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. (2022) Promoting Cognitive Stimulation in Parents Across Infancy and Toddlerhood: A Randomized Clinical Trial. The Journal of Pediatrics, 1-7.,

Access: FREE/Open Access

Publication year


study description

Randomized Controlled Trial

core topic(s)

Pediatric Primary Care

Population Characteristics

Infant/Newborn , Poverty/Low-Income , Pregnancy/Postpartum , Toddler/Preschool

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions , Home Visitation , Parent-Child Relationships/Interactions , Play , Programs and Interventions (other) , School Readiness and Educational Outcomes , Smart Beginnings , Technology and Digital/Screen-Based Media


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

outcomes evaluated

Parental support of cognitive stimulation


Mothers recruited from 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 in postpartum units of hospitals in New York City and Pittsburgh, Pennsylvania, with a consecutive sample of 403 mother-infant dyads. 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. The principal outcome was parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent-child interactions. Ordinary least squares and mixed effects regressions were conducted.

sample size

n=403 (mother-infant dyads)


Measure of Parental Support of Cognitive Stimulation – Survey Measures: 3 subscales of the StimQ was used to assess caregiver cognitive stimulation via structured interview, including
1) Parent Verbal Responsivity (PVR): verbal interactions across components
2) Parental Involvement in Developmental Advance (PIDA): teaching activities
3) Reading Activities (READ): quantity, quality, and diversity of concepts

Measure of Parental Support of Cognitive Stimulation – Observational Measure: participation in structured free-play tasks involving clean-up, free play, and teaching. Tasks were video recorded and for coding using Parent–Child Interaction Rating Scales–Infant Adaptation for a global rating of parent–child interaction.


Families were mostly Black/African-American (50%) or Latinx (42%); all were Medicaid eligible (100%). 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.