Recent advances in neuroscience have led to an increased appreciation of the effects of early experience on the brain, with ramifications for language, cognitive, and social-emotional development.1,2 Language development has been especially well studied, with extensive research documenting relations between early exposure to adult language and children’s language capacities through early elementary school.3,6 

The authors of “Language Experience in the Second Year of Life Predicts Language Outcomes in Late Childhood” extend existing research by using a naturalistic methodology based on analysis of full-day audio recordings (Language ENvironment Analysis, LENA) to demonstrate long-term associations between early language exposure and subsequent child language and IQ through late middle school.7 Gilkerson et al7 found that the strongest predictor was language-based interaction, with relations (less robust) also found for quantity of language exposure. By showing that parent-child verbal interactions in early childhood predict critically important outcomes through age 14 years (∼10 years later), the authors of this study have made a major contribution to this topic, with strong implications for American Academy of Pediatrics policy and clinical practice recommendations.8,10 With these findings, the authors also add to the preponderance of research in which the importance of supporting families toward common goals of developmental progress and educational achievement is demonstrated.6,11,12 

The early environment influences every aspect of child development; in addition to effects on cognitive and language outcomes, recent work has also shown that parent-child verbal interactions also have effects on social-emotional development.13 This speaks to the importance of early language exposure in every domain of early learning and also to the agency with which children elicit stimulation from their caregivers and their environment; children learn through interactions but also use language to elicit and extend the interactions which help them learn. Like language skills, social-emotional skills and self-regulation play vital roles in early learning and school success.14,15 

The authors speak strongly to the importance of interaction during the 18- to 24-month period of “language explosion”; findings suggest that programs seeking to foster language skills in young children should pay careful attention to the context in which young children are exposed to language during this crucial period. Promotion of language-rich and emotionally positive interactions should be the goal, with play and reading aloud offering contexts for parents to provide not only enriched vocabulary but also opportunities and prompts for enriched interactions.16,19 In particular, study findings support “primary prevention” of disparities in development and school readiness, beginning early in life before their onset. This is a fundamentally different approach than that of treatment initiatives, which, although also essential, are designed to address problems after their emergence. Importantly, primary prevention can be used to provide an opportunity for population-level delivery across the socioeconomic spectrum, with potential for low cost and cascading impacts across the life span.20 

Because primary care visits and immunizations are especially frequent in the first 2 years of life, a period in which children are not necessarily enrolled in other programs or institution-based care, pediatric primary health care offers a promising and low-cost platform for universal, population-level prevention through relationship- and strengths-based strategies.20 The Reach Out and Read (ROR) program, in which primary care providers offer anticipatory guidance about and modeling of reading aloud (along with developmentally appropriate children’s books) at health supervision visits from birth to 5, is the most established scaled program, reaching 4.7 million children annually.21 ROR emphasizes dialogic reading techniques in provider training and in parent materials, using the books to foster language-rich interactions. Families receiving ROR report more frequent reading with their children and more positive attitudes toward reading aloud, and children in the intervention have shown improved vocabularies.22,23 

A number of other primary prevention initiatives use pediatric primary care to support language interactions through shared book reading and interactive and pretend play. One well-studied example is the Video Interaction Project (VIP), which enhances ROR by adding a parenting coach at each primary care visit who briefly video records parents and children engaging together around a book or toy provided by the program and then immediately reviews the video with the family.24 Positive, sustained impacts of the VIP on relational health broadly and in child development have been shown in studies.25,26 Additional examples include Healthy Steps,27 Thirty Million Words,28 Bridging the Word Gap,29 Smart Beginnings (links the VIP in primary care to home visiting through Family Check Up),30 Sit Down and Play,31 and City’s First Readers (links to community partners, eg, libraries).32 

In the study by Gilkerson et al,7 it is shown that patterns of language exposure established early in life are associated with trajectories of child language and IQ through late middle school. These findings are especially remarkable given the heterogeneity of children’s experiences as they grow up. The importance of language-based interactions for developmental outcomes across many important domains adds weight to the urgency of universal primary prevention programs, which will help parents establish positive patterns during the crucial early developmental windows.

     
  • ROR

    Reach Out and Read

  •  
  • VIP

    Video Interaction Project

Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.

FUNDING: NIH grant R01 HD076390. Funded by the National Institutes of Health (NIH).

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2017-4276.

1
Shonkoff
JP
,
Garner
AS
;
Committee on Psychosocial Aspects of Child and Family Health
;
Committee on Early Childhood, Adoption, and Dependent Care
;
Section on Developmental and Behavioral Pediatrics
.
The lifelong effects of early childhood adversity and toxic stress.
Pediatrics
.
2012
;
129
(
1
). Available at: www.pediatrics.org/cgi/content/full/129/1/e232
[PubMed]
2
Brito
NH
,
Noble
KG
.
Socioeconomic status and structural brain development.
Front Neurosci
.
2014
;
8
:
276
[PubMed]
3
Hart
BM
,
Risley
TR
.
Meaningful Differences in the Everyday Experience of Young American Children
.
Baltimore, MD
:
Brookes Publishing Co
;
1995
4
Mendelsohn
AL
,
Cates
CB
,
Weisleder
A
,
Berkule
SB
,
Dreyer
BP
.
Promotion of early school readiness using pediatric primary care as an innovative platform.
Zero Three
.
2013
;
34
(
1
):
29
40
5
Tamis-LeMonda
CS
,
Bornstein
MH
,
Baumwell
L
,
Damast
AM
.
Responsive parenting in the second year: specific influences on children’s language and play.
Early Dev Parent
.
1996
;
5
(
4
):
173
183
6
Rowe
ML
.
Understanding socioeconomic differences in parents’ speech to children.
Child Dev Perspect
.
2018
;
12
(
2
):
122
127
7
Gilkerson
J
,
Richards
J
,
Steven
W
,
Oller
DK
,
Russo
R
,
Vohr
B
.
Language experience in the second year of life and language outcomes in late childhood.
Pediatrics
.
2018
;
142
(
4
):
e20174276
8
High
PC
,
Klass
P
;
Council on Early Childhood
.
Literacy promotion: an essential component of primary care pediatric practice.
Pediatrics
.
2014
;
134
(
2
):
404
409
[PubMed]
9
Hagan
JF
,
Shaw
JS
,
Duncan
PM
, eds.
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents
. 4th ed.
Elk Grove Village, IL
:
American Academy of Pediatrics
;
2017
10
Williams
PG
,
Okamoto
J
,
Lieser
D
, et al;
Council on Early Childhood
;
Council on School Health
.
The pediatrician’s role in optimizing school readiness.
Pediatrics
.
2016
;
138
(
3
):
e20162293
[PubMed]
11
Sperry
DE
,
Sperry
LL
,
Miller
PJ
.
Reexamining the verbal environments of children from different socioeconomic backgrounds [published online ahead of print April 30, 2018].
Child Dev
. doi:
[PubMed]
12
Golinkoff
RM
,
Hoff
E
,
Rowe
M
,
Tamis-LeMonda
C
,
Hirsh-Pasek
K
. Talking with children matters: defending the 30 million word gap. 2018. Available at: https://www.brookings.edu/blog/education-plus-development/2018/05/21/defending-the-30-million-word-gap-disadvantaged-children-dont-hear-enough-child-directed-words/. Accessed August 8, 2018
13
Mendelsohn
AL
,
Cates
CB
,
Weisleder
A
, et al
.
Reading aloud, play, and social-emotional development.
Pediatrics
.
2018
;
141
(
5
):
e20173393
[PubMed]
14
Brotman
LM
,
Dawson-McClure
S
,
Calzada
EJ
, et al
.
Cluster (school) RCT of ParentCorps: impact on kindergarten academic achievement.
Pediatrics
.
2013
;
131
(
5
). Available at: www.pediatrics.org/cgi/content/full/131/5/e1521
[PubMed]
15
McCormick
MP
,
Cappella
E
,
O’Connor
EE
,
McClowry
SG
.
Social-emotional learning and academic achievement: using causal methods to explore classroom-level mechanisms.
AERA Open
.
2015
;
1
(
3
):
1
26
16
Hoff-Ginsberg
E
.
Mother-child conversation in different social classes and communicative settings.
Child Dev
.
1991
;
62
(
4
):
782
796
[PubMed]
17
Tomopoulos
S
,
Dreyer
BP
,
Tamis-LeMonda
C
, et al
.
Books, toys, parent-child interaction, and development in young Latino children.
Ambul Pediatr
.
2006
;
6
(
2
):
72
78
[PubMed]
18
Toub
TS
,
Hassinger-Das
B
,
Nesbitt
KT
, et al
.
The language of play: developing preschool vocabulary through play following shared book-reading.
Early Child Res Q
.
2018
;
45
:
1
17
19
Raikes
H
,
Pan
BA
,
Luze
G
, et al
.
Mother-child bookreading in low-income families: correlates and outcomes during the first three years of life.
Child Dev
.
2006
;
77
(
4
):
924
953
[PubMed]
20
Cates
CB
,
Weisleder
A
,
Mendelsohn
AL
.
Mitigating the effects of family poverty on early child development through parenting interventions in primary care.
Acad Pediatr
.
2016
;
16
(
suppl 3
):
S112
S120
[PubMed]
21
Reach Out and Read
. Reach out and read. Available at: http://reachoutandread.org/. Accessed July 15, 2018
22
High
PC
,
LaGasse
L
,
Becker
S
,
Ahlgren
I
,
Gardner
A
.
Literacy promotion in primary care pediatrics: can we make a difference?
Pediatrics
.
2000
;
105
(
4, pt 2
):
927
934
[PubMed]
23
Mendelsohn
AL
,
Mogilner
LN
,
Dreyer
BP
, et al
.
The impact of a clinic-based literacy intervention on language development in inner-city preschool children.
Pediatrics
.
2001
;
107
(
1
):
130
134
[PubMed]
24
Video Interaction Project
. Video interaction project. Available at: www.videointeractionproject.org/. Accessed July 15, 2018
25
Weisleder
A
,
Cates
CB
,
Dreyer
BP
, et al
.
Promotion of positive parenting and prevention of socioemotional disparities.
Pediatrics
.
2016
;
137
(
2
):
e20153239
[PubMed]
26
Cates
CB
,
Weisleder
A
,
Berkule Johnson
S
, et al
.
Enhancing parent talk, reading, and play in primary care: sustained impacts of the Video Interaction Project.
J Pediatr
.
2018
;
199
:
49
56.e1
[PubMed]
27
Minkovitz
CS
,
Strobino
D
,
Mistry
KB
, et al
.
Healthy Steps for Young Children: sustained results at 5.5 years.
Pediatrics
.
2007
;
120
(
3
). Available at: www.pediatrics.org/cgi/content/full/120/3/e658
[PubMed]
28
Suskind
DL
,
Leffel
KR
,
Graf
E
, et al
.
A parent-directed language intervention for children of low socioeconomic status: a randomized controlled pilot study.
J Child Lang
.
2016
;
43
(
2
):
366
406
[PubMed]
29
Bridging the Word Gap Research Network
. Bridging the word gap. Available at: www.bwgresnet.res.ku.edu/. Accessed July 15, 2018
30
Institute of Human Development and Social Change
. Smart beginnings. Available at: https://steinhardt.nyu.edu/ihdsc/smart. Accessed July 15, 2018
31
Shah
R
,
DeFrino
D
,
Kim
Y
,
Atkins
M
.
Sit down and play: a preventive primary care-based program to enhance parenting practices.
J Child Fam Stud
.
2017
;
26
(
2
):
540
547
[PubMed]
32
City’s First Readers
. City’s first readers. Available at: www.citysfirstreaders.com/. Accessed July 15, 2018

Competing Interests

POTENTIAL CONFLICT OF INTEREST: Dr Klass is national medical director of Reach Out and Read (no financial compensation). Dr Mendelsohn is the principal investigator of studies of Reach Out and Read and the Video Interaction Project (no financial compensation).

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.