Supporting Theory of Mind Development in Children with Hearing Loss

As you might imagine, children with hearing loss typically experience delayed skill development in several areas, especially language. Luckily, in addition to the child’s parents and family, pediatric audiologists are available to help build the child’s skills and abilities.
While much of a pediatric audiologist’s work focuses on building the language, vocabulary, syntax, and conversational competence of a child with hearing loss, their work does not end there. While a child may have sufficient vocabulary for their age, they must develop the brain skills needed for successful social interactions and conversations.
Social interactions are key in helping a child understand him- or herself, as well as understanding others as beings with feelings, beliefs, thoughts, and desires. This understanding of others also includes the idea that these feelings and beliefs affect others’ actions and words.
Theory of mind (ToM) is the understanding of people as mental beings. As mental beings, each person has their own mental states of belief, wants, intents, and memory. We use ToM to not only interpret why other people say or do certain things, but also to explain our own actions and statements. As a child develops ToM, they are able to put themselves in another person’s shoes.
Research has uncovered that children with hearing loss often develop theory of mind later than children with normal hearing. Researchers believe this delay is due to reduced auditory access to the conversations of others. Because a significant delay in developing ToM can have a detrimental effect on social relationships and academic achievement, it is essential to help a child with hearing loss develop ToM in the appropriate developmental period.
As a parent or family member of a child with hearing loss, you can help him or her develop theory of mind by using the following tips and ideas:

  • “Eyes open, ears on.”

Because studies have shown that children who wear their hearing aids for more than 10 hours a day achieve better language outcomes than children who wear their hearing aids for less than 10 hours a day, it is imperative that you help your child use their hearing aid or cochlear device during all waking hours. Children who use their hearing aids for more hours every day also typically have better speech recognition and higher parent ratings of auditory skills.

  • Encourage pretend play.

Pretend play is an early step for a child in being able to understand another person’s perspective, making it an important precursor to developing theory of mind. Encourage your child to engage in pretend play, whether it is a tea party, imaginary school classroom, picnic, or piloting a pretend airplane.

  • Read – a lot.

Reading to children helps to increase their vocabulary, as well as expand their syntax and aid in ToM development. The idea is to help a child understand the thoughts, feelings, and beliefs of another person, which is often featured in children’s books. When reading a book to a child, try simply talking about the story rather than reading every word on the page. Ask the child what they think the character in the story is thinking or feeling.

  • Make mental state words familiar.

Mental state verbs or thinking words should become familiar to the child. Mental state verbs are words about thought, such as believe, like, love, hate, think, remember, hope, wonder, guess, wish, feel, forget, learn, imagine, and recognize. Make it a point for you and other family members to use mental state verbs on a daily basis. For example, you might say something like, “Oh, I forgot to bring the dog’s treats to the park with us. I hope she doesn’t get hungry!”
When a child is 18-24 months of age, begin to encourage them to consider the feelings and thoughts of other people. You can promote this with phrases like, “Do you hear the baby crying? I think he might be crying because he is tired or hungry!”
Helping your child develop theory of mind may seem daunting, but these simple daily tasks can help your child build a strong mental foundation. For more information about ToM, developmental issues for children with hearing loss, and how our audiologist can help, we welcome you to contact us today.


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