ProToM: Promoting Deaf and Hard of Hearing Children’s Theory of Mind and Emotion Understanding

Deaf and hard of hearing children are particularly at risk of being many years behind in the development of ToM competence and emotion understanding compared to hearing peers. The ability to put oneself in other people's shoes and to understand the causes of one's own emotions and beliefs and those of others is a central prerequisite for self-regulation, conflict resolution skills, and critical thinking, for example. Developmental delays in ToM and emotion understanding can therefore limit social integration.

The mentioned risk applies to both oral and sign language communicating children. Language acquisition (spoken language and/or sign language) may be more difficult in deaf and hard of hearing children and may be delayed. Although deaf and hard of hearing children progress through the same developmental stages as hearing children, the pace of development may be much slower for deaf and hard of hearing children (Wellman, 2018; Becker et al., 2018). As a result, active and passive participation in language interactions may also be limited, and competencies in mental concepts and grammar may be delayed.

It is of vital importance to implement prevention and intervention measures for these social-cognitive skills in early intervention, kindergarten and school and at the same time - unlike existing support programs from the field of autism spectrum disorder - also train the corresponding language skills in spoken and/or signed languages. Fortunately, research has shown (Sprung et al. 2015 and Hofmann et al. 2016.) that properly designed intervention programs for ToM can train deaf and hard of hearing children.

The development program THE MINDREADERS was developed strictly theory-based by linking it to the developmental steps of Theory of Mind and the emotion understanding according to Peterson, Wellman & Liu (2005) and Pons, Harris, & de Rosnay (2004). The different developmental steps are trained in nine different modules, which can be worked through in a modular fashion.

The program was developed jointly by hearing and deaf and hard of hearing researchers, teachers and educators, and cultural diversity was taken into account.
All materials can be downloaded and used free of charge from our website, taking into account the copyright conditions, and can be individually adapted to the needs of the respective children and young people.

The program was tested in two pilot phases with 116 children and adolescents in Switzerland, Germany, Greece and Cyprus and its effectiveness was evaluated with two tests (pre-post test design with intervention and control group; «Theory of Mind Task Test» by Peterson et al., 2005 adapted into sign languages and the «Test of Emotion Comprehension» by Pons, Harris and De Rosnay, 2004). The testing phases took place in special schools for deaf and hard of hearing students and regular schools during approximately 10 weeks and were conducted by deaf and hearing teachers and educators. The exercises were tried out in classes, small groups and in individual settings. The results and detailed feedback (evaluation journals after each lesson, focus group interviews) from the teachers were used to revise the training program and to develop a so-called toolbox (information on ToM and hearing impairment, instructions for implementation in schools, information on spoken and sign language, family work, research).

Basically, it must be confirmed that the majority of the students in the present sample show a developmental delay in ToM competencies compared to hearing peers.

The pre-post-test of the first testing phase showed that the intervention group increased their competencies in ToM as well as in emotion understanding more than the control group. However, this difference is not statistically significant. For ToM competencies, there is a significant main effect of time (F(1, 103) = 45.656, p < .001, η² = .307), but no group effect (F(1, 103) = 1.398, p = .240, η² = .013), similarly for emotion understanding. However, detailed analyses show that students particular with very low communicative competencies show a significant improvement in the development of ToM competencies compared to the control group (F(1, 9) = 11.375, p = .008, partial η² = .558).

The children in the second pilot phase were also able to improve their performance in both areas. Since the second trial phase had to be interrupted for a longer period of time due to the school closures in the Covid 19 pandemic for quite a few children, the quantitative data of the second trial phase must, however, be treated with caution.

The analysis of the evaluation journals led to the following findings in particular:

• The modular structure of the training, the small-step structure, its differentiation and flexibility make it possible to do justice to the heterogeneity of the students. At the same time, teachers need support at the beginning of the training program in order to be able to orient themselves well in the training.
• The visualization and contextualization of the learning content for deaf and hard of hearing children was considered particularly important. For this reason, pictures were made for most of the stories, which can be used with or without text in the classroom. The concept of thought bubbles was particularly successful and was a pictorial learning aid especially for children with low language skills.
• The multilingualism of the training program is valued by the teachers in order to be able to meet the different linguistic orientation of the children. At the same time, the children's competencies in spoken and/or sign languages can be built up. After the first trial phase, additional sign language videos were added at the request of the teachers. On the one hand, the videos were used in the lessons themselves. On the other hand, teachers used them as a storytelling tool to enhance their own sign language skills.
• The teachers stated that they could better assess the social-cognitive and emotional competencies of their students a) after the training and b) after the implementation of the training program and c) became more sensitive to aspects of ToM and emotion knowledge in everyday life.
• The qualitative focus group discussions after both trial phases showed that, from the teachers' point of view, children succeed in transferring the newly acquired competencies into their everyday lives. This was observed both in free play and, for example, in dispute resolution, in which the students were better able to reflect on their own motives and behavior and that of others.
• The following were found to be particularly helpful in implementing THE MINDREADERS in schools: In-school/out-of-school training, formation of multiplier teams within a teacher team, creation of a box with the materials that can be used by several teachers, school-wide establishment of a fixed time rhythm (per semester/year) for systematic implementation of the training program.

The result that deaf and hard of hearing children and adolescents lag behind in their ToM development shows again that the presented program is necessary. The specialization on hearing impairment (through visualizations, language module, language choices sign and written language) probably supports especially the group of deaf and hard of hearing children with very low language skills - it was not tested, nevertheless it can be assumed that especially these children would not benefit to the same extent with ToM support programs for e.g. for autism spectrum disorder, so this language sensitive specialization is useful.

Furthermore, it must be noted that the material in the program once again makes it possible to have still very rarely available bilingual-bimodal teaching materials (sign language videos, picture materials, sign language photos) and to be able to adapt them individually (Word files, not only PDF) and not to have to create them themselves for each lesson; this is what teachers need and want to have. It has become a very extensive support program, the orientation can be a bit time-consuming despite the manual. The solution for this has already been found: Workshops can be booked as training.

• Becker, C., Hansen, M. & Barbeito Rey-Geissler, P. (2018). Narrative Kompetenzen hörgeschädigter Kinder. Das Zeichen, 108, 90-105.
• Hofmann, S. G., Doan, S. N., Sprung, M., Wilson, A., Ebesutani, C., Andrews, L. A., Curtiss, J. & Harris, P. L. (2016). Training children's theory-of-mind: A meta-analysis of controlled studies. Cognition, 150, 200–212.
• Peterson, C. C., Wellman, H. M. & Liu, D. (2005): Steps in theory-of-mind development for children with deafness or autism. Child Development, 76 (2), 502–517.
• Pons, F., Harris, P. L. & De Rosnay, M. (2004). Emotion comprehension between 3 and 11 years: Developmental periods and hierarchical organization. European Journal of Developmental Psychology, 1 (2), 127-152. http://dx.doi.org/10.1080/17405620344000022 .
• Sprung, M., Münch, H. M., Harris, P.L., Ebesutani, C. & Hofmann, S. G. (2015). Children’s emotion understanding: A meta-analysis of training studies. Developmental Review, 37, 41-65.
• Wellmann, H. M. (2018). Theory of mind: The state of the art. European Journal of Developmental Psychology, 15 (6), 728-755.