Thirty Million Words: Building a Child's Brain - Hardcover

PRAISE FOR THIRTY MILLION WORDS

“Suskind’s vision is empowering, her methods are surprisingly simple to execute, and the results have been proven to nurture children toward becoming stable, empathetic adults. Informative, exciting new data that confirms the significant benefits gained by talking to your child.”

—Kirkus Reviews

“How empowering the realization that each of us can be our children’s personal neuro-developer, that the sheer quality of our interactions can impact the attitude of inquiry and health of our kids. The practical application of Dr. Suskind’s work is limitless; as a dad, and as (a ‘gritty’) someone invested in early child development, I’m excited to see how far it takes us.”

—Steve Nash, president of the Steve Nash Foundation and two-time National Basketball Association MVP

“I thank Dana Suskind for opening doors to solutions and hope. The answer to the growing problem of social inequalities in our country is to make use of America’s top two resources: its children and their parents. If we care about this country and the children who will live in it as adults, we have to make Dr. Suskind’s advice become reality.”

—Sandra Gutierrez, founder and national director of Abriendo Puertas/Opening Doors

“Grounded upon experience as a cochlear implant surgeon, informed by compelling social science research, and inspired by a profound commitment to children and families, this book helps all of us understand the importance of communicating abundantly, pleasantly, and responsively with infants and toddlers. Tell everyone you know to read it! Together, we can enrich language environments for generations to come, in all types of homes and communities. The book is a gem!”

—Ronald F. Ferguson, faculty director at the Achievement Gap Initiative at Harvard University

“Straight from the front lines Dr. Dana Suskind tells the story of the power of talk in helping children learn. Easy to read and with striking insights on every page, this book will not only make you think differently about how you parent but will give you the tools to help your child be at his or her best.”

—Sian Beilock, professor at the University of Chicago and author of Choke and How the Body Knows Its Mind

“Suskind writes with clarity and authority to explain why parents need to talk to their infant children, and why some forms of communication are better than others. Thirty Million Words belongs on the shortlist of books that every parent, teacher, and education policy maker should read.”

—Adam Alter, associate professor at New York University and author of Drunk Tank Pink

“Anyone who cares about children, anyone who cares about the future of this country, should read this book.”

—Barbara Bowman, Irving B. Harris Professor at Erikson Institute

“A passionate, personal account of the power all parents have to raise thriving, successful children.”

—Diana Mendley Rauner, president of the Ounce of Prevention Fund

“Prepare for a revolution. This book will make you cry, laugh, and deeply reflect on what we should be doing to give everyone a chance to succeed in life. As a scholar I was in awe, as a teacher I was dazzled, and as a father I was thankful to the authors of this book. When you pick it up, have a few hours to spare because you will not put it down. Unequivocal 5 stars.”

—John A. List, Homer J. Livingston Professor at the University of Chicago and author of The Why Axis

“Dana Suskind hails others as heroes, but she is the true hero! She stepped out of the safe harbor of her role as a pediatric cochlear implant surgeon when she realized that helping deaf children hear was not enough to help them learn language. She takes us on her compelling and page-turning journey, navigating the best research in children’s early learning, always sharing sound and extremely helpful examples of what we all must do to help children learn language and much more, always in joyful and loving ways.”

—Ellen Galinsky, president of Families and Work Institute and author of Mind in the Making

“Dr. Suskind’s work reveals that the greatest gift we can give our children is free. How empowering to understand that it doesn’t take money to give our children advantages in the world, it takes words. Her research is vital.”

—Chris Nee, creator and executive producer of Doc McStuffins

“Three cheers for the promise of parents, prevention, and neuroplasticity!”

— Dr. T. Berry Brazelton, Clinical Professor of Pediatrics Emeritus at Harvard Medical School

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Copyright © 2015 by Dana Suskind and Beth Suskind

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For Amelie, Asher, and Genevieve

DS

For Lily, Carter, and Michael

BS

For Bob and our wonderful family

LL-S

Praise for Thirty Million Words

Title Page

Copyright

Dedication

1. CONNECTIONS: Why a Pediatric Cochlear Implant Surgeon Became a Social Scientist

2. THE FIRST WORD: The Pioneers of Parent Talk

3. NEUROPLASTICITY: Riding the Revolutionary Wave in Brain Science

4. THE POWER OF PARENT TALK: From Language to an Outlook on Life

5. THE THREE Ts: Setting the Stage for Optimum Brain Development

6. THE SOCIAL CONSEQUENCES: Where the Science of Neuroplasticity Can Take Us

7. SPREADING THE WORDS: The Next Step

EPILOGUE: Stepping Off the Shoreline

Appendix: Early Childhood Organizations and Resources

Notes

Acknowledgments

Index

CHAPTER 1

CONNECTIONS

WHY A PEDIATRIC COCHLEAR IMPLANT SURGEON BECAME A SOCIAL SCIENTIST

Blindness separates me from things; deafness separates me from people.

—Helen Keller

Parent talk is probably the most valuable resource in our world. No matter the language, the culture, the nuances of vocabulary, or the socioeconomic status, language is the element that helps develop the brain to its optimum potential. In the same way, the lack of language is the enemy of brain development. Children who are born hearing, but in an austere language environment, are almost identical to children who are born deaf who have not received a rich sign environment. Without intervention, both can suffer the critical, lifelong effects of silence. On the other hand, children in a rich language environment, whether born hearing or given the gift of hearing via cochlear implants, can soar.

MY STORY

The irony is not lost on me that a pediatric cochlear implant surgeon is writing a book on the power of parent talk. Surgeons are known for many things; talk is not among them. Rather than words, we are defined by our hands, our dexterity in the operating room, and our ability to identify problems and find solutions. To a surgeon, there is nothing more gratifying than when the puzzle pieces fit just so.

Cochlear implantation, allowing a child born deaf to hear, is an extraordinary example of all those components. Coiled two and a half times around the snail-shaped cochlea, the organ where the nerve part of hearing begins, a cochlear implant successfully skips over the defective cells, the point along the hearing pathway where sound had come to a screeching halt, going directly to the acoustic, or hearing, nerve, the superhighway that connects the ear to the brain. The amazing result is that a child born into silence now has the ability to hear, to talk, and to meld into the world both educationally and socially. The cochlear implant is a puzzle piece that fits, just so, a miraculous solution to total deafness.

At least, that’s what I thought.

In medical school, it was the brain, not the ear, that captured my imagination. The brain seemed a profound mystery holding the key to all the unanswered questions about life. My dream was to be a neurosurgeon, fixing with my hands some of the most important and vexing issues facing humanity.

My first neurosurgical case in medical school did not, however, go smoothly. The chief of neurosurgery, Dr. R., had invited me to “scrub in” on a meningioma resection, the removal of a benign brain tumor. We’d been writing a textbook chapter on meningioma resection and he thought it might be helpful if I actually saw one. When I came into the operating room, Dr. R. gestured me toward the operating room table, where a shaved head, stained with the yellow and red of Betadine and blood, confronted me. Inside a large gap of missing skull, a grayish gelatinous mass pulsated rhythmically, as if trying to escape its bony confines. The patient’s torso had disappeared completely, like a magician’s assistant’s, under long blue drapes.

As I walked toward the patient, I suddenly became aware of my own pulsations. Could this blob of overly congealed gelatin really be the epicenter of who we are? Dazzling lights crisscrossed my vision and I could barely register what Dr. R. was saying. The next thing I knew, I was being lowered onto a chair by one of the surgical nurses. Humiliating? You bet!

But that was not the reason I did not go into brain surgery. Ultimately, that was more a fantasy-meets-reality decision.

“When the air hits the brain, you’re never quite the same” was a common saying in neurosurgery back in the 1980s. At that time, surgery on the brain often left patients severely debilitated, though alive. In the intervening years, of course, things have changed for the better, but my own experience prompted me to think of other ways of working with the brain. And, in a circuitous way, I did: the ear. Under the guidance of my extraordinary mentor, Dr. Rod Lusk, during my fellowship at Washington University in St. Louis, I learned the skills necessary to help ensure the success of cochlear implantation.

Cochlear implantation is, to me, one of the most elegant of surgeries. Performed under a high-powered microscope that magnifies the inner ear from the size of a tiny pea to the size of a quarter, it relies on small, precise instruments that match its small, precise movements. I operate with the room lights off, the single light beam from the microscope a spotlight on the star of the show, the ear. The microscope’s penetrating beam has been said to cast an almost romantic halo around the patient and surgeon. And while many surgeons operate with music, I prefer my operating room to be quiet and calm, with only the hum of my drill as backdrop to my concentration on the surgical procedure.

My decision to become a pediatric head and neck surgeon specializing in cochlear implantation was serendipitous. Because the confluence of two historic medical events was about to usher in a golden age for children born deaf.

In 1993, the National Institutes of Health recommended that all newborns undergo a hearing evaluation, the universal newborn screening, before leaving the hospital. This astute public health initiative plummeted the age of the diagnosis of deafness from three years to three months. No longer could parents and pediatricians rest comfortably with “He’s just a slow talker” or “Her older brother does all her talking,” when, in fact, the child was deaf. But its significance was increased exponentially because it coincided with the development of a neurologic miracle, the cochlear implant. The possibility of changing the life course for millions of deaf children had arrived.

THE COCHLEAR IMPLANT

The brain and neural structures in the human body are generally unforgiving. From cerebral palsy to strokes, from spinal cord injuries to football-related head trauma, “making better” rather than “correcting” tends to be the medical dictum. Hearing loss is a spectacular instance where something can, in fact, be done.

In 1984, the first single-channel cochlear implant for adults, allowing sound detection and some awareness of voice, although not “hearing” as we know it, was approved by the FDA. This was followed, in 1990, at about the same time as the new recommendations for universal newborn screening, by a new multichannel cochlear implant with complex speech processing ability, approved for young children. For the first time in history, a child born deaf would be able to hear at an age when the brain pathways for language were being created.

It’s important to understand why the timing of these two coinciding events was so critical. By the end of age three, the human brain, including its one hundred billion neurons, has completed about 85 percent of its physical growth, a significant part of the foundation for all thinking and learning. The development of that brain, science shows us, is absolutely related to the language environment of the young child. This does not mean that the brain stops developing after three years, but it does emphasize those years as critical. In fact, the diagnosis of hearing loss in babies had often been called a “neurologic emergency,” essentially because of the expected negative impact on a newborn’s development.

The importance of early screening coinciding with cochlear implantation for children cannot be overstated. If they had not taken place simultaneously, if, for example, diagnoses of deafness came at a later age, and the cochlear implant had been placed in older children’s ears, the cochlear implant may have been deemed a fabulous piece of technology but not much more, certainly not the game changer that it is. That’s because successful cochlear implantation requires neuroplasticity, the ability for a brain to develop with new stimuli. And although neuroplasticity for learning language may occur, to some degree, at all ages, it is integral to the young brain from birth through about three to four years of age. Exceptions are those who have gone deaf after having learned to talk and whose brain’s language pathways are already established. Those who are born deaf and receive implantation at a much later age will hear sounds, but rarely will they gain the ability to understand their meanings.

I soon learned, however, that even when cochlear implants are put in place at an optimum time, there are other...