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:

sheri.madigan@ucalgary.ca

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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REFERENCES

1. Raviv T, Kessenich M, Morrison FJ. Amediational model of the associationbetween socioeconomic status andthree-year-old language abilities: therole of parenting factors. Early ChildRes Q. 2004;19(4):528–547

2. Walker D, Greenwood C, Hart B, CartaJ. Prediction of school outcomesbased on early language productionand socioeconomic factors. Child Dev.1994;65(spec no 2):606–621

3. Johnson CJ, Beitchman JH, BrownlieEB. Twenty-year follow-up of childrenwith and without speech-languageimpairments: family, educational,occupational, and quality of lifeoutcomes. Am J Speech Lang Pathol.2010;19(1):51–65

4. Beitchman JH, Wilson B, Johnson CJ,et al. Fourteen-year follow-up ofspeech/language-impaired and controlchildren: psychiatric outcome. J AmAcad Child Adolesc Psychiatry. 2001;40(1):75–82

5. Curtis PR, Frey JR, Watson CD,Hampton LH, Roberts MY. Languagedisorders and problem behaviors:a meta-analysis. Pediatrics. 2018;142(2):e20173551

6. Dale PS, Simonoff E, Bishop DV, et al.Genetic influence on language delay intwo-year-old children. Nat Neurosci.1998;1(4):324–328

7. Spinath FM, Ronald A, Harlaar N, PriceTS, Plomin R. Phenotypic g early in life:on the etiology of general cognitiveability in a large population sample oftwin children aged 2–4 years.Intelligence. 2003;31(2):195–210

8. Madigan S, Wade M, Plamondon A,Browne D, Jenkins JM. Birth weightvariability and language development:risk, resilience, and responsiveparenting. J Pediatr Psychol. 2015;40(9):869–877

9. Hart B, Risley TR. MeaningfulDifferences in the Everyday Experienceof Young American Children. Towson,MD: Paul H. Brookes Publishing; 1995

10. Hoff-Ginsberg E, Shatz M. Linguisticinput and the child’s acquisition oflanguage. Psychol Bull. 1982;92(1):3–26

11. Wade M, Jenkins JM, Venkadasalam VP,Binnoon-Erez N, Ganea PA. The role of

maternal responsiveness and linguisticinput in pre-academic skilldevelopment: a longitudinal analysis ofpathways. Cogn Dev. 2018;45:125–140

12. Romeo RR, Leonard JA, Robinson ST,et al. Beyond the 30-million-word gap:children’s conversational exposure isassociated with language-related brainfunction. Psychol Sci. 2018;29(5):700–710

13. Prime H, Pauker S, Plamondon A,Perlman M, Jenkins J. Sibship size,sibling cognitive sensitivity, andchildren’s receptive vocabulary.Pediatrics. 2014;133(2). Available at:www.pediatrics.org/cgi/content/full/133/2/e394

14. Ainsworth MDS. Bell SM, Stayton D.Infant–Mother Attachment and SocialDevelopment: Socialization asa Product of Reciprocal Responsivenessto Signals. London, United Kingdom:Cambridge University Press; 1974

15. Wade M, Browne DT, Madigan S,Plamondon A, Jenkins JM. Normal birthweight variation and children’sneuropsychological functioning: linksbetween language, executivefunctioning, and theory of mind. J IntNeuropsychol Soc. 2014;20(9):909–919

16. McCafferty SG. Gesture and creatingzones of proximal development forsecond language learning. Mod Lang J.2002;86(2):192–203

17. Meins E. Security of attachment andmaternal tutoring strategies:interaction within the zone of proximaldevelopment. Br J Dev Psychol. 1997;15:129–144

18. Paul IM, Savage JS, Anzman-Frasca S,et al. Effect of a responsive parentingeducational intervention on childhoodweight outcomes at 3 years of age: theinsight randomized clinical trial. JAMA.2018;320(5):461–468

19. Bakermans-Kranenburg MJ, vanIJzendoorn MH, Juffer F. Less is more:meta-analyses of sensitivity andattachment interventions in earlychildhood. Psychol Bull. 2003;129(2):195–215

20. Eshel N, Daelmans B, de Mello MC,Martines J. Responsive parenting:interventions and outcomes. Bull WorldHealth Organ. 2006;84(12):991–998

21. NICHD Early Child Care ResearchNetwork. Early child care and children’sdevelopment prior to school entry:results from the NICHD Study of EarlyChild Care. Am Educ Res J. 2002;39(1):133–164

22. Landry SH, Schmidt M, Richardson MA.The effects of intraventricularhemorrhage on functionalcommunication skills in pretermtoddlers. J Dev Behav Pediatr. 1989;10(6):299–306

23. Hirsh-Pasek K, Adamson LB, Bakeman R,et al. The contribution of earlycommunication quality to low-incomechildren’s language success. PsycholSci. 2015;26(7):1071–1083

24. Farrant BM, Zubrick SR. Earlyvocabulary development: theimportance of joint attention andparent-child book reading. First Lang.2012;32(3):343–364

25. Landry SH, Smith KE, Swank PR.Responsive parenting: establishingearly foundations for social,communication, and independentproblem-solving skills. Dev Psychol.2006;42(4):627–642

26. Carpenter M, Nagell K, Tomasello M.Social cognition, joint attention, andcommunicative competence from 9 to15 months of age. Monogr Soc ResChild Dev. 1998;63(4):i–vi, 1–143

27. Dollaghan CA, Campbell TF, Paradise JL,et al. Maternal education and measuresof early speech and language. J SpeechLang Hear Res. 1999;42(6):1432–1443

28. Hoff E. The specificity of environmentalinfluence: socioeconomic status affectsearly vocabulary development viamaternal speech. Child Dev. 2003;74(5):1368–1378

29. Browne DT, Wade M, Prime H, JenkinsJM. School readiness amongst urbanCanadian families: risk profiles andfamily mediation. J Educ Psychol. 2018;110(1):133–146

30. Tamis-Lemonda CS, Briggs RD,McClowry SG, Snow DL. Maternalcontrol and sensitivity, child gender,and maternal education in relation tochildren’s behavioral outcomes inAfrican American families. J Appl DevPsychol. 2009;30(3):321–331

PEDIATRICS Volume 144, number 4, October 2019 9 by guest on July 26, 2021www.aappublications.org/newsDownloaded from

31. Rowe ML. A longitudinal investigation ofthe role of quantity and quality of child-directed speech in vocabularydevelopment. Child Dev. 2012;83(5):1762–1774

32. Fenson L, Dale PS, Reznick JS, Bates E,Thal DJ, Pethick SJ. Variability in earlycommunicative development. MonogrSoc Res Child Dev. 1994;59(5):1–173;discussion 174–185

33. Dunn LM, Dunn LM. Peabody PictureVocabulary Test. 3rd ed. Circle Pines,MN: American Guidance Services; 1997

34. National Institutes of Health. StudyQuality Assessment Tools. 2014.Available at: www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort. Accessed October 15, 2018

35. Bornstein MH, Hahn CS, Putnick DL.Stability of core language skill acrossthe first decade of life in children atbiological and social risk. J ChildPsychol Psychiatry. 2016;57(12):1434–1443

36. Putnick DL, Bornstein MH, Eryigit-Madzwamuse S, Wolke D. Long-termstability of language performance invery preterm, moderate-late preterm,and term children. J Pediatr. 2017;181:74–79.e3

37. Biostat. Comprehensive Meta-Analysis:A Computer Program for ResearchSynthesis [computer program]. Version2.0. Englewood, NJ: Biostat; 2005

38. Rosenthal R. Writing meta-analyticreviews. Psychol Bull. 1995;118(2):183

39. Borenstein M, Hedges LV, Higgins JPT,Rothstein HR. Introduction to Meta-Analysis. Chichester, England: JohnWiley and Sons; 2009

40. Thompson SG, Higgins JPT. How shouldmeta-regression analyses beundertaken and interpreted? Stat Med.2002;21(11):1559–1573

41. Moher D, Liberati A, Tetzlaff J, AltmanDG; PRISMA Group. Preferred reportingitems for systematic reviews and meta-analyses: the PRISMA statement. AnnIntern Med. 2009;151(4):264–269, W64

42. Baker JK, Messinger DS, Lyons KK,Grantz CJ. A pilot study of maternalsensitivity in the context of emergentautism. J Autism Dev Disord. 2010;40(8):988–999

43. Barnett MA, Gustafsson H, Deng M,Mills-Koonce WR, Cox M. Bidirectionalassociations among sensitiveparenting, language development, andsocial competence. Infant Child Dev.2012;21(4):374–393

44. Beckwith L, Rodning C. Dyadicprocesses between mothers andpreterm infants: development at ages 2to 5 years. Infant Ment Health J. 1996;17(4):322–333

45. Bee HL, Barnard KE, Eyres SJ, et al.Prediction of IQ and language skill fromperinatal status, child performance,family characteristics, and mother-infant interaction. Child Dev. 1982;53(5):1134–1156

46. Bornstein MH, Hendricks C, Haynes OM,Painter KM. Maternal sensitivity andchild responsiveness: associations withsocial context, maternalcharacteristics, and childcharacteristics in a multivariateanalysis. Infancy. 2007;12(2):189–223

47. Cheung HS, Elliott JM. Measuringmaternal sensitivity: cultural variationsin the measurement of emotionalavailability. Child Dev. 2016;87(3):898–915

48. Clarke-Stewart KA. Interactionsbetween mothers and their youngchildren: characteristics andconsequences. Monogr Soc Res ChildDev. 1973;38(6):1–109

49. Cusson RM. Factors influencinglanguage development in preterminfants. J Obstet Gynecol Neonatal Nurs.2003;32(3):402–409

50. Gaertner BM. The relations ofhousehold chaos to children’s languagedevelopment: the mediating roles ofchildren’s effortful control andparenting. Diss Abstr Int. 2013;73(8-A[E]):1–229

51. Gocek E. Mothers’ mental statelanguage and emotional availability inclinical vs. nonclinical populations. DissAbstr Int B Sci Eng. 2007;68(6-B):4130

52. Greenberg MT, Crnic KA. Longitudinalpredictors of developmental status andsocial interaction in premature and full-term infants at age two. Child Dev. 1988;59(3):554–570

53. Hann DM, Osofsky JD, Culp AM. Relatingthe adolescent mother-childrelationship to preschool outcomes.

Infant Ment Health J. 1996;17(4):302–309

54. Heinicke CM, Diskin SD, Ramsey-KleeDM, Oates DS. Pre- and postbirthantecedents of 2-year-old attention,capacity for relationships, and verbalexpressiveness. Dev Psychol. 1986;22(6):777–787

55. Karrass J, Braungart-Rieker JM.Parenting and temperament asinteracting agents in early languagedevelopment. Parent Sci Pract. 2003;3(3):235–259

56. Kelly JF, Morisset CE, Barnard KE,Hammond MA, Booth CL. The influenceof early mother-child interaction onpreschool cognitive/linguistic outcomesin a high-social-risk group. Infant MentHealth J. 1996;17(4):310–321

57. Keown LJ, Woodward LJ, Field J.Language development of pre-schoolchildren born to teenage mothers.Infant Child Dev. 2001;10(3):129–145

58. Landry SH, Smith KE, Swank PR,Guttentag C. A responsive parentingintervention: the optimal timing acrossearly childhood for impacting maternalbehaviors and child outcomes. DevPsychol. 2008;44(5):1335–1353

59. Lovas GS. Early Gender Development inthe Context of Parent/ToddlerInteractions: Emotional Availability andLanguage Development. Davis, CA:University of California; 2002

60. Magill-Evans J, Harrison MJ. Parent-child interactions, parenting stress, anddevelopmental outcomes at 4 years.Child Health Care. 2001;30(2):135–150

61. McElwain NL, Holland AS, Engle JM,Wong MS. Child anger pronenessmoderates associations between child-mother attachment security and childbehavior with mothers at 33 months.J Fam Psychol. 2012;26(1):76–86

62. Mistry RS, Biesanz JC, Taylor LC,Burchinal M, Cox MJ. Family income andits relation to preschool children’sadjustment for families in the NICHDStudy of Early Child Care. Dev Psychol.2004;40(5):727–745

63. Mol SE, Neuman SB. Sharinginformation books with kindergartners:the role of parents’ extra-textual talkand socioeconomic status. Early ChildRes Q. 2014;29(4):399–410

10 MADIGAN et al by guest on July 26, 2021www.aappublications.org/newsDownloaded from

64. Nozadi SS, Spinrad TL, Eisenberg N,et al. Prediction of toddlers’ expressivelanguage from maternal sensitivity andtoddlers’ anger expressions:a developmental perspective. InfantBehav Dev. 2013;36(4):650–661

65. Olson SL, Bates JE, Bayles K. Mother-infant interaction and the developmentof individual differences in children’scognitive competence. Dev Psychol.1984;20(1):166–179

66. Pearson RM, Heron J, Melotti R, et al.The association between observed non-verbal maternal responses at12 months and later infantdevelopment at 18 months and IQ at4 years: a longitudinal study. InfantBehav Dev. 2011;34(4):525–533

67. Podmore VN. Mothers’ interactivebehaviours and their children’s pre-school assessments: relationships andissues. N Z J Educ Stud. 1988;23(2):165–174

68. Pungello EP, Iruka IU, Dotterer AM, Mills-Koonce R, Reznick JS. The effects ofsocioeconomic status, race, andparenting on language development inearly childhood. Dev Psychol. 2009;45(2):544–557

69. Ransone SH. Psychometric Evaluation ofthe Nursing Child Assessment Teaching(NCAT) Scale in Two Samples ofMothers and Children [dissertation].Memphis, TN: Health Sciences Center,University of Tennessee; 2017

70. Ruffman T, Slade L, Devitt K, Crowe E.What mothers say and what they do:the relation between parenting, theoryof mind, language and conflict/cooperation. Br J Dev Psychol. 2006;24(1):105–124

71. Steelman LM, Assel MA, Swank PR,Smith KE, Landry SH. Early maternalwarm responsiveness as a predictor ofchild social skills: direct and indirectpaths of influence over time. J Appl DevPsychol. 2002;23(2):135–156

72. Stein A, Malmberg LE, Sylva K, Barnes J,Leach P; FCCC Team. The influence ofmaternal depression, caregiving, andsocioeconomic status in the post-natalyear on children’s languagedevelopment. Child Care Health Dev.2008;34(5):603–612

73. Tompkins V, Farrar MJ. Mothers’autobiographical memory and book

narratives with children with specificlanguage impairment. J CommunDisord. 2011;44(1):1–22

74. Vernon-Feagans L, Garrett-Peters P,Willoughby M, Mills-Koonce R; TheFamily Life Project Key Investigators.Chaos, poverty, and parenting:predictors of early languagedevelopment. Early Child Res Q. 2012;27(3):339–351

75. Vibbert M, Bornstein MH. Specificassociations between domains ofmother-child interaction and toddlerreferential language and pretense play.Infant Behav Dev. 1989;12(2):163–184

76. Wallace IF, Roberts JE, Lodder DE.Interactions of African American infantsand their mothers: relations withdevelopment at 1 year of age. J SpeechLang Hear Res. 1998;41(4):900–912

77. Wasserman GA, Allen R, Linares LO.Maternal interaction and languagedevelopment in children with andwithout speech-related anomalies.J Commun Disord. 1988;21(4):319–331

78. Julious SA. Using confidence intervalsaround individual means to assessstatistical significance between twomeans. Pharm Stat. 2004;3(3):217–222

79. Duncan GJ, Dowsett CJ, Claessens A,et al. School readiness and laterachievement. Dev Psychol. 2007;43(6):1428–1446

80. Magnuson KA, Duncan GJ. The role offamily socioeconomic resources in theblack–white test score gap amongyoung children. Dev Rev. 2006;26(4):365–399

81. Storch SA, Whitehurst GJ. Oral languageand code-related precursors toreading: evidence from a longitudinalstructural model. Dev Psychol. 2002;38(6):934–947

82. Fernyhough C. Getting Vygotskian abouttheory of mind: mediation, dialogue,and the development of socialunderstanding. Dev Rev. 2008;28(2):225–262

83. Blair C, Raver CC. Child development inthe context of adversity: experientialcanalization of brain and behavior. AmPsychol. 2012;67(4):309–318

84. Kochanska G. Multiple pathways toconscience for children with different

temperaments: from toddlerhood toage 5. Dev Psychol. 1997;33(2):228–240

85. Tamis-LeMonda CS, Bornstein MH.Maternal responsiveness and earlylanguage acquisition. Adv Child DevBehav. 2002;29:89–127

86. Pace A, Luo R, Hirsh-Pasek K, GolinkoffRM. Identifying pathways betweensocioeconomic status and languagedevelopment. Annu Rev Linguist. 2017;3(1):285–308

87. Reynolds AJ, Rolnick AJ, Englund MM,Temple JA. Childhood Programs andPractices in the First Decade of Life: AHuman Capital Integration. Cambridge,United Kingdom: Cambridge UniversityPress; 2010

88. Heckman JJ. Invest in Early ChildhoodDevelopment: Reduce Deficits,Strengthen the Economy. Chicago, IL:The Heckman Equation; 2010

89. Madigan S, Browne D, Racine N, Mori C,Tough S. Association between screentime and children’s performance ona developmental screening test. JAMAPediatr. 2019;173:244–250

90. Fraley RC, Roisman GI, Haltigan JD. Thelegacy of early experiences indevelopment: formalizing alternativemodels of how early experiences arecarried forward over time. Dev Psychol.2013;49(1):109–126

91. Lowell DI, Carter AS, Godoy L, Paulicin B,Briggs-Gowan MJ. A randomizedcontrolled trial of Child FIRST:a comprehensive home-basedintervention translating research intoearly childhood practice. Child Dev.2011;82(1):193–208

92. Suskind DL, Leffel KR, Graf E, et al. Aparent-directed language interventionfor children of low socioeconomicstatus: a randomized controlled pilotstudy. J Child Lang. 2016;43(2):366–406

93. Raby KL, Freedman E, Yarger HA, Lind T,Dozier M. Enhancing the languagedevelopment of toddlers in foster careby promoting foster parents’ sensitivity:results from a randomized controlledtrial. Dev Sci. 2019;22(2):e12753

94. Berry D, Willoughby MT. On the practicalinterpretability of cross-lagged panelmodels: rethinking a developmentalworkhorse. Child Dev. 2017;88(4):1186–1206

PEDIATRICS Volume 144, number 4, October 2019 11 by guest on July 26, 2021www.aappublications.org/newsDownloaded from

95. Cabrera N. Why do fathers matterfor children’s development? In:McHale SM, King V, Van Hook J, BoothA, eds. Gender and CoupleRelationships. Cham, Switzerland:Springer International Publishing; 2016:161–168

96. Fagan J, Iglesias A, Kaufman R.Associations among Head Start fathers’involvement with their preschoolersand child language skills. Early ChildDev Care. 2016;186(8):1342–1356

97. Varghese C, Wachen J. Thedeterminants of father involvement andconnections to children’s literacy andlanguage outcomes: review of the

literature. Marriage Fam Rev. 2016;52(4):331–359

98. Hoff-Ginsberg E. The relation of birthorder and socioeconomic status tochildren’s language experience andlanguage development. ApplPsycholinguist. 1998;19(4):603–629

99. Oshima-Takane Y, Goodz E, DerevenskyJL. Birth order effects on earlylanguage development: do secondbornchildren learn from overheard speech?Child Dev. 1996;67(2):621–634

100. Pine JM. Variation in vocabularydevelopment as a function of birth-order. Child Dev. 1995;66(1):272–281

101. Bernier A, Carlson SM, Whipple N. Fromexternal regulation to self-regulation:early parenting precursors of youngchildren’s executive functioning. ChildDev. 2010;81(1):326–339

102. Bernier A, Calkins SD, Bell MA.Longitudinal associations between thequality of mother-infant interactionsand brain development across infancy.Child Dev. 2016;87(4):1159–1174

103. Swingler MM, Perry NB, Calkins SD,Bell MA. Maternal behavior predictsinfant neurophysiological andbehavioral attention processes inthe first year. Dev Psychol. 2017;53(1):13–27

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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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