Pediatric surgeon Dr. Dana Suskind, who specializes in cochlear implants and has authored books on brain development and early childhood development, founded the research initiative that would evolve into the  in 2010 after observing the degree to which differences in her patients’ early language exposure led to inequalities in their ability to learn and thrive. These disparities often fell along socio-economic lines. Parents across the board want to help their children get the best possible start in life, Suskind knew, but she saw that they often lack basic knowledge about how to foster early learning. Envisioning a population-level shift in parents’ and caregivers’ knowledge and behavior, Suskind and her team created an asset-based, parent-centered curriculum — Tune In, Talk More, Take Turns — also known as the . 

The program has been in existence long enough now for researchers to study its long-term effectiveness. The conclusion? It works, and it keeps on working. 

When Parents Know More, They Do More

shows that frequent conversational exchanges with adult caregivers promotes children’s language and vocabulary skills, cognitive performance, brain function and even the . A  by researchers with the LENA Foundation (Language ENvironment Analysis), for example, confirmed that the number of two-way conversations with adults that babies experience in their first three years is related to their verbal abilities and IQ in . 

While all families communicate with their children, studies have shown that children in low-income families generally hear fewer words, shorter sentences and phrases, and are less likely to have books in their homes, setting up disparities that lead to later deficits in academic and social achievement. There’s a lack of consensus around this “word gap” though. Some researchers have  the validity of these findings, while  call for more exploration of them, but encourage the idea of supporting families with specialized programs to help their children develop early language skills — which is what Suskind and her team are doing.

The TMW Center has been focused on developing resources and programs to help parents and caregivers understand more about brain development — and the 3Ts have been core. There’s a 3T curriculum for families, a 3T curriculum centered on home visiting, and an online professional development course for educators who want to engage with families about the science of brain development, which are all free to use. 

These resources provide parents and adult caregivers evidence-based information about how their kids’ brains are developing, and the vital role caregivers play in their child’s cognitive and language development. 

The 3Ts Home Visiting (3Ts-HV) curriculum, for example, is a six-month program for caregivers of 13- to 16-month-old toddlers from low-income families that coaches parents in their homes through 12 tutoring modules. One module discusses executive function and presents strategies for using talk to regulate children’s behavior, particularly during tantrums — and offers guidance to help parents recognize their own emotions and tone of voice. Another addresses the difference between issuing directives versus using explanations to foster young children’s ability to think things through. (Think: “Don’t throw the football in the house because you might break something,” rather than “Don’t throw the #$%$# football in the house” — though the latter is a communication style to which any parent can relate.) Other modules discuss how caregivers can use encouragement, storytelling, numbers and patterns when engaging with babies and toddlers.

Through relatable videos (featuring beyond-adorable infants), parents learn that their young children’s brains are like sponges, soaking up words and ideas, then using them to make billions of neural connections. One lesson describes their verbal interactions like a piggy bank, with every word like a penny in their account. “The more you invest now, the richer they’ll be later.” Parents are encouraged to be in the moment with their child and to talk about what they’re focused on and to look for opportunities to talk and interact. The subtext: language learning isn’t something that exists in isolation, but rather it’s a part of daily life. Everything a child sees and hears shapes their experience, and caregivers are the facilitators who help make that happen.

Evaluating the 3Ts Curriculum

A 2018 study published in the evaluated the 3Ts-HV curriculum and found that caregivers who participated in the twice-monthly visits were significantly more knowledgeable about early childhood development and engaged more with their children in the conversational turn-taking that builds language. These caregivers praised and encouraged their children more, explained more, asked more open-ended questions, and used less critical language and physical control in their interactions with their children.

The initial study showed the effectiveness of the 3Ts-HV intervention in fostering changes in parents’ interactions with their children within six months of their participation. A recent  published in October in the Journal of Academic Pediatrics shows that the program not only improves children’s language learning in their toddler years, but offers sustained benefits to their vocabulary and literacy skills when they reach kindergarten and beyond.

According to Christy Leung, the TMW Center’s director of research who co-authored the most recent study with Suskind, this simple intervention with a group of families increased parental knowledge when the child was 26 months old, contributed to more frequent parent-child conversational turns at 38 months, and promoted children’s language skills at 50 months. The study provides empirical evidence that increasing parents’ knowledge and enriching parent-child linguistic interactions during their toddler years promotes language development at preschool age. Mothers who received the intervention continued to provide their young children with enriched language input without showing significant declines even after the intervention’s “honeymoon phase” ended, Leung says.

When designing the curriculum, Leung notes, “We wanted to emphasize that the parent is the best person to educate their small children. They struggled to realize that they are their child’s first teacher, and they don’t have to wait until their child goes to school [for them] to start learning.” 

One of the hardest things, Leung says, is to change parents’ minds about the idea that educational TV is better than they are at teaching their children, especially at an early age. They think they don’t have a good enough vocabulary or education to do so. 

Leung adds: “But we emphasized that they are exactly the best resource for their children, and they know their child best. Once they saw that their child learns best from a real person — and that they’re learning all the time, even if they may not be verbal yet — that was a big realization for them.”

Simply put: What parents know matters, and it shows up in their children’s learning readiness. 

Prevent, Don’t Remediate

Brain development research has shown that the first years of life are when the brain is growing and developing most rapidly and that the . Early deficits in language learning often accumulate and can affect the entire trajectory of a child’s life. We know this. But that knowledge doesn’t jibe with what the U.S. , to help develop those brains. 

Prevention, rather than remediation, is the battle cry for Suskind and her team at the TMW Center, who view parents as an untapped resource in this equation. Their studies point to a doable and easily replicated way of using the  to support families in building the healthy foundations for lifelong learning. (The Centers for Disease Control and Prevention defines the public health approach as one rooted in the scientific method that strives to provide the maximum benefit for the largest number of people.)

According to the TMW Center, 3Ts programs are on course to reach 15,000 families across the U.S. by the end of 2024. Communities and individuals can sign up on the  and receive free resources to implement the curriculum in their schools, museums, libraries, community centers and other organizations. 

“We’ve gotten such positive feedback from the parents, who say having this experience is unique and valuable,” Leung says. “We heard from our curriculum team that one of the moms receiving the intervention saw another mom in the laundromat and said, ‘This is something you really should sign up for. It changed my life.’”

“That touches us so much it brings us to tears,” she says. “It also gives us another idea for how we can spread the word.”

And here’s a twist: The same core difficulties are bedeviling teachers too.

The findings, contained in a new working paper, are believed to be the first to identify brain changes as an explanation for why students have suffered, both inside and outside the classroom, since the pandemic drove millions out of the classroom. 

, a Harvard University psychologist who studies the effects of stress on executive functions and who is the study’s lead author, said the new findings offer the first evidence to help us “understand the ‘why’” of the pandemic downturn — “what is actually causing all these issues that we’re seeing and talking about in the news.”

The paper, from the educational assessment and services company“, examines the cognitive skills of students nationwide and finds that, simply put, over the past several years, kids’ famously ever-changing brains have changed for the worse. 

Since the pandemic’s onset, students across all ages and economic levels have begun to demonstrate weaker memory and “flexible thinking” skills — those represent the mental bandwidth needed for multitasking, shifting from one activity to another and juggling the day’s demands. But for a few groups, such as younger and lower-income children, the changes have been more profound.

They also show that their teachers’ brains are weaker in almost identical ways, which could help explain high rates of frustration and burnout. They suggest school districts have their work cut out for them if they want to keep their best employees on the payroll and returning to the classroom each fall. 

Understanding the ‘why’ of pandemic downturn

The data come from a large, widely-used assessment, the , developed in 2013 at the University of Pennsylvania. It consists of a series of cognitive tasks that measure subjects’ accuracy and speed in several major cognitive domains, including working memory, abstraction, sustained attention, episodic memory and processing speed. 

MindPrint has administered the assessment periodically to its clients over the past decade. The most recent rounds totaled 35,000 students and 4,000 teachers in 27 states.

By most measures, U.S. students are suffering. Last year, NAEP scores showed the average 13-year-old’s understanding of math dropping to levels last seen in the 1990s and reading levels dropping to 1971, when the test was first administered.

More recent research has shown that while older children are showing encouraging signs of academic recovery, younger kids aren’t making the same progress. Many students who weren’t even in a formal school setting when COVID hit are already falling behind — especially in math.

The Penn assessment found that children who attended elementary or pre-school during the pandemic and who are now 8 to13 years old showed the largest declines in memory. 

“Younger kids haven’t really developed a lot of these core cognitive skills,” Tsai said. “It hasn’t solidified for them, either through development or just through practice in the classroom. And so younger kids are more vulnerable to these pandemic shifts.”

But students across all age groups showed worse flexible thinking, which researchers now theorize contributes to lower academic performance — as well as challenging behaviors.

Tsai said kids from lower income backgrounds were more vulnerable to these changes, specifically in verbal reasoning and verbal memory, than their higher income peers, with bigger declines in verbal scores, which are highly correlated with academic achievement in all subjects.

Adults in the study had similar declines in both memory and flexible thinking, possibly explaining higher reported levels of and .

Nancy Weinstein, MindPrint’s CEO, said weaker flexible thinking isn’t necessarily a problem for experienced teachers who have developed strategies to cope with stressful situations and can modify plans on the fly. But those with less experience may be unable to change gears when lessons go astray or students act out in class. That may lead to higher teacher burnout.

Across the board, teachers’ skills suffered in areas such as verbal and abstract reasoning, spatial perception, attention and working memory, but they saw the greatest losses in verbal memory and flexible thinking.

“If we care about that, we need to know how to help them,” Weinstein said. “And there are some tried and true things you can do.”

She said schools should consider sharing data like this with teachers so they can understand that their frustration in class might not be due to students alone. That could make a big difference, she said, in “their willingness to put in the effort to change, as opposed to saying, ‘Why bother?’”

For students, Weinstein said, offering them more opportunities to practice skills with between study sessions could help. Schools should also consider “” techniques that break learning into chunks and address each individually.

Could such techniques help students — and teachers — regain a measure of pre-pandemic skills? Weinstein suggests the answer is “Yes.”

“The environment will matter, but certainly we can regain some of that if we do the right things,” she said. “And we know what the right things are to do.”

Crystal Green-Braswell, coordinator of staff wellness and culture for the Little Rock School District in Arkansas, said offering the Penn assessment to teachers and staff has helped many think more deeply about their work — and about their own thinking. 

“People who have had the assessment will say, ‘Now, you know my processing speed is slower — y’all are going to have to give me a moment,’” she said. 

That’s a huge change in a profession in which most workers have been asked “to take ourselves out of the equation and just get the work done,” Green-Braswell said. 

She sees offering such insights to educators as part of “rehumanizing” teaching. “When we provide this kind of assessment and we provide this kind of space for folks to actually get to know themselves, we are humanizing this profession and helping people to realize, ‘You play a role. You play an active role. You matter.’ ”

Myelin is the fatty insulation that protects axons, the transmission lines of the nervous system that shoot information-bearing electrical impulses to various parts of the body (which is a much-abbreviated explanation of a fantastically complex process). Myelin helps these electrical impulses to travel efficiently along the axon. This is critical for effectively transmitting information throughout the brain with exquisitely precise timing.

Babies are born with brains full of axons located right where they need to be for various functions, such as hearing, seeing and movement. White-matter pathways associated with language are also present at birth, but their myelin continues to develop for many years after birth. By examining myelin development, scientists have discovered that these neural connections don’t simply grow, they are cultivated by their environments.

Parental input has been considered a key environmental factor for infants’ language development, as shown by a wealth of behavioral research. But few studies have looked at how parents’ verbal interactions with babies affect the physical development of their brains. Given the critical growth in children’s language-related activities in their first two years of life, a better understanding of what’s going on in their brains at this time is badly needed.

Thanks to a long-term intervention study of infant language-learning, researchers at the University of Washington’s  (I-LABS) have a trove of -device home recordings of child vocalizations and parent-child verbal interactions taken at regular intervals throughout babies’ first 24 months.

For their recent study on the effect of language experience on white-matter development, researchers invited all the families back to the lab for an MRI session when the children were around 2 years old. The MRIs imaged the white matter in the toddlers’ dorsal language system, a brain network that is tied to expressive language development and long-term language ability. They found that the frequency of parents’ verbal interactions with their infants, specifically conversational turns, uniquely predicted myelin density in this system.

“Conversational turns” are the back and forth between adult and child that can occur even before the child has actual words, a call and response that speaks “connection” in every utterance. In their study described in a published March 1 in The Journal of Neuroscience, researchers found that parent-infant conversational turns link to white-matter growth (myelination) at age 2 and suggest that early interactive language experiences uniquely contribute to brain development associated with long-term verbal and cognitive ability. The more back and forth between babies and parents, the greater the growth of the brain in areas critical to language ability and sensory-motor integration that affect the child’s ability to learn language and build vocabulary. These effects carry through early childhood and predict cognitive and linguistic ability into adolescence.

In other words, conversational turns are a very big deal, and MRIs show it.

Not Words Alone

I-LABS researcher Dr. Elizabeth Huber, the paper’s first author, says the studies establish that the growth in white matter isn’t related simply to the amount of language a child is exposed to — the number of words that wash over a child — but the amount of high-quality verbal interaction they have with the adults in their lives. The effects of these interactions were apparent as early as six months, when the child is not yet speaking but vocalizes (“babbling”) and the parent vocalizes back.

“Conversational experience as early as 6 months is predicting what the brain looks like at age 2 years,” Huber says. “It was striking to me how early and potentially long-lasting these effects are.”

It is impossible to overestimate the importance of those early years. White-matter pathways develop at their most dramatic rate during these years, though they continue to develop through adolescence. Language exposure during this window has been linked not only to vocabulary building but to multiple aspects of children’s cognitive development. Being exposed to conversational contingency — meaning interactions that acknowledge each other’s presence and take note of what’s happening in their shared physical environment (Do you see that kitty? How does a kitty go?) — encourages shared and sustained attention. If the adult is focusing on something and draws the child’s attention to it, the child is then able to focus on that thing distinct from everything else in the environment. Maybe not for long, but conversational contingency builds the muscle.

Conversational turns have been shown to stimulate more and higher-quality vocalizations from infants, including making sounds that are more consistent with the speech sounds and patterns of the adults around them (phonology). If you keep sharing conversational turns with your child in your Deep South accent, it’s a fair bet that their baby talk will have a drawl.

Through this conversational give and take, babies learn to listen and adjust their vocalizations in response to another person, a critical ability in all human interactions.

So Much More to Learn

Huber stresses that this research really has just begun. The current study was limited to native English speakers and families without known risk factors such as lower social economic status or a family history of dyslexia. The sample size was relatively small, and future work will look at larger and more diverse samples, including a larger control group of families that didn’t take part in an enriched language intervention.

“Right now, we’re really excited about the idea of adding brain scans with 6-month-old, or even younger, infants,” Huber says. “Can we already see these effects (on white matter) at a much younger age? Or is there something special about what’s happening in the brain around 2 years, as toddlers are starting to really use language to communicate in a more sophisticated way? Are there incremental changes in the white matter that connect to what an infant is currently experiencing, or do environmental effects show up at certain points in development more strongly than others? What we see right now is that conversational turns in infancy predict white-matter density in the 2-year-old, but that raises a lot of follow-up questions.”

Another area that’s ripe for research, Huber says, is looking at the effects of environmental factors such as poverty or trauma, which can interrupt the brain’s development, and potential ways to mitigate that interruption. The human brain is incredibly flexible, she says, and if there is some kind of a deficiency, researchers wonder if there are ways that deficiency can be mitigated.

It’s important to avoid thinking that all is lost if a child isn’t exposed to rich conversational interactions in their earliest years, Huber says. People working two jobs and giving their all to keep a roof over their heads and food on the table might not have as much time as they’d like to spend with their children.

“The rich early experience seems to be really important,” she says. “There are moments in development where we’re particularly sensitive to certain aspects of our environments, and where it’s easier to learn certain skills. So, for example, it’s harder to master a second language if you didn’t hear it or have some exposure as a very young child. I studied Spanish for years in college, but I speak it with a heavy Kansas accent, and I have to stop and search for words.

“At the same time, it isn’t as simple as saying, ‘If you have this amount or type of interaction at this exact age, you will excel in learning language, and otherwise you won’t.’ Children learn in different ways, and there is still lots of flexibility to learn and adapt, even later in life.

“Ultimately though,” Huber adds, “it’s exciting to me to think that we are starting to understand more about what matters for different aspects language development. If we can help parents and children so that a given child is coming into school on strong footing, that can make a difference for a child’s whole life going forward.”

In “,” Paul effectively makes the case that most of the metaphors we have for cognition are not useful because they allude to Western society’s assumption that thinking only happens inside the brain: the ubiquitous admonition to “use your head.” Our scientific journals, she writes, mostly proceed from the “brain in a vat” premise that considers our mental organ a disembodied, asocial entity, a computer encased inside our skulls doing all the thinking for a body that barely registers in the hierarchy of value.

The reality is much richer, more complex and delicious. And while it might seem overblown to call a book on cognition “revolutionary,” the ideas in “The Extended Mind” actually could change everything.

We’ve been led to believe, Paul writes, that like the Mighty Oz, the brain is an all-purpose, all-powerful thinking machine — and it is impressive, what with its lightning processing speed and its magnificent mutability. But it turns out, the brain — not just my brain (huge relief!) or your brain — is limited in its ability to pay attention, to remember, to deal with abstract concepts and even to persist at challenging tasks. So much for bearing down.

The smart move, she writes, is not to lean harder on the brain but to reach beyond it. Replace the brain-as-computer and brain-as-muscle metaphor with a more fitting one that compares our brains to, say, magpies. Like the magpie — famous for building its nest out of an astonishing array of materials it finds throughout its environment — our brains weave the bits and bobs of everything they encounter and turn them into cognition. We think with our bodies, our surroundings, our relationships. We think with gestures, with movement and sensation; we think with natural and built spaces, and the spaces we build with our ideas. We think with the other minds with which we interact — our family, coworkers, classmates, teachers, friends.

As Paul explains the new research into these three types of thinking — embodied, situated and distributed cognition — she convincingly and entertainingly makes the case that the research “not only produced new insights into the nature of human cognition; it has generated a corpus of evidence-based methods for extending the mind.”

Then, she goes a step further and lays out the purpose of her book: to operationalize the extended mind. To turn the discussion from something strictly philosophical into something practical and useful. If, when you reach the end of this book, you don’t view yourself and the world at least somewhat differently, well … I invite you to give it another read. And maybe dance more.

Contemplating what this new view of cognition might mean for early learning had me going overboard on the marginalia—with multiple exclamation points (Imagine having kids “act out” the solar system! Children play more imaginatively outdoors—cheers for forest schools!!!). First, as Paul mentions several times, children already come into the world with their thinking extended in these “new” ways. They certainly think with movement and with their relationships — and continue to do so until our education system succeeds in getting them to sit down and stop talking. Children spend an average of 50 percent of the school day sitting, Paul writes. That proportion increases as they enter adolescence; adults in the workplace spend more than two-thirds of the average workday seated — all rooted in society’s erroneous belief that to be thinking, we need to be sitting still.

What this attitude overlooks, she writes, is that human’s capacity to regulate our attention and our behavior is a limited resource and we use it up by suppressing our natural urge to move. In multiple experiments, children who were given license to move were “more focused, confident and productive.” One study of young people diagnosed with ADHD found that the more the kids moved, the more effectively they were able to think. Instead of insisting that children stop moving so they can focus, a more effective approach would be to allow them to move around so that they can focus. Throughout the U.S., recess has been reduced or even eliminated to generate more “seat time” devoted to academic learning. Paul argues that parents, educators and administrators should be arguing for more, not fewer, opportunities for children to be active.

One of the most profound and possibly revolutionary concepts Paul covers is that of interoception, an awareness of the inner state of the body. All of us start life with our interoceptive capacities operating via our onboard sensors taking information from the outside world—our retinas, cochleas, taste buds, olfactory bulbs—which send a constant stream of data to the brain from all over our bodies. Our conscious minds can’t process all they encounter, but the insula, the brain’s interoceptive hub, takes the constant data feed and uses it to navigate the world: the body “rings like a bell,” Paul writes, to alert us with a shiver, a sigh, a cringe.

Research has found that that how caregivers communicate with children about these bodily prompts can strengthen or weaken a child’s sensitivity to these internal signals. Other research has found that greater awareness of these sensations can give us agency in actually creating our emotions. Consider, for example, the difference in a child’s life if their caregivers took their sensations seriously and helped them learn to reappraise their physical sensations—my palms are sweaty; my stomach has butterflies—and label “nervous” or “anxious” as “excited” and “eager.”

Some of the most exciting and potentially transformative research cited in “The Extended Mind” is found in the chapters on thinking with relationships. Humans evolved to learn from other humans and to learn from teaching other people. We are social to our core and a large body of evidence points to the striking conclusion that we think best when we think socially. We evolved to reason, to persuade others of our views and to guard against being misled by others. If you ever wondered why your preschooler can argue you into exhaustion, they’re only fulfilling their evolutionary calling. Humans argue together, Paul writes, to arrive jointly at something close to truth. The key element is learning to argue over ideas with mutual respect. Argument, when done in the right way, produces “deeper learning, sounder decisions and more innovative solutions ….”

Our modern life has gotten too complex, too jammed with information and sensory overload for our brains to manage by themselves. Fortunately, we’re just beginning to realize how far and how well humans can think beyond those limitations. Taking Paul’s information-packed volume as a starting place, it’s thrilling to imagine what futures might be concocted by a whole society of magpie minds thinking together in ways informed by, but no longer bound by, the human brain.