False Belief Understanding in Deaf and Hard of Hearing Children: Systematic Review With Meta-Analysis

This meta-analysis aimed to compare the performance of deaf and hard of hearing (DHH) children who use cochlear implants (CIs) or hearing aids (HAs) with their typically hearing (TH) peers on false belief (FB) understanding tasks.

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✦ The floor

Discussion

Signed responses from readers of the wire.

✦ Clinical Takeaway ✦

Deaf and hard-of-hearing children show delays in false belief understanding compared to hearing peers; audiologists and educators should be aware of this social-cognitive dimension and consider referral for social-cognitive assessment alongside auditory rehabilitation.

✦ Why It Matters ✦

Social-cognitive delays in deaf and hard-of-hearing children represent an underappreciated consequence of hearing loss that extends beyond auditory and language outcomes, underscoring the need for holistic rehabilitation planning.

✦ Key Points ✦

01Systematic review with meta-analysis synthesizing evidence on false belief understanding in DHH children.
02DHH children using cochlear implants or hearing aids showed poorer false belief task performance than hearing peers.
03False belief understanding is a core marker of theory of mind (the ability to recognize others' mental states).
04Gaps persisted even among children with hearing devices, suggesting device use alone does not fully close the deficit.
05Findings call for broader developmental monitoring beyond auditory and speech outcomes.

✦ Claims & Evidence ✦

ClaimEvidenceSupport

Deaf and hard-of-hearing children perform worse than typically developing peers on false belief tasks.

studysupported

Use of cochlear implants or hearing aids does not fully eliminate the false belief understanding gap in DHH children.

studypartially supported

✦ Research metadata ✦

PMID: 42600163
DOI: 10.1044/2026_JSLHR-25-00753.
Journal: Journal of Speech, Language, and Hearing Research
Publication type: meta_analysis
Evidence level: 1a
Population: Deaf and hard-of-hearing children using cochlear implants or hearing aids compared to typically developing hearing peers
Intervention: Cochlear implant or hearing aid use in deaf and hard-of-hearing children
Comparator: Typically developing hearing children

Primary outcomes

False belief task performance (theory of mind); Comparison of social-cognitive development between DHH and hearing children

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