Concern for Others: A Study on Empathy in Toddlers with Moderate Hearing Loss

Altruistic behavior in Chinese children with hearing impairment: Associations with power cognition and word comprehension

Altruistic behavior is a crucial manifestation in the socialization process of preschool children with hearing impairment, yet research on this topic among Chinese children remains limited. This study investigated the effects of power cognition and word comprehension on altruistic behavior in preschool-aged children with hearing impairment. A sample of 64 children, including both hearing-impaired and typically developing children, completed altruistic behavior tasks, power cognition tasks, word comprehension tasks, and the Raven's Combined Test. The results revealed that: (1) Children with hearing impairment exhibited significantly lower levels of altruistic behavior compared to typically developing children; (2) Both power cognition and word comprehension were positively correlated with altruistic behavior in children with hearing impairment; (3) Word comprehension mediated the relationship between power cognition and altruistic behavior in children with hearing impairment.

Vocal Emotion Recognition in School-Age Children With Hearing Aids

OBJECTIVES

In individuals with normal hearing, vocal emotion recognition continues to develop over many years during childhood. In children with hearing loss, vocal emotion recognition may be affected by combined effects from loss of audibility due to elevated thresholds, suprathreshold distortions from hearing loss, and the compensatory features of hearing aids. These effects could be acute, affecting the perceived signal quality, or accumulated over time, affecting emotion recognition development. This study investigates if, and to what degree, children with hearing aids have difficulties in perceiving vocal emotions, beyond what would be expected from age-typical levels.

DESIGN

We used a vocal emotion recognition test with non-language-specific pseudospeech audio sentences expressed in three basic emotions: happy, sad, and angry, along with a child-friendly gamified test interface. The test group consisted of 55 school-age children (5.4 to 17.8 years) with bilateral hearing aids, all with sensorineural hearing loss with no further exclusion based on hearing loss degree or configuration. For characterization of complete developmental trajectories, the control group with normal audiometric thresholds consisted of 86 age-matched children (6.0 to 17.1 years), and 68 relatively young adults (19.1 to 35.0 years).

RESULTS

Vocal emotion recognition of the control group with normal-hearing children and adults improved across age and reached a plateau around age 20. Although vocal emotion recognition in children with hearing aids also improved with age, it seemed to lag compared with the control group of children with normal hearing. A group comparison showed a significant difference from around age 8 years. Individual data indicated that a number of hearing-aided children, even with severe degrees of hearing loss, performed at age-expected levels, while some others scored lower than age-expected levels, even at chance levels. The recognition scores of hearing-aided children were not predicted by unaided or aided hearing thresholds, nor by previously measured voice cue discrimination sensitivity, for example, related to mean pitch or vocal tract length perception.

CONCLUSIONS

In line with previous literature, even in normal hearing, vocal emotion recognition develops over many years toward adulthood, likely due to interactions with linguistic and cognitive development. Given the long development period, any potential difficulties for vocal emotion recognition in children with hearing loss can only be identified with respect to what would be realistic based on their age. With such a comparison, we were able to show that, as a group, children with hearing aids also develop in vocal emotion recognition, however, seemingly at a slower pace. Individual data indicated a number of the hearing-aided children showed age-expected vocal emotion recognition. Hence, even though hearing aids have been developed and optimized for speech perception, these data indicate that hearing aids can also support age-typical development of vocal emotion recognition. For the children whose recognition scores were lower than age-expected levels, there were no predictive hearing-related factors. This could be potentially reflecting inherent variations related to development of relevant cognitive mechanisms, but a role from cumulative effects from hearing loss is also a possibility. As follow-up research, we plan to investigate if vocal emotion recognition will improve over time for these children.

Empathy Development in Preschoolers With/Without Hearing Loss and Its Associations with Social-Emotional Functioning

Empathy plays a crucial role in children's social-emotional development. There is an increasing trend in recent studies to recognize empathy as a multi-dimensional construct, consisting of three distinct hierarchical levels: emotion contagion, attention to others' feelings and prosocial behaviors (Hoffman, Motiv Emot, 14(2), 151-172, 1990). The present study is amongst the first to use a longitudinal approach to examine the development trajectories of the distinct empathic levels, based on a sample of Chinese preschoolers aged 2 to 6 years, half of the sample being deaf or hard-of-hearing (DHH). Our results showed that according to the parental observation, DHH preschoolers manifested similar extent of emotion contagion and attention to others' feelings as their TH (typically hearing) peers over preschool years. Yet, DHH preschoolers showed fewer prosocial behaviors, compared to their TH peers. As for the longitudinal associations over time, emotion contagion contributed to more internalizing and externalizing behaviors in both groups; whilst attention to others' feelings contributed to fewer internalizing behaviors in only DHH children. Prosocial behaviors contributed to better social competence, and fewer internalizing and externalizing behaviors in both DHH and TH children just as expected. These outcomes imply that the early intervention or special education may be useful to safeguard children's empathic development, shrinking the gaps between DHH and TH children; but meanwhile, cultural factors might cause latent effects on children's understandings of empathy and impact on how empathy "regulates" children's social-emotional functioning, in a Chinese cultural context.

The Charactertistics and neural mechanisms of trait and state empathy in deaf individuals

Empathy deficiencies are prevalent among deaf individuals. It has yet to be determined whether they exhibit deficiencies in both trait empathy and state empathy, along with the effect of top-down attention. Here, the current study employed the IRI-C scale and physiological pain empathy tasks (A-P task and A-N task) to explore the temporal dynamics of neural activities when deaf individuals were processing second-hand painful/non-painful stimuli. For trait empathy, we found that deaf individuals have deficiencies in both emotional and cognitive empathy compared to their hearing counterparts. For state empathy, we found that deaf individuals showed stronger automatic emotional empathy responses and paid more cognitive evaluation resources. Moreover, the differential processing of empathy between deaf individuals and hearing individuals towards others' pain could be regulated by top-down attention, which occurs both in the early and late processing stages of pain empathy.

Group membership modulates empathic neural responses to pain in deaf individuals

Empathy deficiencies are prevalent among deaf individuals. It has yet to be determined whether they exhibit an ingroup bias in empathic responses. This study employed explicit and implicit empathy tasks (i.e. attention-to-pain-cue [A-P] task and attention-to-nonpain-cue [A-N] task) to explore the temporal dynamics of neural activities when deaf individuals were processing painful/nonpainful stimuli from both ingroup models (deaf people) and outgroup models (hearing people), which aims to not only assist deaf individuals in gaining a deeper understanding of their intergroup empathy traits but also to aid in the advancement of inclusive education. In the A-P task, we found that (i) ingroup priming accelerated the response speed to painful/nonpainful pictures; (ii) the N2 amplitude of painful pictures was significantly more negative than that of nonpainful pictures in outgroup priming trials, whereas the N2 amplitude difference between painful and nonpainful pictures was not significant in ingroup priming trials. For N1 amplitude of the A-N task, we have similar findings. However, this pattern was reversed for P3/late positive component amplitude of the A-P task. These results suggest that the deaf individuals had difficulty in judging whether hearing individuals were in pain. However, their group identification and affective responses could shape the relatively early stage of pain empathy.

More than a Physical Problem: The Effects of Physical and Sensory Impairments on the Emotional Development of Adults with Intellectual Disabilities

With the introduction of the ICD-11 and DSM-5, indicators of adaptive behavior, including social-emotional skills, are in focus for a more comprehensive understanding of neurodevelopmental disorders. Emotional skills can be assessed with the Scale of Emotional Development-Short (SED-S). To date, little is known about the effects of physical disorders and sensory impairments on a person's developmental trajectory. The SED-S was applied in 724 adults with intellectual disabilities, of whom 246 persons had an additional physical and/or sensory impairment. Ordinal regression analyses revealed an association of movement disorders with more severe intellectual disability and lower levels of emotional development (ED) on the overall and domain levels (Others, Body, Material, and Communication). Visual impairments predicted lower levels of ED in the SED-S domains Material and Body, but not the overall level of ED. Hearing impairments were not associated with intellectual disability or ED. Epilepsy correlated only with the severity of intellectual disability. Multiple impairments predicted more severe intellectual disabilities and lower levels of overall ED. In conclusion, physical and sensory impairments may not only affect physical development but may also compromise intellectual and emotional development, which should be addressed in early interventions.

Emotions in Deaf and Hard-of-Hearing and Typically Hearing Children

For deaf and hard-of-hearing (DHH) children living in an environment where their access to linguistic input and social interactions is compromised, learning emotions could be difficult, which may further affect social functioning. To understand the role of emotion in DHH children's social life, this study investigated emotional functioning (i.e., emotion recognition, empathy, emotion expression), and its relation with social functioning (i.e., social competence and externalizing behaviors), in 55 DHH children and 74 children with typical hearing (aged 3-10 years; Mage = 6.04). Parental reports on children's emotional and social functioning and factors related to DHH children's hearing were collected. Results showed similar levels of emotional and social functioning in children with and without hearing loss. Use of auditory intervention and speech perception did not correlate with any measures in DHH children. In both groups, higher levels of empathy related to higher social competence and fewer externalizing behaviors; emotion recognition and positive emotion expression were unrelated to either aspect of social functioning. Higher levels of negative emotion expression related to lower social competence in both groups, but to more externalizing behaviors in DHH children only. DHH children in less linguistically accessible environments may not have adequate knowledge for appropriately expressing negative emotions socially.

The Developmental Trajectory of Empathy and Its Association with Early Symptoms of Psychopathology in Children with and without Hearing Loss

Empathy enables people to share, understand, and show concern for others’ emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social access, and the effect of hearing on empathic maturation has been unexplored. This four-wave longitudinal study investigated the development of empathy in children with and without hearing loss, and how this development is associated with early symptoms of psychopathology. Seventy-one children with hearing loss and cochlear implants (CI), and 272 typically-hearing (TH) children, participated (aged 1–5 years at Time 1). Parents rated their children’s empathic skills (affective empathy, attention to others’ emotions, prosocial actions, and emotion acknowledgment) and psychopathological symptoms (internalizing and externalizing behaviors). Children with CI and TH children were rated similarly on most of the empathic skills. Yet, fewer prosocial actions were reported in children with CI than in TH children. In both groups, affective empathy decreased with age, while prosocial actions and emotion acknowledgment increased with age and stabilized when children entered primary schools. Attention to emotions increased with age in children with CI, yet remained stable in TH children. Moreover, higher levels of affective empathy, lower levels of emotion acknowledgment, and a larger increase in attention to emotions over time were associated with more psychopathological symptoms in both groups. These findings highlight the importance of social access from which children with CI can learn to process others’ emotions more adaptively. Notably, interventions for psychopathology that tackle empathic responses may be beneficial for both groups, alike.

The impact of mild-to-severe hearing loss on the neural dynamics serving verbal working memory processing in children

Children with hearing loss (CHL) exhibit delays in language function relative to children with normal hearing (CNH). However, evidence on whether these delays extend into other cognitive domains such as working memory is mixed, with some studies showing decrements in CHL and others showing CHL performing at the level of CNH. Despite the growing literature investigating the impact of hearing loss on cognitive and language development, studies of the neural dynamics that underlie these cognitive processes are notably absent. This study sought to identify the oscillatory neural responses serving verbal working memory processing in CHL compared to CNH. To this end, participants with and without hearing loss performed a verbal working memory task during magnetoencephalography. Neural oscillatory responses associated with working memory encoding and maintenance were imaged separately, and these responses were statistically evaluated between CHL and CNH. While CHL performed as well on the task as CNH, CHL exhibited significantly elevated alpha-beta activity in the right frontal and precentral cortices during encoding relative to CNH. In contrast, CHL showed elevated alpha maintenance-related activity in the right precentral and parieto-occipital cortices. Crucially, right superior frontal encoding activity and right parieto-occipital maintenance activity correlated with language ability across groups. These data suggest that CHL may utilize compensatory right-hemispheric activity to achieve verbal working memory function at the level of CNH. Neural behavior in these regions may impact language function during crucial developmental ages.

Developmental Outcomes in Early-Identified Children Who Are Hard of Hearing at 2 to 3 Years of Age

OBJECTIVES

This study examined the psychosocial, adaptive behavior, and language outcomes of young children who are hard of hearing (HH) without additional disabilities or neurocognitive impairments. Relations between early developmental outcomes and child and parent demographic variables, and parenting stress and self-efficacy were also explored.

DESIGN

Participants were 39 children with early identified, permanent mild to severe hearing loss, between the ages of 2 and 3 years, and a comparison group of 47 children with normal hearing (NH). Developmental outcomes were measured using clinician-administered standardized tests and parent-completed behavior rating instruments specific to language, psychosocial functioning, and adaptive behavior. Mothers completed self-report measures that assess parenting stress and maternal self-efficacy.

RESULTS

The children who are HH were similar to the children with NH in terms of their psychosocial functioning and adaptive behavior, with the exception of their socialization skills. As a group, the children who are HH performed significantly worse than their peers with NH on all measures of language ability. Among the children who are HH, maternal self-efficacy showed a strong positive correlation with adaptive behavior outcomes; however, it failed to contribute unique variance above that explained by language ability and gender. Maternal self-efficacy was also significantly correlated with better psychosocial outcomes, but only parenting stress proved to be a significant predictor of child behavioral problems once other variables considered were in the model.

CONCLUSIONS

Early-identified young children who are HH can demonstrate age-appropriate development in multiple domains, including language, psychosocial, and adaptive behavior. However, mild to severe hearing loss places young children with no additional disabilities or neurocognitive impairments at risk for language delays. Although the children who are HH demonstrated no more emotional or behavioral problems than their same-age peers with NH, results suggest that language delays increase their vulnerability for delays in various aspects of social competence.

Talk with me! Parental linguistic input to toddlers with moderate hearing loss

This study examined the quantity and quality of parental linguistic input to toddlers with moderate hearing loss (MHL) compared with toddlers with normal hearing (NH). The linguistic input to eighteen toddlers with MHL and twenty-four toddlers with NH was examined during a 10-minute free-play activity in their home environment. Results showed that toddlers with MHL were exposed to an equivalent amount of parental linguistic input compared to toddlers with NH. However, parents of toddlers with MHL used less high-level facilitative language techniques, used less mental state language, and used shorter utterances than parents of toddlers with NH. Quantity and quality measures of parental linguistic input were positively related to the expressive language abilities of toddlers with MHL.