Metaphor Comprehension and Theory of Mind in Hearing-Impaired Children: A Narrative Review

Document Type : Review Article

Authors

1 Department of Performing Arts, College of Fine Arts, University of Tehran, Tehran, Iran

2 PhD in Audiology, Associate Professor, Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Ph.D. Student in Audiology, Department of Audiology ,m School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.22037/sjrm.2026.117624.3493

Abstract

Background and Aim: Metaphor comprehension, a core component of figurative language, requires moving beyond literal meaning to infer the speaker’s intended message within context. This process relies on multiple linguistic resources (vocabulary, syntax, semantic knowledge) and higher-order cognitive skills (working memory, cognitive flexibility, and executive functions). Theory of Mind (ToM) —the ability to attribute beliefs, emotions, and intentions to oneself and others— plays a facilitating role in interpreting nonliteral meaning, including metaphors. This narrative review aimed to summarize evidence on the relationship between metaphor comprehension and ToM in children with hearing impairment and to clarify mediating factors shaping this relationship.

Methods: A targeted search was conducted in PubMed, Scopus, Web of Science, and Google Scholar using keyword combinations related to hearing Impairment/deafness, Theory of Mind, and figurative language/metaphor. Relevant studies were narratively synthesized and organized across conceptual themes: metaphor comprehension, ToM development, and mediators such as language growth, early language accessibility, and the quality of social interaction.

Results: Findings indicate that children who are deaf or hard of hearing—particularly those with delayed or limited early access to a fully accessible language—may show delays in ToM (e.g., false-belief tasks) and difficulties in figurative language comprehension. However, outcomes are heterogeneous and appear to depend on variables including timing of intervention, communication modality, richness of linguistic input, and parent–child interaction quality. Evidence also supports a distinction between “physical” and “mental” metaphors, suggesting that mental metaphors (involving psychological states) place greater demands on ToM-related inferencing.

Conclusion: Metaphor comprehension in children with hearing impairment emerges from a dynamic interaction between linguistic foundations, inferential/executive processes, and ToM abilities. Clinically, effective interventions should go beyond basic language training to include explicit mental-state language, inferencing practice, and context-based activities targeting speakers’ intentions in real interactions.

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Main Subjects

References

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The Scientific Journal of Rehabilitation Medicine

Articles in Press, Accepted Manuscript
Available Online from 05 August 2026

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History

  • Receive Date: 27 July 2026
  • Revise Date: 05 August 2026
  • Accept Date: 05 August 2026
  • First Publish Date: 05 August 2026

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