Listening beyond words: understanding theory of mind in hearing-impaired children with different hearing loss degree

This study investigated Theory of Mind (ToM) development in children with hearing loss, comparing children with mild-to-moderate hearing loss (MHL, n = 26), severe-to-profound hearing loss (SHL, n = 31), and typical hearing (TH, n = 53), aiming to explore the differences between the three groups and potential factor related to the ToM development in children with hearing loss. Participants completed the ToM scale and language assessments. One-way ANOVA and Bonferroni post-hoc tests were used to analyze group differences, while Pearson's correlation examined relationships between ToM, language, and background variables. Results revealed that both MHL and SHL groups showed delays in overall ToM skills compared to TH peers, with the SHL group exhibiting more substantial delays. The MHL group demonstrated delays only in hidden emotion understanding, while the SHL group showed delays from knowledge access through false belief and hidden emotion tasks. Language comprehension was significantly correlated with ToM skills in both hearing loss groups. Aided audibility was associated with false belief understanding in the MHL group. The study highlights the impact of hearing loss severity on ToM development and emphasizes the crucial role of language comprehension in ToM skills. Findings suggest the need for tailored interventions addressing language and communication challenges to support ToM development in children with hearing loss.