The research, led by Carolien Rieffe of Leiden University and Guida Veiga of the Universidade de Évora, examined 181 preschoolers attending mainstream kindergartens in Portugal, including 32 deaf and hard-of-hearing children and 149 hearing children. The deaf and hard-of-hearing participants all had severe to profound hearing loss, used auditory-verbal communication as their primary modality, and had no additional diagnoses. Eighteen of them wore bilateral cochlear implants, ten used bilateral hearing aids, and four had a cochlear implant in one ear and a hearing aid in the other. Crucially, all had received their devices early in life, reflecting Portugal’s national policy of early and bilateral intervention implemented in 2015.

The study focused on three developmental layers of empathy that can be observed in young children. The first layer, emotion contagion, is considered innate: most babies start crying when they hear or see another baby cry. The second layer, attention to others’ emotions, emerges as children learn to regulate their own arousal and shift focus from themselves to the distressed person, visible in concerned facial expressions or stopping play to watch the other. The third layer, prosocial actions, involves comforting behaviors aimed at alleviating distress in others. While contagion is assumed innate, the researchers note that the other two layers rely heavily on social learning, which is precisely where deaf and hard-of-hearing children face barriers.

Those barriers are often invisible but pervasive. In hearing households, family members talk to each other from different rooms, in dark spaces, or while standing with their backs turned, making conversations inaccessible to a deaf child unless others deliberately provide visual access. At school, peer interactions typically occur in noisy playgrounds with poor acoustics, situations that demand good speech-in-noise understanding and directional hearing, capabilities that remain limited for many deaf and hard-of-hearing children even with cochlear implants and good hearing test scores. Hearing peers and many teachers often lack awareness and strategies to make their communication accessible, meaning they may not notice when or why a deaf classmate is left out.

Caregivers rated each child’s empathy using the Portuguese version of the Empathy Questionnaire, a validated instrument measuring the three layers through 15 items. They also completed scales assessing emotion recognition and emotion regulation, and a 20-item questionnaire measuring children’s knowledge of emotion and mental state words. Language comprehension, production, and pragmatics were assessed directly with the children through standardized tasks, and hearing-related factors such as hearing age, degree of hearing loss, and device type were obtained from clinical records.

The results defied expectations. One-tailed independent samples t-tests showed that deaf and hard-of-hearing preschoolers scored similarly to hearing peers on all three layers of empathy, on emotion recognition, and on emotion regulation. The only significant difference emerged in emotion vocabulary, where deaf and hard-of-hearing children scored lower than their hearing peers. Language production, comprehension, and pragmatics were also lower in the deaf and hard-of-hearing group, yet these general language skills showed no association with any of the three empathy layers.

Hierarchical regression analyses revealed something more profound. Only the model predicting prosocial actions reached significance, showing that better emotion recognition, better emotion regulation, and larger emotion vocabulary each contributed uniquely to more empathic behaviors toward a person in distress, and these associations held to a similar extent in both groups. Hearing factors, including type of device, degree of hearing loss, and hearing age, were unrelated to the three empathy layers in the deaf and hard-of-hearing sample. The findings suggest that the earlier, automatic levels of empathy operate largely independently of language and regulatory skills, while the later, effortful level draws more heavily on them.

The authors argue that part of the empathy deficit reported in earlier literature may reflect historical variation in access to early, bilateral intervention rather than a stable consequence of hearing loss itself. Previous Dutch studies had found lower prosocial actions in deaf and hard-of-hearing children, but a proportion of those participants received hearing intervention unilaterally or were implanted after two years of age. Recent findings from China, where early and bilateral interventions are also standard, showed comparable empathy trajectories between hearing and deaf preschoolers. As intervention timing becomes standard practice, older cohort findings may need revisiting, and cross-study comparisons should account for intervention timing rather than treating deaf and hard-of-hearing children as a uniform category.

The study also carries a message about the environments where social learning happens. Preschoolers’ interactions during recess often occur in areas with noisy backgrounds and poor acoustics, so-called noise pollution that affects all children but more strongly those with hearing loss. A recent Portuguese study showed deaf and hard-of-hearing children engaging more frequently in nonsocial behaviors at the playground than their hearing peers. The researchers suggest redirecting attention from empathy-specific intervention toward improving accessibility of everyday contexts, such as acoustic conditions in classrooms and playgrounds, as a potentially more impactful lever for supporting socio-emotional participation.

From a clinical and educational standpoint, the responsibility for access to the social environment should not be placed on the deaf child. The barriers that deaf and hard-of-hearing children face are often invisible yet no less real, requiring collective awareness at a societal level to ensure they experience the same respect and opportunities as their hearing peers. Adaptations may include special paneling or tiles to provide better acoustics, or clear instructions by a teacher to ensure a deaf child can see the face of a child who is talking, which also requires good light. When early support is accessible, the study concludes, deaf and hard-of-hearing children may develop emotion skills to a similar extent as their hearing peers, giving them a broader repertoire for navigating everyday social situations and expressing empathy.

Subject of Research: Empathy and emotional competence in deaf and hard-of-hearing and hearing preschoolers

Article Title: Empathy and emotional competence in deaf and hard-of-hearing and hearing preschoolers

Article References: Rieffe, C., da Silva, B. M. S., Tsou, Y.-T., Libbi, C., Frijns, J. H. M., & Veiga, G. (2026). Empathy and emotional competence in deaf and hard-of-hearing and hearing preschoolers. Frontiers in Developmental Psychology, 4, Article 1957507. https://doi.org/10.3389/fdpys.2026.1957507

Image Credits: AI Generated

DOI: 10.3389/fdpys.2026.1957507

Keywords: Empathy, emotional, competence, deaf, hard-of-hearing, hearing, preschoolers, scientific research