Pediatric surgeon Dana Suskind understands the gravity of her responsibility when a parent entrusts her to cut into a baby’s head. She does so as part of a delicate, two-hour operation to attach a cochlear implant to a deaf or hearing-impaired child’s inner ear. She does not consider an operation successful if it results merely in a child being able to hear. Success means that, with the assistance of the implant and follow-up support, the child learns to talk.
Six years ago, Suskind noticed a disturbing trend among her patients at the University of Chicago Medicine: While children from affluent families were starting to speak after implant surgery, those from low-income families lagged behind.
Why? The question ate at Suskind, who co-founded the hospital’s cochlear implant unit in 2006. She believes she discovered her answer in research by child psychologists Betty Hart and Todd R. Risley. Their landmark study in the 1990s found that a child born into poverty hears 30 million fewer words by age 3 than a child born to well-off parents, creating a gap in literacy preparation that has implications for a lifetime.
The gap was stark for Suskind’s patients. Since the implications of her observations extended to all children, hearing and deaf alike, she felt compelled to find practical solutions for all parents, particularly those of limited means.
Today, the 45-year-old doctor is trying to turn research that is well established within academic circles into a social movement. Her message is simple: Children aren’t born smart. They’re made smart by their parents talking to them.
So Suskind, a half-dozen staff members, and a rotating cast of student research assistants are developing strategies to get parents to engage their children in rich, meaningful conversation from the moment they’re born.
They’ve completed the first trial of their Thirty Million Words Project, in which Suskind’s staff visited the homes of low-income mothers on the South Side and trained them in a parent-talk curriculum they developed. Every week, a young child in a participating family would spend a day wearing a small electronic device in a shirt pocket to record the number of words heard and spoken, plus the number of “turns” in a conversation—the amount of back-and-forth between parent and child. Words heard on television did not count. The full results haven’t been published yet, but individual participants’ data show dramatic increases in parent-child interaction.
Suskind’s team has numerous studies at various stages, from the planning process to newly published. One staff member is studying how to reach mothers of newborns while they’re still in the hospital. Others are exploring a potential partnership with an established home-visiting program in Chicago to administer an updated Thirty Million Words curriculum. Ideas abound, from young father outreach to working with libraries and pediatricians’ offices. Suskind was just named to the advisory board of Hillary Clinton’s early childhood partnership Too Small to Fail. And she has been invited to present her ideas for a parent language initiative to the White House’s Office of Science and Technology Policy in early October. She imagines a second iteration of Michelle Obama’s Let’s Move campaign: Let’s Talk.
* * *
The Thirty Million Words curriculum is delivered in 12 weekly home visits, each with a multimedia computer presentation for a home visitor and parent to review together on a laptop.
Week 1 begins with a provocative scene. Four animated figures stand in a row: from left to right, an Asian man, an African-American woman, a blond Caucasian woman, and a Hispanic man. A question flashes across the screen: “Whose child will be the smartest?”
Next slide: Now the parents’ outfits reveal their occupations. The Asian man is a janitor, the black woman is a doctor, the white woman works at a fast-food restaurant, and the Hispanic man is a college student. “Does your answer change?” the presentation asks. Click again, and now you see how often the parents talk to their children. The janitor comes out on top, and the fast-food worker is second-highest.
Whose child is smartest now?
The presentation triggered a powerful reaction in Shurand Adams, 25. It prompted her to consider the possibility that, despite her lack of formal education, she had the power to teach her daughter, 3-year-old Teshyia Young. “I don’t have the best vocabulary. I don’t have all the academic skills that I wish I had to give to her,” said Adams, a gentle young woman who dropped out of high school to work for McDonald’s. She said her home visitor, the research coordinator from Suskind’s office, encouraged her to read to her daughter, and “maybe if I don’t know a word, just try to get through it the best I can. … It really gave me a lot of courage and a lot of strength to feel that I am teaching her.”
Adams said she used to think her role as a mother consisted of cleaning, cooking, and making sure her daughter is fed and in clean clothes. Education would begin in kindergarten. But through the weekly interactive presentations and analyses of the recordings of her talking to Teshyia, her views changed.
She learned not only to read to her daughter but to pause on each page to give Teshyia a chance to weigh in. She learned to continually engage her daughter in conversation, whether about food names in the grocery store or colors in the park. “Now I know I can just have a regular conversation with her,” Adams said. “Just ask her about her day, even if I can’t understand half of it.” She was teaching Teshyia the letters of her name on the day I met them, and she’s considering possibilities for continuing her own education.
Topics in the Thirty Million Words curriculum include how to go on a television “diet” and how to effectively encourage a child. The home visitors always present the research behind their recommendations.
“We’re not just telling parents to do something. We’re telling them why,” said Beth Suskind, Dana’s sister-in-law, who runs the office while Dana goes back and forth from the operating room. The office is filled with pink metallic piggy banks, which are given to participants to emphasize the idea that every word they say is like a penny in the bank of their child’s mind.
A similar curriculum is used with Dana Suskind’s original brainchild, Project Aspire, like Thirty Million Words but for children hearing through cochlear implants or other sound-amplifying devices such as hearing aids. Those whose parents talk and listen to them often seem to have success learning to speak, and the program is now undergoing a research trial.
As an early test of how their idea would apply to a general population, Suskind and her team monitored 17 nannies, mostly working for University of Chicago faculty, caring for children ages 10 months to 3 years. After a single, hourlong home visit on language enrichment, the nannies used an average 395 more words per hour, a 32 percent increase. They gave children a chance to respond 14 times more per hour, a 25 percent increase. The findings, published this summer in Communication Disorders Quarterly, suggest that even children from affluent families might be able to benefit from targeted talking.