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Randomized controlled trial of a book-sharing intervention in a deprived South African community: Effects on carer-infant interactions and their relation to infant cognitive and socioemotional outcome
Abstract
Background:
Consistent with evidence from high-income countries (HICs), we previously showed that, in an informal peri-urban settlement in a low-middle income country, training parents in book sharing with their infants benefitted infant language and attention (Vally, Murray, Tomlinson, & Cooper, ). Here, we investigated whether these benefits were explained by improvements in carer-infant interactions in both book-sharing and non-book-sharing contexts. We also explored whether infant socioemotional development benefitted from book sharing.
Methods:
We conducted a randomized controlled trial in Khayelitsha, South Africa. Carers of 14-16-month-old infants were randomized to 8 weeks' training in book sharing (n = 49) or a wait-list control group (n = 42). In addition to the cognitive measures reported previously, independent assessments were made at base line and follow-up of carer-infant interactions during book sharing and toy play. Assessments were also made, at follow-up only, of infant prosocial behaviour in a 'help task', and of infant imitation of doll characters' nonsocial actions and an interpersonal interaction. Eighty-two carer-infant pairs (90%) were assessed at follow-up. (Trial registration ISRCTN39953901).
Results:
Carers who received the training showed significant improvements in book-sharing interactions (sensitivity, elaborations, reciprocity), and, to a smaller extent, in toy-play interactions (sensitivity). Infants in the intervention group showed a significantly higher rate of prosocial behaviour, and tended to show more frequent imitation of the interpersonal interaction. Improvements in carer behaviour during book sharing, but not during toy play, mediated intervention effects on all infant cognitive outcomes, and tended to mediate intervention effects on infant interpersonal imitation.
Conclusions:
Training in book sharing, a simple, inexpensive intervention that has been shown to benefit infant cognitive development in a low-middle income country, also shows promise for improving infant socioemotional outcomes in this context. Benefits are mediated by improvements in carer-infant interactions, particularly in book-sharing contexts.
... Interventions that teach parents to use high-quality (dialogic) reading strategies are a widely recognized, evidence-based approach for preschool and school-aged children (for meta-analyses see Dowdall et al., 2020;Heidlage et al., 2020); yet programs that target children younger than 3 years of age have been limited. Importantly, recent work demonstrates the potential of brief, structured, parent-implemented book-sharing intervention for parents of infants and toddlers (Cooper et al., 2014;Murray et al., 2016;Salley et al., 2022;Vally et al., 2015). This parent-implemented approach is intended to equip parents to use evidence-based book-sharing skills during their everyday book reading interactions with infants/toddlers, with downstream effects for child language and preliteracy. ...
... Department of Education IES What Works Clearinghouse, 2007, 2015. Equally important, a growing body of research demonstrates the broader benefits of book sharing for enhancing child attention and cognitive outcomes (Brown et al., 1986;Cline & Edwards, 2016;Shahaeian et al., 2018;Vally et al., 2015;Whitehurst et al., 1994), social emotional outcomes (Murray et al., 2016;Yont et al., 2003), preliteracy and school readiness Theriot et al., 2003). ...
... Parents receive one-on-one coaching to use high-quality book-sharing skills with their infant or toddler. Notably, recent work has provided strong evidence for the benefit of this relatively simple, low intensity/low cost book-sharing training program for caregivers of very young children (Cooper et al., 2014;Murray et al., 2016;Salley et al., 2022;Vally et al., 2015). Ready, Set, Share A Book! was adapted from the work of Cooper and colleagues with families in South Africa (Cooper et al., 2014;Murray et al., 2016;Vally et al., 2015). ...
Shared book reading is a well-established intervention for promoting child language and early development. Although most shared reading interventions have included children 3 years of age and older, recent evidence demonstrates dialogic strategies can be adapted for parents of infants and toddlers. The current study examines gains in parent book-sharing skills during a brief, structured intervention. Parent–child dyads participated in an 8-week book-sharing intervention, Ready, Set, Share A Book!, designed for 12- to 36-month-old children. Parent book-sharing skills were assessed at baseline, weekly during the intervention, and at intervention end. Parents demonstrated significant gains in book-sharing skills from baseline to end of intervention, and results also indicate immediate skill gains in response to instruction. Furthermore, improvement in book-sharing skills at end of intervention was evident within the same book. The current study extends previous evidence for the benefit of a brief, low intensity, targeted intervention to enhance parent book-sharing interactions with infants and toddlers. Future directions for research and implications for practice are discussed.
... Besides the scarcity of reports on intervention effects beyond the language domain, there is also a need for a better understanding of the mechanisms responsible for intervention effects in studies on interactive book sharing. One previous RCT study for parents with 14-to 16-month-old children revealed that intervention gains in parental sensitivity and reciprocity mediated child language and attention gains [37]. However, this study is a notable exception and the reporting of parental competence and intervention fidelity is rare [26,38]. ...
... The specific intervention involved teaching different interactive scaffolding techniques for caregivers to apply during book sharing with their child. These scaffolding techniques were child-centered and highlighted the importance of following the child's lead, such as emphasizing stimuli to which child attends, using repetition, linking the book's content to the child's world, and helping the child to stay on task [37,39,40]. We collected data on child language, socio-cognition, and EF at baseline, post-intervention and at two follow-ups (6-and 12-months post-intervention). ...
... The program structure and content has been informed by the original Whitehurst model [39,40]. The program has previously been evaluated with children aged 14-18 months [37,39,40]. It was adapted for the targeted age-group by selecting age-appropriate picture-books and by focusing on teaching caregivers' book sharing techniques most relevant for when sharing books with infants. ...
Background
The quality of children’s early home learning environment has an influence on their cognitive development, preliteracy skills, and subsequent educational outcomes. Early intervention programs that promote positive parenting behaviors and child cognition have great potential to positively influence children’s school readiness and thereby support social equality. One often advocated parental practice for promoting child language and cognition is interactive book sharing.
Methods
We have conducted a randomized controlled trial to evaluate the effects of a parent-child interactive book sharing intervention on early child language, cognition, and parental behaviors. Participating caregivers and their 10-month-old child were randomized to an interactive book sharing intervention group ( n = 59) or to an active control group ( n = 56). The intervention was delivered by a facilitator to small groups of parent-child dyads on a weekly basis over 5 weeks. The primary outcomes were child language and socio-cognition; secondary outcomes were child executive function and parental scaffolding, sensitivity and reciprocity during book sharing, and problem-solving tasks. Data were collected at baseline, post-intervention, and at 6 and 12 months post-intervention.
Discussion
The Roadmap to Executive function and Language (REaL) trial aims to evaluate the impact of a brief early parenting intervention on key factors for child development, including child cognition and parental behaviors. If this intervention is beneficial for child outcomes, that would be of significance for the development of early interventions to promote child development.
Trial registration
The REaL trial is registered on the International Standard Randomized Controlled Trial Number database, registration number ISRCTN22319305. Retrospectively registered on 7 February 2020.
... Recent meta-analyses demonstrate this approach has a significant large effect on parents' book-sharing competence and language facilitation/contingent responding and medium to large effects on improving child communication/language (Bus et al., 1995;Dowdall et al., 2020;Heidlage et al., 2020). Beyond language, theory and accumulating evidence demonstrate high quality shared reading yields broader benefits for enhancing child cognitive and attention skills Vally et al., 2015;Whitehurst et al., 1994); social emotional outcomes (Murray et al., 2016;Yont et al., 2003); and preliteracy and school readiness (Bus et al., 1995;Theriot et al., 2003). In sum, there are many benefits of parent-implemented shared reading intervention for preschool/school age children and it is reasonable to expect the benefits may be similar for infants and toddlers, yet programs that target children younger than 3 years have been limited (Dowdall et al., 2020;Heidlage et al., 2020). ...
... Notably, recent work by Cooper and colleagues provides strong evidence for the benefit of a relatively simple (low intensity/low cost) structured book-sharing intervention with high-risk families in South Africa, who had high rates of illiteracy and no culture of book-sharing with young children (Cooper et al., 2014;Murray et al., 2016;Vally et al., 2015). In a randomized trial, parents of 14-to 16-month-old infants participated in eight small group sessions that provided instruction in specific book-sharing skills (child participation; pointing and naming; following child's attention; active questioning; active linking). ...
... The framework for Ready, Set, Share A Book! blends developmentally modified dialogic reading strategies for children 3-to 5-years-old with evidence-based language facilitation strategies for infants and toddlers (as illustrated in Table 1), and is adapted from the work of Cooper and colleagues in South Africa (Cooper et al., 2014;Murray et al., 2016;Vally et al., 2015). Dialogic reading is built on three over-arching principles (encourage child participation; provide feedback to child; adapt reading to child's linguistic ability; Whitehurst et al., 1988), which we developmentally adapt by breaking into smaller, age-appropriate steps. ...
Shared book reading is a well-established vehicle for promoting child language and early development. Yet, existing shared reading interventions have primarily included only children age 3 years and older and high quality dialogic strategies have been less systematically applied for infants and toddlers. To address this gap, we have developed a book-sharing intervention for parents of 12-to 36-month-olds. The current study evaluated acceptability/usability and preliminary efficacy of book-sharing intervention in a randomized controlled trial. Parent-child dyads were randomized to either 8-week book-sharing intervention ( n = 15) or wait list control ( n = 15). Parent book-sharing skills were assessed at baseline, post-intervention, and 2-month follow-up. Results indicated parents found the intervention highly acceptable and useful. Parents receiving intervention demonstrated significant improvement in book-sharing strategies compared to controls at post-intervention and 2-month follow-up. The current study provides evidence for the benefit of a brief, low intensity, targeted intervention to enhance parent book-sharing with infants and toddlers.
... However, other pathways remain empirically understudied. A small number of studies have assessed mother-child interactions (Aboud & Akhter, 2011;Brown et al., 2017;Murray et al., 2016;Obradović et al., 2016;Yousafzai et al., 2015) and child diet (Aboud et al., 2013;Frongillo et al., 2017;Luoto et al., 2021;Yousafzai et al., 2015) as potential means through which multi-input interventions might influence child outcomes. Although these studies build our emerging understanding on the importance of these mechanisms, most were not explicitly designed to study indirect effects or multi-input approaches. ...
... As the 'interpretation' step of the process is difficult to observe, most measures focus on the child's signals and maternal responses (Hentschel et al., 2021). The few studies in LMICs that have collected data on caregiver-child interactions tend to encompass both maternal responsive behaviours and supportive mother-child interactions, which are often assessed in a picture book-reading context (Aboud & Akhter, 2011;Betancourt et al., 2020;Brown et al., 2017;Knauer et al., 2020;Murray et al., 2016;Obradović et al., 2016;Scherer et al., 2019). Evidence from these studies suggests that improvements in mother-child interactions mediate the positive effects of parenting and responsive stimulation interventions on child growth and development (Aboud & Akhter, 2011;Brown et al., 2017;Eshel et al., 2006;Landry et al., 2006;Murray et al., 2016;Obradović et al., 2016). ...
... The few studies in LMICs that have collected data on caregiver-child interactions tend to encompass both maternal responsive behaviours and supportive mother-child interactions, which are often assessed in a picture book-reading context (Aboud & Akhter, 2011;Betancourt et al., 2020;Brown et al., 2017;Knauer et al., 2020;Murray et al., 2016;Obradović et al., 2016;Scherer et al., 2019). Evidence from these studies suggests that improvements in mother-child interactions mediate the positive effects of parenting and responsive stimulation interventions on child growth and development (Aboud & Akhter, 2011;Brown et al., 2017;Eshel et al., 2006;Landry et al., 2006;Murray et al., 2016;Obradović et al., 2016). In addition, limited evidence indicates that mother-child interactions mediate the effects of nutrition interventions in early life on child growth at 4 years of age . ...
This study examined whether child diet and mother–child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0–24 months living in rural Pakistan. Results showed that the intervention improved children's cognitive, language and motor development through child diet and mother–child interactions. Although the intervention did not improve child growth or socio-emotional development, we observed positive indirect effects on child growth via child diet and on socio-emotional development via both child diet and mother–child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother–child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms.
Key messages
• A responsive stimulation and nutrition intervention delivered to young children from birth to 24 months of age in rural Pakistan improved child cognitive, language, and motor development at 24 months, but not child growth or socio-emotional development.
• Child diet and mother–child interactions mediated intervention effects on child cognitive, language and motor development.
• Although we found no total intervention effects on child growth and socio-emotional development, we observed positive indirect effects on socio-emotional development through both child diet and mother–child interactions, and positive indirect effects on child growth through child diet.
• Leveraging both child diet and mother–child interactions as mechanisms may help enhance intervention effects on child outcomes.
... Initial evidence that dialogic reading training impacts some parenting outcomes has been reported. After an 8-week dialogic reading intervention, South African parents of 14-to 16month-old infants improved in sensitivity, elaborations, and reciprocity while reading, compared to a control group (Murray, et al., 2016). In a study conducted in China, parents of 3-to 12-yearold children (identified as having relational problems with their parents) reported an improved parent-child relationship (parenting satisfaction; awareness of how to communicate with their child) following a 12-week dialogic reading intervention (Ganotice et al., 2017). ...
... No change or condition differences in negativity were found. Our results are similar to improvements in parental sensitivity and reciprocity during reading found by Murray et al. (2016), but without the extensive direct training in dialogic reading used in that study. ...
... In comparison to results from other more labor-intensive parenting intervention studies (Bakermans-Kranenburg et al., 2003), our intervention produced relatively large effect sizes for growth in positive parent-child behaviors after reading the dialogic eBook for two weeks. Changing parenting behaviors matters because it has a substantial impact on children's language and literacy outcomes (Murray, et al., 2016;Landry & Smith, 2007;Roberts et al., 2005), which suggests that this kind of tool could have a wide-reaching impact on parent-child reading behaviors and other literacy-based activities. ...
American parents describe bonding with their child as a primary reason for engaging in shared picture book reading. One prominent reading intervention (dialogic reading) reliably increases language outcomes, but until recently, has not been evaluated for how well it promotes warm parent-child interactions. In this study, a digital application designed to promote parent-child conversation by modeling dialogic questioning also increased mutuality, positivity, and on-task behaviors. Three- and 4-year-old American children (n = 73) and their parents were randomly assigned to read 10 times at home either: (a) an eBook with a character who modeled dialogic questioning (experimental); (b) a version of the same eBook without modeling (control); or (c) to choose between versions for each reading (choice). An adaption of the PARCHISY coding scheme was used to evaluate parent, child, and dyadic behaviors during in-lab readings at the beginning and end of the 2-week home reading period. At the final visit, experimental group families showed significant growth in mutuality (i.e., responsiveness, reciprocity, and cooperation), on-task behaviors, and parent and child positivity, and displayed more of these behaviors than families not exposed to modeling. Some increases in mutuality and positivity also emerged in families in the choice condition, but fewer than in families who only read the eBook with modeling. Parents and children exhibited no significant changes in negativity in any condition. This study suggests that carefully designed digital technology has the potential to foster positive shared reading interactions between parents and young children. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Research from multiple countries has shown that shared reading positively impacts: frequency of reading in the home; receptive and expressive language development; acquisition of reading and writing skills; school preparation; and interaction and attachment between caregiver and child (Bus and van Ijzendoorn 1997;Childhood 2014;Fundalectura. Colombia, (n.d.); Murray et al. 2016;Park, 2008;Thakur et al. 2016;Toffol et al. 2011;Vally et al. 2015). Because of the positive impacts reading provides, there are many interventions and initiatives that work with local governments, schools, communities and families to provide free books and reading material to children in order to reach their fullest potential (Barnett et al. 2012;High et al. 1998;Murray et al. 2016;Needlman et al. 1991;Needlman and Silverstein 2004;Thakur et al. 2016;Vally et al. 2015) However, the majority of shared reading studies and interventions are concentrated in high-income countries like the United States, Europe, and Australia, while very few of these studies were conducted in LMICs, particularly in Latin America, and children under three years of age, demonstrating the need for additional research in this area. ...
... Colombia, (n.d.); Murray et al. 2016;Park, 2008;Thakur et al. 2016;Toffol et al. 2011;Vally et al. 2015). Because of the positive impacts reading provides, there are many interventions and initiatives that work with local governments, schools, communities and families to provide free books and reading material to children in order to reach their fullest potential (Barnett et al. 2012;High et al. 1998;Murray et al. 2016;Needlman et al. 1991;Needlman and Silverstein 2004;Thakur et al. 2016;Vally et al. 2015) However, the majority of shared reading studies and interventions are concentrated in high-income countries like the United States, Europe, and Australia, while very few of these studies were conducted in LMICs, particularly in Latin America, and children under three years of age, demonstrating the need for additional research in this area. ...
... The video observations of the mothers reading with their young children provided important information about the dynamics of the shared reading process. Our objective was to observe and understand how caregivers and children read together "naturally," without receiving advice or formal training on how to read to their children, as was provided to caregivers in other similar studies (Cooper et al. 2013;Murray et al. 2016;Needlman et al. 1991;Needlman and Silverstein 2004;Silverstein et al. 2002;Vally et al. 2015). Mothers and children both did well on enhancing attention to the text. ...
Peruvian children’s sub-optimal results on international and national assessments underscore the need for enhanced investments in early childhood development (ECD) such as shared reading between caregivers and young children. We conducted a qualitative study with 13 mothers of young children ages 11–25 months old that: used focus groups to explore caregivers’ perspectives and experiences related to their daily activities, including reading and other ECD activities, with their young children; and used focus groups and video recordings to describe caregivers’ experiences reading with these children during an at-home opportunity for shared reading. The mothers described daily schedules that focused on taking care of their daily chores and making sure that their young children were busy as they carried out those tasks. The mothers reported that they did not designate dedicated time to spend with their children, and children were often without adult attention for lengthy periods of time. We found that after the 1-month at-home opportunity for shared reading, there was a definite positive shift in both mothers’ engagement with their children and their perspectives on reading. The caregivers improved their daily interactions with their children and observed important changes in their children thanks to reading. This study is encouraging and justifies a follow up randomized controlled trial to implement and evaluate the LIBRE shared reading program in Lima, Peru.
... In these studies, caregivers were trained in the importance of reading to their child without a disability, on adopting good reading practices, and on the use of reading strategies such as dialogic reading to enhance learning. At the end of the training, caregivers were found to be more responsive to their children (Cooper, Vally, Cooper, Radford, Sharples, Tomlinson & Murray, 2014), improvement in the use of book reading behaviours, as well as observation of the behaviours in other activities (Murray, De Pascalis, Tomlinson, Vally, Dadomo, MacLachlan, Woodward & Cooper, 2016). The children, on the other hand, showed an increased understanding of words, and the use of new words (Vally, Murray, Tomlinson & Cooper, 2015). ...
... Hence, it is not known how different the interaction would potentially be between caregivers and their children with CCN from a South African context, as many factors have the potential to impact the quality of the interaction. Given that engagement during shared storybook reading provides such positive outcomes of language development, and impacts on future literacy skills for typically developing children from low resource backgrounds (Cooper et al., 2014;Murray et al., 2016;Vally et al., 2015;Whitehurst & Lonigan, 1998), it is hypothesised that an intervention strategy such as shared storybook reading can also be advantageous for children with CCN from a similar background. The findings of the study could further increase the body of literature on the interactions during shared story book in children with CCN, specifically in South Africa. ...
... Shared storybook reading has been recommended as a valuable tool for enhancing cognitive skills (Vally, 2012) increasing vocabulary (Cooper at al., 2014), stimulating preliteracy skills (Justice & Ezell, 2002), and improving caregiver-child interaction behaviours (Murray et al., 2016). Its importance for children, particularly those from disadvantaged backgrounds, has also been emphasised (Vally et al., 2015). ...
Quality early home literacy experiences, specifically young children’s shared storybook reading experiences, have been identified as critical for establishing the foundations of reading and writing skills. Despite this, literature reports that children with complex communication needs (CCN) have limited exposure to literacy material. There is, however, a paucity of research regarding the home literacy experiences of children with disabilities specifically those with CCN and in developing countries contexts. This study aims to analyse the behaviours of both primary caregivers and their children with CCN during shared storybook reading using a descriptive, observational design. Twelve primary caregivers and their children participated in the study. The 12 participating dyads were video recorded during shared storybook reading activity. Their interactions were analysed using a communicative behaviour checklist coding communicative behaviour of both dyad participants during the shared storybook reading. Results were similar to previous studies conducted on children with CCN from developed countries. The caregivers showed higher rates of interaction as compared to their children, whilst they focused on labelling the pictures rather than reading the story verbatim. Although patterns of interaction varied across the caregivers, they seldom asked complex questions or related the story to the child’s utterances. The children, on the other hand, seldom asked questions or commented on the stories. Their interaction patterns could have been improved, should the children have had access to communication devices and caregivers guided on using strategies to facilitate learning during these shared literacy activities.
... The trial is evaluating two low-cost, manualised parent-training programmes. These are: (1) a 'dialogic book-sharing programme' (DBS) that aims to improve child cognition and social understanding [31][32][33], and (2) ' ACT: Raising Safe Kids program' (ACT), which aims to reduce harsh parenting and child maltreatment [34]. The two interventions therefore target both sides of the individual and parenting risks highlighted above, putatively linking adverse environments to persistent child aggression. ...
... The training is delivered to families at weekly meetings over 8 weeks to small groups of parents in 90-minute sessions. Training in DBS is readily culturally transportable, and trials in both HICs [44] and LMICs [32,33] have shown that it has medium-large effects on child language outcomes. Indeed, a trial in South Africa found large positive benefits to both child language and attention, and increased parental sensitivity (at least d = 0.78) [31][32][33], and a recent trial of DBS in Brazil similarly found medium-sized benefits to child cognition [45]. ...
... Training in DBS is readily culturally transportable, and trials in both HICs [44] and LMICs [32,33] have shown that it has medium-large effects on child language outcomes. Indeed, a trial in South Africa found large positive benefits to both child language and attention, and increased parental sensitivity (at least d = 0.78) [31][32][33], and a recent trial of DBS in Brazil similarly found medium-sized benefits to child cognition [45]. While these variables are known to be key protective factors against child aggression, no LMIC study has yet determined whether changing these cognitive factors is associated with reduced later child aggression. ...
Background
Children in many low- and middle-income countries (LMICs) are at high risk for exposure to violence and later violent behaviour. The World Health Organization has declared an urgent need for the evaluation and implementation of low-cost parenting interventions in LMICs to prevent violence. Two areas of significant early risk are harsh parenting and poor child cognitive and socio-emotional development. Parenting interventions suitable for LMIC contexts have been developed targeting these risk factors and have been shown to have promising effects. However, their impact on child aggression, a key precursor of violence, has yet to be determined. The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) has been designed to address this issue.
Methods
We are conducting a randomised controlled trial to evaluate two early parenting interventions for mothers of children aged between 30 and 42 months in a Brazilian city. The first of these, dialogic book-sharing (DBS), aims to promote child cognitive and socio-emotional development; and the second, the ACT Raising Safe Kids Program (ACT), is designed to reduce harsh parenting. These interventions are being compared with a control group receiving neither intervention. Three hundred and sixty-nine families in a birth cohort are being randomly allocated to one of the three groups (DBS, ACT, Control). Facilitators deliver the interventions to groups of five to 10 mothers at weekly sessions for 8 weeks in DBS and 9 weeks in ACT. Independent assessments of parenting and child development are being made before the interventions, shortly afterwards, and at follow-up 6 months later. The primary outcome is child aggression, and the two main secondary outcomes are: (1) child cognitive and socio-emotional development and (2) harsh parenting. Longer-term outcomes will be investigated as the birth cohort is followed into late childhood, adolescence, and adulthood.
Discussion
The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) aims to evaluate the impact of two early parenting interventions on child aggression and several other key risk factors for the development of violence, including aspects of parenting and child cognition and socio-emotional functioning. The study is being carried out in a LMIC context where violence constitutes a major social and health burden. Since the two interventions are brief and, with modest levels of training, readily deliverable in LMIC settings, a demonstration that they benefit parenting and reduce risk factors for violence would be of major significance.
Trial registration
Brazilian Ministry of Health Register of Clinical Trials, ID: RBR-2kwfsk. Registered on 6 June 2018.
Electronic supplementary material
The online version of this article (10.1186/s13063-019-3356-x) contains supplementary material, which is available to authorized users.
... In studies of community samples, the extent to which parents read to their children has been found to be a strong predictor of child language and educational outcomes (Fletcher & Reese, 2005;Gottfried et al., 2015). A causal role of good book-sharing practices is supported by evidence for substantial gains in child development (language, attention) arising from parental book-sharing training (Dowdall et al., 2020), mediated by improvements in parental sensitivity and in reciprocal parent-child engagement (e.g., Cooper et al., 2014;Murray et al., 2016). Of particular relevance to the current work, one study in a low-income, rural Pakistani community linked child intelligence to an assessment of parental scaffolding during book-sharing (Obradovic et al., 2016). ...
... Evidence against this possibility comes from our finding that the parental scaffolding score was independent of child age. Additional evidence that scaffolding is causal comes from previous trials of book-sharing training, which implicitly promote parental scaffolding, and have consistently shown benefit to child cognition (Dowdall et al., 2020), including evidence that such benefit is mediated by improvements in book-sharing practice (Murray et al., 2016). These previous findings contrast with results of the current intervention, which showed significant gains just for vocabulary, and only in a per protocol analysis (Murray et al., 2023). ...
While much variance in general intelligence or g is genetic, a substantial environmental component suggests a possible role for parent-child interaction. In particular, previous evidence suggests the importance of parental scaffolding, or provision of cognitive structure to shape child behaviour. A role for scaffolding is consistent with the proposal that, in adult cognition, a critical aspect of g is decomposition of complex problems into a structure of simpler parts. Building on previous work, we recruited 162 parents attending Children's Centres with a child aged 2-4 years, and examined parental scaffolding during a book-sharing activity. Scaffolding was measured as the first principal component of a variety of parental behaviours, including sensitivity, focusing attention, extending comprehension, and promoting child participation. Child g was measured as the first principal component of a broad cognitive battery, including language, attention, working memory, and executive function. Importantly, we assessed contributions of the parent's own intelligence, education, and family income. Though these variables were all associated with both child g and parental scaffolding, scaffolding remained predictive of child g even once the influence of these variables was removed. In contrast to the correlation with cognitive proficiency, scaffolding did not predict child pro-social behaviour. We suggest that parental scaffolding supports the child's development of a broad skill of attentional structuring, promoting the across-the-board cognitive proficiency that is reflected in g.
... Our findings suggest that more frequent shared reading in early childhood has the potential to influence social-emotional health, consistent with previous evidence associating more frequent reading with increased social-emotional competence. 18,42,55 A possible mechanism connecting shared reading and social-emotional health is social-emotional reciprocity and emotional coregulation between caregiver and child. 56,57 Shared reading invokes caregiver-child joint attention, 58 a pillar of social, cognitive, language, and literacy development. ...
... 17,68 Our findings suggest that ROR, VIP, and other pediatric programs that support book reading may have impacts on child socialemotional development. Although the ROR evidence base is currently centered on cognitive abilities and reading attitudes, [32][33][34]36 extensive evidence linking social-emotional benefits with shared reading, 16,18,42,55,67 bolstered by findings here, could motivate more explicit integration of these two components into the program and future research. ...
BACKGROUND AND OBJECTIVES:
The American Academy of Pediatrics recommends literacy promotion as well as routine developmental surveillance during well-child visits to improve academic, relational, and health outcomes. In this study, we examined the possible association between shared reading and social-emotional problems among young children.
METHODS:
We conducted a retrospective review of longitudinal records for children aged 30 to 66 months presenting for visits to an academic pediatric primary care center between July 1, 2013, and February 1, 2019. The outcome was evidence of social-emotional problems, defined by an Ages and Stages: Social Emotional Questionnaire (ASQ:SE) score above the established cutoff. The predictor was caregiver-reported frequency of shared reading (most = 5–7 days per week, some = 2–4 days per week, rarely = 0–1 days per week) at a previous visit. Generalized linear models with generalized estimating equations were used to assess the association between the longitudinal outcome and predictor, adjusting for child demographics and needs reported on routine social history questionnaires.
RESULTS:
Analyses included 5693 children who completed at least 1 ASQ:SE (total of 7302 assessments) and had shared reading frequency documented before each ASQ:SE assessment. Children were predominantly Black (75%) and publicly insured (80%). Sixteen percent of ASQ:SE scores were suggestive of social-emotional concerns; 6% of caregivers reported sharing reading rarely. Children with rare shared reading had a higher risk of an ASQ:SE above cutoff compared with those with shared reading on most days (adjusted risk ratio, 1.62; 95% confidence interval, 1.35–1.92).
CONCLUSIONS:
Less-frequent caregiver-reported shared reading was associated with higher risk of social-emotional problems in young children presenting for primary care. This highlights potential relational and social-emotional benefits of shared reading.
... The intervention was a group-based dialogic booksharing program based on previous research from South Africa Murray et al., 2016;Vally et al., 2015). It consisted of eight 60-to 90-min sessions run weekly over consecutive weeks. ...
... Child prosocial behavior. This was assessed directly in a prosocial "helping" task where a scenario was created that gave the child the opportunity to help the assessor locate her lost pen (Buttelmann, Carpenter, & Tomasello, 2009;Murray et al., 2016). "Helping behavior" was scored as a binary variable if the child picked up the lost pen and returned it to the assessor, or pointed to the lost pen, or verbally indicated the pen's whereabouts to the assessor. ...
This study evaluated the impact of a parenting intervention on children’s cognitive and socioemotional development in a group of caregivers and their 21‐to‐28‐month‐old children in a low‐income South African township. A randomized controlled trial compared an experimental group (n = 70) receiving training in dialogic book‐sharing (8 weekly group sessions) with a wait‐list control group (n = 70). They were assessed before the intervention, immediately following it, and at a six month follow‐up. The intervention had positive effects on child language and attention, but not behavior problems, prosocial behavior, or theory of mind. Intervention caregivers were less verbally and psychologically harsh, showed more sensitivity and reciprocity and more complex cognitive talk. This program benefitted parenting and child development and holds promise for low‐income contexts.
... First, many programs developed in HIC that support parent-child book reading in the context of poverty and low parental education address barriers to parent-child reading that are faced by low-income parents in HIC and LMIC alike, such as limited access to children's books, low literacy or comfort with reading, stress/exhaustion, and limited knowledge about why and how to read with young children. As in HIC, studies in LMIC, including Brazil (Eickmann et al., 2003;Weisleder et al., 2018), have shown benefits of parent-child shared reading programs on language and cognitive outcomes in early childhood (Dowdall et al., 2019;Jeong, Pitchik, & Yousafzai, 2018;Kim, Lee, & Zuilkowski, 2019;Murray et al., 2016;Roopnarine & Dede Yildirim, 2018;Vally, Murray, Tomlinson, & Cooper, 2015;Worku et al., 2018). ...
... its extensions (Opel, Ameer, & Aboud, 2009), others have used this setting to provide parent education regarding these activities (e.g., the Turkish Early Enrichment Project -TEEP) (Kagitcibasi, Sunar, Bekman, Baydar, & Cemalcilar, 2009 Lorenzana, Klass, & Needlman, 2019) or in other health care settings (Nahar et al., 2012). Other programs have utilized varying degrees of home visiting and parent groups in community centers (for example, Knauer et al., 2019;Murray et al., 2016;Vally et al., 2015). ...
Children in low-and middle-income countries (LMIC) are at risk for adverse early development and school readiness outcomes; low parent literacy is common and an important contributing factor. While prevention programs have sought to improve child outcomes by promoting positive parenting practices such as reading aloud, there has been limited evidence of whether such programs have impacts for parents with low literacy in LMIC. This study investigated: 1) whether parent literacy is associated with parent-child reading interactions, the overall cognitive home environment, and child language and cognitive outcomes; and 2) whether impacts of a toddler/preschool reading aloud program differ depending on parent literacy among low-income families in northern Brazil. We performed a secondary analysis of a single-blind cluster randomized controlled trial (RCT) of a parenting intervention (Universidade do Bebê [UBB]) implemented in educational childcare centers in Boa Vista, Brazil. UBB consisted of: 1) a lending library in which children's books were borrowed weekly; and 2) monthly parent workshops focused on reading aloud. Control families received usual care without the reading aloud program. Five hundred and six mother-infant dyads (279 intervention; 287 control) were enrolled at mean (SD) child age 37.4 (6.5) months. Parents and children were evaluated at baseline/enrollment and approximately 6 to 9 months later. Measures: 1) Predictor/moderator: parent literacy; 2) Parent outcomes: parent-child interaction during shared storybook reading; cognitive home environment; 3) Child outcomes: expressive vocabulary; IQ; working memory and short-term phonological memory. Analyses accounted for baseline performance, sociodemographics, and clustering within centers and sites. Parent literacy was positively associated with parent-child verbal/reading interactions and child developmental outcomes, supporting our first hypothesis, that low parent literacy would be associated with lower quantity and quality of parent-child reading and lower scores on assessments of child development. UBB had positive impacts on parent-child interaction, cognitive stimulation, IQ, and receptive vocabulary for both high and low literacy parents, contrary to our second hypothesis, that low parent literacy would be associated with reductions in impacts of the reading aloud intervention. The comparable impacts of a reading aloud program on parent-child verbal/reading interactions and child cognitive outcomes regardless of parent literacy level suggest that preventive interventions in LMIC should consider promotion of shared reading even for low-literacy families.
... Meta-analyses and systematic reviews have confirmed the effectiveness of parenting programs on improving caregiver-child interaction and child development (Britto et al., 2017;Jeong et al., 2018;Rayce et al., 2017). Specifically, previous studies revealed a positive effect of short duration (approximately 8-12 weeks) parenting programs on child development outcomes (Kochanska et al., 2013;McGillion et al., 2017;Murray et al., 2016;Pontoppidan et al., 2016;Vally et al., 2015). ...
Background
Studies assessing the effects of parenting programs have focused on interventions delivered through face-to-face modalities. There is a need for research to evaluate the effects of online parenting programs on child development, such as the BEM Program (‘Play Teaches Change’ in English), an online play-based parenting program that teaches caregivers on how to introduce playful interactions into their daily household chores.
Objective
To assess the effects of the BEM Program on child development and the quality of caregiver-child interaction.
Method
A two-arm randomized controlled trial was conducted in a socioeconomically disadvantaged district of São Paulo city in Brazil. 129 children aged 12–23 months and their caregiver were randomly assigned to receive either the BEM Program for 8 weeks (intervention, n = 66) or standard child care (control, n = 63). Data were collected at baseline and endline of the intervention through home visits and online interviews. An intention-to-treat analysis was conducted.
Results
The intervention showed positive effects on child development, by improving language development (Cohen’s d = 0.20, 95%CI 0.08–0.47) and reduced intrusiveness (Cohen’s d = 0.35, 95%CI 0.06–0.65) of caregiver-child interaction. No significant differences were observed in caregiver’s repertoire and engagement in age-appropriate play activities with the child while doing the household chores, parenting sense of competence and perceived stress.
Conclusions
Despite the small size and low adherence to the program, such promising results advance evidences for fully remote parenting programs and their effects on child development.
... Warm and sensitive parental interactions during the reading sessions are regarded as an important aspect to explain the potential benefit of parent-infant reading sessions. A randomized controlled trial demonstrated that after receiving an 8-week shared reading intervention, parents showed increased sensitivity, elaboration, and reciprocity during shared reading interactions with their infants compared with the control group (20). ...
The benefits of book-reading interventions on language development in full-term infants have been well investigated. Because children born preterm face a greater risk of cognitive, language and emotional impairments, this narrative review examines the theoretical evidence, empirical findings, and practical challenges for introducing such intervention to this population. The effect of shared book interventions on typically developing infants is mediated by three components: a linguistic aspect (i.e., exposure to enriched linguistic input), an interactive aspect (i.e., eliciting more synchronous and contingent communication), and a parental aspect (i.e., reducing parental stress and increasing sense of control). Parental shared book reading in a neonatal intensive care unit (NICU) was found to be feasible and well accepted. It provides concrete support for positive parenting in a highly stressful context. Preliminary evidence supports a positive effect of shared reading sessions in physiological parameters of preterm infants in NICU. One study showed that parental shared book reading in an NICU is associated with lower decline in language development during the first 24 months compared to a historical control group. Findings from a community-based birth cohort confirm the positive effect of this intervention on cognitive development with a 2-year-follow up. More structured clinical trials are now needed to confirm these preliminary findings. Questions remain about possible moderators of these interventions, in particular cultural features.
... In the book-sharing programme, maternal and infant outcomes were assessed, including infant cognitive development. 57 The study reported that mothers displayed greater sensitivity after the programme and in one study younger children. The programmes varied in duration from 10 to 14 weekly sessions. ...
The report presents findings from an evidence review of violence prevention interventions implemented in South Africa, and draws on an evidence map published by the Forum in 2019, and additional research. The review summarises the available evidence, with an assessment of quality, and perhaps most importantly, highlights the contextual factors which impact success. It identifies and distils principles, approaches and activities that hold promise for effectively reducing violence experienced by women and children in South Africa.
... Not a standardized tool [49] Caregiver-infant interactions are observed and videotaped during two-5-minute periods-book sharing and toy play. Caregivers are given a picture book and are asked to share it with their infant. ...
Nurturing care encompasses five components that are crucial for supporting early childhood development: good health, adequate nutrition, opportunities for early learning, responsive caregiving, and safety and security. While there has been increasing attention in global public health towards designing and delivering programs, services, and policies to promote nurturing care, measurement has focused more on the components of health and nutrition, with less attention to early learning, responsive caregiving, and safety and security. We conducted a scoping review to identify articles that measured at least one nurturing care outcome in a sample of caregivers and/or children under-5 years of age in low- and middle-income countries (LMICs). We systematically searched five electronic bibliographic databases for peer-reviewed articles published from database inception until November 30, 2020. We first classified outcomes to their respective nurturing care component, and then applied an inductive approach to organize key constructs within each nurturing care component and the specific measures and indicators used across studies. We identified 239 total articles representing more than 50 LMICs for inclusion in the review. The majority of included studies reported a measure of nutrition (N = 166), early learning (N = 140), and health (N = 102), followed by responsive caregiving (N = 78) and lastly safety and security (N = 45). For each nurturing care component, we uncovered multiple constructs relevant to children under-5: nutrition (e.g., anthropometry, complementary feeding), early learning (e.g., stimulation practices, early childhood education), health (e.g., birth outcomes, morbidity), responsive caregiving (e.g., parental responsivity, parent-child interactions), and safety and security (e.g., discipline, inadequate supervision). Particularly for outcomes of early learning and responsive caregiving, there was greater variability with regards to the measures used, reported indicators, and analytic construction of variables than the other three nurturing care components. This study provides a comprehensive review of the current state of measurement of nurturing care. Additional research is needed in order to establish the most optimal measures and indicators for assessing nurturing care, especially for early learning and responsive caregiving.
... 4,5 Shared reading is a rich and nurturing source of such verbal stimulation [6][7][8][9][10] and is defined as the interactive, enjoyable experience where a caregiver, most often a parent, shares a book with a child. 11 Shared reading exposes children to a range of word sounds and vocabulary and fuels verbal and social-emotional interactivity. 4 Together, these enhance oral language skills, 12 attitudes toward reading, 13 caregiver-child relationships, 14 and early brain development. 15 Children from socially and economically disadvantaged households face outsized risks of language delays and reading difficulties. ...
Parent-child “shared” reading can be a rich source of language exposure. Clinic-based programs, notably Reach Out and Read (ROR), are intended to enhance this. However, ROR has been traditionally introduced at 6 months and only recently expanded to younger ages. This study explored efficacy of an intervention delivered during pediatric well visits promoting shared reading prior to 6 months old, in terms of home reading attitudes and routines. The intervention group received children’s books and anticipatory guidance about benefits of shared reading, whereas the control group received general age-related anticipatory guidance. Surveys were administered at the child’s newborn (pre-intervention) and 6-month (post-intervention) well visits. Significant findings at 6 months included more frequent shared reading ( P = .03), greater comfort reading at this age ( P = .01), and greater importance attributed to shared reading ( P = .04) in the intervention group relative to controls. These support the expansion of early literacy interventions such as ROR into early infancy.
... There is also evidence for a benefit of training parents in DBS on infant focal attention (Cooper et al., 2014;Vally et al., 2015), an important component of general cognitive processing (Smith, 2013) and a key predictor of scholastic functioning (McClelland et al., 2013). Importantly, intervention studies have shown that it is by virtue of the improvements in parentinfant book-sharing interactions effected by training that the benefits to child language and attention are brought about (Murray et al., 2016). ...
Parental reading to young children is well-established as being positively associated with child cognitive development, particularly their language development. Research indicates that a particular, “intersubjective,” form of using books with children, “Dialogic Book-sharing” (DBS), is especially beneficial to infants and pre-school aged children, particularly when using picture books. The work on DBS to date has paid little attention to the theoretical and empirical underpinnings of the approach. Here, we address the question of what processes taking place during DBS confer benefits to child development, and why these processes are beneficial. In a novel integration of evidence, ranging from non-human primate communication through iconic gestures and pointing, archaeological data on Pre-hominid and early human art, to experimental and naturalistic studies of infant attention, cognitive processing, and language, we argue that DBS entails core characteristics that make it a privileged intersubjective space for the promotion of child cognitive and language development. This analysis, together with the findings of DBS intervention studies, provides a powerful intellectual basis for the wide-scale promotion of DBS, especially in disadvantaged populations.
... In particular, there is a notable lack of randomized controlled evaluations of shared reading programs that follow participating parents and children after school starts (Dowdall et al., 2020). As evidence suggests that the effectiveness of shared reading programs is mediated by whether and how parents use the strategies taught, it is important to evaluate whether the skills taught to parents during preschool are still used after this transition (Murray et al., 2016). Considering the potential impact of encouraging interactive shared reading on family involvement (e.g., DeLoatche et al., 2015), and the call for randomized control trials to show ways in which family involvement can be encouraged (e.g., Garbacz et al., 2017), effects of parent programs on involvement after the transition to school and beginning literacy instruction should be evaluated. ...
Parent–child interactive shared reading can benefit young children’s language and emergent literacy skills; however, studies of programs to enhance shared reading often do not evaluate lasting effects after the transition to primary school. In this randomized control study, 69 parents of 3.5–4.5-year-old children participated in one of three conditions for an evaluation of the 6-week Tender Shoots program: Rich Reading and Reminiscing (RRR), Strengthening Sound Sensitivity (SSS), or Activity-Based Control (ABC). Parents in both Tender Shoots conditions, SSS and RRR, were taught to read interactively with their children and were provided with books to support implementation. RRR targeted meaning-related talk likely to enhance vocabulary and comprehension, whereas SSS targeted sound-related talk to enhance phonological awareness. Children in ABC were provided with resources and materials for developmentally appropriate activities. Fifty-three dyads (77%) were followed after children started primary school and formal literacy instruction. Comparisons of shared reading interactions at follow-up indicated that parents and children in the RRR and SSS groups still used more condition-specific targeted talk than those in other groups. Most parents in shared reading groups reported that they continued to use project activities after children had started school, although parents in RRR reported more frequent use of program activities than the active control, ABC. Moreover, parents in RRR sometimes reported higher levels of some broad involvement dimensions. These findings suggest that shared reading programs as delivered here can have long-lasting effects on extratextual talk during shared reading and may enhance aspects of parents’ involvement with children’s education.
... Few programs have targeted parents (Theriot et al., 2003), and of these, even fewer have been rigorously evaluated. Recently, a dialogic book-sharing program in South Africa that trained mothers on ways of engaging their 14-to 18month-old children in book-sharing found greater sensitivity and content elaboration among intervention mothers which, in turn, increased attention and vocabulary among children (Murray et al., 2016;Vally, Murray, Tomlinson, & Cooper, 2015). ...
... Though the studies included in this meta-analysis were about general shared book reading, the findings likely apply to the dialogic book-reading context as well, as caregivers' competence during shared book reading generally is about their ability to prompt children to talk, evaluate children's responses and elaborate on children's utterances: all are techniques emphasized in dialogic reading. A randomized controlled trial by Murray et al. (2016) carried out in South Africa showed positive connections between caregivers' sensitivity during general shared book reading and children's receptive language, in addition to the positive relations between parent-child reciprocity and children's expressive language, receptive language and focal attention. Thus, we assume that dialogic reading influences children's language skills by boosting parents' book-sharing competence, and in turn improves interactive quality during book sharing, ultimately facilitating children's language development. ...
Shared book reading is often used as an educational tool to promote the development of children's early language and literacy skills. This study aimed to describe and compare the linguistic features of parent-child interactions during two shared book-reading sessions among 45 children (aged 4-6 years old) and their mothers. The dyads were divided into 2 groups: the intervention group (n = 25), and the control group (n = 20). In the first reading session, mothers read with their children the way they were most comfortable with and as they would usually do at home. Before the second reading session, we provided a 30-minute intervention on strategies of dialogic reading to the intervention group. Both readings were video-recorded. Mothers completed home literacy environment questionnaires. The results showed that even for mothers who were initially very skillful at reading with their children, this immediate intervention promoted a number of aspects of interactivity between mothers and their children, namely, the number of utterances, completion, open-ended, closed and labeling questions, and type token ratio by mothers, the number of utterances and initiated talk by children, and extra-textual talk and total number of turns by both mother and child. Mothers who received the intervention demonstrated more flexibility and more discursive styles, even though the intervention was short, and the time for them to practice was minimal.
... Durante il gioco con oggetti, invece, l' interazione tra genitore e figlio presentava solo un leggero miglioramento nell' ambito della sensitività. I miglioramenti nel comportamento prosociale dei bambini così come negli esiti cognitivi erano mediati dall' interazione che si svolgeva durante la lettura ad alta voce e non dall' interazione durante il gioco con oggetti [16]. Ma le continue interazioni offerte dalla lettura condivisa, che sostengono la continua regolazione intersoggettiva della diade e che portano a sensibili miglioramenti nel comportamento prosociale del bambino agiscono anche sul genitore che riduce l' utilizzo di uno stile duro e punitivo [17]. ...
Effects of reading aloud beyond language: self-regulation as a mediator Reading aloud is a family activity which, if carried out frequently in the first years of life, supports the child’s linguistic and alphabetic development. Being a social process, shared reading in the family improves the child’s psychosocial development and parenting skills. It has recently been shown that cognitive and linguistic stimulation are associated with an improvement in self-regulation skills. This article describes the most recent findings on the importance of conversation during shared reading and the relationship of this activity with self-regulation and parenting.
... Second, the results show that young children's language and literacy abilities develop more rapidly than we realised. The majority of past studies on the first years of life thoroughly described infants' organising speech sounds into categories (Kuhl et al. 1992), longer-term interventions in infancy (Niklas, Cohrssen, and Tayler 2016;O'Farrelly et al. 2018), and reading frequency (Murray et al. 2016). When it is thought that the age of onset of reading is related to literacy and language outcomes (Zauche et al. 2017) these findings deserve further attention. ...
This study examined implementation of a newly developed shared book reading intervention program, to boost infants’ early skills and provide a solid foundation for continued language learning. A randomised control study was conducted to elevate the effects of Shared Book Reading Intervention with 20 parents (n = 10 experiment, n = 10 control) and their infants/toddlers aged 8–16 months. The program including 12-week parental training, had a powerful alterable influence on infant’s language comprehension, word production, and literacy skills. Additionally, findings provide further evidence that the shared book intervention instructional strategies helped parents learn language domain content. When taken together, the results suggest that parents have the potential to shape their infants’ development in the short-term by initiating reading skill changes in their home environment.
... Given that the primary focus of parenting interventions is to support parents and improve the caregiving environment, it is critical to measure parenting as a way of understanding how interventions impact ECD [21,52]. More mediation analyses are needed to empirically substantiate program theories of change and identify the key caregiving mechanisms by which parenting programs lead to improved ECD outcomes [36,[53][54][55]. ...
Background
Parents are the primary caregivers of young children. Responsive parent–child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes.
Methods and findings
We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent–child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = −0.13, 95% CI: −0.18 to −0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent–child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = −0.07, 95% CI: −0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent–child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies.
Conclusions
Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.
... Grazie alle nuove tecnologie di immagine, sono meglio compresi i meccanismi attraverso i quali la lettura condivisa iniziata in età precoce produce i suoi effetti sulle reti neurali che sostengono le diverse funzioni cognitive [8]: effetti benefici sono stati dimostrati sull'attenzione sostenuta [9], e su altre funzioni esecutive. Molto importanti sono i risultati di studi che hanno dimostrato i benefici sull'interazione madre-bambino, sul senso di autoefficacia genitoriale e sullo stato emotivo del bambino [10][11][12][13]. Gli studi confermano inoltre che sia i benefici sul piano cognitivo che quelli sul piano socio-relazionale sono maggiori in bambini e genitori di stato socio-economico e culturale basso, venendo quindi a svolgere un effetto di contrasto all'insorgere precoce delle diseguaglianze. ...
Available data regarding the implementation and main outcomes of the Nati per Leggere program in Italy over twenty years are described, based on the findings of both surveys conducted by the program and studies made by a variety of institutions. The extension of the program in all regions has strongly increased, although still with a more favourable trend in the North and Centre of the country with respect to the South, and has paralleled an increase in the proportion of children who are exposed to shared reading early in their families at least four times per week, and a dramatic decrease of those who are not exposed from 46 to 10.9%. The gap in exposure to shared reading in children from low educated mothers is also substantially smaller.
... Reading interventions targeting younger children (from infancy to primary school ages) also show positive outcomes on socio-emotional development. For instance, a reading intervention in South African children from low socioeconomic status (SES) backgrounds aged between 14 and 16 months, showed improvements in prosocial behavior compared to a control group, although these measures were taken only at follow up and thus the groups may have differed prior to the intervention (Murray et al., 2016). A classroom-based reading intervention in primary school children in Germany showed improvements in emotional vocabulary and emotional knowledge in participating children compared to controls (Kumschick et al., 2014). ...
Early adversity and trauma can have profound effects on children’s affective development and mental health outcomes. Interventions that improve mental health and socioemotional development are essential to mitigate these effects. We conducted a pilot study examining whether a reading-based program ( We Love Reading ) improves emotion recognition and mental health through socialization in Syrian refugee ( n = 49) and Jordanian non-refugee children ( n = 45) aged 7–12 years old ( M = 8.9, 57% girls) living in Jordan. To measure emotion recognition, children classified the expression in faces morphed between two emotions (happy–sad and fear–anger), while mental health was assessed using survey measures of optimism, depression, anxiety, distress, and insecurity. Prior to the intervention, both groups of children were significantly biased to interpret ambiguous facial expressions as sad, while there was no clear bias on the fear–anger spectrum. Following the intervention, we found changes in Syrian refugee children’s bias in emotion recognition away from sad facial expressions, although this returned to pre-intervention levels 2 months after the end of the program. This shift in the bias away from sad facial expressions was not associated with changes in self-reported mental health symptoms. These results suggest a potential positive role of the reading intervention on affective development, but further research is required to determine the longer-term impacts of the program.
... DR and HIPPY (Home Instruction Program for Preschool Youngsters) were both evaluated in four studies (DR: Chow & McBride-Chang, 2003;Lonigan & Whitehurst, 1998;Reese et al., 2010;HIPPY: Brown & Lee, 2017;Kağıtçıbașı et al., 2001;Necoechea, 2007;Van Tuijl et al., 2001). In four other studies, effects of an adapted version of DR were examined (Aram et al., 2013;Cooper et al., 2014;Ergül et al., 2016;Murray et al., 2016). Three programs were evaluated twice: PCHP (Parent-Child Home Program; Allen et al., 2007;Manz et al., 2016), PRIMER (PRoducing Infant/Mother Ethnic Readers; Cronan et al., 1996;Cronan et al., 1999), and MEES (Migrant Education Even Start; St. Clair & Jackson, 2006;St. ...
The aim of this meta-analysis was to investigate effects of family literacy programs on the emergent literacy skills of children from low socioeconomic status families (0–6) and to establish which program, sample, study, and measurement characteristics moderate program effects. Outcomes of 48 (quasi-)experimental studies covering 42 different programs revealed a medium average effect of Cohen’s d = 0.50 on immediate posttests and a marginal average effect of Cohen’s d = 0.16 on follow-up measures. Together, effects of different moderator variables indicate that children benefit from targeted programs that focus on a limited set of activities and skills and that are restricted to one (training) context. Additionally, we found larger effects in experimental studies and when researcher-developed tests were used. Our outcomes not only provide guidelines for program developers but also call for more longitudinal research that examines how positive short-term changes as a consequence of program participation can be sustained over time.
... Few programs have targeted parents (Theriot et al., 2003), and of these, even fewer have been rigorously evaluated. Recently, a dialogic book-sharing program in South Africa that trained mothers on ways of engaging their 14-to 18-month-old children in book-sharing found greater sensitivity and content elaboration among intervention mothers which, in turn, increased attention and vocabulary among children (Vally, Murray, Tomlinson, & Cooper, 2015;Murray et al., 2016). ...
... Most studies on shared reading interventions have focused on evaluating researcher-designed shared reading interventions, which means that 'there is decidedly little evidence regarding the nature, quality, and impact of real-world professional development offerings and the value-added of such investments' (Piasta et al., 2017, p. 356). Most studies with lower SES groups focus on researchers training parents directly not via an independent organisation (e.g., Murray et al., 2016;Vally, Murray, Tomlinson & Cooper, 2015). Additionally, most intervention programmes run in schools are not designed by researchers, and there is evidence that these are likely to be less effective than researcher-devised programmes. ...
Background: Shared reading interventions can impact positively on preschool children’s language development and on their caregiver’s attitudes/behaviours towards reading. However, a number of barriers may discourage families from engaging with these interventions, particularly families from lower socioeconomic (SES) backgrounds. We investigated how families from such backgrounds responded to an intervention designed explicitly to overcome these barriers. Methods: In a pre-registered cluster randomised controlled trial, 85 lower SES families and their 3- to 4-year old children from 10 different preschools were randomly allocated to take part in The Reader’s Shared Reading programme (intervention) or an existing ‘Story Time’ group at a library (control), once a week for eight weeks. Three outcome measures were assessed at baseline and post-intervention: (i) attendance, (ii) enjoyment of the reading groups, and (iii) caregivers’ knowledge of, attitudes and behaviours towards reading. A fourth, - children’s vocabulary - was assessed at baseline and four weeks post-intervention. Results: Families were significantly more likely to attend the intervention group and rated it more favourably, compared to the control group. However, there were no significant effects on caregivers’ knowledge, attitudes and behaviours, or on children’s language. Conclusion: The intervention was only successful in engaging families from disadvantaged backgrounds in shared reading. Implications for the use, duration and intensity of shared reading interventions are discussed.
... Despite these concerns, there have been no early childhood obesity prevention interventions evaluated in SA (Prioreschi et al., 2017). There have, however, been stimulation interventions that have been shown to have a positive impact on early childhood development in low-income SA settings (Cooper et al., 2009;Murray et al., 2016;Vally, Murray, Tomlinson, & Cooper, 2015). Considering the importance of early childhood development outcomes for educational trajectories in SA children from low-income settings (Pretorius & Spaull, 2016;Spaull & Kotze, 2015), interventions that could address these as well as obesity-related outcomes could address an important research need. ...
Background:
The aim of this study was to assess the feasibility and acceptability of a home-based intervention - 'Amagugu Asakhula' - to promote nurturing interactions and healthy behaviours with the caregivers of preschool children. Amagugu Asakhula means 'treasures that are still growing', and focuses on children's cognitive development, physical activity, screen time, diet and sleep, while also promoting the caregiver-child relationship.
Methods:
This study took place in a low-income setting in Cape Town, South Africa. The 6-week intervention was implemented by community health workers (CHWs) with 20 caregivers of preschool children. CHWs provided written feedback on intervention sessions, and two focus groups were conducted, one with the CHWs involved (n=4), and another with caregivers (n=6) to obtain their feedback on the intervention and its implementation. Data were collated according to themes relating to implementation. In this pilot study, training and recruitment proved feasible, and were facilitated by partnership with a community-based organisation.
Results:
The intervention was generally implemented as intended, in terms of dose and delivery. Family support and active engagement of caregivers' preschool children in intervention activities were reported by CHWs and caregivers, and CHWs also reported mostly positive interactions with caregivers. CHWs and caregivers perceived the intervention to have benefits relating to the following: caregivers' awareness and knowledge of health behaviours, awareness of their role, changes in behaviours, and connection between the caregiver and child. The only change to the intervention suggested was the inclusion of some group sessions to promote support amongst intervention participants and sustain engagement in the intervention.
Conclusions:
The findings of this pilot study indicate that Amagugu Asakhula was both feasible and acceptable with caregivers of preschool children in a low-income urban setting. Further research is needed to assess the extent to which this intervention has an objective and measurable effect on intended outcomes.
... Few programs have targeted parents (Theriot et al., 2003), and of these, even fewer have been rigorously evaluated. Recently, a dialogic book-sharing program in South Africa that trained mothers on ways of engaging their 14-to 18month-old children in book-sharing found greater sensitivity and content elaboration among intervention mothers which, in turn, increased attention and vocabulary among children (Murray et al., 2016;Vally, Murray, Tomlinson, & Cooper, 2015). ...
Worldwide, 250 million children under five (43%) are not meeting their developmental potential because they lack adequate nutrition and cognitive stimulation in early childhood. Several parent support programs have shown significant benefits for children's development, but the programs are often expensive and resource intensive. The objective of this study was to test several variants of a potentially scalable, cost-effective intervention to increase cognitive stimulation by parents and improve emergent literacy skills in children. The intervention was a modified dialogic reading training program that used culturally and linguistically appropriate books adapted for a low-literacy population. We used a cluster randomized controlled trial with four intervention arms and one control arm in a sample of caregivers (n = 357) and their 24- to 83-month-old children (n = 510) in rural Kenya. The first treatment group received storybooks, while the other treatment arms received storybooks paired with varying quantities of modified dialogic reading training for parents. Main effects of each arm of the trial were examined, and tests of heterogeneity were conducted to examine differential effects among children of illiterate vs. literate caregivers. Parent training paired with the provision of culturally appropriate children's books increased reading frequency and improved the quality of caregiver-child reading interactions among preschool-aged children. Treatments involving training improved storybook-specific expressive vocabulary. The children of illiterate caregivers benefited at least as much as the children of literate caregivers. For some outcomes, effects were comparable; for other outcomes, there were differentially larger effects for children of illiterate caregivers.
... When any children' s book is available at home, it is likely to promote caregiver-child interactions that may be stimulating and promote the development of emergent literacy and numeracy skills [18,22]. Evidence suggests that availability of books at home and sharing of books promote increased parental sensitivity and reciprocity and these mediate the linkage with the improved cognitive outcomes for the child [20,23]. Although other factors in the home environment such as parental education may contribute to how the availability of books may affect literacy and numeracy skills, no study to date has described the association between the availability of children' s books at home and children' s literacy and numeracy skills as a composite. ...
Background:
Stimulating home environments that have children's books, pictures and play toys facilitate caregiver-child interactions and enhance children's development. Although this has been demonstrated in small-scale intervention studies, it is important to document whether book ownership is beneficial at large scale in low and middle-income settings.
Methods:
We conducted a secondary analysis using data from the multiple-indicator cluster survey, covering 100 012 children aged 36-59 months, from 35 countries. The outcome was children being on-track for a literacy-numeracy index (LNI) constructed from three questions assessing children's ability to identify/name at least 10 letters of the alphabet, read at least four simple popular words and know the names and symbols of all numbers from 1-10. The main exposure was availability of children's book to the child within household. Analysis considered the survey design, assessed and ranked risk ratios of being on track, adjusting for potential confounders such as child's age (in months), maternal education, household wealth index quintile and area of residence (rural/urban). Ecological analysis was performed using meta-regression after grouping countries by World Bank income groups (low- to high-income).
Results:
Only half (51.8%) of children from all the countries analysed have at least one children's book at home and less than one-third (29.9%; 95% confidence interval (CI) = 23.5%, 36.3%) are on track for literacy-numeracy. After adjusting for confounders, the likelihood of being on track in literacy-numeracy almost doubled if at least one book was available at home compared to when there was none: RR = 1.89 (95% CI = 1.75, 2.03). There was an economic gradient showing that the likelihood of children being on track for LNI decreased with the country's income group: adjusted-RR ranged from 1.65 in upper middle income to 2.23 in LIC (F-test P-value <0.0001). Only three high-income countries were included, and children's books were universally available resulting in wide confidence intervals for the effect.
Conclusions:
These findings are policy-relevant, as they corroborate the results from small scale experiments. Making children's book available to children is a cheap and feasible intervention that could change home dynamics to improve the future economic fortunes of children especially in the poorest countries.
Studies have shown that book reading intervention may scaffold children's language development. However, whether book reading interventions are equally effective for children's cognitive development in a Chinese rural school setting remains to be explored. We conducted a four-month book reading intervention to address these issues in rural Chinese areas. A total of three hundred twenty-one children aged between 2.56 and 6.47 years (M = 4.66 ages, SD = 0.80) were assigned to three groups as follows: (a) control group without donated picture books; (b) active reading control group with donated picture books; and (c) intervention group with a 4-month instructed picture book reading intervention. The findings indicate that the available books could produce significant positive changes in the development of receptive language (F(1,191) = 14.46, p < 0.01) and inhibitory control (F(1,190) = 7.64, p = 0.01) of rural children. However, a 4-month intervention was noneffective at boosting participants' performance on these tasks (F(1,203) = 0.07~2.73, p > 0.10). The results discussed the possible explanations, implications for behavioral intervention researchers, and suggestions for social service organizations or public institutions.
Research Findings: This study examined how family socioeconomic status and home environment may help explain the indirect relationship between parental migration status and rural Chinese children’s holistic development. A total of 198 preschool-age children and their primary caregivers were recruited from three rural preschools in Jiangsu Province in China. The results indicated that parental migration was negatively associated with family socioeconomic status. When the family’s socioeconomic background is low, the less favorable and stimulating home environment the family can provide for children, resulting in detrimental effects on the child’s development. The findings not only provide support for the family system theory to explain the relationship between parental migration and child development, but also reveal family socioeconomic status and home environment as potential sequential pathways. Practice or Policy: The study calls for attention to children’s development in rural China, considering the complexity of the parental migration status. The findings can facilitate rural parent education in the context of rural education revitalization. Primary caregivers in rural areas should become aware of the critical value of a family’s structural and process factors, adjust their parenting attitudes and behaviors, create a positive home environment for the child, and eventually align to reduce the risk factors and enhance the well-being of rural children.
Shared picture-book reading is well-recognized as beneficial for children's early language development, especially where “dialogic book-sharing” techniques are used. Possible benefits of dialogic book-sharing to other aspects of child development have been little investigated, and it has not been widely studied in European populations. We conducted a randomized trial of dialogic book-sharing in Children's Centers in the UK, with parents of 2- to- 4-year-old children, hypothesizing that it would benefit parenting and a range of child developmental outcomes. Intervention group parents (n = 110) received 7, weekly, group training sessions, and control parents (n = 108) the usual center input. Parenting and a range of child outcomes (language, attention, executive function, social development, and emotional-behavior difficulties) were assessed on 3 occasions: before, after, and 4–6 month following intervention. For all study outcomes we compared controls with each of the Intention-to-Treat population and the per-protocol population (participants attending the requisite number of sessions); and, for primary child outcomes only, the population of parents who engaged well with the intervention. There were substantial benefits of dialogic book-sharing training to parental behavior during book-sharing, especially for sensitivity and cognitive scaffolding. For all 3 sets of comparisons there were small-medium effects of on child expressive language, and, for the per protocol and engaged populations, similar sized effects on child receptive language and attention. There was no evidence of benefit of dialogic book-sharing for the other areas of child development; we suggest that specific intervention components need to be added to standard dialogic book-sharing to effect change in these areas.
One out of every three children under age 5 in developing countries lives in conditions that impede human capital development. In this study, we survey the literature on parenting training programs implemented before age 5, with the aim to increase parental investment in human capital accumulation in developing countries. Our review focuses on the implementation and effectiveness of parenting training programs (i.e., training in child psychosocial stimulation and/or training about nutrition). We emphasize the mechanisms that drive treatment-induced change in human capital outcomes and identify the demand- and supply-side behaviors that affect efficacy and effectiveness. Although the literature includes evidence on program features that are associated with successful interventions, further evidence on the dynamics of human capital formation, documentation of medium- to long-term persistence of treatment impacts, and research on the implementation and evaluation of programs at scale are needed to delineate a scalable and inclusive program that provides long-term treatment impacts.
Expected final online publication date for the Annual Review of Resource Economics, Volume 14 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
This study provides a rigorous assessment of a community-based early child development (ECD) intervention to understand the drivers of caregivers’ reading and playing practices in a low-resourced township in South Africa. Mentors visited 157 homes biweekly (2474 observations from 2019–21; children ages 0–5), completing surveys regarding caregiver behaviors and engagement. One hundred and fifty-seven caregivers (mostly Black, Zulu women) participated in the program during this time period and completed surveys biannually on their support system (modified version of the Multidimensional Scale of Perceived Support) and ECD beliefs (modified versions of the Parental Play Beliefs Scale and the Parent Opinion Survey). Longitudinal Hierarchical Linear Model revealed that several behaviors and beliefs significantly predicted positive parenting behaviors. Regression discontinuity plots suggest that positive parenting behaviors could continue and even improve following Covid-19 shutdowns, especially in homes with more intervention visits. This paper provides translational evidence on tangible ways interventions can engage caregivers in stimulating ECD behaviors.
While much variance in general intelligence or g is genetic, a substantial environmental component suggests a possible role for parent-child interaction. In particular, previous evidence suggests the importance of parental scaffolding, or provision of cognitive structure to shape child behaviour. A role for scaffolding is consistent with the proposal that, in adult cognition, a critical aspect of g is decomposition of complex problems into a structure of simpler parts. Building on previous work, we recruited 164 parents attending Children’s Centres with a child aged 2-4 years, and examined parental scaffolding during a book-sharing activity. Scaffolding was measured as the first principal component of a variety of parental behaviours, including sensitivity, focusing attention, extending comprehension, and promoting child participation. Child g was measured as the first principal component of a broad cognitive battery, including language, attention, working memory, and executive function. Importantly, we assessed contributions of the parent’s own intelligence, education, and family income. Though these variables were all associated with child g, their links to parental scaffolding were weaker, and scaffolding remained predictive of child g even once the influence of these variables was removed. In contrast to the correlation with cognitive proficiency, scaffolding did not predict child pro-social behaviour. We suggest that parental scaffolding supports the child’s development of a broad skill of attentional structuring, promoting the across-the-board cognitive proficiency that is reflected in g.
El desarrollo infantil en el marco del ciclo vital puede resultar limitado si se eligen variables, además de la edad, que sólo se circunscriben a condiciones inevitables para la supervivencia. Este artículo recoge un intento por lograr una definición amplia, más allá del ciclo vital y en el marco de una estructura evolutiva del cuidado. Para tal objetivo, además de una discusión conceptual previa sobre una estructura evolutiva del cuidado y desarrollo socio-cognitivo, se presentan algunos resultados del Programa Inicio Parejo de la Vida. Se analizan los datos de 1177 participantes sobre actividades delectura, juego y otras más consideradas constitutivas e indispensables en la definición adoptada de desarrollo infantil y cuidado. Un primer análisis descriptivo de estos resultados indica una situación adversa para más del 80% de los niños participantes y genera dos hipótesis a discutir e indica una necesidad de atender con mayor urgencia la función de los agentes de cuidado y desarrollo en diversos niveles de atención.
Introduction. Within the relatively young field of social neuroscience, there is growing interest in the interplay between biological and social influences on early prosociality (which includes key constructs of helping, sharing and comforting). In particular, neuroimaging (electroencephalography [EEG], functional near infrared spectroscopy [fNIRS]) and eye tracking haven proven invaluable methods to study infants and young children. These measures are more easily adapted for use in different cultural settings than many behavioural paradigms and so hold great potential for implementation in cross- cultural research. Method. We conducted two searches of studies of prosocial development during infancy and early childhood, one with a focus on recent methodological advances and one to review studies in low- and middle-income countries (LMICs) over the past 20 years. Results. In total, we identified 15 studies that used neurocognitive methods; these had a strong focus on helping behaviour and conducted almost exclusively in high-income settings. We also identified 20 studies that investigated prosocial development in LMICs; these focussed primarily on sharing, and included just two eye-tracking studies and no studies using either EEG or fNIRS. Discussion. Several directions for future research emerged from this review. These include the need for: (i) longitudinal research to elucidate developmental trajectories; (ii) investigations involving young infants (<12 months); and (iii) the potential importance of applying EEG, fNIRS and eye tracking in cross cultural research into prosocial development.
This chapter examines the implementation of a range of parenting interventions and preschool programmes designed to promote the mental health and wellbeing of families, enhancing parent and child outcomes and preventing problem behaviours. These programmes aim to develop a range of cognitive, social, emotional and behavioural skills that support positive child development and enhance school readiness. In this chapter, we examine a number of evidence-based parenting and preschool programmes and explore details of their successful implementation, identifying critical factors which contribute to their success. Case studies of parenting programmes are also presented, examining the realities of implementing these programmes outside of controlled research conditions in high-, middle- and low-income countries.
Knowledge of child-rearing and child development is of the utmost importance to optimal parenting and child well-being. Most of what is known about parenting knowledge is derived from mothers or at-risk samples. Accordingly, in a sample comprising both mothers and fathers, we examined and compared parenting knowledge, dysfunctional discipline practices, and parenting self-efficacy. We also explored the preferred sources of knowledge employed by parents in gathering information about child development. Fathers demonstrated lesser knowledge about child development compared to mothers, were more likely to employ dysfunctional disciplining strategies, and relied on their partner for information about parenting. Parent gender, parent age, and ethnicity were significant predictors of parenting knowledge, and higher parenting knowledge was associated with diminished use of dysfunctional discipline behaviors. We discuss these findings in relation to the ‘gate-keeping process’ and sociocultural changes in relation to gender norms for mothers and fathers.
Objective:
Shared reading is believed to enhance parent-child relationships, but the extent to which it reduces harsh parenting is understudied. Associations between early shared reading and subsequent harsh parenting were investigated.
Methods:
Data from a national urban birth cohort were used to estimate associations between mother-reported shared reading at ages 1 and 3 years and harsh parenting-based on a composite of psychological and physical aggression subscales of a validated self-report instrument-when the children were at ages 3 and 5 years. The authors used multivariable linear regression and generalized estimating equations to account for repeated observations. Given potential inverse associations between shared reading and child disruptive behaviors, which can trigger harsh parenting, the authors investigated the extent to which children's behavior at age 3 years mediated the association between shared reading at age 1 year and harsh parenting at age 5 years.
Results:
This study included 2165 mother-child dyads. Thirty-four percent and 52% of mothers reported daily reading at ages 1 and 3 years. In adjusted models, shared reading at age 1 year was associated with less harsh parenting at age 3 years. Similarly, shared reading at age 3 years was associated with less harsh parenting at age 5 years. These associations remained significant in lagged repeated-measures models. Decreased disruptive behaviors partially mediated the association between shared reading at age 1 year and harsh parenting at age 5 years.
Conclusion:
Shared reading predicted less harsh parenting in a national urban sample. These findings suggest that shared reading contributes to an important aspect of the parent-child relationship and that some of the association operates through enhanced child behaviors.
La lettura è uno strumento dalle straordinarie potenzialità. Negli ultimi decenni è aumentata la consapevolezza, anche da parte dei non addetti ai lavori, del valore che la lettura ad alta voce, proposta ai bambini sin dalla primissima infanzia, possa rivestire sullo sviluppo cognitivo ed emotivo dei bambini medesimi e sul loro futuro formativo e professionale (Scierri, Bartolucci, Salvato, 2018). In questo contributo si esplora, in particolare, prima attraverso l'analisi delle ricerche in letteratura e poi presentando uno studio complesso, articolato in più sottocampioni divisi per età anagrafiche, la rilevanza della fascia di età 0-6 per la particolare potenza con la quale gli effetti che la lettura produce si esplicano. Tali effetti potrebbero, ragionevolmente, costituire uno strumento per rimediare allo svantaggio costituito da un ambiente di provenienza debole dal punto di vista socio-culturale. L'attenzione al sistema 0-6 rappresenta allora un'occasione da non perdere per inserire, in modo stabile e quantitativamente significativo, la lettura nel percorso dei nidi e della scuola dell'infanzia. 1. Introduzione: chi ben comincia… Da alcuni anni, come anche questo volume e il Convegno da cui è scaturito dimostrano, si è sollevata l'attenzione attorno al "sistema 0-6". Due segmenti storicamente molto diversi tra loro per origine, culture di riferimento e storia, come i nidi e le scuole dell'infanzia, sono stati avvicinati da una serie di iniziative di carattere normativo, formativo (relativo anche alla qualificazione del personale), istituzionale e persino architettonico (con la costruzione in molte aree del paese di poli 0-6). L'attenzione è stata giudicata immediatamente in modo positivo da molti addetti ai lavori perché non è sfuggita, ai più, la possibilità che offrirebbe pensare a un percorso di apprendimento di sei anni pre-scolastico. L'ingresso a scuola evidenzia, sin dai primi mesi della primaria, le differenze in termini di competenze di cui i bambini sono portatori in diretta relazione con la situazione socio
Interventions that train parents to share picture books with children are seen as a strategy for supporting child language development. We conducted meta‐analyses using robust variance estimation modeling on results from 19 RCTs (Ntotal = 2,594; Mchildage = 1–6 years). Overall, book‐sharing interventions had a small sized effect on both expressive language (d = 0.41) and receptive language (d = 0.26). They had a large effect on caregiver book‐sharing competence (d = 1.01). The impact of the intervention on child language was moderated by intervention dosage, with lower dosage associated with a minimal impact. Child age and caregiver education level were unrelated to child outcome. This review and meta‐analysis confirms the promise of book‐sharing interventions for enhancing and accelerating child language development.
This article introduces an innovative mentalization-based treatment (MBT) parenting intervention for families where children are at risk of maltreatment. The Lighthouse MBT Parenting Programme aims to prevent child maltreatment by promoting sensitive caregiving in parents. The programme is designed to enhance parents' capacity for curiosity about their child's inner world, to help parents 'see' (understand) their children clearly, to make sense of misunderstandings in their relationship with their child and to help parents inhibit harmful responses in those moments of misunderstanding and to repair the relationship when harmed. The programme is an adaptation of MBT for borderline and antisocial personality disorders, with a particular focus on attachment and child development. Its strength is in engaging hard to reach parents, who typically do not benefit from parenting programmes. The findings of the pilot evaluation suggest that the programme may be effective in improving parenting confidence and sensitivity and that parents valued the programme and the changes it had helped them to bring about.
Shared book reading is thought to have a positive impact on young children’s language development, with shared reading interventions often run in an attempt to boost children’s language skills. However, despite the volume of research in this area, a number of issues remain outstanding. The current meta-analysis explored whether shared reading interventions are equally effective (a) across a range of study designs; (b) across a range of different outcome variables; and (c) for children from different SES groups. It also explored the potentially moderating effects of intervention duration, child age, use of dialogic reading techniques, person delivering the intervention and mode of intervention delivery.
Our results show that, while there is an effect of shared reading on language development, this effect is smaller than reported in previous meta-analyses (g ̅ = 0.194, p = .002). They also show that this effect is moderated by the type of control group used and is negligible in studies with active control groups (g ̅ = 0.028, p = .703). Finally, they show no significant effects of differences in outcome variable (ps ≥ .286), socio-economic status (p = .658), or any of our other potential moderators (ps ≥ .077), and non-significant effects for studies with follow-ups (g ̅ = 0.139, p = .200). On the basis of these results, we make a number of recommendations for researchers and educators about the design and implementation of future shared reading interventions.
Joint attention has long been accepted as constituting a privileged circumstance in which word learning prospers. Consequently research has investigated the role that maternal responsiveness to infant attention plays in predicting language outcomes. However there has been a recent expansion in research implicating similar predictive effects from individual differences in infant behaviours. Emerging from the foundations of such work comes an interesting question: do the relative contributions of the mother and infant to joint attention episodes impact upon language learning? In an attempt to address this, two joint attention behaviours were assessed as predictors of vocabulary attainment (as measured by OCDI Production Scores). These predictors were: mothers encouraging attention to an object given their infant was already attending to an object (maternal follow-in); and infants looking to an object given their mothers encouragement of attention to an object (infant follow-in). In a sample of 14-month old children (N=36) we compared the predictive power of these maternal and infant follow-in variables on concurrent and later language performance. Results using Growth Curve Analysis provided evidence that while both maternal follow-in and infant follow-in variables contributed to production scores, infant follow-in was a stronger predictor. Consequently it does appear to matter whose final contribution establishes joint attention episodes. Infants who more often follow-in into their mothers' encouragement of attention have larger, and faster growing vocabularies between 14 and 18-months of age.
Background
Dialogic book-sharing is an interactive form of shared reading. It has been shown in high income countries (HICs) to be of significant benefit to child cognitive development. Evidence for such benefit in low and middle income countries (LMICs) is scarce, although a feasibility study of our own produced encouraging findings. Accordingly, we aimed to establish the impact on child language and attention of providing training in dialogic booksharing to carers of infants in an impoverished South African community.Methods
We conducted a randomized controlled trial in Khayelitsha, an informal settlement in South Africa. Mothers of infants aged between 14 and 16 months were recruited and randomized to either 8 weeks of manualized training in dialogic book-sharing or a no-intervention control group. Independent assessments were made of infant language and attention at baseline and following training. The trial was registered (ISRCTN39953901).ResultsNinety one carer-infant dyads were recruited and randomized to the intervention group (n = 49) or the control group (n = 42), 82 (90%) of whom were available for follow-up assessments. On a standardized carer report of infant vocabulary, compared to those in the control group, carers who received the intervention reported a significantly greater increase in the number of words understood by their infants as well as a larger increase in the number of words that their infant understood and could vocalize. Intervention group children also showed substantially greater gains on a measure of sustained attention.Conclusions
In line with evidence from HICs, a dialogic book-sharing programme delivered to an impoverished South African sample was shown to be of considerable benefit to the development of child language and focussed attention. The training programme, which is simple and inexpensive to deliver, has the potential to benefit child cognitive development in LMIC contexts where such development is commonly compromised.
Book reading has been demonstrated to promote vocabulary. The current study was conducted to examine the added value of an interactive shared book reading format that emphasizes active as opposed to noninteractive participation by the child. Studies that included a dialogic reading intervention group and a reading-as-usual control group, and that reported vocabulary as an outcome measure were located. After extracting relevant data from 16 eligible studies, a meta-analysis was conducted to attain an overall mean effect size reflecting the success of dialogic reading in increasing children's vocabulary compared to typical shared reading. When focusing on measures of expressive vocabulary in particular (k = 9, n = 322), Cohen's d was .59 (SE = .08; 95% CI = 0.44, 0.75; p < .001), which is a moderate effect size. However, the effect size reduced substantially when children were older (4 to 5 years old) or when they were at risk for language and literacy impairments. Dialogic reading can change the home literacy activities of families with 2- to 3-year-old children but not those of families with children at greatest risk for school failure. Preparation of this manuscript was supported by a grant (#411-02-506) from the Netherlands Organization for Scientific Research (NWO) to Adriana G. Bus.
The effects of 2 preschool-based shared-reading interventions were evaluated with 95 children, ages 2- to 5-years, from low-income families. Language skills of the children were below age-level as measured by standardized tests. Children were pretested and randomly assigned to 1 of 3 conditions: (a) no-treatment control, (b) typical shared-reading condition, and (c) dialogic (interactive) shared-reading condition. For both intervention conditions, undergraduate volunteers read to children in small groups. Following the 6-week intervention, children were posttested on measures of oral language, listening comprehension, and phonological sensitivity. Both interventions produced positive effects. Results favoring dialogic reading were found on a measure of descriptive use of language, whereas results favoring typical shared-reading were found on measures of listening comprehension and alliteration detection.
The MacArthur Communicative Development Inventories (CDIs) are a pair of widely used parent-report instruments for assessing communicative skills in infants and toddlers. This report describes short-form versions of the CDIs and their development, summarizes newly available normative data and psychometric properties of the instruments, and discusses research and clinical applications. The infant short farm (Level I, for 8- to 18-month-olds) contains an 89-word checklist for vocabulary comprehension and production. The two parallel versions of the toddler short form (Level II, Forms A and B, for 16- to 30-month-olds) each contain a 100-word vocabulary production checklist and a question about word combinations. The forms may also be useful with developmentally delayed children beyond the specified age ranges. Copies of the short forms and the normative tables appear in the appendices.
This research revealed both similarities and striking differences in early language proficiency among infants from a broad range of advantaged and disadvantaged families. English-learning infants (n = 48) were followed longitudinally from 18 to 24 months, using real-time measures of spoken language processing. The first goal was to track developmental changes in processing efficiency in relation to vocabulary learning in this diverse sample. The second goal was to examine differences in these crucial aspects of early language development in relation to family socioeconomic status (SES). The most important findings were that significant disparities in vocabulary and language processing efficiency were already evident at 18 months between infants from higher- and lower-SES families, and by 24 months there was a 6-month gap between SES groups in processing skills critical to language development.
What role does socialization play in the origins of prosocial behavior? We examined one potential socialization mechanism, parents' discourse about others' emotions with very young children in whom prosocial behavior is still nascent. Two studies are reported, one of sharing in 18- and 24-month-olds (n = 29), and one of instrumental and empathy-based helping in 18- and 30-month-olds (n = 62). In both studies, parents read age-appropriate picture books to their children and the content and structure of their emotion-related and internal state discourse were coded. Results showed that children who helped and shared more quickly and more often, especially in tasks that required more complex emotion understanding, had parents who more often asked them to label and explain the emotions depicted in the books. Moreover, it was parents' elicitation of children's talk about emotions rather than parents' own production of emotion labels and explanations that explained children's prosocial behavior, even after controlling for age. Thus, it is the quality, not the quantity, of parents' talk about emotions with their toddlers that matters for early prosocial behavior.
Babies may opt for a simpler way to turn on a light after watching an adult do it. Here we show that if an adult demonstrates a new way to execute a task to a group of infants aged 14 months, the children will use this action to achieve the same goal only if they consider it to be the most rational alternative. Our results indicate that imitation of goal-directed action by preverbal infants is a selective, interpretative process, rather than a simple re-enactment of the means used by a demonstrator, as was previously thought1, 2, 3.
Investigated serial effects in recurrent ostensive definitions of words in the context of joint picture-book reading by 20 mother–infant (aged 17–22 mo) dyads. Content analysis revealed a number of labeling formats, among them simple labeling by the mother or by the infant, elicitation of labeling by "what" questions, elicitation of pointing by "where" questions, and elicited and spontaneous imitation by the infant. The dyads applied a mixture of labeling formats to the same referent on its successive occurrences. Imitation was more likely following previous error in labeling than were correct labeling and pointing by the infant. Mothers tended to follow errors and no responses with simple labeling of the same referent on its next appearance, whereas they followed correct responses with attempts to elicit labeling or pointing from the infant. Results imply that imitation, comprehension, and productive responses to words by vocabulary-learning infants do not represent different levels of word knowledge and that the respective vocabularies are overlapping at a given point in time. (17 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The MacArthur Communicative Development Inventories (CDIs) are a pair of widely used
parent-report instruments for assessing communicative skills in infants and toddlers. This report
describes short-form versions of the CDIs and their development, summarizes newly available
normative data and psychometric properties of the instruments, and discusses research and
clinical applications. The infant short form (Level I, for 8- to 18-month-olds) contains an
89-word checklist for vocabulary comprehension and production. The two parallel versions of
the toddler short form (Level II, Forms A and B, for 16- to 30-month-olds) each contain a
100-word vocabulary production checklist and a question about word combinations. The forms
may also be useful with developmentally delayed children beyond the specified age ranges.
Copies of the short forms and the normative tables appear in the appendices.
The achievement of labelling was investigated in a longitudinal study of one mother–infant dyad, using video-recordings of their free play in a period between 0; 8 and 1; 6. Analysis of joint picture-book reading revealed that this activity had very early on the structure of a dialogue. The child's lexical labels might be regarded as more adult-like substitutes for earlier communicative forms that he had utilized in the dialogue. These were smiling, reaching, pointing and babbling vocalizations, all of which were consistently interpreted by the mother as expressing the child's intention of requesting a label or providing one. Participating in a ritualized dialogue, rather than imitation, was found to be the major mechanism through which labelling was achieved.
The current review is a quantitative meta-analysis ofthe available empirical evidence related to parent-preschooler reading and several outcome mea- sures. In selecting the studies to be included in this meta-analysis, we focused on studies examining thefrequency ofbook reading to preschoolers. The results support the hypothesis that parent-preschooler reading is related to outcome measures such äs language growth, emergent literacy, and reading achievement. The overall effect size ofd = .59 indicates that book reading explains about 8% of the variance in the outcome measures. The results support the hypothesis that book reading, in particular, ajfects acqui- sition of the written language register. The effect of parent-presch ooler reading is not dependent on the socioeconomic Status of the families or on several methodological differences between the studies. However, the effect seems to become smaller äs soon äs children become conventional readers and are able to read on their own.
This study investigated the mediating mechanisms responsible for the effects of a program designed to reduce intentions to use anabolic steroids, improve nutrition, and increase strength training self-efficacy. Fifteen of 31 high school football teams (N = 1,506 players at baseline) in Oregon and Washington were assigned to receive the intervention. The multicomponent program addressed the social influences promoting ergogenic drug use and engaging students in healthy nutrition and strength training alternative behaviors. Although the results differed across the three dependent variables, the program appeared to work by changing team norms. Unlike prevention of other drugs, changes in knowledge and perceived severity were mediators of program effects in this study.
The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research.
A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described.
Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.
Before social cognition there is joint processing of information about the attention of self and others. This joint attention requires the integrated activation of a distributed cortical network involving the anterior and posterior attention systems. In infancy, practice with the integrated activation of this distributed attention network is a major contributor to the development of social cognition. Thus, the functional neuroanatomies of social cognition and the anterior-posterior attention systems have much in common. These propositions have implications for understanding joint attention, social cognition, and autism.
The present study was conducted to assess the effect of didactic techniques used during storybook reading on young children's acquisition of new vocabulary introduced in storybooks. Thirty children for each group of three- and four-year-old children were read one storybook individually. The study included three storybook reading conditions: single-reading, repeated-reading and questioning. In both the repeated-reading and the questioning conditions, the storybook was read three times. Children in the questioning condition were asked, during each reading of the storybook, to label target items with the novel words. Listening to multiple readings of a storybook facilitated children's acquisition of expressive and receptive vocabulary, whereas answering questions during the multiple readings was more helpful to the acquisition of expressive than receptive vocabulary. These findings suggest that, under certain conditions, didactic techniques used by adults have differential effects on preschoolers' receptive and expressive vocabulary.
Using a cross-sectional natural language database, the authors investigated the parent-child conversations of 36 three-, 4-, and 5-year-olds to explore 2 issues regarding the development of metarepresentation. First, children's uses of explicit contrastives (ECs)--utterances that explicitly contrast 2 differing mental states--were explored. Four-year-olds and, to a greater extent, 5-year-olds were found to reliably use ECs. Second, parents' responses to children's uses of "I don't know" and implicit contrastives (e.g., contradictions) were examined to determine whether parents took these opportunities to highlight the representational nature of mental states. All children regularly elicited mentalistic responses from their parents and, in some cases, these parental responses were positively related to children's production of mental talk. Findings are discussed in terms of how theory of mind development may be guided by scaffolding processes.
Here we show that if an adult demonstrates a new way to execute a task to a group of infants aged 14 months, the children will use this action to achieve the same goal only if they consider it to be the most rational alternative. Our results indicate that imitation of goal-directed action by preverbal infants is a selective, interpretative process, rather than a simple re-enactment of the means used by a demonstrator, as was previously thought.
This study examined parental report as a source of information about toddlers' productive vocabulary in 105 low-income families living in either urban or rural communities. Parental report using the MacArthur Communicative Development Inventory - Short Form (CDI) at child age 2 ; 0 was compared to concurrent spontaneous speech measures and standardized language assessments, and the utility of each source of data for predicting receptive vocabulary at age 3 ; 0 (Peabody Picture Vocabulary Test) was evaluated. Relations between language measures of interest and background variables such as maternal age, education, and race/ethnicity were also considered. Results showed that for the sample as a whole, parental report was moderately associated with other language measures at age 2 ; 0 and accounted for unique variance in PPVT at age 3 ; 0, controlling for child language skills derived from a standard cognitive assessment. However, predictive validity differed by community, being stronger in the rural than in the urban community. Implications of significant differences in background characteristics of mothers in the two sites are discussed.
Previous research demonstrates linguistic advances in middle-class 2-year-olds in the United States resulting from training parents to read with their children following a particular style. This style, called dialogic reading, encourages children to talk about picture books and gives them models and feedback for progressively more sophisticated language use. This research extends these procedures to a day-care setting using 20 Mexican 2-year-olds from low-income backgrounds. Children in the intervention group were read to individually by a teacher using dialogic reading techniques. The control group children were given individual arts and crafts instruction by the same teacher. Effects of the intervention were assessed through standardized language tests and by comparing the children's spontaneous language while they shared a picture book with an adult who was unaware of their group assignment. Differences favoring the intervention group were found on all standardized language posttests and on some measures of language production.
The effects of an interactive shared-reading intervention were evaluated with 3-to 4-year-old children from low-income families who attended subsidized child care. The children entered the program with oral language skills that were significantly below age-level as measured by standardized tests. Children were pretested and randomly assigned to 1 of 4 conditions: (a) no treatment control, (b) a school condition in which children were read to by their teachers in small groups, (c) a home condition in which children were read to by their parents, and (d) a combined school plus home condition. Parents and teachers were trained in a specific form of interactive reading via an instructional videotape. The intervention was conducted for 6 weeks, after which children were posttested on standardized measures of oral language, and language samples were obtained during a shared-reading assessment. Significant effects of the reading intervention were obtained at posttest and were largest for children in conditions involving home reading.
Human infancy has been studied as a platform for hypothesis and theory testing, as a major physiological and psychological adjustment, as an object of adults' effects as well as a source of effects on adults, for its comparative value, as a stage of life, and as a setting point for the life course. Following an orientation to infancy studies, including previous reviews and a discussion of the special challenges infants pose to research, this article focuses on infancy as a foundation and catalyst of human development in the balance of the life course. Studies of stability and prediction from infancy illustrate the depth and complexity of modern research on infants and provide a long-awaited reply to key philosophical and practical questions about the meaningfulness and significance of infancy.
The low rates of child literacy in South Africa are cause for considerable concern. Research from the developed world shows that parental sharing of picture books with infants and young children is beneficial for child language and cognitive development, as well as literacy skills. We conducted a pilot study to examine whether such benefits might extend to an impoverished community in South Africa, by evaluating the impact of training mothers in book sharing with their 14–18 month old infants. Seventeen mothers received book sharing training; and 13 mothers did not, but instead received a comparison training in toy play. We assessed the mothers’ behavior during both book sharing and toy play before and after training, and we also assessed infant attention and language. Mothers receiving book sharing training engaged well with it, and they also benefited from it; thus, compared to the comparison group mothers, they became more sensitive, more facilitating, and more elaborative with their infants during book sharing, and they also became more sensitive to their infants during toy play. In addition, infants whose mothers received the book sharing training showed greater benefits than the comparison group infants in both their attention and language. Training in book sharing for families living in conditions of marked socio-economic adversity in South Africa has the potential to be of considerable benefit to child developmental progress. A large scale controlled trial is required to confirm this.
Various methods are discussed for the problem of comparing two or more populations with respect to a response variable Y in the presence of a (possibly multivariate) concomitant variable X—a situation in which the usual method is the standard one-way analysis of covariance. A method based on ranks is developed.
Understanding communication processes is the goal of most communication researchers. Rarely are we satisfied merely ascertaining whether messages have an effect on some outcome of focus in a specific context. Instead, we seek to understand how such effects come to be. What kinds of causal sequences does exposure to a message initiate? What are the causal pathways through which a message exerts its effect? And what role does communication play in the transmission of the effects of other variables over time and space? Numerous communication models attempt to describe the mechanism through which messages or other communication-related variables transmit their effects or intervene between two other variables in a causal model. The communication literature is replete with tests of such models. Over the years, methods used to test such process models have grown in sophistication. An example includes the rise of structural equation modeling (SEM), which allows investigators to examine how well a process model that links some focal variable X to some outcome Y through one or more intervening pathways fits the observed data. Yet frequently, the analytical choices communication researchers make when testing intervening variables models are out of step with advances made in the statistical methods literature. My goal here is to update the field on some of these new advances. While at it, I challenge some conventional wisdom and nudge the field toward a more modern way of thinking about the analysis of intervening variable effects.
G. J. Whitehurst et al (see record
1989-02401-001) taught mothers specific interactive techniques to use when reading picture books with their preschool-age children. This intervention program, called
dialogic reading, produced substantial effects on preschool children's language development. However, the costs of one-on-one training limit the widespread use of dialogic reading techniques. In this study the authors aimed to replicate and extend the results of the original study of dialogic reading by developing and evaluating an inexpensive videotape training package for teaching dialogic reading techniques. Mothers were randomly assigned to receive no training, traditional direct training, or videotape training. Results supported the conclusions of Whitehurst et al: Dialogic reading had powerful effects on children's language skills and indicated that videotape training provided a cost-effective, standardized means of implementing the program. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We experimentally assessed a 1-month, home-based intervention, designed to optimize parental reading of picture books to young children. Parents in the experimental group received instructions to increase their rates of open-ended questions, function/attribute questions, and expansions; to respond appropriately to children's attempts to answer these questions; and to decrease their frequency of straight reading and questions that could be answered by pointing. Control-group parents were instructed to read in their customary fashion. All families audiotaped their reading sessions at home. Analysis of these tapes demonstrated that the experimental group scored significantly higher than children in the control group on standardized posttests of expressive language ability. On the basis of analysis of audiotapes, children in the experimental group also had a higher mean length of utterance (MLU), a higher frequency of phrases, and a lower frequency of single words. Follow-up 9 months after the completion of treatment disclosed continued, although statistically diminished, differences between the two groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved)