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2/21/2005 Theory of Mind: Implications for Intervention Maura Berndsen, MA, CED, Cert. AVT | |
| Listen and Talk Education for Children with Hearing Loss Bothell, Washington Abstract: “Theory of Mind” (ToM) addresses social cognition, such as people thinking about people. Through early childhood development, children recognize that people (including themselves) have thoughts, intentions, wants, and feelings. ToM describes a child’s understanding that people’s behaviors can be predicted or explained by various mental states. ToM is being researched in relationship to children who are deaf. Research confirms that children who are deaf demonstrate delays in ToM development, which leads to implications for practice. Introduction: Webster’s Dictionary (1988) defines communication as “…a process by which information is exchanged between individuals through a common system…” (p. 266). While the meaning of this commonly used word appears relatively plain and simple, the very fact that the definition involves the words “process” and “exchange” leads to complexities. As we consider the use of spoken language for communication, it is recognized that this process and exchange involves the integration of audition, speech, language, and cognition (Ling, 2002). As described by Estabrooks (1994, 1998), these aspects exist in a symbiotic relationship, which rely on access afforded humans throughout their neurologic system. The human body allows individuals to express themselves and build relationships, learn and share ideas. In recent years, our understanding of the brain and how it functions has led to new horizons in fields related to human development. Meltzoff (1999) described “…a revolution in our understanding of infant and toddler cognition that promises to have far-reaching implications for our understanding of communicative and linguistic development” (p.251). Current research has led to the realization that the depth of a young child’s knowledge exceeds long-held beliefs supported by classical theory (Gopnik, et al..,, 1999; Meltzoff, 1999). As science has focused on an individual’s understanding of the mind and how that understanding impacts interpersonal communication, attention has been drawn to Theory of Mind (ToM). Theory of Mind: An Overview In regard to ToM, Meltzoff (1999) wrote, “People are more than physical bodies. We are more than dynamic bags of skin that can be seen, heard, and weighed. In the adult framework, persons also have beliefs, desires, and intentions that lie below the surface behavior. One cannot directly see, taste, smell, or hear mental states, but it is an essential part of our ordinary adult understanding that other people have them. Theory of Mind research investigates the development of this framework” (p.257). ToM resides under social cognition, where people think about people (Remmel, et al., 2001). Through the course of early childhood development, children recognize that people, including themselves, have thoughts, intentions, wants, and feelings. ToM describes a child’s understanding that people’s behaviors can be predicted or explained by mental states. ToM enables us to recognize there may be multiple viewpoints held by individuals for particular situations, and we can take on those perspectives even when they differ from our own (Gray & Hosie, 1996; Gray, et al., 2001; Marschark, et al., 2000; Siegal and Varley, 2002). This understanding of mental states and their impact on others’ behavior significantly affects our interpersonal relationships. Siegal and Varley (2002) further described ToM as crucial to social competence and necessary for the creation and maintenance of a variety of relationships with other people. Examples of the relationship between mental state and understanding behavior include the following (Marschark, et al., 2000; Meltzoff, 1999; Moeller, 2002; Reiffe & Terwogt, 2000): Desires: A child recognizes that Mom reaches into the cookie jar because she wants a cookie.A child’s awareness and understanding of the mind influences several aspects of human life. ToM can influence pragmatic language skills and participation in communicative interactions. Gray and Hosie (1996) described ToM as “mind reading”, while Moeller (2002) and Schick, et al. (2002) relate ToM to our ability to perceive the emotions of others allowing us to respond appropriately. The ability to understand the relationship between action and mental states affects a child’s understanding of surprises, secrets, tricks, mistakes, and lies, as well as impacting a child’s ability to take perspective and infer (Moeller, 2002). ToM can impact how we adopt the beliefs of a particular culture and how we recognize the meaning of words (Siegal & Varley, 2002). Research associates the importance of ToM in literacy development and a child’s understanding of stories (Gray & Hosie, 1996; Moeller, 2002; Schick, et al., 2002). ToM significantly impacts our ability to communicate and function. A modern understanding of ToM stems from the non-human primate research of Premack and Woodruff in the late 1970s (Marschark, et al., 2000; Siegal & Varley, 2002). Attempts to identify the cognitive and linguistic abilities of chimpanzees help create the foundation for ToM research with children. Marschark (2000) noted early work of Premack and Woodruff, “An individual has theory of mind if he imputes mental states to himself and to others…and chimpanzees possess a theory of mind ‘not markedly different from our own’ imputing intentions and purposes, as well as knowledge and beliefs, to humans with whom they were familiar)” (p. 1067). Prior to the recent surge in ToM research related to human development, philosophers of the mind and social psychologists have studied this area. As Remmel, Betger, and Weinberg (2001) noted, the terms folk psychology and intuitive psychology were originally used, differentiating ToM from academic or scientific psychology. Now, ToM is described as “…one of the most active and productive areas in developmental psychology” (p. 114). Interest in identifying the linguistic and cognitive processes contributing to ToM reasoning led to the creation of several theoretical positions applied to ToM development in children. Brief descriptions of theoretical positions follow (below), providing a foundation for readers. Detailed reviews are also available (see: Astington and Gopnik, 1991). Theoretical Positions: ToM development is rooted in the familiar research traditions of Piaget and metacognition (Meltzoff, 1999; Moeller, 2002; Remmel, et al., 2001). Through these explanations of egocentrism, perspective-taking, and thinking about thinking, we have a springboard for delving into theories explaining the development of ToM. Current theories stem from nativist or constructivist traditions. Both recognize that nature and nurture play roles in ToM development, but various theories weigh these factors differently. Nativist theories emphasize a child’s innate understanding of the mind and the role of maturation or automatic triggers (Meltzoff, 1999; Moeller, 2002; Remmel, et al., 2001). There is also a position supporting the necessity of domain specific neural processors for ToM development. Scholl and Leslie (1999, 2001) proposed a developing selection processor (SP) mechanism is necessary for children to successfully complete ToM tasks. With activation of the SP mechanism, children are able to indicate a mismatch between reality and a false, but invisible, belief. Physiologic maturation influences activation of these neural processors (Moeller, 2002). Other nativist theorists recognize the importance of social interactions, simulations, and information-processing. Maturation, however, is critical across the spectrum of nativist theories (Moeller, 2002; Meltzoff, 1999; Remmel, et al., 2001). Constructivists propose that children experiment in the world around them and in doing so, build their understanding of the mind (Meltzoff, 1999; Moeller, 2002). In comparing this process to the development of other scientific theories, the term “theory theory” has emerged. In this theory, children observe the behavior of others, hypothesize about mental states’ causal relationships, and modify their ideas based on the data, or the input they received (Meltzoff, 1999; Remmel, et al., 2001). As with traditional Piagetian theories of development, children progress through phases which are influenced by experiences. Unlike traditional Piagetian views on egocentrism, the ‘theory theory’ recognizes early perspective taking (Meltzoff, 1999; Moeller, 2002). Moeller (2002) describes variations of constructivist theories that include the process of enculturation and interpretive narrative discourse as explanations for a child’s developing ToM, with language and social/cultural contexts playing a major role. Moeller (2002) explained the argument for hybridization of theoretical positions and research agendas which recognize the importance of empirical study. She suggested integration is necessary “…to break the boundaries of the traditional set of theories, and pursue greater insight into social understanding to resolve issues raised by ToM” (p.8). Developmental Milestones: While there is debate surrounding developmental processes and influential factors associated with ToM, a common milestone reached is the understanding of a “false belief.” To recognize a false belief, an individual must be able to simultaneously consider two conflicting mental representations, including their own belief, representing reality, and another’s belief which is “false” (Marschark, et al., 2000; Peterson, 2004; Remmel, et al., 2001). Children who have developed ToM can consider the knowledge they have, recognize the knowledge another does not have, and correctly predict what the other person will say or do, even if the action taken is incorrect. An understanding of false belief is often measured by an unexpected contents task or a displaced object task (Marschark, et al., 2000; Moeller, 2002; Peterson, 2004). For example: If a child is shown a crayon box with animal crackers inside, can the child describe why she knows what is inside the container? What will the child predict her parents would say about the probable contents of the container? If the child witnessed the peanut butter being moved from the cabinet to the refrigerator, can she describe why she knows where the peanut butter is located? Where will she predict her friend, who did not witness the change (from the cabinet to the fridge) will look for the peanut butter? Wellman, Cross, and Watson (2001) identify a pattern in children with typical development: “The understanding of belief, and relatedly, understanding of mind, exhibit genuine conceptual change in the preschool years” (p.655). Peterson and Slaughter (2003) noted that “…by the time they reach age 6, most normally developing children have acquired ToM, enabling at least a rudimentary understanding of their own and other people’s true, false and imaginary mental states” (p. 399-400). Evidence consistently notes the development of ToM (as measured by success with false belief tasks) in preschoolers with typical development at approximately 4 years of age. Patterns demonstrate the progression of understanding increasingly complex situations with action attributed to mental states (Gray & Hosie, 1996). Meltzoff (1999) cautions that verbal language in test protocols is an issue in determining early development of ToM, and alternate approaches must be considered for nonverbal and preverbal populations. Through the use of a nonverbal procedure, referred to as the “behavioral reenactment technique,” Meltzoff (1999) demonstrated that ToM does not spontaneously emerge between 3-5 years of age. Meltzoff found that 18 month-old children can understand intentions, even if we fail to accomplish them. Young toddlers recognize an adult play partner’s plan when the adult under- or over-shoots his target. With further research related to inferring target acts based on failed attempts, Meltzoff (1999) indicated that this ability appears to emerge around 15 months of age, and by the 2 years of age, “…children have already adopted a fundamental aspect of a theory of mind--- persons (but not inanimate objects) are understood within a framework involving goals and intentions…” (p.258). Meltzoff (1999) believes the origins of ToM could be based in an infant’s capacity for nonverbal imitation. Gray, et al. (2001) stresses the importance of “joint attention,” which develops during infancy, as ToM develops. Perner and Dienes (2003) considered early stages of conscious awareness, which influences ToM, and conscious awareness was noted as early as infancy. Links between ToM and language development are extremely complex. While constructivists argue that language development stems from nonverbal cognitive and social development in infancy, nativists disagree, believing that language is a separate module (Meltzoff, 1999). Regardless of an individual’s position on the relationship between language and cognition, it appears that language has a critical role as children apply their ToM. Language reflects the activity in the mind, and a growing body of research shows that language competence can predict ToM (Moeller, 2002; Peterson, 2004; Peterson & Slaughter, 2003; Schick, et al., 2002). Interestingly, Moeller (2002) noted syntax, not semantics, appears to significantly impact ToM scores. Other studies assessed communicative interactions between children and primary caregivers with regard to ToM development. Peterson and Slaughter (2003) reported significant correlations between mother’s preferences for talk about mental states, and the child’s ToM performance. Peterson and Slaughter noted causal talk, meaning explanations follow mention of mental states and feelings, may also positively impact ToM development. Statement: Parents, caregivers and others interact with children. The quantity and quality of their interactions provide access to information allowing children to grow, learn and reach new heights, and impacts a young child’s development of ToM. Question(s): What happens when a related sense is impacted in such a way so as to create a barrier to access? What happens to communication when an individual experiences a congenital, pre-lingual, or peri-lingual hearing loss? Theory of Mind Development in Children who are Deaf: Historically, children with hearing loss born to parents with normal hearing experience delays in acquisition of skills related to communication. Compromised auditory access to the family’s native language negatively impacts the child’s ability to develop the shared common communication system. However, like children with normal hearing, children described as native signers (those born into a family with a deaf parent or primary caregiver who uses sign language fluently) can develop natural and fluent communication skills (Marschark, et al., 2000; Moeller, 2002; Gray & Hosie, 1996). Early identification of hearing loss, advances in hearing and related technologies and early access to quality intervention programs have resulted in higher levels of linguistic competency at faster rates (Ling, 2002; Yoshinago-Itano, 1998;). However, ToM development within this population has not been considered until recently (Remmel, et al., 2001; Schick, 2002). Preliminary research indicates that ToM development in deaf children is delayed in oral and simultaneous communication settings (Marschark et al., 2000; Moeller, 2002; Remmel, et al., 2001; Schick, et al., 2002; Siegal and Varley, 2002). When comparing false belief task results of pre-lingually deafened children of hearing parents, children with normal hearing, and children with autism, children with normal hearing successfully complete the tasks with relative ease while deaf children fail the task as often, or more often, than children with autism (Marschark, et al., 2000). In his literature review, Marschark, et al. (2000) noted that Peterson and Siegal indicated higher success rates for native signers, and for children who use spoken language with their normal hearing parents. Additionally, Remmel, et al. (2001) noted that children who are deaf do not typically demonstrate theories of mind until their teens. Hosie and Gray (1996) stressed that children who are pre-lingually deaf of hearing parents, eventually reach a higher level of conversational experience, and as such, achievement of ToM is delayed, and not prevented. In the various studies related to ToM in children who are deaf, researchers attribute delays in ToM to limited conversational access (Gray, et al., 2001; Moeller, 2002; Marschark, et al., 2000; Peterson, 2004; Siegal and Varley, 2002). When children with hearing loss are born to parents with normal hearing, this may result in a family constellation without a common communication system. Families of native signers, who share a common communication system, present a different situation. In this situation (above), parents act as fluent conversational partners with their children from infancy. Peterson and Siegal (in Marschark, et al., 2000) noted these children may achieve an understanding of false belief earlier than children with normal hearing born to hearing parents. Unlike native signers, parents learning sign language may not be fluent communicators in the critical early years and parents relying on spoken language must learn to accommodate their child’s compromised auditory access as communication and cognitive skills develop. Moeller (2002) cautioned that claims of curtailed conversations resulting in delayed ToM are not definitive at this time. However, her research does indicate that when engaging in conversations about mental state, a mother’s signing skill impacts the frequency and diversity of these discussions. Children who are deaf in hearing families do, however, communicate with their hearing parents, and therefore she suggests that the quality of conversations should be explored. Issues surrounding research methods also raise questions about our understanding of ToM in deaf children. Consideration of the examiner’s communication abilities, the communication mode, and as previously suggested by Meltzoff (1999), the heavy reliance on verbal language in false belief tasks may result in an underestimation of ToM abilities in deaf children (Marschark, 2000). Peterson (2002) reported that measures incorporating visual representations of false beliefs (false-photo task and obsolete drawing tasks) reflect “…the first budding awareness of mental representation on the part of children whose disabilities may, in different ways, curtail access to conversations about many other kinds of mental states” (p. 1452). Peterson’s experiments suggest that when false belief tasks involve drawings, children with hearing loss experience improved performance, but it is also noted that these results cannot be extended to other aspects of ToM, as children passing false drawing tasks often did poorly on traditional false belief measures. Believing that despite failing false belief tasks, deaf children may have ToM, Marschark et al.. (2000) posed this question: “[Do] deaf children typically ascribe various mental states to themselves and others and recognize them as being causal with regard to behavior?” (p. 1069). To answer this question, stories told by deaf children (communicating with sign language) and children who are hearing (communicating with speech), ages 9-15 years were videotaped. Their words were transcribed and scored with a focus on mental state attributions, as opposed to English grammar. Deaf children did produce mental state attributions, with more self-attributions than other attributions. According to the research team, these results suggest “false belief task and attributions of mental states are not equivalent abilities” (p. 1070). They further caution that linguistically complex tasks underestimate the cognitive skills of children who are deaf and they encourage further study of ToM with younger children. In summary, children who are deaf currently experience delays in a variety of areas, including ToM. These delays in ToM development can impact their ability to access information and build relationships in a society driven by communication. Additionally, the relationship between language and ToM is extremely complex. Research indicates there is a link between parental/caregiver conversations and ToM outcomes for children, but there appears to be restricted access to these elaborative conversations for children who are deaf, particularly those born into families with hearing parents. Children who are deaf do eventually demonstrate ToM to varying degrees. Language plays a role in the expression and understanding of mental states, and syntax appears to be crucial to this process. Question: How can professionals working with children and families impacted by hearing loss respond and address this important area of development? Comments and Implications for Intervention: Early identification of hearing loss, access to advanced technology, and participation in quality early intervention programs have challenged professionals to revisit their expectations for children with hearing loss. In recent years, “communication outcomes” have extended beyond traditional measures of speech perception, speech articulation, and syntax. Communication is a dynamic process integrating various aspects of language. Data indicate that early identification followed by appropriate early intervention results in accelerated language growth, resulting in normal, or near normal, rates of language acquisition (Yoshinago-Itano, 1998). Peterson recently noted (2004) “children who acquire language swiftly will have more chances than their peers with delayed language, to take a full part in a broad range of interactions with others, including talk about mental states” (p. 9). In relationship to ToM, both product and process are critical for children who are deaf or hard of hearing, and practitioners and parents must work to balance the two elements. Moeller (2002) concluded that child language is associated with ToM skills as well as factors such as mental state talk, pretense, and cause-effect reasoning within mother-child interactions. These findings require service providers to reflect on ToM when planning for school-aged children possibly presenting with delays, in addition to working with infants, toddlers and preschoolers, who may meet us with higher levels of linguistic competence. Parent education, modeling, and facilitation with families will be critical as ToM impacts our work with families in several areas:
Table 1: Vocabulary Reflecting Mental States (Moeller, 2003)  Figure 1: Suggested Activities to Support ToM Development  The study of the mind continues to fascinate and inspire researchers, practitioners, and families by providing information that opens new opportunities for children who are building communication skills. A complex relationship between language and ToM exists and it will be necessary to keep abreast with current research related to ToM. By critically considering information about typical and atypical development of ToM, professionals will provide robust services that will result in effective interpersonal communication for children and families. References: Astington, J.W., & Gopnik, A. (1991). Theoretical explanations of children’s understanding of the mind. British Journal of Developmental Psychology, 9, 7-31. Estabrooks, W. (Ed). (1994). Auditory-verbal therapy for parents and professionals. Washington, DC: Alexander Graham Bell Association for the Deaf. Estabrooks, W. (Ed.). (1998). Cochlear implants for kids. Washington, DC: Alexander Graham Bell Association for the Deaf. Gopnik, A., Meltzoff, A.N., & Kuhl, P.K. (1999). The scientist in the crib: Minds, brains, and how children learn. New York: Morrow. Gray, C.D. & Hosie, J. A. (1996). Deafness, story understanding and theory of mind. Journal of Deaf Studies, 1(4), 217-233. Gray, C.D., Hosie, J.A., Russell, P.A. & Ormel, E.A. (2001). Emotional development in deaf children: facial expressions, display rules, and theory of mind (pp. 135-160). In M.D. Clark, M. Marschark, & M. Karchmer (Eds.) Context, cognition, and deafness. Washington, DC: Gallaudet University Press. Ling, D. (2002). Speech and the hearing impaired child: Theory and practice (2nd Edition). Washington, DC: Alexander Graham Bell Association for the Deaf. Marschark, M., Green, V., Hindmarch, G., & Walker, S. (2000). Understanding theory of mind in children who are deaf. Journal of Child Psychology and Psychiatry, 41(8), 1067-1073. Meltzoff, A.N. (1999). Origins of theory of mind, cognition, and communication. Journal of Communication Disorders, 32, 251-269. Mish, F.C. (Ed.) (1988). Webster’s ninth new collegiate dictionary. Springfield, MA: Merriam-Webster Inc. Moeller, M.P. (2002). Mothers’ mental state input and theory of mind understanding in deaf and hearing children. Unpublished Doctoral Dissertation, University of Nebraska, Lincoln, Nebraska. Perner, J. & Dienes, Z. (2003). Developmental aspects of consciousness: How much theory of mind to you need to be consciously aware? Consciousness and Cognition, 12, 63-82. Peterson, C.C. (2002). Drawing insight from pictures: The development of concepts of false drawing and false belief in children with deafness, normal hearing, and autism. Child Development, 73(5), 1442-1459. Peterson, C.C. (2004). Theory-of-mind development in oral deaf children with cochlear implants or conventional hearing aids. Journal of Child Psychology and Psychiatry, 45(0), 1-11. Peterson, C., & Slaughter V. (2003). Opening windows into the mind: Mothers’ preferences for mental state explanations and children’s theory of mind. Cognitive Development 18, 399-429. Readinger, W. (2002). Theory of mind: The eyes have it. TRENDS in Cognitive Sciences, 6(10), 413. Reiffe, C., & Terwogt, M.M. (2000). Deaf children’s understanding of emotions: Desires take precedence. Journal of Children Psychology and Psychiatry. 41(5), 601-608. Remmel, E., Bettger, J.G., & Weinberg, A.M. (2001). Theory of mind development in deaf children (pp. 113- 134). In M.D. Clark, M. Marschark, & M. Karchmer (Eds.) Context, cognition, and deafness. Washington, DC: Gallaudet University Press. Schick, B., de Villiers, J., de Villiers, P., & Hoffmeister, B. (2002). Theory of mind: Language and cognition in deaf children. The ASHA Leader Online. Retrieved May 1, 2003 from http://www.asha.org/about/publications/leader-online/archives/2002/q4/f021203.htm Scholl, B. & Leslie, A.M. (1999). Modularity, development and theory of mind. Mind and Language, 14, 131-153. Scholl, B. & Leslie, A.M. (2001). Minds, modules, and meta-analysis. Child Development, 72, 131-153. Siegal, M., & Varley, R. (2002). Neural systems involved in ‘theory of mind’. Neuroscience, 3, 463-471. Tuohy, J., Brown, J., & Mercer-Moseley, C. (2001). St. gabriel’s curriculum for the development of audition, language, speech, cognition. Sydney, Austrailia: St. Gabriel’s School for Hearing Impaired Children. Wellman, H.M., Cross, D., & Watson, J. (2001) Meta-analysis of theory-of-mind development: The truth about false belief. Child Development, 72, 655-684. Wilkes, E.M. (1999). Cottage acquisition scales for listening, language, and speech. San Antonio, TX: Sunshine Cottage School for Deaf Children. Yoshinago-Itano, C., Sedey, A. L., Coulter, D. K., & Mehl, A. L. (1998). Early- and later-identified children with hearing loss. Pediatrics, 102, 1161-1171 Editor's Note: It is with great pride that we re-release this peer reviewed and CE approved version of this article. This paper was originally released on this website as a non-peer reviewed paper. The author has worked with our staff and members of the www.SpeechPathology.com Review Board (click here to visit the Review Board) to successfully complete the peer review process. We are grateful to the author and the peer reviewers for their time and commitment. | |