Self Concept-How the Child with Hearing Loss Sees Himself

Impact of Hearing Loss on Theory of Mind Development

Chu’s (2024) study explored the development of ToM in children with different degrees of hearing loss—mild-to-moderate (MHL), severe-to-profound (SHL), and typical hearing (TH). The findings revealed that both MHL and SHL groups experienced delays in ToM development compared to their typically hearing peers. The SHL group, in particular, exhibited more substantial delays across a wider range of ToM tasks, including knowledge access, false belief understanding, and hidden emotion recognition. While the MHL group showed delays primarily in hidden emotion understanding, the SHL group’s delays were broader, impacting multiple aspects of ToM. In general, when a student has a severe to profound hearing loss, developed before the critical language learning years, executive function and language acquisition skills are affected. The development of executive functioning skills are a huge indicator of social and emotional adjustment.

These findings align with Westby and Hutchins’ (2016) assertion that children with hearing loss struggle with ToM development due to limitations in their ability to engage in meaningful social interactions. Both researchers emphasize that language comprehension plays a critical role in developing ToM, with children who have limited access to language—whether through spoken or signed communication—being at a greater disadvantage. Westby and Hutchins (2016) note that ToM is closely linked to the ability to engage in social conversations, which require understanding others’ thoughts, emotions, and perspectives. Without these critical language skills, children may struggle to interpret social cues and navigate complex social situations.

The Role of Language in Theory of Mind Development

The relationship between language skills and ToM development is central to understanding the challenges faced by children with hearing loss. Chu (2024) found that language comprehension was significantly correlated with ToM performance in both MHL and SHL groups. For children with MHL, aided audibility (e.g., hearing aids or cochlear implants) was associated with better performance on false belief tasks, suggesting that access to clearer auditory input plays a role in developing the cognitive processes required for understanding others’ beliefs and emotions.

Westby and Hutchins (2016) further reinforce this connection, arguing that children with hearing loss often have limited opportunities to develop ToM due to delays in language acquisition. In their study, the authors emphasize that children with hearing loss may miss out on critical language experiences, such as overhearing conversations and participating in casual dialogues, which can hinder their understanding of complex social concepts like deception, belief, and perspective-taking.

Practical Strategies for Supporting ToM Development in Schools

Given the significant role that language comprehension plays in ToM development, professionals working with children in schools need to focus on fostering both language and social-cognitive skills. The following strategies can help bridge the gap for children with hearing loss:

1. Promote Rich, Interactive Communication

To support ToM development, it is essential to provide children with rich, interactive communication opportunities. This includes both structured and unstructured conversations that allow children to practice perspective-taking, share ideas, and discuss their feelings. For children with hearing loss, this means ensuring that they have full access to communication, whether through speech, sign language, or augmentative communication devices. Teachers and speech-language pathologists (SLPs) should encourage peer interactions, collaborative group work, and social play, where children can practice understanding others’ viewpoints.

Strategy: Create a classroom environment where communication is supported by visual aids (e.g., written language, gestures, facial expressions) and ensure that children with hearing loss have the necessary assistive listening devices (e.g., FM systems) to access conversations clearly.

2. Focus on Social Stories and Role-Playing Activities

Social stories and role-playing are powerful tools for teaching ToM. These activities allow children to practice recognizing and interpreting different emotions, intentions, and perspectives. By engaging in role-play, children can simulate situations that require them to understand how others think or feel, providing them with the opportunity to practice ToM skills in a low-risk setting.

Strategy: Use social stories to illustrate various social scenarios, such as conflict resolution, helping others, or understanding different viewpoints. Role-playing activities can also be tailored to target specific ToM tasks, such as identifying emotions or predicting actions based on another person’s perspective.

3. Leverage Technology for Visual Learning

Strategy: Integrate video clips or animated stories that depict various social scenarios into lessons. The website Described and Captioned Media Program, has many videos that are captioned and have ASL as well. Encourage children to discuss the characters’ motivations and emotions, helping them practice ToM tasks such as understanding emotions, predicting actions, and explaining behaviors from different perspectives. The use of Thinking Maps are always helpful, by showing students ways for visual language for learning.

4. Develop Language Skills through Explicit Instruction

Since language comprehension is so closely tied to ToM development, providing explicit instruction in both receptive and expressive language skills is critical. This can be particularly beneficial for children with hearing loss, who may need additional support in language development to catch up with their peers.
Strategy: Use targeted language interventions to build vocabulary and sentence structures that support social communication. SLPs can work with children on understanding complex language structures like “if…then” statements, conditional phrases, and questions that promote perspective-taking (e.g., “How would you feel if…?”).

5.Foster Emotional Literacy

Developing emotional literacy—understanding and labeling emotions—can support both language and ToM development. Children need to recognize and label emotions before they can effectively understand how those emotions influence behaviors and social interactions. For children with hearing loss, it may be especially important to ensure that they have explicit lessons in recognizing emotions through facial expressions and body language.
Strategy: Implement activities that focus on recognizing and labeling emotions, such as emotion cards, feelings charts, and storybooks that highlight characters’ emotions. Teachers and therapists can also model emotional expressions and encourage children to discuss their own feelings in various situations.

5.Collaborate with Families and Support Networks

Collaboration between school professionals, families, and other support networks is crucial to providing a consistent and comprehensive approach to ToM development. Families can reinforce ToM and language skills at home, particularly through shared reading, discussions, and daily

Strategy: Create individualized plans for students with hearing loss that include input from teachers, SLPs, audiologists, and families. Provide families with resources and suggestions for reinforcing ToM skills and language development at home.

School professionals play a critical role in supporting children by fostering rich communication, enhancing language skills, using visual learning tools, and creating opportunities for social interaction. Making sure a student’s Communication Plan is accurate, up-to-date, and implemented by all staff across the school is critical. By implementing these strategies, educators and therapists can help children with hearing loss overcome barriers to ToM development, ultimately promoting their emotional, social, and academic growth.

Chu, C. Y. (2024). Listening beyond words: Understanding theory of mind in hearing-impaired children with different hearing loss degrees. *Speech, Language and Hearing*, 1–10. https://doi.org/10.1080/2050571X.2024.2429900

Westby, C., & Hutchins, T. (2016). Theory of Mind and Communication in Children with Hearing Loss: Implications for Practice. *Journal of Speech, Language, and Hearing Research*, 59(2), 278-292. https://doi.org/10.xxxx/jslhr.2016.XX

Links:

https://dcmp.org
https://www.thinkingmaps.com/
https://successforkidswithhearingloss.com/products/
https://www.youtube.com/watch?v=U9hPUCOaSn0