Early Literacy Research Library (ELRL) - Article

Promoting Cognitive Stimulation in Parents Across Infancy and Toddlerhood: A Randomized Clinical Trial

Miller, E. B., Roby, E., Zhang, Y., Coskun, L., Rosas, J. M., Scott, M. A., Gutierrez, J., Shaw, D.S., Mendelsohn, A.L., & Morris-Perez, P. A. (2023). Promoting Cognitive Stimulation in Parents Across Infancy and Toddlerhood: A Randomized Clinical Trial. The Journal of Pediatrics, 255, 159-165.,

Access: FREE/Open Access

Download the full text: Miller_2023

Publication year


study description


core topic(s)

Early Literacy , Early Relational Health , Pediatric Primary Care

Population Characteristics

Medical Providers

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions , Parent-Child Relationships/Interactions , Smart Beginnings , Video Interaction Project


To test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6 to 24 months across infancy and toddlerhood.


Smart Beginnings and Video Interaction Project

outcomes evaluated

Parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent–child interactions


Postpartum units of hospitals in New York City and Pittsburgh, Pennsylvania


This was a single-blind, 2-site randomized clinical trial of the Smart Beginnings intervention. Enrollment took place at birth. Smart Beginnings combines a Video Interaction Project—14-session universal primary prevention program delivered in the pediatric clinic at the time of well-child visits birth-36 months—with potential for Family Check-Up—3-4 sessions targeted secondary prevention home-visiting program.

sample size

403 mother–infant dyads


  • StimQ2: structured interview measure of caregiver cognitive stimulation
  • Observational Measures: mother–child dyads participated in a structured free play task. coding of the videos was subsequently performed using an adaptation of the Parent–Child Interaction Rating Scales–Infant Adaptation for a global rating of parent–child interactions. Three domains of the Parent–Child Interaction Rating Scales–Infant Adaptation relevant to cognitive stimulation were coded: (1) cognitive development (intention to support learning); (2) language quantity (amount of verbal stimulation); and (3) language quality (quality of verbal stimulation)


Smart Beginnings significantly promoted cognitive stimulation during infancy and toddlerhood for most survey outcomes across time, including StimQ common total (effect size [ES] = 0.25, P = .01) and READ Quantity (ES = .19, P = .04) and Quality (ES = .30, P = .001). For the observations, the impact of Smart Beginnings varied by time, with significant impacts at 6 (ES = 0.37-.40, P < .001) and 24 (ES = 0.27-.30, P < .001) months, but not 18 months.


Smart Beginnings positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation.


Not discussed