Association of parental verbal responsivity with reduced mental health problems in preschool-aged children: a cross-sectional study of 21,366 dyads in western China

Background: Mental health problems affect 7%−18% of preschool-aged children globally, with early interventions crucial for mitigating long-term impacts. Parental verbal responsivity (PVR) is a modifiable factor linked to cognitive and emotional development, yet large-scale studies on its association with mental health in young children remain scarce.

Methods: This cross-sectional study was conducted between February 28 and March 5, 2025, in a western Chinese city, involving 21,366 parent-child dyads from 189 kindergartens. Parental Verbal Responsivity (PVR) was assessed using the parent-reported StimQ, which measures verbal interactions during daily routines, play, and regulation activities. Child mental health was evaluated via the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multivariable logistic regression models were employed, adjusting for relevant sociodemographic and lifestyle covariates.

Results: After full adjustment, each unit increase in PVR corresponded to 4% reduced odds of total difficulties (95%CI 0.95–0.96) and 7% increased odds of prosocial behaviors (95%CI 1.06–1.08), both with P < 0.0001 significance. Subgroup analyses revealed effect modifications by parental gender, education, employment status, annual family income, and smoking status and alcohol intake status.

Conclusion: In this large-scale study, a weak association was found between verbal interaction frequency and child mental health, explaining less than 1% of outcome variance. This highlights the limitation of measuring only interaction frequency and underscores the need for future research to incorporate multi-informant and observational methods to better understand pathways to child mental health.

Background

Although mental health problems can arise throughout childhood, the preschool years (ages 3–6) constitute a particularly sensitive and unique developmental window, during which emotional and behavioral difficulties—most commonly hyperactivity/inattention, emotional symptoms, conduct problems, and peer relationship problems—frequently first become apparent. Reported prevalence rates of behavioral and emotional problems in preschool children vary across Asian populations, ranging from 11.9% to 25.1%, with higher rates often linked to specific demographic or socioeconomic factors (Teekavanich et al., 2017; Wu et al., 2012). However, large-scale, population-representative epidemiological data on preschool mental health remain scarce in western China. Longitudinal research indicates that symptoms of poor mental health can emerge in infancy and persist across childhood and adolescence into adulthood, influenced by individual and familial trajectories (Nilsen et al., 2017; Steinvoord and Junge, 2019). These conditions are associated with adverse outcomes, including diminished academic performance (Gräf et al., 2019) and increased risk of communicable and non-communicable diseases (Prince et al., 2007). Early identification and intervention are critical for mitigating these impacts, improving developmental outcomes, and enhancing quality of life (McGorry and Mei, 2018). Among the multiple influences on preschool children's mental health, the family caregiving environment represents one of the most proximal and modifiable environmental factors. Within this caregiving context, parental verbal responsivity (PVR)—the frequency, contingency, and emotional warmth of parents' verbal responses to their child during daily routines, play, and emotion-regulation moments—stands out as a key protective mechanism. Therefore, investigating PVR is of paramount importance for developing evidence-based preventive strategies. PVR refers to a parent's responsive, non-structured verbal interactions with their child, such as engaging in games like peek-a-boo, bath play, or talking about the day's events (Dreyer et al., 1996). It measures how parents spontaneously use language to connect with and stimulate their child's cognitive development. Previous research has consistently shown that high-quality parent–child interactions during everyday activities can significantly enhance parent–child relationship closeness (intimacy) and attachment security. Examples of such interactions include joint play (Teufl and Ahnert, 2022), parent-implemented early language and communication interventions (Cocquyt et al., 2024), and shared home learning activities (e.g., painting, playing games, reading together, singing, and teaching letters and numbers) (Hoyne and Egan, 2024). High-quality parent–child interactions foster closeness and secure attachment through contingent, warm verbal exchanges. This association is supported by attachment theory (secure base formation), Vygotsky's sociocultural theory (scaffolding in the zone of proximal development), Bronfenbrenner's bioecological model (proximal processes as primary developmental drivers), and the transactional model (bidirectional cycles of responsiveness). Collectively, these frameworks indicate that higher PVR promotes emotional security, self-regulation, and prosocial behavior while reducing mental health risks in preschool children.

Seminal work by Hart and Risley underscores the critical role of verbal exposure in early vocabulary development, highlighting that the quantity of words a child hears and the degree of parental encouragement before age three are pivotal environmental predictors (Freeman and Kasari, 2013). However, parental communication styles vary: responsive strategies, such as linguistic mapping and expansions, foster child-initiated communication, whereas directive approaches, which redirect attention or demand behavioral changes, may hinder linguistic growth (Edmunds et al., 2019). PVR is a key facilitator of early language development, a period marked by rapid linguistic advancement. The mechanisms underlying PVR's influence on language outcomes may hinge on whether parents respond directly to children's communicative acts or merely to their focus of attention (Shriver et al., 2020). Responsive PVR fosters a transactional cycle, in which improved language abilities facilitate more intricate forms of interaction, which additionally supports the growth of language proficiency (Hunter and Daw, 2021). To assess PVR, this study employs the validated StimQ assessment, which quantifies verbal interactions across three behavioral domains: daily routines, imaginative play, and regulatory activities (Dreyer et al., 1996; Mendelsohn et al., 1999). The PVR evaluates cognitive stimulation in the home environment, focusing on verbal exchanges during routine activities, such as conversational exchanges during feeding or joint sound-making (Dreyer et al., 1996; Mendelsohn et al., 1999).

Although a limited number of studies have directly examined the association between PVR and preschool children's mental health, accumulating evidence indicates that higher levels of responsive, contingent verbal interaction are consistently linked to better emotional and behavioral outcomes. Specifically, greater PVR—characterized by frequent conversational turns, affective verbal engagement, linguistic mapping, and verbal scaffolding during daily routines, play, and emotion-regulation activities—has been associated with higher self-esteem, fewer internalizing and externalizing problems, reduced anxiety symptoms, and enhanced prosocial behavior in young children (Lee and Ha, 2023; Polcari et al., 2014; Solomon and Serres, 1999). In contrast, low parental verbal responsivity, manifested as infrequent or non-contingent verbal exchanges without hostility, is related to poorer emotion regulation, increased behavioral difficulties, and lower prosocial scores, independent of overt verbal aggression (Percy et al., 2016). Notably, a significant gap exists in large-scale research on PVR and mental health outcomes specifically for children aged 3–6 years. To address this, our study leverages a large, population-based cohort from a Chinese city, employing stratified cluster sampling across 189 kindergartens to ensure diverse representation and generate robust evidence on PVR's impact in this critical developmental window. To accurately isolate this impact from confounding contextual factors, our analysis incorporates key variables—socioeconomic status (SES), parental substance use, and educational attainment—whose influence is well-established. Extant literature consistently links low SES and financial strain to increased family stress and compromised caregiving (Nilsen et al., 2025), while parental cigarette and alcohol use is directly associated with reduced maternal sensitivity and child emotional dysregulation (Kisner et al., 2025; Wang et al., 2025). Educational attainment further intersects with these factors, affecting parenting resources and knowledge (Sajewicz-Radtke et al., 2025; Liu et al., 2025). Including these variables is therefore essential to disentangle the specific mechanistic pathway from contextual adversity to PVR and, ultimately, to child mental health.

Materials and methods

Study population

This study employed a cross-sectional study design, jointly implemented by a municipal education administration and local educational institutions in a western Chinese city. Using multistage probability proportional to size sampling, we selected 13 administrative divisions as primary sampling units, with study sites systematically and randomly chosen from the official kindergarten registry in each district. The research adopted a stratified cluster random sampling strategy, applying population-proportionate sampling to ensure the sample size was proportional to the population of enrolled preschool children aged 3–6 years in each district, thereby enhancing generalizability. The final cohort included 189 preschool education institutions, representing various levels of urban-rural dichotomy. Study participants comprised children in junior (3–4 years), middle (4–5 years), and senior (5–6 years) classes and their primary caregivers. Data collection was conducted through standardized questionnaire surveys between February 28 and March 5, 2025. Following the informed consent principle, the institution-assisted survey was administered after obtaining written informed consent forms from guardians. Using nuclear family sampling methodology, one legal guardian per household served as a proxy respondent to complete the assessment. The initial study cohort included 25,017 parent-child dyads. After data cleaning procedures and application of predetermined exclusion criteria, we excluded: (1) responses from non-parental guardians (n = 2,408) and (2) cases with missing critical demographic variables, including missing caregiver age (n = 517) and missing child age (n = 726). The final analytic dataset contained 21,366 valid cases, achieving a valid response rate of 85.41%. The study protocol strictly adhered to the ethical principles of the Declaration of Helsinki and received ethical approval from the Institutional Review Board of Xi'an Jiaotong University Children's Hospital (Approval No. 20250225-21).

Assessments of the children's mental health problems

Parents provided standardized assessments of their children's psychological wellbeing through the official simplified Chinese version of the Strengths and Difficulties Questionnaire (SDQ) and the SDQ's psychometric properties remain robust across its 40+ language versions and wide age applicability (3–17 years) (Goodman and Goodman, 2009; Du et al., 2008; Pang et al., 2024). This 25-item instrument, employing a 3-point Likert scale (0 = Not True to 2 = Certainly True), represents the gold standard for developmental behavioral screening in epidemiological studies. The items can be divided into the following subscales: emotional symptoms, conduct problems, peer relationship problems, hyperactivity/inattention, and prosocial behavior. The SDQ prosocial scale is a stand-alone measure of positive emotions and behaviors toward others, representing the “strengths” portion of the SDQ (Zoumenou et al., 2025). Each subscale yields scores from 0 to 10, while the first four symptom subscales combine for a total difficulties score (0–40); using Chinese-recommended cutoffs, we dichotomized outcomes as normal ( ≤ 14) vs. at-risk (>14) and identified potential prosocial deficits at scores < 6 (Wang et al., 2024). This internationally recognized screening measure allows parents to systematically document clinically relevant aspects of their child's socioemotional development (Goodman, 1997).

Assessments of parental verbal responsivity

Parental verbal responsivity (PVR) was assessed using the StimQ, which is a validated ecological assessment tool specifically designed for children aged 0–6 years (Salve et al., 2023). The StimQ measures four distinct domains: READ (shared book reading), PIDA (parental involvement in developmental activities), PVR (parental verbal interactions), and ALM (availability of learning materials). In this study, the PVR scale was administered as a parent-report instrument, assessing three aspects of parental verbal interactions: everyday routines (0–9 points), play, pretend, and imagination (0–6 points), and regulation activities (0–4 points). These scores were combined into a composite PVR score (0–19 points), with higher values indicating stronger parental verbal responsivity (Choi et al., 2018).

Variables

The variable in this study include child age, child gender, age, gender, education level, employment status, marital status, annual family income, smoking status, and alcohol intake status. Participants were categorized by age into distinct groups: children (< 4 years, 4–5 years, and ≥5 years) and parents (< 30 years, 30–45 years, and ≥45 years), with gender recorded as male or female for both groups. Parental education attainment was stratified into three tiers: elementary education or below ( ≤ primary school), secondary education (junior/senior high school), and post-secondary qualifications (≥junior college). Employment status was dichotomized into working and not working. Marital status was categorized as married or other, and annual family income was grouped into < ¥60,000, ¥60,000 to ¥150,000, and >¥150,000. Smoking status was classified into three groups: never smokers, former smokers, and current smokers. Similarly, alcohol intake status was grouped as never drinkers, former drinkers, and current drinkers.

Statistical analysis

All analyses were performed using EmpowerStats (https://www.empowerstats.net/cn/) and the statistical package R (4.2 version). Continuous variables expressed as mean ± standard deviation and categorical variables presented as percentages (%). Chi-square tests were used to compare categorical variables, with statistical significance set at P < 0.05. Multivariable logistic regression models were employed to evaluate the association between PVR and children's mental health problems, including both unadjusted models and adjusted models controlling for potential confounders (child age and gender, parental age and gender, education level, employment status, marital status, annual family income, smoking status, and alcohol intake status). Additionally, subgroup analyses and interaction tests were conducted to assess potential effect modification by these covariates on the PVR-mental health relationship.

Results

Baseline characteristics

This cross-sectional study initially enrolled 25,017 parent-child pairs. After applying exclusion criteria, the final cohort comprised 21,366 participants, including 11,062 males and 10,304 females. Participant characteristics showed mean ages of 34.75 ± 4.56 years for parents and 4.81 ± 0.89 years for their children. Participant characteristics across different levels of total difficulties are detailed in Table 1. Significant intergroup differences emerged across all measured variables (all P < 0.05), with the exception of child age which showed no statistical significance (P > 0.05). Compared with the lower group (total difficulties score ≤ 14), participants in the higher group (total difficulties score >14) were generally younger and had lower PVR A subscale, PVR B subscale, PVR C subscale and PVR scale.

Table 1

Table 1. Baseline characteristics of the study participants according to total difficulties score.

Relationship between parental verbal responsivity and mental health problems

Based on the results presented in Table 2, PVR demonstrated a consistent, statistically significant association with both measures of child mental health, both before and after adjusting for relevant sociodemographic and lifestyle covariates. For total difficulties, a one-unit increase in PVR score was associated with a 4% reduction in the odds of being categorized as at-risk (adjusted OR = 0.96, 95% CI: 0.95–0.96, p < 0.0001). When analyzed as a continuous outcome, the same increase in PVR corresponded to a significant decrease in the total difficulties score (adjusted β = −0.08, 95% CI: −0.10 to −0.07, p < 0.0001). For prosocial behavior, the association was positive and slightly stronger. A one-unit increase in PVR score was linked to a 7% increase in the odds of having a higher level of prosocial behavior (adjusted OR = 1.07, 95% CI: 1.06–1.08, p < 0.0001). Similarly, when treated continuously, higher PVR was associated with a significant increase in the prosocial behavior score (adjusted β = 0.09, 95% CI: 0.08–0.09, p < 0.0001). Stratified analyses and interaction tests (Tables 3, 4) revealed effect modifications in the association between PVR and mental health outcomes. For total difficulties, the composite PVR score showed significant interactions with smoking status (P interaction = 0.0286) and alcohol intake status (P interaction = 0.0149).

Table 2

Table 2. Relationship between parental verbal responsivity and mental health problems.

Table 3

Table 3. Stratified analysis between parental verbal responsivity and total difficulties.

Table 4

Table 4. Stratified analysis between parental verbal responsivity and prosocial behavior.

Discussion

This large cross-sectional study of 21,366 parent–child dyads in western China found statistically significant but very small associations between parent-reported parental verbal responsivity (PVR) and parent-reported mental health outcomes in preschool children. After full adjustment, each 1-point increase in the PVR composite score was associated with a 4% lower odds of total difficulties (adjusted OR 0.96) and a 7% higher odds of prosocial behavior (adjusted OR 1.07). Although these associations are highly significant (P < 0.0001), the effect sizes are extremely small (ORs very close to 1.00). At the individual child level, therefore, the clinical relevance of differences in PVR score is likely to be modest, and the observed associations should not be overstated. Crucially, the most plausible explanation for the observed marginal correlation is Common Method Variance (CMV). Both the predictor (StimQ-PVR) and the outcome (SDQ) were derived from the same informant (the parent). A parent's current psychological state, overall reporting style, or general perception of the parent-child relationship could easily account for the shared variance of less than 1% between their assessment of their own verbal behavior and their rating of their child's behavior. Therefore, the detected association likely reflects shared rater bias rather than a direct causal mechanism linking verbal frequency to mental health. This fundamental limitation tempers any causal interpretation of the results.

The study's use of the StimQ-PVR subscale, which evaluates verbal interactions across everyday routines, imaginative play, and regulatory activities, provides a nuanced understanding of how specific domains of PVR contribute to mental health in toddlers and children (Malhi et al., 2018; Jimenez et al., 2021; Green et al., 2009). PVR is a core factor for children's language and socio-emotional development. PVR varies by context and adapts to a child's developmental level. For example, book sharing and social play elicit higher rates of child communication and more supportive parental responses (Lee and Ha, 2023; Laudańska et al., 2025; Dyne et al., 2025). In clinical populations, such as children with autism or developmental delay, parents often use fewer language-enhancing responses like expansions and follow-in directives, which are strongly predictive of later language outcomes (Grzadzinski et al., 2021; Delehanty et al., 2024a,b). Maternal mental health also influences PVR: mothers with postpartum psychosis show significantly reduced verbal output and responsiveness (Raju et al., 2025). The primary value of this study lies not in identifying a powerful intervention target but in providing a robust, large-scale descriptive benchmark. It quantifies the tenuous nature of the link between a simple measure of verbal interaction frequency and complex mental health outcomes as reported by the same parent. This finding ‘calibrates expectations' in the field, demonstrating that such frequency measures, while convenient for large-scale surveys, have limited standalone explanatory power. Future research must move beyond simplistic frequency counts. To understand if and how verbal interactions matter, studies should prioritize: (1) multi-informant designs (e.g., incorporating teacher reports or observational data) to overcome CMV; (2) direct assessment of interaction quality, affective tone, and contingency; and (3) investigation of moderators (e.g., socioeconomic status, child temperament) that might reveal contexts where interaction patterns are more impactful.

Subgroup analyses indicated that the small associations were modestly modified by parental smoking and alcohol-use status, suggesting that lifestyle-related family stress or reduced parental availability may attenuate any potential benefit of verbal interaction frequency. These interaction effects further highlight the embeddedness of PVR within broader socioeconomic and familial contexts.

Limitations

Although this study provides valuable insights, several limitations should be noted. These limitations also highlight clear directions for future research. First, the cross-sectional design prevents causal inferences. Longitudinal studies are needed to clarify the causal and dynamic relationships between parental verbal responsivity (PVR) and children's psychological and behavioral outcomes. Second, both PVR (measured by the StimQ) and child behavioral outcomes (measured by the SDQ) relied exclusively on parent-reported instruments. This approach, while practical for large-scale studies, may introduce measurement bias due to variations in parental perceptiveness, education level, and reporting tendencies. Furthermore, using the same informant for both exposure and outcome increases the risk of common-method variance, potentially inflating observed associations. Future research would benefit from incorporating standardized behavioral observations, multi-informant reports (e.g., from teachers or caregivers), or objective measures to enhance the robustness and validity of findings. Third, although the sample was large and drawn from a major metropolitan area in China, generalizability to rural populations, less-developed regions, or different cultural contexts should be interpreted with caution. In summary, the present findings should be regarded as preliminary evidence, and addressing these limitations in future work will strengthen our understanding of how parental verbal responsivity influences child development.

Conclusion

In summary, this large cross-sectional study documents a statistically robust yet substantively very weak association between parent-reported frequency of verbal interactions and parent-reported mental health in preschool children. Given the minimal effect sizes, the exclusive reliance on single-informant reports, and the absence of data on interaction quality, these findings do not support isolated frequency of verbal exchange as a meaningful clinical or public health intervention target. Instead, the study provides a definitive quantitative reference point for the strength of this relationship in a large population, underscoring the critical need for more nuanced, multi-method longitudinal research to identify the specific components of parent-child interaction that may yield clinically meaningful benefits for mental health.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by the Ethics Committee of the Affiliated Children's Hospital of Xi'an Jiaotong University (No. 20250225-21). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants' legal guardians/next of kin.

Author contributions

FF: Formal analysis, Data curation, Methodology, Writing – review & editing, Writing – original draft. HS: Writing – review & editing, Writing – original draft, Investigation, Conceptualization, Software. YW: Writing – review & editing, Writing – original draft, Visualization, Supervision, Validation.

Funding

The author(s) declared that financial support was received for this work and/or its publication. This study was financially supported by the Shaanxi Provincial Key Research plan general project -Social development field (2024SF-YBXM-313).

Acknowledgments

We acknowledge the support of the local education bureau and all participants involved in the study.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

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References

Choi, J. H., Mendelsohn, A. L., Weisleder, A., Cates, C. B., Canfield, C., Seery, A., et al. (2018). Real-world usage of educational media does not promote parent-child cognitive stimulation activities. Acad. Pediatr. 18, 172–178. doi: 10.1016/j.acap.2017.04.020

PubMed Abstract | Crossref Full Text | Google Scholar

Cocquyt, M., Claeys, T., Derese, A., Six, S., and Bilsen, J. (2024). Evaluating structure and content of parent-implemented early logopaedic intervention models following the three stages of communicative development in children with cleft lip and/or palate: Systematic literature review with narrative synthesis. Int. J. Lang. Commun. Disor. 59, 1923–1945. doi: 10.1111/1460-6984.13038

PubMed Abstract | Crossref Full Text | Google Scholar

Delehanty, A., Hooker, J. L., and Wetherby, A. M. (2024a). Verbal responsiveness in parents of toddlers with and without autism during a home observation. J. Autism Dev. Disord. 54, 2440–2453. doi: 10.1007/s10803-023-05935-6

PubMed Abstract | Crossref Full Text | Google Scholar

Delehanty, A., Lorio, C. M., Romano, M., Brown, J. A., Woods, J. J., Wetherby, A. M., et al. (2024b). Social communication and parent verbal responsiveness across interaction contexts in toddlers on the autism spectrum. Am. J. Speech-Lang. Pathol. 33, 1266–1282. doi: 10.1044/2024_AJSLP-23-00319

PubMed Abstract | Crossref Full Text | Google Scholar

Dreyer, B. P., Mendelsohn, A. L., and TamisLeMonda, C. S. (1996). Assessing the child's cognitive home environment through parental report: reliability and validity. Early Dev. Parent. 5, 271–287. doi: 10.1002/(SICI)1099-0917(199612)5:4<271::AID-EDP138>3.0.CO;2-D

Crossref Full Text | Google Scholar

Du, Y., Kou, J., and Coghill, D. (2008). The validity, reliability and normative scores of the parent, teacher and self report versions of the Strengths and Difficulties Questionnaire in China. Child Adolesc. Psychiatry Ment. Health. 2:8. doi: 10.1186/1753-2000-2-8

PubMed Abstract | Crossref Full Text | Google Scholar

Dyne, H., Bergsten, U., and Carlsson, E. (2025). “Aha, so that's how it's done!” - parents' voices on an early language and literacy intervention. Logoped Phoniatr. Vocol. 50, 1–10. doi: 10.1080/14015439.2024.2304139

PubMed Abstract | Crossref Full Text | Google Scholar

Edmunds, S. R., Kover, S. T., and Stone, W. L. (2019). The relation between parent verbal responsiveness and child communication in young children with or at risk for autism spectrum disorder: a systematic review and meta-analysis. Autism Res. 12, 715–731. doi: 10.1002/aur.2100

PubMed Abstract | Crossref Full Text | Google Scholar

Freeman, S., and Kasari, C. (2013). Parent-child interactions in autism: characteristics of play. Autism 17, 147–161. doi: 10.1177/1362361312469269

PubMed Abstract | Crossref Full Text | Google Scholar

Goodman, A., and Goodman, R. (2009). Strengths and difficulties questionnaire as a dimensional measure of child mental health. J. Am. Acad. Child Adolesc. Psychiatry. 48, 400–403. doi: 10.1097/CHI.0b013e3181985068

PubMed Abstract | Crossref Full Text | Google Scholar

Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. J. Child Psychol. Psychiatry. 38, 581–586. doi: 10.1111/j.1469-7610.1997.tb01545.x

PubMed Abstract | Crossref Full Text | Google Scholar

Gräf, C., Hoffmann, I., Diefenbach, C., König, J., Schmidt, M. F., Schnick-Vollmer, K., et al. (2019). Mental health problems and school performance in first graders: results of the prospective cohort study ikidS. Eur. Child Adolesc. Psychiatry 28, 1341–1352. doi: 10.1007/s00787-019-01296-7

PubMed Abstract | Crossref Full Text | Google Scholar

Green, C. M., Berkule, S. B., Dreyer, B. P., Fierman, A. H., Huberman, H. S., Klass, P. E., et al. (2009). Maternal literacy and associations between education and the cognitive home environment in low-income families. Arch. Pediatr. Adolesc. Med. 163, 832–837. doi: 10.1001/archpediatrics.2009.136

PubMed Abstract | Crossref Full Text | Google Scholar

Grzadzinski, R., Nowell, S. W., Crais, E. R., Baranek, G. T., Turner-Brown, L., Watson, L. R., et al. (2021). Parent responsiveness mediates the association between hyporeactivity at age 1 year and communication at age 2 years in children at elevated likelihood of ASD. Autism Res. 14, 2027–2037. doi: 10.1002/aur.2557

PubMed Abstract | Crossref Full Text | Google Scholar

Hoyne, C., and Egan, S. M. (2024). Exploring the role of home play and learning activities in socioemotional development at 36-months: Findings from a large birth cohort study. Infant Behav. Dev. 77:102000. doi: 10.1016/j.infbeh.2024.102000

PubMed Abstract | Crossref Full Text | Google Scholar

Hunter, L. E., and Daw, N. D. (2021). Context-sensitive valuation and learning. Curr Opin Behav Sci. 41, 122–127. doi: 10.1016/j.cobeha.2021.05.001

PubMed Abstract | Crossref Full Text | Google Scholar

Jimenez, M. E., Crabtree, B. F., Hudson, S. V., Mendelsohn, A. L., Lima, D., Shelton, P. A., et al. (2021). Enhancing reach out and read with a video and text messages: a randomized trial in a low-income predominantly latino sample. Acad. Pediatr. 21, 968–976. doi: 10.1016/j.acap.2021.02.011

PubMed Abstract | Crossref Full Text | Google Scholar

Kisner, M. A., Gonçalves, S. F., Fuchs, A. M., Thompson, J. C., and Chaplin, T. M. (2025). Parental alcohol use predicts neural emotion reactivity and substance use intentions in early adolescence. J. Early Adolesc. 45, 624–650. doi: 10.1177/02724316241273414

PubMed Abstract | Crossref Full Text | Google Scholar

Laudańska, Z., Babis, K., Kozioł, A., Szmytke, M., Marschik, P. B., Zhang, D., et al. (2025). Context shapes (proto)conversations in the first year of life. Dev. Sci. 28:e70018. doi: 10.1111/desc.70018

PubMed Abstract | Crossref Full Text | Google Scholar

Lee, Y., and Ha, S. (2023). Parental verbal responsiveness to infant vocalizations from 9 to 14 months of age. Infant Behav. Dev. 73:101886. doi: 10.1016/j.infbeh.2023.101886

PubMed Abstract | Crossref Full Text | Google Scholar

Liu, X., Guo, C., Lyu, L., Liu, H., Yu, J., Huang, Z., et al. (2025). Parental educational levels association with autism risk in offsprings and their autistic phenotypes. Psychiatry Res. 351:116649. doi: 10.1016/j.psychres.2025.116649

PubMed Abstract | Crossref Full Text | Google Scholar

Malhi, P., Menon, J., Bharti, B., and Sidhu, M. (2018). Cognitive development of toddlers: does parental stimulation matter? Indian J. Pediatr. 85, 498–503. doi: 10.1007/s12098-018-2613-4

PubMed Abstract | Crossref Full Text | Google Scholar

McGorry, P. D., and Mei, C. (2018). Early intervention in youth mental health: progress and future directions. Evid. Based Ment. Health. 21, 182–184. doi: 10.1136/ebmental-2018-300060

PubMed Abstract | Crossref Full Text | Google Scholar

Mendelsohn, A. L., Dreyer, B. P., Tamis-LeMonda, C. S., and Ahuja, P. (1999). Validity of StimQ, a scale for assessing the cognitive home environment. J. Dev. Behav. Pediatr. 20:399. doi: 10.1097/00004703-199910000-00033

Crossref Full Text | Google Scholar

Nilsen, S. A., Radlick, R. L., and Askeland, K. G. (2025). Poor family finances, family-based adverse childhood experiences, and depressive and behavioral symptoms in adolescence. Soc. Psychiatry Psychiatr. Epidemiol. 60, 1707–1719. doi: 10.1007/s00127-025-02824-4

PubMed Abstract | Crossref Full Text | Google Scholar

Nilsen, W., Kjeldsen, A., Karevold, E. B., Skipstein, A., Sand Helland, M., Gustavson, K., et al. (2017). Cohort profile: the tracking opportunities and problems study (TOPP)-study of Norwegian children and their parents followed from infancy to early adulthood. Int J Epidemiol. 46, 1399–1399g. doi: 10.1093/ije/dyx057

PubMed Abstract | Crossref Full Text | Google Scholar

Pang, X., Wang, H., Qian, Y., Zhu, S., Hu, Y. A., Rozelle, S., et al. (2024). The association between visual impairment, educational outcomes, and mental health: insights from eyeglasses usage among junior high school students in rural China. Sci. Rep. 14:24244. doi: 10.1038/s41598-024-72119-2

PubMed Abstract | Crossref Full Text | Google Scholar

Percy, R., Creswell, C., Garner, M., O'Brien, D., and Murray, L. (2016). Parents' verbal communication and childhood anxiety: a systematic review. Clin. Child Family Psychol. Rev. 19, 55–75. doi: 10.1007/s10567-015-0198-2

PubMed Abstract | Crossref Full Text | Google Scholar

Polcari, A., Rabi, K., Bolger, E., and Teicher, M. H. (2014). Parental verbal affection and verbal aggression in childhood differentially influence psychiatric symptoms and wellbeing in young adulthood. Child Abuse Negl. 38, 91–102. doi: 10.1016/j.chiabu.2013.10.003

PubMed Abstract | Crossref Full Text | Google Scholar

Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., et al. (2007). No health without mental health. Lancet. 370, 859–877. doi: 10.1016/S0140-6736(07)61238-0

Crossref Full Text | Google Scholar

Raju, R., Srikar, M., Swaminathan, D., Chandra, P. S., Vasuki, P. P., Meera, S. S., et al. (2025). Maternal linguistic input to infants born to mothers with and without postpartum psychosis and infant language skills: a preliminary study. Am. J. Speech-Lang. Pathol. 34, 3477–3488. doi: 10.1044/2025_AJSLP-25-00104

PubMed Abstract | Crossref Full Text | Google Scholar

Sajewicz-Radtke, U., Łada-Maśko, A., Olech, M., Jurek, P., Bieleninik, Ł., Radtke, B. M., et al. (2025). Association between parental education level and intelligence quotient of children referred to the mental healthcare system: a cross-sectional study in Poland. Sci. Rep. 15:4142. doi: 10.1038/s41598-025-88591-3

PubMed Abstract | Crossref Full Text | Google Scholar

Salve, R. D., Romanelli, S., Frontani, F., Policastro, F., Berardi, A., et al. (2023). Translation and cultural adaptation of the StimQ for use with italian children from kindergartens. Children (Basel) 10:109. doi: 10.3390/children10010109

PubMed Abstract | Crossref Full Text | Google Scholar

Shriver, A. E., Bonnell, L. N., Berman, S., and Camp, B. W. (2020). Cumulative risk, the cognitive home environment and vocabulary in early childhood. Child Care Health Dev. 46, 244–246. doi: 10.1111/cch.12738

PubMed Abstract | Crossref Full Text | Google Scholar

Solomon, C. R., and Serres, F. (1999). Effects of parental verbal aggression on children's self-esteem and school marks. Child Abuse Negl. 23, 339–351. doi: 10.1016/S0145-2134(99)00006-X

PubMed Abstract | Crossref Full Text | Google Scholar

Steinvoord, K., and Junge, A. (2019). Does an association exist between socio-economic status and subjective physical, mental and social well-being among early adolescents? Int. J. Adolesc. Med. Health. 34:20190090. doi: 10.1515/ijamh-2019-0090

PubMed Abstract | Crossref Full Text | Google Scholar

Teekavanich, S., Chantaratin, S., Sirisakpanit, S., and Tarugsa, J. (2017). Prevalence and factors related to behavioral and emotional problems among preschool children in Bangkok, Thailand. J. Med. Assoc. Thailand 100, 175–182. Available online at: http://www.jmatonline.com

PubMed Abstract | Google Scholar

Teufl, L., and Ahnert, L. (2022). Parent-child play and parent-child relationship: are fathers special? J. Family Psychol. 36, 416–426. doi: 10.1037/fam0000933

PubMed Abstract | Crossref Full Text | Google Scholar

Wang, H., Zhao, J., Yu, Z., Pan, H., Wu, S., Zhu, Q., et al. (2024). Types of on-screen content and mental health in kindergarten children. JAMA Pediatr. 178, 125–132. doi: 10.1001/jamapediatrics.2023.5220

PubMed Abstract | Crossref Full Text | Google Scholar

Wang, J., Duan, M., Sun, H., and He, W. (2025). Nonlinear thresholds and bidirectional effects: paternal smoking's dose-response impact on mental health in 21,212 Chinese preschoolers. J. Affect. Disord. 384, 53–59. doi: 10.1016/j.jad.2025.04.169

PubMed Abstract | Crossref Full Text | Google Scholar

Wu, Y. T., Chen, W. J., Hsieh, W. S., Chen, P. C., Liao, H. F., Su, Y. N., et al. (2012). Maternal-reported behavioral and emotional problems in Taiwanese preschool children. Res. Dev. Disabil. 33, 866–873. doi: 10.1016/j.ridd.2011.11.018

PubMed Abstract | Crossref Full Text | Google Scholar

Zoumenou, R., Costet, N., Boivin, M. J., Wendland, J., and Bodeau-Livinec, F. (2025). Associations between the Strengths and Difficulties Questionnaire (SDQ) and Tests of Variables of Attention (TOVA) in rural school-aged children in Benin Africa. Glob Ment. Health 12:e7. doi: 10.1017/gmh.2024.128

PubMed Abstract | Crossref Full Text | Google Scholar