Head Start may be too late. The iconic federal preschool program targets low-income kids between 3 and 5, but the brain forms critical language connections in its first thousand days, experts say.
That’s the message the American Academy of Pediatrics sent to doctors who care for low-income children in a recent policy statement. A child who is read aloud to and has a rich language environment enjoys distinct advantages, the report argues, which linger well into the school years.
A 2012 study, cited in the AAP report, found that 60 percent of high-income children were read to daily, while only 34 percent of those well below the poverty line were read to.
“Children from low-income homes are much less likely to have a language rich environment,” said Dr. Pamela High, director of developmental and behavioral pediatrics at Hasbro Children’s Hospital in Providence, Rhode Island. “They hear fewer words and they know fewer words at age 3 than their more advantaged peers.”
Those differences play out in vocabulary and reading ability, said High, the primary author of the APP statement.
One study, also cited by High, found that 60 percent of vocabulary differences in children between 8 and 9 could be explained by differences in exposure to language in the home before the age of 3. And 8 or 9 is when the bill comes due: 80 percent of children below the poverty line will fail to achieve reading proficiency by the end of third grade.
And while most people wouldn’t look to pediatricians as the front line of literacy, the APP notes that, for many toddlers, the family doctor is the only trusted professional who routinely sees them during those first three years.
Pediatrician intervention on early reading isn’t just an abstract idea. For over 25 years now, American doctors have been reaching out to young patients with a program called Reach Out and Read.
Combining foundation funding with local corporate sponsors and some governmental funding, ROR coordinates 5,000 primary care physicians who participate in the program.
ROR has a longstanding partnership with Scholastic Books, which gives physicians a steady supply of books. Starting at 6 months of age, kids participating in the program are handed a new book with each well child visit, High said.
The new book then becomes a prop the doctor uses to talk to the parent and the child to observe their developmental stages. The doctors observe how the child manipulates the book, how comfortable she is with it, and can point to pictures and age-appropriate questions.
Fourteen published studies prove that ROR works, said Brian Gallagher, acting executive director of Reach Out and Read. These studies include a handful of “gold standard” random controlled experiments.
At least four strong studies show that kids given the ROR treatment had more advanced vocabularies than the control groups. And other studies showed that ROR shifted parental attitudes and behavior shifted significantly.
What you do with the book varies by the child’s age, High said. “At six months, the child reaches for the book, looks at it and pats some of the pictures. As they get older they learn how to orient the book and open the pages, and name the objects in pictures.”
“Where is the baby?” “Where is the kitty?”
High looks for how comfortable kids and parents are as they look at the book together. If they are not that comfortable, she models ways to read with the child. As the child gets older, the doctor asks the child to point out letters in the child's name.
Fifteen minutes in a well child visit may not seem like enough time for a doctor to learn much from the book exchange, but Gallagher says many doctors say the books help make the visit more efficient, allowing them to gauge parental reactions and the child’s development in a matter of seconds.
“They can’t see a dozen things they want to see in just a few minutes,” Gallagher said.
When the APP called for reading to children from infancy, some mistakenly hear “from birth,” said Daniel Willingham, a professor of psychology at the University of Virginia and the author of the forthcoming book "Raising Kids Who Read."
“The idea that it is never too early can backfire,” Willingham said. “It’s hard to make room for that in those first few months. Reading to a newborn is not rewarding for anybody involved, and you just feel silly.”
How early is too early? Many experts agree that somewhere around six months is the time to start reading aloud to a child.
In the early months, the key concept is “serve and return,” Gallagher said. The tennis metaphor describes the early efforts babies make to interact with the people in their lives, which is then reciprocated by the parent.
High agrees that reading is not the first thing a new parent should do. “Dry them off and get the breast-feeding going,” she said. “Get some sleep. There are a whole lot of things you take care of first. But it is a lovely thing to do early on.”
While the research on Reach Out and Read is very strong, there are some things it can’t tell us. Children in the program developed stronger verbal skills, for instance, but it's not known how that played out in the home.
How long do you need to get results? There is some guesswork here, experts concede. Most use a few minutes a day as a baseline, but in part this is to assuage the apprehensions of stressed parents.
“Very young toddlers do not have a very long attention span,” Gallagher notes, “and the typical board book takes about five minutes to read.”
When he tells parents to read for five minutes, Gallagher said, most agree they could do that. Then he points out that there are “crevices” in the evening where reading can be squeezed in. One parent could read while the other fixes dinner, he suggested, or you can read during bath time.
“People who are readers find little crumbs of time to squeeze reading into a busy day,” Gallagher said.
“Reading aloud is about creating readers and building a richer vocabulary,” High said, “but it is also powerful because it builds a bond between the caregiver and child.”
Some people with low literacy skills or those who were not read to as children themselves may think that reading aloud is about “instruction,” Gallagher noted. “Instead, it should be a warm bonding time between the parent and the child, and the reading gets folded into it. People who have fond childhood memories of reading aloud always seem to remember that time spent with the parent.”
If there is one new point in the AAP statement, High agrees, it’s that reading together is more than about words. Reading and vocabulary matter, but the shared experience between caregiver and child is critical.
“We are not trying to get kids to read earlier,” Gallagher said. “It’s all about parental engagement, a way to bring you both together that you both enjoy and has long-term benefits for your child.”
Words and perspectives
Some argue that reading aloud is unnecessary and think all you have to do is just talk to kids, Willingham says. He counters that reading introduces new vocabulary, perspectives and forms of expression than even most educated parents can conjure on their own.
“Even preschool books have a richer vocabulary than most college educated adults use in daily conversation,” he said. “Most parents don’t use low-frequency words.”
Willingham does point out that reading aloud is just one feature in a “literacy rich home.” Ideally parents would also ask the child lots of questions, comment on words they hear and look them up, and show they care about learning.
“A good proxy for this is to count the number of books in a home,” Willingham added, noting that it is not uncommon to find highly successful people who have no books at all in their home.
In addition to new perspectives and a thirst for learning, another advantage to reading aloud is the shift in perspective between the parent and child, according to Gallagher.
“So much of parent and child interaction is directive,” Gallagher said. “Put on your shoes. Do this. Don’t do that. The book opens up a new world for the parent and child.”