Video Abstract

Video Abstract

OBJECTIVES

In some studies, parents and toddlers verbalize less when engaging with a tablet versus a print book. More needs to be known regarding child contributions to specific parent verbalizations. We examined parent-toddler contingent interactions with tablet applications versus print books, as well as moderators of these associations.

METHODS

We conducted a laboratory-based, within-subjects counterbalanced study of 72 parent-toddler dyads engaging with a nursery rhyme application (with enhanced + autonarration [E+A] and enhanced formats) and print book. We coded parent verbalizations (eg, dialogic, nondialogic) and proportions of child responses to these in 5-second epochs. Poisson regressions were used to analyze within-subjects variance by tablet or print format. We tested effect modification by child emotion regulation and home media practices.

RESULTS

Children responded more to parent overall (print 0.38; E+A 0.31, P = .04; enhanced 0.11, P = .01), dialogic (print 0.21; E+A 0.13, P = .04; enhanced 0.1, P = .02), and nondialogic (print 0.45; E+A 0.27, P < .001; enhanced 0.32, P < .001) verbalizations during print book versus tablet. Stronger child emotion regulation, greater frequency of co-viewing, and instructive practices moderated associations such that differences between conditions were no longer significant for some parent verbalizations and child responses.

CONCLUSIONS

Parent-toddler reciprocal verbal interactions occurred less frequently with tablet versus print book use. Child emotion regulation and parent home media practices moderated some of these associations. Pediatricians may wish to promote co-viewing and instructive media practices but may also consider that child emotion regulation may determine response to interactive tablet design.

What’s Known on This Subject:

Parent-toddler verbalizations and nonverbal indicators of social reciprocity are diminished when using some tablet applications compared with print books. No studies have examined toddler responses to specific types of parent verbalizations, and none have examined moderators of such interactions.

What This Study Adds:

Toddlers exhibited lower responses to all parent verbalizations when using tablet devices compared with print books. Child emotion regulation difficulties and parent home media practices moderated associations between certain types of child responses and parent verbalizations during tablet use.

Digital media use makes up a growing share of young children’s daily activities.1,2  More than 98% of families of young children (0–8 years old) own a mobile or tablet device,24  and 2- to 4-year-olds spend on average >2 hours per day using digital media.1,2  When toddler-aged children are using a tablet device, interactions with a responsive adult, otherwise known as joint media engagement,58  can help facilitate their translation of information from the tablet into the real world.8,9  Joint media engagement goes above and beyond the simple presence of a caregiver, with elements that include parent verbal input, child responses and/or conversational reciprocity, joint attention (both parent and child attending to the device), and parent emotional responsiveness.10,11 

High-quality electronic book design may promote joint media engagement and emerging literacy skills in toddlers, preschool-aged children, and kindergarteners.1215  For example, when a book character provides dialogic reading prompts (eg, asking open-ended questions), parents exhibited more dialogic reading behaviors,14  which has been shown to increase child responses or conversational reciprocity.16,17  However, most commercially available electronic books and applications (apps) lack these high-quality interactive enhancements18  and instead contain extraneous animations and advertisements that can distract young viewers.19 

Indeed, authors of previous work have examined parent-child interactions with commercially available narrative electronic books, noting variable findings depending on the enhancements included in the electronic books.13,2022  In our previous work, parents exhibited fewer dialogic and total verbalizations but more format-related verbalizations (eg, comments such as “swipe the screen,” “tap the picture”) with a commercially available electronic tablet book compared with a print book,23,24  and children showed lower nonverbal social reciprocity when using electronic books.24  We did not examine toddlers’ responses (eg, building on parent statements, answering questions, or acknowledging their parents) to specific types of parent verbal statements. However, different types of parent verbalizations elicit different toddler responses,16,17  and both the parent verbalizations and child responses are 2 important aspects of joint media engagement.11  The authors of one previous study examined toddler responses to parent verbalizations with an electronic book app containing no distracting interactive hot spots.13  Yet most commercially available apps contain a high quantity of such extraneous design features, which may make it harder for a parent to verbally engage and for a young child to hear or notice parents’ verbalizations and respond reciprocally.25,26  To our knowledge, there have been no studies on child responses to different types of parent verbalizations (eg, dialogic, nondialogic, and format related) during use of popular apps with a high quantity of hot spots and interactivity.18,27 

Furthermore, characteristics of the child or parent home digital media practices have not been examined in previous studies, which may shape interactions with a tablet. Yet there is a high degree of variability in how dyads engage with tablet devices.25  For instance, children with emotion regulation difficulties may use screen media for greater durations and rely on the device as a soothing tool, which may make joint engagement more challenging. Regarding home media practices, parents’ previous experiences of joint media engagement (eg, co-viewing and instruction) may also modify interactions with a tablet. Identifying moderators of parent-child interactions with the tablet may help tailor specific guidance for families.

Therefore, in this study, we aim to examine these gaps. We hypothesize that when toddlers and parents are engaging with 2 tablet apps (enhanced + autonarration [E+A] and enhanced formats) compared with a print book, (1) parents’ verbalizations toward toddlers occur with lower frequency for each type of parent verbalization, with the exception of format verbalizations; (2) toddler response (verbal and nonverbal) toward parents is lower for all types of parent verbalizations; and (3) child emotion regulation difficulties (eg, negative affect, tantrum behaviors) and parent home digital media practices moderate associations with parent-child verbalizations.

We recruited 72 parent-toddler dyads from the University of Michigan online research registry (UMHealthresearch.org), social media (eg, Facebook), and community-based settings (eg, pediatric offices, child care). Inclusion criteria were as follows: (1) child aged 24 to 36 months, (2) child without developmental delay or a serious medical condition, (3) parent able to read English sufficiently to provide consent, (4) parent the legal or physical custodial guardian, and (5) parent and child with no uncorrected hearing or vision impairments.

This study was approved by the University of Michigan Institutional Review Board and completed in November 2018 to May 2019. Parents provided written informed consent during the study visit. The laboratory approximated a living room, with couches, 3 books in separate boxes (2 tablets containing 1 app each, 1 print book) placed out of children’s reach, a 1-way-mirror, and video cameras.

Participants first completed 5-minute video-recorded free play with nondigital toys, followed by a counterbalanced, preassigned, randomly ordered reading activity using an E+A tablet app, enhanced tablet app, and print book (with 3 different book titles). Parents received instructions to complete each activity with their toddler sequentially as prompted for 3 minutes each.

Book Formats

Three Fisher Price nursery rhyme apps were chosen because of their popularity (each app has been downloaded >1 000 000 times in the Google Play Store) and use of design elements that are widely prevalent in the children’s app store. We chose nursery rhyme apps because they naturally elicit turn-taking (eg, a child completing a stanza the parent started) and gesturing compared with other toddler-directed apps. Apps were configurable in 2 settings: E+A and enhanced. Enhanced tablet app capabilities allowed for swiping to turn pages and allowed for hot spots (eg, tapping a frog resulted in the appearance of white stars with a sound effect, the nature of which was often extraneous to the nursery rhymes), in addition to the nursery rhyme instrumentation playing when swiping between pages. E+A apps had the same capabilities as the enhanced tablet, with the addition of an automatic-play sing-along when swiping between pages. For the print condition, we created a softcover print book by printing and binding high-resolution screen shots from each app page, including the nursery rhyme text. Print books were softcover and scaled to 19.1 × 11.4 cm (height × width). Apps were preloaded on a 25.4-cm Samsung Galaxy tablet. The interactive portions covered ∼20.3 × 11.4 cm of the tablet screen. App 1 contained The Itsy, Bitsy Spider and One, Two, Buckle My Shoe; app 2 contained Row, Row, Row Your Boat and The Animal Fair; app 3 contained Hickory Dickory Dock and Pat-a-Cake.

Survey Measures

Parents completed surveys regarding constructs to be used as covariates and/or moderators in statistical models, including demographic information (parent’s age, sex, educational attainment, household income, race and ethnicity, relationship to child, and marital status; child’s age, sex, and race and ethnicity) and standardized questionnaires.

Standardized questions were used to assess frequency of home child media use (including tablet, smartphone, and electronic book usage and book reading) and parental mediation strategies (co-viewing, instructive).28  The co-viewing subscale was used to assess the frequency with which parents watched digital media with their children; the instructive subscale was used to assess the frequency with which parents taught or explained content to children. Each subscale included 5 items rated on a 5-point Likert scale (5 = high mediation) that were then summed (Cronbach α co-viewing = 0.77, instructive = 0.87).

Toddler Emotion Regulation

Toddler emotion regulation was measured 2 ways. One included the 12-item negative affect subscale of the Early Childhood Behavioral Questionnaire Very Short Form (ECBQ), a validated, reliable29  parent-report questionnaire of toddler temperament. Items were rated on a scale of 1 to 7 (1 = never, 7 = always) and averaged, with higher values indicating more negative affect (Cronbach α = 0.67). The second measure was an observational measure of toddler tantrums, coded in the period of time when a parent returned the tablet or book, with 0 indicating no tantrum, and 1 indicating verbal complaint, crying, or frustration (intraclass correlation = 0.88–0.96; multiple measurements due to 3 coders).30 

Observed Parent-Toddler Exchanges (Parent Verbalizations, Toddler Conversational Reciprocity)

Because parent verbalizations elicit different child responses, the following parent verbalization categories were coded on the basis of previous work17,21,23,31  in 5-second epochs: dialogic, nondialogic, repeats nursery rhyme, format related, off task, and behavioral management (Table 1). Codes were not mutually exclusive. Because toddlers may communicate nonverbally as well, child responses to each of these parent verbalizations were coded as response (either verbal or nonverbal) or no response (ignores parent). Child response to each type of parent verbalization category was calculated as a proportion of times children responded to their parents. Three undergraduate students blinded to the hypothesis coded to reliability, with Cohen’s κ of at least 0.70 for each code (20% of videos were double-coded to ensure no coder drift).

We conducted Poisson regressions using Proc Genmod, comparing each behavioral outcome by book format (print, enhanced, E+A). Given occasional variation in reading duration, total elapsed time was included as a covariate. All models included a repeated-measures statement to allow for within-subjects comparison of behavioral outcomes by book format, and order effects were accounted for. Covariates in final models with P < .05 were included to improve model fit (eg, income-to-needs ratio, marital status, etc). Race and ethnicity was included as a potential covariate if P < .05 because of previous work identifying systemic inequities in digital media access (eg, lack of reliable Wi-Fi) for Black and Latinx populations.32  We tested effect modification by creating interaction terms between 2 measures of child emotion regulation difficulties (ECBQ negative affect, tantrums) and 2 types of parent home digital media practices (co-viewing, instructive) and parent verbalizations and child responses with tablet or book use. All analyses were completed in SAS 9.4 (SAS Institute, Inc, Cary, NC).

TABLE 1

Coding Definitions and Examples of Parent Verbalizations

DefinitionExamplesCohen’s κ
ParentChild
Reads book Parent reads book “We went to the animal fair.” 0.82 n/a 
Dialogic Dialogic reading techniques often prompt a child to expand and elaborate on concepts related to the story. These were defined as follows: parent asks open-ended question, expands on an idea the child has, repeats what the child says, or relates the story content to the child’s experience “What’s happening here?” “What did they do next?” “What did you think about that?” “Remember when we went to the zoo and saw an animal?” 0.74 0.69 
Nondialogic Verbalizations that are related to story content but have not been previously shown to elicit child engagement to the degree of dialogic reading; these included the following: parent labels, asks a simple question requiring only a name or label, makes a pointing request or attention prompt, or askes the child to fill in the word “What is that?” Parent: “The itsy bitsy…” child: “Spider.” 0.78 0.72 
Nursery rhyme Parent repeats nursery rhyme, not reading “The itsy bitsy spider went up the water spout.” 0.84 0.79 
Format related Verbalizations that are related to the book format; parent comments, asks a question, or adds a directive on an aspect of the print or tablet interface “Great job, you’re turning the page!” “Can I hold the tablet/book?” “You can push the button here.” 0.77 0.72 
Off task These are unrelated to book content or book format and include all other parent verbalizations that are not categorized “We are going to the store after this.” 0.80 0.72 
Behavior management Verbalizations in which the parent appears to be trying to redirect the child or manage the child’s behavior Child getting off the couch; parent says, “Get back here!” “You can have your goldfish later.” 0.74 0.70 
DefinitionExamplesCohen’s κ
ParentChild
Reads book Parent reads book “We went to the animal fair.” 0.82 n/a 
Dialogic Dialogic reading techniques often prompt a child to expand and elaborate on concepts related to the story. These were defined as follows: parent asks open-ended question, expands on an idea the child has, repeats what the child says, or relates the story content to the child’s experience “What’s happening here?” “What did they do next?” “What did you think about that?” “Remember when we went to the zoo and saw an animal?” 0.74 0.69 
Nondialogic Verbalizations that are related to story content but have not been previously shown to elicit child engagement to the degree of dialogic reading; these included the following: parent labels, asks a simple question requiring only a name or label, makes a pointing request or attention prompt, or askes the child to fill in the word “What is that?” Parent: “The itsy bitsy…” child: “Spider.” 0.78 0.72 
Nursery rhyme Parent repeats nursery rhyme, not reading “The itsy bitsy spider went up the water spout.” 0.84 0.79 
Format related Verbalizations that are related to the book format; parent comments, asks a question, or adds a directive on an aspect of the print or tablet interface “Great job, you’re turning the page!” “Can I hold the tablet/book?” “You can push the button here.” 0.77 0.72 
Off task These are unrelated to book content or book format and include all other parent verbalizations that are not categorized “We are going to the store after this.” 0.80 0.72 
Behavior management Verbalizations in which the parent appears to be trying to redirect the child or manage the child’s behavior Child getting off the couch; parent says, “Get back here!” “You can have your goldfish later.” 0.74 0.70 

Child response was coded for each of these types of parent verbalizations as present (1), including a verbal response or a nonverbal acknowledgment, or absent (0). n/a, not applicable.

As shown in Table 2, children were 30.2 months of age, and parents were 33.0 years of age. Of the parents, 93% were mothers, 69% had a 4-year college degree or greater, and 89% were married. Of the children, 40% were boys and 74% were White non-Hispanic.

TABLE 2

Participant Characteristics

Study SampleN = 72
Child age, mo, mean (SD) 30.2 (3.8) 
Parent age, y, mean (SD) 33.0 (4.3) 
Parent relationship to child, n (%)  
 Mother 67 (93) 
 Father 5 (7) 
Child sex, n (%)  
 Male 29 (40) 
 Female 43 (60) 
Child race and ethnicity, n (%)  
 White, non-Hispanic 53 (74) 
 Black, Hispanic, Asian, Pacific Islander, or biracial 19 (26) 
Parent education, n (%)  
 High school or GED 4 (6) 
 Some college courses 12 (17) 
 2-y college degree 6 (8) 
 4-y college degree 24 (33) 
 >4-y college degree 26 (36) 
Parent marital status, n (%)  
 Single 2 (3) 
 Married 62 (86) 
 In a committed relationship 4 (6) 
 Separated or divorced 4 (6) 
ECBQ negative affect score, mean (SD) 2.9 (0.6) 
No. children with presence of tantrums, n (%) 20 (28) 
Child has actively used smartphone, n (%) 66 (92) 
Child has actively used iPad or tablet, n (%) 55 (76) 
Time child has spent using iPad, tablet, or smartphone on the most typical weekday, n (%)  
 Not used or never 36 (51) 
 <30 min 18 (25) 
 30 min to 1 h 6 (9) 
 1–2 h 9 (13) 
 2–3 h 1 (1) 
 3–4 h 1 (1) 
Time child has spent reading with adult on the most typical weekday  
 Not used or never 6 (8) 
 <30 min 22 (31) 
 30 min to 1 h 33 (46) 
 1–2 h 9 (13) 
 3–4 h 1 (1) 
Co-viewing, mean (SD) 14.6 (3.0) 
Instructive, mean (SD) 15.5 (3.5) 
Study SampleN = 72
Child age, mo, mean (SD) 30.2 (3.8) 
Parent age, y, mean (SD) 33.0 (4.3) 
Parent relationship to child, n (%)  
 Mother 67 (93) 
 Father 5 (7) 
Child sex, n (%)  
 Male 29 (40) 
 Female 43 (60) 
Child race and ethnicity, n (%)  
 White, non-Hispanic 53 (74) 
 Black, Hispanic, Asian, Pacific Islander, or biracial 19 (26) 
Parent education, n (%)  
 High school or GED 4 (6) 
 Some college courses 12 (17) 
 2-y college degree 6 (8) 
 4-y college degree 24 (33) 
 >4-y college degree 26 (36) 
Parent marital status, n (%)  
 Single 2 (3) 
 Married 62 (86) 
 In a committed relationship 4 (6) 
 Separated or divorced 4 (6) 
ECBQ negative affect score, mean (SD) 2.9 (0.6) 
No. children with presence of tantrums, n (%) 20 (28) 
Child has actively used smartphone, n (%) 66 (92) 
Child has actively used iPad or tablet, n (%) 55 (76) 
Time child has spent using iPad, tablet, or smartphone on the most typical weekday, n (%)  
 Not used or never 36 (51) 
 <30 min 18 (25) 
 30 min to 1 h 6 (9) 
 1–2 h 9 (13) 
 2–3 h 1 (1) 
 3–4 h 1 (1) 
Time child has spent reading with adult on the most typical weekday  
 Not used or never 6 (8) 
 <30 min 22 (31) 
 30 min to 1 h 33 (46) 
 1–2 h 9 (13) 
 3–4 h 1 (1) 
Co-viewing, mean (SD) 14.6 (3.0) 
Instructive, mean (SD) 15.5 (3.5) 

GED, general equivalency diploma.

Overall, parents had fewer total verbalizations (excluding reading) during tablet use in either tablet condition compared with print book use (E+A mean 27.16 [SD = 1.47] versus print mean 35.95 [SD = 1.17], P < .001; enhanced mean 30.46 [SD = 1.35] versus print mean 35.95 [SD = 1.17], P < .001; enhanced versus E+A P < .001). As shown in Fig 1, parents read the app or book more in the enhanced tablet and print book compared with the E+A tablet (enhanced 8.84 [0.54] versus print 8.49 [0.55], P = .58; E+A 4.19 [0.43] versus print 8.49 [0.55], P < .001; enhanced versus E+A P = .58). Use of both tablet formats resulted in fewer parent dialogic verbalizations compared with print book use (E+A 1.74 [0.19] versus print 3.65 [0.43], P < .001; enhanced 1.62 [0.19] versus print 3.65 [0.43], P < .001; enhanced versus E+A P = .52). There were fewer nondialogic verbalizations during use of both tablet formats compared with print book use (E+A 11.78 [0.68] versus print 17.43 [0.81], P < .001; enhanced 11.80 [0.67] versus print 17.43 [0.81], P < .001; enhanced versus E+A P = .97). Parents repeated the nursery rhyme with lower frequency when using the E+A tablet format compared with the enhanced tablet and print formats but had more format-related verbalizations, fewer off-task verbalizations, and fewer behavioral comments when using both tablet formats compared with the print format.

FIGURE 1

Parent verbalization counts (average verbalizations for parents by each type of book format). Footnotes represent covariates included in models. a Book title. b Parenting self-efficacy and book title. c Parenting self-efficacy, child race and ethnicity, and parent race and ethnicity. d Book title and child race and ethnicity. e Marital status. f ITN and marital status. g No additional covariates. *** P < .001. ITN, income-to-needs ratio.

FIGURE 1

Parent verbalization counts (average verbalizations for parents by each type of book format). Footnotes represent covariates included in models. a Book title. b Parenting self-efficacy and book title. c Parenting self-efficacy, child race and ethnicity, and parent race and ethnicity. d Book title and child race and ethnicity. e Marital status. f ITN and marital status. g No additional covariates. *** P < .001. ITN, income-to-needs ratio.

Overall, child conversational response was lower for parent verbalizations during tablet use in either tablet condition compared with print book use (E+A proportion 0.31 [SD = 0.02] versus print proportion 0.38 [SD = 0.02], P = .004; enhanced proportion 0.30 [0.02] versus print proportion 0.38 [SD = 0.02], P < .001; enhanced versus E+A P = .039). Figure 2 reveals the proportion of child responses to each type of parent verbalization. Children responded to fewer dialogic verbalizations during tablet use in either tablet condition compared with print book use (E+A 0.13 [0.03] versus print 0.21 [0.03], P = .04; enhanced 0.11 [0.03] versus print 0.21 [0.03], P = .02; enhanced versus E+A P = .58). Children responded to fewer parent nondialogic verbalizations during tablet use in either tablet condition compared with print book use (E+A 0.27 [0.02] versus print 0.45 [0.03], P < .001; enhanced 0.32 [0.03] versus print 0.45 [0.03], P < .001; enhanced versus E+A P = .04). Children responded to fewer parent nursery rhyme verbalizations during tablet use in either tablet condition compared with print book use (E+A 0.12 [0.03] versus print 0.24 [0.04], P = .01; enhanced 0.07 [0.02] versus print 0.24 [0.04], P < .001; enhanced versus E+A P = .08). However, children responded to more parent format-related verbalizations during tablet use in either tablet condition compared with print book use (E+A 0.51 [0.04] versus print 0.27 [0.07], P = .01; enhanced 0.53 [0.04] versus print 0.27 [0.07], P = .01; enhanced versus E+A P = .54). There were no differences in child responses to parent off-task or behavioral verbalizations across all 3 conditions.

FIGURE 2

Child response, in proportions, to each parent verbalization type. Footnotes represent covariates included in models. a Child age and book title. b Child age and marital status c Child sex. d Parent age and book title. e Child age, parenting self-efficacy, and ITN. f Child age and marital status. * P < .05; *** P < .001. ITN, income-to-needs ratio.

FIGURE 2

Child response, in proportions, to each parent verbalization type. Footnotes represent covariates included in models. a Child age and book title. b Child age and marital status c Child sex. d Parent age and book title. e Child age, parenting self-efficacy, and ITN. f Child age and marital status. * P < .05; *** P < .001. ITN, income-to-needs ratio.

As shown in the Fig 3 moderation analyses, child emotion regulation characteristics moderated some parent verbalizations and child responses. ECBQ negative affect moderated child response to parent nursery rhyme verbalizations (P = .03) such that children with high negative affect responded to their parents more when using the print book versus the E+A tablet; this was no different for children with low negative affect. Child tantrums moderated parent nondialogic verbalizations (P = .004) such that parent nondialogic verbalizations were greater in the print book condition versus the E+A tablet condition for children without tantrums, and this was no different for children with tantrums.

FIGURE 3

Effect modification results after stratifying for child individual characteristics (ECBQ negative affect, presence of tantrums) and home digital media practices (co-viewing, instructive). A, Child nursery rhyme. B, Parent nondialogic. C, Child nursery rhyme. D, Parent nursery rhyme. E, Parent dialogic. F, Child nursery rhyme. * P < .05; ** P < .01; *** P < .001.

FIGURE 3

Effect modification results after stratifying for child individual characteristics (ECBQ negative affect, presence of tantrums) and home digital media practices (co-viewing, instructive). A, Child nursery rhyme. B, Parent nondialogic. C, Child nursery rhyme. D, Parent nursery rhyme. E, Parent dialogic. F, Child nursery rhyme. * P < .05; ** P < .01; *** P < .001.

Parent home digital media practices moderated some parent verbalizations and child responses. Co-viewing moderated the child response to parent nursery rhyme verbalizations during use of the E+A tablet (P = .003) such that children exposed to greater co-viewing responded more to their parents during use of the E+A tablet compared with children exposed to lower co-viewing. Instructive media practices moderated parent nursery rhyme verbalizations during use of the E+A tablet (P = .006) such that parent nursery rhyme verbalizations were lower during use of the E+A tablet, resulting in greater differences between E+A tablet and print book use in those with low instruction compared with those with high instruction. Instructive media practices moderated parent dialogic verbalizations during use of the enhanced tablet (P = .01) such that dialogic verbalizations were higher during print book use, resulting in a greater difference between enhanced tablet and print book use for children exposed to greater instruction compared with lower instruction. Instructive media practices moderated child response to nursery rhyme verbalizations during use of the enhanced tablet (P = .04) such that children with high instruction responded similarly to their parents when using print and tablet formats, and those with low instruction responded more to their parents when using a print book compared with either tablet format.

Parent-child interactions are central correlates of future child developmental outcomes (language, peer relationships, academic achievement),3337  which are shaped by several aspects of the environment,38,39  including digital media.26,40  We found that toddler responses to parent verbalizations (a central aspect of parent-child conversational reciprocity) was lower during use of both E+A and enhanced tablet nursery rhyme apps compared with a print book use. Not only were parent verbalizations toward toddlers less frequent in the tablet conditions but also a majority of these verbalizations were ignored by toddlers and to a more substantial degree when using tablets compared with a print book.

Parent verbalization results were similar to those in our previous study (in which we used an app with less interactivity),23  revealing fewer dialogic, nondialogic, and overall verbalizations from parents, suggesting that previous findings generalize to apps with stronger visual features and distractions. It is possible that the app we chose with common nursery rhymes may not promote dialogic reading practices to the same degree as more narrative books, and perhaps the E+A app might not have allowed sufficient time for parents to verbalize and children to respond because of autonarration. Our work is similar to previous findings among preschool-aged children reading electronic books that include interactive hot spots2022  but differs from one study that found similar parent verbalizations with an electronic book without hot spots13  and print books. This suggests that such interactive hot spots may impede parents’ optimal ability to verbally engage with their children. Differing from our previous work,23  we found greater parent behavioral verbalizations during use of the print book compared with the tablet apps.

Such interactive hot spots and tablet design features may also come at the expense of children’s response to parents’ verbalizations and parent-child conversational reciprocity. In this experimental paradigm, toddlers responded to their parents less when using the tablet, even when the parents were engaging in dialogic techniques. Nevertheless, diminished child responsivity in both tablet conditions was noted overall and across almost each parent verbalization category (dialogic, nondialogic, and nursery rhyme). Because parent-child interactional patterns are transactional in nature (eg, parents adjust their approach depending on their children’s responses),41  we surmise that low child response to parents could mean that over time, parents may minimize the quantity of parent verbalizations when engaging with tablet devices. This may reflect differences in how parents tailored their verbalizations to their children in our results. For instance, in the enhanced and E+A conditions, children responded to more format-related verbalizations compared with the print condition, which may have led parents to exhibit greater format-related verbalizations.

Child emotion regulation difficulties moderated associations between child response to nursery rhymes and parent nondialogic verbalizations. This suggests that (1) children with emotion regulation difficulties may struggle with responding to parent verbalizations while engaging with tablet devices and (2) their parents may adjust their verbalizations as a result. In contrast, home media practices, such as co-viewing and instruction, may also promote certain types of parent verbalizations and children’s responses. Households engaging in co-viewing and instructive practices may promote more conversational reciprocity when using a tablet compared with households engaging in such practices less frequently because the dyad may be used to interacting in this manner.

Fluent, connected, and reciprocal conversation in the toddler years has been associated with improved expressive language development in preschool42  and greater social competence in future peer interactions and academic achievement into adolescence.43  Such interactions from both toddlers and parents are occurring with lower frequency with tablet use compared with print book use. Limitations of this study included a sample slightly more White and college educated than the general population, which may limit the study generalizability to other populations. Strengths include use of a tablet app with common design features, within-subjects approach, and observational coding of parent and child behavior. Next steps might include sequential analysis of parent-toddler conversational reciprocity (and conversational turn-taking), assessing the parent and toddler emotional experience when co-viewing, and replicating this study in a more racially and ethnically diverse sample.

Tablets and mobile devices are prominent fixtures in modern family life, and app design features can impede children’s responses despite parent’s efforts to engage their children in developmentally enriching conversation. Software designers could consider limiting extraneous enhancements for young children and incorporating feedback from trained early childhood specialists. Pediatric providers should continue recommending engagement in co-viewing and instructive home media practices when possible (eg, by asking open-ended questions) and focus on ways to incorporate dialogic practices when possible. Lastly, pediatric providers may also wish to note that some children have varying responses to digital media and that children with emotion regulation challenges may have more difficulties interacting with a tablet device, even in the context of joint media engagement.

Dr Munzer drafted the initial manuscript, created the analysis plan, and reviewed and revised the manuscript; Dr Miller conceptualized and designed the study and reviewed and revised the manuscript; Ms Yeo recruited participants, developed standardized operating procedures, collected participant data, conducted data management, and reviewed and revised the manuscript; Ms Wang conducted the data management and processing and data analyses and reviewed and revised the manuscript; Mr McCaffery conducted the moderation data analyses and reviewed and revised the manuscript; Dr Kaciroti created the data analysis plan and conducted data analysis and reviewed and revised the manuscript; Dr Radesky conceptualized and designed the study, coordinated and supervised data collection, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: Funded by the Eunice Kennedy Shriver National Institute of Child Health and Development (grant 5R03HD94077), which made it possible to conceptualize, implement, collect, and analyze data and write this article. Funded by the National Institutes of Health (NIH).

     
  • E+A

    enhanced + autonarration

  •  
  • ECBQ

    Early Childhood Behavioral Questionnaire Very Short Form

1
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Competing Interests

POTENTIAL CONFLICT OF INTEREST: Dr Radesky is paid to write articles for the PBS Parents Web site and is on the board of directors of and consults for Melissa & Doug, LLC; the other authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: Dr Radesky is paid to write articles for the PBS Parents Web site and is on the board of directors of and consults for Melissa & Doug, LLC; the other authors have indicated they have no financial relationships relevant to this article to disclose.

Supplementary data