Int J Pediatr Otorhinolaryngol. 2026 Jul 8;207:112928. doi: 10.1016/j.ijporl.2026.112928. Online ahead of print.
ABSTRACT
BACKGROUND: Theory of mind refers to the ability to attribute mental states to oneself and others and is foundational for effective social interaction. Children with hearing impairments often experience delays in theory of mind development, potentially due to limited access to language-based communication. While cochlear implants (CIs) and hearing aids (HAs) improve auditory access, the extent to which theory of mind skills can be enhanced through targeted intervention remains underexplored-particularly in Persian-speaking populations.
OBJECTIVE: To evaluate the effectiveness of a structured theory of mind intervention in improving theory of mind skills, comprehension of mental verbs, and mean length of utterance in Persian-speaking children aged 5-7 years with hearing impairments using CIs or HAs.
METHODS: A randomized controlled trial was conducted with 60 children (n = 15 per group), stratified into four groups: CI-Intervention, CI-Control, HA-Intervention, and HA-Control. The 8-week intervention (16 sessions) was adapted from existing theory of mind training programs and delivered by trained facilitators in rehabilitation centers across Kerman, Iran. Primary outcomes were theory of mind skills assessed using a validated Persian version of the theory of mind. Secondary outcomes included comprehension of mental verbs and mean length of utterance. Assessments were conducted at baseline, mid-intervention, post-intervention, and one-month follow-up. Repeated-measures ANOVA and post hoc tests were used for data analysis.
RESULTS: Both intervention groups demonstrated significant improvements in theory of mind performance across all three levels (p < 0.001), with moderate to large effect sizes (0.58-0.75). Comprehension of mental verbs significantly improved in the CI-intervention group post-intervention (p = 0.03). While mean length of utterance increased over time in both intervention groups, no statistically significant difference was observed between groups post-intervention. Children with cochlear implants consistently outperformed those using hearing aids across multiple outcome measures. Gains in theory of mind and mental verb comprehension were maintained at one-month follow-up, though some attenuation was observed.
CONCLUSION: Structured theory of mind intervention is effective in enhancing theory of mind skills and mental verb comprehension in Persian-speaking children with hearing impairments, particularly those using cochlear implants. However, the limited impact on MLU and the partial maintenance of gains at follow-up suggest that sustained and linguistically enriched interventions may be necessary to consolidate and generalize improvements.
TRIAL REGISTRATION: IRCT20230827059274N1.
PMID:42424679 | DOI:10.1016/j.ijporl.2026.112928
