Early Literacy Research Library (ELRL) - Article

Links between Shared Reading and Play, Parent Psychosocial Functioning, and Child Behavior: Evidence from a Randomized Controlled Trial

Weisleder, A., Cates, C.B., Harding, J.F., Johnson, S.B., Canfield, C.F., Seery, A.M., Raak, C.D., Alonso, A., Dreye, B.P., Mendelsohn, A. (2019) Links between Shared Reading and Play, Parent Psychosocial Functioning, and Child Behavior: Evidence from a Randomized Controlled Trial. The Journal of Pediatrics, 213, 187-195.,

Access: FREE/Open Access

Publication year


study description

Longitudinal analysis of a randomized controlled trial.

core topic(s)

Early Relational Health , Shared Reading

Exposures, Outcomes, Other

Building Blocks , Child Behaviors and Skills , Child Development (general) , Clinic-Based Programs and Interventions , Mental Health , Parent-Child Relationships/Interactions , Play , Programs and Interventions (other) , Video Interaction Project

additional materials

Weisleder_2019_NYT article


To investigate pathways by which interventions that promote shared reading and play help prevent child behavior problems. We examined whether family processes associated with the family investment pathway (eg, parental cognitive stimulation) and the family stress pathway (eg, mothers’ psychosocial functioning) mediated impacts of a pediatric-based preventive intervention on child behavior.


Interventions: Video Interaction Project (VIP) or Building Blocks (BB).

outcomes evaluated

Child externalizing behaviors.


Urban public hospital serving low-income families (Bellevue Hospital Center).


The sample included 362 low-income mothers and their children who participated in a randomized controlled trial of Video Interaction Project (VIP), a pediatric-based preventive intervention that promotes parent-child interactions in the context of shared reading and play. Parent-child dyads were randomly assigned to group at birth. Three mediators—parental cognitive stimulation, maternal stress about the parent-child relationship, and maternal depressive symptoms—were assessed at child ages 6 and 36 months. The outcome, child externalizing behaviors, was assessed at 36 months. We used a series of path analytic models to examine how these family processes, separately or together, mediated the impacts of the Video Interaction Project on child behavioral outcomes.

sample size

n=362 (mothers and their children)


Measures of Child Externalizing Behaviors:

    • Child’s Behavior Problems: parents reported child’s behavioral problems using 4 subscales from the Parent Rating Scales of the Behavior Assessment System for Children–Second Edition (BASC-2).
    • Parental Cognitive Stimulation: assessed via parent interview using the StimQ-I2 (infants) and StimQ-P2 (preschooler).
    • Mothers’ Stress about the Parent-Child Relationship: assessed using the Parent-Child Dysfunctional Interaction (P-CDI) subscale.
    • Maternal Depressive Symptoms: assessed using the Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiological Studies Depression Scale (CES-D)

Measure of Sociodemographic Characteristics: maternal age, ethnicity, education, literacy, country of origin, marital status, and primary language, as well as child sex and birth order. Families were classified into low or high socioeconomic strata based on the Hollingshead Four Factor Index.


Intervention impacts on child behavior were mediated by enhancements in cognitive stimulation and by improvements in mothers’ psychosocial functioning. A sequential mediation model showed that Video Interaction Project impacts on cognitive stimulation at 6 months were associated with later decreases in mothers’ stress about the parent-child relationship and that this pathway mediated intervention impacts on child behavioral outcomes at 3 years of age (P = .023).


Using an experimental design, this study identifies pathways by which parent-child interactions in shared reading and play can improve child behavioral outcomes.


First, our measures relied exclusively on parent report and, although we used measures that have been shown to be reliable and valid, these measures can nonetheless be subject to recall and social desirability biases. Future research should try to incorporate observational measures of parenting behaviors, as well as teacher, clinician, or examiner reports of child behavior. Second, although we assessed mothers’ feelings of stress about the parent-child relationship, we did not assess the parent-child relationship directly. Future research could expand the present findings by including additional measures of parent-child relationship quality. Third, participating mothers were primarily first-generation Hispanic/Latino immigrants and the analytic sample was slightly less advantaged than the enrolled sample; although, importantly, this did not differ by treatment and control. Thus, these results may not be generalizable to families with other sociodemographic characteristics. Finally, although the effects of VIP on parenting outcomes and child behavior are causal, it is possible there could be additional mediators accounting for the relationships found in this study. In addition, although overall analyses were conducted utilizing data collected longitudinally, assessments of the mediators at 36 months were performed concurrently with assessments of child behavior, limiting our capacity for causal inference.