Global Educators Cohort Program - Teacher Education

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Theory of mind and language in children with cochlear implants.


Dr. Ethan Remmel/Western Washington University, WA was available from 2/2/09 until 2/22/09 to answer questions and share ideas concerning his research and its implications for parents of children who are deaf/hard of hearing, their teachers and other professionals who work with them.
  • You are encouraged to read the research summary below and review the attached discussion.

Thirty children with cochlear implants (CI children), age range 3-12 years, and 30 children with normal hearing (NH children), age range 4-6 years, were tested on theory of mind and language measures. The CI children showed little to no delay on either theory of mind, relative to the NH children, or spoken language, relative to hearing norms. The CI children showed a slightly atypical sequence of acquisition of theory of mind concepts. The CI children’s theory of mind performance was associated with general syntactic proficiency more than measures of complement syntax, and with time since implantation more than age at implantation. Results suggest that cochlear implantation can benefit spoken language ability, which may then benefit theory of mind, perhaps by increasing access to mental state language.

I’m interested in the relationship between language experience and cognitive development (the development of children’s thinking and knowledge). Some previous research indicates that cochlear implantation can improve deaf children’s access to spoken language. Relatively little research has looked at cognitive development in children with cochlear implants. My focus is a particular area of cognitive development called “theory of mind.” Theory of mind is a fancy name for something we all do all the time: we predict and explain people’s actions as motivated by their mental states (desires, beliefs, emotions, etc.). For example, to explain “Why did Bob give Sarah flowers?” we might say “He wanted [desire] her to like him and he thought [belief] that it would make her feel happy [emotion].” Theory of mind is very important because without understanding people’s mental states we cannot understand anyone’s behavior.

Some previous research indicates that deaf children of hearing parents are often quite delayed in their theory of mind development. Some other research suggests that the more hearing parents talk to their hearing children about mental states (what people want, think, feel, etc.), the better the children understand these concepts. Deaf children of hearing parents often have limited ability to partake in such conversations. Therefore we wondered: if cochlear implantation improves children’s access to spoken language, would it also benefit their theory of mind?
We tested 30 children with cochlear implants, ages 3-12 years (average age 7 ½ years). All their parents were hearing and all the children used spoken English and not sign language to communicate. Most were in mainstream classrooms. We also tested a comparison group of 30 children with normal hearing, ages 4-6 years. The theory of mind tests consisted of presenting the children with situations and then asking them to predict or explain the actions or mental states of the characters in the situations. For example, the child is shown that a Band-Aid box actually contains something else (a toy pig). The child is then asked to predict what a character (Peter), who has not seen inside the box, thinks is inside. The correct answer is to say that Peter thinks there are Band-Aids inside, even though the child knows that this belief is false (this is known as false belief understanding, and typically develops around age 4-5 in hearing children). We also measured the children’s spoken language ability, both comprehension and production.

Overall, the children with cochlear implants did well on both the theory of mind and language measures. Unlike deaf children of hearing parents in previous research, they were not delayed in their theory of mind development, compared to the children with normal hearing. Although there was individual variability, on average they were not delayed for their age on either comprehension or production of spoken language.
Years since implantation predicted theory of mind performance, but age at implantation did not. In other words, children who had been implanted for a longer time tended to do better on the theory of mind measures, but children who had been implanted at younger ages did not consistently do better (or worse) than children who had been implanted at older ages. This is interesting because it suggests that children’s theory of mind development may benefit from increased access to and experience with language, regardless of the age at which that occurs. However, it may simply reflect the fact that older children tended to have been implanted later and longer and also to do better on the theory of mind measures.

Are the good outcomes we found in this study typical of children with cochlear implants? Unfortunately, we cannot answer this question. We recruited children through aural rehabilitation clinics in North America, and we tested every child that we could, but we cannot be sure that our sample was representative of all children who have received cochlear implants. For example, children who have stopped using their implants or oral communication were not represented in our study. As always, more research is needed.

Remmel, E., & Peters, K. (in press). Theory of mind and language in children with cochlear implants. Journal of Deaf Studies and Deaf Education.