Introduction
Research in the normally hearing (NH) population has demonstrated that moral emotions such as shame, guilt, and pride are important determinants of social competence, reflected in being liked by others, for example [
1,
2]. Conversely, an impaired moral development is associated with a range of undesirable behaviors in preadolescents, including bullying and aggression [
3‐
5] and, at the far end of the spectrum, even criminal behavior and psychopathy in adolescents and adults [
6,
7]. These studies indicate that moral emotions play a significant role in regulating social behavior, but whether this association can already be observed in early childhood is unclear. Although literature concerning the development of moral emotions in young children is abundant (e.g., [
1,
8,
9]), few studies have examined the relationship between moral emotions and social behavior in early childhood. The general consensus among emotion theorists is that moral emotions start to develop in early toddlerhood but that children’s ability to experience and regulate these emotions increases in the next couple of years (cf. [
8]). For example, Nunner-Winkler [
10] found that 8-year-olds, but not 4-year-olds, expect negative feelings after a moral transgression. This seems to imply that although young children are able to experience a moral emotion, their ability to anticipate the consequences of their behavior is still limited. Consequently, moral emotions might not regulate young children’s social behavior to the same extent as observed in older children and adults.
The ability of children with hearing impairments to experience and express moral emotions, and how this ability relates to their social functioning, has received little or no attention to date even though social problems are known to exist in this population. Children and adolescents with prelingual, severe to profound hearing loss more often experience social difficulties than NH peers, which is manifested in problematic peer relations [
11], behavior problems [
12], and symptoms which may be precursors of behavior disorder and antisocial personality (i.e., poor impulse control, lack of empathy) [
13]. These days, the vast majority of young children with severe to profound hearing loss born in Western countries receive a cochlear implant (CI), often before their second birthday [
14,
15]. This electronic device bypasses the damaged part of the ear by directly stimulating the auditory nerve which, combined with extensive rehabilitation, enables sound perception and in turn could benefit spoken language skills [
16,
17]. Yet, how cochlear implantation affects these young children’s social functioning and which factors underlie their social development is largely unknown. Determining risk or protective factors is important in light of optimizing rehabilitation programs for children with CI. This study is the first to explore the moral development of children with CI and to examine its relationship with these children’s social functioning.
Function and development of moral emotions
Emotions have a social function, motivating people to find a balance between their own interests and certain social requirements to optimize interpersonal relations [
18,
19]. A number of theorists have argued that moral emotions take a special position in the spectrum of emotions (e.g., [
1,
20‐
24]). Crucially, moral emotions include a self-evaluative component, and occur when people judge their own behavior as (morally) right or wrong [
8]. This self-awareness or self-reflection may motivate people to correct their own behavior or even better, to prevent themselves from committing moral transgressions in the future [
1,
21]. Each moral emotion has its own function and a corresponding pattern of behavior. Although the same event may cause shame in one person and guilt in the next [
21,
25], a distinction between these two emotions can be made based on appraisals concerning stability and globality [
24,
25]. Shame arises when a failure or transgression is attributed to a global and stable cause (e.g., ‘I broke the vase because I am clumsy’). Guilt, on the other hand, is caused by specific and unstable attributions (e.g., ‘I broke the vase because I did not look where I was going’). Both emotions communicate to others that you are aware of your transgression and feel bad, yet shame is associated with escape-related behavior (e.g., making yourself smaller, avoiding eye contact), whereas guilt is associated with reparative behavior (e.g., apologizing, trying to undo the consequences) [
1,
21,
25]. Pride can be felt when you have accomplished something notable, and makes you want to repeat or sustain the behavior that led up to this emotion. Its expression is aimed at drawing attention to this accomplishment (e.g., expanded posture, making eye contact), and signals to others that you (temporarily) deserve a higher status within the group [
22,
26]. In sum, moral emotions discourage inappropriate (i.e., morally incorrect) and reinforce appropriate (i.e., morally correct) behavior. Therefore, it is not surprising that emotionally competent NH children—those who know when and how to express (moral) emotions—are generally also perceived to be more socially competent [
1,
2,
27].
Moral emotions require certain insights and capacities, which develop over time. Children need to be aware of the dominant moral standards and have to be able to evaluate their own behavior in this context [
8,
21,
23‐
25]. Having a sense of self is a prerequisite for the ability to reflect upon one’s own behavior. Self-awareness typically develops during the second year of life, which is illustrated by self-referential behaviors such as the use of personal pronouns (i.e., I, me, myself, mine) and self-recognition [
8,
25]. Parents play an important role in children’s developing sense of self. By providing feedback on their children’s behavior, parents direct children’s attention to their actions, helping them to reflect upon, evaluate, and ultimately regulate their behavior [
8]. Yet, an overly critical attitude toward their children’s behavior could lead to shame proneness, which in turn could impact children’s development of self [cf. 9]. During the toddler period, most NH children become increasingly able to evaluate their own behavior based on what they have learned from previous feedback and will start to generalize this knowledge to other situations. From 3 years onwards, NH children start to internalize a personal set of moral standards that will eventually channel their (emotional) behavior, independent from outside guidance [
9,
23‐
25].
In order for a personal set of moral standards to develop, children need to be able to judge their own behavior through other people’s eyes, which requires certain socio-cognitive abilities. The best-known example of these is the so-called Theory of Mind (ToM), which entails the capacity to take other people’s perspective into account [
28]. The majority of NH children show a major development in their ToM understanding between the ages of 2 and 5 years old [
29], but ToM skills of children with CI are known to fall behind during this crucial period. In early and middle childhood, children with CI are typically less able than their NH peers to predict other people’s behavior based on these people’s desires and expectations, but tend to use their own frame of reference instead [
30,
31]. A limited understanding of other people’s perspectives also implies a limited ability to anticipate other people’s judgments of their behavior. Consequently, children with CI may be less inclined to express moral emotions because they do not realize that they have done something that would be judged as reprehensible or admirable by others. Also in the context of overt feedback on their behavior, children with CI could still experience and express moral emotions to a lesser extent than NH children. Studies have shown that children with CI more often than their NH peers have difficulties recognizing other people’s emotions [
32,
33] and are less sensitive to intonation [
34]. Therefore, these children might not pick up on more subtle forms of feedback, which are relayed by someone’s facial expression or tone of voice, for example. If children with CI are indeed less aware of other people’s evaluations of their behavior, this could hamper the process of internalizing moral standards.
The role of communication and socialization
Emotions are subjective experiences in response to meaningful events. Yet, how these emotions are interpreted and displayed is modulated by the social environment [
1,
18]. For example, play with other children provides a platform for learning to regulate emotions and for practicing social skills. In addition, parents act as role models and instructors, providing examples of appropriate behavior and correcting children’s (emotional) behavior if necessary. Children need to pick up on cues in their environment in order to form a conception of how they should behave, which emotions to experience and when and how to express these emotions. These cues are communicated in various ways, such as through body language, eye contact, facial expressions, language content, and tone of voice. For example, a parent may provide verbal feedback to correct a child’s behavior (“do not hit your brother”) or may show a disapproving facial expression. Both acts of communication convey the same message. On the other hand, the same sentence can carry different meanings dependent upon tone of voice.
Children with CI are less likely to pick up on these cues from the environment. Even though a CI enables sound perception, a large proportion of these children still faces language delays [
16], which is problematic given that at least 90 % of deaf children are born into hearing families [
35]. Parents of children with hearing impairments more often have difficulties conversing with their children, particularly about abstract topics [
36]. This includes having conversations about emotions; helping children to label their emotions and discussing how to communicate their emotions appropriately. Having a limited ability to identify own and other people’s emotions is likely to also hinder children’s ability to interpret nonverbal messages. For example, facial expressions may not have much meaning for children if they have not learned how to interpret these. Moreover, limited emotion knowledge also leads to difficulties in verbally communicating emotions during interactions with others. This in turn could lead to misinterpretation of the intended message by the other party, potentially damaging the relationship [
27].
In addition to communication difficulties that can arise in situations where children with CI interact with other people, these communication difficulties will also play a role when the child with CI is not directly addressed. In other words, children with CI will also more often miss out on opportunities for so-called incidental learning, i.e., overhearing conversations between others, as has been shown for children with hearing impairments without a CI [
37]. Particularly in noisy situations, for example in playgrounds or at family gatherings, children with hearing impairments are known to benefit less from their CI [
38]. And even when children with CI are addressed directly, they will often have to rely on visual as well as auditory cues, which means they need to face the person who is talking to them. This makes it hard for them to simultaneously focus on the object or event this person is talking about (cf. [
39]). An impoverished quality of interactions with NH people in their immediate surroundings combined with limited opportunities for incidental learning could negatively impact these children’s ability to develop moral emotions.
Current study
This study’s first aim is to examine the extent to which young children with NH or with CI display moral emotions in an experimental setting. Because of communication difficulties and limited opportunities for incidental learning [
36,
37], children with CI presumably have had less opportunity to learn and internalize moral standards, and subsequent moral emotions. Moreover, compared with NH children, children with CI more often have an impaired insight into other people’s emotions and perspective [
30‐
33], which further hampers their ability to make inferences about their own behavior from cues in their environment. Therefore, we expect children with CI to display moral emotions to a lesser degree than NH peers.
Secondly, the associations between moral emotions and social behavior are examined. Because moral emotions play such a crucial role in social functioning of the NH population at later ages [
2,
3,
7], we could expect to observe this relationship already early in life, both in the NH group and in the CI group. Alternatively, it could be that young children (regardless of hearing status) cannot yet anticipate moral emotions to follow from their behavior [
10], which would imply that in both groups of children in this study moral emotions are not related to social behavior.
Thirdly, we wish to verify whether communication indeed plays an important role in the development of moral emotions. We examine children’s language skills as a determinant of communication. Particularly emotion-related language might be important for children’s social–emotional development. Regardless of children’s hearing status, we expect to find a positive relationship between their ability to understand and use emotion language and the extent to which they express moral emotions. Within the CI group, we also assess whether general spoken language abilities are related to moral emotions.
Fourthly, we explore whether earlier implantation promotes children’s social and emotional functioning similar to what has been found for their spoken language skills [
16].
Discussion
Research shows that moral emotions such as shame, guilt and pride have the ability to promote positive social behavior and to protect against negative social behavior in the NH population [
2,
3,
21]. Yet, to our knowledge, this study is the first to examine whether the link between moral emotions and social behavior can already be observed in young children (age 1–5). We examined this in a group of NH children and in a group of children with hearing impairments who had received a CI. The majority of the latter group of children is assumed to have limited opportunities for acquiring social–emotional skills because of restricted communication with their surroundings [
36,
37]. Comparing these two groups indirectly provides insight into the influence of socialization on the development of moral emotions.
Our study confirms previous studies [
23,
45], which demonstrated that young NH children already display moral emotions, and that this ability increases with age. As expected, children with CI expressed shame/guilt to a lesser extent than their NH peers in response to staged emotion-evoking events (i.e., failing on a mastery task and breaking a toy). In addition, children with CI also showed less pride than NH children when they succeeded on a mastery task. General feedback on children’s performance or behavior was provided by the experimenter, which should have focused children’s attention on their failure or transgression (or in the case of pride, on their success). Nonetheless, children with CI seemed to be less aware than their NH peers of what was expected of them in terms of moral behavior in these situations. On a positive note, as in the NH group, an association was found between age and moral emotions in children with CI. This could imply that moral skills develop along the same lines as in NH children, but at a different pace. Longitudinal studies are required to confirm this.
Expectations concerning the associations between moral emotions and social behavior were largely not met. Firstly, we expected to find a relationship between the extent to which NH children expressed moral emotions and their level of social behavior. Yet, we only found a relationship between moral emotions and positive behavior, not with negative behavior. In other words, a better-developed moral sense did promote positive (i.e., friendly, prosocial) behavior, but did not seem to prevent NH children from displaying negative (i.e., disruptive, externalizing) behavior. It should however be noted that parents of NH children reported quite low levels of behavior problems, which could have masked an association between moral expressiveness and negative behavior. Future studies could try to examine this association in children who show high levels of behavior problems.
Secondly, we expected that the associations between moral and social behavior would be similar in the NH and the CI group. In contrast to this expectation, we found no associations between moral emotions and social behavior in the CI group. As in the NH group, parents of children with CI reported low levels of behavior problems in their children, which could explain the lack of an association between moral emotions and negative behavior. Yet, the absence of a relationship between moral emotions and positive behavior requires some additional attention. Levels of positive as well as negative social functioning were equal in both groups of children, which, in combination with the absence of a relationship between moral emotions and social functioning in children with CI, lead us to question the importance of a delayed development of moral emotions for these children.
The absence of a relationship between moral emotions and social behavior in children with CI could be explained by differences in the ways in which children acquire social–emotional competence. Instilling a moral sense in children is not about teaching them a repertoire of socially appropriate behaviors, rather it is about providing children with the resources to judge their own (intended) behavior as right or wrong. Children are likely to receive explicit feedback on the behavior they display, particularly if this behavior stands out in a positive or a negative way. However, the feedback provided will not always include an evaluation of the morality of children’s behavior. Moreover, children with CI are generally less proficient than NH children in recognizing facial expressions [
32,
33] and are also less able to detect differences in intonation in spoken language [
34]. In addition, the majority of children with CI have fewer opportunities than their NH peers for incidental learning. They have difficulties overhearing other people’s conversations, particularly in noisy environments [
38]. Combined, this could explain why the social skills of children with CI are comparable to those of their NH peers while their moral development is delayed. Moreover, factors related to the rehabilitation program that children in the Netherlands enter after receiving their CI could also play a role. Children with CI receive a lot of attention from adults during their frequent visits to the hospital and in their specialized playgroups. This could provide them with ample models for appropriate social behavior. It is, however, unlikely that these role models also explain how and when to express moral emotions.
An alternative explanation for both the finding of lower levels of moral emotions and of equal levels of social functioning in children with CI as compared to NH children could be group differences in parental attitudes and expectations. Although to our knowledge no studies are currently available on the relation between parenting and social–emotional functioning of children with CI, one previous study did demonstrate that fathers of children with hearing impairments were more protective and less strict in disciplining their children with hearing impairments compared with fathers of NH children [
46]. If parents of children with CI indeed have more lenient attitudes toward their children, this could affect their judgment of their children’s behavior. Possibly, these parents rate the level of social competence higher and the level of behavior problems lower compared with how parents of NH children would rate similar behaviors. In addition, we could speculate that a more lenient attitude and lower expectations by parents of children with CI hamper these children’s moral development. Parents who do not correct their children’s inappropriate or rule-breaking behavior will raise children who are unaware of the prevailing moral standards and values. It seems there might be an optimal level of parental power assertion which helps children to internalize moral values. Parents who come on too strong may only foster anger and resentment in their children, leading children to attribute their transgressions to external causes instead of acknowledging their own responsibility and feeling guilty or ashamed. On the other hand, if parents condone bad behavior and do not set firm boundaries, children will also fail to internalize moral values [
47]. More research is needed to unravel the relations between parental attitudes, expectations and behavior on the one hand and the development of moral emotions in children with CI on the other hand.
Although the social skills of children with CI seem to develop well, it remains to be seen whether these will continue to develop at the same pace as NH children’s social skills in the absence of equally well-developing emotional skills. As children grow older, more sophisticated social skills are expected, which could draw more heavily on children’s emotional skills. Children with CI are often found to have an impaired ToM [
30,
31], which hampers their ability to judge their own behavior from another person’s perspective, and thus could prevent them from experiencing and displaying moral emotions when these are called for. A lack of expressing moral emotions following a transgression does not seem to damage the social relationships of children with CI at this early age. Down the line, peer relations become more important and peers may be less forgiving than parents when children cross the line without showing remorse. There is no doubt that everyone will violate the social norms from time to time. Yet, individuals who display or report feelings of shame or guilt following a transgression are less likely to be socially rejected than those who seem to be indifferent to their wrong doing [
2,
48].
To verify whether communication is important for children’s moral and social development we examined one of its components: language. Language did not turn out to be the important determinant of children’s moral emotion expressions we had hypothesized. Children who used more emotion language did not express more moral emotions. Two explanations for this outcome come to mind. First, language does not equal communication. Communication can take on many other forms besides language. Moreover, we only assessed language skills of the children themselves, we did not assess language exchanges between children and important others in their environment. This could have provided much more detailed information on the content of conversations or the way messages are communicated, for example. Second, other factors besides language might be more important for the development of moral emotions. For example, children’s previous experiences regarding consequences of moral transgressions, parental attitudes toward emotions in general or children’s temperament could play a role in the development of moral emotions [
9,
47]. Emotion language was, however, associated with more positive social behavior in both groups and with less negative behavior in the CI group. Important to note is that general spoken language skills of children with CI did not influence their emotional or their social functioning. These outcomes support the assumption previously made by other researchers [
49] that it is not just the ability to understand and produce general language that is important for social–emotional functioning; it is the ability to understand and use emotion language in daily conversations that is critical for adequate social functioning.
A recent study by Quittner et al. [
50] demonstrated that parental behaviors, including language stimulation and maternal sensitivity, had a major impact on language outcomes in children with CI. Nonetheless, parents might continue to experience difficulties conversing about abstract concepts such as emotions with their children with CI, despite these children having adequate concrete language skills. In a study by Zaidman-Zait [
51], 39 % of parents reported that they experienced difficulties communicating with their children with CI. A previous study by the current authors demonstrated that children with CI who had well-developed general language understanding still had an impaired theory of mind in comparison to NH age mates [
31]. In addition, emotion language was unrelated to implantation timing in the current study, whereas general language was better developed in children who had been implanted at a younger age, or who had been using their implant for a longer time. Together, these findings validate that professionals and parents should actively try to promote the emotion language skills of children with CI to enhance their ability to understand their own and other people’s (emotional) behavior, and to further raise their level of social skill.
The outcomes of this study should be interpreted with caution and represent a preliminary step toward understanding the relations between moral and social behavior. We included a specific subset of children with CI, who were implanted before age three, had hearing parents, and no apparent mental health disorders. Generalization to the whole population of children with CI, of which approximately one-third is reported to have an additional disability [
52,
53], is problematic. Furthermore, the correlational and cross-sectional nature of the study precludes drawing any conclusions as to causation. Another point that needs to be addressed concerns the type of data gathered for the purpose of this study. Although parents are a well-informed source regarding their young children’s behavior, their reports on their children’s social and externalizing behavior may have been biased. As discussed above, parents of children with CI may have been overly positive in judging their children’s capacities. Likewise, we cannot be certain that children’s responses to the experimental tasks designed to induce moral emotions were a genuine reflection of how they would behave in a real-life situation. Therefore, adopting a multi-informant approach in future studies is advisable and would resolve some of the limitations present in the current study. Clearly, more (longitudinal) research is necessary to confirm the current findings.
Moreover, the outcomes of this study give rise to new research questions. For example, regarding which factors contribute to children’s moral development. As moral development in children with CI turns out to be impaired it is even more important to gain an understanding of the underlying reasons for this impairment. This might provide us with valuable information on how moral development in these children could be promoted. Attention could be directed to children’s ToM understanding as a likely contributing factor. In addition, it might also be worthwhile to assess parent–child communication more directly instead of by means of children’s language skills (i.e., through observational measures). Communication entails more than just language. Future studies should also incorporate other important aspects of communication, such as nonverbal communication and characteristics of parent–child interactions (e.g., sensitivity, intersubjectivity). Moreover, future studies should address the potentially mediating role of parental attitudes and expectations on children’s moral and social development.
Despite its limitations, this study constitutes an important first step in shedding light on the moral development of young children with CI and with NH, and on its relationship to social functioning. An important finding of this study is that shame and guilt are highly adaptive emotions. They serve the purpose of guiding our social behavior [
1,
21], and seem to do so at a very young age already. NH children who displayed higher levels of shame/guilt in response to a transgression were more skilled in interacting with peers and adults.
On the other hand, there is a reason that shame and guilt are often associated with impaired social functioning and are even part of the criteria for several clinical disorders (cf. [
54]). Indeed, excessively high levels of shame or guilt may lead to distress and feelings of worthlessness, and hamper the individual’s daily functioning. For instance, proneness to shame and guilt is associated with symptoms of depression and (social) anxiety, and also with aggression [
9]. We can conclude that moral emotions are adaptive as long as they are appropriate to the situation and do not become too intense. Therefore, it is important that children learn to find a balance regarding the level of moral emotions they experience in any given situation.
The outcomes of this study support our idea that moral emotions develop in interaction with the social environment. Through their daily social experiences, children learn what acceptable emotion expressions are and with what kind of intensity they should be expressed [
55]. In this study, the children with CI represented a group of children with limited opportunities to interact with their social environment. This group indeed turned out to display moral emotions to a lesser extent than a comparison group of NH peers. The notion that moral emotions develop in interaction with the environment is not only important for clinicians who are dealing with children with hearing impairments, but also for clinicians dealing with other clinical groups. For example, children who exhibit conduct problems are also known to have a less well-developed moral sense [
5]. Investing in increasing the quality and quantity of social interactions these children have with people in their environment may result in an improved development of moral emotions and consequently, better social functioning.