Dana Suskind, M.D., spoke at Rotary International on Sept. 24

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On Sept. 24, Dana Suskind, M.D., spoke to about 200 people at Rotary International on the critical importance of a rich early language environment in the first three years of a child’s life, starting at day one. The event was sponsored by the Evanston Community Foundation and the Evanston Public Library, with participation by the Evanston Cradle to Career Initiative.

“Language is power,” Dr. Suskind said. “It’s at the very heart of every child’s ability to reach his or her potential. That language is power, it’s at the heart of the achievement gap and so many issues that we’re seeing in this country. Language is power and an essential element to address so many of these issues. It’s part of the solution.”

Dr. Suskind is a surgeon at University of Chicago Hospitals who performs cochlear implants that enable young patients to hear. She became interested in the word gap after noticing that her patients went on to develop language skills at markedly different rates and that those who thrived generally lived in households that had rich language environments.

A recurring theme in her presentation is that parents have the power to shape their child’s developing brain through a simple means: by talk.

She is the founder of the Thirty Million Words Initiative (TMW), and author of the book, “Thirty Million Words, Building a Child’s Brain” (2015).

The Hart and Risley Study

Dr. Suskind says a study conducted by Betty Hart and Todd R. Risley about 30 years ago ­­­is pivotal. “Because of Hart and Risley,” she said, “the importance of the early language environment began to be understood: that the words a child heard, both the quantity and the quality, from birth through three years of age could be linked to the predictable disparities in ultimate educational achievement.”

Hart and Risley found that children from low-income families heard 30 million fewer words than children from professional families by the time they were 4 years old.

“Quantity was one part of the issue,” Dr. Suskind said. “There were significant qualitative differences, with children born into poor homes having more prohibitions, less affirmations – ‘Don’t do that,’ ‘Stop that,’ less conversation, less back-and-forth, less complex vocabulary.”

The differences correlated with differences in vocabulary skill at age 4, but also correlated with differences in vocabulary, IQ and test scores in third grade. 

Hart and Risley answered another key question. In her book, Thirty Million Words, Dr. Suskind, says, “Counter to prevalent thought at the time, neither socioeconomic status, nor race, nor gender, nor birth order was the key component in a child’s ability to learn because, even within groups, whether professional or welfare, there was variation in language.

“The essential factor that determined the future learning trajectory of a child was the early language environment: how much and how a parent talked to a child. Children in homes in which there was a lot of talk, no matter the educational or economic status of that home, did better. It was as simple as that.

“How many words a child heard in those first three years and how they were spoken were critical factors in their school readiness and ultimate achievement, catapulting some to the top, sending some to languish at the bottom,” said Dr. Suskind. “Ultimately, the ease with which we learn and the design of our entire lives are essentially predicated on what happens in those first three years.”

Architecture of the Brain

Neuroscience explains from a scientific perspective what Hart and Risley observed empirically.

In the first three years of life, “the brain is creating 700 – 1,000 new neural connections every second, creating a complex circuitry,” said Dr. Suskind. “And certainly while brain development will occur throughout our lifetime, … at no other time will it be as rapid or more influential.

“While genetics provides the ultimate potential for improvement for each and every one of us, science strongly indicates that reaching that potential is based on our early language environment – basically how and how much parents interact with us.

 “When language around is rich, the brain can build complex neural circuitry with excellent architecture for all of our learning, ultimately affecting all of our brain functions from emotion to memory to behavior and certainly language.

“The fact is that ‘parent talk’ truly impacts every crevice of who we are. It builds brains. So it impacts the whole child. … It is the most powerful and truly underutilized resource in our country.”

Thirty Million Words Initiative (TMW)

TMW is a research-based initiative at the University of Chicago. It is based on the science that “parents through their words have the power to build their child’s brain from the moment when they’re born.

“Our goal,” Dr. Suskind said, “is not simply on an individual level, but that every caregiver in this country, every adult in the country understands the power of language and the power of the early years to set the course for their children.”

She made clear that, “though we’re talking about difference in socio-economic status and language and mind and achievement, we’re not talking about differences in love of parents or wanting their children to be happy and successful.” She added, “There are many factors that impinge on a home language environment, families without stable homes, living in violent neighborhoods, without stable childcare, or stable jobs.” Parents “must be supported so that they may be able to invest in their children.”

TMW’s Home-Visiting Program

The home-visiting program is TMW’s “flagship program.” A trained coach works one-on-one with families as partners in a series of 12 visits over six months. In each session the coach uses a computer-based curriculum developed with parents that contains animation and videos that explain the importance of parent talk to a child’s development and that illustrate techniques that parents can use to increase their child’s development. During the sessions, parents practice new skills with their coach, using video modeling.

A foundation of the program is to educate parents that their child’s brain and intelligence are malleable. “Unless we understand that we are the key architects of our children’s brain development, why spend the little resources we have on talking to our children?

 “Once we allow parents to understand that intelligence is malleable and that they are critical architects in their child’s brain development,” parents are provided tips on ways to interact with their children using the Three Ts: Tune In, Talk More, and Take Turns, said Dr. Suskind.

• Tune In “involves a parent’s making a conscious effort to notice what a baby or child is focused on, then, when it’s appropriate, talking with a baby or child about it. In other words, focusing as the child is focused.”

• Talk More, “refers to more than just numbers of words; it’s the kinds of words and how those words are said that are the salient factors.” It “refers to a parent’s increased talking with a child, especially about what the child is focusing on, not to him or her.”

• Take Turns, “entails engaging a child in a conversation exchange. The gold standard of parent-interaction, it is the most valuable of the Three Ts when it comes to developing a child’s brain. In order for the necessary serve-and-return of conversational interaction to be successful, there has to be active engagement between the parent and child.” One key part of this is “for the parent to wait for the child to respond,” – to take turns.

The Three Ts can be used as an “overlay” while parents are doing any activity, such as changing a diaper, playing with blocks, doing the laundry, cooking, or reading a book.

One tool used with parents in the home visits is a digital language processor – akin to a pedometer – which counts the number of words a child has been exposed to in a 16 hour period, how many conversation turns have taken place, and other things. TMW generates charts that the coach and parents use to track progress and to jointly set goals. Examples of the charts which track words heard and conversation turns are below.  


Dr. Suskind says of the processor, “I think its power is in the mindfulness.”

The first pilot of the home-visiting program showed promising results. Parents gained knowledge about early language and brain development, and increased their talk and conversational turns with their children.

After the pilot, TMW sought input from parents who participated in the program. One comment was parents were interested in not only how they build their child’s language skills, but how they could build their child’s behavior. Based on the input, TRW modified its curriculum.

TMW received a grant from the PNC Foundation to conduct a five-year longitudinal study of the initiative.

Major Focus, Other Initiatives

 “We want to see really a population-level shift,” said Dr. Suskind, “so that every parent, every caregiver, every educator, every policymaker understands how powerful language is in allowing every child to reach their genetic, intellectual potential. So we are developing science-based programs that really meet families where they are.”

She said TMW is working on curricula and single-shot interventions that may be used during a hearing screening at birth, in the maternity wards, during well-being visits to the pediatrician’s offices, during home-visiting programs, at day-care centers, as well as in displays at children’s museums, and libraries. 

“Our program is about getting this message and these science-based programs to parents – to really, hopefully get it into the groundwater,” said Dr. Suskind.

One part of the program is called “Spread the Words.” It is geared to helping parents become the agents of change within their communities. As an example, Dr. Suskind said parents who participated in the pilot of the home-visiting program talked to their co-workers and church members and some talked to their sisters and brothers about how to use the Three Ts with their children.

The brain is composed of billions of highly integrated sets of neural circuits (i.e., connections among brain cells) that are “wired” under the influences of genes, the environment, and experience. Continuing scientific research demonstrates that early childhood experiences leave chemical signatures on genes that affect how easily the genes are turned “on” or “off.” In this way, early childhood experiences combine with genes and the environment to physically shape the architecture of a child’s brain. (NSCDC 2010)

In a 2012 report, the National Scientific Council on the Developing Child (NSCDC) concluded, “Beginning after birth, a strong foundation for human well-being requires responsive environments and supportive relationships to build sturdy brain circuits, facilitate emerging capabilities, and strengthen the roots of physical and mental health.” (NSCDC 2012)

A “major ingredient” of a responsive relationship is what NSCDC calls “serve and return” interactions between a child and adults. “Beginning shortly after birth, the typical ‘serve and return’ interactions that occur between young children and the adults who care for them actually affect the formation of neural connections and the circuitry of the developing brain. Over the next few months, as babies reach out for greater engagement through cooing, crying and facial expressions – these reciprocal and dynamic exchanges literally shape the architecture of the developing brain.” Id.

As children get older, more sophisticated “serve and return” interactions with a child, reading on a regular basis to a child and exposing a child to more cognitive language have positive impacts. The stimulation that occurs in the brain through these activities “can result in epigenetic changes that establish a foundation for more effective learning capacities in the future.”(NSCDC 2010)

By age 3, a great deal of brain architecture is developed. While, for most functions the window of opportunity remains open well beyond the age of 3, this is subject to one important caveat. NSCDC says, “More complex brain circuits build upon earlier, simpler circuits. … Building more advanced cognitive, social and emotional skills on a weak foundation of brain architecture is far more difficult and less effective than getting things right the first time.

“Just as a faulty foundation has far-reaching detrimental effects on the strength and quality of a house, adverse early experience can have far-reaching effects on the development of brain architecture.” (NSCDC 2008)

Notes: “The Timing and Quality of Early Experiences Combine to Shape Brain Architecture” (2008), prepared by NSCDC; “Early Experiences Can Alter Gene Expression and Affect Long-Term Development” (2010), prepared by NSCDC; “The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain” (2012), prepared by NSCDC.

Hart and Risley: The 30 Million Words Gap

A study conducted by Betty Hart and Todd R. Risley and described in their book “”Meaningful Differences in the Everyday Experiences of Young American Children”” (1995) and their article, “”The Early Catastrophe: The 30 Million Word Gap by Age 3,”” found that the language environments of young children in low-income households differed significantly from the language environments of children in working class and professional households.

While “”all the families [in the study] nurtured their children and played and talked to them,”” one key difference was the number of words heard by the children. “”Simply in words heard, the average child on welfare was having half as much experience per hour (616 words per hour) as the average working-class child (1,251 words per hour) and less than one-third that of the average child in a professional family (2,153 words per hour).””

By age 4, the average child in a low-income household heard 13 million words less than a child in a working class family and 32 million less than a child in a professional family.

Moreover, Hart and Risley found that families who talked more with their children used a more varied and richer vocabulary. They did not attribute this to educational status, but concluded if parents talked more they would inevitably increase the variety of words spoken to a child and the topics talked about, and it would also lead to more give-and-take conversations and exploring things in more depth.

Significantly, the differences in a child’s early language experiences strongly correlated with the child’s language skills at age 3, as well as at ages 9-10, or third grade. The more parents talked to their children, the higher the children’s vocabulary growth and vocabulary use at age 3, and the higher their level of general accomplishment on a test administered at age 3. In turn, Hart and Risley said, “”We were awestruck”” at how vocabulary use at age 3 and the general measures of accomplishments at age 3 “”predicted measures of language skill at 9-10.””

The authors also looked at the impact of positive versus negative comments. Among the professional families studied, a much higher proportion of the talk was affirming, which was defined to include not just compliments, but also responses in which parents expanded on a child’s comments. Where parents used relatively more negative comments, such as “”Don’t,”” “”Stop,”” “”Quit,”” it had “”powerful dampening effects”” on a child’s development.

Hart and Risley’s findings have been supported by subsequent studies. See e.g., “”The Specificity of Environmental Influence: Socioeconomic status affects early vocabulary development via maternal speech”” (2003), by Erika Hoff

More recently, a study by Stanford researchers found that the word gap is already evident at 18 months of age, and by 24 months there was a 6-month gap in language skills between higher- and lower -income households. See “”SES Differences in Language Processing Skill and Vocabulary Are Evident at 18 months”” (2013)