PP1001 - Discovering Theory of Mind: Journey of a Child with Bilateral Hearing Loss

Abstract:
Theory of mind (ToM) is the capacity to understand the state of mind of others—their emotions, intentions, and beliefs. Communication and language development, which are affected by hearing loss, are necessary to develop ToM. Maya, who was born with bilateral atresia and hearing loss, realized early on that she had significant difficulty interpreting social cues and emotions of others, which left her feeling isolated. Maya’s experiences will be presented as an example to illustrate the consequences of hearing loss on the development of ToM. The importance of early intervention to develop a robust ToM for children who are deaf or hard-of-hearing will be discussed.

Summary:

Introduction
Theory of mind (ToM) is a psychological concept focused on understanding others' mental states, including their emotions, intentions, and beliefs, and recognizing that they may differ from one's own. For example, inferring that “Jack is upset because he is stuck in traffic.” ToM is classified into Cognitive and Affective components.

Cognitive ToM:

Interpersonal – Understanding that others' thoughts, beliefs, and desires are different from one's own.
Intrapersonal – Reflecting on one's own mental state and planning behavior.
Affective ToM:

Interpersonal Affective Cognitive – Recognizing and inferring the emotions of others and predicting behaviors based on emotions.
Intrapersonal Affective Cognitive – Reflecting on and regulating one's own emotions and motivations.
Affective Empathy – Empathizing with others.
A deaf or hard-of-hearing (DHH) child is not just a child who cannot hear, as hearing loss causes global changes in neurocognitive function (Conway et al., 2011; Marschark & Hauser, 2008). Hearing loss affects the development of both Cognitive and Affective ToM. Communication and language development are required for a robust ToM, both of which are impacted by hearing loss. Access to sound is a critical pillar for language acquisition, along with incidental learning and language immersion with fluent speakers. For a fully developed ToM, there are three essential requirements: intention understanding, desire understanding, and belief understanding (Netten et al., 2017). These skills work together to help children form and maintain relationships.

Early intervention plays a significant role in language development. With proper intervention, the language development of children with mild and unilateral hearing loss can catch up to their typically developing peers (Nassrallah et al., 2020). However, the pragmatic and language/literacy skills of children and adolescents who are DHH may not keep pace with hearing children (Nittrouer, 2016).

This presentation includes a rare first-hand account of a young woman born with bilateral atresia and her self-learning journey in developing ToM. Maya was born without pinnae or ear canals. Doctors told her mother that Maya would not hear, talk, or walk. Surgeries to construct ear canals were unsuccessful. A later MRI revealed an intact right cochlea. Maya began using a bone-conducted hearing aid at four months of age and later used a bone-anchored hearing aid (BAHA) during college. Her mother’s persistence in ensuring that Maya would talk helped her progress, and today, Maya works as a speech-language pathologist (SLP) with children who are DHH.

However, Maya reported feeling that she was missing “something” early in life. It wasn’t just her hearing loss that made her feel different—it isolated her from people around her. Maya constantly worried about her social-emotional experiences, wondering what people thought about her when she did not respond as expected, either because she hadn’t understood or had misinterpreted what was said or done. Throughout her life, she sought strategies to read social cues (Westby, 2021).

Maya’s experiences exemplify the consequences of hearing loss on ToM development. Her journey to increase her self-awareness about ToM through books and movies will be presented. The importance of early intervention programs emphasizing emotional understanding and communication skills for children who are DHH and their caregivers (Blose et al., 2022) will also be discussed.br/>