When twins Kaila and Jackson were a year old, they didn’t use speech at all. Their mother, Christine Brey, was concerned.
“Basically, they just looked at me,” she said.
Her concern was natural, since her older daughter had begun talking right on schedule, imitating speech sounds and saying a few words, such as “mama,” by 12 months. The fact that the twins were born about two months premature also put them at risk for developmental delays.
UpWORDS, a free, 15-week class at Texas Children’s Hospital The Woodlands, was a real eye opener for Brey.
“We learned how speech impacts the brain and how it’s really important to talk to your kids and share lots of things with them, even if they’re too young to understand what you’re saying,” Brey said. “We learned a lot about physiology and some tips and tricks to speak to the babies – how you have to be over the top and very animated.”
The first few years of a child’s life provide the greatest opportunity to influence their success later in life. By the age of 3, approximately 80 percent of a child’s brain development is complete. Research shows that early exposure to language affects brain processing speed and vocabulary acquisition, which later affect reading skills, which in turn predict high school graduation and success in life.
Research also shows that high-risk children may be exposed to nearly 30 million fewer words than their peers from birth to 3 years old. The upWORDS program helps parents of infants and toddlers close the “talk gap.”
“The goal is to provide skills to help parents engage with their children to facilitate language development, which is so important to the long-term outcome of their children,” said Christopher S. Greeley, MD, chief of the Section of Public Health Pediatrics at Texas Children’s Hospital and vice chair of community health in the Baylor College of Medicine Department of Pediatrics.
Developed in association with the LENA Research Foundation, upWORDS teaches parents how to improve the quantity and quality of language spoken with their child. Available in both English and Spanish, the program includes group classes where parents learn simple techniques to increase interactive talk with their child and learn to use the LENA (Language ENvironment Analysis) System™ to monitor their home language environment.
The LENA System uses a sort of talk pedometer, or language Fitbit, a small recorder that fits inside a vest worn by the child. The recorder measures the number of words parents speak to their child and how much their child responds.
“We focus on teaching parents the importance of conversational turns or what is known as serve and return. This starts when children are infants and the baby makes a sound, mom responds, and then the baby makes a sound in response,” said Maura Dugan, public health pediatrics manager. “Research shows that tuning into the child and having conversational turns from a young age are extremely important for brain development.”
Turn-taking is the way young children, even in the first year of life, begin to communicate and build the foundation for conversations. Weekly data reports from recordings and individual coaching help parents identify opportunities to increase their spoken interactions with their child.
“There’s always something positive we can find in that report to help the parents grow. We try to create a nonjudgmental, safe place for families to come and learn,” Dugan said. Besides teaching about communication and brain development, Texas Children’s supplements the LENA curriculum with support for families, such as connecting them with community resources and information on positive parenting skills. To encourage reading aloud, upWORDS gives parents a free children’s book at every session.
Parents also have an option to sign up for the Food for Change program, which provides a voucher for 30 pounds of food twice a month in partnership with the Houston Food Bank. The Section of Public Health launched upWORDS in June 2016 as a pilot program at Texas Children’s Hospital West Campus in partnership with the West Campus Speech Therapy department. Since then, 835 families have participated in the program, which is now offered free of charge at 22 locations across the greater Houston area, including community development centers, the Children’s Museum, schools and libraries, as well as Texas Children’s campuses.
Texas Children’s upWORDS is the largest program in the country using the LENA curriculum and device. It was the first location based in a children’s hospital.
To track language development, UpWORDS uses a small recorder that fits inside a vest worn by the child. The recorder measures the number of words parents speak to their child and how much their child responds.
Results have been positive, with data demonstrating improved language acquisition for the children and improved communication of the parents.
For example, the Brey twins heard adults speaking an increase of about 20,000 words per day just in the 15 weeks of the program. They began speech therapy a few months after the class. “They had already made such progress by the time we started speech therapy,” Brey said. “Now, a year later, they’ve been released from speech therapy. They’ve gone from not communicating whatsoever to having appropriate language use for their age in just a short time.”
The chance to socialize in upWORDS class with other parents and children was a plus.
“When you have a child who’s delayed, you wonder if they’re going to outgrow it, and what the future holds,” Brey said. “I learned so much and got great results. Everybody was so supportive, and friendships were made with other kids and other parents who were going through the same thing.”
For some families, Developmental Language Snapshots from upWORDS help bring problems to light and pave the way for early interventions to help the children.
For instance, when Evelyn Carroll’s son Isaac was 2 years old, he was not speaking any words.
“We were going through a very difficult time with him because he would get frustrated, and he would bang his head on the floor,” Carroll said. “The class led me down a path that I didn’t think of. They would draw from all the information that the device would collect, and we would talk about it. It led to Isaac being diagnosed with autism.”
UpWORDS coordinators, including speech pathologists who were working with Isaac, helped connect Evelyn to assistance in the Early Childhood Intervention program.
“I feel that this was the first stepping stone,” she said.
UpWORDS may be a stepping stone to additional broad goals, Greeley believes. The program has been cited by the National Academy of Medicine as a national model of how a children’s hospital meets the needs of a community.
“We don’t want to mistake language as the ultimate goal,” he said. “We want to start looking at maternal infant bonding, infant socialization and the broader category of brain development. One of the clearly critical components is language, but it’s not the only thing. There could be a tremendous number of other positive benefits.”
Greeley sees upWORDS as a platform for postnatal classes that provide skills training for new parents or tune-ups for experienced parents.
“We want to pivot toward this as a good example of how pediatricians, health care and children’s hospitals can lean into community engagement. We want to be a partner with whatever the child or the family needs,” Greeley said.
Beyond language development, the Section of Public Health – the only one that is part of a US children’s hospital – is already screening for postpartum depression because the mother’s depression affects her child. Positive results are emerging from a pilot home visitation program, in which a social worker conducts therapy with the depressed mother at her home.
“UpWORDS is a response to social needs, and right now we’re looking at what this means for us in the future. We have a researcher dedicated to looking at both short- and long-term outcomes for the child and the parents. We want to be able to work with other children’s hospitals, and perhaps be a hub of outreach and education to integrate this type of program into routine care,” Greeley said.
This program, which helps parents engage and interact with their young children, may have far-reaching results. For more information about participating in, partnering with or donating materials to upWORDS, call 832-227-1828, email upwords@texaschildrens.org, or visit texaschildrens.org/upwords-program.