Theory of Mind Development in Children With Congenital Visual Impairment: Role of Visual Impairment and Verbal Ability

This study aims to explore the theory of mind (ToM) status in individuals with congenital visual impairment (CVI) and identify key predictive factors. For Study 1, the false-belief task was used to assess ToM ability in children aged 7-10 years (60 with normal sight, 33 with legal blindness, and 23 with total blindness). The results showed that children with total blindness had significantly lower false-belief scores than sighted children, with those with legal blindness performing in between. In the first-order false-belief task, verbal ability only moderated differences between children with total blindness and sighted children. Meanwhile, in the second-order false-belief task, verbal ability moderated differences between children with total blindness and sighted children and between children with legal blindness and sighted children. For Study 2, the faux pas task was used to examine the roles of age, residual vision, and verbal ability in ToM development among 166 adolescents aged 7-19 years with CVI. While age and verbal ability significantly predicted ToM development, residual vision had no significant predictive effect. In conclusion, compared with sighted children, those with CVI show delayed ToM development, though children with legal blindness perform better than those with total blindness. Age and verbal ability are key predictors of ToM development in children with CVI. Thus, in the early stages of ToM development, maximizing the use of residual vision and other senses is crucial. Further, enhancing verbal abilities, such as through using mental state terms in conversations and reading literary works, can mitigate the negative impact of CVI. Finally, intervention strategies should be tailored to age characteristics.