facebook.com/DrLibrarian · (worden and boettcher, 1990; ehri and roberts, 2006) abcdefghijklmnopqrstuvwxyz middle-income child’s letter recognition (22 letters) low-income child’s

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Dipesh Navsaria,

MPH, MSLIS, MD

DIPESH NAVSARIA, MPH, MSLIS, MD !DEPARTMENT OF PEDIATRICS UW SCHOOL OF MEDICINE & PUBLIC HEALTH !SCHOOL OF LIBRARY AND INFORMATION STUDIES UNIVERSITY OF WISCONSIN–MADISON !MEDICAL DIRECTOR, REACH OUT AND READ WISCONSIN

HOW PROMOTING LITERACY IS KEY TO EARLY BRAIN AND CHILD DEVELOPMENT

B O O K S

B R A I N S

B U I L DB E T T E R

www.facebook.com/DrLibrarian Twitter: @navsariaLive-tweeting encouraged!

DISCLOSURE !

I have no relevantfinancial relationships to disclose.

!

I will not discussoff-label use or investigational use

in my presentation.

Although…

I don’t know if “mouthing” is an FDA–approved use of board books.

Image courtesy of Dipesh Navsaria

“Oh, that’s so nice…”CRITICAL

A stroll through the Early Brain !

Reading Reality !

Reach Out and Read

Detail from The Departure of Odysseus from the Land of the Phaeacians by Claude Lorrain, Louvre Museum. Public domain.

First, a story…

Part TwoReading Reality

Meaningful Differences in the Everyday

Experiences of Young American Children.

!

Todd Risley & Betty Hart, 1995

By Age 3… Welfare Professionals

Vocabulary Size 525 words 1100 words

IQ 79 117

Utterances 178/hour 487/hour

Encouragements 75,000 500,000

Discouragements 200,000 80,000

Children from low–income families hear as many as

30 million fewer words than their more affluent peers

before the age of 4.

ARIZONA

24

44

50439

2147

5131

101350*

43

21*

47.8

40.350.158.9

55.037.838.133.446.4

48.347.0

12.826.0

1,368

30

11.3

43.2

32.445.163.2

55.031.4

/26.0

/

40.648.1

18.733.6

2,398

24

9.7

ARIZONA STATE STATE RANKINGNATIONAL

White (non-Hispanic)

Black (non-Hispanic)

Hispanic

Other/Multiple

Racial/Ethnic Distribution amongChildren Age 0-5 in Arizona

(N~450,000)

Income Distribution among ChildrenAge 0-5 in Arizona (N~450,000)

400%FPL and above

<200% FPL

200-399% FPL

Parental Reading% Children ages 0-5 read to daily 1

% Daily reading by poverty level 1

Less than 200% FPL200-399% FPL400% FPL or greater

% Daily reading by race/ethnicity 1

White (non-Hispanic)Non-White

Black (non-Hispanic)HispanicOther/Multiple Race

% Daily reading by age 1

Children age 0-3 years read to dailyChildren age 4-5 years

Early Childhood Literacy Resources% Children served by ROR 2

% Children in/near poverty served by ROR 2

Number of children age 0-5 per public library 3

School Performance% Students at or above Proficient in reading, Grade 4 4

% Children age 6-17 who have repeated at least one grade1

Reading Across the Nation: A Chartbook | October 2007 www.reachoutandread.org | www.healthychild.ucla.edu

ror.final 11/16/07 9:39 AM Page 25

The Problem: One-Third of Children Enter School Unprepared to Learn35% of American children entering kindergarten today lack the basic language skills

they will need to learn to read. And children living in poverty are especially at risk.

Children who start out with reading difficulties are more likely to remain poor

readers and ultimately fail in school. Without intervention, they will grow into

adults with low literacy skills and poor economic potential. Since 20% of U.S.

workers are functionally illiterate, this problem is not only a tragedy for each

individual; it also has a significant effect on the ability of the United States to

compete in the global economy.

The Science:Early Exposure to Language is CriticallEarly language skills, the foundation for reading ability, are based primarily on

language exposure – resulting from parents and other adults talking to young

children. Research shows that the more words parents use when speaking to an 8-

month-old infant, the greater the size of their child’s vocabulary at age 3. Recent

studies, including the landmark Hart-Risley study on language development, show

that children from low-income families hear as many as 20 million fewer wordsthan their more affluent peers before the age of 4. The problem is compounded

further by the fact that low-income children are far more likely to not have any

children’s books in their homes.

School reform, including universal pre-kindergarten,

is vital, but far too much time is lost before children

enter the classroom. Intervening early to improve

the home learning environment for disadvantaged

children will ensure that they are ready to learn

when they enter school and succeed later in life. In

fact, Nobel Prize-winning economist James J.

Heckman found that economic returns on dollars

invested in early education are as high as 15-17%

per year – higher than other traditional economic

development strategies.

Low-income children are at a disadvantagebefore school beginsA TYPICAL MIDDLE-CLASS 5-YEAR-OLD IS ABLE TO IDENTIFY 22 LETTERS

AND SOUNDS OF THE ALPHABET, COMPARED TO JUST 9 LETTERS FOR A

CHILD FROM A LOW-INCOME FAMILY.

(WORDEN AND BOETTCHER, 1990; EHRI AND ROBERTS, 2006)

A B C D E F G H I J K L M N O P Q R S T U V W X Y ZMIDDLE-INCOME CHILD’S LETTER RECOGNITION (22 LETTERS)

LOW-INCOME CHILD’S LETTER RECOGNITION (9 LETTERS)

ROR

3

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Courtesy of Reach Out and Read National Center

One-third of children

enter school unprepared

to learn.

Most (88%) will never catch up.

Creative Commons-licensed work by flickr user Horizontal Integration

School intervention is too late. Innate interest in learning and curiosity can be irreparably damaged if reading is not enjoyable at an early age.

Reading difficulty

School failure

Absenteeism

School dropout

Juvenile delinquency Substance abuse

Teenage pregnancy

Poverty & Dependency

When I think about children growing up in homes without books, I have the same

visceral reaction as I have when I think of children in homes without milk or food or heat: It cannot be, it must not

be. It stunts them and

deprives them before they’ve had a fair chance.

— Perri Klass, MD

Chicago, 1985

“The group in Washington that did the study looked at three factors,” he said. “The first was our sentencing laws; the second was the crimes that were being committed. The third factor, the key factor, was the

reading and math scores in the fourth, fifth,

and sixth grades.” The projection of 21,000 beds proved to be very accurate…

Mississippi State Senator Willie Simmons […] said that the state of Mississippi once used elementary school achievement scores to project future prison population. In 1992 [he] was the deputy commissioner of Mississippi’s Department of Corrections [which] commissioned a study to project what the state’s prison population [...] would be in 10 years. !

America’s Cradle-to-Prison Pipeline: A Report of the Children’s Defense Fund, October 2007

Why Reading?

Everyone needs

to read. !

Even stormtroopers.

Image courtesy of Dipesh Navsaria

Reading is the fundamental skill

for learning

Awareness of books

Understanding of printed words and what they

represent

Emergent Literacy: the early display of an awareness by children that print conveys information. It is an amalgamation of children’s oral language development and their initial attempts at reading and writing. Such attempts include “reading” the pictures of a book, or scribbling. Emergent literacy, if supported by meaningful interaction in oral and written language, evolves into full literacy skills. (Teale & Sulzby, 1986)

���=king

�=state (or “kingdom”)

�=center (or “middle”)

“Middle Kingdom” or…China!

Awareness of books

Understanding of printed words and what they

represent

Using background knowledge and

strategies to obtain meaning from print

In the great green room…

Awareness of books

Understanding of printed words and what they

represent

Using background knowledge and

strategies to obtain meaning from print

Fluent reading

Dialogic Reading: The act of reading becomes a conversation between the adult and the child; the adult helps the child become the teller of the story by becoming the listener, questioner, and audience for the child.

Some people there are who, being grown, forget the horrible task of learning to read. It is perhaps the single greatest effort that the human undertakes, and he must do it as a child. !

John Steinbeck

Creative Commons-licensed work by flickr user tempophage

General Aspects of Language Development

Extended Vocabulary and Language Development

Phonological Awareness (“dog” vs “dark”)

Speech Discrimination (“coat” vs “goat”)

Knowledge of narrative

Literacy as a Family Activity

Parent “teaching” to child

Sharing family and other stories

Physical closeness

Part of routine and ritual

General Aspects of Print Awareness

Letter and early word recognition

Comprehension of physical text

Reading to children maynot be a natural skill for adults.

Reading at all may not be

something an adult is capable of.

Reading problems may have been an issue for generations.

The babe in the cradle knows about the dragon; he needs the stories to know about Saint George. !

GK Chesterton

Public-domain image from Cassell, Petter, Galpin & Co.: “Magazine of Art Illustrated” (1878)

Reading should be fun!

Part ThreeReach Out and Read

Images from Reach Out and Read National Center

Reach Out and Read prepares America’s youngest children to succeed in school by partnering with clinicians to prescribe books and encourage families to read together.

Creative Commons-licensed work by flickr user DucDigital

In the exam room, health care providers trained in the developmental strategies of early literacy encourage parents to read aloud to their young children, and offer age-appropriate tips.

One

Image courtesy of Dipesh Navsaria

The primary care provider gives every child between the ages of six months and five years a new, developmentally-appropriate children’s book to take home and keep while intentionally and skillfully observing the child and family’s interaction with the book.

Two

Literacy-rich waiting rooms feature books, posters and reading nooks. Volunteers read aloud to children, showing parents and children the techniques and pleasures of looking at books together.

Three

Our goal is not about

Teaching a child to actually read early

It is about learning to love books.

Nearly 90% of all young children see a child health provider at least annually for a check-up, while less than one-third are

in any childcare setting, the next most common

contact with a formal service system.

Charles Bruner, writing in The Colorado Trust’s Issue Brief: Connecting Child Health and School Readiness,

February 2009Creative Commons-licensed work by flickr user dmason

Evidence

15 studies published in peer-reviewed medical journals

Needlman et al., 1991…High et al., 1998…Golova et al., 1999…High et al., 2000…Sanders et al., 2000…Jones et al., 2000…Mendelsohn et al., 2001…Sharif et al., 2002…Silverstein et al., 2002…Theriot et al., 2003…Weitzman et al., 2004…Needlman et al., 2005…Byington et al., 2008…King et al., 2009

ROR increases the likelihood that children at-risk will be read to regularly.

!ROR improves language scores in young children at-risk.

!ROR improves the home literacy environment. !There is more extensive published research

available supporting the ROR model than for any

other psychosocial intervention in general pediatrics.

The British Millennium Cohort Study

Pediatrics, February 2010

12,500 children given vocabulary tests at age 5 Delays of almost a year in the poorest homes

“The research shows that a child who is read to every day at age 3 has a vocabulary at age 5 that is 1.92

months more advanced than a child who has exactly the same

observable characteristics (including income group), but who is not read to

every day at age 3.”

“More affluent family circumstances are clearly associated with better parenting behaviours. At age 3, 78% of the richest

children were read to daily and 91% had regular bedtimes, much higher than the corresponding numbers for the lowest

income group.”

“Nevertheless, it is still the case that 45% and 70% of the lowest income parents practiced these beneficial behaviours,

providing grounds for optimism that good

parenting can be adopted and

extended in even the most

disadvantaged families.”

Parenting Behaviours, Perceptions, and Psychosocial Risk: Impacts on Young Children’s Development

Glascoe FP, Leew S. Pediatrics, January 2010 382 families assessed for child language development

“Of the families who seemed to be nonreaders or limited book readers, 21% had children at risk for developmental problems, compared

with 12% of the families who were book readers…Families for whom book reading was uncommon were almost twice as likely to

have a child with delays.”

“By 6 months of age, children whose parents read aloud frequently outperformed children

whose parents read rarely; this pattern continued through 24 months of age.”

!“Differences in communications skills increased with age, and the magnitude of the discrepancy between groups increased steadily with the age of the child.”

!“Another critical focus for future studies is to

operationalize parenting behaviors/perceptions into developmental promotion interventions that are brief and workable in busy primary care settings, following the example of effectiveness research established by the Reach Out and Read

program.”

What we do Reach Out and Read in the Exam Room

Videos courtesy of Reach Out and Read – Massachusetts

Model dialogic reading and explain to the parents what you’re doing: !name pictures for the infantask a toddler “what’s that?”ask the 3 year old “what’s that color?”ask a 5 year old “what’s he going to do next?”

Six to Twelve months

Child sits up, reaches for the book, and

grasps it

Puts the whole book in mouth immediately

Bats at pages with hand…or may have a pincer grasp later on

Six to Twelve months

“Allow your baby to explore and mouth the book”

“Point at objects and name them to encourage language

development”

“Respond when your baby makes sounds or taps a picture.”

Six to Twelve months

books with few (or one!) word per page

sturdy and mouthable

small, easy to grasp

board pages which turn easily

pictures of faces and babies

bright, contrasting colors

Image courtesy of Dipesh Navsaria

Image courtesy of Dipesh Navsaria

Image courtesy of Dipesh Navsaria

6 months

Larry

Accessible at

Child

Parent

Initially not focused

Receives book: his joy is apparent!

Calms, brings hands to midline,

focuses

Rudimentary attempts to turn/

stroke pages

Proud of his interest and

glee

Lets him explore book because provider said it

was “ok”

Has questions and is clearly engaged

What did we see?

Twelve to Twenty-four months

Child holds the small, sturdy book Child identifies

common objects in the book

Turns the board books pages without help from the adult: several at once at first, then one at a time

later (ready for paper!)

“Point and label objects in the book”

“Ask your child to identify common objects on the page

(book, ball)”

“Expand on what they tell you: ‘Yes, it’s a truck! It’s a red truck!’”

Twelve to Twenty-four months

“Use the book as a transition or bedtime

tool”

still use board books

contains rhymes and sound effects (animal sounds)

theme orientation: shapes, colors

Twelve to Twenty-four months

contains familiar objects to name

Image courtesy of Dipesh Navsaria

Image courtesy of Dipesh Navsaria

12–15 months

Nyla

Accessible at http://youtu.be/DsJ2OkKrSHQ

Child

Parent

Constant, happy babble: exposed to language &

books

Eagerly explores book

with eyes/hands/mouth

Calms and tunes to Dad when she

reads

Holds book and turns pages easily

Allows Nyla control of

book

Describes enjoyment of quality time; notice joint

attention

Points to objects to engage and

teach

What did we see?

Encouraged not to give

up

Twenty-four to Thirty-six months

Child turns paper pages one at a time

Looks at the book with an adult; correlates spoken text

with pictures

Completes sentences and answers questions about the

story

Twenty-four to Thirty-six months

“Make reading part of daily routine: reading signs, etc.”

“Relate the story in the text to your child: you like to play ball

too!”

“Allow your child to complete rhymes.”

“Use the book as a transition or bedtime

tool”

books with paper pages

theme orientation: animals, trucks

emphasize routines of a child’s day: bedtime, outside, etc

Twenty-four to Thirty-six months

child’s sense of humor

advanced themes such as big/little, over/under

Image courtesy of Dipesh Navsaria

Three to Five Years

Child can answer questions about the story in complex

language: “what is happening on this page?”

“Why” questions about the story

Child participates in story and anticipates actions

Recognition of letter and print

conventions

“Let your child try to tell the story”

“Ask open-ended questions like ‘what do you think will happen

next?’”

“Respond to your child’s questions as

you read.”

“Point out the letters of your child’s name and make the sounds

of the letters.”

Three to Five Years

books with more sophisticated stories and multiple characters

fairytales

social themes such as sharing and taking turns

fun and predictable repetition: “four little monkeys jumping on

the bed”

Three to Five Years

Image courtesy of Dipesh Navsaria

Image courtesy of Dipesh Navsaria

Image courtesy of Dipesh Navsaria

Images courtesy of Dipesh Navsaria

5 years

Youcef

Accessible at

Child

Parents can…

Uses complex language and proper grammar

Asks and answers

questions

Recognizes letters

Anticipates outcomes

Lets child tell story

Respond to and expand on child’s questions

Provide books about child’s

specific interests

What did we see?

Encourage interest in books

and reading

Elaborates on storyline

CROWD: C let the child complete sentences in familiar books R recall what happened in the story already read O open-ended questions about pictures and story W what, when and why questions for preschoolers D distancing or encouraging the child to relate the

pictures or words to experiences outside the story (Whitehurst, 1992)

A bit about the books themselves…

We are not wise enough, we adults, to know what books will be right for any child at any particular moment, but the richer the book, the more imaginative, the more emotionally true, the more beautiful the language, the better the chance it will minister to a child’s deep inarticulate fears.

!—Katherine Paterson The Horn Book, Jan/Feb 1991

SPRING/SUMMER 1998

those heard on television.These relative differences in word rarity have di-

rect implications for vocabulary development. Ifmost vocabulary is acquired outside of formal teach-ing, then the only opportunities to acquire newwords occur when an individual is exposed to aword in written or oral language that is outside hiscurrent vocabulary.That this will happen vastly moreoften while reading than while talking or watchingtelevision is illustrated in the second column of Table1. The column lists how many rare words per 1000are contained in each of the categories.A rare wordis defined as one with a rank lower than 10,000;roughly a word that is outside the vocabulary of afourth to sixth grader. For vocabulary growth tooccur after the middle grades, children must be ex-posed to words that are rare by this definition.Again,it is print that provides many more such word-learn-ing opportunities. Children’s books have 50 percent

more rare words in them than does adult prime-timetelevision and the conversation of college graduates.Popular magazines have roughly three times as manyopportunities for new word learning as does prime-time television and adult conversation.Assurances bysome educators that “What they read and write maymake people smarter, but so will any activity that en-gages the mind, including interesting conversation”(Smith, 1989) are overstated, at least when applied tothe domain of vocabulary learning.The data in Table1 indicate that conversation is not a substitute forreading.

It is sometimes argued or implied that the type ofwords present in pr int but not represented inspeech are unnecessary words—jargon, academicdoublespeak, elitist terms of social advantage, orwords used to maintain the status of the users butthat serve no real functional purpose. A considera-tion of the frequency distributions of written andspoken words reveals this argument to be patentlyfalse. Table 2 presents a list of words that do notoccur at all in two large corpora of oral language(Berger, 1977; Brown, 1984), but that have apprecia-ble frequencies in a written frequency count (Fran-cis & Kucera, 1982). The words participation, lux-ury, maneuver, provoke, reluctantly, relinquish,portray, equate, hormone, exposure, display, in-variably, dominance, literal, legitimate, and infi-nite are not unnecessary appendages, concocted toexclude those who are unfamiliar with them. Theyare words that are necessary to make critical dis-tinctions in the physical and social world in whichwe live. Without such lexical tools, one will be se-verely disadvantaged in attaining one’s goals in anadvanced society such as ours. As Olson (1986)notes:

It is easy to show that sensitivity to the subtleties oflanguage are crucial to some undertakings.A person whodoes not clearly see the difference between an expressionof intention and a promise or between a mistake and anaccident, or between a falsehood and a lie, should avoid alegal career or, for that matter, a theological one.

The large differences in lexical richness betweenspeech and print are a major source of individual dif-ferences in vocabulary development. These differ-ences are created by the large variability among chil-dren in exposure to literacy.Table 3 presents the datafrom a study of the out-of-school time use by fifthgraders conducted by Anderson,Wilson, and Fielding(1988). From diaries that the children filled out dailyover several months’ time, the investigators estimatedhow many minutes per day that individuals were en-gaged in reading and other activities while not inschool.The table indicates that the child at the 50thpercentile in amount of independent reading wasreading approximately 4.6 minutes per day, or about ahalf an hour per week, over six times as much as thechild at the 20th percentile in amount of reading time(less than a minute daily).Or, to take another example,the child at the 80th percentile in amount of indepen-dent reading time (14.2 minutes) was reading overtwenty times as much as the child at the 20th per-centile.

Anderson et al. (1988) estimated the children’s read-

3 AMERICAN EDUCATOR/AMERICAN FEDERATION OF TEACHERS

Table 1Selected Statistics for Major Sources of Spoken and

Written Language (Sample Means)Rank of Rar e Wor ds

Median Wor d per 1 000

I. Printed textsAbstracts of scientific articles 4389 128.0Newspapers 1690 68.3Popular magazines 1399 65.7Adult books 1058 52.7Comic books 867 53.5Children’s books 627 30.9Preschool books 578 16.3

II. Television textsPopular prime-time adult shows 490 22.7Popular prime-time children’s shows 543 20.2Cartoon shows 598 30.8Mr. Rogers and Sesame Street 413 2.0

III. Adult speechExpert witness testimony 1008 28.4College graduates to friends, spouses 496 17.3

Adapted from Hayes and Ahrens (1988).

Table 2Examples of words that do not appear in two large

corpora of oral language (Berger, 1977; Brown, 1984) butthat have appreciable frequencies in written texts

(Carroll,Davies & Richman, 1971;Francis & Kucera, 1982):

displaydominancedominantexposureequateequationgravityhormoneinfiniteinvariably

literallegitimateluxurymaneuverparticipationportrayprovokerelinquishreluctantly

•Beware of the “developmentally appropriate” book which is marketed as such.

For more depth…

“What the Dormouse Said…”:

An accessible guide to the shadowy lands between child development,

reading & children’s literature.

!

Available now at www.navsaria.com

a freely distributable 50+ page PDF

Read aloud together daily.

Have a bedside lamp for your child and allow reading time every night possible.

Limit screen time to less than two hours a day.

No TV, computers or video games in bedrooms.

Audio Books are fine.

Visit your school and public libraries.

Have reading be fun, not a chore.

A D V I C E F O R P A R E N T S

A 600+ book professionally–curated collection

Spanning all ages from infants to teens

Compliant with infection control standards

AFCH Inpatient Reading Library

Amazing future extensions

and opportunitiesImage courtesy of University of Wisconsin Communications

Images courtesy of UW Pediatric Early Literacy Projects; taken by Gary P Williams, MD

We need solutions which…

Build capacities

Build capabilities

Are based in homes & communities

Address root causes

Have long-term effects

Are scalable

Address preventionLeverage the

first 1000 daysAre evidence-guided

Public domain work by Itcho Hanabusa

a book giveaway

a relational

assessment tool

developmental

surveillance

an educational

intervention

a parental

capacity-builder

a public health

approach

a scalable,

evidence-based

model

a toxic stress-

buffering routine

It’s All These Things.

T Questions?facebook.com/DrLibrarian

twitter.com/navsaria [email protected]

END

Image courtesy of Dipesh Navsaria

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