Adriana Weisleder

Promotion of Positive Parenting and Prevention of Socioemotional Disparities.

OBJECTIVE: The goal of this study was to determine what effects pediatric primary care interventions, focused on promotion of positive parenting through reading aloud and play, have on the socioemotional development of toddlers from low-income, primarily immigrant households. METHODS: This randomized controlled trial included random assignment to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks [BB]) or to a control group. Mother–newborn dyads were enrolled postpartum in an urban public hospital. In VIP, dyads met with an interventionist on days of well-child visits; the interventionist facilitated interactions in play and shared reading through provision of learning materials and review of videotaped parent–child interactions. In BB, parents were mailed parenting pamphlets and learning materials. This article analyzes socioemotional outcomes from 14 to 36 months for children in VIP and BB versus control. RESULTS: A total of 463 dyads (69%) contributed data. Children in VIP scored higher than control on imitation/play and attention, and lower on separation distress, hyperactivity, and externalizing problems, with effect sizes ∼0.25 SD for the sample as a whole and ∼0.50 SD for families with additional psychosocial risks . Children in BB made greater gains in imitation/play compared with control. CONCLUSIONS: These findings support the efficacy of VIP, a preventive intervention targeting parent–child interactions, for enhancing socioemotional outcomes in low-income toddlers. Given the low cost and potential for scalability of primary care interventions, findings support expansion of pediatric-based parenting programs such as VIP for the primary prevention of socioemotional problems before school entry.

Mitigating the Effects of Family Poverty on Early Child Development through Parenting Interventions in Primary Care

Poverty related disparities in early child development and school readiness are a major public health crisis, the prevention of which has emerged in recent years as a national priority. Interventions targeting parenting and the quality of the early home language environment are at the forefront of efforts to address these disparities. In this article we discuss the innovative use of the pediatric primary care platform as part of a comprehensive public health strategy to prevent adverse child development outcomes through the promotion of parenting. Models of interventions in the pediatric primary care setting are discussed with evidence of effectiveness reviewed. Taken together, a review of this significant body of work shows the tremendous potential to deliver evidence-based preventive interventions to families at risk for poverty related disparities in child development and school readiness at the time of pediatric primary care visits. We also addresss considerations related to scaling and maximizing the effect of pediatric primary care parenting interventions and provide key policy recommendations.

Reducing Maternal Depressive Symptoms through Promotion of Parenting in Pediatric Primary Care

We studied associations between 2 pediatric primary care interventions promoting parental responsiveness and maternal depressive symptoms among low-income mothers. This randomized controlled trial included 2 interventions (Video Interaction Project [VIP], Building Blocks [BB]) and a control group. VIP is a relationship-based intervention, using video-recordings of mother–child dyads to reinforce interactional strengths. BB communicates with parents via parenting newsletters, learning materials, and questionnaires. At mean (SD) child age 6.9 (1.2) months, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), parental responsiveness was assessed with StimQ-I. A total of 407 dyads were assessed. Rates of mild depressive symptoms were lower for VIP (20.6%) and BB (21.1%) than Controls (32.1%, P = .04). Moderate depressive symptoms were lower for VIP (4.0%) compared to Controls (9.7%, P = .031). Mean PHQ-9 scores differed across 3 groups (F = 3.8, P = .02): VIP mothers scored lower than controls (P = .02 by Tukey HSD). Parent–child interactions partially mediated VIP-associated reductions in depressive symptoms (indirect effect −.17, 95% confidence interval −.36, −.03).

Twenty Years after “Meaningful Differences,” It's Time to Reframe the “Deficit” Debate about the Importance of Children's Early Language Experience

Fifty years of research have documented a sobering reality: There are substantial differences among parents in how they engage and communicate with their children, and these differences impact the development of a child’s language and cognitive skills. Studies initiated during the War on Poverty first explored how parents’ verbal engagement with young children varied among families differing in education and income, or socioeconomic status (SES) [e.g. Bee, Van Egeren, Pytkowicz Streissguth, Nyman, & Leckie, 1969; Hess & Shipman, 1965; Schachter, 1979]. In their 1995 monograph Meaningful Differences in the Everyday Experience of Young American Children , Betty Hart and Todd Risley were the first to document huge disparities in the sheer amount of language that caregivers in different families directed to young children. Although they found substantial variability in child-directed speech within as well as between SES groups, the differences between children in advantaged and disadvantaged families were surprisingly large. They also found that those children who did not have the benefits of rich verbal engagement early in life were more likely to be behind in cognitive and language skills in kindergarten and elementary school. Hart and Risley’s [1995] discovery of a 30-million-word gap in language to children from higherand lower-SES backgrounds over the first three years of life is now widely cited in the popular press as well as in academic journals. But for more than a decade, this powerful study was essentially ignored. In the 1960s, claims that some learning difficulties in children from disadvantaged families could be linked to inadequate cognitive stimulation at home came to be known as the “cultural deficit” model [Riessman, 1962]. A fierce backlash emerged in the 1970s, rejecting this view as unsubstantiated by scientific evidence and as deeply disrespectful of minority parents in poverty whose use of language with children was grounded in cultural traditions of parenting different from those in more affluent mainstream families [Fernald & Weisleder, 2011]. Consistent with these criticisms, a dominant view in the field of language acquisition through the 1990s was that focusing on SES differences in speech

Reading Aloud, Play, and Social-Emotional Development

In an RCT of the VIP, it was demonstrated that pediatric promotion of reading aloud and play resulted in reduced hyperactivity at school entry. OBJECTIVES: To determine impacts on social-emotional development at school entry of a pediatric primary care intervention (Video Interaction Project [VIP]) promoting positive parenting through reading aloud and play, delivered in 2 phases: infant through toddler (VIP birth to 3 years [VIP 0–3]) and preschool-age (VIP 3 to 5 years [VIP 3–5]). METHODS: Factorial randomized controlled trial with postpartum enrollment and random assignment to VIP 0-3, control 0 to 3 years, and a third group without school entry follow-up (Building Blocks) and 3-year second random assignment of VIP 0-3 and control 0 to 3 years to VIP 3-5 or control 3 to 5 years. In the VIP, a bilingual facilitator video recorded the parent and child reading and/or playing using provided learning materials and reviewed videos to reinforce positive interactions. Social-emotional development at 4.5 years was assessed by parent-report Behavior Assessment System for Children, Second Edition (Social Skills, Attention Problems, Hyperactivity, Aggression, Externalizing Problems). RESULTS: VIP 0-3 and VIP 3-5 were independently associated with improved 4.5-year Behavior Assessment System for Children, Second Edition T-scores, with effect sizes (Cohen’s d) ∼−0.25 to −0.30. Receipt of combined VIP 0-3 and VIP 3-5 was associated with d = −0.63 reduction in Hyperactivity (P = .001). VIP 0-3 resulted in reduced “Clinically Significant” Hyperactivity (relative risk reduction for overall sample: 69.2%; P = .03; relative risk reduction for increased psychosocial risk: 100%; P = .006). Multilevel models revealed significant VIP 0-3 linear effects and age × VIP 3-5 interactions. CONCLUSIONS: Phase VIP 0-3 resulted in sustained impacts on behavior problems 1.5 years after program completion. VIP 3-5 had additional, independent impacts. With our findings, we support the use of pediatric primary care to promote reading aloud and play from birth to 5 years, and the potential for such programs to enhance social-emotional development.

Enhancing Parent Talk, Reading, and Play in Primary Care: Sustained Impacts of the Video Interaction Project

Objective To determine the early impacts of pediatric primary care parenting interventions on parent cognitive stimulation in low socioeconomic status families and whether these impacts are sustained up to 1.5 years after program completion. Study design This randomized controlled trial included assignment to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks) or to a control group. Mother–newborn dyads were enrolled postpartum in an urban public hospital. In VIP, dyads met with an interventionist on days of well‐child visits; the interventionist facilitated interactions in play and shared reading through provision of learning materials and review of videotaped parent–child interactions. In Building Blocks, parents were mailed parenting pamphlets and learning materials. We compare the trajectories of cognitive stimulation for parents in VIP and control from 6 to 54 months. Results There were 546 families that contributed data. VIP was associated with enhanced reading, parent verbal responsivity, and overall stimulation at all assessment points, with analyses demonstrating a 0.38 standard deviation increase in cognitive stimulation overall. Trajectory models indicated long‐term persistence of VIP impacts on reading, teaching, and verbal responsivity. Conclusions VIP is associated with sustained enhancements in cognitive stimulation in the home 1.5 years after completion of the program and support expansion of pediatric interventions to enhance developmental trajectories of children of low socioeconomic status. Trial registration Clinicaltrials.gov: NCT00212576.

Towards a bioecological model of bilingual development

At its best, the field of bilingualism is a dynamic discipline informed by diverse perspectives. Carrolls critical review – situated within a linguistics framework – contends that current research on bilingual exposure and language development suffers from a lack of theoretical clarity, and makes little contribution to our understanding of bilingual acquisition. Carrolls push (Carroll) towards greater precision in our thinking about the relation between input and outcomes is an important and welcome challenge. However, it is also critical to keep in mind the social context that motivates much of the current research on bilingual development, and to leave room for studies whose main goal is to provide answers to societally important questions about bilingual childrens health and development.

Reading aloud and child development: A cluster-randomized trial in Brazil

This cluster-randomized trial shows that a parenting program promoting reading aloud enhanced child language and cognitive development in a low-income community in Brazil. OBJECTIVES: Many children in low- and middle-income countries fail to reach their developmental potential. We sought to determine if a parenting program focused on the promotion of reading aloud enhanced parent-child interactions and child development among low-income families in northern Brazil. METHODS: This was a cluster-randomized study of educational child care centers randomly assigned to receive an additional parenting program (intervention) or standard child care without a parenting component (control). Parent-child dyads were enrolled at the beginning of the school year and were assessed at enrollment and at the end of the school year. Families in intervention centers could borrow children’s books on a weekly basis and could participate in monthly parent workshops focused on reading aloud. We compared parents and children in intervention and control centers 9 months after the start of the intervention on measures of parent-child interaction and child language, cognitive, and social-emotional development. RESULTS: Five hundred and sixty-six parent-child dyads (279 intervention; 287 control) in 12 child care clusters (26–76 children per cluster) were assessed at enrollment; 464 (86%) contributed follow-up data. Parents in the intervention group engaged in significantly greater cognitive stimulation (Cohen’s d = 0.43) and higher quantity and quality of reading interactions (d = 0.52–0.57) than controls; children in the intervention scored significantly higher than controls on receptive vocabulary (d = 0.33), working memory (d = 0.46), and IQ (d = 0.33). CONCLUSIONS: An innovative program focused on the promotion of parent-child reading aloud resulted in benefits to parent-child interactions and to child language and cognitive development that were greater than those provided by educational child care alone. This promising approach merits further evaluation at scale.