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. Author manuscript; available in PMC: 2025 Dec 13.
Published in final edited form as: Soc Dev. 2025 Sep 14;34(4):e70024. doi: 10.1111/sode.70024

Supporting Early Social-Emotional Competencies Through Reading and Play: Findings From an RCT of the Tiered Smart Beginnings Program

Erin Roby 1, Elizabeth B Miller 1, Caitlin F Canfield 1, Daniel S Shaw 2, Pamela A Morris-Perez 3, Alan L Mendelsohn 1
PMCID: PMC12700640  NIHMSID: NIHMS2118694  PMID: 41394760

Abstract

Social-emotional competence is critical to children’s social and school success, prompting interest in understanding factors that promote these skills prior to elementary-school. Cognitive stimulation (e.g., reading, playing) is related to preschool children’s social outcomes; However, few studies have examined these associations earlier, or determined whether interventions that encourage cognitive stimulation may enhance children’s early social-emotional competencies either directly, or through impact on these behaviors. The present study examined whether cognitive stimulation in infancy predicted social competence in toddlerhood and the impact of a positive parenting intervention on these child outcomes. Mother–infant dyads in the Smart Beginnings (SB) RCT (primarily Hispanic/Latino or Black and from low-income backgrounds) were randomly assigned to treatment or control. SB integrates universal primary prevention in pediatric primary care (PlayReadVIP); and targeted/secondary prevention through home visiting (Family Check-Up). Mothers’ cognitive stimulation at 6 months significantly predicted children’s social-emotional competence at 24 months. Although there was no direct effect of SB on children’s social-emotional competence, there was an indirect effect on children’s social competence through maternal cognitive stimulation. Findings suggest that associations between cognitive stimulation and children’s social-emotional competence emerge earlier than previously shown, and that positive parenting interventions can support early social-emotional competence through impact on cognitive stimulation.

Trial Registration:

ClinicalTrials.gov identifier: NCT02459327

Keywords: cognitive stimulation, poverty, prevention, social-emotional competence, tiered intervention

1 ∣. Introduction

The development of social-emotional competence in early childhood is critical for school readiness and has lasting implications for adult outcomes (Denham et al. 2006; Jones et al. 2015; Moffit et al. 2011), with particular importance for children from low-income families who are at greater risk for disparities. Previous research has shown associations between cognitive stimulation (reading, playing, etc.) and preschool children’s social-emotional competence (Foster et al. 2005; Gershoff et al. 2007; Mistry et al. 2010), but few studies have examined these associations at earlier ages. In particular, limited work in this area has focused on racial/ethnic minority families from low-income backgrounds or utilized a multi-method approach for assessing cognitive stimulation. Moreover, it is unclear whether interventions that target cognitive stimulation can also enhance children’s early social-emotional competence. We addressed these questions in the current study by examining mother–child dyads enrolled in the Smart Beginnings (SB) RCT, a tiered intervention that addresses heterogeneity in family strengths and challenges among primarily Hispanic/Latine and Black families with low income by integrating two evidence-based programs delivered in pediatric primary care (PlayReadVIP) and via home visiting (Family Check Up).

1.1 ∣. Social-Emotional Competence

To navigate the social world, children must develop a range of social behaviors, including showing interest in and sharing positive emotions with others, having empathy, successfully engaging in social interactions, and developing attention and emotion regulation (Denham et al. 2006; Domitrovich et al. 2017). These abilities, known as social-emotional competencies, play an important role in children’s developmental trajectories across a number of important domains.

Children who demonstrate social-emotional competencies in preschool and kindergarten have better adjustment to and attitudes about elementary school, higher grades and academic achievement, and more positive relationships with teachers and other children (Domitrovich et al. 2017; Ladd et al. 1999). Children with high social competence assessed prospectively during the preschool, kindergarten, and elementary school periods, also have better mental health and well-being (Jones et al. 2015), as well as long-term career and financial outcomes in adulthood (Moffit et al. 2011). These findings suggest that the development of children’s social-emotional competencies can have lasting impacts that extend across the lifespan.

Given the important role social-emotional competence plays in children’s immediate and longer-term outcomes, there is interest among researchers, practitioners, and policy makers in understanding the factors that promote children’s social-emotional competencies prior to elementary-school entry, including in the first years of life (Gleason et al. 2016; U.S Department of Health and Human Services 2015). These issues are particularly relevant for children living in poverty, who are more likely than children from higher-income backgrounds to develop disparities in social outcomes (Briggs-Gowan et al. 2001; Galindo and Fuller 2010).

1.2 ∣. Cognitive Stimulation and Social-Emotional Competence

One factor that has potential to support children’s early social-emotional competencies is cognitive stimulation in the home. Cognitive stimulation includes parent-child interactions such as shared reading, pretend play, engaging children in everyday routines, and other activities involving high levels of verbal responsivity (Cates, Roby et al. 2023). Research has shown that providing children with cognitive stimulation beginning in infancy and continuing through toddlerhood is associated with a range of positive outcomes, including increased communication and language abilities, cognitive development, and literacy and numeracy skills (Cates et al. 2012; Malhi et al. 2018; Melhuish et al. 2008; Miller et al. 2023).

Although it has been well-established that cognitive stimulation is important for promoting cognitive development in infants and toddlers, less research has focused on how it relates to young children’s social-emotional development. However, there is reason to posit such a relationship, particularly for aspects of cognitive stimulation involving shared reading, collaborative play, and verbal responsivity. Beginning in infancy, parents may begin to read children’s books aloud, engage in symbolic play with toys, and involve infants in conversations about their surroundings and familiar routines. These kinds of cognitively stimulating parent–child interactions often involve attention regulation, cooperation, imitation, persistence, empathy, and prosociality, all of which are considered important features of early social-emotional competence (Carter et al. 2003). For instance, in a study examining parent-child shared reading with 9- to 27-month-olds, parents used several strategies to recruit and sustain their infants’ and toddlers’ attention, including using directives (e.g., “Look”, “See?”) (Sénéchal et al. 1995). Parents also facilitated imitation and turn taking by engaging children in reciprocal routines (e.g., labeling, asking questions, waiting for responses, providing feedback). Similar findings from studies of parent-child play suggest that beginning in the first year of life, play interactions frequently involve following simple rules or routines (e.g., exchanging objects, simple hand games) assigning roles/pretend (e.g., chase, peek-a-boo) and opportunities to persist in the face of challenges (Crawley and Sherrod 1984; Lucca et al. 2019; Suarez-Rivera et al. 2019). It has also been suggested that engaging infants and toddlers in reading, play, and daily routines (feeding, chores self-care) provides them with a model for how people behave in different contexts, helping them to learn social rules and norms and building a foundation for interactions with peers (Dahl and Campos 2013; Gralinski and Kopp 1993). Activities involving verbal exchanges also provide opportunities to talk about thoughts and emotions of self and others (Cassidy et al. 1998; Roby and Scott 2022a), a feature of parents’ talk that relates to infants’ and toddlers’ empathy and perspective taking (Brownell et al. 2016; Drummond et al. 2014; Roby and Scott 2018). Thus, there is potential for cognitive stimulation to support early social-emotional development beginning in a child’s first years.

Consistent with this perspective, findings from research with preschool and elementary-school children have revealed that parents’ cognitively stimulating activities, and in particular, those involving reading, play, and other language-rich interactions, are significantly related to children’s social-emotional competence, including skills such as attention, cooperation, compliance, and prosocial behavior (Baker 2013; Foster et al. 2005; Gershoff et al. 2007; Mistry et al. 2010). Moreover, several studies have reported that exposure to parental cognitive stimulation during the toddler years predicts children’s later social-emotional competencies in kindergarten, suggesting that cognitive stimulation in the first years of life may be particularly important for promoting children’s later social-emotional competence (Baker 2013; Mistry et al. 2010). Fewer studies have focused on associations between cognitive stimulation in the first years of life in relation to emergent social competencies in the toddler years. However, findings suggest that specific aspects of parent-child interactions, which often occur in the context of reading and play, such as the use of mental-state language (e.g., discussion of psychological and emotional states), emotional coaching and contingency (awareness and validation of and responsivity to emotions), and sharing attention (Brandone 2015; Drummond et al. 2014; Newton et al. 2016; Roby and Scott 2018; Spinrad et al. 2007; Taumoepeau and Ruffman 2008) relate to key social-emotional constructs among toddlers. These skills include helping, perspective taking, intention and emotion understanding, attention, and prosocial behavior. However, the majority of this work has assessed parental cognitive stimulation after infancy (12 months), utilized single (either only survey or only observation) and narrow measures of cognitive stimulation (e.g., mental-state language), and examined these questions cross-sectionally among middle and high-income White families. It is therefore an open question whether these findings would generalize to contexts where cognitive stimulation was assessed at younger ages, among racially/ethnically diverse families with low income, using a multi-method approach to capture multiple aspects of cognitive stimulation.

1.3 ∣. Supporting Social-Emotional Development in Children From Low-Income Backgrounds

These issues are particularly important for families living in poverty, a disproportionate number of whom are Black and Latine (Dearing 2008). Systemic injustices and structural racism have imposed barriers to resources that encourage cognitive stimulation and reduced opportunities for children to develop social-emotional competencies (Dearing 2008; Heard-Garris et al. 2021). Existing theories, including the family stress and parental investment models (Conger et al. 1994; Masarik and Conger 2017; Yeung et al. 2002), have hypothesized that poverty, economic pressures, and the complex set of factors associated with poverty impose stress, increase cognitive load (Roby and Scott 2022b), and reduce access to particular resources (e.g., time, money), including those that that could support children’s development (Gershoff et al. 2007). These pressures can affect family functioning, parenting practices, and in turn, child development outcomes (Conger et al. 1994; Masarik and Conger 2017; Gershoff et al. 2007).

On the other hand, findings also suggest that strengths-based factors, such as parent-child relations and interactions can support child development in the face of negative consequences of poverty (Garner et al. 2021). These pathways demonstrating positive parent–child interactions as a mediator between poverty and child outcomes can also help to explain income-related differences in children’s social-emotional development specifically and have been tested in families with preschool and school-aged children (McLoyd 2011; Yoshikawa et al. 2012).

Therefore, cognitive stimulation may represent a protective factor that buffers the consequences of poverty on children’s early social outcomes. Moreover, interventions that promote cognitive stimulation may enhance children’s early social-emotional competencies through impact on these positive parenting behaviors. However, additional work is needed to understand whether these effects are apparent in the first years of life when children’s social-emotional capacities are emerging.

1.4 ∣. The SB Model

One program that has potential in supporting children’s early social competencies, and may do so through effects on parenting behaviors is SB (See Figure). SB is a novel birth to 3 year tiered intervention program that is tailored to family risk and promotes positive parenting practices, such as cognitive stimulation, with the ultimate goal of supporting children’s school readiness (Shaw et al. 2021). The SB model was developed to address barriers in achieving population-level reach and impact for families with young children living in poverty by integrating two tiers of preventive intervention—a universal health-care based component (PlayReadVIP, formerly Video Interaction Project) and a targeted, selective home-visiting component (Family Check-Up; FCU) (Shaw et al. 2021). SB’s universal prevention program, PlayReadVIP, is provided in pediatric primary care at the time of well-child visits between birth to 3, which helps to maximize identification, engagement, and retention of families with young children while reducing costs (i.e., due to use of existing infrastructure). SB’s targeted selective prevention program, the FCU, is provided in the home for families identified as having additional problems related to the family (e.g., maternal depression, stress), parent-child dyad (e.g., parent-child interactions) or the child (e.g., child behavior problems).

The SB model was developed to intervene on family assets and vulnerabilities that are common across the family investment and stress pathways and has been hypothesized to mediate the relationship between poverty and children’s school readiness outcomes, such as social-emotional competence. Consistent with the family investment model (e.g., Yeung et al. 2002) and the focus of the current study, both programs emphasize the promotion of positive parenting and parent–child relationship quality broadly (Shaw et al. 2021). PlayReadVIP specifically targets parents’ cognitive stimulation by supporting parents in their goals to engage in reading, talking, and play with their child. In addition, the FCU uses a variety of techniques, such as video feedback and motivational interviewing to encourage positive parenting and family management practices, and in turn, children’s prosocial and self-regulatory behaviors (Sitnick et al. 2015).

In separate RCTs of the individual components of SB, PlayReadVIP and FCU have demonstrated efficacy in supporting positive parenting, including cognitive stimulation in early childhood (Roby et al. 2021; Dishion et al. 2008). Both programs have also had direct impacts on children’s social-emotional outcomes, such as imitation, play, attention, and self-regulation (Dishion et al. 2008; Chang et al. 2014; Mendelsohn et al. 2018; Weisleder et al. 2016; Weisleder et al. 2019), and indirect impacts on child behavior through changes in responsive parenting and cognitive stimulation across the preschool period (Shelleby et al. 2012; Weisleder et al. 2019). For example, Weisleder and colleagues (Weisleder et al. 2016) showed that participation in PlayReadVIP was associated with increases in children’s imitation/pretend play abilities and attention at 36 months. These effects were moderate for the full sample with greater impacts for families with additional psychosocial risks. Similarly, an examination of the FCU with parents and children between the ages of 3 and 5 revealed direct effects of the intervention on positive parent-child interactions, which in turn predicted children’s effortful control at age 5 (Chang et al. 2017). Thus, although social-emotional competence is a multidimensional construct encompassing a variety of skills that have not fully been examined in prior studies of PlayReadVIP and FCU, these results provide initial support that SB could impact early social capacities.

Finally, when considering the fully integrated SB model, studies have shown robust impacts of the tiered SB program on supporting parental cognitive stimulation across the infant and toddler period (Roby et al. 2021; Miller et al. 2023). However, research has yet to explore the potential impact of the SB intervention on children’s early social-emotional development or whether cognitive stimulation could serve as a mechanism through which SB could support children’s social-emotional skills in the first 2 years of life.

2 ∣. The Present Research

This study builds on research demonstrating associations between parents’ engagement in cognitively stimulating activities and children’s emerging social-emotional competencies. We seek to extend those findings to the first years of life to determine whether cognitively stimulating interactions as early as 6 months relate longitudinally to children’s later social emotional competence at age 2 in a racially/ethnically diverse group of low-income families. We focused specifically on aspects of cognitive stimulation related to reading and play because prior research suggests these activities involve verbally rich interactions that provide opportunities to model and practice social-emotional competencies, learn social rules and norms, and discuss the behaviors, emotions, and mental states of self and others (Dahl and Campos 2013; Lucca et al. 2019; Sénéchal et al. 1995; Suarez-Rivera et al. 2019). In addition, we utilized both survey and observational measures of cognitive stimulation to examine consistency and cohesiveness (or lack thereof) across measurement methods. We reasoned that a combination of variables with strong theoretical and methodological basis would provide a robust indicator of cognitive stimulation with high potential to relate to early social-emotional competence. Further, prior findings suggest that cognitive stimulation mediates the impact of poverty on child development across a range of outcomes. Therefore, we also examined whether participation in a tiered positive parenting program, SB, which has previously been shown to enhance cognitive stimulation, could directly or indirectly impact children’s early social-emotional competencies through increases in these parenting behaviors.

We addressed these issues through longitudinal analysis of a randomized controlled trial of SB. Based on prior studies of PlayReadVIP and FCU demonstrating impacts on dimensions of positive parenting and children’s social skills, we hypothesized that participation in SB would be positively associated with children’s early social-emotional competence. In addition, consistent with the theory of change underlying the SB model, which emphasizes enhancing positive parenting behaviors rather than intervening directly on child behaviors, we hypothesized that these associations would be mediated by enhancements to parents’ cognitive stimulation in the context of reading, play, and other verbally rich interactions.

3 ∣. Materials and Methods

3.1 ∣. Study Design

This study is a single-blind randomized control trial of SB, taking place in New York City (NYC), NY and Pittsburgh, PA. SB delivers a pediatric primary care intervention, PlayReadVIP, (Mendelsohn et al. 2018) universally, and FCU for families with additional, identified challenges (Shaw et al. 2016). Participants were assigned postpartum to either SB or to a control group. All participants assigned to SB were offered the PlayReadVIP component of SB. At child ages 6 and 18 months, treatment families meeting eligibility criteria were also offered the FCU component of SB. All participants provided informed written consent. All study procedures were approved by [the NYU School of Medicine and University of Pittsburgh Institutional Review Boards, and by Bellevue Hospital Center/NYC H+H, Children’s Hospital of Pittsburgh, and Magee Women’s Clinic research review committees]. This study was registered in clinicaltrials.gov [NCT02459327].

3.2 ∣. SB Tiered Interventions

3.2.1 ∣. PlayReadVIP

PlayReadVIP is an evidence-based preventive parenting intervention that seeks to reduce poverty-related disparities in early child development and school readiness through promotion of positive parenting practices (Mendelsohn et al. 2018). PlayReadVIP utilizes pediatric primary care and consists of 14 sessions between 0 and 3 aligned with well-child visits. At each session, families meet with a Bachelor’s-level coach, who asks parents to reflect on their child’s development, encouraging them to be an active observer of their child. Parent–child dyads are given a developmentally appropriate book/toy and are recorded playing or reading together for 3–5 min, with immediate real-time review to identify and reinforce positive parenting behaviors and promote self-reflection. Parents are provided a copy of the video to share and a personalized pamphlet that includes goals and plans parents have established for continuing to read, play, and talk with their child.

3.2.2 ∣. The Family Check-Up

The FCU is a brief, family-centered home-visiting intervention with a strong evidence base that provides parents with tools for managing children’s behavior and building positive family relationships and interactions (Dishion et al. 2014). In the FCU, a Master’s-level coach meets with parents three times annually to complete several components of the intervention. During the first visit, the coach completes an ecological assessment of the family’s strengths and challenges, including parental functioning/practices, child behavior, and the quality of parent-child interactions. The assessment involves video-recording home observations, collecting caregiver reports of parent and child functioning, and the family’s broader ecological context. In a second meeting, the coach and parent participate in a Get-to-Know-You (GTKY) session, which builds rapport and establishes a collaborative relationship between the family and coach. The FCU incorporates Motivational Interviewing (Dishion et al. 2003; Miller and Rollnick 2012), which identifies parent concerns and methods for addressing child behavior while supporting parents’ readiness to set goals and change caregiving practices. In clinical practice, the GTKY session precedes the assessment, but in research studies, the order is reversed so parents in the intervention group do not have prior contact with the interventionist before the assessment session occurs (i.e., to prevent bias). In a third session, the coach meets with parents to provide feedback based on data from the GTKY and assessment sessions. Here, the coach identifies services (including engagement in follow-up FCU sessions) that can support positive parenting, family functioning, and child behavior. This typically leads to 50-70% of parents engaging in follow-up sessions, typically two to four per year.

3.3 ∣. Participants

Consecutive mothers and newborns were enrolled in the postpartum units of large urban hospitals in NYC (between 2015 and 2017) and Pittsburgh (between 2016 and 2017). Inclusion criteria included uncomplicated full-term delivery, no major medical complications, birthweight ≥2500 g, singleton gestation, and intended primary care at the institution. Mothers’ primary language was either English or Spanish. Four hundred and three mother–child dyads (200 in NYC, 203 in Pittsburgh) were randomly assigned to treatment (SB) or control group at enrollment.

Mothers in NYC were primarily Hispanic/Latine while mothers in Pittsburgh were primarily Black/African American (see Table 1). Baseline equivalency between treatment and control groups has been reported previously (Roby et al. 2021). There was some differential attrition at 24 months, reflecting the fact that families in the control group were more likely to have participated in assessments than treatment families (87% vs. 78%, p = 0.01). However, importantly, treatment and control families with outcome data at 24 months were compared on baseline characteristics (see Table 1), and there were no significant differences between these groups (omnibus F-test, F(16, 221) = 0.79, p = 0.70). Further comparison of baseline characteristics between families with and without outcome data at 24 months also revealed no significant differences between groups (omnibus F-test, F(16, 273) = 1.36, p = 0.16). Therefore, despite minor differential attrition, baseline equivalence was maintained. Lastly, Little’s test indicated that data were missing completely at random for the overall sample and all relevant subgroups, (MCAR; all χ2 < 25.90, all ps > 0.14).

TABLE 1 ∣.

Sample demographics.

Smart
Beginnings		 Control
Mean (SD) or (%)
N = 178 N = 186
Child characteristics
Child female 54% 52%
Maternal characteristics
 Maternal race/Ethnicity
  Black/African-Am 46% 44%
  Hispanic/Latine 44% 46%
  White 2% (3) 2%
  Other 4% (4) 5%
 Married/living with partner 4% 61%
 Education
  HS graduate 73% 67%
  Some college 40% 30%
 Family household characteristics
  Income-to-needs ratio 0.80 (0.66) 0.67 (0.57)
  Crowding ratio 1.09 (0.49) 1.16 (0.57)
  Interview in Spanish 28% 33%
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Note: The above sample demographic variables were used to assess baseline equivalency.

a

Income-to-needs ratio of 1.00 indicates that a family is right at the poverty threshold; 2.00 indicates that a family is 200% above that threshold.

b

The crowding ratio indicates how many people live per room in the dwelling. A ratio above one indicates household crowding.

The analytic sample includes 364 mother–child dyads (184 from New York, 180 from Pittsburgh; 178 treatment, 186 control), who had data for at least one of the included measures of cognitive stimulation at 6 months.

3.4 ∣. Intervention Design

All families who were randomly assigned to SB were offered PlayReadVIP. Those assigned to SB were also offered FCU if they were found to have additional risk factors through screening. Delivery of PlayReadVIP began at birth. Families were initially offered FCU at 6 months, and then again at 18 months, based on meeting eligibility through screening these time points. Primary criteria included: meeting clinical threshold for maternal depressive symptoms, reports of family violence, child welfare agency involvement with the study target child, or low maternal literacy (i.e., below 6th grade reading level; Mendelsohn et al. 2005). Secondary criteria included: elevated scores on screening instruments for two of the following domains: child behavior (e.g., regulatory/externalizing behaviors), family well-being and support (e.g., maternal stress), caregiving (e.g., low supportive parenting), and family capital (e.g., food insecurity). Approximately 50% of families assigned to the SB treatment qualified for FCU.

3.5 ∣. Procedures

Mothers completed an interview at enrollment and completed assessments with their children at child ages 6, 18, and 24 months. The current study focuses on assessments conducted in a laboratory setting at 6 and 24 months. These assessments were selected because (1) prior studies of SB have shown impacts of the intervention on measures of cognitive stimulation at 6 months (Roby et al. 2021) and (2) the earliest assessment of children’s social-emotional competence in this trial was collected at 24 months.

3.5.1 ∣. Cognitive Stimulation

3.5.1.1 ∣. Maternal Report of Cognitive Stimulation.

At 6 months, mothers were interviewed using the StimQ2-Infant (Cates, Roby et al. 2023; Cates, Weisleder et al. 2023), a structured interview that assesses cognitive stimulation in the home. It has been validated in English and Spanish, including among populations with low income and has been shown to have high internal consistency (Cronbach’s α = 0.69–72 for the subscales relevant to this study; Cates, Roby et al. 2023). The StimQ2 offers several advantages to other parental-report measures of cognitive stimulation including the that it is structured to reduce social desirability bias and simultaneously measures multiple aspects of early cognitive stimulation (Cates, Roby, et al. 2023; Cates, Weisleder et al. 2023). Mothers completed the Reading (READ) subscale Parental Verbal Responsivity (PVR) subscales of the StimQ2. The READ subscale (14 items) assesses the frequency and quality of parent-child reading interactions and the diversity of books parents share with their child. For instance,

“Do you ask your child questions about the pictures in books and try to have a conversation?” It includes three components (Quantity, Quality, and Diversity of Content). The PVR subscale (15 items) measures parents’ tendency to engage children in interactions that involve verbal exchanges during play and routines. For example, “Do you play pretend games using a stuffed animal or puppet to talk to your child?” The PVR subscale has two components: Play and Pretend, and Everyday Routines. Cronbach’s alpha for the current sample ranged between 0.70 and 0.72 for the READ and PVR subscales.

3.5.1.2 ∣. Observed Cognitive Stimulation.

Cognitive stimulation was also assessed in the context of mother–child play interactions at 6 months. Mother–infant dyads sat on the floor with an array of toys and were asked to play as they would at home. Interactions lasted approximately 5 min. These sessions were video-recorded and later scored offline by trained coders blind to treatment condition.

Observations were scored using the Parent-Child Interaction Rating Scales-Infant Adaptation (PCIRS-IA), an observational coding protocol adapted from several parent-child interaction measurement tools (Bosquet Enlow et al. 2014). Coders rated mothers on parental stimulation of cognitive development, which was defined as mothers’ tendency to engage infants with the intent to facilitate learning, development, and achievement. These included behaviors such as focusing children’s attention on an object, task, or aspects of a particular object, verbally responding to and expanding child vocalizations, and elaborating on children’s activities to guide them into new directions or enhance its complexity. Coders rated parents’ behavior during the play interaction, providing a single score for stimulation of cognitive development on a scale from 1 (very low, the parent did not demonstrate the behavior) to 7 (very high, the parent characteristically demonstrated the behavior) (S1). An additional 15% of the play interactions were scored by a second coder. Weighted kappa was 0.70, indicating satisfactory agreement.

3.5.2 ∣. Child Social-Emotional Competence

Children’s social-emotional competence was measured at 24 months based on maternal reports using the competence subscale of the Infant and Toddler Social and Emotional Assessment (ITSEA) (Carter et al. 2003). The ITSEA is a measure of children’s social-emotional competencies and problem behaviors that is appropriate for use with children between one and three and has been highlighted as a strong assessment for examining social-emotional competencies among young children (Denham et al. 2006). The ITSEA competence subscale has high internal consistency (Cronbach’s α = 0.90). The version used in the current study consisted of 32 items (reduced from the original 37 to shorten assessment time) spanning six subdomains: compliance, attention, mastery motivation, imitation/play, empathy, and prosocial peer relations. Mothers were presented with items about their child such as, “Tries to help someone when they are hurt” and “Is aware of other people’s feelings”, and rated each of these items on a 3-point scale: (0) Not true/rarely, (1) Somewhat true/sometimes, and (2) Very true/often. Responses across items in each of the six subdomains were summed, resulting in six separate social-competence scores and a total social-competence score. We focused on the ITSEA total score. Cronbach’s α for the full competence subscale in the current sample was 0.87.

3.6 ∣. Treatment Group

Treatment group was coded as a dichotomous variable (1 = SB; 0 = control) representing randomized groups for intent-to-treat (ITT) analysis. As described above, all families randomly assigned to the treatment group were offered the PlayReadVIP component of SB. Treatment families meeting eligibility criteria were also offered FCU. SB treatment therefore represents assignment to PlayReadVIP with potential for FCU.

4 ∣. Results

4.1 ∣. Analytic Plan

We first specified a latent construct for parental cognitive stimulation (specifically reading, play, and other verbal interactions) at 6 months using mothers’ survey responses on the READ and PVR subscales of the StimQ2 and global ratings of observed mother–child play interactions.

We then used structural equation modeling to examine: (1) whether this latent construct, reflecting mothers’ tendency to engage their child in cognitively stimulating reading and play activities during infancy would relate to children’s social-emotional competencies at 24 months; and (2) whether the SB intervention would be directly or indirectly related to children’s social competence. Significant effects were determined using 95% confidence intervals around the standardized estimates of direct and indirect effects, using Full Information Maximum Likelihood estimation (FIML; Allison 2003), which accounts for missing data. In this method, a likelihood function is estimated for each individual using the variables present so that all the available information is used to estimate the model. These 95% confidence intervals are also bias-corrected, which adjusts for skew in the population (Fritz and MacKinnon 2007). Because randomization occurred separately within each site, a fixed effect for site was included in our mediation analyses. As traditional fit indices such as chi-square often produce poor fit with even moderately large sample sizes (Schermelleh-Engel et al. 2003), model fit was evaluated using Comparative Fit Index (CFI), Tucker–Lewis Index (TLI), and the Root-Mean-Square Error of Approximation (RMSEA). Generally accepted guidelines for these fit indices suggest that a CFI and TLI of 0.90 or above, and a RMSEA of 0.06 or below indicates good fit. All analyses were performed using Stata 18 (StataCorp 2023).

To calculate power for mediation analysis, we used Monte Carlo simulation (Schoemann et al. 2017) with 1000 replications and 20,000 draws per replication. Results showed that we had >80% power to detect an indirect effect of 0.10, assuming small to medium effect sizes.

Lastly, we performed exploratory analyses examining whether any associations that emerged varied by FCU eligibility.

4.2 ∣. Preliminary Analyses

Means, standard deviations, and ranges for the variables included are shown in Table 2. Bivariate correlations between the cognitive stimulation variables and children’s total social competence scores of the ITSEA are shown in Table 3. All of the cognitive stimulation variables at 6 months were statistically significantly positively correlated with children’s total social competence scores.

TABLE 2 ∣.

Descriptive statistics.

Mean (SD) Sample range Possible range
Cognitive stimulation
 Reading 6m (N = 364) 6.11 (3.37) 0–14 0–14
 Parental verbal responsivity 6m (N = 358) 7.44 (2.82) 0–14 0–14
 Observed cognitive stimulation 6m (N = 358) 3.43 (1.11) 1–7 1–7
Social competence
 Total score 24m (N = 315) 51.26 (9.91) 22–74 0–74
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TABLE 3 ∣.

Correlations between cognitive stimulation and social competence.

Cognitive stimulation Social competence
Reading 6m Parental verbal
responsivity 6m		 Total score 24m
Cognitive stimulation
 Reading 6m — 0.28**
 Parentalverbal responsivity 6m 0.37** — 0.34**
 Observed cognitive stimulation 6m 0.30** 0.25** 0.14*
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Note: *p < 0.05, **p < 0.001.

4.3 ∣. Measurement Model

The measurement model for maternal cognitive stimulation was just identified, and thus meaningful fit statistics could not be derived. However, all variables had significant factor loadings with ßs ranging from 0.46 and 0.67, suggesting that each of the variables were relevant to the latent variable for cognitive stimulation.

4.4 ∣. Mediation Analysis

Using structural equation modeling, we examined whether the latent variable for cognitive stimulation at 6 months predicted children’s total social-emotional competence and whether there was an impact of SB on children’s social competence through this latent factor of mothers’ cognitive stimulation.

We tested a mediation model examining direct and indirect paths to children’s total social competence. The fit statistics suggested that the hypothesized model fit the data well (See Figure 2; CFI = 0.96; TLI = 92; RMSEA = 0.05). In line with earlier published reports using the current sample (Roby et al. 2021; Miller et al. 2023), there was a direct impact of SB on cognitive stimulation at 6 months (See Figure 2). Consistent with our predictions, maternal cognitive stimulation significantly predicted children’s social competence at 24 months (ß = 0.46, p < 0.001).

FIGURE 2 ∣.

FIGURE 2 ∣

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Direct and indirect pathways from the SB intervention to children’s total social competence through parents’ cognitive stimulation.

Parent-reported reading and play = StimQ2; Observed cognitive stimulation = PCIRS-IA.

Note: b (SE) Beta [CI]; **p < 0.001, *p < 0.01;

We then examined effects of SB on children’s social competence at 24 months. Findings revealed that there was no direct effect of SB on children’s social competence. However, consistent with the theory of change underlying the SB intervention, there was a significant indirect effect of SB on children’s social competence (β = 0.09, p = 0.002). This effect was mediated through cognitive stimulation at 6 months.

4.5 ∣. Exploratory Subgroup Analysis

Because the sample included families who varied in their exposure to certain risk factors, and in turn, their eligibility for the FCU, we performed exploratory analyses to examine the above mediation pathways separately for families meeting or not meeting FCU eligibility (though eligibility was assessed post-randomization). FCU eligibility was scored dichotomously (1 = FCU eligible; 0 = not eligible), representing families who met screening criteria at either child age 6 or 18 months or who never met screening criteria. Screening was completed for families in both the treatment and control groups, but FCU was only offered to families in the treatment group. Therefore, FCU eligibility is applicable to the full sample although it is not considered part of ITT analysis.

Examination of separate mediation models revealed that the same patterns of results emerged for FCU-eligible and FCU non-eligible families. More specifically, in both subgroups, cognitive stimulation at 6 m significantly predicted children’s social competence at 24 m (βs > 0.44). In addition, there were indirect effects of SB on child social competence via cognitive stimulation with comparable effect sizes across subgroups (Bs range 0.09–0.10).

5 ∣. Discussion

Social-emotional competence is essential for navigating everyday interactions and plays an important role in school readiness and later adjustment (Denham 2006; Jones et al. 2015). Thus, there is interest in understanding the factors that support children’s early social-emotional competence prior to school entry, particularly for children living in poverty, who are more likely than children from high-income homes to develop disparities in this area (Briggs-Gowan et al. 2001; Galindo and Fuller 2010). We examined whether parents’ engagement in cognitively stimulating activities at 6 months was associated with children’s social-emotional competence at age 2 among Hispanic/Latine and Black, low-income families. We also explored impacts of a tiered positive parenting intervention program, SB, on children’s early social-emotional competencies.

Results showed positive associations between maternal cognitive stimulation (measured using surveys and observations) at 6 months, and children’s total social-emotional competence at 24 months. These findings suggest that cognitively stimulating parent-child activities such as reading and play, assessed using a multi-method approach prior to the first year of life, support the development of children’s social-emotional capacities as early as age two. This study provides additional evidence that parental cognitive stimulation is beneficial not only to children’s cognition and language but also to children’s social-emotional competence, and extends findings to children in a racially/ethnically diverse sample with low-income families. This is noteworthy because social-emotional development is increasingly recognized as an important aspect of school readiness (U.S. Department of Health and Human Services 2015; Gleason et al. 2016). The current findings align with prior work with toddlers from middle-and high-income families suggesting that it is possible to promote social-emotional competence prior to school entry. The fact that these findings emerged among racial/ethnic minority families who face adversities related to poverty further highlights cognitive stimulation as a protective factor that can buffer the consequences of early adverse experiences on children’s social-emotional development. Our results are consistent with prior theory and research seeking to understand the mechanisms underlying relations between poverty and child development and identifying factors that promote children’s resiliency in the context of poverty (McLoyd 2011; Yoshikawa et al. 2012).

In addition, findings suggested that there was no direct effect of SB on children’s social-emotional competence at age 2. However, there was an indirect effect of SB on social-emotional competence through enhancements to maternal cognitive stimulation at 6 months. These findings provide additional evidence for the efficacy of the SB model in enhancing mothers’ cognitive stimulation (Roby et al. 2021; Miller et al. 2023), and in turn, children’s school readiness outcomes (Miller et al. 2024). These results suggest that by supporting positive parenting behaviors such as cognitive stimulation, the SB intervention also indirectly impacts children’s early social-emotional competencies. Further, although prior research has demonstrated positive effects of the SB program in reducing child internalizing (Miller et al. 2023) and externalizing (Canfield et al. 2025) problem behavior, the current study is the first to show intervention effects of SB on children’s prosocial behavior.

Findings showing an indirect effect of SB on children’s social-emotional competence in the absence of a direct effect is consistent with the SB model theory of change, which posits robust and lasting direct effects of the intervention on positive parenting behaviors such as reading, playing, and verbal responsivity which then translate into impacts on child development (see Figure 1). These findings are also consistent with broader trends in mediation analysis that help to clarify mechanisms of change (e.g., O’Rourke and MacKinnon 2018).

FIGURE 1 ∣.

FIGURE 1 ∣

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Population-level conceptual model: SB tiered intervention, mechanisms of action.

Our findings are aligned with prior studies focused on the features of early parent-child interactions showing that particular contexts involving cognitive stimulation, such as reading, play, and engagement in everyday routines can offer opportunities for parents to model social norms, rules, and behaviors, and for infants and toddlers to observe and practice social-emotional competence skills (Brownell 2016; Dahl and Campos 2013). Interactions involving shared-reading and play often involve key social capacities (many of which are measured by the ITSEA), such as taking on roles, acts of pretend, and following rules (Crawley and Sherrod 1984; Fantasia et al. 2014; Suarez-Rivera et al. 2019), coordination and replication of specific behaviors (Fletcher and Reese 2005), empathy and collaboration/cooperation (Roth-Hanania et al. 2011; Warneken et al. 2006), and persistence and sustained attention to a common goal (Sénéchal et al. 1995). Our results build on this research and provide additional evidence that parent-child reading, play, and other verbally rich activities are related to children’s early social-emotional competence.

These results are consistent with work showing that certain aspects of parent-child interactions such as parents’ use mental-state language (i.e., references to psychological and emotional states) and emotion coaching (e.g., awareness and validation of emotions) relate to early social-emotional development during the infant and toddler period (Drummond et al. 2014; Roby and Scott 2018). Thus, in addition to providing opportunities to observe and engage in social skills, these kinds of cognitively stimulating activities also afford parents opportunities to engage in specific behaviors that have been linked to children’s social-emotional development. These findings are also consistent with prior work showing associations between broader measures of maternal sensitivity and responsivity (e.g., showing attention and contingent responsivity to children’s affect and interests) and toddlers’ social-emotional competence (Brophy-Herb et al. 2011; Kelly et al. 2024). Although there is overlap between these two important constructs, we posit that cognitive stimulation, especially in the contexts emphasized in this study, goes beyond general sensitivity by providing young children with opportunities to observe and put into action specific behaviors that are important for social interactions with both adults and peers (e.g., pretending, turn taking, thinking about others) that are not necessarily subsumed within the broader construct of sensitivity. We therefore conclude that cognitive stimulation is a key and independent factor in supporting the development of early social competence.

Importantly, this work provides additional evidence for the efficacy of tiered interventions seeking to reduce poverty-related disparities in children’s school readiness by supporting positive childhood experiences (Garner et al. 2021). The SB model addresses key barriers to population-level reach and impact for families with young children including (1) identifying and engaging families shortly after birth, (2) reducing barriers to participation by increasing accessibility, (3) addressing heterogeneity in risk, and (4) limiting programmatic costs by building on existing infrastructure and providing higher intensity services only to families with greater need. This approach is supported by the American Academy of Pediatrics (Garner et al. 2021) and other early childhood development leaders (e.g., Willis and Eddy 2022). The current findings can inform preventive interventions seeking to support early child development through encouraging positive parenting and parent-child interactions that involve reading, talking, and playing with infants and toddlers.

5.1 ∣. Strengths and Limitations

This study had many strengths, including the use of an RCT, with implementation across two sites and a racially/ethnically diverse sample from low-income backgrounds, and assessment of key variables using multiple methods in the first years of life. However, it also had limitations. As the sample was primarily Hispanic/Latine and Black, findings may not generalize to other populations. There was also some minor differential attrition at 24 months. This difference could reflect that assessment visits required additional participation for treatment families above and beyond their intervention sessions. As control families did not take part in interventions, they may have had more interest in participating in assessments. This pattern of assessment participation is consistent with prior RCTs of the FCU, where there was greater participation the 8.5 year assessment among control than intervention families (Shaw et al. 2019). Despite this differential attrition, baseline equivalence was maintained, lending support for the internal validity of our findings. In addition, although we used standardized and commonly used measures, both the mediating and outcome variables were measured either partially (cognitive stimulation) or fully (social-emotional competence) using parental self-report, which could lead to bias in responding. This issue was addressed in part for the mediating variable by utilizing both observation and survey information to capture cognitive stimulation and by using a survey measure (StimQ2), developed to minimize social desirability bias (Cates, Roby et al. 2023; Cates, Weisleder et al. 2023). Finally, because this study involves an intent to treat analysis in which the treatment condition is randomization to PlayReadVIP with the option for FCU for families with greater risk we, cannot distinguish the impact of each individual program. Our exploratory subgroup analyses focused on post-baseline group assignment to FCU, which could have differed across treatment and control families. As such, the subgroup analyses cannot be considered experimental. Even so, it is encouraging that effects did not differ across these groups.

6 ∣. Conclusion

In this study, we showed that mothers’ engagement in cognitively stimulating activities such as reading, play, and other verbally rich interactions was related to children’s early social competence at age 2 and that the SB intervention enhanced children’s early social skills during toddlerhood through changes in cognitive stimulation. Our results demonstrate the benefits of early cognitive stimulation for children’s emerging social-emotional competence and provide additional support for the efficacy of the SB model. Findings underscore the importance of experiencing cognitive stimulation from as early as the first months of life and how these parenting behaviors can support school readiness abilities in the context of adversity.

Supplementary Material

Roby et al., 2025 Soc Dev SupMat

Additional supporting information can be found online in the Supporting Information section.

Supporting file 1: sode70024-sup-0001-SuppMat.docx

Acknowledgments

We thank many individuals who contributed to this project, including Angelica Alonso, Jenny Arevalo, Adriana Chung, Aida Custode, Fernanda Fernandez, Ashley Griffin, Julianna Gutierrez, Julia Honoroff, Maya Matalon, Maritza Morales-Gracia, Anne Seery, Johana Rosas, Emily Russell, Anne Gill, Tracie Stufft, Helena Wippick, and Mackenzie Whipps. We also thank all of the children and parents who participated in this research.

Footnotes

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The analyses presented here were preregistered in clinicaltrials.gov (NCT02459327, https://clinicaltrials.gov/ct2/show/NCT02459327). The materials necessary to reproduce the analyses presented here are not publicly accessible. The analytic code necessary to reproduce the analyses is available from the first author Erin Roby (erin.roby@nyulangone.org). De-identified data used in the analyses presented here are available to interested researchers upon request through the establishment of data sharing agreements to researchers who provide a methodologically sound proposal.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Roby et al., 2025 Soc Dev SupMat
NIHMS2118694-supplement-Roby_et_al___2025_Soc_Dev_SupMat.docx (27.5KB, docx)

Data Availability Statement

The analyses presented here were preregistered in clinicaltrials.gov (NCT02459327, https://clinicaltrials.gov/ct2/show/NCT02459327). The materials necessary to reproduce the analyses presented here are not publicly accessible. The analytic code necessary to reproduce the analyses is available from the first author Erin Roby (erin.roby@nyulangone.org). De-identified data used in the analyses presented here are available to interested researchers upon request through the establishment of data sharing agreements to researchers who provide a methodologically sound proposal.

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