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Q&A: How a neurosurgeon became an early childhood education activist after watching her young patien
Cochlear implant surgeon Dana Suskind founded the Thirty Million Words program in Chicago after discovering that language-rich environments affected whether her young patients learned to talk. - photo by Eric Schulzke
Dana Suskind is a professor of surgery at the University of Chicago, whose speciality is cochlear implants that allow people who are born deaf to hear. She is also founder and director of the Thirty Million Words Initiative, also based at the University of Chicago. TMW researches programs that maximize the critical language development period of birth to 3 years old while helping to draw public attention to this critical phase of brain development.

Early in her surgical career, Suskind writes in her book, she discovered that children who appeared similar in every other respect would differ dramatically in how quickly they learned language after their hearing was restored. She discovered that the difference fell largely along socio-economic lines, and that the key difference was how much language the child was hearing at home.

This soon led her into an advocacy effort focused on the critical role of a language-rich environment for children born with hearing, but who do not hear enough words at home.

Suskind's new book, titled "Thirty Million Words," was released this month. This interview has been edited for length and clarity.

How did a career as a neurosurgeon lead you to early childhood education advocacy?

I am a cochlear implant surgeon working with this amazing technology that allows a child born deaf to hear. It opens up the world of sound to a child who was born into silence. About nine years ago I started the pediatric implant program at the University of Chicago, and I very quickly started noticing profound differences in the outcomes, the ability to talk and read, of patients who looked very similar at the outset. Some learned to talk easily, while others were able to communicate. The differences almost always fell along socio-economic lines. So I began wondering why, and what I could do about it.

And what did you discover?

I came across research conducted about 30 years ago, where they found that the critical factor in a childs ability to learn was his or her early language environment. They found that by the time they reached their fourth birthday, children born into poverty heard 30 million fewer words than their more affluent peers.

And I understand your experience with the cochlear implants directly correlates to that age cutoff?

Yes. If I implant a child at the age of 3 versus the age of 1, the differences are so significant. I was seeing the same differences in my implant patients. The implant gave them all the same ability to hear. But for those born into poor language homes, they never were able to understand that the sounds have meaning. They could hear the sounds, but they couldnt get meaning.

So you are saying that kids who hear nothing at all until they are 3 are in some ways not that different from kids raised in a poor language environment? Its a difference of degrees?

Yes. If your ears now get sound to the brain, but if you are born into a home without a lot of language, your brain, which requires language to be built, wont understand that these sounds have meaning. That was how I got into this whole world of early language.

We talk so much about pre-K. Are we just barking up the wrong tree?

The reason I wrote this book is that I am hoping to get across that 0-3 is a critical period. Not to say that later on is not important, but this is a critical period. But whenever we talk about early childhood, we talk about pre-K. Thats missing the mark. Weve got to start earlier, and with more intentionality. Learning doesnt start on the first day of preschool. It starts on the first day of life. We need to re-imagine what education means.

People talk about the nanny state. To do what you are talking about would almost literally require a nanny state, right? You are talking about very intrusive home interventions and monitoring?

I am totally not in favor of a nanny state. I dont want to tell parents what to do. But Ive never met a parent who doesnt want the best for their children. We need them to understand this, and get it into the groundwater. If we are talking about allowing every child to reach their true potential, then this information needs to be out there. Im talking about policies that support parents so they can do their best by their children. And a lot of parents are working. So we need to talk about day care and home day cares. All of these places need to understand the science.

In your book you talk about the importance of parent talk, but you also brush up against the reality that many of these kids will spend more waking time with caregivers than with parents. Are caregivers and parents interchangeable on this?

I use parent talk in a very global way. I think every adult in the country needs to understand the science. If we look at every child in our country as our own, we will do our best with each child.

If the intense language interaction you call for is that urgent, how can you scale that or synthesize it outside of the parental bond?

There is nothing like a parent. But the reality of our world right now is that often in single-parent homes, parents have to work. Its not an easy question. Ive talked about a language-rich environment being a key public health indicator. And we have ways to measure that, especially in an early day care setting. I think when caregivers are more aware of these interactions they can do them more and do them better. We have a piece of technology called the LENA, which is kind of like a language pedometer. You can imagine in these day care settings that people are trained in the science.

In your book you have a formula you train parents with: tune in.

The core tenets of our program are, first, intelligence is malleable. Babies arent born smart. Unless we understand that brains arent born, they are built, you won't understand why you should verbally invest in very young children. Thats the foundation. Then weve pared down a rich language environment to three points: tune in, talk more and take turns. Tune in is seeing what your child is interested in. Talking more is using more language, and using a more rich vocabulary. Taking turns is viewing your relationship as give and take from day one. Too often, adults dont realize that babies are born communicating with eye contact, expressions and gurgles. By responding, you are getting them ready to talk and building their brain.

Arent the people who most need your message least likely to read your book?

I want to emphasize that this book is an extension of the research program I lead. What is going on at ground level, not just in research, but with the families we are working with, is really exciting. I wrote the book with the hope that translating this compelling science can help drive policy. Im not saying that high school, grade school and pre-K are not important, but if we want to truly move the needle and lets face it, we have not moved the needle weve got to go earlier with more intentionality. We need to really understand what it takes to grow a brain.

Tell me a little more about the Thirty Million Words program.

Our long-term vision is a population level shift, where all parents and caregivers understand the importance of talk and turning it into action. We are developing interventions that work with parents and caregivers where they are. Home visits, maternity wards, pediatrician offices and even childrens museums. We are testing these methods to make sure they are actually effective. Then we are working to integrate those into the public health sector. This is not a three-year election cycle effort. Its a longer-term vision.

What is your most exciting initiative right now?

We are working with the city of Chicago with 200 families on home visits for early Head Start, starting with children from 13 to 15 months old and following them into kindergarten. We are studying whether working with parents can affect reading readiness when they start kindergarten.