Theory of Mind (ToM) is the ability to understand that other people’s thoughts, desires, motivations, and preferences are not the same as our own. Babies begin life seeing everyone in the world as an extension of themselves (which makes sense, because for the past nine months, they basically were!). Toddlers might not realize that even if they say, “I didn’t eat the cookie,” the chocolate around their mouths tells a different story. Young children may have difficulty dealing with the fact that not everyone wants to play their favorite game or talk about their favorite topics 24/7. But as we grow, typically-developing people begin to learn the boundaries between “my thoughts” and “others’ thoughts” and use that Theory of Mind to navigate social situations. If Theory of Mind doe snot develop, or does not develop fully, social difficulties can follow. People with autism generally struggle with this “mind blindness,” which might not be so shocking, but did you know that children with hearing loss are at particular risk for ToM difficulty, too?
One classic example of Theory of Mind is called the Sally-Ann test, which is as follows:
Can a child realize that what he knows, having seen the whole story, is different from what the characters know, as some of them were not present when the object in question was moved?
We hypothesize that children with hearing loss may struggle with theory of mind because of their decreased access to incidental learning — to put it simply, as great as hearing aids, BAHAs, and cochlear implants are, they are no match for the “overhearing potential” of a typically-hearing ear. Overhearing is how we pick up on social nuances as a child — hearing your mother mutter to your father, “I’ve told you a million times, I hate gardenias,” hearing your older sister say, “I thought Tanisha was the one who told Jordan I liked him, but it was actually Leela, so I blew up at Tanisha for no reason,” or hearing your grandmother say, “I really hate chocolate cake, but everyone else in the family likes it, so I guess I’ll make one for the party.” These things aren’t explicitly taught, but boy is life tough if you don’t understand them. A child can have perfect articulation, a huge vocabulary, and impeccable grammar and still struggle mightily in social situations if he doesn’t have well-developed Theory of Mind.
So what to do? Check out Part Two…