June 2018 Albuquerque Journal

Dana Suskind of the University of Chicago is a paediatric cochlear implant surgeon who implants hearing aids in hearing-impaired babies and toddlers. From the beginning of her surgical practice in 2005, Suskind encountered a frustration: While her paediatric patients from middle- and upper-income families rapidly caught up in language acquisition and speech, the children of low-income families did not. She set out to discover why. That is when she discovered the seminal work of psychologists Betty Hart and Todd Risley, who in the 1980s were the first to identify the language gap.

Their research followed 42 families in Kansas City, Kan., over three years, observing baby development from 9 months to nearly 4 years old. Based on characteristics like parental occupation, maternal education and income, they divided the families into three groups: high, middle and low socioeconomic status families. After recording and analysing everything “done by the children, to them and around them” for an hour per family each month over the course of three years, Hart and Risley found remarkable similarities in parenting approaches and goals. Parents all “socialised their children to a common cultural standard,” and the kids all learned to talk.

But the difference in the language they heard – the quality and quantity of words – was stunning. On average, in the course of one hour, the highest socioeconomic status children heard 2,000 words; the children of low-income families heard only 600. The highest-income parents responded to their kids an average of 250 times an hour; the lowest-income parents about 50 times.

The gap by 4 years old? Thirty million words. “But the most significant and most concerning difference? Verbal approval,” Suskind wrote in her book, “Thirty Million Words: Building a Child’s Brain.” “Children in the highest socioeconomic status heard about 40 expressions of verbal approval per hour. Children in welfare homes, about four.” Some scholars have questioned Hart and Risley’s findings, discrediting the small sample size and challenging the idea that altering language at home could help children overcome extreme social inequality.

But Suskind focused on a subtle point in her study: The essential factor that determined a child’s future learning trajectory wasn’t socioeconomic status. It was the quality – and positive nature – of the language spoken. Money didn’t matter; words did. “Children in homes in which there was a lot of parent talk, no matter the educational or economic status of that home, did better,” Suskind wrote. “It was as simple as that.”

In Chicago, the Thirty Million Words project today teaches new parents to “tune in, take turns and talk more” – the three T’s for paying attention to a child’s cues, taking conversational turns and talking more. Suskind envisions the program being implemented in prenatal care, at birthing hospitals, in paediatric clinics and home visits around the city.

In Pensacola, hospitals were an obvious place to start, since virtually every birth in the city occurs in one of the three facilities. Baptist Hospital, Sacred Heart Hospital and West Florida Hospital have been cutthroat competitors in nearly every medical specialty. But when the CEOs were individually approached, each agreed to collaborate.

Mother and babyBrain bagsBrain Bags are the brainchild of a Pensacola nonprofit called the Studer Community Institute, founded by health care guru Quint Studer, who made a fortune in hospital consulting before setting his sights on improving Pensacola. Each bag contains a binder with a bib and rattle reminding parents to “talk, talk, talk.” There is a picture book, “P is for Pelican,” and a workbook with developmental milestones for parents. The bags, free to parents, cost $25 apiece to produce. The $108,000 project is privately funded by a network of women donors and embraced by the business community; its outcomes will be tracked once babies born in the past year hit kindergarten. “In health care, the majority of money is spent on symptoms – the same thing in education,” said Studer, who has led the “Early Learning City” effort.

“In Florida, we tried to get some money for (age) 0 to 5, but it all went to ‘K’ and above because that is who has got all the lobbying power: the public school system and the universities,” he said. “But the reality is, if 85 percent of the brain is developed by age 3, that is where we need to be focused. What we’re really trying to do is treat the cause.”

Pensacola has given up waiting on the state and federal governments. Business leaders a year ago were persuaded by emerging brain science showing that about 85 percent of a child’s brain – including its 100 billion neurons – is hard-wired by the end of age 3. Language is what builds these brain connections and enhances a child’s capacity to learn; the most important component for building strong brains is parent talk.

Brain Bags emerged as one potential solution, as well as an effective fundraising tool for the philanthropic and private sectors. The Studer Community Institute acknowledges that it will take more than a bag and a delivery room conversation to change decades of inequality. It plans to reinforce the “tune in, take turns and talk more” message to parents wherever it will have the most impact. Reggie Dogan, who helped shape the institute’s mission, calls the outreach effort “a day-to-day struggle.” Parents, especially mothers in poverty, “may increase their reading today, but will they continue three years, five years, down the road?” he asked. “Or will this child fall by the wayside just like the parent did? That is what scares me.”

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