Introduction

In the hearing population, moral emotions (called social emotions in class) are important influencing factors of social competence. Moral emotions such as shame, guilt, and pride, are reflected, for example, in being loved by others. Moral emotions seem to play an important role in regulating social behavior. It is unclear whether this can also be observed in early childhood. It seems that young children can already experience moral emotions, but that they do not yet have the capacity to understand the consequences of their behavior.

This research explores the moral development of children with a CI (cochlear implantation) and the relationship with this implantation and the social functioning of these children.

Function and development of moral emotions

Emotions have a social function; they motivate people to find a balance between their own interests and certain social requirements in order to optimize interpersonal relationships. Moral emotions would assume a special position in the spectrum of emotions. Moral emotions have a self-evaluating component and occur when people judge their own behavior as to whether it is morally right or wrong. Self-awareness and self-reflection will allow for correcting one's own behavior. Moral emotions discourage inappropriate behavior (morally incorrect) and reinforce appropriate behavior (morally correct).

NH (normal hearing) children know how and when to express moral emotions and will also be more socially skilled.

Moral emotions require certain insights and capacities that develop over time. Self-awareness develops during the second year of life. Parents play an important role in developing children's sense of self. During infancy, most NH children are getting better at judging their own behavior based on what they have learned from previous feedback (from their parents). At the age of three, NH children begin to develop a personal set of standards, which ultimately will guide their (emotional) behavior in the right direction, independent of external guidance.

The majority of NH children learn to understand Theory of Mind (ToM) between 2 and 5 years old. Children with CI fail in ToM during this crucial period. In the early and middle of childhood, children with CI are less able to predict the behavior of others based on the expectations and wishes of these people. They tend to use their own frame of reference more often. Children with CI are less able to express moral emotions because they do not realize that they are doing something that can be judged as reprehensible or admirable by others.

Communication and socialization

Children pick up signals from the environment to know how to behave, which emotions to experience and when and how to express these emotions. These signals are communicated in various ways, such as through body language, eye contact, facial expression, language content and pitch of voices. Children with CI are less likely to pick up these signals from the environment. Even though the CI is responsible for the perception of sound, a large amount of the children with CI still suffer from language delays. This is particularly problematic for children with CI who grow up in a 'hearing environment'.

Research goals

The first aim of this study is to study the extent to which young children with CI or normally hearing children display moral emotions in an experimental setting. The hypothesis is that children with CI are less likely to learn and internalize moral norms and show subsequent moral emotions, due to communication problems and the limited possibility of incidental learning. In addition, children with CI will have a disturbed insight into emotions and the perspective of other people, impeding the ability to draw conclusions about their own behavior from signals from the environment.

The second goal in this study is to investigate associations between moral emotions and social behavior. Young children are expected to be unable to anticipate the consequences of their behavior, regardless of whether or not they can hear. This would mean that in both groups of children there is no relationship between moral emotions and social behavior.

Third, it is studied whether communication plays an important role in the development of moral emotions. The language skills of the children will be examined as a determinant of communication. The hypothesis is that a positive relationship is found between the ability to understand and use emotion language and the extent to which moral emotions are expressed. This will be the outcome for both groups of children.

Finally, it is studied whether previous implantation stimulates the social and emotional functioning of the children in a way comparable to what was found for the spoken language skills.

Method

Participants

224 children, of which 60 with CI and 184 NH, from the Netherlands and the Dutch-speaking part of Belgium. All children are born to hearing parents and have no mental health disorder. The children with implants had all received their first implant before the age of three.

Index for moral emotions: guilt, shame, pride

There were three tasks that should provoke the feelings of shame and guilt. The Broken Car Task; children would believe they had broken the investigator's toy car. The Copy Task; the children had to draw a drawing over, after which they received negative feedback on their performance. And the Bottle Task; the children had to open a bottle on which there was a safety cap without the children knowing, so that they could not open the bottle and the researcher did. The following four behaviors were coded on a three-point scale (0 = not at all, 1 = a little, 2 = a lot): negative reaction to the situation, gaze away from the situation, collapse of the body, letting the corners of the mouth hang down / lower lip to push outside.

There were also tasks where pride was provoked. With the Copy Task, positive feedback was given and with the Bottle Task the protection was removed by the researcher, so that the child's second attempt to open the bottle was successful. Pride was scored on the same three-point scale with the following three behaviors: positive response to the situation, (smile) laughter, eye contact / upright posture.

Index for social functioning: social competence, cooperation, behavioral problems

Social competence was determined by calculating the average score for the items of the Prosocial and Peer Problems scales of the Dutch parent report version of the Strengths and Difficulties Questionairre (SDQ). Parents rate each item on a three-point scale (0 = not true, 1 = somewhat true, 2 = certainly true).

Cooperation was tested with the use of a questionnaire specially designed for this study. The scale of cooperation reflects the extent to which children were motivated to perform tasks and how they responded to the researcher's instructions. Items were assessed on a three-point scale (0 = none, 1 = sometimes, 2 = often), after which the average score of the items was calculated.

Behavioral problems were determined by calculating the average score for the hyperactivity and behavioral scales of the SDQ.

Index for language: emotional vocabulary, spoken language comprehension and production

The emotion language of children was measured with the Emotion Vocabulary Questionnaire. This is a parent reported questionnaire designed for this study. Parents assessed their children for knowing or using (through sign language or simply spoken language) mental state words or emotion words (0 = no, 1 = yes).

Spoken language comprehension and language production were obtained from children with a CI through admissions from hospitals and elsewhere. Part of the rehabilitation process after implantation supervises the language development of the children, usually through the use of the Dutch version of the Reynell Developmental Language Scales for language comprehension and the Schlichting Expressive Language Test for word and sentence production. So the spoken language skills were only measured in children with CI.

Results

It appears that children with CI express moral emotions to a lesser extent compared to normal hearing children. No major effects were found between the two groups for one of the measures of social functioning. So social competence, cooperation and behavioral problems were the same. Furthermore, it is indicated that NH children know and use more emotion words than children with CI.

Shame, guilt and pride appeared to increase with age in both groups of children. Cooperation also appeared to increase in both groups with age, while social competence only increased with age in NH children. In addition, it was striking that behavioral problems were not related to age in the NH group, while it did increase with age in children with CI.

Emotion language, indexed by emotion vocabulary, turned out not to be related to moral emotions in both groups. Emotion vocabulary turned out to be positively related to social competence in the CI group. The younger the age of insertion and the longer use of the implant, the more positively related to pride and language skills, but not to shame and guilt or other indexes of social functioning. The timing of the implantation was otherwise unrelated to emotion language.

Discussion

Moral emotions have the ability to promote positive social behavior and to protect against negative social behavior in the NH population. The majority of the group of children with CI appeared to have limited opportunities for acquiring social-emotional skills as a result of limited communication with their environment.

Young NH children may already show moral emotions, but this ability grows with age. Children with CI express shame and guilt less widely than NH children in response to emotion-provoking events. Children with CI also showed less pride. This group also appeared to be less aware of what was expected of them in terms of moral behavior in the situations. In both groups, however, a link was found between age and moral emotions. This would mean developing the moral skills along the same lines, but at a different pace. For example, the social skills of children with CI appear to develop just as well and develop at the same pace as NH children.

A relationship was found between moral emotions and positive behavior, not with negative behavior. A better developed moral sense promoted positive behavior, but did not appear to show negative behavior. Children with CI were less likely to recognize facial expressions than NH children. In addition, they were less able to detect differences in intonation in spoken language and were less likely to learn incidentally.