Examining the Relationship Between Executive Functions and Theory of Mind with Behavioral Problems in Children with Hearing Impairment

Hearing impairment is a multidimensional disorder that causes personal and social problems. Children and adolescents with hearing impairment are more likely to be at risk than behavioral problems. Regarding the high prevalence of behavioral problems in children with hearing impairment, recognizing the behavioral characteristics, abilities, and issues of people with hearing impairment are important. Difficulties in expressive language and verbal processing are significantly associated with problems in executive functions. Some researchers have tried to justify relatively modest behavioral problems in children with hearing impairment with a defect in the growth of the theory of mind in these individuals. To study the effective factors causing behavioral problems in children with hearing impairment, we aimed to investigate the relationship between executive functions and theory of mind with behavioral problems in children with hearing impairment.

Methods:

The research method was descriptive correlational. The research community consisted of all elementary students in Tehran who were studying in deaf schools during the academic year of 2017–2018. According to Tabachnick and Fidell's formula, the sample size is estimated to be 84. This formula determines the minimum volume required for multiple regression studies. This study used 120 cluster randomized sampling to increase the external credibility and test power. We selected six schools randomly. Then, five classes were selected randomly from selected schools. Finally, four students with hearing impairment were selected in each school. The study data were collected using Stringenman's theory of mind test, Coolidge neurology questionnaire, and child behavioral inventory. The results were analyzed in SPSS software, using the Pearson correlation and multiple regression analysis systematically at a significance level of 0.05.

Results:

 The results of this study showed significant negative relationships between planning and internalized behavioral problems (r=–0.22, p=0.014) and externalized behavioral problems (r=–0.33, p<0.001). There were significant reverse relationships between inhibition and internalized behavioral problems (r=–0.27, p=0.002) and externalized behavioral problems (r=–0.31, p<0.001). However, no significant relationships existed between the organization and internalized behavioral problems (r=0.14, p=0.112) and externalized behavioral problems (r=0.03, p=0.731). There were significant reverse relationships between the theory of mind and behavioral problems of externalization (r=–0.42, p<0.001) and internalization (r=–0.28, p<0.001). The theory of mind was the strongest predictor of internalized behavioral problems (β=–0.28, p=0.002) and externalized behavioral problems (β=–0.42, p<0.001) in children with hearing impairment.

Based on the study findings, executive functions and theory of mind play a major role in the behavioral problems of students with hearing impairment. Designing and implementing educational and therapeutic programs is essential to cultivate these factors.