Importance of early access to language: theory of mind in school-aged children with cochlear implants

Objective:This study aimed to investigate the theory of mind (ToM) understanding in early implanted school-aged children in Norway, comparing their performance to that of typically developing (TD) peers, and considering age at implantation and hearing age.Methods:Twelve 8-12-year-old children, who received cochlear implants (CI) before 18 months of age, were recruited. Ten of them were included in early speech-language and listening intervention. The control group comprised 22 TD peers. All children underwent tests evaluating cognitive and affective ToM. Bayesian methods were used to examine group differences in cognitive and affective ToM, and the relationships between ToM variables and implantation and hearing age.Results:The children with CI were more likely to perform comparably to TD peers on both affective and cognitive ToM, than differing from them. The relationship between affective ToM and implantation age was more likely to be present than absent, while a converse correlation pattern was found for cognitive ToM and implantation and hearing age. The relationship between affective ToM and hearing age was inconclusive, suggesting more data is needed.Conclusion:Our findings underscore the importance of early implantation in supporting ToM progress, aligning with the sensitive period account. Missing the sensitive period for optimal ToM development could lead to lasting ToM developmental gaps. Therefore, to minimize potential delays, it might be essential to provide CI and speech-language and listening intervention early in life. These measures facilitate the social interactions with caregivers that are critical for fostering ToM development.