Early Literacy Research Library (ELRL) - Article

Shared Reading Quality and Brain Activation during Story Listening in Preschool-Age Children

Hutton, J.S., Phelan, K., Horowitz-Kraus, T., Dudley, J., Altaye, M., DeWitt, T., Holland, S.K. (2018) Shared Reading Quality and Brain Activation During Story Listening in Preschool-Age Children. The Journal of Pediatrics, 191, 204-211.,

Access: FREE/Open Access

Publication year


study description


Population Characteristics

Poverty/Low-Income , Toddler/Preschool

Exposures, Outcomes, Other

Brain/Neurocognitive , Child Development (general) , Home Visitation , Language and Literacy Development , Parent Behaviors and Skills , Parent-Child Relationships/Interactions


To explore the relationship between maternal shared reading quality (verbal interactivity and engagement) and brain function during story listening in at-risk, preschool-age children, in the context of behavioral evidence and American Academy of Pediatrics, recommendations.


Shared reading.

outcomes evaluated

Maternal shared reading quality and child brain function.


Recruited from a longitudinal home injury prevention trial that consisted of 650 mother-child dyads recruited in infancy from a home visiting program serving low-SES, first-time mothers.


In this cross-sectional study, 22 healthy, 4-year-old girls from low socioeconomic status households completed functional magnetic resonance imaging using an established story listening task, followed by videotaped observation of uncoached mother-daughter reading of the same, age-appropriate picture book. Shared reading quality was independently scored applying dialogic reading and other evidence-based criteria reflecting interactivity and engagement, and applied as a predictor of neural activation during the functional magnetic resonance imaging task, controlling for income and maternal education.

sample size

n=22 (4-year old girls)


Measure of Brain Activity: blood oxygen dependent fMRI.


Measure of Maternal Reading Quality: videotaped interactions of reading observations were scored using a standardized form with the following categories:

    • introducing the book to build interest.
    • CROWD prompts: sentence Completion, Recall of parts of the story, Open-ended questions, “Wh-” questions, and Distancing to relate the story to the child’s life.
    • PEER responses to what child says after Prompt: Evaluate, Expand, and/or Repeat.
    • discussing the book after reading.
    • proximity, child page turning, child-adjusted voice as sound effects.


Shared reading quality scores were generally low and negatively correlated with maternal distraction by smartphones (P < .05). Scores were positively correlated with activation in left-sided brain areas supporting expressive and complex language, social-emotional integration, and working memory (P <.05, false discovery rate corrected).


Maternal shared reading quality is positively correlated with brain activation supporting complex language, executive function, and social-emotional processing in at-risk, preschool-age children. These findings represent novel neural biomarkers of how this modifiable aspect of home reading environment may influence foundational emergent literacy skills, reinforce behavioral evidence and American Academy of Pediatrics, recommendations, and underscore the potential of dialogic reading interventions to promote healthy brain development, especially in at-risk households.


Our low-SES sample limits generalizability, though this demographic is most often cited in dialogic reading literature,5 and low-SES populations stand to benefit most from improved interventions. Our study involved only girls, though this sampling strategy was guided by historical success rates and negligible sex differences in activation during our story listening task,30 allowing us to collect high-quality data efficiently and cost-effectively in very young children. Our shared reading observation was conducted in a non-natural setting. However, the room was comfortably arranged via a scripted protocol with prompts provided, highly conducive compared with oft-chaotic home environments experienced by low-SES families.80 Our reading score reflected a single snapshot, and may not be representative of longer-term behavior, though household reading behaviors tend to be stable during the preschool period81 and discrete observations are reliably used in assessment of the home environment,82 including reading.83, 84 Applying dialogic scoring criteria to mothers showing low mastery may be unrealistic. However, although developed for intervention,85 the dialogic construct is a well-defined means to assess nurturing behaviors during shared reading – questioning, responding, closeness - that do not require explicit teaching, and other basic, evidence-based items were included.13 Our finding of generally low scores is concerning, highlighting the difficulty of remediating shared reading quality compared with book distribution, given limited resources86, 87 and provider training.7 That said, our findings suggest that even modest improvement in shared reading quality may provide meaningful benefits for brain development supporting emergent skills in at-risk children. Determining the relative impact of qualitative behaviors - from lap sitting, to dialogic prompts, to reducing maternal distraction by smartphones, a major observed barrier worthy of emphasis - warrants further study. Finally, whereas our results show compelling correlation between maternal shared reading quality and brain function during a foundational developmental stage, our cross-sectional design cannot establish causation. Longitudinal studies are needed to better understand how a child’s developing brain responds to various modifiable aspects of home reading environment, to optimize literacy and health outcomes.