|Year : 2014 | Volume
| Issue : 3 | Page : 255-263
Effect of parent interaction on language development in children
Rasha Farouk Safwat, Aya R Sheikhany
Department of Otolaryngology, Phoniatric Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
|Date of Submission||03-Apr-2014|
|Date of Acceptance||18-Apr-2014|
|Date of Web Publication||12-Aug-2014|
Rasha Farouk Safwat
Department of Otolaryngology, Phoniatric Unit, Faculty of Medicine, Cairo University, Cairo
Source of Support: None, Conflict of Interest: None
Positive quality of parent-child interactions is essential for shaping a child's language development. Many individual factors have been found to be associated with language development, but their interaction with each other and their relation with language development is still less clear.
The aim of the study was to evaluate whether the quantity and quality of parent-child interactions contribute to language development and to detect the factors that would influence this interaction in different socioeconomic standards to consider them while planning the therapy program.
Patients and methods
This study included 100 parents and their children; they were attendants at the Phoniatric Unit of Kasr Al Aini Hospital, complaining of delayed language development in their children. Parents included 60 women and 40 men; their ages ranged between 21 and 43 years, with a mean age of 32.7 ± 5.5 years. The age range of the children was 27-49 months, with a mean of 38 ± 5.7 months. The parents were asked to fill in a questionnaire, which was divided into two sections (A and B). Section A described the parents' communicative behavior and section B included basic information on the parents and their beliefs about causes and management of delayed language development. Socioeconomic status of the parents was assessed. Children included in the study were subjected to the protocol of language assessment.
Results indicate that the majority of the included parents did not use effective methods to foster their child's language acquisition, although their knowledge about language development and intervention was adequate. There was a significant positive association between the parent's interaction score and the child's total language age. Socioeconomic status has been shown to be a significant predictor of a child's language outcomes.
Parent-child interaction is an important variable in the development of a child's language. Future research and intervention services should focus on increasing the quality of these interactions.
Keywords: language development, parent interaction, socioeconomic status
|How to cite this article:|
Safwat RF, Sheikhany AR. Effect of parent interaction on language development in children. Egypt J Otolaryngol 2014;30:255-63
| Introduction|| |
Language development among children is a complex process that is foundational to their communication skills, school readiness, and achievements. Parents are the primary people engaging and interacting with infants on a consistent basis; consequently, parents are seen as a child's first teacher. Positive quality of parent-child interactions and increased verbal responsiveness are essential in shaping a child's literacy environment and language development. The first 3 years are the most intensive, as this is when the brain rapidly develops and is able to learn new information. If this critical period passes without adequate interaction and opportunity for language development, it will become more challenging to accomplish the milestones as the child develops [1,2].
Parental perceptions are essential to the development of parent-child interactions. Understanding the ways in which parents perceive language development, difficulties, and intervention would allow speech and language therapists to be more sensitive to the needs of the families with whom they work, and would reduce the likelihood of parents misconstruing the purposes and processes involved in therapy. This, in turn, may affect uptake of, attendance to, participation in, and satisfaction with therapy . Crosscultural variations in child-rearing practices have been well documented. However, limited data are available with regard to the opinion of parents or speech and language therapists on the nature of language development, difficulties, and interventions .
Language and conceptual development involve many factors; socioeconomic status (SES) is considered one of the many important factors linked to language development as it encapsulates differences in parental beliefs, attitudes, motivations, and behaviors. A vast body of research has been dedicated to understanding the social-contextual factors that support children's early language development and learning. Many individual factors have been found to be associated with language development, but their interaction with each other and their relationship with language development is still unclear [5-8].
It is hypothesized that different parent-child interaction patterns could play a major role in holding back or facilitating a child's language development. To verify this hypothesis, an analysis of parent-child interactions was designed. The aim of the present study was to assess whether the quantity and quality of parent-child interactions contribute to language development and to detect the factors that would influence this interaction in different socioeconomic standards, to consider them while planning the therapy program.
| Patients and methods|| |
This study included 100 parents and their children; they were attendants at the Phoniatric Unit of Kasr Al Aini Hospital, with complaints of delayed language development in their children. The parents included 60 women and 40 men; their ages ranged between 21 and 43 years, with a mean age of 32.7 ± 5.5 years. The age range of the children was 27-49 months, with a mean age of 38 ± 5.7 months. This study was conducted from March 2013 until January 2014. Among the included participants, 51 (51%) parents were consulting a physician for the first time, 26 (26%) had consulted a clinician previously and had come for a second opinion for their child's problem, and 23 (23%) of the included children had undergone language stimulation sessions for a duration of 1-3 months, with a mean of 2.2 months.
Written consent was obtained from the parents before the study; parents were then asked to fill in a questionnaire, which was divided into two sections (A and B). Section A elicited the parents' communicative behavior (i.e. the quality and quantity of parental interactions with their children). Quality was detected in terms of the use of various strategies by parents that would enhance their child's language acquisition. The frequency of interactions was measured using a three-point scale (never, sometimes, most of the time). Section B included basic information on the parents and their opinions on the causes and management of delayed language development (Appendix 1 [Additional file 1]). The socioeconomic status of the parents was assessed according to the scale developed by El-Gilanny et al. , which measured six domains: a score was assigned for each item and the total score was calculated (Appendix 2 [Additional file 2]). At the end of the interview, parents were instructed on how to interact with their child to facilitate language acquisition; they were then asked for their opinion on whether they would be able to implement those interactions.
Children included in the study were subjected to the protocol of language assessment applied at Kasr Al Aini  to confirm the diagnosis, and they were selected if they had a Stanford-Binet test of intelligence score of 89 or higher. Children with a history of hearing impairment, those with psychiatric, neurological, or developmental disorders, and those with severe medical conditions were excluded from the study.
Data analysis was carried out using SPSS software program for Windows, version 21 (SPSS Inc., Chicago, Illinois, USA). Data were expressed as number and percentage for qualitative variables and mean and SD for quantitative variables. Cronbach's α for reliability was calculated for questionnaire consistency. Pearson's or Spearman's correlation coefficients were calculated for the association of different quantitative variables. Standard linear regression analysis was carried out to explore the significant predictors of total language age. P-values less than 0.05 were considered significant.
| Results|| |
This study included 100 parents and their children. The frequency distribution of parent-child interactions is shown in [Table 1]. Mean, SD, range, and interquartile range (IQR) for the total interaction % score are shown in [Table 3]. Interaction % score was classified into insufficient (<50%) and sufficient (350%). Results show that 93 (93%) of the included parents had insufficient interactions and seven (7%) had sufficient interactions.
[Table 2] shows parents knowledge about language development and intervention. Mean, SD, range, and IQR for the total knowledge % score are shown in [Table 3]. Total knowledge % score was classified into inadequate (<50%), adequate (50-70%), and excellent (<70%). It was found that 18 (18%) of the included parents had inadequate knowledge, 78 (78%) had adequate knowledge, and four (4%) had excellent knowledge.
|Table 3 Mean, SD, range, and interquartile range for the variables included in the study|
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Mean, SD, range, and IQR for SES are shown in [Table 3]. The total SES score was 61; hence, the score of two cutoff points was selected to categorize SES into three levels (low, intermediate, and high SES). The two points were 20 and 40; accordingly, SES was classified into three categories as follows:
(1) 20 or lower (low SES)
(2) 21-40 (intermediate SES)
(3) 41 or higher (high SES)
It was found that 81 (81%) of the included parents had an intermediate score and 19 (19%) had a high score.
Language age was calculated for each child, range 12-34 months; mean 19.3 ± 5.9. [Table 4] shows a significant association between the knowledge % score, the interaction % score, and the language age.
|Table 4 The Pearson correlation coeffi cient (r) of total language age, total interaction % score, and total knowledge % score with other parameters|
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Multivariate analysis was carried out to explore the variables affecting the total language age (SES, total interaction score, total knowledge score). SES was found to be a significant predictor of a child's language age (P = 0.002).
| Discussion|| |
The primary purpose of this study was to understand the relationship between parent-child interaction and language acquisition; a secondary intent was to determine the presence of any possible relationship between socioeconomic standard and the parents' communicative behavior. Results indicate that the majority of the included parents did not use effective methods to foster their child's language acquisition, although their knowledge about language development and intervention was adequate, and this was associated with the child's language outcome among the included socioeconomic standards.
The present findings reveal that the quality and quantity of parent-child interactions in the majority of the studied sample (93%) were defective in providing an enriching and stimulating environment necessary for language acquisition, and this was reflected in the significant positive association between the interaction score % and a child' total language age [Table 4]. Several studies found similar findings [11-15]. It was evident from the majority of parent reports that the parents failed to create an ideal setting while interacting with their child, and their communication style and responses to their children were poor. Mothers reported that their verbal interactions mainly included asking questions, corrections, and instructions. A large number of parents (60%) reported that they were not actively involved with their child, who was left to play alone or with other siblings; they were less likely to consider that children learn important things while playing and emphasized the role of direct teaching and imitating others. Sixty-five percent of the included parents reported that they participated in routine activities with their children. Raikes et al.  reported that frequent and consistent participation in routine activities provides young children with a familiar structure for interpreting others' behavior and language, helps them anticipate the temporal sequencing of events, provides rich information about objects and events in the environment, and allows them to draw inferences from new experiences.
A possible explanation for the relationship between quality of interaction and language outcome was offered by Umek et al. ; in their study, they found that the quality of verbal interactions between a parent and child during reading and play-time stimulates the child's language development, improves his/her vocabulary skills and reading comprehension, and increases his/her school readiness. Parents who contingently respond to their children's verbal initiatives tend to have children with advanced phonological awareness and story comprehension skills. The role of maternal interaction with their child was emphasized by several studies [18-20], they recommended frequent maternal labeling, expansion of child's utterances, speaking to the child in a grammatically correct fashion, and interactive story telling.
The present data provide evidence that parent interactions are associated with language outcome; however, it was not obvious whether the quality or quantity of parent interaction was a predictor of language development. Several studies emphasize that the quality of the interactions may be a better predictor of achievement scores than quantity [7, 12, 21, 22]. Morales et al.  reported that following the child's lead and maintaining joint attention were more effective in increasing a child's vocabulary than high maternal vocabulary alone. Westerlund and Lagerberg  found that parents who were warm and accepting while interacting with their child had interactions that involved follow through (reciprocity) and sustained engagement (synchrony) on the part of the child.
An unexpected finding was that the majority of the included parents (78%) had adequate information about language development and intervention, and there was a strong positive association between parental knowledge and interaction scores and a weaker interaction with language scores [Table 4]. It was noted from parental opinions about the possible cause of delay in their child's language development that 51% considered much of a child's language learning to be incidental and reported that the home environment had a powerful influence in enhancing or hindering language acquisition. Peacey  reported a similar finding. Others suggested that the problem was due to hereditary factors, difficulties within the family, lack of time to spend with the child, inconsistency in the implementation of strategies that would facilitate language acquisition, and difficulty in dealing with stubborn or noncompliant children. Few parents were uncertain or confused about the reasons for delayed language development, and others blamed themselves because they felt that these problems reflected badly on their parenting abilities. Parental concerns were consistent with the finding of Ayoub et al. ; they suggested that children with lower language skills may be more stressful for parents to interact with.
In the current study, it was obvious that parents had different views about the effectiveness of interventions; accordingly, their willingness to be involved in the therapy process varied. In this study many parents (61%) considered that the nursery would be the main solution to enhance their child's social and communication problem. Thirty-six percent suggested that watching television would be effective, as they believed that their children needed to 'see and hear more' than the immediate family surroundings to acquire new vocabulary. A minority (25%) thought that medication would help increase their child's concentration, whereas others took language development for granted and were waiting for spontaneous recovery given that their child had no organic abnormality. It was also evident that there were discrepancies in the evaluation of the child's problem by parents and clinicians. Few parents reported that their children had received therapy and counseling; however, they failed to make all the recommended linguistic adjustments and/or did not find expected improvement. The results of this study added to previous research [26-28].
It emerged from some parents' accounts after completion of the questionnaire that they were surprised at the expectation that they would have to take part in treatment and reported that they would not be able to implement the interactions that would enhance their child's language acquisition. Several reasons were given: Some parents reported that they were not convinced that it would work, some claimed that they did not have the necessary skills to communicate effectively with their child as they were impatient and wanted a quick response, and some claimed that other family members were not helping. It also seemed that, although some parents were willing to be involved in their child's therapy, they believed that a therapist needed to be involved and to administer the bulk of the therapy. The variation in the extent of parental involvement might reflect the fact that what may be effective for one family may be inappropriate for another.
With regard to the effect of SES, the present data revealed a strong positive association with total interaction score and to a lesser extent with knowledge score and child's language age; this highlights the impact of socioeconomic factors [Table 4]. In agreement with this finding, other studies [29,30] found that middle-SES and high-SES parents were more likely to engage in long conversations with their children, verbalized more to their children, participated more actively in their child's play, were more didactic, responsive, and elaborative, and practiced fewer penalizing behaviors during interaction.
In the current study, the differences between financial status, level of parental education, occupation, and number of children in the included families might have contributed to the different outcomes. A small association was found between poverty and differences in parent talk and language delay. It is assumed that parents who are preoccupied with the stress of everyday life may perceive the needs of their child as an additional and overwhelming stress and fail to establish a reciprocal or emotional relationship with their child. Poverty might influence the quality of environmental support, the availability of material resources, and the provision of age-appropriate earning materials, adequate nutrition, and medical care. Data on the aspect(s) of poverty that are causally related to language delay are incomplete [22, 25, 31]. The present data also show that parents' occupations and education were more significantly associated with the outcome than their economic status [Table 4]. Education permits different life experiences, which might influence parental values and child-rearing practices, and this was evident in the significant positive association between parents' access to health information and their knowledge and interaction scores. Several studies found similar results [6, 14, 15, 30, 32]. Ruhm  and Pancsofar et al.  suggested that maternal employment can negatively impact the quality of parenting interactions because of less time spent by the mothers with their children.
The present data reveal a significant positive association between the home sanitation domain (measured by crowding index) and interaction scores. It was expected that a large number of siblings would act as a barrier to responsiveness of parents to their children. Evidence from previous studies suggests poor cognitive, language, social, and behavioral outcomes [3, 35, 36].
SES has been shown to be a significant predictor of child language outcomes. However, it is possible that even in the presence of demographic-related barriers, a child's language skills can be improved if parenting behaviors are enhanced. As demographic characteristics are rather stable and present a challenge for change, parental behaviors appear to be a critical point of intervention for a child's language acquisition.
Strengths and limitations
The interpretation of parental accounts enriches our understanding of parents' perspectives about language development, delay, and intervention. The study includes a relatively large sample of families with different socioeconomic levels. It used reliable and valid measures (detailed interviews as well as questionnaires) of parental interaction quality with a verbal outcome measure, and examined the association between socioeconomic variables and outcome.
The study did not include ratings from direct observation of parents with their children; in addition, it was not possible to identify the contributions solely from each parent interaction and different language outcomes.
| Conclusion|| |
(1) Parent-child interaction is an important variable in language development of a child.
(2) Future research should focus on increasing the quality of these interactions; this would involve providing parents with education aimed at increasing the sophistication of their language skills.
(3) Our study highlights the need to understand the constituents of an appropriate environment for a child. Phoniatricians should investigate and take into account socioeconomic variables to work more successfully with families from a wide range of backgrounds.
| Acknowledgements|| |
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[Table 1], [Table 2], [Table 3], [Table 4]