Parenting Behavior and Child Language: A Meta-analysis · Parenting Behavior and Child Language: A...
Transcript of Parenting Behavior and Child Language: A Meta-analysis · Parenting Behavior and Child Language: A...
Parenting Behavior and ChildLanguage: A Meta-analysisSheri Madigan, PhD,a,b,* Heather Prime, PhD,c,* Susan A. Graham, PhD,a,b Michelle Rodrigues, MSc,d Nina Anderson, BSc,a
Jennifer Khoury, PhD,e Jennifer M. Jenkins, PhDd
abstractCONTEXT: Early language development supports cognitive, academic, and behavioral success.Identifying modifiable predictors of child language may inform policies and practices aimingto promote language development.
OBJECTIVE: To synthesize results of observational studies examining parenting behavior andearly childhood language in typically developing samples.
DATA SOURCES: Searches were conducted in Medline, Embase, PsycINFO, Web of Science, andDissertation Abstracts (1967 to 2017).
STUDY SELECTION: Studies had 1 of 2 observational measures of parenting behavior (i.e., sensitiveresponsiveness or warmth) and a measure of child language.
DATA EXTRACTION: Data from 37 studies were extracted by independent coders. Estimates wereexamined by using random-effects meta-analysis.
RESULTS: Two meta-analyses were conducted, which examined (1) the association betweensensitive-responsive parenting and child language (k = 36; r = 0.27; 95% confidence interval:0.21 to 0.33); and (2) the association between parental warmth and child language (k = 13; r =0.16; 95% confidence interval: 0.09 to 21). The pooled effect size for the association betweensensitive responsiveness and child language was statistically higher than that of warmth andchild language. The association between sensitive responsiveness and child language wasmoderated by family socioeconomic status (SES): effect sizes were stronger in low and diverseSES groups compared with middle to upper SES groups. Effect sizes were also stronger inlongitudinal versus cross-sectional studies.
LIMITATIONS: Results are limited to typically developing samples and mother-child dyads.Findings cannot speak to causal processes.
CONCLUSIONS: Findings support theories describing how sensitive parenting may facilitatelanguage and learning.
aDepartment of Psychology, University of Calgary, Calgary, Canada; bAlberta Children’s Hospital Research Institute, Calgary, Canada; cOfford Centre for Child Studies, McMaster University,Hamilton, Canada; dDepartment of Applied Psychology and Human Development, University of Toronto, Toronto, Canada; and eDepartment of Psychiatry, Harvard Medical School, HarvardUniversity, Boston, Massachusetts
*Contributed equally as co-first authors
Dr Madigan conceptualized and designed the study, coordinated data collection, conducted the analyses, and drafted the initial manuscript; Dr Prime supervised andassisted in data collection, drafted the initial manuscript, and reviewed and revised the manuscript; Ms Rodrigues, Ms Anderson, and Dr Khoury assisted in datacollection and contributed to and critically reviewed the manuscript; Drs Jenkins and Graham assisted with study conceptualization and design and critically reviewedthe manuscript; and all authors approved the final manuscript as submitted.
DOI: https://doi.org/10.1542/peds.2018-3556
Accepted for publication May 10, 2019
To cite: Madigan S, Prime H, Graham SA, et al. Parenting Behavior and Child Language: A Meta-analysis. Pediatrics. 2019;144(4):e20183556
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One of the most critical developmentalmilestones in early childhood is theacquisition of language.1 Early deficitsin language have been found to beassociated with difficulties in cognitiveabilities, academic achievement,occupational outcomes,2,3 and mentalhealth.4,5 Many factors are associatedwith children’s language development,which include both genetic andenvironmental influences. Heritabilityfor language skills has been estimatedat 25%.6,7 Many environmentalinfluences have been associated withlanguage development, including birthoutcomes,8 socioeconomic status(SES),9 spoken language by parents,10,11 turn-taking,12 and siblingbehavior.13
Several aspects of parenting behavior,focused on relationship quality andincluding behaviors such assensitivity, responsiveness, andwarmth, have also been associatedwith children’s language outcomes.Sensitive responsiveness includescontingently responding to children’sverbalizations and initiations, andaccordingly, attuned and stimulatingcommunicative exchanges. Oneaccount of why such behavior isimportant to children’s developmentis rooted in attachment theory,14
which suggests that sensitive-responsive parenting providesa secure base for exploration and aidsin the formation of secureattachment. Moreover, a sensitive-responsive parent is believed tooperate within the child’s zone ofproximal development, therebybuilding the neural architecture forjoint attention and language.15–17
Warmth involves providing comfortand support during interactions withthe child. These parenting behaviorshave been linked to a variety ofadvantageous outcomes in childrenworldwide,18–21 including inlanguage. Although the majority ofstudies to date have confirmedassociations between parentingbehaviors and child language, thereare some studies that have shown no
association or weak associations.22–24
These mixed findings led us to comparethe relative strength of the associationsof sensitive responsiveness andwarmth, respectively, with childlanguage. Because of the contingentnature of sensitive-responsivebehaviors, which foster attuned dyadiccommunicative engagement,8,25,26 wehypothesized that sensitive-responsivebehaviors would be more stronglyassociated with child language thanparental warmth.
Moderator analyses cansystematically examine why there isvariation in effect sizes across studiesin a meta-analysis. They can detail“for whom” and “when” effect sizesare stronger or weaker, which canprove highly informative forprevention and interventions seekingto target their efforts. For example,socioeconomic disparities areassociated with children’s languageskills9,27 as well as parental behaviorssuch as linguistic input andsensitivity.28,29 Because severalstudies have found that parentingbehaviors are more stronglyassociated with child language inhigh-risk circumstances,8,13 it isimportant to test this meta-analytically. It is also of interest toexamine child sex and age aspotential moderators of associations.There is evidence that mothers mayexhibit less responsive parentingtoward male versus female children30
and that parenting behavior may havea greater impact on children’slanguage skills at certaindevelopmental stages of language.31
Our primary objective in the currentstudy was to statistically synthesizefindings from a large number ofstudies on 2 primary types ofparenting (sensitive responsivenessand warmth) as they relate to childlanguage skills. A second objectivewas to further understand variationin effect sizes, and thus, moderatoranalyses were used to explore wheneffect sizes are stronger or weaker.These included child age, sex, and
family SES. Also included weremethodologic moderators such asdyadic observation duration andlocation, sample type (term versuspreterm), and study design (cross-sectional versus longitudinal).
METHODS
Definitions of Constructs
Child language in the current studyrefers to either receptive or expressivelanguage assessed via parent-reportquestionnaires (eg, MacArthurCommunicative DevelopmentInventory32) or standardizedassessments (eg, Peabody PictureVocabulary Test33). In terms ofobserved parenting constructs,sensitive responsiveness refers toa parent’s ability to perceive andinterpret the child’s signals and cuesand to respond to those cues andsignals promptly and appropriately.14
Warmth refers to caregiver physicalaffection or their positive affectivequality during contact andinvolvement with the child.
Search Strategy
Searches were conducted bya medical librarian in Medline,Embase, PsycINFO, Web of Science,and Dissertation Abstracts up to June2017 (Supplemental Information).Both database-specific subjectheadings (when available) and textword fields were searched for theconcepts of “language,” “parents,” and“children.” Synonymous terms werefirst combined with the Boolean “OR.”These 3 concepts were thencombined with the Boolean “AND.” Inall databases, truncation symbolswere used in text word searcheswhen appropriate to capturevariations in spelling and phrasing.References of all included studieswere also searched. No language ordate limits were applied.
Study Eligibility Criteria
Inclusion criteria were as follows: (1)a typically developing sample; (2)
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a measure of child language, inEnglish, including measures ofreceptive (eg, understanding ofwords) or expressive language (eg,total utterances); (3) an observationalmeasure of sensitive responsivenessor warmth; and (4) a statistic thatcould be transformed into an effectsize. If effect sizes could not becalculated from the statisticsprovided, the corresponding authorwas contacted for this information.Exclusionary criteria includedsamples of children with diagnosticlanguage delays, intellectualdisabilities, deafness (in parents orchildren), hearing loss or middle eardisease, autism spectrum disorders,speech anomalies, and brain injuries.Intervention studies were onlyincluded if they provided pretest (orbaseline) estimates of parenting andlanguage.
Screening of Search Results
All titles and abstracts emerging fromthe search strategy were reviewed todetermine eligibility criteria. Anexperienced systematic reviewer(S.M.) trained a group of coders onthe title and abstract review. Whentitles and abstracts were insufficientto determine eligibility criteria, fulltexts were retrieved.
Data Extraction
A data-extraction coding protocol wasdeveloped to extract effect sizes aswell as the following moderatorvariables: (1) SES, $80% of sampleconsidered middle to upper or lowSES (mixed SES = diverse); (2) childsex (percentage of boys); (3) child age(in months at languagemeasurement); (4) location (homeversus laboratory) and duration ofparenting observation (in minutes);(5) sample type (term versuspreterm); and (6) study design(cross-sectional versus longitudinal).Approximately 10% of the articlesmeeting inclusion criteria weredouble coded throughout the dataextraction process. Reliability oncontinuous measures based on
Pearson correlations were r .0.93.Reliability on categorical measuresbased on k estimates ranged from0.64 to 1.0. Any disagreements wereresolved with the expert coder.
Assessment of Study MethodologicQuality
An assessment of the methodologicquality and validity of each study andtheir risk of bias was conducted byusing a 13-point quality assessmenttool adapted from the NationalInstitutes of Health QualityAssessment Tool for ObservationalCohort and Cross-Sectional Studies34
(Supplemental Table 3). Studies wereassigned a score of 1 if the criterionwas sufficiently met (SupplementalTable 4). A total score was thencalculated by summing criteria withpossible scores ranging from 0 to 13.Any study deemed to have lowmethodologic quality (scores #5)were removed from analyses.
Data Synthesis and Analysis
Data Synthesis
We identified overlapping studies anddeveloped a protocol for sampleselection to ensure inclusion ofindependent effect sizes for bothmeta-analyses. If there were multiplestudies published based on the samedata set, we selected the study withthe largest sample size, readilyavailable statistics, andpsychometrically soundmeasurement. If a single studyassessed sensitive responsiveness orwarmth, both effect sizes wereextracted and their associations withchild language were examined inseparate meta-analyses. If a singlestudy provided a measure ofreceptive and expressive language,these 2 effect sizes were pooled toprovide the most global andrepresentative assessment of childlanguage. If studies assessed languageat multiple time points, the latest timepoint of language was selected tocapture the most developed languageskills.35,36 The most temporally
distant effect size for parenting andchild language was selected whenmultiple assessments of parentingbehavior were provided. Finally, ifstudies reported multiple effect sizesfor term versus preterm infants andthe samples did not containoverlapping participants, they wereentered into the meta-analysisseparately.
Sensitivity Analysis
Outlier detection was examined inSPSS (version 23.0; IBM SPSSStatistics, IBM Corporation) by usingvisual inspection of box plots. Studieswith an effect size value 63 SDs fromthe mean were considered outliers.
Data Analysis
Comprehensive Meta-AnalysisSoftware (version 3.0)37 was used tocalculate and analyze effect sizes andmoderator analyses. Effect sizes werecalculated directly from informationprovided in each study (eg,correlations, means and/or SDs, etc;see Supplemental Table 5 for detailsof data extraction of effect sizes). In 1study, a nonsignificant finding wasreported without accompanyingstatistical information, and therefore,P = .50 was entered into theComprehensive Meta-AnalysisSoftware.38 Pooled effect sizes arerepresented as correlations with 95%confidence intervals (CIs).Calculations were based ona random-effects model to account forexisting heterogeneity amongstudies.38 To formally assess forheterogeneity of effect sizes, the Qand I2 statistics were computed. Asignificant Q statistic and an I2 .50%suggest moderators should beexplored.23 Heterogeneity of effectsize and significance of categoricalmoderators were determined byQ-statistics,38,39 and dimensionalmoderators were determined bymixed-effects–model meta-regressions.40 Given the preferencefor studies with significant findings tobe published in the literature, there isrisk of meta-analyses overestimating
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overall effect sizes. Thus, in additionto including a dissertation databasesearch in our search strategy, theEgger test and funnel plots were usedto examine publication bias.
RESULTS
Studies Selected
The number of nonduplicate abstractsidentified by using this searchstrategy was 12 949. Figure 1 outlinesthe Preferred Reporting Items forSystematic Reviews and Meta-Analyses flow diagram.41 Of thoseidentified in the search, 315 metinitial screening criteria, and full-textabstracts were retrieved. Of these,278 were excluded. No outliers wereidentified. In total, 37 studies (with39 samples) met full inclusion criteriaand proceeded to methodologicreview for final determination ofstudy inclusion.
Study Characteristics
A detailed description of study andsample characteristics can be foundin Table 1. Sample size across studiesranged from 9 to 1026 (median =142). The average child age at thelanguage assessment was33.5 months (range = 12–71 months),and the mean percentage of boyswas 51.1%.
Methodologic Quality Review
The mean score across all studies formethodologic quality was 9.24 ofa possible maximum of 13.0 (range =6–12; Supplemental Table 4). Thus,all studies met the inclusion criteriafor methodologic quality (ie, a scoreof $5).
Meta-analyses: Pooled Effect Sizes
The effect size for the associationbetween sensitive responsivenessand child language across 36 samples(7315 parent-child dyads) wassignificant (r = 0.27 [95% CI: 0.21 to33]; Fig 2). There was no indication ofpublication bias (Supplemental Fig 3;Egger test P = .14). A separate
meta-analysis was conducted todetermine the pooled associationbetween parental warmth and childlanguage across 13 samples(1961 parent-child dyads). Thisassociation was also significant (r =0.16 [95% CI: 0.09 to 0.21]; Fig 2).There was no indication ofpublication bias (Supplemental Fig 4;Egger test P = .13). CIs (95%) aroundthe pooled effect sizes for sensitiveresponsiveness and language versusparental warmth and language wereused to assess statistical significancebetween the 2 effect sizes.78 Resultsindicated that the associationbetween sensitive responsivenessand child language was statisticallystronger than that between parentalwarmth and child language.
Moderator AnalysesFor the association between sensitiveresponsiveness and child language,the Q statistic was significant (Q =225.11; P , .001; I2 = 84.5),indicating heterogeneity of effectsizes. Moderator analyses revealedthat effect sizes varied according tofamily SES, with stronger effect sizesseen in the low SES (k = 7; r = 0.37;95% CI: 0.19 to 0.53) and diverse SES(k = 17; r = 0.29; 95% CI: 0.22 to0.36) groups compared with themiddle to upper SES group (k = 12;r = 0.15; 95% CI: 0.05 to 0.24). Effectsizes also varied as a function ofwhether the study examinedassociations longitudinally (k = 24;r = 0.30; 95% CI: 0.23 to 0.37) versuscross-sectionally (k = 12; r = 0.18;
FIGURE 1Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow used to identify studiesfor detailed analysis of parenting and children’s language.
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TABLE1StudyCharacteristicsforStudiesIncluded
intheMeta-analyses
onParentingBehavior
andChild
Language
Study
Year
NChild
Characteristics
SES
ObservationLocationandDurationa
StudyDesign
SampleType
ParentingType
Language
Type
Ageb
Boys,%
Bakeret
al42
2010,noautism
group
930
64Middle-upper
Laboratory,5
Longitudinal
Term
SRBoth
Barnettet
al43
2012
174
3648
Diverse
Laboratory,10
Longitudinal
Term
SRBoth
Beckwith
andRodning4
41996
5136
55Diverse
Laboratory
Longitudinal
Preterm
SRBoth
Beeet
al45
1982
140
3649
Middle-upper
Home
Longitudinal
Term
SRBoth
Bornsteinet
al46
2007
254
2054
Diverse
Home,10
CSTerm
SRBoth
Cheung
andElliott47
2016
164
6744
Middle-upper
Home,30
CSTerm
SRBoth
Clarke-Stewart48
1973
3817
53Low
Home,90
Longitudinal
Term
SRBoth
Cusson
492003
4326
50Low
Laboratory
Longitudinal
Preterm
SRBoth
Gaertner
c,50
2013
236
5456
Diverse
Laboratory,6
Longitudinal
Term
SR,w
armth
Both
Gocekc
,51
2007,norisk
3921
59Diverse
Laboratory,10
CSTerm
SRBoth
2007,risk
3921
54Diverse
Laboratory,10
CSTerm
SRBoth
Greenberg5
21988,term
4024
57Middle-upper
Laboratory,10
Longitudinal
Term
SRBoth
1988,preterm
3024
44Middle-upper
Laboratory,10
Longitudinal
Preterm
SRBoth
Hann
etal53
1996
6944
45Diverse
Laboratory,6
Longitudinal
Term
SR,w
armth
Receptive
Heinicke
etal54
1986
4424
50Middle-upper
Home
Longitudinal
Term
SRExpressive
Karrasset
al55
2003
102
1655
Middle-upper
Laboratory,5
Longitudinal
Term
SRBoth
Kelly
etal56
1996
5336
57Diverse
Laboratory,20
Longitudinal
Term
SR,w
armth
Both
Keow
net
al57
2001
4243
50Diverse
Home,30
CSTerm
SR,w
armth
Both
Landry
etal58
2008
6922
50Low
Laboratory,10
Longitudinal
Preterm
SR,w
armth
Both
Lovasc,59
2002
113
1856
Low
Laboratory,12
CSTerm
SRExpressive
Madigan
etal8
2015
467
3651
Middle-upper
Home,15
Longitudinal
Term
SRBoth
Magill-Evans
andHarrison
602001
9348
59Middle-upper
Home,120
Longitudinal
Term
,preterm
SRBoth
McElwainet
al61
2012
120
3350
Diverse
Laboratory,22
CSTerm
SRExpressive
Mistryet
al62
2004
984
3652
Diverse
15Longitudinal
Term
SRBoth
Mol
andNeum
an63
2014
6071
37Diverse
Home,12.5
Longitudinal
Term
SRBoth
Nozadi
etal64
2013
212
3055
Middle-upper
Laboratory,3
Longitudinal
Term
SRExpressive
Olsonet
al65
1984
117
2457
Diverse
Home,360
CSTerm
Warmth
Receptive
Pearsonet
al66
2011
732
4952
Diverse
Laboratory,5
Longitudinal
Term
Warmth
Both
Podm
ore6
71988
7542
47Diverse
Home
CSTerm
SR,w
armth
Both
Pungello
etal68
2009
146
2750
Low
Laboratory,10
Longitudinal
Term
SRBoth
Ransonec,69
2017
946
2750
Diverse
Laboratory,10
Longitudinal
Term
SRBoth
Ruffm
anet
al70
2006
5548
40Middle-upper
10Longitudinal
Term
SR,w
armth
Receptive
Steelman
etal71
2002
282
4047
Low
Home,60
Longitudinal
Preterm
SR,w
armth
Both
Steinet
al72
2008
944
3650
Diverse
Home,120
Longitudinal
Term
SRBoth
Tompkinsc
andFarrar
732011
3757
49Diverse
Home
Longitudinal
Term
Warmth
Both
Vernon-Feagans
etal74
2012
1026
3751
Low
Home,40
Longitudinal
Term
SRBoth
VibbertandBornstein7
51989
3413
50Middle-upper
Home,70
CSTerm
Warmth
Both
Wallace
etal76
1998
9212
48Diverse
Laboratory,10
CSTerm
SR,w
armth
Both
Wasserm
anet
al77
1988
control
4524
62Middle-upper
Laboratory,5
CSTerm
SRExpressive
1988,n
onspeech
anom
alies
1323
38Diverse
Laboratory,5
CSPreterm
SRExpressive
CS,cross-sectional;SR,sensitiveresponsiveness.
aTimein
min.
bAgein
moat
child
language
assessment.
cDissertation.
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FIGURE 2Forest plot of the association between parenting behavior and child language. Observed effect sizes and 95% CIs are indicated for each sample. Thediamond shapes represent the pooled effect size.
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95% CI: 0.09 to 0.27). No othermoderators were significant(Table 2).
For the association between parentalwarmth and child language, between-study heterogeneity was notidentified (Q = 17.5; P = .13; I2 =31.3); thus, moderator analyses werenot explored.
DISCUSSION
Language development is 1 of thefundamental building blocks forschool readiness, readingcomprehension, academicachievement, and occupationaloutcomes.2,3,79–81 Results of thecurrent meta-analyses indicate thatchildren whose caregivers showhigher levels of sensitiveresponsiveness and warmth displaystronger language skills comparedwith children who received lowerlevels of such parenting behavior. Themagnitude of this effect sizetranslates into 2.8-fold increasedodds that children who receive theseparenting behaviors will acquirestronger language skills. This findingis in line with theoretical frameworks
describing how parenting behaviorscan help build the mental architecturerequired for children to engage withand learn from the social world.26,82
The meta-analytic associationbetween sensitive responsivenessand child language was highercompared with the associationbetween parental warmth and childlanguage. Consistent with attachmenttheory,14 this finding may speak tothe importance of attunedinteractions between a parent andchild to foster learning versuswarmth alone. That is, measures ofsensitive responsiveness are morelikely to capture the parents’contingent response to theirchildren’s interests, focus of gaze, anddevelopmental capacity. A sensitive-responsive parent can build on themoment-to-moment shifts inchildren’s attention, providing a finelytuned enhancement to the child’sexperience.26,82 Neural developmentis thought to occur through theinternalization of these finely tuned,reciprocal interactions.83 Warmth, onthe other hand, does not involvecontingency or reciprocity. Warmth
can be demonstrated withoutsolicitation if, for example, the parentis providing affection to the child,without any cues from the child. Theprovision of warmth can also benonverbal, whereas sensitiveresponsiveness is more likely to haveaccompanying utterances in responseto cues, which may be crucial for childlanguage development.
On a behavioral level, responsiveparenting may encourage childreninto social interactions that enhancelearning. For instance, children ofresponsive mothers have been foundto have an eager and willing stancetoward others84 and are moremotivated, exploratory, and enthusiasticto seek out new information. This, inturn, enhances the likelihood that theywill learn from their caregivers andothers in their environment.85 Thiswilling stance positions children tobenefit considerably from stimulatinginteractions. That said, a consequenceof children’s limited language and/orlimited interest or engagement inreciprocal exchanges with a parentis that parents may find feweropportunities to engage in sensitive-responsive parenting. Future researchshould examine this possibility throughcross-lag models that examine thedirectionality of associations betweenparenting behavior and child languageover time.43
Findings indicated that theassociations between parentalsensitive responsiveness and childlanguage were comparatively largerin samples with low and diverse SESgroups, as compared to middle toupper SES groups. A possibleinterpretation of this finding is thatmaternal sensitive responsiveness isparticularly advantageous tochildren’s language when they areraised in socially disadvantagedfamilies. These findings are in linewith previous evidence fromobservational research documentingthe protective effect of high-qualityparent-child interactions in thecontext of adversity.8,86 These
TABLE 2 Results of Categorical and Continuous Moderators for the Association Between ParentalSensitive Responsiveness and Child Language
Results
Categorical moderators k r 95% CI Homogeneity Q PSES — — — 8.09 .02Low 7 0.37* 0.19 to 0.53 —
Middle to upper 12 0.15* 0.05 to 0.24 —
Diverse 17 0.29* 0.22 to 0.36 —
Sample type — — — 0.20 .65Term birth 30 0.26* 0.19 to 0.41 —
Preterm birth 4 0.36 20.11 to 0.69 —
Observation location — — — 1.12 .29Family home 15 0.30* 0.19 to 0.41 —
Laboratory 19 0.23* 0.16 to 0.30 —
Study design — — — 4.04 .05Cross-sectional 12 0.18* 0.09 to 0.27 —
Longitudinal 24 0.30* 0.23 to 0.37 —
Continuous moderators k b 95% CI z score PChild age at language assessment 35 20.001 20.004 to 0.006 20.43 .67Percentage of boys in sample 36 20.007 20.020 to.006 21.12 .27Parenting observation length 31 0.001 20.002 to 0.003 0.71 .48
—, not applicable.* P , .001.
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findings also lend additional supportto economic analyses suggesting thatearly investments in preventiveinterventions in disadvantagedgroups may have the best return oninvestment.87,88 Although theseinterventions can be expensive toundertake, initial investment costsare often recovered because of cost-saving reductions in social servicesand health professional use.Specifically, it has been shown thatearly investments in disadvantagedchildren aged 0 to 5 result in a 13%return on investments.88
The association between sensitiveresponsiveness and child languagewas larger in studies usinglongitudinal versus cross-sectionalstudy designs. The sheer number oflongitudinal studies is notable (k =24), especially given the arduousnature of collecting long-termresearch and the potential theyprovide in terms of distinguishingpredictions from outcomes andaddressing directionality ofassociations.89 Methodologicallyspeaking, longitudinal designs aremore stringent and less susceptible tobias and are therefore considered toyield a truer estimate of effect sizes.Longitudinal designs are also morelikely to capture the enduring effectof parenting on child development.90
LIMITATIONS
Several limitations should be noted.First and foremost, meta-analyses of
observational studies arecorrelational in nature and thus donot permit conclusions aboutcausality. Conclusions about causalitycan only be made in the context ofexperimental studies,58,91–93 andapproximations of causality may bederived from longitudinal designsthat address directionality andtemporal precedence.94 Second, thesemeta-analysis focused on typicallydeveloping samples, and thus,findings are not generalizable tochildren with language delay,intellectual disability, autism, and/orhearing or vision difficulties. Third,the generalizability of the currentfindings is also limited to samples ofmother-child dyads. Although fathersengage in sensitive and responsiveparenting,95 the large majority ofstudies retrieved in this reviewreported on maternal, as opposed topaternal, measures of parentingbehavior. Given the unique role thatfathers’ language plays in children’slanguage development,96,97 there isa need for more published research inthis area. Finally, because ofinsufficient studies stratifying resultson the basis of birth order,98–100 wewere unable to examine this variableas a potential moderator ofassociations.
CONCLUSIONS
Early language development is anessential developmental skill thatfosters academic, social, and
behavioral success and well-being.29,101 As such, understanding theantecedents to individual differencesin children’s language abilities iscritical to informing the policy andpractice guidelines that aim to laythe foundation for healthydevelopmental trajectories. Thefindings indicate a moderateassociation between sensitive-responsive parenting and children’slanguage skills.102,103 Sensitiveresponsiveness is a modifiable riskfactor that has been successfullytrained in parents in randomizedcontrolled trials and shown toimprove the language developmentof children.25,58,91–93 Thus, thedemonstration of a significantassociation between sensitiveresponsiveness and children’slanguage coupled with the evidencefrom randomized controlled trials onimproving parental responsivenesssuggests the importance ofaddressing this skill in parents,particularly in economicallydisadvantaged families.
ACKNOWLEDGMENT
Cheri Nickel, MLIS (University ofCalgary), conducted the literaturesearch.
ABBREVIATIONS
CI: confidence intervalSES: socioeconomic status
Address correspondence to Sheri Madigan, PhD, Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada. E-mail:
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2019 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Supported by a grant from the Social Sciences and Humanities Research Council awarded to the first and last authors. Drs Madigan and Graham’s
contributions were supported by funding from the Alberta Children’s Hospital Foundation.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-2157.
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DOI: 10.1542/peds.2018-3556 originally published online September 24, 2019; 2019;144;Pediatrics
Anderson, Jennifer Khoury and Jennifer M. JenkinsSheri Madigan, Heather Prime, Susan A. Graham, Michelle Rodrigues, Nina
Parenting Behavior and Child Language: A Meta-analysis
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Parenting Behavior and Child Language: A Meta-analysis
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