S2 Episode 7: Talking About Screens and Language Delay // Carol Westby, PhD, CCC-SLP of Bilingual Multicultural Services

"There is a correlation between greater uses of screen time in little ones and later developmental delays."

- Dr. Carol Westby

Healthy Screen Habit Takeaway

For More Info:

Carol Westby

"Westby Playscale"

"Screentime and Children With Autism Disorder - a study" written by Dr. Carol Westby

Show Transcript

Hillary Wilkinson (00:00):

When I talk to teachers and parents about technology, I tend to look for trends. Like what are parents concerned about? What apps are becoming the most popular? Et cetera. So when I started hearing repeated concerns from primary grade teachers about the growing number of students, they were referring for speech therapy, my ears perked up, I contacted the American Speech Language Hearing Association to see if they could refer me to someone who might be able to tease apart this mystery. And what happens next was something akin to contacting your local sports authority, to ask about a few Pop Warner football rules and suddenly finding yourself in a conversation with Tom Brady. My guest today is an absolute legend of speech language pathology. She's been awarded the highest honors in multiple organizations, has published and presented nationally and internationally on topics including: screen time, autobiographical memory, theory of mind, adverse childhood experiences, and the language literacy relationship, just to name a few, Dr. Carol Westby has traveled the globe studying all areas of speech development, play, and more. I'm unbelievably honored to welcome to the Healthy Screen Habits Podcast, Dr. Carol Westby.

Carol Westby (01:31):

Thank you so much, Hillary. I'm really pleased to be here and have this time to chat with you.

Hillary Wilkinson (01:38):

I can't wait to get into some of the meat of it all! So, I shared some of your achievements in your professional work already but I wondered if you could share a little bit about your path of how you got to where you are today?

Carol Westby (01:56):

It's been a very long career. Uh, I've been a speech language pathologist for some quite a number of years. And my undergraduate degree was in the liberal arts and early after becoming a speech language pathologist. A lot of my work has been around language and literacy. Literacy was so critical to me because without literacy, I would not be where I am today. Uh, I came from an immigrant family with a mother with a third grade education. And if people had really not, uh, given me the background skills I had in literacy, I would not be here. So that's always been extremely important. And over the years, I've worked with a lot of culturally, linguistically, diverse students first in, um, the Albany area of New York, um, with minority children. And I've been in New Mexico for many years and we're a minority/majority state. 70% of our population are from non-Northern European heritage, large numbers of our children come to school speaking, even the traditional native languages, as well as a lot of Spanish speakers.

Carol Westby (03:15):

And so a lot of my work has been both with speech and language therapy, but also promoting literacy. Um, I'm not a luddite, I love technology. I got my first computer in 1980. I cannot keep track of how many I've had and even how many I have around the house. And as computers came in, we began to make use of computers in our teaching and began to look at, "How do you teach digital literacy?" Being literate with the computer is more complex than just being literate on paper. So we started looking at that. The screen time issue came up about three and a half years ago, uh, I decided to visit a past student of mine who was working as a speech language pathologist in a private program in Kuala Lumpur. This was a school that was run by an American special educator for children, with learning problems, many of them with autism. So I went out to spend the month in Kuala Lumpur, and I told the principal I'll help out in any way you want. And she said, oh, would you please do training for the parents on screen time?

Hillary Wilkinson (05:51):

It's so interesting to me to hear that even in Kuala Lumpur there, we're sharing a global concern of the amount of time on screens, particularly with our young children.

Carol Westby (06:09):

And so the principal asked me to do a workshop. I think she personally called the parent of every child in the school. And their concern was, she says, I think the kids are spending all their waking hours when they're not eating or with us in school, they're on their screens. We take them away from them when the parents drop them off in the morning, the parents hand them back to them. As soon as they pick them up, they're not getting other kinds of interaction. So that's when I really then began looking at what does the research say about screen time? So that's how the focus on screen time began. And then after I got back, the states looked extensively at the research literature coming out on screens, and I've done numerous presentations on the topic now.

Hillary Wilkinson (07:21):

Excellent. So one of the things that you have done in your career is create the Westby Play Scale, which is something that most practitioners, when, when I realized, that I was talking to Carol Westby of the Westby Play Scale, I kind of had my own little fan girl moment because most practitioners in early childhood development definitely know about this. And can you speak to how important is this role of play in language development?

Carol Westby (07:53):

Oh, for language to be meaningful, it has to be functional. You have to be able to communicate, just being able to speak clearly, just having the words is insufficient. And you have to be able to communicate something to someone and you have to learn, "How do I do that?" So you have to have interactions and it's in those playful interactions, then that you're learning how to get an idea across to someone else. What you're also learning that is equally as important is how do I read the cues from my peers? What are they trying to convey? What are their needs? What are their wants? So developing the social communication aspects of language are really, really critical. And that's where I get concerned. If I see teachers or SLPs, just focusing on teaching the words, teaching the sentences without a realistic, naturalistic context.

Hillary Wilkinson (09:02):

Excellent. So for those who are not in this realm, SLP stands for Speech Language Pathologist. When we're talking about learning to speak or communicate in a primary language, can, are there specific stages or what is needed for this communication development to occur?

Carol Westby (09:36):

I'm not sure that I'd say there are specific stages, but what is absolutely essential for children to learn language... They have to have face to face communicative interactions, particularly young children. We have lots of research information that shows children cannot learn language from a screen. Uh, they cannot even learn it just by hearing words. They have to have the face-to-face exchange. The Harvard Center on the Developing Child has a number of really excellent videos and what they call serve and return because they're saying that's what you need. And communication. Even back in the early 1990s, we thought just the kids hearing lots and lots of words, that was most important because the literature did show that the more words that parents use during the day, the more language children had at three and at five. But then as we look more carefully, it wasn't just number of words.

Carol Westby (10:49):

It was the number of back and forth turns that were more important than the total number of words. What we mean in "serve and return." It's like the baby looks at you and go, and you say, "oh, you were talking to mom?" And he turns his head and go, and you said, "oh yes, mommy heard you. What are you trying to tell me?" And he waves his arms and you say, "oh, I think maybe you're getting hungry" and you have this back and forth, serve and return. Babies can do that from birth. That is the absolute foundation that has to be there for communication to develop.

Hillary Wilkinson (11:35):

I love how you point out that that is not something that a screen can teach. So that whole concept of serve and return is fascinating. Now we have to take a quick break, but when we come back, I want to dive into how technology can affect this development of language and kind of continue along those trains of thought.

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Hillary Wilkinson (12:24):

My guest is Carol Westby. Before the break, we were talking about language development and being Board Certified in child language and literacy disorders. Carol kind of places you in this unique spot to discuss some of the concerns places you in this unique spot to discuss some of the concerns that surround what seemed to be rising numbers of speech referrals in the primary grades. I'm talking with a lot of pre-kindergarten to like say third grade teachers. And just anecdotally only I have no, I have no complete research to back this up, but anecdotally, when they go back in their classrooms and trace it, the numbers of speech referrals seem to be on the rise since about 2016 to 2018. Now I know from Jean Twenge's studies that the smartphone reached a tipping point in 2012 of over 50% of the United States taking ownership at that time. So when we do the backwards, math of figuring out the ages of kids born in 2012 and moving forward, and you can see those speech referrals start hitting right in that window. So anecdotally to me, recognizing confirmation bias, it would appear as though we have a smoking gun, but I am no language expert. And that's why I have you here today. Do you see technology affecting language development or speech development in today's young children?

Carol Westby (14:05):

Well, we now have several very good studies that have shown that it does. That there is a correlation between greater uses of screen time in little ones and later developmental delays. So studies looking at how much time children were on screens between two and three showed that by the time they were five or six more screen time correlated with reduced developmental scores in language, visual perceptual skills, um, motor skills, uh, and, uh, emergent literacy skills, rapid processing. This is also the ability to rapidly name something was reduced. And so there was a strong correlation. There have been several studies now that have looked at that amount of screen time, early on and later developmental problems. Because of our technology now we can also get a picture on what's going on in the brain. And those studies have shown that more screen time - poorer developmental scores, uh, less what we call white matter integrity.

Carol Westby (15:30):

And we have white matter tracks that connect different parts of our brain. And there's a specific track that runs between our auditory area of the brain that takes in the sound and the frontal lobe of our brain, where we program out what we're going to talk about. Those tracks have been shown to be significantly smaller in youngsters that have had greater amounts of screen time, which is then going to slow down that language process. What we don't know with that is, is that a direct cause of the screens or is it that children aren't getting talked to? For that track to operate we know the brain, the neurons have to be stimulated. If they're not stimulated, they're not going to continue.

Hillary Wilkinson (16:54):

Interesting - so that kind of speaks to even what role a parent's overuse of technology would have.

Carol Westby (17:04):

Um, and when you ask, uh, uh, about that, um, again, if people have looked at what happens when parents are on their cell phones, there was, uh, an excellent, um, CBS 60 minutes that was done, oh, about a year and a half ago, looking at that. And some of the, the data on this shows that parents who spend more time on their phones have children that show more behavioral problems. This is a chicken and egg thing. It turns out that if children have more behavioral problems, parents retreat more to their phones so - two things going on. Um, what's happening, uh, that can be very disrupting to that, uh, serve and return. Some children that lack of interaction can be very disruptive and becomes very frustrating. They can't get the parent's attention. They're trying to get the attention. The parent isn't reading their cues, the kids are trying to send, but the parents aren't returning and the children then are also missing out on learning how to read social cues. That can disrupt attachment. We talk about secure attachment.

Hillary Wilkinson (18:53):

Yes, feeling safe, seen and soothed.

Carol Westby (18:56):

Yes. And you have to have people who are responsive. People who are looking at your cues and looking out and say, oh, are you upset? Or do you need, mommy needs to get you something?. If they're not getting people reading those cues, they don't learn how to read them themselves. It also turns out that children who have less secure attachments have less ability to tell coherent narratives, which are the extended language. So what you start seeing is this snowballing.

Hillary Wilkinson (19:39):

It's an overlap of, you know, what starts is what I was thinking was just primarily a speech production issue. You're now talking can have long-term ramifications into even the mental health of, of a person over the, you know, the continuum of their life. Because if they're unable to form emotional attachment with another person, then it starts leading us down the path of loneliness studies, which we have made tremendous leaps into knowing about how loneliness can be as detrimental to someone's health as say, smoking cigarettes, smoking a pack of cigarettes a day.

Carol Westby (20:24):

Yeah. I'm just finishing off these couple of days, a chapter on social neuroscience and was reading a recent Norwegian study where they were finding that the children who had more screens have less empathy and could not read people's faces as easily. And then that disrupts your ability to interact with your peers. Yes.

Hillary Wilkinson (20:47):

And I, um, there's a book written by Michelle Borba. I'm sure you're familiar with it called UnSelfied. That speaks exactly to the growing empathy gap that is being reported. So it seems like when we're talking about things of this magnitude, it's hard to come back to, um, you know, just, just learning to read that being said, you yourself said that literacy is what formed the basis of your career. And honestly, I come from a deep philosophy of "education saves lives". And if without literacy, you are going to have a very difficult time learning to educate yourself. So that's how I'm going to swing us back around. So if a child has this sort of speech or language delay, do you see effects on that ultimately having a detrimental effect on learning to read?

Carol Westby (22:01):

Oh, considerably, this is such an issue. And we have so many children in our country that aren't where they should be with literacy. Any language problem is going to result in a literacy problem. Now, here, I want to make that distinction between speech and language. Speech is just, is the ability to make the sounds of your language. So being able to say the words and you will have youngsters, some children are delayed in speech and it takes them longer to learn, to say rabbit, they'll say "wabbit", uh, or they'll say "thoup" instead of soup. And some children can have problems with quite a number of sounds. Some of those children, the problem was is just with the speech production in their language can be okay. A number of them, however, have not only speech, but language problems, but it's possible.

Carol Westby (23:04):

The children's speech is fine, but their language isn't where it should be. They don't have the vocabulary, they don't have the sentence complexity. And then as we look at development, you're first able to talk about what's in front of you. Then you can talk about something you can't see, that's where the narrative skills come in. And so you can have youngsters that sound fine when you're just talking to them face-to-face but when you try to get them to tell a little story, they can't tell it coherently. And then you have to explain something and that's more complex than telling a story. That's what I mean by language and increasing language complexity. And when children have language problems, that's going to have long-term affects on your reading ability. First learning the decoding. That's the first step that has to be there. And language problems will disrupt that ability to match the sounds to the print. But then once you can do that, you also have to understand how those sentences are constructed and what meaning is being conveyed.

Hillary Wilkinson (24:17):

And have that prior knowledge to sink the, you may be able to sound out a word, but if you only know what those sounds are and have no base level understanding of, you may be able to sound out the word "app-le" and make sure it's an apple. If you've never eaten an apple, you don't really get the essence of what an apple is. So in talking about, you're talking about the storytelling, uh, component con is, I mean, it just goes right into, that's a key part of learning how to write effectively as well. So, okay, so now we've taken listeners down kind of a rabbit hole of what can happen. And now we need to get let's let's, let's give some tools and best practices to help people. If they recognize some of the patterns that are happening, maybe in their own house or in loved ones lives. And so what types of things can parents do to help lay the groundwork for speech development and language enrichment?

Carol Westby (25:27):

Oh, one of the foremost in what we were teaching the parents in Kuala Lumpur is how to reminisce with your child. This is one of the best ways to facilitate language development. Um, by the time, uh, youngster is, around 18 months, they begin to give you a hint that they remember something that happened earlier. So let's say early in the day, your youngster got her fingers caught in the door and you put a Bandaid on them. And later you see her going up and touching the door. And maybe she's just looking at her hand and looking, or maybe she'll say "hurt" or "door" that gives you a cue. She remembers that she got her finger caught in the door and you reminisce by saying, "yes, you got your finger caught! It hurts. Mommy, put a Bandaid on your finger." That's reminiscing. It's through reminiscing. The children learn to talk about past experiences.

Carol Westby (26:30):

You're linking the present and you're linking the past. That's also eventually going to help the child be able to tell her own personal stories. So we're doing a tremendous amount of work, uh, with parents and teachers reminisce with your child. Look for those cues. Talk about the experience after it happened with little ones start right afterwards. So you just ate up that whole chocolate chip cookie. It's all gone. That is your favorite cookie. Talk about the event as you see the child doing it, but also afterwards, and as the children get older, there can be a longer period of time between the action. And when you talk about it. Okay.

Hillary Wilkinson (27:30):

And I can absolutely see how that holds hands with attachment theory as well, because you're recognizing and validating prior experiences when you do things like that. Yeah.

Carol Westby (27:41):

It turns out that promotes attachment. Moms who do more reminiscing have better attached children.

Hillary Wilkinson (27:50):

Oh Wow. Okay. So we know that technology is here to stay and kids are going to be interacting with screens. Can you go over how to use screens appropriately? Maybe talk about those. Uh, you and I had talked previously about pillars of quality, digital media content?

Carol Westby (28:09):

Right? Hirsh-Pasek has had come up with this again, we're going to be dealing with screens. And when you're thinking about the apps to use kind of keep four principles in mind, the first thing at first pillar is it should be engaging and not distracting. Uh, some apps for little kids are distracting and some of them, um, that read the stories to the children are the worst because it'll have a children's storybook there and it will be reading it, but the child can tap the screen and the window opens and the drapes open, and then the rooster crows. And what I find kids doing, they're just tapping everything on the screen. They lose what the story was about on, and those kinds of books, comprehension is worse. So look for apps where you're not going to have things that pull the child away from what it is you're wanting them to attend to.

Carol Westby (29:13):

The other thing. You want things that are where they're actively involved. And this is another problem with many of the apps are the little kids. They just hit, they just swipe and you'll even see kids, you know, trying to swipe magazines because they think there's some way to be able to make this thing work. So you want apps where the touch has to be specific. Don't hit, don't just swipe the interaction needs to be something meaningful. So when you tap like, um, there's a Grover story, uh, "There's A Monster At The End Of The Book". And this is a really good little app because on that while I'm gross, just don't turn the page. And if you tap the corner of the page, it turns that's functional and grow. Who gets up, you turn the page. I told you don't turn the page. So you're interacting with the book, promotes the story.

Carol Westby (30:13):

So that's what you're wanting to look for it where the action is appropriate. It's not just hitting to make something magically appear. The next one. And particularly for little kids choose apps and programs that are meaningful. Something that they can relate to so that you can link it with their life. Now, clearly as kids get older, one of the advantage of the internet, there's so much we can learn, but with little ones, you want to have some of that contact things that they can connect with so that, uh, we do what we call tech to self. How is this like you? How is this something you do? And that's what, like some of, uh, the Pippa pig or Dora the Explorer apps can be very appropriate because they're experiences that the child has had. They can relate to them. You can add on. And the fourth pillar, particularly for the children under six are apps where you can engage with the child.

Carol Westby (31:26):

You can do them jointly. Um, even for older kids at times, um, playing the games with your children, but particularly with the children under six, they must be engaging. The children have to be actively involved, it has to be meaningful, and the parent needs to be mediating. And in fact, the turns out that if parents mediate those apps, you get a spike in language development. If you just leave the kid on their own, you don't. So there was one study that looked at what happens if parents engage. And so the app indeed can promote language development. If the parent is sharing with the child during the experience.

Hillary Wilkinson (32:14):

So it needs to be a joint experience. Yes. Okay. We have to take a short break, but when I come back, I'm going to ask Carol Westby for her healthy screen habit.

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Hillary Wilkinson (32:30):

We are back, I'm talking with Carol Westby on every episode of the healthy screen habits podcast. I ask each guest for a healthy screen habit. This is a tip or takeaway that our listeners can put into practice in their own home. Carol, do you happen to have one that you can share with us today?

Carol Westby (32:51):

Again, we've kind of already mentioned this it's, uh, finding apps where you can really become engaged and do the serve and return with the app. Um, I like some of the, the Toca Boca apps for little ones, because, um, like there's the doctor one and you can take turns taking the splinter out of the, the character's finger or wiping its nose with the Kleenex. So, uh, act activities with your youngsters under six, where you can engage in this serve and return where taking turns within the activity and within the game. And it can be appropriate. Even with the older children. I really encourage parents play the game. So, you know, what's in them. So the cheeks talk meaningfully about the child, when I was doing the training in Kuala Lumpur, a ten-year-old, he was playing really violent video games and the parents didn't really have notice particularly.

Carol Westby (34:01):

And they said, but it's okay. He says, he knows the games are pretend so it doesn't matter. And it's like, no, it really does. If you came to be on there, you need to SEE what he's looking at. Uh, because you also need to mediate, you need to talk about some of those things with the older kids, Mine Craft or, uh, the, uh, Horizons app doing that was the most popular, uh, app during, uh COVID, which was a really nice one, uh, that both adults and kids were playing. And, um, you're doing daily activity kinds of things. You're making decisions. That's where again, those apps can be really helpful when you're using them with the child in problem solving. "What would you do? Why would you do it that way?"

Hillary Wilkinson (34:56):

Right. Kind of taking that tech experience and, um, bringing it forward into real life and living, living your thought process out loud.

Carol Westby (35:05):

Carol, if people would like to read more about yourself or the Westby Playscale or your research, is there someone they could go to look up your studies?

Carol Westby (36:26):

Um, if you Google me, you'll usually find me on Google. And I think there's some versions of the place scale floating around.

Hillary Wilkinson (36:35):

Most, definitely all over.

Carol Westby (36:40):

So, uh, I, I think they, they can usually track me down. Okay.

Hillary Wilkinson (36:47):

Wonderful. Well, thank you very much for your time this morning and for all of the information,

Carol Westby (36:56):

Thanks so much for this opportunity, Hillary, I always enjoy talking about this.