Abstract
Parent-child interactions are critical for language development in early life. To test whether a clinic-based intervention was associated with improved home language environment and language development. A pre-post study of a multifaceted clinic-based intervention called Talk It Up was conducted for 61 English- or Spanish-speaking families with children aged 2 to 12 months. Enrollment took place at a single urban pediatric clinic from January to November 2017, with follow-up data collection through May 2018. Analyses took place from June to August 2018. The 6-month multifaceted intervention consisted of delivering Language Environment Analysis word counts with clinician feedback, coaching, and twice-weekly pushes of brief instructional videos via a commercially available smartphone application. Baseline and follow-up z scores for adult word counts, parent-child conversational turns, and child vocalizations and language development as measured by the Developmental Snapshot score were compared and adjusted for confounders. Among 61 families, the mean (SD) child's age at baseline was 5.9 (3.3) months. English was the primary language spoken in the home for 54 families (89%). At follow-up, Talk It Up was associated with significant improvements in adult word counts (mean z score, 0.30; 95% CI, 0.05-0.55), parent-child conversational turns (mean z score, 0.29; 95% CI, 0.002-0.59), and Developmental Snapshot score (mean, 6.59; 95% CI, 0.95-12.23), but there were no improvements in child vocalizations (mean z score, -0.13; 95% CI, -0.49 to 0.24). A multifaceted clinic-based approach to promote parent-child interactions holds some promise. Future, larger studies are warranted.
Highlights
In their seminal work, Hart and Risley[1] found that low-income children grow up in a considerably impoverished linguistic environment
At follow-up, Talk It Up was associated with significant improvements in adult word counts, parent-child conversational turns, and Developmental Snapshot score, but there were no improvements in child vocalizations
The goal was to leverage the fact that children aged 2 to 18 months have, per American Academy of Pediatrics guidelines, 7 recommended well-child care visits (WCVs)
Summary
Hart and Risley[1] found that low-income children grow up in a considerably impoverished linguistic environment. By the time they start kindergarten, low-income children hear approximately 30 million fewer words than do their high-income counterparts. This disparity has been confirmed multiple times.[2,3] the word gap is only part of the problem. Important is the paucity of reciprocal exchanges between caregivers and children, called conversational turns, which help build social, cognitive, and emotional capacity.[4] Recent data suggest that diminished parental engagement is becoming a problem for all children regardless of class
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