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.
Corresponding Author: Anna V.
Sosa, PhD, Department of
Communication Sciences and
Disorders, Northern Arizona
University, 208 E Pine Knoll Dr,
JAMA Pediatr. doi:10.1001/jamapediatrics.2015.3753 15045, Flagstaff, AZ 86011
Published online December 23, 2015. (anna.sosa@nau.edu).

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 Research Original Investigation
V
ariation in early language development is in part de-
termined by a childs language environment.1 The quan-
tity of language input received from caregivers during
the first few years is positively associated with a childs lan-
guage 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 influ-
ence language development.1 For example, maternal respon-
siveness and the number of adult-child conversations both
positively affect language development.4,5 Beyond family-
specific factors, such as socioeconomic status and parental edu-
cation, little is known about everyday activities that may pro-
mote 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 lan-
guage 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 chil-
dren are often recommended as activities that boost lan-
guage 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 dif-
ferent 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 par-
ent-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 educa-
tional toys that claim to promote language development in
very young children, including infants. These toys are typi-
cally battery-operated electronic toys with buttons that pro-
duce lights, sounds, music, words, and phrases when acti-
vated. Other options parents have when selecting toys for their
very young children are traditional nonelectronic toys, includ-
ing blocks, puzzles, and stacking cups, as well as toys that en-
courage 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 re-
garding 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 deter-
mine whether the type of toy used during parent-child play
time influences the quantity and quality of the communica-
tive interaction in ways that are known to be associated with
better language development.
E2 JAMA Pediatrics Published online December 23, 2015 (Reprinted)
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Toy Type and Parent-Infant Communication
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 fly-
ers 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 16-
month 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 lan-
guage with the child. Because race/ethnicity and socioeco-
nomic status may affect parent-child communication, this in-
formation was collected via parent report using a written
questionnaire with set categories for race/ethnicity and ma-
ternal education level.
Data Collection
To maximize the ecological validity of study findings, partici-
pants engaged in study procedures in their own homes with-
out 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 equip-
ment used was the LENA Pro System (Language Environ-
ment 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 proces-
sor records up to 16 hours of recorded sound and is worn con-
tinuously by the child for at least 10 hours. The accompany-
ing 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, tele-
vision). The algorithms used to generate these automatic analy-
ses are designed to calculate estimates over an extended re-
cording period rather than specific counts during a short period.
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 Toy Type and Parent-Infant Communication
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 rep-
resenting 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 partici-
pant did only 1 play session on the first day and 3 play ses-
sions on the second day. Participants were instructed to en-
gage in play sessions at their convenience during the day and
play sessions did not need to be back to back. Parents were in-
structed to play as they usually do with their child and were
not explicitly told to minimize distractions (eg, presence of sib-
lings, 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.
Toy Sets
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 pro-
duce lights, words, phrases, and songs. The electronic toys in-
cluded a baby laptop, a talking farm, and a baby cell phone.
These 3 toys were selected because they are marketed as edu-
cational toys that promote language development for chil-
dren 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 ani-
mal names, colors, and shapes. These traditional toys in-
cluded 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 ani-
mal theme, 2 with a shape theme, and 1 with a color theme.
Three of the books included lift-the-flap opportunities.
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 vo-
calizations, (4) number of conversational turns, and (5) num-
ber of parent responses per minute. These measures were op-
erationally defined as follows. An adult word was any word
produced by the parent during the play session. Words pro-
duced by other adults who may have been present in the in-
teraction were not included in the adult words count. A content-
specific 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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Original Investigation Research
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 conversa-
tional 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 sec-
onds of an immediately preceding child vocalization. A par-
ent utterance was only counted as a parent response if it was
determined to be a direct response to the preceding child ut-
terance; a parent utterance that occurred within the 5-sec-
ond window but was judged to be unrelated to the previous
child vocalization and not prompted by the child vocaliza-
tion (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 be-
tween infant and parent while parent response measures di-
rect 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 per-
minute count was used for all analyses. Reliability coding was
conducted by a second research assistant for all of the play ses-
sions for 15 of the participants.
Statistical Analysis
Pearson-product moment correlations were calculated be-
tween 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 be-
cause the toy set was identifiable by listening to the play ses-
sion.
My research team and I analyzed the data using repeated
measures analysis of variance for each of the 5 outcome vari-
ables, 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 in-
fluence the general quality of the parent-infant communica-
tion 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 mea-
sures between individual toy sets.
Results
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, re-
sulting in useable data from 26 parent-infant dyads. Twenty-
five parent participants were biological mothers and 1 parent
participant was the biological father. Two children were born
prematurely and were identified with moderate developmen-
tal delay; parents of the other children reported no develop-
mental 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
(Reprinted) JAMA Pediatrics Published online December 23, 2015 E3
 Research Original Investigation Toy Type and Parent-Infant Communication

who did not complete all study procedures, 2 were Hispanic ported in Table 2 along with repeated-measures analysis of vari-
and 2 were non-Hispanic white, suggesting overrepresenta- ance P values. Main effects of condition were statistically
tion of Hispanic families in the nonparticipant group. significant for all outcome variables. My research team and I
Average per-minute counts with 95% CIs for each out- conducted post hoc analyses for each outcome variable to ex-
come variable by condition are displayed in the Figure and re- amine significant differences for the 3 possible toy set con-
trasts (ie, electronic vs traditional, traditional vs books, and
Table 1. Descriptive Data on Study Participants books vs electronic); Bonferroni-adjusted P values for each
2-way contrast are reported in Table 3.
Characteristic No. (%)
During play with electronic toys, there were fewer adult
Male 12 (46)
words (mean, 39.62; 95% CI, 33.36-45.65), fewer conversa-
Age, mean (SD), mo 13 (2.1)
tional turns (mean, 1.64; 95% CI, 1.12-2.19), fewer parental re-
Race/ethnicity
sponses (mean, 1.31; 95% CI, 0.87-1.77), and fewer produc-
Non-Hispanic white 24 (92)
tions of content-specific words (mean, 1.89; 95% CI, 1.49-
Hispanic 1 (4)
2.35) than during play with traditional toys or books (Table 2).
Native American 1 (4)
Children vocalized less during play with electronic toys (mean
Maternal education
per minute, 2.9; 95% CI, 2.16-3.69) than during play with books
High school diploma 1 (4)
(mean per minute, 3.91; 95% CI, 3.09-4.68). Parents pro-
Some college 3 (12)
duced fewer words during play with traditional toys (mean per
College degree 22 (85)
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
Figure. Means and 95% CIs for Each Outcome Measure By Toy Set of content-specific words was lower during play with tradi-
tional toys (mean per minute, 4.09; 95% CI, 3.26-4.99) than
10
during play with books (mean per minute, 6.96; 95% CI,
Electronic 6.07-7.97).
Frequency per Minute (10 for AW)

Traditional
8 Results showed that the largest and most consistent dif-
Books
ferences were between electronic toys and books (with greater
6
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
4 least consistent and smallest differences were between books
and traditional toys (with larger values in the book condition
2 for adult words and content-specific words only).

0
AW CV CT RESP CSW
Discussion
AW indicates adult words; CSW, content-specific words; CT, conversational In this controlled experiment in a natural environment of
turns; CV, child vocalizations; and RESP, parent responses.
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 Content Specific Child Conversational
Comparison Words Vocabulary Vocalizations Turns Responses
Electronic vs <.01 <.001 .24 .006 .004
traditional
Traditional vs book <.001 <.001 >.99 >.99 >.99
a
P values using Bonferroni
Book vs electronic <.001 <.001 .01 <.001 <.001
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 mea-
sures, play with books provided a better communication
interaction than play with electronic toys. The effect was most
pronounced for the quantitative measures of parental lan-
guage use, suggesting that parents tend to let the toys do the
talking for them when their child is interacting with elec-
tronic toys. This is particularly worrisome given that there is
no evidence that children this young are able to learn vocabu-
lary from media or other nonhuman interactions.14,15 For the
2 qualitative measures of parent-infant interaction, conversa-
tional 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 con-
versations and parental responsiveness. For parents who may
not be inclined to read to their preverbal infants or for par-
ents 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 previ-
ous 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 limita-
tions that should be taken into account. The most notable limi-
tations were the small sample size and the relative homoge-
neity 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 re-
sults would differ for families from more diverse demo-
graphic backgrounds is an important one that remains to be an-
swered. Given that cultural and socioeconomic factors are
known to influence both the amount of time spent en-
gaged in parent-child play and the nature of the play interac-
tion, 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 Fur-
thermore, the findings of this study are applicable to children
in a very limited age range of prelinguistic and very early lan-
guage development and effects may be different for older tod-
dlers and preschoolers. Another limitation is that investiga-
tors 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 empiri-
cal basis for primary care professionals and pediatricians for
making recommendations regarding the types of play activi-
ties 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 of-
ten 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 dem-
onstrating that play with traditional toys may result in com-
municative interactions that are as rich as those that occur dur-
ing 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 repli-
cated in other activities (eg, literacy socialization and expo-
sure 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 em-
phasis is on activities that promote a rich communicative in-
teraction between parents and infants, both play with tradi-
tional toys and book reading can be promoted as language-
facilitating activities while play with electronic toys should be
discouraged.

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 Speech-
Language-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.
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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