Theory of mind and social competence in preschool children with cochlear implants: relationships with language proficiency

Abstract

This study examined receptive and expressive language proficiency, Theory of Mind (ToM), emotional expressiveness, and social competence in preschool-aged children with cochlear implants (CIs) and age-matched typically hearing (TH) peers. Thirty-two children with CIs and 32 TH children aged 48–72 months completed scenario-based ToM tasks and standardized language assessments; emotional expressiveness and social behavior were rated by parents and teachers. Children with CIs obtained significantly lower scores than TH peers on ToM and receptive and expressive language measures and were rated as having lower social competence. In contrast, the groups did not differ in emotional expressiveness, anger–aggression, or anxiety–withdrawal. Within the CI group, receptive and expressive language were positively associated with both ToM and social competence. The zero-order associations between hearing age and receptive and expressive language were no longer statistically significant after chronological age was controlled, whereas hearing age remained associated with ToM. These findings suggest that language proficiency and accumulated auditory experience may each contribute to individual differences in socio-cognitive outcomes, although causal relationships cannot be inferred from the present study.