Research

Original Investigation

Association of the Type of Toy Used

During Play With the Quantity and
Quality of Parent-Infant Communication
Anna V. Sosa, PhD
Editorial
IMPORTANCE The early language environment of a child influences language outcome, which

in turn affects reading and academic success. It is unknown which types of everyday activities
promote the best language environment for children.
OBJECTIVE To investigate whether the type of toy used during play is associated with the
parent-infant communicative interaction.
DESIGN, SETTING, AND PARTICIPANTS Controlled experiment in a natural environment of
parent-infant communication during play with 3 different toy sets. Participant recruitment
and data collection were conducted between February 1, 2013, and June 30, 2014. The
volunteer sample included 26 parent-infant (aged 10-16 months) dyads.
EXPOSURES Fifteen-minute in-home parent-infant play sessions with electronic toys,
traditional toys, and books.
MAIN OUTCOMES AND MEASURES Numbers of adult words, child vocalizations, conversational
turns, parent verbal responses to child utterances, and words produced by parents in 3
different semantic categories (content-specific words) per minute during play sessions.
RESULTS Among the 26 parent-infant dyads, toy type was associated with all outcome
measures. During play with electronic toys, there were fewer adult words (mean, 39.62; 95%
CI, 33.36-45.65), fewer conversational turns (mean, 1.64; 95% CI, 1.12-2.19), fewer parental
responses (mean, 1.31; 95% CI, 0.87-1.77), and fewer productions of content-specific words
(mean, 1.89; 95% CI, 1.49-2.35) than during play with traditional toys or books. Children
vocalized less during play with electronic toys (mean per minute, 2.9; 95% CI, 2.16-3.69) than
during play with books (mean per minute, 3.91; 95% CI, 3.09-4.68). Parents produced fewer
words during play with traditional toys (mean per minute, 55.56; 95% CI, 46.49-64.17) than
during play with books (mean per minute, 66.89; 95% CI, 59.93-74.19) and use of
content-specific words was lower during play with traditional toys (mean per minute, 4.09;
95% CI, 3.26-4.99) than during play with books (mean per minute, 6.96; 95% CI, 6.07-7.97).
CONCLUSIONS AND RELEVANCE Play with electronic toys is associated with decreased
quantity and quality of language input compared with play with books or traditional toys. To
promote early language development, play with electronic toys should be discouraged.
Traditional toys may be a valuable alternative for parent-infant play time if book reading is not
a preferred activity.

Author Affiliation: Department of

Communication Sciences and
Disorders, Northern Arizona
University, Flagstaff.

JAMA Pediatr. doi:10.1001/jamapediatrics.2015.3753

Published online December 23, 2015.

Corresponding Author: Anna V.

Sosa, PhD, Department of
Communication Sciences and
Disorders, Northern Arizona
University, 208 E Pine Knoll Dr,
15045, Flagstaff, AZ 86011
(anna.sosa@nau.edu).

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Research Original Investigation

Toy Type and Parent-Infant Communication

ariation in early language development is in part determined by a childs language environment.1 The quantity of language input received from caregivers during
the first few years is positively associated with a childs language accomplishments and this early advantage can have
long-lasting implications for overall academic success.2,3
Previous evidence suggests that in addition to the quantity of
language exposure, measures of interaction quality also influence language development.1 For example, maternal responsiveness and the number of adult-child conversations both
positively affect language development.4,5 Beyond familyspecific factors, such as socioeconomic status and parental education, little is known about everyday activities that may promote both the quantity and quality of communicative
interactions between parents and young children. Television
exposure, book reading, and independent and guided play are
activities that have been investigated. Television exposure was
found to be associated with decreased quantity and quality of
parental language input, and media viewing by children
younger than 2 years has been shown to negatively affect language development, likely because media use displaces other
more beneficial language-promoting interactions.6-8 On the
other hand, book reading and playing together with young children are often recommended as activities that boost language development. Clinic-based programs, such as Reach Out
and Read, that distribute books to impoverished families have
been shown to improve language ability, and a variety of different play activities, including early symbolic play and block
play, have been linked to better language ability in toddlers.9-12
Based on these and other findings, the American Academy of
Pediatrics discourages media use by children younger than 2
years and emphasizes the importance of book reading and other
types of parent-child play time.13 However, the reality for many
families of young children is that opportunities for direct parent-child play time is limited owing to financial, work, and
other familial factors. Thus, optimizing the quality of limited
parent-child play time is imperative.
At the same time that parents are being encouraged to read
to their young children and engage in direct parent-infant play,
they are also bombarded with advertisements for educational toys that claim to promote language development in
very young children, including infants. These toys are typically battery-operated electronic toys with buttons that produce lights, sounds, music, words, and phrases when activated. Other options parents have when selecting toys for their
very young children are traditional nonelectronic toys, including blocks, puzzles, and stacking cups, as well as toys that encourage symbolic play such as dolls and tea sets. Primary care
professionals and pediatricians working with families of young
children may be called on to provide recommendations regarding selection of toys for infants and toddlers, particularly
for those children and parents for whom reading may not be a
preferred activity.
The purpose of this controlled experiment was to determine whether the type of toy used during parent-child play
time influences the quantity and quality of the communicative interaction in ways that are known to be associated with
better language development.
E2

At a Glance
To promote language development, parents are encouraged to
read to their infants and spend time playing 1 on 1, but little is
known about how different types of play activities affect
parent-infant communication.
In the present study, play with books and traditional toys was
superior to play with electronic toys in promoting high-quality
communication.
Children vocalized less during play with electronic toys than
during play with books.
Because play with electronic toys is associated with decreased
quantity and quality of language input, it should be discouraged
to promote early language development.

Methods
My research team and I conducted a controlled experiment
using observational measures of a volunteer community
sample of parent-infant dyads recruited through posting of flyers in public places frequented by parents of young children
in Flagstaff, Arizona, a midsized city in the southwestern United
States. Enrollment and data collection occurred over a 16month period between February 1, 2013, and June 30, 2014.
All procedures were approved by the institutional review board
at Northern Arizona University. Written informed consent was
obtained from parents.

Participants
Pairs of parents (mother or father) and infants (aged 10-16
months) were eligible. Parent-infant dyads were excluded if
the participating parent did not use English as the primary language with the child. Because race/ethnicity and socioeconomic status may affect parent-child communication, this information was collected via parent report using a written
questionnaire with set categories for race/ethnicity and maternal education level.

Data Collection
To maximize the ecological validity of study findings, participants engaged in study procedures in their own homes without being directly observed by researchers. On enrollment in
the study, audio recording equipment, 3 sets of toys, and study
paperwork were delivered to participants. The recording equipment used was the LENA Pro System (Language Environment Analysis; LENA Foundation). The system includes a small
digital recording device called a digital language processor that
is placed in a pocket in a vest worn by the child. The processor records up to 16 hours of recorded sound and is worn continuously by the child for at least 10 hours. The accompanying LENA software conducts automatic analyses of the
recordings and generates estimates of the amount of speech
produced by adults in the childs environment, the number of
child vocalizations, the number of adult-child conversational
turns, and the amount of exposure to electronic noise (eg, television). The algorithms used to generate these automatic analyses are designed to calculate estimates over an extended recording period rather than specific counts during a short period.

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Toy Type and Parent-Infant Communication

Original Investigation Research

For that reason, the automatic analyses were used to obtain

general information about the language environment of each
child but were not used in data analysis for the main research
questions.
Each dyad engaged in 2 15-minute play sessions per toy set
over a 3-day period, resulting in 30 minutes of play per day.
Participants were given a daily log indicating which toy set to
play with each day and in which order. To minimize potential
order effects, 6 different daily logs were generated, each representing a different presentation order. As participants were
enrolled, they were assigned a daily log-in sequential order
(from 1 to 6 and then starting again at 1). All but 1 participant
followed the order presented on their daily log; this participant did only 1 play session on the first day and 3 play sessions on the second day. Participants were instructed to engage in play sessions at their convenience during the day and
play sessions did not need to be back to back. Parents were instructed to play as they usually do with their child and were
not explicitly told to minimize distractions (eg, presence of siblings, pets, and television). Start and stop times for each play
session were recorded by the parent on the daily log so that
they could be found easily on the audio recordings for coding
and analysis.

a speechlike utterance consisting of, at minimum, a voiced

vowel. Non-speechlike utterances, such as cries, grunts, and
laughs, were not coded as child vocalizations. A conversational turn was a speechlike utterance by either the parent or
the infant that occurred within 5 seconds of an immediately
preceding utterance by the other speaker. Parent response was
a speechlike response by the parent that occurred within 5 seconds of an immediately preceding child vocalization. A parent utterance was only counted as a parent response if it was
determined to be a direct response to the preceding child utterance; a parent utterance that occurred within the 5-second window but was judged to be unrelated to the previous
child vocalization and not prompted by the child vocalization (eg, speaking to a pet or other adult) was not counted as a
parent response. The conversational turn measure is a purely
quantitative measure of back-and-forth vocal interactions between infant and parent while parent response measures direct parental verbal responsiveness to a childs vocalization.
Per-minute counts for each outcome variable were averaged
across the 2 play sessions with each toy set; this average perminute count was used for all analyses. Reliability coding was
conducted by a second research assistant for all of the play sessions for 15 of the participants.

Toy Sets

Statistical Analysis

All toys were selected based on their potential to elicit speech

centered on 3 semantic themes: animal names, colors, and
shapes. The electronic toy set consisted of 3 battery-operated
toys with buttons and switches that can be manipulated to produce lights, words, phrases, and songs. The electronic toys included a baby laptop, a talking farm, and a baby cell phone.
These 3 toys were selected because they are marketed as educational toys that promote language development for children in this age range and are advertised as teaching animal
names, colors, and shapes. The traditional toy set consisted
of 3 nonelectronic toys that also have the potential to teach animal names, colors, and shapes. These traditional toys included a farm animal chunky wooden puzzle, a shape-sorter
with 10 pieces representing 5 different shapes and 5 different
colors, and a set of 10 small multicolored rubber blocks with
pictures of animals and common objects on each side. The
books toy set consisted of 5 board books: 2 with a farm animal theme, 2 with a shape theme, and 1 with a color theme.
Three of the books included lift-the-flap opportunities.

Pearson-product moment correlations were calculated between coder 1 and coder 2 results for each outcome variable
in each toy condition. Intercoder agreement was very high for
all outcome variables in all conditions (overall r = 0.981; range,
0.925-0.999). Coders could not be blinded to the condition because the toy set was identifiable by listening to the play session.
My research team and I analyzed the data using repeated
measures analysis of variance for each of the 5 outcome variables, with the toy set as the within-participants factor. This
design allows each dyad to serve as its own control, thereby
eliminating the influence of dyad-specific factors that may influence the general quality of the parent-infant communication interaction (eg, age of the child, developmental level of
the child, and socioeconomic status of the family). We used
post hoc analyses to explore differences in outcome measures between individual toy sets.

Results

Outcome Variables
Each play session was transcribed by a research assistant and
coded for the variables of interest: (1) number of adult words,
(2) number of content-specific words, (3) number of child vocalizations, (4) number of conversational turns, and (5) number of parent responses per minute. These measures were operationally defined as follows. An adult word was any word
produced by the parent during the play session. Words produced by other adults who may have been present in the interaction were not included in the adult words count. A contentspecific word was a word produced by the parent that was in 1
of the 3 semantic categories that the toys were selected to elicit
(ie, animal names, colors, and shapes). Child vocalization was
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Thirty-seven parent-infant dyads were enrolled in the study.

Seven participants were not home at the scheduled material
delivery time and 4 did not complete all study procedures, resulting in useable data from 26 parent-infant dyads. Twentyfive parent participants were biological mothers and 1 parent
participant was the biological father. Two children were born
prematurely and were identified with moderate developmental delay; parents of the other children reported no developmental concerns. The sex of the child, age of the child, race/
ethnicity of the child, and maternal education are presented
in Table 1. Demographic data from the 7 families who were not
home at the delivery time are not available. Of the 4 families
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Research Original Investigation

Toy Type and Parent-Infant Communication

who did not complete all study procedures, 2 were Hispanic

and 2 were non-Hispanic white, suggesting overrepresentation of Hispanic families in the nonparticipant group.
Average per-minute counts with 95% CIs for each outcome variable by condition are displayed in the Figure and reTable 1. Descriptive Data on Study Participants
Characteristic

No. (%)

Male

12 (46)

Age, mean (SD), mo

13 (2.1)

Race/ethnicity
Non-Hispanic white

24 (92)

Hispanic

1 (4)

Native American

1 (4)

Maternal education
High school diploma

1 (4)

Some college

3 (12)

College degree

22 (85)

Figure. Means and 95% CIs for Each Outcome Measure By Toy Set

Frequency per Minute (10 for AW)

10
Electronic
Traditional
Books

ported in Table 2 along with repeated-measures analysis of variance P values. Main effects of condition were statistically
significant for all outcome variables. My research team and I
conducted post hoc analyses for each outcome variable to examine significant differences for the 3 possible toy set contrasts (ie, electronic vs traditional, traditional vs books, and
books vs electronic); Bonferroni-adjusted P values for each
2-way contrast are reported in Table 3.
During play with electronic toys, there were fewer adult
words (mean, 39.62; 95% CI, 33.36-45.65), fewer conversational turns (mean, 1.64; 95% CI, 1.12-2.19), fewer parental responses (mean, 1.31; 95% CI, 0.87-1.77), and fewer productions of content-specific words (mean, 1.89; 95% CI, 1.492.35) than during play with traditional toys or books (Table 2).
Children vocalized less during play with electronic toys (mean
per minute, 2.9; 95% CI, 2.16-3.69) than during play with books
(mean per minute, 3.91; 95% CI, 3.09-4.68). Parents produced fewer words during play with traditional toys (mean per
minute, 55.56; 95% CI, 46.49-64.17) than during play with
books (mean per minute, 66.89; 95% CI, 59.93-74.19) and use
of content-specific words was lower during play with traditional toys (mean per minute, 4.09; 95% CI, 3.26-4.99) than
during play with books (mean per minute, 6.96; 95% CI,
6.07-7.97).
Results showed that the largest and most consistent differences were between electronic toys and books (with greater
values for all measures with books), followed by electronic toys
and traditional toys (with larger values in the traditional toy
condition for all measures except child vocalization), and the
least consistent and smallest differences were between books
and traditional toys (with larger values in the book condition
for adult words and content-specific words only).

AW

CV

CT

RESP

CSW

AW indicates adult words; CSW, content-specific words; CT, conversational

turns; CV, child vocalizations; and RESP, parent responses.

Discussion
In this controlled experiment in a natural environment of
parent-infant communicative interaction during play, my

Table 2. Mean Values for Each Outcome Measure by Toy Set, With Repeated-Measures Analysis
of Variance P Value to Test for Significant Effects of the Toy Set
Mean (95% CI)
Outcome Measure

Electronic

Traditional

Books

P Value

Adult words

39.62 (33.36-45.65)

55.56 (46.49-64.17)

66.89 (59.93-74.19)

<.001

Content-specific words

1.89 (1.49-2.35)

4.09 (3.26-4.99)

6.96 (6.07-7.97)

<.001

Child vocalizations

2.9 (2.16-3.69)

3.74 (2.75-4.89)

3.91 (3.09-4.68)

.04

Conversational turns

1.64 (1.12-2.19)

2.49 (1.79-3.34)

2.73 (2.04-3.38)

<.001

Responses

1.31 (0.87-1.77)

2.09 (1.47-2.79)

2.18 (1.53-2.80)

<.001

Table 3. Results of Post Hoc Analyses for Each 2-Way Comparison for Each Outcome Measure
P Valuea
Adult
Words

Content Specific
Vocabulary

Electronic vs
traditional

<.01

<.001

.24

Traditional vs book

<.001

<.001

>.99

>.99

>.99

Book vs electronic

<.001

<.001

.01

<.001

<.001

Comparison

Child
Vocalizations

Conversational
Turns
.006

Responses
.004

E4

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P values using Bonferroni

adjustment.
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Toy Type and Parent-Infant Communication

Original Investigation Research

research team and I found that the type of toy used during the
play session was significantly associated with both the
quantity and quality of language use. For all outcome measures, play with books provided a better communication
interaction than play with electronic toys. The effect was most
pronounced for the quantitative measures of parental language use, suggesting that parents tend to let the toys do the
talking for them when their child is interacting with electronic toys. This is particularly worrisome given that there is
no evidence that children this young are able to learn vocabulary from media or other nonhuman interactions.14,15 For the
2 qualitative measures of parent-infant interaction, conversational turns and parental responses, play with traditional toys
was equivalent to book reading, yet both were superior to play
with electronic toys. While play with books may provide a script
that encourages parents to talk more and produce more words
associated with the themes in the books, it was not superior
to play with traditional toys in promoting parent-child conversations and parental responsiveness. For parents who may
not be inclined to read to their preverbal infants or for parents whose children do not prefer book reading activities, play
with traditional toys, such as blocks and shape sorters, may
be an equally valuable use of limited parent-infant play time.
This is consistent with and may help explain results of previous work that found that distribution of blocks to families of
young children resulted in better child language ability.12
While the results of this study are robust given that the play
sessions were conducted in the participants homes rather than
in a controlled laboratory setting, there are important limitations that should be taken into account. The most notable limitations were the small sample size and the relative homogeneity of participants by race/ethnicity and socioeconomic status.
Given the robustness of the results despite the small sample
size, however, it is likely that the findings would be replicated
with a larger group of participants. The question of whether results would differ for families from more diverse demographic backgrounds is an important one that remains to be answered. Given that cultural and socioeconomic factors are
known to influence both the amount of time spent en-

ARTICLE INFORMATION
Accepted for Publication: October 18, 2015.
Published Online: December 23, 2015.
doi:10.1001/jamapediatrics.2015.3753.
Author Contributions: Dr Sosa had full access to all
of the data in the study and takes responsibility for
the integrity of the data and the accuracy of the
data analysis.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was funded by a
research grant from the American SpeechLanguage-Hearing Foundation.
Role of the Funder/Sponsor: The funder had no
role in the design and conduct of the study;
collection, management, analysis, and
interpretation of the data; preparation, review, or
approval of the manuscript; and decision to submit
the manuscript for publication.

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gaged in parent-child play and the nature of the play interaction, it is important to acknowledge that the effect of toy type
on parent-infant communication may be different for parents
from different cultural and economic backgrounds.16-18 Furthermore, the findings of this study are applicable to children
in a very limited age range of prelinguistic and very early language development and effects may be different for older toddlers and preschoolers. Another limitation is that investigators did not have complete control over the timing of the play
sessions and it is possible that participants may have chosen to
play with certain toy sets when either the parent or child was
more tired, thereby impacting the communicative interaction.
Despite these limitations, the results provide an empirical basis for primary care professionals and pediatricians for
making recommendations regarding the types of play activities that promote rich language interactions.

Conclusions
These results provide a basis for discouraging the purchase of
electronic toys that are promoted as educational and are often quite expensive. These results also add to the large body
of evidence supporting the potential benefits of book reading
with very young children. They also expand on this by demonstrating that play with traditional toys may result in communicative interactions that are as rich as those that occur during book reading. I do not claim that book reading and play with
traditional toys are developmentally equivalent activities; book
reading provides numerous benefits that cannot be replicated in other activities (eg, literacy socialization and exposure to novel vocabulary and concepts) and play with toys, such
as blocks and puzzles, provides developmental and cognitive
benefits beyond the language domain.19-22 However, if the emphasis is on activities that promote a rich communicative interaction between parents and infants, both play with traditional toys and book reading can be promoted as languagefacilitating activities while play with electronic toys should be
discouraged.

Additional Contributions: The following

individuals participated in data coding while
graduate students at Northern Arizona University
and received hourly financial compensation as
student research assistants, providing statistical
consultation and analysis assistance for this project:
Lauren Crane, MS, Brooke Santos, MS, Heather
Wiest, MS, and Luke Plonsky, PhD (Northern
Arizona University).
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