-to-profound hearing losses using HAs had significantly more behavioral problems than children with CIs. Regression analyses showed that non-verbal cognitive ability, language, and functional auditory behavior were significantly associated with psychosocial outcomes for children with HAs, whereas outcomes for children with CIs were associated with functional auditory behavior and the presence of additional disabilities. Age at hearing intervention, severity of hearing loss, and communication mode were not associated with outcomes. The results suggest that even children who develop good language ability with the help of a HA or CI may have psychosocial problems if they exhibit difficulties with listening and communicating in everyday environments. The findings have implications for developing interventions for young children with hearing loss.

False Belief Development in Children Who Are Hard of Hearing Compared With Peers With Normal Hearing

PURPOSE

This study investigates false belief (FB) understanding in children who are hard of hearing (CHH) compared with children with normal hearing (CNH) at ages 5 and 6 years and at 2nd grade. Research with this population has theoretical significance, given that the early auditory-linguistic experiences of CHH are less restricted compared with children who are deaf but not as complete as those of CNH.

METHOD

Participants included CHH and CNH who had completed FB tasks as part of a larger multicenter, longitudinal study on outcomes of children with mild-to-severe hearing loss. Both cross-sectional and longitudinal data were analyzed.

RESULTS

At age 5 years, CHH demonstrated significant delays in FB understanding relative to CNH. Both hearing status and spoken-language abilities contributed to FB performance in 5-year-olds. A subgroup of CHH showed protracted delays at 6 years, suggesting that some CHH are at risk for longer term delays in FB understanding. By 2nd grade, performance on 1st- and 2nd-order FBs did not differ between CHH and CNH.

CONCLUSIONS

Preschool-age CHH are at risk for delays in understanding others' beliefs, which has consequences for their social interactions and pragmatic communication. Research related to FB in children with hearing loss has the potential to inform our understanding of mechanisms that support social-cognitive development, including the roles of language and conversational access.

Confronting the language barrier: Theory of mind in deaf children

The current study addressed deaf children's Theory of Mind (ToM) development as measured by a battery of first- and second-order belief tasks. Both a chronological age-matched control group and a younger group of pre-school aged hearing children were compared to a group of deaf children born to hearing parents. A hearing native signer enacted each of the tasks, which were pre-recorded in video clips in English (SSE), British Sign Language (BSL) and spoken English, in order to consider all communication preferences of the deaf children. Results revealed no differences in performance between the deaf and the young hearing children. However, despite the inclusion of ToM tasks based on their preferred mode of communication, the deaf children performed significantly worse at the unexpected-content and second-order belief task compared with their age-matched controls. These findings imply a delay rather than a deficit in ToM in deaf children that could be attributed to limited opportunities to converse and overhear conversations about mental states.

LEARNING OUTCOMES

None.

Long-term improvements in oral communication skills and quality of peer relations in children with cochlear implants: parental testimony

BACKGROUND

Few research studies have examined longitudinal improvements in oral communication skills and quality of peer relationships of children with implants. Moreover, although the emerging literature suggests that improvement in social functioning follows improvement in oral communication, it is still unknown what factors enhance or impede the relations between these constructs.

METHODS

Based on parent interviews, the current study examined the long-term improvements in speech and oral language skills and relationships with hearing peers in 19 implanted children.

RESULTS

Results demonstrate that on average, children continue to improve in oral communication skills and quality of peer relationships even years after implantation, especially those with initial poorer skills. While oral communication ability and quality of peer relationships are strongly associated at each time point, gains in these two variables are associated only for some of the children. Other factors, including self-confidence and peer acceptance, seem to moderate this relationship. Qualitative data are presented to illustrate these relations among variables and to assist in theory building.

CONCLUSIONS

The results highlight the need for more specific examination of various developmental periods in combination with the progress of oral communication and peer relationships among children with implants.

Understanding minds: early cochlear implantation and the development of theory of mind in children with profound hearing impairment

OBJECTIVE

The present study investigates how auditory stimulation from cochlear implants (CI) is associated with the development of Theory of Mind (ToM) in severely and profoundly hearing impaired children with hearing parents. Previous research has shown that deaf children of hearing parents have a delayed ToM development. This is, however, not always the case with deaf children of deaf parents, who presumably are immersed in a more vivid signing environment.

METHODS

Sixteen children with CI (4.25 to 9.5 years of age) were tested on measures of cognitive and emotional ToM, language and cognition. Eight of the children received their first implant relatively early (before 27 months) and half of them late (after 27 months). The two groups did not differ in age, gender, language or cognition at entry of the study. ToM tests included the unexpected location task and a newly developed Swedish social-emotional ToM test. The tests aimed to test both cognitive and emotional ToM. A comparison group of typically developing hearing age matched children was also added (n=18).

RESULTS

Compared to the comparison group, the early CI-group did not differ in emotional ToM. The late CI-group differed significantly from the comparison group on both the cognitive and emotional ToM tests.

CONCLUSION

The results revealed that children with early cochlear implants solved ToM problems to a significantly higher degree than children with late implants, although the groups did not differ on language or cognitive measures at baseline. The outcome suggests that early cochlear implantation for deaf children in hearing families, in conjunction with early social and communicative stimulation in a language that is native to the parents, can provide a foundation for a more normalized ToM development.

Understanding of emotions and false beliefs among hearing children versus deaf children

Emotion understanding and theory of mind (ToM) are two major aspects of social cognition in which deaf children demonstrate developmental delays. The current study investigated these social cognition aspects in two subgroups of deaf children-those with cochlear implants who communicate orally (speakers) and those who communicate primarily using sign language (signers)-in comparison to hearing children. Participants were 53 Israeli kindergartners-20 speakers, 10 signers, and 23 hearing children. Tests included four emotion identification and understanding tasks and one false belief task (ToM). Results revealed similarities among all children's emotion labeling and affective perspective taking abilities, similarities between speakers and hearing children in false beliefs and in understanding emotions in typical contexts, and lower performance of signers on the latter three tasks. Adapting educational experiences to the unique characteristics and needs of speakers and signers is recommended.

How children with normal hearing and children with a cochlear implant use mentalizing vocabulary and other evaluative expressions in their narratives

This study explored the use of mental state and emotion terms and other evaluative expressions in the story generation of 65 children (aged 2-8 years) with normal hearing (NH) and 11 children (aged 3-7 years) using a cochlear implant (CI). Children generated stories on the basis of sets of sequential pictures. The stories of the children with CI were obtained over the 5-year follow-up period. The children with NH continued to show an increased story length (number of words) with age. In the children with a CI, the increase was similar initially, but plateaued after 3 years of using a CI. In children with NH, the spontaneous use of mental state vocabulary in narratives increased significantly between the ages of three and six. The delayed use of mental state terms in the children with a CI was related to a reduced amount of linguistic production overall. The theoretical and clinical implications were discussed.

Does hearing lead to understanding? Theory of mind in toddlers and preschoolers with cochlear implants

OBJECTIVE

Theory of Mind (ToM) refers to the ability to understand the subjectivity of people's intentions, desires, and beliefs. Research shows that ToM in deaf children is delayed, yet the few studies that examined ToM in deaf children with a cochlear implant (CI) report contradictory results. This study examined multiple aspects of ToM in early-implanted children.

METHODS

3 intention tasks were administered to 72 children with CI and 69 normal-hearing children (age, 12-60 months). Furthermore, 3 desire and belief tasks were administered to a subsample of children aged 30 months or over.

RESULTS

Children with CI showed intention-understanding skills equal to normal-hearing children, but lagged behind on desire and belief understanding, even after excluding children with language delays.

CONCLUSIONS

Children with CI appear to master the initial stages of ToM development, but fall behind on more advanced ToM abilities. Yet, both groups showed similar patterns of development.

The mind behind the message: advancing theory-of-mind scales for typically developing children, and those with deafness, autism, or Asperger syndrome

Children aged 3-12 years (n = 184) with typical development, deafness, autism, or Asperger syndrome took a series of theory-of-mind (ToM) tasks to confirm and extend previous developmental scaling evidence. A new sarcasm task, in the format of H. M. Wellman and D. Liu's (2004) 5-step ToM Scale, added a statistically reliable 6th step to the scale for all diagnostic groups. A key previous finding, divergence in task sequencing for children with autism, was confirmed. Comparisons among diagnostic groups, controlling age, and language ability, showed that typical developers mastered the 6 ToM steps ahead of each of the 3 disabled groups, with implications for ToM theories. The final (sarcasm) task challenged even nondisabled 9-year-olds, demonstrating the new scale's sensitivity to post-preschool ToM growth.

The mind behind the message: advancing theory-of-mind scales for typically developing children, and those with deafness, autism, or Asperger syndrome

Children aged 3-12 years (n = 184) with typical development, deafness, autism, or Asperger syndrome took a series of theory-of-mind (ToM) tasks to confirm and extend previous developmental scaling evidence. A new sarcasm task, in the format of H. M. Wellman and D. Liu's (2004) 5-step ToM Scale, added a statistically reliable 6th step to the scale for all diagnostic groups. A key previous finding, divergence in task sequencing for children with autism, was confirmed. Comparisons among diagnostic groups, controlling age, and language ability, showed that typical developers mastered the 6 ToM steps ahead of each of the 3 disabled groups, with implications for ToM theories. The final (sarcasm) task challenged even nondisabled 9-year-olds, demonstrating the new scale's sensitivity to post-preschool ToM growth.

Sequential progressions in a theory-of-mind scale: longitudinal perspectives

Consecutive retestings of 92 U.S. preschoolers (n=30), Chinese preschoolers (n=31), and deaf children (n=31) examined whether the sequences of development apparent in cross-sectional results with a theory-of-mind scale also appeared in longitudinal assessment. Longitudinal data confirmed that theory-of-mind progressions apparent in cross-sectional scaling data also characterized longitudinal sequences of understanding for individual children. The match between cross-sectional and longitudinal sequences appeared for children who exhibit different progressions across cultures (United States vs. China) and for children with substantial delays (deaf children of hearing parents). Moreover, greater scale distances reflected larger longitudinal age differences.

Peer relationships of deaf children with cochlear implants: predictors of peer entry and peer interaction success

This study investigated factors that affect the development of positive peer relationships among deaf children with cochlear implants. Ten 5- to 6-year-old deaf children with implants were observed under conditions varying peer context difficulty in a Peer Entry task. Results revealed better outcomes for deaf children interacting in one-on-one situations compared to interactions including two other hearing children and better performance among girls than boys. In addition, longer duration of implant use and higher self-esteem were associated with better performance on the Peer Task, which was in turn related to parental reports of children's social functioning outside the experimental situation. These findings contribute to the growing literature describing the benefits of cochlear implantation in the areas of communication and socialization, while pointing to interventions that may enhance deaf children's social competence.

Language, Mental State Vocabulary, and False Belief Understanding in Children With Cochlear Implants

Purpose

This study examined false belief understanding and its predictors in school-age children who are deaf with cochlear implants and who use spoken language.

Method

False belief understanding was measured through an explanation-of-action task in 30 children between the ages of 3 and 12 years who used cochlear implants. Children told a wordless story from which expressive syntax and vocabulary scores were obtained. Scores on the false belief explanation task were then correlated with a variety of language and vocabulary variables, and regression analyses were completed to ascertain significant predictors of theory of mind (ToM) performance.

Results

Children’s false belief explanation of anomalous action was best predicted by age; general language ability; and spontaneous use of mental state vocabulary, specifically, cognitive vocabulary. Even the youngest children demonstrated awareness of others' mental states and made reference to them in explaining mistaken actions, supporting the assertion by M. Marschark, V. Green, G. Hindmarsh, and S. Walker (2000) that children who are deaf are not lacking a ToM.

Clinical Implications

Results of this study suggest that ToM maturation in deaf children might be facilitated by developing general spoken language skills as well as understanding and using cognitive and emotional language. These findings might also extend to children with normal hearing who are also at risk for ToM deficits (e.g., children on the autistic spectrum and children with pragmatic language delays).