Understanding theory of mind in school age: Insights from cochlear implant users and typically developing peers

While language and working memory (WM) have been linked to theory of mind (ToM) performance in preschool children, their relationship in middle to late childhood remains less understood, especially in children with cochlear implants (CI). This study aimed to investigate the relationship between ToM understanding and language, as well as WM, in early implanted school-aged children and typically developing (TD) peers. Thirty-four 8- to 12-year-old participants (12 with CI) underwent tests evaluating cognitive and affective ToM, language, and WM. Bayesian Kendall's Tau correlation tests were used to examine how different ToM components relate to language and WM. In TD children, both ToM components were more likely to be correlated with language than not, whereas the opposite was observed in children with CI for cognitive ToM and language. Affective ToM performance was more likely to correlate with WM than not in both groups. This implies the importance of verbal information storage and processing in emotion understanding. The findings underscore the conceptual distinction between cognitive and affective ToM, suggesting diverse pathways for their understanding. Clinical and educational implications are discussed.