The Village Effect: How Face-to-Face Contact Can Make Us Healthier and Happier (23 page)

By all accounts the program is a success. A dozen peer-reviewed articles in medical journals show that parents in the program read to their children ten times as often as other parents did. And reading to their children boosted the kids’ language skills. One long-running study found that children in Reach Out and Read understood language at a level that was eight points higher on standardized tests than that of similar kids who weren’t in the program. They were more advanced in their spoken language, too.
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Another study showed that explicitly teaching parents of two- and three-year-olds how to read to them interactively significantly improved the children’s language skills.
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Impressive on their own, these gains also augured well for the children’s later school progress. And that was the point. Concerned about the evidence that certain types of parent–child interactions were less common in low-income homes and that TV and other screens had often replaced face-to-face banter between parent and child, these doctors had come up with a plan they hoped would help change that trajectory.

Their idea was prescient. A study of more than two thousand children published by the Kaiser Family Foundation in 2010 found that media use had increased dramatically since they started monitoring it in the late nineties; most children now devote well over seven and a half hours a day to TV, video games, and social networking sites. Most striking was a class-related digital divide. Children whose parents did not have a college degree were spending ninety minutes more a day with various media than children from more educated families. Black and Hispanic children spent nearly four and a half hours more a day on TV and computer games than white children. There was no proof that screens were
the cause, but children who were heavy media users were getting lower grades in school.
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Dr. Perri Klass, a pediatrician, author, and NYU professor, has been associated with Reach Out and Read since its inception and is now the program’s medical director. When I met her in the clinic that day, I discovered that Reach Out and Read is an ethical commitment for her as well as a professional one. “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,” Klass writes on her website. When we sat down to chat in one of Bellevue’s few vacant examining rooms, one of the first questions I asked her was about digital technology. Books seemed so, well, quaint, compared to the recent zeal for tablets, apps, and educational software. A recent article in the
New York Times Magazine
was typical in its enthusiasm: it suggested that underperforming third-grade children from a working-class Chicago suburb had boosted their intelligence simply by playing a computer game for fifteen minutes a day; the game required them to remember the location of a black cat in a haunted house.
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I asked whether she thought that handing a parent a copy of
Goodnight Moon
could trump this sort of thing.

Klass paused, considering, then said, “I don’t want to dismiss touch screens and e-books, because they’re going to be important in some families. And I can tell you stories of ways that videos have been used that are wonderful. But as far as we know, nothing replaces face time—the parent–child interaction—when it comes to language, cognitive, and socio-emotional development. And with reading aloud, they’re all in there together. When you take a child on your lap and use dialogic reading—asking ‘Where’s the baby? Where’s the baby’s nose?’—a lot is happening around language. But something is also going on about social and emotional
development, and something is going on around written language. The book is promoting this interaction. And as kids get older they’re learning about sequencing of words in print, on the page, and all of that is happening in a pleasurable, safe place, often sitting on the parent’s lap. There’s an awful lot that goes on with the book. And most parents grasp that. If you tell a room of parents, ‘Think about holding your baby on your lap and reading to him,’ parents tear up.”

Still, even though Reach Out and Read was getting results, it was hard to know exactly what was doing the trick. After interviewing Klass, I watched how it all unfolded for parents at Bellevue. First, a bilingual parent educator, in this case Claudia Aristy, greeted parents and kids in the waiting room, encouraging the parents to talk to their babies and toddlers and to engage them in banter and play. Dressed in gold sling-back heels and a zebra-print skirt that swung jauntily when she walked, Aristy was hardly able to finish a sentence before she stopped to hug, pat, squeeze, or greet—in rapid-fire Spanish—one of the toddlers who crossed her path. Weaving her way through the packed, sun-filled waiting area, she warmly greeted each of the children and the nearly sixty young parents by name, while in the background the clinic receptionist bellowed out patients’ names, the phones rang incessantly, and the hospital PA system blared.

A handful of trained volunteers sat on gym mats reading aloud and chatting with any children who happened by, trying to draw them in. The point was to model what interactive reading looked like and to show these stressed-out parents that their kids could really be engaged by books. After their names were called and the family finally got to the examining room, the doctor offered a book to the child sitting on his or her parent’s lap. The books were used as distractions from the physician’s prodding, but also as diagnostic tools that could tell the doctor something about the child’s development. Could she hold a book upright? Bring it to her mouth? Point to the baby on the page? Count the ducklings? The pediatrician shared that knowledge with
the parents, then showed them how books could be used to tell stories (a print-shy parent was encouraged to use the pictures to make up her own stories). At the end of the exam, the pediatrician exchanged the drooled-on board book the child had been handling for a new one to take home, often in the child’s native language.

Later, Claudia walked me over to where the new books were stored, in a low metal cabinet hidden in an alcove. As I kneeled down to peer in, I inadvertently blocked a young doctor who was reaching in to pull out a book in Mandarin for a toddler. I recognized favorites from my own kids’ childhoods, and Claudia pointed out books in Spanish, Portuguese, Bengali, Haitian Creole, and Vietnamese, all neatly sorted by language and age level, from board books for six-month-olds to simple stories that some preschoolers could sound out on their own. By the time a child turned five and was ready to enter kindergarten, he or she would have had a number of checkups at Bellevue, gotten to know the pediatrician and Claudia (or Jenilda, the other parent educator), been read to by volunteers in the waiting room dozens of times, and would have a library she could call her own.

“With minimal intervention we’re having a big impact,” Alan Mendelsohn told me the day I visited the hospital. A professor of developmental pediatrics and one of the lead researchers evaluating Bellevue’s parent-training programs, Mendelsohn said that the average six-month-old baby seen at the clinic watches two hours of television a day. Programs such as Reach Out and one its offshoots, the Video Interaction Project (which films parents at home with their children and coaches them via watching video playbacks together), help parents interact with their children instead of sitting them down in front of a screen. Kids whose families participated in either program ended up watching fewer hours of TV, a decline that was matched by an increase in IQ. In fact, a twenty-year follow-up study found that the participants started school with language skills that were six months ahead of their peers.
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These are encouraging results, and I stopped by Mendelsohn’s office to ask him a bit more. Dressed in a striped shirt and an animal-print tie, Mendelsohn had squeezed in a few minutes for me between a meeting and a class he had to teach that afternoon. “What’s really cool about Reach Out and Read is that it’s based on health care. All children receive health care in their first five years because they need vaccinations to go to school,” he said, leaning back in his chair and playing with his tie. “So this is a platform where you can reach everybody. And three million of the children in Reach Out and Read across the country are low-income children, which represents 20 to 30 percent of all low-income children in the States.”

“Now, if you ask parents what their concerns are, the main thing parents want to talk about when they come to these visits is their child’s development and behavior,” he continued. “Whether they’re low-income, low-education, low-literacy, or the other extreme, all parents want the exact same things for their children. They want them to stay in school and succeed. They want their children to become professionals, to be doctors.” Here he laughed ruefully. “Of course, that’s what you’d say to a doctor who just asked what they wanted their children to be. Still, they want their children to be successful.” But they don’t always have the tools they need, especially in the early stages. “In the late nineties we did home visits around New York City as part of a study. And we found that every single family, almost without exception, if they had nothing else in their homes, they had a TV and a VCR.” These parents want their children to start school ready to succeed, he told me, but they don’t realize that technology isn’t the answer.

Most of the kids at the Bellevue clinic are native Spanish speakers whose parents are Hispanic immigrants, some of them as young as Claudia Aristy was when she first showed up at the hospital, pregnant at sixteen. If the clinic waiting room was any indication, many of these parents believe that gadgets are part of the American dream.
Nearly every one of them was preoccupied by a smartphone, lost in his or her own silent screen world. Meanwhile their babies and toddlers were being ignored, some of them transfixed by their own screens. That is, until Claudia planted herself in their sightlines.

SIXTEEN AND PREGNANT

If Claudia had been the average teenage mother, persuading herself that she and her baby would enjoy a rosy future would have been an exercise in self-delusion. In the United States, which has the highest rate of teenage mothers in the developed world, more than 360,000 girls between the ages of fifteen and nineteen have babies every year. That’s more than a thousand a day. The rate has dropped over the past twenty years, but it is still nine times what it is in other industrialized countries.
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Only half of these girls end up graduating from high school (compared to 90 percent of their non-pregnant peers). And compared to the children of mothers in their twenties or thirties, the children of teen moms are more likely to be born prematurely or underweight; receive inadequate medical care; be neglected or abused; become dropouts, juvenile delinquents, or teenage parents themselves; live in poverty as adults; suffer from poor health and unemployment; or land up in jail than any other American group. This sad litany is hard to square with Claudia’s upbeat personality. Demographically, she knows she fits the stereotype, even if she sidestepped the dire outcomes.

I once teased my mother that she too fit the stereotype. I’d just returned from an academic conference on high-risk mothers and I listed the risk factors for her, counting them off on my fingers. She became pregnant as a teenager and was just twenty when her first child, my brother Steve, was born. Like many of her generation, she was also a smoker and a coffee drinker, and her first child was a boy—of the two sexes, far more vulnerable to developmental problems. She was not amused. Her stony response was a reminder
that people are not a laundry list of predisposing factors. They’re individuals. My mother is exceptional now and was surely exceptional then, even if she did conform to her era’s expectations that women should marry and have children before they were twenty. Now this is considered risky behavior; then it was normal. Norms and developmental risks morph with each generation.

Even if it’s politically incorrect to point this out, Hispanic and black girls make up barely a third of American teenage girls yet give birth to 60 percent of all babies born to adolescents in the U.S.
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In Britain it’s a similar story: its teenage birthrates are the highest in the European Union, matching those of the former Soviet republics.
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Reflecting on this fact, British economist Marco Francesconi wrote that adolescent motherhood in the U.K. “is not just a symptom, but a
cause
of socioeconomic disadvantages that are transmitted across generations,” because having a baby when you’re barely an adult can generate lasting consequences. Like the epigenetic mechanisms we encountered in the previous chapter, deprivation gets handed off from mother to child. The associations between teenage pregnancy and iffy outcomes are hard to ignore. The children of British teenagers are far less educated, for example, and are twice as likely to be poor as the children of older mothers. Like their American counterparts, they are highly likely to become teenage mothers themselves.
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If that legacy weren’t onerous enough, in the United States young Hispanic immigrant mothers interact less with their babies and toddlers than American-born mothers do, Claudia told me. “To have a conversation with a baby doesn’t feel natural to everyone,” she said quietly. Whereas middle-class families often engage their young children in Socratic-type discussions, especially around the dinner table, that interaction is less likely to go on in Latino families, especially among new immigrants, she continued. “In a lot of these families it’s not the custom to ask children to express themselves. You just don’t challenge authority.”

Compare that reality to the other extreme. In a parenting blog,
Huffington Post
writer Lisa Belkin describes having been so hell-bent on using sophisticated language with her toddlers that her three-year-old explained “that he wasn’t responsible for making his brother cry because ‘he provoked-ed me, Mommy.’ ” Research shows that using simplified speech promotes language development and bonding between mother and child, as Belkin notes. “Yet I came to feel like an idiot babbling inanely at my kids, particularly in public, when the English language was filled with evocative and descriptive words.”
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