Early Social-Emotional Development Aided by Reading and Pretend Play

Alan L. Mendelsohn, MD

Reading aloud, making playtime a priority, and simply having conversations with children has a positive impact on their social skills and behavioral regulation, according to a new study.

The pediatric community has honed a holistic perspective on health, parent-child relationships, and parenting itself as a critical indicator of health, study author Alan L. Mendelsohn, MD, a developmental-behavioral pediatrician and Associate Professor of Pediatrics and Population Health at New York University School of Medicine and Bellevue Hospital Center, told MD Magazine.

“We have recognized that we can engage in similar efforts to enhance parenting and child development during primary visits,” Mendelsohn said.

Current research shows that positive parenting strategies are linked with improved social-emotional development. Researchers of this study said that there have been gaps in investigating this area, including within families with additional psychosocial risks and already developing problems, different impacts of infant through toddler interventions, sustained impact of low-cost, low-intensity primary programs, and the social-emotional impacts of primary care programs promoting reading aloud and play.

A factorial, single-blind randomized controlled trial of the Video Interaction Project (VIP), Bellevue Project for Early Language and Literary Success, was conducted at an urban public hospital serving low-income families. VIP is a pediatric primary care intervention that promotes positive parenting through play, reading aloud, and daily routines. The 2 VIP components include VIP 0-3 (infant-toddler) and VIP 3-5 (preschool-aged). Evidence had already shown that VIP 0-3 improved social-emotional development by age 3.

Researchers aimed to determine if the VIP 0-3 component had sustained impacts on social-emotional development at 4.5 years and if the VIP 3-5 component had independent impacts at the 4.5-year follow-up.

Enrollment and first random assignment was conducted during the postpartum period, second assignment at age 3, and 5 assessments through and up to 4.5 years. At postpartum, of the 675 families enrolled, 450 mother-child dyads were assigned to VIP 0-3 and control 0-3 years; 275 made it to the 4.5-year assessment. Of the 450 families enrolled at postpartum, 296 were enrolled a second time into the VIP 3-5 and control 3-5 years; 252 of those families completed the 4.5-year assessment. At ages 3 and 4.5 years, social-emotional development was determined using the Behavior Assessment System for Children, Second Edition (BASC-2).

Results showed that VIP 0-3 and VIP 3-5 were independently associated with improved 4.5-year Behavior Assessment System for Children T-scores. Children who received the combined VIP 0-3 and VIP 3-5 interventions had -0.63 reduction in Hyperactivity (P = 0.001). VIP 0-3 participants showed a reduced, clinically significant hyperactivity (relative risk reduction for overall sample: 69.2%; P = 0.03; relative risk reduction for increase psychological risk: 100%; P = 0.006).

“Pediatricians can let parents know that early literacy activities such as reading aloud, pretend play, teaching and talking beginning at birth can help support behaviors that will be important for learning when children enter school,” Mendelsohn said.

Pediatric early literacy programs, such as Reach Out and Read and VIP can make a huge difference for many families. But implementation and dissemination of programs are an issue and vary by region.

“We’re studying how to link VIP with a home visiting program called Family Check Up through an integrate model called Smart Beginnings,” Mendelsohn said. “We’re also working with the New York City Council to link healthcare, home visiting and library-based programs together through a program called City’s First Readers.”

The study, "Reading Aloud, Play, and Social-Emotional Development," was published online in Pediatrics this month.