Theory of mind in children with severe speech and physical impairment (SSPI): a longitudinal study (summary)


The term theory of mind (ToM) relates to being able to attribute thought beliefs and feelings to ourselves and other people and to understand that how we behave is linked to these things. Children also need to understand that beliefs are not always true and can represent the world incorrectly. Testing a child's ability to recognise this 'false-belief' is the most commonly used way of determining whether a child has developed ToM.

Possible causes for impairment in the development of ToM include a lack of experience of conversation about mental states, this has mainly been researched in relation to deaf children, and a reduction or difference in early social interactions such as pretend play.

Children with severe speech and physical impairments (SSPI) have been found to have fewer, or different, opportunities for pretend play and interaction with other children and different communication interactions with their carers than typically developing peers.

What was the aim of the study?
The study was to look at the development of ToM in a group of children with SSPI over a long time period to consider whether they showed a delay in the development of ToM over and above their general development, and whether, despite this, they followed a typical sequence of ToM development.

What did the authors do?
Six children with SSPI were included in the study that involved collecting information about their ToM development over a period of several years. At the first testing point all of the participants had very little speech that was intelligible to unfamiliar listeners and communicated using either Bliss symbols or a combination of Bliss symbols and other communication modes such as signs, gestures and body movements. They were aged from 5 to 7 years and had a mental age assessed as being 4 years or more. A group of typically developing children matched for age and non-verbal abilities were also tested. At the first assessment the children with SSPI were found to have lower levels of understanding of spoken language than the others.

Only one test of Tom was carried out at the first testing stage. At the second stage around four years later 7 tests were carried out enabling the researchers to look at the developmental progression of ToM.

The same tests were given to each of the children individually and they were able to respond using whatever mode of communication they were most comfortable with, usually pointing or indicating 'yes' or 'no'.

What did they find?
All of the typically developing children passed all of the tests at both testing points. In the group with SSPI only one child passed the first task.

At the second testing point all of the children with SSPI passed all or some of the tasks, but their results showed a delay in the development of their ability to pass the 'false-belief'.

The results indicated that the children with SSPI developed the ability to pass the ToM tasks in the same sequence as typically developing children, but that this took place significantly later in terms of their mental age, even when their language levels were similar to the comparison group.

The research involved only a small number of children and looked at a limited range of ToM functions so the findings cannot be widely generalised.

Compared to their typically developing peer the children with SSPI had a specific delay in developing ToM that is greater than their general cognitive delay, but follows a typical pattern of the order of development.

The authors believe that although children with SSPI are constantly exposed to spoken language and conversation their lack of active participation and reduced opportunities for initiating and managing interactions slows the development of skills in the area of understanding their own and other people's perceptions of the world. It is therefore important that children with SSPI are provided with the appropriate tools and opportunities to develop these skills to reduce the chance that expectations of them are lowered.

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Added to site July 2014