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DHH children with cochlear implants or hearing aids perform significantly worse on false belief tasksChildren with Hearing Loss Struggle More with False Belief Tasks

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Key Takeaway
Note that DHH children perform significantly worse on false belief tasks than typically hearing peers.

This meta-analysis synthesized data from 13 studies to evaluate false belief (FB) understanding in 292 deaf and hard of hearing (DHH) children using cochlear implants (CIs) or hearing aids (HAs). The study compared the performance of these children against typically hearing (TH) peers to determine the impact of hearing loss on cognitive development.

The primary finding was that DHH children demonstrated significantly lower performance in FB understanding compared to TH peers (95% confidence interval [-1.110, -0.599], p <.001). Additionally, the analysis of implicit tasks using eye gazing as a method of response suggested a possible sensitivity in the CI/HA group, though this finding is not confirmed.

Clinical implications suggest that language plays an essential role in the development of FB skills. The results indicate that performance in DHH children may be heavily influenced by specific task demands and the method of response used during assessment. These findings highlight the need for nuanced assessment protocols in pediatric audiology.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the cognitive development of children with hearing loss. While prior coverage noted that children with cochlear implants report lower quality of life in social and school domains, this study provides specific evidence regarding the cognitive deficits in false belief understanding. It further expands on the known developmental challenges faced by children with hearing loss, who have also been shown to have lower physical fitness in strength, agility, speed, and balance.

A review of 13 studies looked at how children with hearing loss perform on false belief tasks. These tasks test a child's ability to understand that someone else might have a belief that is different from reality. The study included 292 children who used cochlear implants or hearing aids, comparing them to children with typical hearing.

The results showed that children with hearing loss performed significantly worse on these tasks than their hearing peers. The researchers noted that the specific way a task is designed and the method used to give an answer can change how well a child performs. For example, some tasks used eye gazing to track responses.

These findings highlight how important language is for developing these social skills. Because different tasks have different demands, results can vary. This information helps experts understand how to better support children with hearing loss in developing social understanding. You should talk to a specialist to see how these findings apply to a specific child's development.

What this means for you:
Children with hearing loss often perform lower on false belief tasks, highlighting the vital role of language.

Common questions

What is a false belief task?

A false belief task is a test used to see if a child understands that other people can have beliefs that are different from reality. It is a key part of social development. This study found that children with hearing loss and hearing aids or cochlear implants performed significantly lower on these tasks than children with typical hearing.

How does hearing loss affect social understanding?

The study suggests that language is essential for developing skills like understanding false beliefs. Because children with hearing loss may have different language experiences, their performance on these tasks can be affected. The results show a significant difference in performance compared to children with typical hearing.

Do different types of hearing devices change the results?

The study looked at children using both cochlear implants and hearing aids. While the study found that these children performed lower on false belief tasks, it also noted that the specific method of response, such as eye gazing, might show some sensitivity in the results for those using these devices.

Study Details

Study typeMeta analysis
Sample sizen = 292
EvidenceLevel 1
Follow-up168.4 mo
PublishedOct 2026
View Original Abstract ↓
PURPOSE: 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. METHOD: Data were synthesized from 13 studies comprising 292 participants 1.92-14.03 years of age. A multilevel random-effects meta-analysis was conducted, followed by metaregression to examine the effects of age, mean age at onset, type of hearing amplifier, type of FB task, and method of response. RESULTS: Results indicated significantly lower performance in DHH children ( = -0.854, 95% confidence interval [-1.110, -0.599], < .001) compared to their TH peers. Additionally, the CIs/HAs group showed a possible sensitivity when assessed with implicit tasks using eye gazing as a method of response. CONCLUSION: The results supported previous evidence on the essential role of language in FB skills development and indicated that performance in DHH children may be critically influenced by variability in task demands and method of response. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.33228822.
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