Understanding Theory of Mind in Deaf and Hearing College Students

The Role of Early Intact Auditory Experience on the Perception of Spoken Emotions, Comparing Prelingual to Postlingual Cochlear Implant Users

OBJECTIVES

Cochlear implants (CI) are remarkably effective, but have limitations regarding the transformation of the spectro-temporal fine structures of speech. This may impair processing of spoken emotions, which involves the identification and integration of semantic and prosodic cues. Our previous study found spoken-emotions-processing differences between CI users with postlingual deafness (postlingual CI) and normal hearing (NH) matched controls (age range, 19 to 65 years). Postlingual CI users over-relied on semantic information in incongruent trials (prosody and semantics present different emotions), but rated congruent trials (same emotion) similarly to controls. Postlingual CI's intact early auditory experience may explain this pattern of results. The present study examined whether CI users without intact early auditory experience (prelingual CI) would generally perform worse on spoken emotion processing than NH and postlingual CI users, and whether CI use would affect prosodic processing in both CI groups. First, we compared prelingual CI users with their NH controls. Second, we compared the results of the present study to our previous study (Taitlebaum-Swead et al. 2022; postlingual CI).

DESIGN

Fifteen prelingual CI users and 15 NH controls (age range, 18 to 31 years) listened to spoken sentences composed of different combinations (congruent and incongruent) of three discrete emotions (anger, happiness, sadness) and neutrality (performance baseline), presented in prosodic and semantic channels (Test for Rating of Emotions in Speech paradigm). Listeners were asked to rate (six-point scale) the extent to which each of the predefined emotions was conveyed by the sentence as a whole (integration of prosody and semantics), or to focus only on one channel (rating the target emotion [RTE]) and ignore the other (selective attention). In addition, all participants performed standard tests of speech perception. Performance on the Test for Rating of Emotions in Speech was compared with the previous study (postlingual CI).

RESULTS

When asked to focus on one channel, semantics or prosody, both CI groups showed a decrease in prosodic RTE (compared with controls), but only the prelingual CI group showed a decrease in semantic RTE. When the task called for channel integration, both groups of CI users used semantic emotional information to a greater extent than their NH controls. Both groups of CI users rated sentences that did not present the target emotion higher than their NH controls, indicating some degree of confusion. However, only the prelingual CI group rated congruent sentences lower than their NH controls, suggesting reduced accumulation of information across channels. For prelingual CI users, individual differences in identification of monosyllabic words were significantly related to semantic identification and semantic-prosodic integration.

CONCLUSIONS

Taken together with our previous study, we found that the degradation of acoustic information by the CI impairs the processing of prosodic emotions, in both CI user groups. This distortion appears to lead CI users to over-rely on the semantic information when asked to integrate across channels. Early intact auditory exposure among CI users was found to be necessary for the effective identification of semantic emotions, as well as the accumulation of emotional information across the two channels. Results suggest that interventions for spoken-emotion processing should not ignore the onset of hearing loss.

Enhancing social-emotional functioning in adolescents with developmental language disorder or deaf or hard of hearing through a Theory of Mind intervention

BACKGROUND

This study examines the effect of a Theory of Mind (ToM) intervention on ToM abilities and social-emotional functioning in adolescents with developmental language disorder (DLD) or who are deaf/hard of hearing (D/HH). It emphasizes the importance of self-reflection and measurement for personal growth. The research design incorporates both subjective and objective measures to evaluate the intervention's efficacy.

AIMS

To investigate the impact of the ToM intervention on ToM abilities and social-emotional functioning in adolescents with DLD or who are D/HH. It hypothesizes that participants in the intervention groups will show improved ToM and social-emotional functioning compared with those in the control groups.

METHODS & PROCEDURES

Adolescents with DLD or who are D/HH were recruited through collaboration with educational institutions. The study utilized a pre-/post-test design, assigning participants to either the intervention or the control group. The ToM intervention involved targeted activities to enhance ToM abilities. ToM abilities and social-emotional functioning were assessed using standardized tests and self-report questionnaires. Statistical analyses compared outcomes between the intervention and no intervention groups.

OUTCOMES & RESULTS

The findings reveal subjective improvements in social-emotional functioning among the D/HH intervention group. However, no significant effects on objective ToM measures were observed. These results highlight the need for further investigation and refinement of interventions in these areas. Future research should focus on improving intervention strategies and exploring additional objective measures to gain a comprehensive understanding of the intervention's impact on ToM and social-emotional functioning in this population.

CONCLUSIONS & IMPLICATIONS

The ToM intervention shows subjective benefits in improving social-emotional functioning among D/HH adolescents. However, it does not yield significant effects on objective ToM measures. These findings emphasize the ongoing need to refine interventions targeting ToM abilities and social-emotional functioning in this population. Future studies should explore alternative strategies and incorporate additional objective measures to enhance understanding and outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Before this study, it was known that ToM interventions have the potential to enhance ToM abilities. However, the specific effects of such interventions on subjective and objective measures for ToM and social-emotional functioning in adolescents with DLD or who are D/HH remained unclear, necessitating further research. What this paper adds to the existing knowledge This study adds to the existing knowledge by demonstrating subjective improvements in social-emotional functioning among adolescents who are D/HH and underwent a ToM intervention. However, no significant effects on objective ToM measures were observed. These findings highlight the need for refining interventions and exploring additional measures to better understand the intervention's impact. What are the potential or actual clinical implications of this work? The subjective improvements in social-emotional functioning observed in this study have important clinical implications. They suggest that ToM interventions can positively impact the social well-being of adolescents who are D/HH. However, the lack of significant effects on objective ToM measures emphasizes the need for further research and intervention refinement to address specific areas of improvement in this population.

Differentiating Language for Students Who Are Deaf or Hard of Hearing: A Practice-Informed Framework for Auditory and Visual Supports

PURPOSE

Speech-language pathologists (SLPs) serving students who are d/Deaf or hard of hearing (Deaf/hh) and their deaf education counterparts must navigate complexities in language that include modalities that are spoken or signed and proficiency, which is often compromised. This tutorial describes a practice-informed framework that conceptualizes and organizes a continuum of auditory and visual language supports with the aim of informing the practice of the SLP whose training is more inherently focused on spoken language alone, as well as the practice of the teacher of the Deaf/hh (TDHH) who may focus more on visual language supports.

METHOD

This product resulted from a need within interdisciplinary, graduate programs for SLPs and TDHHs. Both cohorts required preparation to address the needs of diverse language learners who are Deaf/hh. This tutorial includes a brief review of the challenges in developing language proficiency and describes the complexities of effective service delivery. The process of developing a practice-informed framework for language supports is summarized, referencing established practices in auditory-based and visually based methodologies, identifying parallel practices, and summarizing the practices within a multitiered framework called the Framework of Differentiated Practices for Language Support. Recommendations for use of the framework include guidance on the identification of a student's language modality/ies and proficiency to effectively match students' needs and target supports.

CONCLUSIONS

An examination of established practices in language supports across auditory and visual modalities reveals clear parallels that can be organized into a tiered framework. The result is a reference for differentiating language for the interdisciplinary school team. The parallel supports also provide evidence of similarities in practice across philosophical boundaries as professionals work collaboratively.

Parental Competence as a Teacher in the Auditory Development of Children with Cochlear Implants

The number of children with partial or total hearing loss is increasing every day, and most of them are undergoing cochlear implant surgery. The paper aims to assess the teaching competence of parents of children with cochlear implants. The study took one year (2022) in 1 [Almaty, Kazakhstan] kindergarten and 1 specialized school. Twenty-four parents of children (mean age 3.5 ± 0.5 years) and 20 parents of children of primary school age (10.0 ± 0.5 years) who underwent surgery at the age of 1-2 and 6-9 years were included in the study. A minimal number of parents had a high level of competence; sufficient competence was noticed among the two times larger number of parents; however, most of the parents had insufficient competence. The indicators of children were as follows: 3 children had a high level of listening perception; twice as many of them had a sufficient level; the same number had an insufficient level. There were more children with a low level, 3 times more than with a high level. A high level of pedagogical competence of parents correlated with a high level of children's auditory verbal abilities (on the scale of auditory ability integration). There was also a direct relationship with the level of speech development (on the scale of speech use) for children who had the surgery a year earlier. The obtained data can apply to the educational process for children with cochlear implants to improve their auditory and speech skills as quickly as possible. The involvement of parents in the education and rehabilitation of children with cochlear implants is crucial for the successful adaptation and development of the child. Parents can become irreplaceable partners of specialists and educational institutions, providing their children with optimal support and assistance on their way to the development of auditory and communication skills. To enhance parental competence in the area of auditory development of children with cochlear implants, it is recommended to participate in specialized educational programs designed for parents, offered by professionals and organizations. Additionally, actively engaging with educational resources, online materials, and informational communities is beneficial for acquiring up-to-date knowledge and receiving support from other parents, specialists, and experts.

Theory of Mind and Parental Mental-State Talk in Children with CIs

Previous studies have suggested that parents may support the development of theory of mind (ToM) in their child by talking about mental states (mental state talk; MST). However, MST has not been sufficiently explored in deaf children with cochlear implants (CIs). This study investigated ToM and availability of parental MST in deaf children with CIs (n = 39, Mage = 62.92, SD = 15.23) in comparison with their peers with typical hearing (TH; n = 52, Mage = 52.48, SD = 1.07). MST was measured during shared storybook reading. Parents' narratives were coded for cognitive, emotional, literal, and non-mental references. ToM was measured with a parental questionnaire. Children with CIs had lower ToM scores than their peers with TH, and their parents used more literal references during shared storybook reading. There were no significant differences in the frequencies of cognitive and emotional references between groups. Parental emotional references contributed positively to children's ToM scores when controlling for the child's age and receptive grammar only in the CI group. These results indicated some distinctive features in parents of deaf children with CIs' MST and highlighted the role of MST in the development of ToM abilities in this group.

Training College Students with Hearing Loss in Theory of Mind

This paper explored training methods to improve the Theory of Mind levels of Chinese college students with hearing loss and investigated the transfer effect of training. Ninety Chinese college students with hearing loss were randomly divided into two groups: the ToM training group and the physical-conversation training group. The ToM training group received ToM training, and the physical-conversation training group as the control group received physical-conversation training. All the participants attended four separate 60-min lectures. The ToM Story Task and the False Belief Task were used to assess the training's effect, and the ToM animation task was adopted to investigate the transfer effect. Before training, the level of ToM of the two participant groups was similar. After training, the ToM level of Chinese college students with hearing loss who participated in ToM training was significantly higher than the students who underwent physical-conversation training. Moreover, the findings revealed that ToM training has long-term transfer effects. This study thus showed that ToM training can effectively improve the ToM level of Chinese college students with hearing loss.

Measuring Theory of Mind in Adolescents With Language and Communication Problems: An Ecological Perspective

We tested if the newly designed ToMotion task reflects a single construct and if the atypical groups differ in their performance compared to typically developing peers. Furthermore, we were interested if ToMotion maps a developmental sequence in a Theory of Mind (ToM) performance as exemplified by increasing difficulty of the questions asked in every item. The sample consisted of 13 adolescents that have been diagnosed with a developmental language disorder (DLD) and 14 adolescents that are deaf or hard of hearing (DHH). All of these adolescents were in special schools for secondary vocational education. The control group existed of 34 typical developing adolescents (TD) who were in regular intermediate vocational education, ranging from level 2 to 4. The ToMotion, available in a spoken Dutch version and in a version in Sign Language of the Netherlands (SLN), was used to map ToM abilities. An attempt has been made to fill the gap of missing studies of ToM in adolescents by developing a new measuring instrument. In conclusion, assessing ToM with the ToMotion results in a picture that DHH adolescents score lower than TD peers. However, their scores are as consistent as those of the TD peers. The picture of DLD adolescents is the reverse. They show no differences in ToM scores, but seem to be somewhat more inconsistent compared to TD peers. We provide a discussion on those results and its implications for future research. What this paper adds? The current study introduces a new visual Theory of Mind (ToM) task, ToMotion, designed specifically to assess ToM in adolescents in an ecologically valid way and adapted to the needs of adolescents with language and communication difficulties.

Theory of Mind and Alexithymia in Deaf and Hard-of-Hearing Young Adults

The aim of the current study was to examine theory of mind (ToM), the ability to infer the mental states of others, in young adults who are deaf and hard-of-hearing (DHH), and to explore the influence of alexithymia, an inability to understand emotions of the self and others, on ToM performance in this group. Compared to participants with typical hearing, DHH participants displayed significantly lower affective ToM skills and greater alexithymia. After accounting for verbal intelligence quotient, hearing status and alexithymia significantly contributed to poorer ToM performance, accounting for over 14% of the variance. Having a parent who is deaf and being part of the Deaf community were associated with better emotion processing and appear to be important protective factors. Findings provide support that ToM difficulties may linger into young adulthood among DHH individuals and that alexithymia may be a contributing factor. Early intervention programs emphasizing emotional understanding, perspective-taking, and communication skills are warranted for DHH children as well as their caregivers.

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.

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

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.

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.

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 Interplay Between Theory of Mind and Social Emotional Functioning in Adolescents With Communication and Language Problems

Adolescents with developmental language disorders (DLDs) and adolescents who are deaf or hard of hearing (D/HH) are at greater risk of social emotional problems. These problems may not only be attributed to communication and language problems but, at least in part, to Theory of Mind (ToM) deficits as well. In this mini review, an overview is provided of studies on social emotional functioning and ToM performance in adolescents with DLD and D/HH adolescents. A possible interplay between social emotional functioning and Theory of Mind is discussed. There is empirical evidence for social emotional problems and ToM problems in both adolescents with DLD and D/HH. We hypothesized that language deficits as seen in adolescents with DLD and impoverished exposure to language and communication, as seen in adolescents who are D/HH can explain differences in social emotional functioning and ToM performance. The present mini review provides a possible framework for the relation between ToM and social emotional functioning in adolescents with communication and language problems, which is mediated by their limited linguistic ability or restricted language exposure and gives suggestions for future research.