Language and Theory of Mind: A Study of Deaf Children

The role of speech-language pathologists in supporting theory of mind through literacy-based activities

PURPOSE

This tutorial discusses the importance of speech-language pathologists (SLPs) supporting individuals with language disorders in their understanding of others' cognitive and affective states (theory of mind, ToM), with a special consideration given to applying these suggestions with individuals who are neurodivergent.

METHOD

I motivate this tutorial by first reviewing the literature related to ToM and language abilities for various populations of individuals with language difficulties, highlighting the need for explicitly targeting the language-related skills that are thought to underlie ToM for individuals with language disorders. I next present concrete examples of how to support ToM through literacy-based activities. I follow this discussion with a short description of how these activities may be applied with individuals who are neurodivergent through concrete examples, such as how inclusion of neurodivergent characters in storybooks can aid in educating children about understanding others' perspectives. It further emphasizes the importance of discussing various types of mental and emotional states for individuals who share as well as differ in their neurotypes.

CONCLUSIONS

Language skills are an integral part of ToM abilities. SLPs play an important role in supporting clients' academic, literacy, and social outcomes and can support important perspective-taking skills through associated language/communication skills. The various skills that fall under the umbrella term 'theory of mind' can be appropriately incorporated into intervention and literacy-based tasks in a way that respects differences in neurotype while still building important language and communication skills for clients.

Differences in the type of vocabulary understood by deaf and hearing students: Results to guide interventions

INTRODUCTION

Vocabulary knowledge is an essential element in language development. There is evidence of significant differences in vocabulary knowledge between deaf children and hearing peers of the same age. These differences put deaf students at a disadvantage when compared to their hearing counterparts. The aim of this study was to investigate whether certain types of words characterise the lexical difficulties of deaf students. Our starting point is that this knowledge is needed to design interventions that are adapted to the particular needs of these students for their lexical development.

METHODS

We evaluated the lexical comprehension of 90 Spanish students. The sample comprised 45 hearing students and 45 students with severe or profound hearing loss. Both groups were attending the later years of primary school (8 to -12-year-olds). They were tested using the Spanish Peabody Picture Vocabulary Test-III. The performance of both groups was statistically compared using percentiles and standard scores as well as a selected set of words from the test.

RESULTS

No significant differences between hearing and deaf groups were found by age, sex, and sociocultural level. Significant differences were found between groups in their percentile and standard scores. There were no significant differences in performance between the two groups on only five of the 25 words with the highest error rate in the deaf group. The qualitative analysis of the remaining 20 words that were especially challenging for deaf students reveals results of interest which could help guide interventions.

CONCLUSIONS

The results indicate the need for lexical intervention for deaf students in the final years of primary school. The specialised support service for deaf learners should approach the intervention by targeting a specific type of vocabulary, making the semantic relationships between these words more transparent and promoting a deeper understanding of them.

Narrative reconstruction in deaf and hearing children: A comparative study in the context of Arabic diglossia

This study explores the narrative skills of deaf and hearing children within the context of Arabic diglossia, a linguistic environment characterised by significant differences between spoken dialects and formal written language. Using Stein and Glenn's (1979) and Bruner's (1991) frameworks, the research analyses the narrative constructions of 13 hearing and 13 deaf children in Kuwait. The findings reveal that hearing children, benefiting from consistent exposure to spoken and formal Arabic, produced more coherent and detailed narratives compared to deaf children. Hearing participants also demonstrated greater vocabulary diversity. Age-related improvements in narrative skills were more pronounced among hearing children, while the impact of sign language exposure on narrative abilities was significant among deaf children. The study underscores the critical role of early language exposure and educational support in fostering narrative development, particularly in a diglossic context. These findings highlight the need for specialised educational strategies to support the unique narrative development needs of deaf children.

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.

Developing expressive language skills of deaf students through specialized writing instruction

Writing is an essential element of literacy development, and language plays a central role in the composing process, including developing, organizing, and refining ideas. Language and writing are interconnected, making it paramount for educators to attend to the development of deaf students' language skills. In this quasi-experimental study, we examined the impact of strategic and interactive pedagogical approaches, namely Strategic and Interactive Writing Instruction, implemented with deaf students in grades 3-6 to develop genre-specific traits in their expressive language (spoken or signed) and writing. In this study, a total of 16 teachers and their 69 students participated in the treatment and comparison groups. Expressive language and writing samples were collected at the beginning and end of the year for three different genres. Students in the treatment group showed statistically significant gains in their expressive and written language for recount and information genres when compared to students in the comparison group. There was not a significant treatment effect on persuasive expressive language or writing. In addition, there was a significant positive correlation between expressive language and writing at both time points across all three genres. This study provides evidence on the importance of attending to language skills during literacy instruction.

The roles of language and executive function in Mandarin-speaking children's theory of mind development

Introduction

Research has indicated that language and executive function relate closely to first-order false belief reasoning, yet their roles in second-order false belief reasoning are under-explored, and their interplay in theory of mind development remains obscure.

Methods

This study assessed 160 Mandarin-speaking preschoolers' and early primary schoolers' language, executive function, and theory of mind abilities to examine the unique roles and interplay of language and executive function in first-order and second-order false belief reasoning.

Results

Results showed that language significantly uniquely predicted the children's first-order as well as second-order false belief reasoning when controlling for the effects of age and executive function. Although executive function significantly predicted first-order FB reasoning when controlling for age, it was no longer a significant predictor of first-order FB reasoning when language was included in the model. However, executive function played a significant unique role in second-order FB reasoning when controlling for the effects of age and language.

Discussion

The current findings suggest that language plays a greater role than executive function in Mandarin-speaking children's theory of mind development and the contributors to theory of mind development vary in different levels of false belief reasoning.

Emotion recognition and false belief in deaf or hard-of-hearing preschool children

This study aims to examine emotion recognition and false belief performances of 4-5-year-old (48-71 months) deaf or hard-of-hearing (DHH) children. The performances have been assessed using the Turkish Version of the Theory of Mind Task Battery for Children. The DHH children have been continuing schooling in inclusive settings with an auditory-oral approach. The emotion recognition performances of hearing children (n = 100) and DHH (n = 100) children have appeared to be similar. The ANOVA analysis has revealed that the groups do not differ concerning false belief performances between the ages of 4 and 5.5. However, from the age of 5.5, hearing children have performed better than DHH children. According to correlation analysis, parental education has been determined as a remarkable factor in DHH children's false belief development. The findings point to the need for research across a wide range of ages to better understand the developmental course of false belief in DHH children.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study

Background and aims

Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD.

Methods

Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories.

Results

For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions.

Conclusions

By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD.

Implications

The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

Classroom Discourse: What Is Conveyed Through Educational Interpretation

When a deaf or hard-of-hearing child enters a classroom with an interpreter, the goal, and sometimes the assumption, is that they will be granted full access to the classroom experience. This study focuses on the clarity and completeness with which critical elements of classroom discourse are conveyed through the interpretations of 40 educational interpreters. Elements studied include conveyance of main ideas, directions for assignments, relevance strategies, orienting commentary, participation solicitation, mental state reference, and semantic organization. The interpretations clearly and completely conveyed approximately one-third to two-thirds of the information (M = 48.6%) related to these elements of classroom discourse. Frequent omissions and alterations rendered large parts of the message markedly different. Results suggest a need to improve training of educational interpreters, increase communication between teachers and interpreters, provide students supplementary services, and heighten awareness that the interpretation process is fallible in ways that can impact access to classroom discourse.

Deaf and Hearing American Sign Language-English Bilinguals: Typical Bilingual Language Development

Some studies have concluded that sign language hinders spoken language development for deaf and hard-of-hearing (DHH) children even though sign language exposure could protect DHH children from experiencing language deprivation. Furthermore, this research has rarely considered the bilingualism of children learning a signed and a spoken language. Here we compare spoken English development in 2-6-year-old deaf and hearing American Sign Language-English bilingual children to each other and to monolingual English speakers in a comparison database. Age predicted bilinguals' language scores on all measures, whereas hearing status was only significant for one measure. Both bilingual groups tended to score below monolinguals. Deaf bilinguals' scores differed more from monolinguals, potentially because of later age of and less total exposure to English, and/or to hearing through a cochlear implant. Overall, these results are consistent with typical early bilingual language development. Research and practice must treat signing-speaking children as bilinguals and consider the bilingual language development literature.

Family ASL: An Early Start to Equitable Education for Deaf Children

Deaf and hard of hearing (DHH) children experience systematic barriers to equitable education due to intentional or unintentional ableist views that can lead to a general lack of awareness about the value of natural sign languages, and insufficient resources supporting sign language development. Furthermore, an imbalance of information in favor of spoken languages often stems from a phonocentric perspective that views signing as an inferior form of communication that also hinders development of spoken language. To the contrary, research demonstrates that early adoption of a natural sign language confers critical protection from the risks of language deprivation without endangering spoken language development. In this position paper, we draw attention to deep societal biases about language in information presented to parents of DHH children, against early exposure to a natural sign language. We outline actions that parents and professionals can adopt to maximize DHH children's chances for on-time language development.

Executive Function in Deaf Native Signing Children

The aim of this study is twofold: To examine if deafness is invariably associated with deficits in executive function (EF) and to investigate the relationship between sign language proficiency and EF in deaf children of deaf parents with early exposure to a sign language. It is also the first study of EF in children acquiring Polish Sign Language. Even though the mothers of the deaf children (N = 20) had lower levels of education compared with the mothers of a hearing control group, the children performed similarly to their hearing peers (N = 20) on a variety of EF task-based assessments. Only in the Go/No-go task were weaker inhibition skills observed in younger deaf children (6-9 years) compared with hearing peers, and this difference was not seen in older children (10-12 years). Hence, deafness does not necessarily impair EF; however, attentional and inhibition abilities may be acquired via a different route in deaf children. Sign language receptive skills predicted EF in deaf children. In conclusion, we highlight the importance of deaf parenting building the scaffolding for EF in deaf children.

Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language

PURPOSE

The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL-English bilingual deaf and hard of hearing (DHH) children.

METHOD

This cross-sectional study of vocabulary size included 56 DHH children between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were independently assessed via parent report checklists.

RESULTS

ASL vocabulary size positively correlated with spoken English vocabulary size. Spoken English vocabulary sizes in the ASL-English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL-English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the average range based on norms for hearing monolingual children.

CONCLUSIONS

Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when considering the entirety of their language skills. We found no evidence to support recommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English.

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.

Comparison of Diagnostic Profiles of Deaf and Hearing Children with a Diagnosis of Autism

There is limited research comparing the presentation of autism in deaf and hearing children and young people. These comparisons are important to facilitate accurate diagnosis, as rates of misdiagnosis and delay in diagnosis amongst deaf children and young people are high. The aim of this study was to compare diagnostic assessment profiles of a UK cohort of autistic deaf and hearing children and young people. The Autism Diagnostic Interview-Revised-Deaf adaptation was completed with the parents of 106 children and young people (deaf children = 65; hearing children = 41). The majority of items explored showed no significant differences between deaf and hearing children and young people. Differences were found in peer relationships, where autistic deaf participants were less likely to respond to the approaches of other children or play imaginatively with peers. These findings need to be taken into consideration by clinicians in the assessment process.

Relationship between different types of complement syntax and false belief in Mandarin-speaking children with autism spectrum disorder and typically developing children

Previous studies have shown that complement syntax is closely associated with false belief (FB) in children with autism spectrum disorder (ASD). However, the relationship between different types of complement syntax and FB remains unclear. This study examined the relationship between different types of complement syntax and FB in both ASD and typically developing (TD) children. Thirty Mandarin-speaking ASD and TD children, each matched for language ability, were included. Children completed different types of complement syntax tasks, verbal and nonverbal FB. For the ASD children, results demonstrated that sentential complement syntax independently predicted verbal and nonverbal FB, while phrasal complement syntax only predicted nonverbal FB. For the TD children group, sentential complement syntax only predicted verbal FB. This indicates that as the language demands of the FB task decrease, ASD children can use both types of complement syntax for its prediction. Moreover, the characteristics of ASD children differ from TD children in terms of the relationship between different types of complement syntax and FB. The results of this study support de Villiers’ point of view from the Mandarin perspective and provide evidence for the social-cognitive component of the theory of mind.

Second-Order False Beliefs and Linguistic Recursion in Autism Spectrum Disorder

This study investigates the role of recursive language and working memory (WM) in second-order false belief skills in Danish-speaking children with autism spectrum disorder (ASD; n = 62; 8 females) and typical development (n = 41; 15 females), ages 6-16. Second-order false belief skills correlated with receptive grammar, vocabulary, and age; sentential complement production predicted second-order false beliefs, controlling for age, receptive grammar and WM. Regressions showed that second-order false belief was associated with age across groups, but with sentential complements in the ASD group only. Second-order false belief skills improved in children who received training in either recursive phrases (d = 0.21) or WM (d = 0.74), compared to an active control group. Results suggest that false belief skills are entwined with both linguistic and executive functions.

Associations Between Parent Mental State Language and Child Inhibitory Control in Children Who Are Deaf or Hard of Hearing

PURPOSE

Children who are deaf or hard of hearing (D/HH) are at increased risk for neurocognitive delays, which can have cascading effects on development. Associations between neurocognition and the content of parental language-specifically the use of mental state vocabulary-have been observed in typically hearing (TH) children. This study investigated the role of parental use of mental state language (e.g., vocabulary related to thought processes, desires, and emotions) in explaining variability in neurocognition in children who are D/HH.

METHOD

Dyads of 62 TH and 69 D/HH children who wear hearing aids or cochlear implants (ages 3-8 years) and their primary parent were videorecorded during a 20-min play session. Specific mental state words used by parents were extracted. Child neurocognition (specifically, inhibitory control) was assessed using norm-referenced measures.

RESULTS

Parent use of mental state language predicted child inhibitory control differentially based on hearing status, with a significant relation in the D/HH but not the TH group. Mental state vocabulary related to cognition (e.g., "think," "know"), but not to desire (e.g., "want," "like") or emotion (e.g., "feel," "frustrated"), predicted child inhibitory control in the D/HH group. Finally, there was a significant relation between the use of first person, but not second or third person, mental state verbs (e.g., "I think") and child inhibitory control.

CONCLUSIONS

Parental use of cognitive mental state vocabulary models language around thought processes, and parents' use of first-person referents models "self-talk." Modeling of these linguistic forms is likely foundational for developing self-regulation. Children who are D/HH often experience reduced auditory access and/or language delays and thus rely on high-quality parental language input for longer periods of development than their TH peers. Continued support from interventionists is indicated to coach parents to be high-quality models of more abstract, decontextualized language, supporting complex language development and inhibitory control in children who are D/HH.

Making sense of sensory language: Acquisition of sensory knowledge by individuals with congenital sensory impairments

The present article provides a narrative review on how language communicates sensory information and how knowledge of sight and sound develops in individuals born deaf or blind. Studying knowledge of the perceptually inaccessible sensory domain for these populations offers a lens into how humans learn about that which they cannot perceive. We first review the linguistic strategies within language that communicate sensory information. Highlighting the power of language to shape knowledge, we next review the detailed knowledge of sensory information by individuals with congenital sensory impairments, limitations therein, and neural representations of imperceptible phenomena. We suggest that the acquisition of sensory knowledge is supported by language, experience with multiple perceptual domains, and cognitive and social abilities which mature over the first years of life, both in individuals with and without sensory impairment. We conclude by proposing a developmental trajectory for acquiring sensory knowledge in the absence of sensory perception.

The development of early numeracy in deaf and hard of hearing children acquiring spoken language

Most deaf and hard-of-hearing (DHH) children are born to hearing parents and steered toward spoken rather than signed language, introducing a delay in language access. This study investigated the effects of this delay on number acquisition. DHH children (N = 44, mean_age  = 58 months, 21F, >50% White) and typically-hearing (TH) children (N = 79, mean_age  = 49 months, 51F, >50% White) were assessed on number and language in 2011-13. DHH children showed similar trajectories to TH children but delayed timing; a binary logistic regression showed that the odds of being a cardinal-principle (CP) knower were 17 times higher for TH children than DHH children, controlling for age (d = .69). Language fully mediated the association between deaf/hearing group and number knowledge, suggesting that language access sets the pace for number acquisition.

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.

Characterizing North Carolina's Deaf and Hard of Hearing Infants and Toddlers: Predictors of Vocabulary, Diagnosis, and Intervention

PURPOSE

This study sought to (a) characterize the demographic, audiological, and intervention variability in a population of Deaf and Hard of Hearing (DHH) children receiving state services for hearing loss; (b) identify predictors of vocabulary delays; and (c) evaluate factors influencing the success and timing of early identification and intervention efforts at a state level.

METHOD

One hundred DHH infants and toddlers (aged 4-36 months) enrolled in early intervention completed the MacArthur-Bates Communicative Development Inventories, and detailed information about their audiological and clinical history was collected. We examined the influence of demographic, clinical, and audiological factors on vocabulary outcomes and early intervention efforts.

RESULTS

We found that this sample showed spoken language vocabulary delays (production) relative to hearing peers and showed room for improvement in rates of early diagnosis and intervention. These delays in vocabulary and early support services were predicted by an overlapping subset of hearing-, health-, and home-related variables.

CONCLUSIONS

In a diverse sample of DHH children receiving early intervention, we identify variables that predict delays in vocabulary and early support services, which reflected both dimensions that are immutable, and those that clinicians and caretakers can potentially alter. We provide a discussion on the implications for clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19449839.

Training Syntax to Enhance Theory of Mind in Children with ASD

Preschool children with neurotypical development (ND) trained on sentential complements ("X thinks/says that") improve their Theory of Mind (ToM) performance. Can complementation training also enhance ToM in children with Autism Spectrum Disorder (ASD)? Thirty-three children with ASD (Mage = 8;11) and 20 younger ND peers (Mage = 4;3) were trained on sentential complements (4-6 weeks, 2-3 times per week, via the DIRE i-Pad App). Pre-training and post-training comparisons show that (1) training boosted both complementation and ToM performance across groups; (2) improvements remained 4-6 weeks after training ended; (3) participants with milder ASD symptoms made most gains. Training on sentential complements thus seems beneficial for addressing ToM difficulties in children with ASD, especially those with milder symptoms.

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.

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model

At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.

A systematic review and meta-analysis of social cognition training success across the healthy lifespan

Socio-cognitive abilities and challenges change across the healthy lifespan and are essential for successful human interaction. Identifying effective socio-cognitive training approaches for healthy individuals may prevent development of mental or physical disease and reduced quality of life. A systematic search was conducted in MEDLINE Ovid, Web of Science Core Collection, CENTRAL, and PsycInfo databases. Studies that investigated different socio-cognitive trainings for healthy individuals across the human lifespan assessing effects on theory of mind, emotion recognition, perspective taking, and social decision making were included. A random-effects pairwise meta-analysis was conducted. Risk-of-Bias was assessed using the Cochrane Risk-of-Bias-2-Tool. Twenty-three intervention studies with N = 1835 participants were included in the systematic review; twelve randomized controlled trials in the meta-analysis (N = 875). Socio-cognitive trainings differed regarding duration and content in different age groups, with theory of mind being the domain most frequently trained. Results of the meta-analysis showed that trainings were highly effective for improving theory of mind in children aged 3–5 years (SMD = 2.51 (95%CI: 0.48–4.53)), children aged 7–9 years (SMD = 2.71 (95%CI: − 0.28 to 5.71)), and older adults (SMD = 5.90 (95%CI: 2.77–9.02). Theory of mind training was highly effective in all investigated age-groups for improving theory of mind, yet, more research on transfer effects to other socio-cognitive processes and further investigation of training effects in other socio-cognitive domains (e.g., emotion recognition, visual perspective taking, social decision making) is needed. Identified characteristics of successful socio-cognitive trainings in different age groups may help designing future training studies for other populations.

Registration:www.crd.york.ac.uk/PROSPERO/ (ID: CRD42020193297).

Comparing Theory of Mind Development in Children with Autism Spectrum Disorder, Developmental Language Disorder, and Typical Development

BACKGROUND

Theory of mind (ToM) is the ability to recognize, comprehend, and consider oneself's and others' mental states and perspectives to predict and explain behaviors and motivations. It is widely accepted that children with autism spectrum disorder (ASD) experience difficulties with ToM. However, there are also findings suggesting that ToM abilities might also be compromised in children with Developmental Language Disorders (DLD).

PURPOSE

To assess ToM abilities in three groups of children: 1. ASD with no language difficulties; 2. DLD, known for their language disorder; and 3. TD with no language issues.

MATERIALS AND METHODS

A total of 41 preschool children aged 5-to-6 were examined and assigned to one of the three groups based on previous clinical reports and a standardized Hebrew language assessment tool. Nonverbal IQ was established with a standardized test to verify within average range placement (>75 IQ). ToM skills were examined with a Hebrew version of the ToM Task Battery and parent's questionnaire (ToMI).

RESULTS

Children with ASD had significantly lower ToM scores compared to the children with DLD, and TD. The ToM scores of the children with DLD were similar to the scores of the TD children. According to the parents' questionnaires, both the ASD children and the DLD children had less developed ToM skills compared to their TD peers.

CONCLUSION

The present findings suggest that children with ASD have a fundamental difficulty in ToM that is independent of their language abilities. Children with DLD show difficulties in everyday social interactions that involve ToM. It is possible that both ASD and language disorders influence ToM development, suggesting that different developmental routes affect the acquisition of ToM.

Syntactic Strategy Training for Theory of Mind in Deaf Children

Children who are deaf or hard of hearing (DHH) show delays in Theory of Mind (ToM) development. Complement sentences such as "Eliane says that Santa Clause exists" influence ToM performance. Can a training program targeting sentential complements enhance ToM? Twenty-one French-speaking DHH children (Mage = 8 years 11 months) with delays in ToM and sentential complements completed a first series of tests (T0). Children were tested again to control for maturation effects (T1), after which they were included in a 6- to 8-week training program targeting complements with verbs of communication. Post-training tests (T2) assessed if the training yielded improvements on complements (direct effect) and ToM (transfer effect). While no gains were noted in the absence of training (at T1), results indicate post-training (T2) improvements in complements and ToM tasks, suggesting that the acquisition of sentential complements provides a tool to represent subjective truths and boosts ToM reasoning in DDH children.

A systematic scoping review of early interventions for parents of deaf infants

Background

Over 90% of the 50,000 deaf children in the UK have hearing parents, many of whom were not expecting a deaf child and may require specialist support. Deaf children can experience poorer long-term outcomes than hearing children across a range of domains. After early detection by the Universal Newborn Hearing Screening Programme, parents in the UK receive support from Qualified Teachers of the Deaf and audiologists but resources are tight and intervention support can vary by locality. There are challenges faced due to a lack of clarity around what specific parenting support interventions are most helpful.

Methods

The aim of this research was to complete a systematic scoping review of the evidence to identify early support interventions for parents of deaf infants. From 5577 identified records, 54 met inclusion criteria. Two reviewers screened papers through three rounds before completing data extraction and quality assessment.

Results

Identified parent support interventions included both group and individual sessions in various settings (including online). They were led by a range of professionals and targeted various outcomes. Internationally there were only five randomised controlled trials. Other designs included non-randomised comparison groups, pre / post and other designs e.g. longitudinal, qualitative and case studies. Quality assessment showed few high quality studies with most having some concerns over risk of bias.

Conclusion

Interventions commonly focused on infant language and communication followed by parental knowledge and skills; parent wellbeing and empowerment; and parent/child relationship. There were no interventions that focused specifically on parent support to understand or nurture child socio-emotional development despite this being a well-established area of poor outcome for deaf children. There were few UK studies and research generally was not of high quality. Many studies were not recent and so not in the context of recent healthcare advances. Further research in this area is urgently needed to help develop evidence based early interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02893-9.

Diagnosing Autism Spectrum Disorders in Deaf Children Using Two Standardised Assessment Instruments: The ADIR-Deaf Adaptation and the ADOS-2 Deaf Adaptation

The aim was to investigate the agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation overall diagnostic categorisation for autism (AUT) and a wider threshold to include autism spectrum (ASD) in a cohort of deaf children with and without ASD. We compared results of the instruments used on their own and when combined and propose standard criteria for the combined use of the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for use with deaf children. In total, 116 deaf children had a Gold standard NICE guideline assessment; 58 diagnosed with ASD and 58 without ASD, and for both groups a blinded informant based ADI-R Deaf adaptation and direct assessment using the ADOS-2 Deaf adaptation were separately completed. There was moderate agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for the wider threshold of ASD (Kappa, 0.433). To achieve the lowest number of false negatives, the most successful assessment tool approach is using the wider threshold of ASD with either ADI-R Deaf adaptation or ADOS-2-Deaf adaptation (95% sensitivity). This compares with 88% for the ADI-R Deaf adaptation alone and 74% for the ADOS-2-Deaf adaptation alone (wider threshold of ASD). To achieve a low number of false positives, the most successful assessment tool approach is a combination of ADI-R Deaf adaptation and ADOS-2- Deaf adaptation (using the narrow threshold of autism for both) (95% specificity). This compares with 83% for the ADI-R Deaf adaptation alone and 81% for the ADOS-2-Deaf adaptation (narrow threshold) alone. This combination is therefore recommended in specialist clinics for diagnostic assessment in deaf children.

Development and Implementation of a Low-Cost Tracking System after Newborn Hearing Screening in Upper Austria: Lessons Learned from the Perspective of an Early Intervention Provider

More than one decade after the introduction of newborn hearing screening in Upper Austria, most children were still older than 6 months at enrolment in early intervention. In this study, under the guidance of health authorities, a revised screening and tracking protocol was developed by a network of early intervention providers and representatives of ENT, obstetrics, and pediatrics, including screening professionals and parents of children with hearing loss. Critical process indicators following internationally recommended benchmarks were defined and collected annually by the health authorities. Due to data protection issues, the data collection system was not personalized. Regular network meetings, case-oriented meetings, and screener training sessions were held. As a result, even without additional costs and within the legal constraints related to data protection in Austria, the proportion of children enrolled in early intervention before 6 months of age was significantly increased from 26% to 81% in two representative birth cohorts before and after the introduction of the new protocol, respectively. The coverage for bilateral screening increased from 91.4 to 97.6% of the total number of births.

Shared understanding of color among sighted and blind adults

Empiricist philosophers such as Locke famously argued that people born blind might learn arbitrary color facts (e.g., marigolds are yellow) but would lack color understanding. Contrary to this intuition, we find that blind and sighted adults share causal understanding of color, despite not always agreeing about arbitrary color facts. Relative to sighted people, blind individuals are less likely to generate "yellow" for banana and "red" for stop sign but make similar generative inferences about real and novel objects' colors, and provide similar causal explanations. For example, people infer that two natural kinds (e.g., bananas) and two artifacts with functional colors (e.g., stop signs) are more likely to have the same color than two artifacts with nonfunctional colors (e.g., cars). People develop intuitive and inferentially rich "theories" of color regardless of visual experience. Linguistic communication is more effective at aligning intuitive theories than knowledge of arbitrary facts.

Adapting and validating the Autism Diagnostic Interview - Revised for use with deaf children and young people

LAY ABSTRACT

Autism assessment processes need to improve for deaf children as they are currently being diagnosed later than their hearing counterparts and misdiagnosis can occur. We took one of the most commonly used parent developmental interviews for autism spectrum disorder the Autism Diagnostic Interview-Revised and adapted it using international expert advice. Modifications were proposed and agreed by the expert panel for 45% of items; the remaining 55% of items were unchanged. We then tested the revised version, adapted for deaf children (Autism Diagnostic Interview-Revised Deaf Adaptation), in a UK sample of 78 parents/carers of deaf children with autism spectrum disorder and 126 parents/carers with deaf children without autism spectrum disorder. When compared to National Institute for Health and Care Excellence guideline standard clinical assessments, the Autism Diagnostic Interview-Revised Deaf Adaptation diagnostic algorithm threshold scores could identify those deaf children with a definite diagnosis (true autism spectrum disorder positives) well (sensitivity of 89% (79%-96%)) and those deaf children who did not have autism spectrum disorder (true autism spectrum disorder negatives) well (specificity of 81% (70%-89%)). Our findings indicate that the Autism Diagnostic Interview-Revised Deaf Adaptation is likely to prove a useful measure for the assessment of deaf children with suspected autism spectrum disorder and that further research would be helpful.

The mediating effect of language on the development of cognitive and affective theory of mind

Theory of mind (ToM) development is critical to effective social functioning and appears to depend on complementary language abilities. The current study explored the mediating influence of language on the development of both cognitive and affective ToM. A total of 151 children aged 5-12 years completed ToM (cognitive and affective) and language assessments, and parents provided ratings of their children's empathic ability. Results showed that language mediated the relationship between age and both cognitive and affective ToM but not parent-reported cognitive empathy. Examination of younger and older subgroups revealed that language mediated cognitive and affective ToM differently across developmental periods. Findings highlight the dynamic role that language plays in the development of both cognitive and affective ToM throughout early and middle childhood.

Deaf Children of Hearing Parents Have Age-Level Vocabulary Growth When Exposed to American Sign Language by 6 Months of Age

OBJECTIVE

To examine whether children who are deaf or hard of hearing who have hearing parents can develop age-level vocabulary skills when they have early exposure to a sign language.

STUDY DESIGN

This cross-sectional study of vocabulary size included 78 children who are deaf or hard of hearing between 8 and 68 months of age who were learning American Sign Language (ASL) and had hearing parents. Children who were exposed to ASL before 6 months of age or between 6 and 36 months of age were compared with a reference sample of 104 deaf and hard of hearing children who have parents who are deaf and sign.

RESULTS

Deaf and hard of hearing children with hearing parents who were exposed to ASL in the first 6 months of life had age-expected receptive and expressive vocabulary growth. Children who had a short delay in ASL exposure had relatively smaller expressive but not receptive vocabulary sizes, and made rapid gains.

CONCLUSIONS

Although hearing parents generally learn ASL alongside their children who are deaf, their children can develop age-expected vocabulary skills when exposed to ASL during infancy. Children who are deaf with hearing parents can predictably and consistently develop age-level vocabularies at rates similar to native signers; early vocabulary skills are robust predictors of development across domains.

Beyond the Senses: How Self-Directed Speech and Word Meaning Structure Impact Executive Functioning and Theory of Mind in Individuals With Hearing and Language Problems

Many individuals with developmental language disorder (DLD) and individuals who are deaf or hard of hearing (D/HH) have social–emotional problems, such as social difficulties, and show signs of aggression, depression, and anxiety. These problems can be partly associated with their executive functions (EFs) and theory of mind (ToM). The difficulties of both groups in EF and ToM may in turn be related to self-directed speech (i.e., overt or covert speech that is directed at the self). Self-directed speech is thought to allow for the construction of non-sensory representations (i.e., representations that do not coincide with direct observation). Such non-sensory representations allow individuals to overcome the limits set upon them by the senses. This ability is constrained by the development of word meaning structure (i.e., the way words are understood). We argue that the greater ability to construct non-sensory representations may result in more enhanced forms of EF and ToM. We conclude that difficulties in EF, ToM, and social–emotional functioning in those with hearing and language problems may be accounted for in terms of word meaning impairments. We propose that word meaning structure and self-directed speech should be considered in assigning EF and ToM treatments to individuals with DLD and those who are D/HH.

Teaching With Picture Books on Deaf and Hard-of-Hearing Students'Creativity

Studies have shown that teaching with picture books can help improve creativity development of deaf and hard-of-hearing (DHH) students. A quasi-experimental research design was applied in this study. Deaf and hard-of-hearing students in grades 3-6 from two cities, B and T, were selected as the samples in a pilot study. The Evaluation of Potential Creativity (EPoC) test tool (Ver. A) was applied to measure creativity through student performance on individual tests of divergent and integrative thinking. Following thirty 40-min lessons over 10 weeks, the EPoC test tool (Ver. B) was used to measure student creativity in the experimental and control groups. The results showed the following: (1) the performance of DHH students was better on graphic divergence than on verbal divergence, (2) performance on the divergent dimensions of creativity was significantly higher for DHH students from the experimental group than the control group, and (3) there was no difference in integrative thinking between the two groups in the posttest. In practice, teachers could use picture books in their lesson plans to improve the creativity of DHH students that results from divergent thinking. Future research should focus on the development of creativity in DHH students through integrative thinking with a longer teaching intervention.

Narrative competence in Italian children with cochlear implants: a comparison with children matched by chronological or hearing age

The present study aimed to analyse the narrative competence of a group of Italian children with a bilateral cochlear implant (CI) implanted before 30 months of age. Participants were ten children with CI (aged from 42 to 83 months) and two control groups of typically hearing children one-to-one paired by sex, non-verbal reasoning, and chronological or hearing age. A story generation task, specifically developed to assess narrative skills in children (i.e., the Narrative Competence Task) was used to evaluate both macrostructural and microstructural features of the children's narratives. Results showed that children with CI presented only one significant difference in the macrostructural aspects of narratives compared to typically hearing children matched by hearing age, specifically in the higher number of events told. In addition, concerning microstructural features, the only statistically significant difference was a lower lexical variety in the narratives produced by children with CI than in those produced by typically hearing children matched by chronological age. Both macrostructural and microstructural indices appeared to be related to the hearing age of children with CI. Early CI appeared to play a crucial role in the acquisition of a complex area of language development, as narrative competence.

Verbal mediation of theory of mind in verbal adolescents with autism spectrum disorder

This study tests the role of verbal mediation during theory of mind processing in autism spectrum disorder (ASD). Adolescents with ASD or typical development completed a false belief task while simultaneously performing a verbal or nonverbal load task. There was no group difference in false belief accuracy; however, under verbal load, the ASD group was relatively less efficient, with slower reaction times, in false belief compared to true belief trials. Faster false belief task performance under verbal but not nonverbal load was associated with pragmatic language ability for the ASD group only. Results were consistent with the theory that there are two (implicit, nonverbal and explicit, verbal) processes that support cognitive reasoning about other people's minds (Apperly & Butterfill, 2009), and that people with ASD rely more on the explicit system. Verbal mediation may be critical for false belief understanding in individuals with ASD, but not typical development.

Frühe Prädiktoren der Sprachentwicklung von Kindern mit permanenter Hörstörung

Zusammenfassung. Theoretischer Hintergrund: Sprachentwicklungsverläufe bei Kindern mit Hörstörungen zeigen eine hohe und überwiegend ungeklärte Varianz. Fragestellung und Methode: Unsere Übersichtsarbeit präsentiert aktuelle Evidenz zu frühen Prädiktoren der Sprachentwicklung. Ergebnisse und Diskussion: Trotz deutlicher positiver Trends erreicht nur jedes zweite Kind ein Sprachentwicklungsniveau im Normbereich. Der Literaturüberblick ergibt signifikante kindbezogene und familiäre Prädiktoren mit eher geringer Beeinflussbarkeit. Als hoch prädiktiv für sprachliche Ergebnisse und zudem der Intervention zugänglich erweisen sich die frühe Erkennung und technische Versorgung mit Hörgeräten oder -implantaten und Aufnahme in die Frühförderung, konsistente Hörtechnikverwendung und/oder früher Zugang zur Gebärdensprache. Zudem zeigt sich die Qualität der täglichen Eltern-Kind-Interaktion als hocheffektiv für die Sprachentwicklung. Schlussfolgerung: Es bestätigt sich die Wirksamkeit aktueller Best Practice früher Erkennung, Versorgung und familienzentrierter Frühförderung.

Goodnight Gorilla: Deaf Student American Sign Language Narrative Renditions After Viewing a Model

The present study used an observational learning framework to investigate changes in non-native signing deaf children's narrative renditions before (Time 1) and after (Time 2) a single viewing of a signing adult's rendition of the same story. The deaf adult model rendered the picture book Goodnight Gorilla in American Sign Language (ASL) with the pages of the book displayed behind her. We analyzed the details children aged 6-13 years included within their narratives and how they rendered those details. Specifically, we compared their use of depicting constructions (DCs), constructed action (CA), simultaneous use of both DCs and CA, and only lexical signs before and after viewing the model. The deaf adult predominantly and equally used CA and constructed actin paired with DCs and rarely used lexical signs alone during her rendition. After watching the adult rendition, children's renditions were longer and they included more details. Children increased their use of DCs, CA, and to a lesser extent, combinations of DCs and CA. However, half of the children never used DCs paired with CA. Suggestions for pairing ASL content standards with viewings of deaf adult sign language models are discussed.

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.

Modifying and validating the social responsiveness scale edition 2 for use with deaf children and young people

A Delphi consensus methodology was used to adapt a screening tool, the Social Responsiveness Scale– 2 (SRS-2), for use with deaf children including those whose preferred communication method is sign language. Using this approach; 27 international experts (The Delphi International Expert Panel), on the topic of autism spectrum disorder (ASD) in deaf people, contributed to the review of item content. A criterion for agreement was set at 80% of experts on each item (with 75% acceptable in the final fourth round). The agreed modifications are discussed. The modified SRS-2 research adaptation for deaf people (referred to here as the “SRS-2 Deaf adaptation”) was then translated into British Sign Language using a robust translation methodology and validated in England in a sample of 198 deaf children, 76 with Autism Spectrum Disorders (ASD) and 122 without ASD. The SRS-2 Deaf adaptation was compared blind to a NICE (National Institute for Health and Care Excellence) guideline standard clinical assessment. The area under the Receiver Operating (ROC) curve was 0.811 (95% CI: 0.753, 0.869), with an optimal cut-off value of 73, which gave a sensitivity of 82% and a specificity of 67%. The Cronbach Alpha coefficient was 0.968 suggesting high internal consistency. The Intraclass Correlation Coefficient was 0.897, supporting test-retest reliability. This performance is equivalent to similar instruments used for screening ASD in the hearing population.

Autobiographical Memory in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, Hearing Loss, and Childhood Trauma: Implications for Social Communication Intervention

Purpose Speech-language pathologists (SLPs) work with a variety of populations at risk for poor autobiographical and episodic memory. The purpose of this tutorial is to describe autobiographical memory and how it is affected in children with autism spectrum disorder, attention-deficit/hyperactivity disorder, hearing loss, and childhood trauma, as well as provide clinicians with practical strategies for supporting autobiographical memory in each of these clinical populations. Method This tutorial reviews the literature on (a) autobiographical and episodic memory in typical development; (b) its relation to theory of mind, personal narrative skills, and executive functions; (c) elaborative reminiscing in typical development; (d) how autobiographical memory is impaired in children with autism spectrum disorder, attention-deficit/hyperactivity disorder, hearing loss, and childhood trauma; and (e) strategies for supporting autobiographical memory in each clinical population. Conclusions When adequately prepared, SLPs are uniquely situated to address autobiographical and episodic memory in their work with children, families, and related professionals. This is a long-overdue focus of such great clinical import that justifies its inclusion in the traditional training and preparation of SLPs. Adapting elaborative reminiscing strategies for use with various clinical populations is promising for facilitating healthy EM development and related cognitive functions.

Theory of Mind, Executive Functions, and Syntax in Bilingual Children with Autism Spectrum Disorder

Impairments in Theory of Mind (ToM) are a core feature of Autism Spectrum Disorder (ASD). ToM may be enhanced by various factors, including bilingualism, executive functions (EF), and complex syntax. This work investigates the language-cognition interface in ASD by exploring whether ToM can be enhanced by bilingualism, whether such ToM boosts would be due to EF or syntax, and whether routes to mentalizing would differ between bilinguals and monolinguals on the spectrum. Twenty-seven monolingual Greek-speaking and twenty-nine bilingual Albanian-Greek children with ASD were tested on ToM reasoning in verbal and low-verbal ToM tasks, an executive function 2-back task, and a sentence repetition task. Results revealed that bilingual children with ASD performed better than monolinguals with ASD in the low-verbal ToM and the 2-back tasks. In the sentence repetition task, bilinguals scored higher than monolinguals in complex sentences, and specifically in adverbials and relatives. Regarding the relations between ToM, EF, and sentence repetition, the monolingual group’s performance in the verbal ToM tasks was associated with complement syntax, whereas, for the bilingual children with ASD, performance in both verbal and low-verbal ToM tasks was associated with EF and adverbial clause repetition. The overall pattern of results suggests that mentalizing may follow distinct pathways across the two groups.

Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

In this article, we review relational factors in early childhood believed to contribute in unique ways to pragmatic skill development in deaf and hard of hearing (DHH) infants and toddlers. These factors include attending to infant interactions with caregivers and others, supporting development of theory of mind through play and use of mental state language (ie, describing one's own or others' thoughts, feelings, and beliefs), and providing accessible opportunities for social interaction. On the basis of a review of the literature and clinical experience, we offer prescriptive strategies for supporting DHH children's development in these areas. To improve outcomes for DHH children, medical care providers and allied health professionals have a responsibility to support the development of young DHH children's pragmatic abilities by understanding these variables, coaching caregivers regarding their importance, and facilitating referrals for support when necessary.

Narrative Abilities of Adults' With Down Syndrome as a Window to Their Morphosyntactic, Socio-Cognitive, and Prosodic Abilities

Down syndrome (DS) is the most common developmental disorder characterized by mild to moderate intellectual disability. Several studies have reported poor language and prosodic skills and contradictory results regarding individuals’ with DS socio-cognitive skills, whereas most of them have focused on children with DS. The present study attempts to explore adults’ with DS language, socio-cognitive and prosodic abilities via the use of story-retellings. Twenty adults with DS and two groups of TD children, one matched to their expressive vocabulary (TD-EVT) and the other matched to their non-verbal mental age (TD-RCPM), took part in the present study. Participants listened to a story while viewing a wordless picture PowerPoint presentation on a computer screen, and then, they were instructed to retell the story while viewing the pictures for a second time. Each participant listened to two stories, one with “lively” and one with “flat” prosody. Results revealed that adults’ with DS performance was comparable with the one presented by the TD-RCPM group, whereas the TD-EVT group performed significantly better in almost all variables. Individuals’ with DS re-narrations, however, contained significantly less complement clauses and internal state terms (related or not related to Theory of Mind–ToM) compared to the re-narrations of both control groups. In contrast, the group with DS performed similarly to both control groups in comprehension questions related to main characters’ internal state terms and significantly better compared to the TD-RCPM group in questions related to ToM. In terms of prosody, all three groups performed significantly better on story structure and comprehension questions when prosody was “lively” compared “flat” prosody. DS group’s re-narrations did not contain enough internal state terms, not due to their inability in recognizing them, but due to their poor morphosyntactic abilities, which did not allow them to find the proper means to express the main characters’ internal states. Prosody facilitated participants with DS in the comprehension and re-narration. This suggests that intervention programs based on prosody could support the language skills of adults with DS.

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.