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Abstract

The American Association of Pediatrics recommends reading to young children from birth as a method of exposing children to language and literacy as early as possible. This article describes the known neurobiological support for this recommendation—also addressing the differential effects of parental versus stranger reading as well as other factors, that is, pathological conditions, that may influence the contributions of the recommended early reading interactions. Finally, the possible effects of screen exposure on parent–child interaction around the book will be discussed to inform new possible policies.

Keywords

joint reading interactive reading literacy exposure children dialogic reading

This article provides neurobiological support for the American Association of Pediatrics recommendation to read to children starting from birth and informs future policies for early exposure to literacy.

Key Points

This article reviews the benefits of parental storytelling and how it shapes the child's future reading network.

Reading books out loud to children from birth supports the neurobiological development of language abilities and future reading networks.

The American Association of Pediatrics has recommendations for enhancing home literacy environment, including limiting screen exposure for developing brains.

Future policy should support shared reading and, ideally, the provision of books for shared reading to expectant mothers.

Policy Regarding the Need for Literacy Exposure and Interactive Reading

Children's school readiness is critical for academic success, socially, emotionally and cognitively (Council on Early Childhood et al., 2014; Williams & Lerner, 2019). Critical to school readiness is language development, which includes literacy awareness as well as listening, speaking and vocabulary skills (Williams & Lerner, 2019). Literacy knowledge specifically defines the child's readiness to learn, including print awareness, story sense, and writing and drawing processes (per the National Education Goals Panel). However, school readiness depends on many factors: biological, communal, and epigenetic (Williams & Lerner, 2019).

Giving children exposure to language from birth triggers development of both language (Mayberry et al., 2002) and brain regions associated with language development (Kuhl, 2010; May et al., 2011). Therefore, the AAP recommends that parents talk with their children from birth (May et al., 2011). Going a step farther, the AAP (2014) recommended reading books to children from birth (Pediatrics, 2014). The AAP continues to cultivate this practice, which promotes optimal language and literacy development through the school years, even after the child's reading ability has emerged (Pediatrics, 2014). Specifically, once the child can read and wishes to read aloud, parents should continue to read aloud stories with more complex narratives and vocabulary (Pediatrics, 2014).

Does reading to a child from a book, as early as birth (i.e., early literacy exposure), have any justification in neurobiology? This article will discuss the neurobiological support for reading to children earlier in life. More specifically, neurobiological studies reveal parent–child reading styles, the relations to future developmental outcomes, and how these findings could help support future policy.

Dialogic Reading: Definition and Effects on Child's Language, Cognitive, and Emotional Development

Considering how new reading is within the timeframe of human evolution, it is worth exploring the consequences of reading to children within a parent–child dynamic. Studies show that attention is increased during and as a result of joint reading (Zivan & Horowitz-Kraus, 2020). When parents, as compared to a stranger, read an illustrated book to children at prereading age (i.e., 4–6 years), children showed more and longer eye movements toward and fixations on the print versus the illustrations, contrasting with the stranger reading (Zivan & Horowitz-Kraus, 2020). Perhaps children feel more comfortable exploring unknown stimuli in the presence of their parents and hence gave their attention more to the letters (vs. images). However, the participants were at a prereading stage (Zivan & Horowitz-Kraus, 2020).

Previous work suggested that increased attentiveness and visualization, more exploratory behaviors, and better self-regulatory skills during joint reading positively correlated to the emotional attachment the child experiences when reading with a parent versus with a stranger (Bus & Van Ijzendoorn, 1997; Hutton et al., 2017a; Zivan & Horowitz-Kraus, 2020). This increased attentiveness was related to exploratory behavior while children felt more secure with their parents (Zivan & Horowitz-Kraus, 2020). This emotional component may be explained by attachment theory, which highlights the necessity of safety, security, and bonding within the caregiver–child relationship to increase emotional and social development (Bowlby, 1969). Whether longer parent–child time and more quality reading time relate to better attachment or vice versa remains an open question.

In brief, reading together is one of the best ways for a parent to engage with a child on emotional and cognitive levels (Hutton et al., 2017a; Zivan & Horowitz-Kraus, 2020). Joint parent–child reading builds attachment and is also key for expanding language, emergent literacy and for promoting later success in independent reading (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2017a).

One technique for reading together is dialogic reading (DR), the process through which a pair engages in reciprocal conversation while reading a book, rather than merely narrating or listening passively (Hutton et al., 2017a). When speaking and naming abilities emerge, DR follows a set of prompts for optimal outcomes of the joint storytelling activity. One is the PEER acronym which stands for: Prompting the child to say something about the story, Evaluating and supporting their response, Expanding on what the child said, and Reinforcing relevant associations. The other is the CROWD acronym, which stands for Caregiver prompts for initiating conversation (completion of a sentence), Recalling aspects of the story, asking Open-ended questions, starting with “W” questions (i.e., who/what/where/when/why), and Distancing (relating the story to the child's life experiences) (Hutton et al., 2018). Further benefits of DR include enhancing expressive language, narrative comprehension, and attention, skills needed for emergent literacy (Hutton et al., 2017a).

The AAP recommends using a DR technique as early and as often as possible, as reading aloud together benefits the child's brain from birth (Hutton et al., 2023; Hutton et al., 2018). The nonprofit organization Reach Out and Read incorporates developmentally appropriate storytelling and literacy into a child's healthcare plan from six months of age, encouraging joint attention and parental bonding (Zuckerman & Needlman, 2020). The rationale for applying DR earlier in life is that engaging in reading conversation, even as language acquisition is just emerging, enhances the child's vocabulary, verbal engagement, literacy skills, and connection with the caregiver (Hutton et al., 2018). Reading aloud with babies should include distraction-free conversation or mimicking their faces and sounds as they communicate with the caregiver (Pediatrics, 2015). In time, as babies develop motor and linguistic abilities, caregivers can provide more appropriate interaction and exploration with the books.

To date, few studies have examined the effect of DR on the development of the human brain's neural systems for reading, language, and other domains of cognition. The first such study examined the effect of a DR intervention for six weeks (3 times per week) in 4–6 year-old kindergarten-age children, comparing them to age-matched children listening to, and watching on a computer screen, a prerecorded storytelling of the same book (Twait et al., 2019). Children in the DR group showed greater evidence of cognitive control (Twait et al., 2019). Measures included event-related potential amplitudes, that is, N200; generated from an electroencephalogram; (EEG) representing inhibition abilities during a task examining executive functions (i.e., the Flanker Task) (Twait et al., 2019).

These results also accompanied better visual attention and vocabulary scores in the DR versus the control-screen exposed group. An additional study also using EEG examined the brain synchronization between parent–child DR interactions in 2–3-year-old children (Zivan et al., 2022). Higher brain-to-brain synchronization during DR was associated with more fluent maternal reading, which likely assists with the child's fluent flow of verbal information and lowers cognitive system load while listening to the story (Zivan et al., 2022).

However, the question remains: whether storytelling in general, and DR, in particular, engage the child differently when the narrator is the child's parent or caregiver compared to a stranger?

Greater Attention and Visualization Are Present During Parental Reading

Specific benefits of joint parental reading include enhancing oral or expressive language, an overall increase in basic and health literacy, and closing the so-called “word gap” (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2017a). The word gap, a term used to describe the difference in the number of words spoken to or heard by children from varying socio-economic backgrounds, estimated in the millions, can be reduced significantly through interventions such as shared reading, while promoting future literacy readiness for all children regardless of background (Colker, 2014).

The quality of the joint parental reading activity is crucial, determined in part by the home life environment, socio-economic status (SES), and child's involvement (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2015; Hutton et al., 2017a). A high-quality experience of joint reading with a parent includes measures of “verbal interactivity and engagement” (Hutton et al., 2017a), which can include child-directed speech, dialogic, or out loud and conversational reading (Horowitz-Kraus & Hutton, 2015), and behaviors of the reader that assist when necessary, allowing the child to actively engage without distraction or control from the reader (Bus & Van Ijzendoorn, 1997; Hutton et al., 2017a). This high level of parent–child engagement was associated with greater activation of brain regions associated with learning and future reading skills (such as the cerebellum and left angular gyrus and insula (Hutton et al., 2017b)).

Neurobiology of Listening to Stories and Literacy Exposure: Preparing the Brain for Future Reading Acquisition?

One of the advantages of technological development, especially in neuroscience, is that it allows the visualization of brain regions and networks participating in a given activity, even without directly using a specific task (i.e., examining networks associated with reading abilities while individuals are listening to stories). This approach allows the characteristics of neural circuits to support future abilities before they are fully acquired. Next, we will outline the neurobiology of story listening and describe how it stimulates specific brain regions that are also relevant to other cognitive and affective skills.

Whereas past literature focuses on aspects dependent upon the caregiver, recent research aims to affirm the role of the child's own motivation or interest level during the shared reading task (Hutton et al., 2017b). Hutton et al. (2017a) suggested that child-intrinsic motivations may boost, or “turbocharge,” the neural mechanisms already building during shared reading, helping to advance emergent literacy for the prereader. This discovery of cerebellar activation in relation to more significant interaction with the parent during storytelling is relevant to social-emotional processing in children as young as four years, that is, prior to typical reading acquisition age (Hutton et al., 2017b). This study supports the importance of inner self-motivation and enjoyment stimulated by the shared storytelling activity, furthering the likelihood that parents and children will read together more often, thus creating a cascade of enhancing attachment, strengthening neural systems, and reading readiness (Hutton et al., 2017b).

The ability to listen to stories relies on more basic cognitive abilities such as attention, visualization or mental imagery of the story, executive functions, and, through the learning of oral language, narrative comprehension and reciprocal conversation with the narrator (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2015). As visual processing and oral language processing precede semantic processing, language acquisition is necessary for passive story-listening (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2015). Younger children likely have greater neuroplasticity. Thus, it is ideal to stimulate these language, visual, and semantic processing networks early (Hutton et al., 2015), beginning with joint parental reading. Here, we will mainly outline several key basic abilities and their related brain regions shared among storytelling and future reading acquisition: executive functions, visual processing, and language/semantic processing.

Executive functions are a set of cognitive abilities supporting learning that mature later in life but do participate in language and reading processing (Dosenbach et al., 2008; Fair et al., 2007; Farah & Horowitz-Kraus, 2019; Horowitz-Kraus & Hutton, 2015). While completing a story-listening task within a stimulating home environment offering books, toys, and joint reading opportunities (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2015), the brain regions involved in visual-semantic processing (parietal-temporal-occipital [PTO] network), vocabulary learning (left angular gyrus), and executive functions were associated with the child's emergent literacy skills later (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2015; Zivan & Horowitz-Kraus, 2020).

Mental imagery, supported by visual processing, describes the process of creating images or scenes in one's head even without external sensory stimulus (Pearson et al., 2015; Ragni et al., 2020), which is important for the developing child, as it is part of the reading network (Commodari et al., 2020; Hutton et al., 2015). Increased scores of home reading exposure are positively correlated with left PTO activation (Hutton et al., 2015, 2017b), suggesting a stimulating home environment helps to build networks supporting mental imagery and narrative comprehension.

Language processing, a critical ability for both storytelling comprehension and participation in DR activities, becomes more left-lateralized with age and with language exposure (Sroka et al., 2015; Zivan & Horowitz-Kraus, 2020). Other left-sided brain regions within the cerebral cortex, namely the left anterior insula, temporal pole, and inferior frontal gyrus, among others, are also activated during passive story listening (Hutton et al., 2017a). These regions are responsible for semantic memory (Sroka et al., 2015), and complex language processing and expression, respectively (Horowitz-Kraus & Hutton, 2015; Hutton et al., 2017a; Sroka et al., 2015).

Overall, the above literature supports the shared neural systems for both parent–child joint reading at the prereading age and the reading network at reading age.

Several studies directly examined the relationship between engagement of neural systems at prereading age and future reading scores. These studies revealed the utilization of neural systems associated with executive functions (brain activation primarily in the frontal lobe), language (activation primarily in the temporal lobe), and visual processing (activation primarily in the occipital lobe) during stories listening at pre-reading age (5 years) in relation to higher reading outcomes at age 11 years (Horowitz-Kraus et al., 2013). The authors suggested that the ability to imagine the stories and visualize them while listening is related to the ability to recognize words during reading age. Similar to that observed for executive functions, an increased engagement of the language network in pre-readers (i.e., 4-year-old children) was related to greater reading scores at reading age (Jasińska et al., 2021). Finally, the ability to decode and read words holistically is related also to the activation of parts of the occipital lobe (i.e., the precuneus), which was previously related to imagery (or visualization) (Ragni et al., 2020).

Taken together, the literature points to the involvement of brain network activation and functional connections during narrative comprehension at pre-reading age and emergent literacy and reading ability at reading age.

Environmental Factors Affecting Parent–Child Joint Reading

Both Dialogic Reading and Reach Out and Read were initially developed to target populations who may demonstrate decreased literacy exposure at home (Blanchard, 2023; Romeo et al., 2022). This section will overview the known effects of DR on parent–child relationships and the child's outcomes in families prone to decreased literacy exposure (including, but not limited to, low SES families (Brito & Noble, 2014), English as a second language (Chow et al., 2010), and maternal depression (Farah, Greenwood et al., 2021)).

Joint parent–child reading and its outcomes can be negatively affected within households of lower SES, in part due to time constraints, lack of access to materials, and opportunity or desire (Hutton et al., 2015). Low SES has been shown to affect neural circuitry and brain structure related to reading proficiency, similar to those with reading disorders (Brito & Noble, 2014). For example, greater activation in language-related brain regions both in children with reading difficulties and those raised in a lower-income household was observed during reading (Brito & Noble, 2014). This increased activation in both groups suggests that successful reading is more effortful for typically developing children or those of a higher SES (Brito & Noble, 2014). In all areas of academic achievement milestones, children below the poverty line, who faced more adverse childhood events (ACEs), scored lower at entry level and maintained fewer abilities through school age and beyond (Williams & Lerner, 2019). These life factors negatively influence skills required for future reading acquisition, as well as attention, emotions, and behaviors (Castro et al., 2023).

Regardless of the etiology, some reading difficulties and emergent literacy skills may be remedied by enhancing the quality of the environment, access to literacy materials, and reading practices (Hutton et al., 2017a). The gains during DR from an early age positively influence children's development globally; one study from South Africa showed benefits to child language and attention after a DR intervention between guardians and their 1-year-old (Vally et al., 2015). Lastly, a pilot DR intervention in Indonesia demonstrated improved expressive language ability and enjoyment of the activity of low-SES preschool children (Asrifan et al., 2022).

Another example of a lack of interaction during shared reading is in the setting of maternal depression (McLearn et al., 2006). Mothers with depression show less engagement with their children in reading activities and are less likely to read to them even from infancy (McLearn et al., 2006). Other research suggests negative correlations between persistent maternal depression and child's reading gains during school-age (Claessens et al., 2015; Cowderoy et al., 2020; Wagner & Valdez, 2023). Neurobiological evidence for the alteration in narrative processing in children of mothers with depression was recently published (Farah, Greenwood et al., 2021). Greater maternal depression was associated with decreased engagement of brain regions associated with executive functions and visual processing in 4-year-old children listening to stories (Farah, Greenwood et al., 2021). The authors suggested that greater maternal depression is related to less interactive storytelling, decreased functional connectivity of semantic and language processing networks, and higher use of right-sided regions (Farah, Greenwood et al., 2021).

These studies demonstrate that with respect to learning to read, exposure to parental storytelling enhances the development of neural systems and their integration for reading skill acquisition and ought to be considered core to optimal attainment of this essential future reading development.

Screen Use and Possible Impact on Current and Future Policy

Neurobiological findings indeed support AAP recommendations to expose children to literacy early in life; examples include dialogic reading and exposure to stories in print versus on a screen. Digital media exposure at a younger age can serve as a possible distractor during parent–child activities, especially joint storytelling, as they take away from parent–child interaction and optimal learning time (Pediatrics, 2015), and the lack of social cues are not optimal for maximizing infants’ learning abilities (Kuhl, 2011).

EEG and functional magnetic resonance imaging (fMRI) research suggest neurobiological evidence for the benefits for all ages of reading from paper sources as compared with digital media. Using EEG, one study examining 6- to 8-year-olds reading from a screen versus from paper yielded higher theta waves and worse performance time on an additional attentional task, suggesting challenges in allocating attention and greater cognitive load (Zivan et al., 2023). In another, dialogic reading had positive effects on 4- to 6-year-olds’ attention during narrative comprehension, network efficiency, and subsequent vocabulary scores (Farah et al., 2019). Using fMRI, studies show decreased synchronization in activation (i.e., functional connectivity) in reading-related visual and attention areas when 8- to 12-year-olds were watching a video versus completing a story-listening task (Meri et al., 2022), as well as decreased connectivity in visual word form, language, and cognitive regions associated with screen time versus reading books (Horowitz-Kraus & Hutton, 2018). Another study suggested that among screen-based story-listening to audio, visual, and animation, preschoolers benefit more in the areas of attention and visual-language integration from listening to illustrated stories (Hutton et al., 2019). A positive association was also found between parent–child interactions and cognitive control abilities, highlighting that parent–child engagement is of greater importance than the specific joint activity (Meri et al., 2022); the importance of the relationship is backed by newer evidence of shared neural fingerprints between biological parent–child couples during narrative comprehension (Habouba et al., 2023). These findings suggest exposure to a physically printed illustrated storybook is superior to that on a screen, and best completed as a shared interaction for optimal developmental benefit.

Screen use is impacted by many factors, including the global COVID-19 pandemic. An analysis of screen use in young children from 12 countries revealed that children of all ages used screens more during a lockdown, increased screen time was associated with lower maternal education, more maternal screen use, and lower SES, and that smaller increases in screen time were correlated with larger increases in expressive vocabulary (Bergmann et al., 2022). More specifically, this research into the association between pandemic-driven disruptions (i.e., “lockdowns”) and language development found a positive correlation between how often children were read to and the number of new words learned, as well as a negative association between increased screen exposure and new words spoken (Bergmann et al., 2022).

Joint storytelling beginning as early as possible can help children not only gain cognitive skills throughout development but also become excited about learning through reading and thus continue the positive cycle. Researchers found that reading for pleasure, even a few hours a week during childhood, was positively associated with cognition/attention, mental health, and brain volume when they reached young adolescence (Sun et al., 2023). Ultimately, the benefits to be gained for any child from exposure to print reading and positive parent–child interactions are dramatic.

The Future: Neuroscience Can Inform Policy About Children's Literacy Exposure

This article provides neurobiological evidence for brain regions and networks that support future reading in children, even prior to reaching reading age. Interactive storytelling with the child through DR engages these brain regions, which may prepare the child for better future reading skills. These findings support the AAP recommendation to expose children to literacy as soon as possible, even starting from birth. Based on current evidence, future policy should support shared reading, the provision of books to all expectant mothers for shared reading, along with clear information/instruction on DR inclusive of the principles upon which it is based. Such future policy should be championed by policymakers whose areas of focus include education, health, commerce, labor, and beyond as literacy impacts all of those domains. This is even more important for bilinguals and for those whose spoken and written language differ (i.e. Arabic). The effect of the implementation of these DR instructions on health, academic, cognitive, emotional, and social outcomes in children should be followed up with cost/benefit analyses. How specific the level of reliance on visualization, language, and executive function networks is to parental reading is unknown. It is also not clear how much a synchronization of these regions during parental reading is related to the child's reading readiness and to parent–child interaction during reading.

Studies need to investigate attention, executive functions, and the sensory system—the visual (visualization) and auditory (language) networks during parental stories listening and their relation to future reading readiness. Such studies will draw a longitudinal line between the neurobiology of parent–child storytelling during early childhood and future reading outcomes and may inform policy-making to advise and train parents to read to their children as soon as possible in development.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Ministry of Education, Israel grant (PI: Horowitz-Kraus).

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Neurobiological Evidence for the Benefit of Interactive Parent–Child Storytelling: Supporting Early Reading Exposure Policies

Abstract

Keywords

Tweet

Key Points

Policy Regarding the Need for Literacy Exposure and Interactive Reading

Dialogic Reading: Definition and Effects on Child's Language, Cognitive, and Emotional Development

Greater Attention and Visualization Are Present During Parental Reading

Neurobiology of Listening to Stories and Literacy Exposure: Preparing the Brain for Future Reading Acquisition?

Environmental Factors Affecting Parent–Child Joint Reading

Screen Use and Possible Impact on Current and Future Policy

The Future: Neuroscience Can Inform Policy About Children's Literacy Exposure

Footnotes

Declaration of Conflicting Interests

Funding

References