Early Literacy Research Library (ELRL) - Article

Shared Reading and Risk of Social-Emotional Problems

Martin, K.J., Beck, A.F., Xu, Y., Szumlas, G.A., Hutton, J.S., Crosh, C.C., Copeland, K.A. (2022) Shared Reading and Risk of Social-Emotional Problems. Pediatrics, 149(1), 1-11.,

Access: FREE/Open Access

Publication year


study description

Retrospective review of longitudinal records.

core topic(s)

Shared Reading

Population Characteristics


Exposures, Outcomes, Other

Child Development (general) , Mental Health , Reading Frequency , Social-Emotional


In this study, we examined the possible association between shared reading and social-emotional problems among young children.


Shared reading.

outcomes evaluated

Childhood social-emotional problems.


Urban, academic pediatric primary care centers between July 1, 2013 and February 1, 2019.


We conducted a retrospective review of longitudinal records for children aged 30 to 66 months presenting for visits to an academic pediatric primary care center between July 1, 2013, and February 1, 2019. The outcome was evidence of social-emotional problems, defined by an Ages and Stages: Social Emotional Questionnaire (ASQ:SE) score above the established cutoff. The predictor was caregiver-reported frequency of shared reading (most 5 5–7 days per week, some 5 2–4 days per week, rarely 5 0–1 days per week) at a previous visit. Generalized linear models with generalized estimating equations were used to assess the association between the longitudinal outcome and predictor, adjusting for child demographics and needs reported on routine social history questionnaires.

sample size

n=5693 (children)


Measure of Social-Emotional Problems: Ages and Stages Social Emotional Questionnaire (ASQ:SE).


Measure of Shared Reading: caregiver self-reported frequency of shared reading.


Measure of Potential Covariates: pediatric primary care center (PPCC) Social history questionnaire with questions assessing food insecurity, housing insecurity, and caregiver depression (Patient Health Questionaire-2).


Analyses included 5693 children who completed at least 1 ASQ:SE (total of 7302 assessments) and had shared reading frequency documented before each ASQ:SE assessment. Children were predominantly Black (75%) and publicly insured (80%). Sixteen percent of ASQ:SE scores were suggestive of social-emotional concerns; 6% of caregivers reported sharing reading rarely. Children with rare shared reading had a higher risk of an ASQ:SE above cutoff compared with those with shared reading on most days (adjusted risk ratio, 1.62; 95% confidence interval, 1.35–1.92).


Less-frequent caregiver-reported shared reading was associated with higher risk of social-emotional problems in young children presenting for primary care. This highlights potential relational and social-emotional benefits of shared reading.


First, included children were predominantly publicly insured and Black, limiting generalizability to more affluent populations and other racial and ethnic groups. Second, the ASQ:SE is a caregiver-completed screening tool, not a diagnostic assessment of social-emotional problems. Reporting biases on the part of certain caregivers (eg, self-report bias, social desirability bias) may lead to indications that a child does not have social-emotional problems when they actually do, or vice versa. Completion of the ASQ:SE while caregivers are focused on another presenting medical concern may also reduce accuracy of responses...Third, our data included only those variables charted in our EMR and not other potentially important variables (eg, caregiver education, history of developmental delay, or prematurity). The absence of these variables raises the possibility that the association observed between shared reading and social-emotional development occurs as a function of an unmeasured third variable. Fourth, because our reading category of most days of the week (5–7 days per week) included daily reading (7 days per week), we suspect that our findings may have been stronger if there was a separate category for daily shared reading, particularly given data demonstrating the benefit of daily shared reading.4,5 Fifth, because our EMR does not capture data on the fidelity of the ROR intervention, we cannot determine if or how ROR exposure or uptake plays into the associations we observed between shared reading and social-emotional problems. Sixth, physician accuracy in calculating and reporting ASQ:SE scores as well as provider verification of caregiver report of shared reading frequency is not captured in this study or in typical clinical practice. The branching logic of our EMR asks for what was done in response to an ASQ:SE above cutoff. Thus, our EMR responses are more likely to be biased toward true failures than documenting false passes....Finally, our study design used caregiver-completed screening tools that did not allow for formal assessments of social-emotional development, including temperament at baseline. Our analysis of each ASQ:SE assessment in association with the most recently reported shared reading also does not allow us to evaluate the potential bidirectional relationship between caregiver shared reading and child social-emotional development.