Dana Suskind gives piggyback rides into her operating room. “Except when the patients are bigger than I am,” she says with a laugh. “But they usually aren’t.”
Suskind, who is 47 and stands 5-foot-1, grants the gift of sound to children as young as a year old—kids who were born deaf, experienced traumatic hearing loss, or for any other reason do not have the ability to hear.
In 2006 she founded the pediatric cochlear implant program at Comer Children’s Hospital at the University of Chicago. She has since operated on more than 100 children, surgically inserting into the damaged ear an electronic device about the size of a quarter that stimulates the auditory nerve. The procedure ushers in a world of noises,experiences, and pursuits that would otherwise be reserved for their hearing peers. “We call the moment the cochlear device is activated the ‘hearing birthday,’” Suskind says. “It’s very emotional. We give them a little balloon and a present because it really is a monumental moment.”
If you’ve seen YouTube videos of toddlers hearing their parents’ voices for the first time, you know it’s nothing short of transcendent. “The surgery is wonderful—it’s delicate, it’s beautiful,” Suskind says. “But when they start to hear is when the excitement really begins.” The world as they’ve known it their entire lives is altered in an instant.
During follow-up appointments, however, Suskind began to notice disturbing discrepancies in her patients’ progress. Some children took almost immediately to language, speaking and reading as well as their peers who were born hearing, while others lagged behind. Two of her first patients, Zach and Michelle, were both diagnosed deaf at birth and received cochlear implants around their first birthdays. “Same potential, same surgery,” Suskind says, “but very different outcomes.
“Zach took off like a racehorse out of the gate,” she says. He immediately soaked up sounds and words. By third grade, he was mainstreamed into a public school classroom and scored at grade level in reading and math.
Michelle, on the other hand, was only reading at a kindergarten level in third grade and used very little spoken or sign language. Her hearing was evaluated and deemed normal, but she struggled to grasp the meaning of most words and appeared unable to learn them, even with extra help from teachers and speech therapists.
To diagnose the problem, Suskind knew she needed to better understand her patients’ worlds. She toured hearing impaired classrooms in the Chicago area and discovered that Zach and Michelle’s disparate narratives weren’t all that unusual. Some kids who received cochlear implants struggled to speak and read at grade level, even as others soared. She felt compelled to understand why. “It is without a doubt the greatest of privileges to give my young patients the ability to hear,” Suskind says. “But I realized that taking the Hippocratic Oath meant that my obligation didn’t end when I finished the operation; it ended when my patient was well.”
A surgeon trying to solve a social problem is a bit like planning a trip to the moon, Suskind admits, because it means leaving the familiar confines of the operating room. Fortunately, her operating room sits on the campus of a storied university. She signed up for Introduction to Child Language Development—a surgeon sitting in a classroom full of undergraduates—and encountered research that rerouted the course of her career. In the 1960s, University of Kansas child psychologists Betty Hart and Todd Risley set out to investigate why lower-income children consistently underperformed at school compared to their higher-income peers. They refused to accept conventional wisdom, which held that children who performed well were simply smarter, thanks to genetics. Poor people? It wasn’t in their genes to be smart.
Hart and Risley analyzed more than two years of daily exchanges between parents and their children and discovered that kids born into poverty heard, in their first three years of life, 30 million fewer words than those born into more affluent families. The words the poorer children did hear consisted of more prohibitions (“Don’t touch that!”), fewer affirmations (“Nice job!”), and fewer back-and-forth conversations. Hart and Risley linked this word gap to vocabulary development, test scores at third grade, and IQ.
Why do those early years matter so much? Because 80 to 85 percent of the physical brain develops in the first three years of life. A brain surrounded by frequent, positive language forms an abundance of positive neuron connections, building a strong architecture that becomes the foundation for thinking and learning. And while our brains continue to develop throughout our lives, the growth is never as rapid as it is between birth and age 3. So just as a baby who is deprived of adequate food for the first three years will never grow to his or her full potential height, a baby whose brain is deprived of adequate language will never reach his or her full intellectual potential.
Suskind was struck that Michelle, one of her first patients, exemplified these findings. Born into poverty, Michelle lived with a kind, loving mother, but her language environment at home was austere, and the effect on Michelle was crippling. Suskind observed Michelle during a visit to the girl’s third-grade classroom, about eight years after “curing” her by implanting the cochlear device. Her teacher communicated primarily through sign language, and the children sat silently. The sparkle had faded from Michelle’s eyes. “When I looked at her lovely face, it was hard to say whether I was seeing the tragedy of deafness or the tragedy of poverty,” Suskind writes in her recently published book, Thirty Million Words: Building a Child’s Brain—Tune in, Talk More, Take Turns. “Without question, however, I knew that I was seeing the tragedy of wasted potential.”
In 2009, suskind founded the Thirty Million Words Initiative to teach parents how to harness the power of their own speech to build their children’s brains. “You don’t need a master’s degree to make your child smart,” Suskind says. “You just need to talk with them.”
Her mission is itself a moon shot: narrowing the achievement gap, mitigating the effects of poverty on a child’s academic success, and boosting our nation’s standing in the global marketplace. She soon garnered national attention, and to help keep up with the growth she enlisted her sister-in-law, Beth, as co-director. “You can only go to so many dinners at Dana’s house before she ropes you into something,” Beth says.
Beth had spent the previous 15 years as a TV producer and show runner for such networks as NBC, TLC, and A&E. She’s spent the last few months fielding calls from the Jim Henson Company, which is developing a Netflix series for preschoolers. At the conclusion of each episode, they want to include a 50-second segment that shows parents how to introduce new words to their children, and they’ve tapped Thirty Million Words to help create them.
Still, much of Thirty Million Words’ work happens on a smaller scale. The staff connects with families at community centers, faith-based organizations, and day care centers, approaching parents with a proposal: Allow us into your home for six months of weekly visits, and we’ll teach you how to build your child’s brain.
Parents document their child’s language environment using a small digital audio recorder that fits inside the child’s T-shirt pocket—a word pedometer, in essence. The device records up to 16 hours of sound, which is then uploaded each week to compare with recordings done before and after the interventions begin. The feedback is shared with parents, who are coached on how to improve their use of the “Three T’s”: Tune in. Talk more. Take turns. “Tune in” urges parents to pay attention to a child’s coos and squeals and to treat them as the beginning of a conversation. “Talk more” involves surrounding kids with a wide variety of words. “Take turns” reminds parents to stick around for what their child has to say, even if he or she is pre-verbal and mostly babbles.
Claudia Herrera, a mother of three, stumbled upon Thirty Million Words at a Mother’s Day breakfast at her church on Chicago’s South Side. Her youngest son was 15 months old (her other children are 7 and 15). “There are so many people like me,” she says. “We take really good care of our kids, but we don’t know the importance of talking to them and how much that helps. Before the program, I would say, ‘Do this. Do that.’ Now I talk to my son all the time. We go grocery shopping and I make sure when he points at something, I say what he is seeing. ‘Oh, are you pointing to that apple?’ I explain to him that I am putting on his shoes.”
Transforming typical daily activities into learning opportunities is precisely what Thirty Million Words teaches, ensuring that overloaded parents can participate without the burden of an added task. “My husband says our youngest son is the smartest,”
Herrera says with a hint of amusement.
Suskind’s group is also piloting videos, in both English and Spanish, for parents to watch in the hospital soon after giving birth. While their newborn’s hearing gets tested, they’ll view a 10-minute video explaining how to capitalize on the connection between hearing and brain development. They’ve even developed a well-baby curriculum to be taught at pediatricians’ offices during 1-, 2-, 4-, and 6-month checkups. If Thirty Million Words has its way, parents will be reminded repeatedly that babies aren’t born smart; they’re made smart by parents interacting with them.
“It shows you how smart the brain really is because, in absolute evolutionary brilliance, it harnesses a plentiful, natural resource as the key catalyst for its own development,” Suskind writes in her book, which received glowing reviews from T. Berry Brazelton, clinical professor of pediatrics emeritus at Harvard Medical School, and James Heckman, winner of the 2000 Nobel Prize in Economic Sciences.
But not everyone is a believer. “Focusing on the ‘word gap’ as an explanation for the achievement gap between poor students and wealthier students is both distracting and potentially harmful,” Molly McManus, a Ph.D. candidate in educational psychology at the University of Texas, wrote in the New Republic. Teachers are primed, she argues, to view poor children as so far behind they’re past the point of helping. Others believe it forces a middle- to upper-class value system on populations who have every right to their own brand of parenting. Yet Suskind is unfazed. “We’re responding to an almost universal desire of parents to have children who reach their full potential,” she says. “When that environment doesn’t exist at home, schools, no matter how good they are, are remedial—trying to solve problems that need not exist in the first place.”
It’s an imperative message for all families, particularly in an era when digital enticements compete for parents’ attention. One needn’t look further than the nearest playground to see parents ignoring their tiny charges in favor of a hand-held device.
Economist and author John List is optimistic that Suskind’s work will be a game changer. “In medicine we have randomized trials, and we test the efficiency and efficacy of drugs, but we didn’t—until now—have science to tell us what exactly we should be doing with our kids to give them the best chance at success,” he says. “Some people say, ‘Well, that’s because medicine is life or death and education isn’t.’ But if you walk around the halls of a Chicago Public School, you see that when things don’t work out and kids drop out, that is life or death.”
The word gap has captured the attention of academics, politicians, and foundations alike. The White House built its Early Learning Initiative around it, and President Obama has called closing the word gap one of his top priorities. It’s also a centerpiece of the Clinton Foundation’s Too Small to Fail program, aimed at improving the well-being of kids from birth to age 5.
List points to this pairing of public and private entities as evidence of a cultural sea change. Altering attitudes about smoking and seat belts required similarly monumental partnerships, he says. Only when the government and manufacturers teamed up did it become second nature to buckle up when you hop in a car. “You can make small, incremental changes at the individual level, but for broad progress you need a general movement that changes the way the next generation thinks,” he says. “It’s science like Dana’s that will get us to that point. There isn’t one study of cigarettes that you can point to that changed everything. It was a general scientific consensus that arose because of overwhelming evidence about the risks of tobacco.”
Suskind’s work is also deeply personal. In 2012 her husband, DonaldLiu, died while rescuing two 12-year-old boys from drowning in Lake Michigan. Liu, 50, was the internationally recognized surgeon-in-chief at Comer Children’s Hospital. Patients traveled from across the nation to see him. “This is a man that would wake up at 2 in the morning, be in the operating room in 10 or 15 minutes, literally save a child’s life who was bleeding to death from trauma—a car accident, gunshot wound, a beating—then he would go home and go back to sleep,” his colleague John Alverdy told a reporter shortly after Liu’s death. “An hour later he would wake up, come to the OR, operate for five hours, maybe grab some lunch, go to another hospital, and save another life—all in a day’s work.”
Liu’s death was an inconceivable tragedy for his family—Suskind and their three children, who were 13, 10, and 7 at the time. “He was Dana’s biggest fan,” says Beth Suskind. “He believed so strongly in her work.”
In the epilogue of her book, Suskind points to her husband’s legacy as inspiration: “A child needed help; the child got help. It was not simply a maxim; it was his way of life. He would never have considered standing on the shoreline while two children struggled, even if he knew taking action would cost him his life.”
Across the country, she writes, too many children still struggle silently, with no one to fight like mad to ensure they reach their potential. “They are floundering. We cannot stand on the shoreline.”