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CHICAGO — As a mother, pediatric surgeon Dana Suskind understands the gravity of her responsibility when a parent entrusts her to cut open 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, the petite, auburn-haired doctor 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 with implications for a lifetime.
The gap was obvious and stark for Suskind’s patients. Since the implications of her experience 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 a well-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:
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 one begins with a provocative scene. Four animated figures stand in a row, from left to right an Asian man, an African-American woman, a blonde 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, 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, hour-long 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. Their findings, published this summer in Communication Disorders Quarterly, suggest that even children from affluent families might be able to benefit from targeted talking.
The Thirty Million Words trial took a bigger intervention to a low-income population, following 25 mothers through eight weeks of home visits and recordings. In low-income households, parents commonly speak to their children in simple commands, and participant Aneisha Newell said the week on directives was particularly significant to her. “Instead of saying, ‘go put on your shoes,’ I can say, ‘Alright, it’s time to go. What else do you need? … That gives my child the chance to respond, and say, ‘shoes,’” said Newell, 25, who has a 4-year-old daughter and a 10-month-old son and works for a company providing recess supervision and after-school activities in Chicago Public Schools.
Newell said many of her friends and relatives think she’s crazy for talking to her daughter like she’s an adult. “I can quote this: ‘Neisha, no one wants to sit and talk to the kids like they understand.’ That’s basically the response I get.” During her time being recorded by Thirty Million Words, Newell became competitive with herself. One day, she spoke an average 2,736 words per hour to her daughter, Alona Sharp, compared with a normal rate of 1,023.
She jokes that sometimes even she wonders if she’s gone too far. “She asks so many questions I’m like, ‘What did I get myself into?’” Newell said, laughing. “We’ll be on the bus, and people will look over.… She cracks people up sometimes, ‘What is this little girl talking about?’” Newell is proud that her daughter can spell her first and last names, recite her address and phone number, recognize and spell colors, and count to 200. She’s also frustrated that more of Alona’s peers can’t do the same.
“If you have people who don’t read, what do you expect for the child?” Newell said. “It’s like, ‘ding dong.’ Somebody please pay attention.”
Dana Suskind believes passionately that all communities deserve access to information that will make their children educationally successful. But, she says, not all communities have the same access.
Case in point: a pile on her desk of more than a dozen books on child language development. The titles include Everything Your Baby Would Ask, Baby Talk, and Baby! Talk! What do they have in common? The parents and babies on the covers are all white.
Activism runs in Suskind’s blood. Her father, once a Peace Corps physician in Senegal, spent years as a pediatrics professor specializing in child malnutrition. Her mother is a social worker whose old newspaper op-eds and letters to the editor on various injustices Suskind keeps in a green folder on her desk.
In residency at the University of Pennsylvania, Suskind met Donald Liu, a fellow pediatric surgeon to whom she was married for 17 years. He rose to prominence for his work in minimally invasive surgery on children. On Aug. 5, 2012, while on a family vacation, Liu drowned in Lake Michigan helping to save two boys struggling in treacherous currents.
The tragedy fueled Suskind’s determination to take her vision for child language development even further. For whatever impact she is able to have, she feels, the work helps her remain connected to her husband. In the middle of sleepless nights, her and Liu’s own three kids will find her under the covers, working on her laptop. The eldest, 14-year-old Genevieve, is following suit by pouring her energy into a cause to help children: a Web site for those who have lost a parent.
“Purpose gives you the ability to see beyond your own grief,” Suskind said. She is actively seeking out new funders for her research. (A $1.6 million startup grant from the U.S. Department of Education for Project Aspire will run out next year; a $350,000 grant from the Colorado-based Hemera Foundation supports Thirty Million Words.)
In December 2012, Suskind surgically placed a cochlear implant on the left inner ear of a 10-month-old boy named Jadiel Engstrom. In April of this year, Suskind implanted Jadiel’s right side. His parents, Carmen DeLeon and Neil Engstrom, were petrified of the operations, but they went ahead thanks to Suskind’s reassurances.
They had already been on a painful journey, discovering that their baby could not hear and that they didn’t know how to communicate with him. Suddenly, Jadiel could hear when they attached magnetic microphones to two circular bumps that the implants make in his blonde curls. What then?
The parents enrolled in the clinical trial of Project Aspire, which offered strategies for helping Jadiel make sense of the new sensations. For instance: When they speak to him, they need to give him a chance to respond. They finished the program in May, but the 36-year-old Engstrom, who works nights stocking trucks, still brings Jadiel weekly to Suskind’s office to meet with a speech and language therapist. And the boy, at 19 months, is trying mightily to talk. Jadiel’s three older sisters speak to him, and he babbles back. He tries to imitate everything they do.
“The surgery is the easiest part,” said DeLeon, 33, a licensed practical nurse. “The long journey is getting him to speak.”
More than 99 percent of newborns in the United States are screened for congenital hearing impairments while still in the hospital. Only about two in 1,000 have such impairments, but Suskind imagines using the time during the hearing test to show all new mothers a video about the power of parent talk. Get the message out in enough places, her thinking goes, and maybe it will go viral.
Whether or not her vision is carried out on a large scale, Suskind finds much joy in changing the lives of individual children and families. She lights up when she sees Jadiel. “You get to watch these kids and their families, their whole trajectory,” she said. “What a great honor.”
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Not new. But, maybe we have the right zeitgeist. I work in Samoa. This is a major cultural problem.
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