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Annual Review of Developmental Psychology

Language Development
in Context
Meredith L. Rowe1 and Adriana Weisleder2
1
Graduate School of Education, Harvard University, Cambridge, Massachusetts 02138, USA;
email: meredith_rowe@gse.harvard.edu
2
Department of Communication Sciences and Disorders, Northwestern University, Evanston,
Illinois 60610, USA

Annu. Rev. Dev. Psychol. 2020. 2:201–23 Keywords


First published as a Review in Advance on
language development, language processing, linguistic input, language
September 15, 2020
environment, language socialization, parent-child interaction
The Annual Review of Developmental Psychology is
online at devpsych.annualreviews.org Abstract
https://doi.org/10.1146/annurev-devpsych-042220-
Young children learn to communicate in the language(s) of their communi-
121816
ties, yet the individual trajectories of language development and the partic-
Copyright © 2020 by Annual Reviews.
ular language varieties and modes of communication children acquire vary
All rights reserved
depending on the contexts in which they live. This review describes how
context shapes language development. Building on the bioecological model
of development, we conceptualize context as a set of nested systems sur-
rounding the child, from the national policies and cultural norms that shape
the broader environment to the particular communicative interactions in
which children experience language being used. In addition, we describe
how children’s developing sensory-motor, perceptual, and social-cognitive
capacities respond to and are tuned by the surrounding environment. Closer
integration of research on the mechanisms of language learning with inves-
tigation of the contexts in which this learning takes place will provide critical
insights into the process of language development.

201
Contents
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
THE MACRO CONTEXT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Social, Political, and Economic Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Policies and Ideologies About Language(s) Spoken . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Culture, Values, and Belief Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
From Macro to Micro: Communities and Neighborhoods as Contexts
for Language Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
THE MICRO CONTEXT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
What Counts as Input for Language Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Situational Contexts Shape Input for Language Learning . . . . . . . . . . . . . . . . . . . . . . . . . 209
Interaction Partners Shape Input for Language Learning . . . . . . . . . . . . . . . . . . . . . . . . . 210
THE CHILD LEARNING IN CONTEXT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Sensorimotor, Perceptual, and Cognitive Processes That Mediate the Uptake
of Linguistic Input . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Social and Cognitive Processes That Mediate the Uptake of Linguistic Input . . . . . . 213
ON THE MALLEABILITY OF CONTEXT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

INTRODUCTION
Language develops in context. Young children learn the languages and language varieties they are
exposed to, and the quantity and quality of their early social interactions with language shape their
language learning trajectories. It is accepted that both the environment and the human child’s bi-
ological capacities contribute to the language development process. Yet uncovering the specific
features of the environment and capabilities of the child that interact to result in language learn-
ing across early development is not a simple task. While much research in developmental psy-
chology has focused on determining the contribution of individual features of the environment,
there is increasing recognition that clusters of correlated features—differentiated along multiple
dimensions—may work jointly to shape the course of language learning (Rowe & Snow 2020).
This points to the importance of considering the contexts that organize children’s language envi-
ronments. The literature on the role of social context in language development has been reviewed
previously (e.g., Hoff 2006). Here we provide an updated review of the role of context in language
development while at the same time integrating the literature on children’s perceptual-cognitive
and social-cognitive processes that influence their uptake of the language they are exposed to in
various contexts.
Our review draws upon multiple theoretical frameworks. Primarily, we build on Bronfenbren-
ner’s bioecological model of development (Bronfenbrenner & Ceci 1994), which provides a lens
through which to examine different levels of context that may simultaneously influence language
development. In particular, we discuss aspects of the macro context (e.g., broad societal norms) as
well as the micro context (e.g., day-to-day language exposure) with particular attention to the im-
portance of proximal processes or ongoing interactions between the child and others in the micro
context. In doing so, we primarily present the perspective of language acquisition research, which
focuses on how the child acquires language from the input, although we attempt to incorporate
insights from language socialization research (e.g., Ochs & Schieffelin 2011), which focuses on

202 Rowe • Weisleder


the culturally and socially structured interactions that organize the process of socialization into
particular communities and their language practices.

THE MACRO CONTEXT


Similar to Bronfenbrenner’s macrosystem (Bronfenbrenner & Ceci 1994), we define the macro
context as including the social, political, and economic systems in which the child resides; national
policies and norms about language(s) spoken; and the broader culture, values, and belief systems.

Social, Political, and Economic Systems


Children’s language development is shaped by the social, political, and economic contexts in which
they live. National and local policies have pervasive effects on children’s lives, determining access
to basic needs such as sanitation, housing, nutrition, and safety, as well as opportunities for learning.
Policies regarding parental leave and access to childcare are also likely to directly affect children’s
language environments. For example, while many studies have found that maternal education is
positively associated with child vocabulary, the strength of this relation varies across countries.
In an analysis of vocabulary data from the Wordbank project, Frank and colleagues (2021) exam-
ined the relation between maternal education and child vocabulary across 12 languages or dialects
from around the world. They found that, although there were differences in child vocabulary as a
function of maternal education in nearly every language, the magnitude of these differences var-
ied by country. To illustrate, the vocabulary advantage for children whose mothers have a college
degree is about twice as large for English-speaking children in the United States as for Norwegian-
speaking children in Norway. This suggests that structural factors in the way different societies
are organized moderate the relation between maternal education and child vocabulary, possibly by
providing differential access to childcare and preschool education. Norwegian parents have access
to the highest level of family benefits and services compared to many other countries, and there
is some evidence that these policies—in addition to providing childcare services—release time for
parents to spend with children, particularly for fathers, and relative to other countries, for parents
with lower education (Sayer et al. 2004).

Policies and Ideologies About Language(s) Spoken


Social and political contexts also shape the status of different languages in society, which is particu-
larly important for understanding the language trajectories of children from bilingual or language
minority homes. Children growing up bilingual in regions where bilingualism is officially recog-
nized by the state exhibit different language learning trajectories than children who are growing
up in regions where bilingualism is explicitly or implicitly discouraged. For example, in Quebec,
where English and French are both officially recognized and where bilingualism is integrated
into most aspects of society—from school instruction and government business to the language
used on road signs and food labels—children routinely learn two languages and develop linguistic
and academic competency in both (Genesee 2006). In contrast, studies in countries where one lan-
guage is dominant, such as the United States, often report lower academic outcomes for bilinguals
relative to monolinguals, as well as loss of skills in the home language for children from language
minority homes (Hoff 2013, Wong Fillmore 1991).
Two main ways in which social and political forces influence children’s bilingual development is
through policies about bilingual education and by shaping parents’ attitudes and language choices
in the home. Research from around the world clearly shows that bilingual children’s language and

www.annualreviews.org • Language Development in Context 203


academic outcomes are affected by the degree to which the two languages are supported in school
(Winsler et al. 1999). Yet bilingual education continues to be the subject of political controversy in
many countries, and changes in policies about bilingual education are tied to attitudes about im-
migration and national identity (Goldenberg & Wagner 2015). The political discourse also affects
families’ own attitudes and language practices at home. For example, a recent qualitative study of
Spanish-speaking immigrant parents in the United States found that although mothers universally
agreed that bilingualism was beneficial for their child’s economic prospects and connections with
family and culture, factors such as peer influences and the political climate often undermined their
efforts to maintain the home language (Surrain 2018).
It is also important to recognize that in some societies, attitudes about bilingualism are expe-
rienced differently by children and families from different racial and social backgrounds. Some
scholars have argued that race/ethnicity and social class contribute to the way bilingual children’s
language abilities are evaluated (Flores & Rosa 2015). In the United States, White children from
English-speaking homes are celebrated for learning a second language, while immigrant children
with similar or higher levels of bilingualism are viewed as a challenge for the school system and
in need of remediation (Flores & Rosa 2019). This illustrates the way societies can elevate elite
multilingualism while continuing to use a monolingual standard to evaluate the language abilities
of children from immigrant communities, and it suggests a need to consider race/ethnicity and
social status when examining the impact of bilingual education policies on children’s outcomes
(Valdés 1997).

Culture, Values, and Belief Systems


Cultural practices and knowledge are transmitted through social interaction, and young children
are socialized both through language and to use language within their respective communities
(Ochs & Schieffelin 1984). Thus, the process of acquiring language is deeply tied to the process of
becoming a competent member of one’s community, and the communicative interactions among
caregivers and children that lead to language learning are culturally constructed. Cross-cultural
research highlights how cultural variations in parenting beliefs lead to variations in young chil-
dren’s language environments (e.g., Super & Harkness 2002). For example, Ochs & Schieffelin
(1984) explain how in the United States and United Kingdom, parents view infants as commu-
nicative partners and thus make eye contact and talk to them face-to-face, using baby talk to adapt
to the level of the child, with the child as the focus of attention. The Kaluli caregivers in Papua
New Guinea, in contrast, believe that babies have no capacity to understand and thus carry the
babies facing outward and do not use baby talk with them. The Kaluli child learns language by
hearing adults model language use for them and around them rather than with them.
Vast differences are seen across cultures in the amount that caregivers talk with children, and
there is evidence that in nonindustrial cultures young children are exposed to less child-directed
speech than in industrial cultures (e.g., Greenfield 2009). For example, American infants and tod-
dlers in urban settings hear three times as much infant-directed speech as infants and toddlers in
rural settings or those in foraging or farming cultures (Casillas et al. 2019, Cristia et al. 2019).
The ways parents communicate with children differ across more or less industrialized cultures as
well. Richman et al. (1992) found that American parents in Boston and Mexican parents in Cuer-
navaca were more than three times as likely to respond verbally to their 10-month-old infants’
cries or vocalizations than Gusii parents in Kenya, who were more likely to respond by holding
or touching the child. Importantly, there is also less-pronounced yet significant variation within
cultures based on urbanization and education level, as the more educated mothers in Cuernavaca
were significantly more likely to respond to their children by talking to them and looking at them,

204 Rowe • Weisleder


whereas less educated parents were more likely to respond by holding the child (Richman et al.
1992). Further, a study in Mozambique (Vogt & Mastin 2013) shows differences in the amount
and type of talk addressed to infants in urban versus rural settings, with some of the variation
attributed to different parental education levels. LeVine and colleagues (2012) argue that formal
schooling may socialize individuals to communicate in more verbal, decontextualized ways and in-
still the value of that form of communication, which then carries over to how they communicate
with their children when they become parents.
These examples point to ways in which children’s experiences with language are shaped by the
norms, values, and belief systems of the cultural communities they inhabit, which are reproduced
within individual families as well as within larger institutions such as the educational system. Fam-
ilies belonging to different social classes within the same country can also be viewed as inhabiting
different cultural contexts. For example, Lareau (2011) characterizes middle-class and working-
class American parents as subscribing to different cultural logics of child-rearing. Middle-class
parents were more likely to view child-rearing as concerted cultivation and their role as parents as
involving the transmission of skills and knowledge that prepare children for success in school. In
contrast, Lareau characterizes working-class parents’ cultural logic of child-rearing as the accom-
plishment of natural growth—the belief that parents need to provide love and basic care so that
their children can grow and thrive. These descriptions of different views of child-rearing align
with findings about average social class differences in parental beliefs about communicative prac-
tices in the US context (e.g., Heath 1983). Studies with both urban and rural American parents
that vary in socioeconomic status (SES) find that, on average, more educated parents do use more
speech, more diverse vocabulary, and more complex syntax with their toddlers, and that this pos-
itive relationship between SES/education and how parents interact verbally with their children is
explained in part by the parents’ knowledge and beliefs about child development (e.g., Rowe 2008,
Vernon-Feagans et al. 2008).
In Western contexts, parenting beliefs and practices related to communicating with children
are also found to vary by race and ethnicity. While Lareau (2011) finds that race had much less im-
pact than social class in her ethnographic work with African-American and European-American
families in the United States, other studies find differences across ethnic groups that are worth not-
ing. Tamis-LeMonda and colleagues (2012) have been studying parent-child interactions in three
different ethnic groups of low-SES families living in the New York City area: African-American
families, Dominican-American families, and Mexican-American families. They find that, control-
ling for SES, there are significant ethnic differences in how the mothers in the three groups
communicate with their children during book sharing and bead stringing tasks. For example, the
Dominican-American and Mexican-American mothers gestured more than the African-American
mothers, whereas the African-American mothers used more referential talk (e.g., labeling) than
the Dominican- and Mexican-American mothers, who used more talk to regulate their child’s
actions and attention. Further, there were also differences between the Dominican- and Mexican-
American mothers in language used at home, with the Mexican-American mothers using more
Spanish (Song et al. 2012). In sum, variations in culture, social class, and ethnicity can all con-
tribute to variations in parenting knowledge and beliefs, which shape the language environments
children are exposed to.

From Macro to Micro: Communities and Neighborhoods as Contexts


for Language Learning
Where children live, play, and learn also contributes to their language development. A substantial
body of research suggests that characteristics of the communities and neighborhoods in which

www.annualreviews.org • Language Development in Context 205


children live are associated with differences in child development over and above child and family
characteristics (Minh et al. 2017). Neighborhoods influence children’s opportunities for language
learning in at least three ways: (a) through the physical spaces and material resources available,
(b) through the characteristics of individuals living in neighborhoods, and (c) through the socio-
cultural and historical features of neighborhoods (Lloyd et al. 2010).
A neighborhood’s built environment, including its parks, playgrounds, roads, and other play
spaces, provides various affordances for caregiver-child communicative interactions. A recent pi-
lot study found that Urban Thinkscape, a developmentally informed playground with installations
that create active and socially interactive learning contexts, produced significantly more language
interaction between parents and children than a traditional playground in the same neighborhood
(Bustamante et al. 2019). This suggests that design features of the built environment can alter
interactions among children and families, with likely consequences for language learning. The
availability of other material resources in neighborhoods also affects children’s learning oppor-
tunities. For example, one study of low- and middle-income neighborhoods in the United States
found large disparities in the availability of literacy resources, including the number of children’s
books in stores and libraries, the quality of public spaces for reading, and the presence of en-
vironmental print (Neuman & Celano 2001). Further, studies have found positive associations
between neighborhood safety and young children’s language outcomes (De Marco & Vernon-
Feagans 2013). This may be because children in safer neighborhoods are better able to take ad-
vantage of neighborhood resources and to have more interactions with adults and peers in their
neighborhood.
Social properties of neighborhoods, such as cohesion and community involvement, are also
associated with children’s language and academic outcomes (Minh et al. 2017). In the study of
rural communities by De Marco & Vernon-Feagans (2013), social cohesion moderated the effect
of neighborhood safety on childcare quality. In neighborhoods with lower levels of safety, families
that had stronger relationships with neighbors accessed higher quality childcare, which in turn
was associated with better child language outcomes. This is consistent with other studies showing
that high social cohesion and trust among neighbors may increase options for childcare outside of
parents and relatives (Burchinal et al. 2008), increasing children’s exposure to a greater diversity
of language.
Neighborhoods also affect the specific language varieties that children learn and use. A study
by Rickford and colleagues (2015) used follow-up data from the Moving to Opportunity project,
a residential-mobility experiment in which families in public housing were randomly assigned the
opportunity to relocate to a low-poverty neighborhood, to examine changes in the speech patterns
of African-American youth. They found that moving into a more economically advantaged neigh-
borhood caused a decline in the rate with which young African Americans used African-American
Vernacular English (AAVE). This is consistent with observational research showing that social
class is correlated with use of AAVE within African-American communities and shows that neigh-
borhood composition can influence patterns of language use for minority youth.
It is important to point out that, in general, where families live is not an accident. Neighbor-
hood residence reflects individual factors (e.g., preferences, income) as well as current policies (e.g.,
zoning laws) and historical and political processes (e.g., discriminatory practices in home lending).
Because neighborhoods may indicate processes of self-selection as well as place-based inequalities
in the distribution of social and environmental risks, it can be difficult to tease apart their unique
effects. However, some scholars have argued that the problem of disentangling neighborhood and
individual effects may represent a false dichotomy (Macintyre et al. 2002). Indeed, a central aspect
of the bioecological model is its consideration of multiple processes taking place simultaneously
across ecological levels. The research on neighborhoods suggests that the places where children

206 Rowe • Weisleder


live affect child development through both neighborhood- and family-level processes (Minh et al.
2017). Thus, these studies underscore the importance of the child’s proximal environments while
also highlighting the broader forces that shape them.

THE MICRO CONTEXT


Our discussion of the micro context focuses on the direct interactions the child has with others
in context. It is through these reciprocal proximal processes (Bronfenbrenner & Ceci 1994) that
the young child learns language, and variations in these micro contexts contribute to variations in
learning.

What Counts as Input for Language Learning


Young children need to be exposed to language to learn language. While there are large varia-
tions in exposure across cultures, communities, and households, evidence suggests that to learn
a language the exposure needs to be social. That is, research shows that infants will not learn a
language from hearing language used, for example, on television or radio alone; they need the
language to be embedded in social interactions (e.g., DeLoache et al. 2010, Kuhl et al. 2003). It
appears that it is not the screen per se that limits learning in the case of television but the lack of
social contingency in the interaction. For example, using video chat software, researchers found
that 24–30-month-old toddlers can learn new verbs from an adult interlocuter on a screen if the
interaction is socially contingent (back-and-forth), consistent with a video chat, whereas toddlers
did not learn from a noncontingent video of the same information (Roseberry et al. 2014). As
children grow and develop language skills, after around 3 years of age, they can learn vocabulary
from nonsocial outlets such as educational television shows (e.g., Rice et al. 1990), and once they
are literate, reading is a robust source of vocabulary knowledge ( Jenkins et al. 1984), yet the ac-
tual process of learning a language in young children is found to be socially mediated (Kuhl 2007,
Snow 1972).
It has been well documented that some children are exposed to more social language than
others over the early childhood years, and this variation in the quantity of language input predicts
the rate of early language development (e.g., Huttenlocher et al. 1991). Some studies find that girls
are exposed to more child-directed speech than boys (Leaper et al. 1998) and that first-borns are
exposed to more talk than later-borns (Hoff-Ginsberg 1998). Exposure to language input is also
found to differ, on average, across social classes in Western contexts (e.g., Hart & Risley 1995),
and socioeconomic differences in young children’s vocabulary skills are at least partially explained
by those differences in language exposure (Hoff 2003). Young children who are exposed to more
language have more opportunities to build processing skills that facilitate language development
(Weisleder & Fernald 2014). Even within entirely lower-SES or higher-SES samples, there is large
variation in parent input that predicts child vocabulary growth (Pan et al. 2005, Huttenlocher
et al. 1991). Indeed, one study with low-income Spanish-speaking US families found that within
this relatively homogeneous sample, infants who experienced more child-directed speech were
more efficient at processing spoken words and had larger vocabularies 6 months later as toddlers
(Weisleder & Fernald 2013).
One current open question in the field is the extent to which children can also learn language
from speech that is not directed to them, otherwise referred to as overheard speech or other-
directed speech. Interestingly, the studies to date that have examined child-directed speech as
well as overheard speech in home environments find that it is the variation in the child-directed
speech that predicts children’s vocabulary knowledge and that the overheard speech does not

www.annualreviews.org • Language Development in Context 207


explain additional variability in language outcomes (e.g., Shneidman & Goldin-Meadow 2012,
Shneidman et al. 2013, Weisleder & Fernald 2013). However, laboratory studies show that in
controlled settings children can learn from overheard speech starting at around 20 months of age
(e.g., Akhtar 2005). Further, individual differences in how well children learn in an overhearing
condition in a lab setting are found to be associated with the children’s exposure to multiple adults
in the home environment (Shneidman et al. 2009). Thus, children who are more often exposed to
multiple adult speakers at home may develop different attention strategies for learning. Indeed,
it has been argued that one reason child-directed speech may be a more useful input for children
is because it better captures children’s attention (Shneidman & Woodward 2016).
One reason the debate about overheard speech is important is that there are many communities
in which child-directed speech is infrequent, yet children still acquire a linguistic system and the
skills necessary to communicate successfully (Brown 2011, de León 2011). These findings, which
have long been documented in ethnographic reports, have recently been confirmed in studies us-
ing quantitative methods (Casillas et al. 2019, Cristia et al. 2019). A study using daylong recordings
found that young children in a Tseltal Mayan village were exposed to little child-directed speech
[about one-third of that found for North American children using similar methods (Bergelson
et al. 2019)] but much more other-directed speech (Casillas et al. 2019). Critically, these children
achieved key language milestones (onset of canonical babble, first words, and first word combi-
nations) at similar ages to what has been documented for Western children (for an example from
Wichi, see Taverna & Waxman 2020). A key question for understanding these findings is whether
there are different types of other-directed speech that are more or less useful for young children’s
language learning. Lieven (1994) has suggested that in many communities, language is frequently
used in highly routinized situations, which facilitates children’s ability to make word-meaning pair-
ings. Indeed, in Shneidman & Goldin-Meadow’s (2012) study of language input in US and Mayan
communities, they found that a higher proportion of overheard utterances in the Mayan sample
made reference to activities in which the child was a participant. More generally, and consistent
with sociocultural theories of human development (Rogoff 2003), it is possible that the contexts
in which children live and the types of input available to them shape not only language outcomes
but also their attention and mechanisms for learning (Shneidman & Woodward 2016, Weisleder
& Marchman 2018).
Building on the importance of children’s attention in the language learning process, research
on children’s language environments, primarily in Western contexts, is converging on the fact that
it is not merely the quantity of child-directed speech that best predicts language learning but also
the extent to which that speech occurs in episodes of joint engagement and attention with children
where there is a connected and contingent back-and-forth conversation between a caregiver and
child (e.g., Hirsh-Pasek et al. 2015, Romeo et al. 2018) and where the caregiver’s communication
is clearly interpretable (Cartmill et al. 2013). Further, within those episodes of joint attention or
discussion, certain linguistic features of the input are more or less helpful at different points in early
development (for a review, see Rowe & Snow 2020). For example, infants benefit from baby talk
or parentese, a simplified speech register (Ferjan-Ramírez et al. 2019), whereas 4-year-olds benefit
from more complex syntax (Huttenlocher et al. 2010). Similarly, infants benefit from language that
is focused on the here and now and the objects they are paying attention to in their visual field (Yu
& Smith 2012), whereas preschoolers benefit from talk that is more abstract and removed from
the current context (Rowe 2012). This suggests that what children learn from the input changes
as their perceptual, cognitive, and social-cognitive capacities develop, and as their knowledge of
their native language(s) unfolds (e.g., from phonemes to words to grammar) (Perszyk & Waxman
2018, Werker & Hensch 2015).

208 Rowe • Weisleder


Situational Contexts Shape Input for Language Learning
Just like the macro context influences caregiver-child interactions, the language input children
hear is also shaped by the more immediate situational context in which those interactions take
place. Scholars investigating language development from a social-interactionist perspective in the
1980s argued that children learn language in the context of frequently recurring routines or in-
teraction formats (Bruner 1985), which include a predictable set of actions, objects, and locations
(Nelson 1985). In particular, Bruner (1985) proposed that well-understood, predictable activities
enable the child to infer word meanings. Modern usage-based accounts of language acquisition
also suggest that it is through these routinized contexts that children start to map utterances to
meanings (Tomasello 2000).
Recent studies using contemporary methods have found support for the idea that regulari-
ties in the contexts in which a word is used provide important cues to meaning (Roy et al. 2015,
Tamis-LeMonda et al. 2019). In a landmark study, Roy and colleagues (2015) analyzed audio and
video recordings of the first 3 years of one child’s life. The child’s house was outfitted with ceiling-
embedded cameras and microphones that provided near complete coverage and captured about
70% of the child’s waking hours from birth to age 3. The study examined three dimensions of
the context in which specific words appeared: physical location (e.g., kitchen), time of day when
they were spoken (e.g., 8 AM), and the other words that appeared nearby in the conversation.
They found that some words, such as “breakfast” and “kick,” had more distinct spatial, temporal,
and linguistic distributions, suggesting they were tied to particular activities (e.g., meals, playtime),
while other words, such as “beautiful” or “with,” had a more diffuse pattern of occurrence. Consis-
tent with Bruner’s (1985) theory, words that occurred within more coherent contexts were learned
earlier, suggesting that routinized activities may play a facilitative role for learning words. Indeed,
experimental evidence also suggests that infants are better at learning the names for objects when
those objects appear at predictable locations (Benitez & Smith 2012).
Research has also found that the quantity and properties of caregiver speech vary across dif-
ferent activities. The talk that caregivers use during book sharing tends to be more abundant,
lexically diverse, and syntactically complex than talk in other contexts and contains a higher pro-
portion of questions and referential language (Hoff-Ginsberg 1991, Tamis-LeMonda et al. 2019).
This is likely, at least in part, because the text in children’s books contains more unique words
and more rare and complex sentence types than those used in typical conversations with children
(Montag 2019, Montag et al. 2015). Moreover, perhaps because of the support from the book’s
text, socioeconomic differences in mothers’ speech to children is minimized during book shar-
ing interactions (Hoff-Ginsberg 1991). In contrast, activities such as mealtime, bath time, and
getting dressed contain less talk than book sharing or play (Hoff-Ginsberg 1991, Soderstrom &
Wittebolle 2013). However, these activities have been found to contain high word specificity for
certain classes of words (e.g., food, utensils, clothing, body parts), suggesting they may be im-
portant contexts for building semantic networks (Tamis-LeMonda et al. 2019). And mealtimes in
particular are found to elicit more decontextualized talk, such as narratives and explanations, which
is a useful type of discourse for promoting oral language skills in preschool-aged children (e.g.,
Aukrust & Snow 1998). Importantly, simulations based on large corpora of child-directed speech
show that the addition of certain contexts, such as book reading, changes the relationship between
certain properties of language input, such as the number of word types and tokens (Montag et al.
2018). Together, this suggests that small differences in the activity contexts children experience
can make a large difference in the characteristics of their language learning environments.
Of course, although children all over the world participate in a variety of activities, the types
of activities and the specific practices that comprise them are culturally rooted. A recent revision

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to Bronfenbrenner’s bioecological model proposes that culture does not operate at the macro
level but rather at the micro level, in the everyday activities and practices of different cultural
communities (Vélez-Agosto et al. 2017). Caregivers from different cultures and SES backgrounds
engage children in different kinds of activities and forms of participation (Keller 2003, Rogoff
2003), resulting in conversational settings that vary in the interactive, structural, and pragmatic
properties of their speech. For example, in a study of higher- and lower-SES families in Argentina,
the type of activity the child was engaged in helped explain SES differences in the proportion of
entity- versus action-oriented utterances, as well as in the ratio of nouns and verbs in child-directed
speech (Rosemberg et al. 2020). Thus, the activities children participate in may be an important
mediator between aspects of the macroenvironment, such as SES and culture, and the properties
of the language they hear.

Interaction Partners Shape Input for Language Learning


Children’s language input is also shaped by the number and types of participants in the interac-
tions. For example, mothers and fathers are found to be similar in their overall responsiveness
toward their child (Clarke-Stewart 1978) and in their use of several features of infant-directed
speech, such as repetition (Kruper & Uzgiris 1987), high pitch (Warren-Leubecker & Bohannon
1984), and shorter utterances (Golinkoff & Ames 1979). However, in some studies, mothers are
found to talk more to their children than fathers (e.g., Leaper et al. 1998). And fathers are often
found to be more challenging communicative partners in that they ask more wh- questions and
produce more clarification requests than mothers (Gleason 1975), which, in turn, leads children
to use more talk and more complex utterances with fathers than mothers (Rowe et al. 2004). In-
terestingly, a large study of low-income rural two-parent (mother/father) families in the United
States found that, using data from book reading interactions, it was the variation in the father talk
with the toddlers that predicted the children’s later vocabulary, not the mother talk, controlling for
maternal education and a number of other factors (Pancsofar et al. 2010). However, other studies
find significant unique effects of both mother and father talk on child outcomes (e.g., Malin et al.
2014).
An open question in the field is the extent to which siblings contribute to children’s language
development. For many years, the predominant view has been that siblings are less supportive con-
versational partners than adults and thus do not contribute prominently to children’s language
development. Studies have shown that, when interacting with their younger infant or toddler
sibling, older siblings use speech that is more directive, has fewer questions, is less syntactically
complex, and is less attuned to the child’s level or attentional focus than that of adults (Hoff-
Ginsberg & Krueger 1991, Tomasello & Mannle 1985). Consistent with this view, first-born chil-
dren have more advanced lexical and grammatical development than later-born children (Fenson
et al. 1994, Hoff-Ginsberg 1998), although this birth-order effect seems to vary significantly by
country (Frank et al. 2021). However, studies also suggest that later-born children are better able
to negotiate multiparty conversations (Dunn & Shatz 1989) and have more advanced conversa-
tional skills than first-born children (Hoff-Ginsberg 1998), suggesting a positive effect of older
siblings on some aspects of communicative competence. Moreover, a recent study using a large
cohort of children in France found that having an older sibling was negatively related to language
development only for children with an older brother, not those with an older sister, suggesting
that perhaps girls but not boys contribute to their younger siblings’ language development—at
least in a French context (Havron et al. 2019).
Older siblings may be particularly important as language models for children in bilingual and
language minority homes. A study of children from Spanish–English bilingual households in the

210 Rowe • Weisleder


United States found that older siblings spoke more English to their younger siblings than their
parents did and that toddlers with an older sibling were more advanced in English language de-
velopment than those without an older sibling (Bridges & Hoff 2014). Other studies with kinder-
garten children in the United States and Canada have found that English input from older siblings,
but not from parents, was associated with stronger lexical, grammatical, and narrative abilities in
English (Rojas et al. 2016, Sorenson Duncan & Paradis 2020). Together, these findings suggest that
siblings can contribute to young children’s language development, although their contributions
may depend on characteristics of the sibling and of the language learning context more broadly.
Indeed, studies of language input in childcare centers have found positive effects of peer talk in
addition to the conversations engaged in with teachers (Perry et al. 2018).
It is worth noting that most of these studies come from children in industrialized societies.
In nonindustrialized societies, children are often cared for by multiple caregivers, including older
siblings (Brown 2011, Zukow-Goldring 2002). Consistent with this, in the previously mentioned
study of language input in a Mayan community, children heard a high proportion of directed input
from other children. However, input from other children did not predict toddlers’ vocabulary out-
comes (Shneidman & Goldin-Meadow 2012). The extent to which children in different societies
learn language from siblings and other children is an important question for ongoing research.

THE CHILD LEARNING IN CONTEXT


To understand children’s language development in context, we must consider children’s own ca-
pacities and proclivities. Children are active agents who play a role in shaping interactions with
those around them, are selective in their learning, and vary in their preferences and abilities. In
this section, we discuss research on sensorimotor, perceptual, social, and cognitive processes that
influence the uptake of linguistic input.

Sensorimotor, Perceptual, and Cognitive Processes That Mediate


the Uptake of Linguistic Input
The past two decades have produced mounting evidence that infants are skilled statistical learn-
ers, able to make distributional analyses of the speech signal in order to discover structure in their
native language(s) (for a review, see Saffran & Kirkham 2018). Two types of evidence have lent sup-
port to this perspective. First, analyses of natural language corpora—which have grown even more
powerful in the era of big data—have revealed statistical patterns in the input that could help learn-
ers discover meaningful structure in their native languages, including phonological, grammatical,
and semantic categories ( Jones & Mewhort 2007, Redington et al. 1998). Second, experimental
studies have shown that infants track statistical regularities in continuous speech and can use dis-
tributional patterns to discern relevant linguistic units (Saffran et al. 1996). Together, these two
lines of evidence suggest that statistical learning is a key mechanism by which infants discover lin-
guistic structure. Although there is disagreement about the extent to which these mechanisms can
provide a full explanation for language acquisition (e.g., Lidz & Gagliardi 2015), there is consensus
that it is a fundamental piece of the puzzle.
But how do infants deploy these abilities for learning language in context? In the real world,
children learn language from dynamic and multimodal conversational exchanges in complex envi-
ronments. There is evidence that children track cross-situational statistics about the correlations
between words and their referents and can use social, linguistic, and discourse cues to infer word
meanings (Bloom 2002, Smith & Yu 2008). But how infants determine which sources of informa-
tion to attend to and which statistical regularities to track is one of the key outstanding questions

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about language learning (Saffran & Kirkham 2018). Scholars have posited the existence of general
and domain-specific constraints that may guide infants’ decisions about which statistics to track
(Saffran 2002, Thiessen 2011). In addition, recent research has focused on the way infants’ devel-
oping bodies and sensorimotor abilities play a role in determining the data they encounter (Smith
et al. 2018). Studies using head cameras and head-mounted eye-trackers have shown that infants’
view of the world is different from that of adults and that their view changes as sensorimotor abili-
ties develop (Fausey et al. 2016). For example, because newborns cannot move much on their own,
most of what they see depends on what caregivers show them. In contrast, crawling infants can
move toward an object to get a closer view. Once walking, infants can see more in their visual field
and free up their hands for manipulating objects. In fact, infants’ locomotor status (crawler versus
walker) affects how they share objects with their mothers (Karasik et al. 2011), and mothers’ verbal
responses are qualitatively different to walkers versus crawlers (Karasik et al. 2014). Thus, infants’
maturing sensory and motor systems constrain the data available to them at different points in
development, and as these capacities develop, children’s increasing exploration helps create their
own contexts for learning (Smith et al. 2018).
In addition, the input to the system is determined not only by the information available in the
environment but also by the way this information is filtered through infants’ perceptual and cog-
nitive capacities. To learn language in real-world contexts, children need to extract information
from fluent speech and map it to units of meaning (Perszyk & Waxman 2018). One implication of
this is that differences in children’s ability to process sensory information could have consequences
for language learning. For example, studies have shown that infants can use a known verb to infer
the meaning of a novel noun (Ferguson et al. 2014, 2018). Upon hearing a sentence such as “The
dax is crying,” infants as young as 19 months identified that “dax” referred to an animate object.
But their efficiency in doing this improved between 19 and 24 months (Ferguson et al. 2018), a
period of documented gains in children’s language-processing skill more generally (Fernald et al.
2006). In addition to these developmental changes, research suggests that individual differences in
infants’ auditory processing (Benasich & Tallal 2002), speech perception (Tsao et al. 2004), word
segmentation (Singh et al. 2012), and spoken word recognition (Fernald et al. 2006, Lany et al.
2018) are related to differences in lexical development. And recent research suggests that individ-
ual differences in nonverbal prediction abilities are also related to vocabulary size (Reuter et al.
2018). This suggests that information-processing skills support access to linguistic information
during real-time language interactions and may affect children’s ability to learn from the input.
In light of these findings, recent studies have begun to examine relations between children’s
early language experience, speech-processing skills, and language learning trajectories. One possi-
bility is that early language experience and children’s processing skills make independent contribu-
tions to language outcomes. Another possibility is that participation in language interactions helps
sharpen infants’ speech-processing skills and hence improves their ability to learn from language
input over time. Although studies are limited, there is currently support for both of these possi-
bilities. In a study with 7-month-old infants, Newman and colleagues (2016) found that speech
segmentation skills and maternal language input contributed independently to children’s vocab-
ulary at age 2. Other studies suggest that by 18 months, children’s prior language experience is
related to their efficiency in lexical processing, and that lexical processing skill helps mediate the
relationship between language input and vocabulary outcomes (Hurtado et al. 2008, Weisleder &
Fernald 2013). Finally, a study with preschool-aged children showed that lexical processing was
a stronger predictor of later vocabulary than language input (Mahr & Edwards 2018). Together,
these findings suggest that the relationships between language experience, processing skills, and
language outcomes may change over the course of development. There are likely developmental
periods where specific types of sensory and language input can have a greater effect on distinct

212 Rowe • Weisleder


aspects of language learning, which in turn will have cascading effects on children’s uptake in the
next developmental period, altering the child’s developmental trajectory over time (e.g., Werker
& Hensch 2015). A better understanding of these nuanced relations between language experience
and children’s developing processing skills may help constrain our theories of language learning
in context.

Social and Cognitive Processes That Mediate the Uptake of Linguistic Input
Children’s attentional skills also contribute to their processing and uptake of linguistic input. As
noted earlier, infants and toddlers learn best when the speech they hear is focused on objects they
are looking at (Yu & Smith 2012) or occurs in episodes of joint attention with another individual
and object (e.g., Tomasello & Farrar 1986). However, even within episodes of joint attention,
the degree to which the infants’ attention is sustained on the object being discussed is a better
predictor of later vocabulary than the amount of joint attention itself (Yu et al. 2018). Similar
findings are elicited from studies of parent-child book reading that examine children’s attention
or interest in the reading sessions. For example, consistent relationships are found between the
quality of parents’ talk during book reading (e.g., use of metalingual talk) and toddlers’ interest
during the book reading sessions. Further, quality of parents’ talk during book reading predicts
children’s later vocabulary development, and that relationship is mediated by children’s interest
during the book reading session (Deckner et al. 2006, Malin et al. 2014). These findings suggest
that children’s attentional skills and the input they receive are related and work together to predict
their vocabulary learning.
In addition to the importance of sustaining attention to speech for learning, preschool-aged
children are also adept at monitoring characteristics of their interlocutors, which they use to guide
their learning. One characteristic children monitor is the trustworthiness of the speaker. The re-
search on selective trust shows that by age 4, children can keep track of whether individuals are
knowledgeable or ignorant based on their accurate or inaccurate labeling of familiar items, and
they use that information to choose whom to learn new words from (e.g., Koenig & Harris 2005,
Pasquini et al. 2007). Children also prefer to learn from speakers with a native accent than from
those with a non-native accent (Kinzler et al. 2011), and when accent and previous accuracy in
labeling are pitted against each other experimentally, 3-year-olds choose the speaker with the na-
tive accent (even when previously inaccurate) but 4–5-year-olds are more likely to choose based
on accuracy (Corriveau et al. 2013). Furthermore, by 4 years of age children can also monitor the
intent of their interlocutor, and models suggest they are more likely to learn from someone who
is knowledgeable but also has the intent to be helpful rather than deceptive (Shafto et al. 2012).
Relatedly, research on word learning through pragmatic inferencing suggests that children can
rely on speakers’ intents more broadly when interpreting their utterances (for a recent review, see
Bohn & Frank 2019). Thus, as children develop language skills, they draw upon cognitive and
social-cognitive abilities to determine why certain input is being presented to them and whose
input might be most valuable for learning.
Once young children are engaged in social interactions with others, there are also charac-
teristics of the child’s and the interlocutor’s communication dynamics that help expand language
learning. For example, when parents respond contingently to infants’ babbling, their responses are
found to be clearer and simplified verbally compared to noncontingent utterances (Elmlinger et al.
2019). In an experimental study, infants who received contingent feedback changed their babbling
to resemble the phonological structure of their mothers’ responses, while infants who received the
same responses in a noncontingent fashion did not (Goldstein & Schwade 2008). Furthermore,
the diversity of parents’ vocabulary within contingent responses only predicts children’s vocal

www.annualreviews.org • Language Development in Context 213


development (Elmlinger et al. 2019). This suggests that by babbling, children elicit simplified,
learnable input from caregivers (Elmlinger et al. 2019), which promotes their language develop-
ment. In another study, children ages 8–48 months were more likely to produce a speech-like
vocalization when their previous vocalization had been responded to by an adult, in essence con-
tinuing the social-feedback loop to promote language and conversation (Warlaumont et al. 2014).
Similar patterns can be identified with particular speech acts, such as children’s question asking and
parents’ explanation providing. For example, toddlers who ask information-seeking questions and
are not provided with a satisfactory explanation are more likely to reask the question (Chouinard
2007), and children who receive explanations are more likely to learn about the topic (e.g., Frazier
et al. 2009). Further, when parents pose wh- questions (who, what, where), toddlers are more
likely to respond verbally than when parents ask other types of questions (yes/no), and there is a
positive association between frequency of parents’ wh- questions and toddlers’ vocabulary (Rowe
et al. 2017). These findings and others point to the cooperative nature of communication as being
integral to language development (e.g., Renzi et al. 2017). Indeed, recent computational models
suggest that the problem of word learning is made much more tractable under two key assump-
tions: that speech directed to children is produced with the purpose of communicating, and that
children attempt to make inferences about what adults are trying to communicate within these
interactions (Yurovsky 2018). These models formalize ideas about the importance of the social-
communicative nature of the learning context for children’s language development.

ON THE MALLEABILITY OF CONTEXT


Examinations of changes in the macro context over time can offer insights into the mechanisms
through which the broader context affects development. Further, intervention or training studies
provide evidence about the extent to which features of the micro context are malleable, and if
so, whether changes in the micro context invoke changes in children’s language development.
Given the large socioeconomic disparities in early language development in Western contexts
(e.g., Hoff 2006), there are a growing number of studies targeting children’s early home language
environments that speak to this issue of the malleability of context.
At the macro level, the spread of Western schooling around the world is resulting in girls re-
ceiving more years of formal schooling than in previous decades, an increase that is associated
with how they communicate with their children when they become mothers and their children’s
language development (e.g., LeVine et al. 2012). Further, Patricia Greenfield’s (2009) theory of so-
cial change and human development describes how the global shift toward industrialization affects
cultural values and learning environments, which influence children’s cognitive development over
time. Thus, broader sociocultural environments are not static, and while changes in the macro
context are gradual, they can result in changes in the micro context and in child development
across generations.
At the micro level, many intervention studies focus on providing parents or other caregivers
with information, modeling, and feedback regarding the types of adult-child interactions that are
thought to promote language development in young children (Adamson et al. 2020, Biel et al.
2020). In general, studies of this sort have been successful in affecting parent behaviors (i.e., micro
context), such as the amount of parent talk or conversational turn taking with the child. As recent
examples, the citywide Providence Talks initiative finds positive results from its home-visiting
model on quantity of parents’ talk with their children compared to a control group (Wong et al.
2020). Similarly, a randomized controlled trial of the 3Ts Home Visiting curriculum in Chicago
found that providing low-income parents with knowledge and child-rearing strategies resulted in
these parents talking more and engaging their children in more conversational turn-taking than

214 Rowe • Weisleder


parents in a healthy lifestyle control group (Leung et al. 2020). Furthermore, a parenting program
in Senegal also showed significant effects on parent verbal interaction with children for the par-
ents in the villages that participated in the program compared to those in control villages (Weber
et al. 2017). In this study, there were also positive outcomes on vocabulary for the children living
in the treatment villages compared to controls 1 year later (Weber et al. 2017). These studies are
examples of the growing evidence of the malleability of the micro context, specifically in relation
to parents’ language input. The example from Senegal is particularly noteworthy, as the parent in-
tervention and home visits conveyed information to parents that emphasized parenting practices
(i.e., verbal interaction) that differed from their existing cultural norms and practices. While some
have argued that there are ethical issues with interventions of this sort (e.g., Morelli et al. 2018),
the findings provide causal evidence to support the correlational studies showing links between
parenting knowledge of child development and parents’ talk with children (e.g., Leung & Suskind
2020, Rowe 2008). Further, the links to child outcomes suggest that changes in the micro context
cause changes in language development. Indeed, a recent meta-analysis of 25 studies examining
the effectiveness of parent-implemented interventions shows significant, positive effects of inter-
ventions focused on book reading, play, and routines on children’s expressive vocabulary skills,
including in families from low-SES backgrounds (Heidlage et al. 2020).
Other training studies target even more specific features of parent communication known to
promote language learning. For example, a study encouraging parents of infants to use parentese
or baby talk was successful in increasing this type of talk and resulted in greater vocabulary skills for
the children of the parents in the training group several months later compared to a control group
(Ferjan Ramírez et al. 2019). A gesture training study for parents of 10-month-olds increased
parents’ use of gestures with their children at 12 months, as well as children’s use of gestures
with parents (Rowe & Leech 2019). A training to increase parent contingent talk with 1-year-olds
resulted in an increase in contingent talk for the treatment group compared to the control group
and also produced some benefits in child language production up until 18 months, which faded
out by 24 months (McGillion et al. 2017). A parent training to increase use of explanations and
narrative talk with preschool-aged children resulted in an increase in this type of decontextualized
talk for both parents and children and also increased the length of parent-child conversations
(Leech & Rowe 2020, Leech et al. 2018).
Interventions targeting childcare centers that also contain a parenting or family component re-
sult in larger effects than those without the parenting component (Neville et al. 2013, Weisleder
et al. 2018). This result is important because it suggests that a child’s language development will
benefit more if multiple micro contexts are enhanced (school and home). Furthermore, the pedi-
atric clinic context has been used successfully as a setting through which to implement parenting
interventions that have resulted in changes in parental interaction with children and children’s
development (Cates et al. 2018, Mendelsohn et al. 2007). Pathway models of such programs sug-
gest impacts on parent-child engagement in reading and play that have cascading effects on par-
ents’ psychosocial functioning (e.g., reductions in maternal depression and parenting stress) and
child development outcomes (Weisleder et al. 2019). Taken together, these studies suggest that
programs that provide support for parents of young children can be effective at enhancing chil-
dren’s everyday social interactions with caregivers, with cascading effects on language develop-
ment. Thus, there is growing evidence for the malleability of the micro context and causal effects
of context on children’s language learning trajectories.
Despite these promising findings, it is important to note that the majority of these interven-
tions have demonstrated relatively short-term impacts with modest effect sizes, and with some
evidence of impacts fading over time (e.g., Suskind et al. 2016, Zhang et al. 2015). Thus, it is not
yet clear whether these interventions can meaningfully alter children’s language outcomes in the

www.annualreviews.org • Language Development in Context 215


long term. The study of language development in context has the potential to inform these inter-
vention efforts going forward. In particular, the studies reviewed here support the core premise of
the majority of these interventions: that young children learn language through proximal interac-
tions with caregivers, and that variations in micro contexts contribute to variations in outcomes. At
the same time, the evidence suggests that economic, political, and cultural forces play a powerful
role in shaping these proximal processes. With regard to low-SES families in particular, evidence
suggests that financial stressors, food and housing insecurity, and reduced access to education and
childcare affect parents’ interactions with their children, including caregiver speech (Weisleder &
Marchman 2018). Thus, interventions focused exclusively on the micro context, without attention
to the broader forces shaping families’ lives, may not be sufficient to create meaningful change.
Rather than being thought of as isolated programs, these efforts are best thought of as key com-
ponents within a comprehensive public health strategy to ensure children’s healthy development.
Indeed, global health scholars have proposed that promoting early child development at scale re-
quires broad support from an array of social contexts—including home, childcare, schooling, the
wider community, and policy (e.g., Britto et al. 2017).

CONCLUSION
Child language development is a process inherently embedded in context. Here we drew upon
the bioecological model (Bronfenbrenner & Ceci 1994) as a framework for describing various
features of the macro and micro context that contribute to children’s language development. We
emphasized how children’s developing cognitive, perceptual, and social-cognitive skills interact
with the surrounding context to influence language learning. Finally, we reviewed the literature
on interventions that target the child’s language environment to help further uncover key mech-
anisms and point to practical implications. We conclude that there is vast research to date on the
mechanisms involved in language development and on individual contextual factors that play a
role in shaping it, yet going forward research that integrates these approaches will be best suited
to offer critical insights into the process of language development in context.
Of course, it is not feasible to conduct individual research studies that examine all the poten-
tial contextual and child factors that contribute to language development. However, research that
combines a variable-centered with a person-centered approach can be useful, as can longitudi-
nal and intervention studies. For example, some of the research discussed looked simultaneously
at effects of children’s developing skills and features of linguistic input (e.g., Malin et al. 2014,
Newman et al. 2016) to help describe how both types of factors contribute to learning. Other
studies have examined variables across different levels of context—for example, how similar micro
contexts, such as exposure to two languages at home, could have different effects on learning when
the macro context, such as national policies toward bilingualism, differs (e.g., Floccia et al. 2018).
Studies have also begun to model how the relationships among features of the language environ-
ment, such as the total amount and diversity of words, vary as a function of context (e.g., Montag
et al. 2018). Indeed, the child is nested within various contexts and the contextual features work
together, not in isolation, to influence development. To the extent that future research can un-
cover the ways that different components of the young child’s environment combine to influence
development, we will be better equipped to help promote that development long term.

DISCLOSURE STATEMENT
The authors are not aware of any affiliations, memberships, funding, or financial holdings that
might be perceived as affecting the objectivity of this review.

216 Rowe • Weisleder


ACKNOWLEDGMENTS
We thank Dean Redfearn for comments and editorial assistance. This paper was written while we
were home during the coronavirus disease 2019 (COVID-19) pandemic. We are thankful to our
families and for our health during this time.

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