About this trial

Sharing Tales That Teach is a randomised study of a shared picturebook reading programme for 4- to 5-year-old children and their primary caregivers. The study will test whether a caregiver-delivered, emotion-focused shared reading programme leads to greater improvements in children's emotion regulation than a standard dialogic shared reading programme.

Emotion regulation refers to children's developing ability to understand, express and manage emotions in ways that support learning, relationships and wellbeing. These skills are closely linked with executive function, including children's ability to remember instructions, control impulses and shift flexibly between activities. Shared picturebook reading may provide a natural, low-cost way for caregivers to support these skills through everyday interaction.

Families in the randomised part of the study will be allocated to one of two 8-week shared reading programmes. In the emotion-focused group, caregivers will receive training in strategies such as naming emotions, discussing why characters feel as they do, talking about consequences of emotions and modelling ways to manage feelings. In the comparison group, caregivers will receive training in standard dialogic picturebook reading strategies, such as naming, describing, sequencing and asking open questions, without an explicit focus on emotions or emotion regulation. Both groups will use the same picturebooks and will be asked to complete three shared reading sessions per week at home.

The main hypothesis is that children in the emotion-focused shared reading group will show greater improvement in emotion regulation from baseline to 12-month follow-up than children in the standard dialogic shared reading group. The study will also examine whether the programme affects children's executive function, caregiver wellbeing and caregiver emotion regulation. Additional exploratory analyses will examine caregiver-child interaction processes and whether caregiver or child characteristics are associated with different intervention effects.

The study will recruit caregiver-child dyads through state primary schools in Greater London. Children will complete age-appropriate tasks and caregivers will complete questionnaires at baseline and follow-up. A laboratory subsample may also complete additional behavioural, observational and neurophysiological assessments. The study is low risk, non-invasive and does not involve medical treatment.

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

Child aged 4 to 5 years at baseline assessment

Child enrolled in a participating state primary school

At least one primary caregiver willing to participate in shared reading activities and study assessments

Caregiver has sufficient proficiency in English to engage with intervention materials and questionnaires

Disqualifiers

Child has an identified sensory impairment, such as uncorrected hearing or vision difficulties, that would impede engagement with study tasks

Family is unable to commit to baseline and follow-up assessments

Trial design

Design model

Parallel

Treatments tested in this trial

Emotion-Focused Shared Picturebook Reading
Behavioral
An 8-week caregiver-delivered shared picturebook reading programme designed to support emotion regulation in 4- to 5-year-old children. Caregivers receive standardised training materials, delivered through short instructional videos, introducing emotion-focused scaffolding strategies during shared reading. Strategies include emotion labelling, discussion of emotional causes and consequences, modelling of regulatory strategies and reflective questioning. Families are provided with age-appropriate picturebooks and asked to complete three shared reading sessions per week at home. Weekly feedback forms and audio recordings of the first and final sessions are used to support monitoring of engagement and fidelity.
Standard Dialogic Picturebook Reading
Behavioral
An 8-week caregiver-delivered shared picturebook reading programme used as an active comparator. Caregivers receive standardised training materials introducing dialogic and narrative reading strategies, including naming, describing, sequencing and encouraging child participation through open-ended questions. The comparator is matched to the emotion-focused intervention for duration, materials and caregiver involvement, but does not include explicit training in emotion recognition, emotional states or regulation strategies. Families use the same picturebooks as the experimental arm and are asked to complete three shared reading sessions per week at home.

Treatment groups

200 Participants

are divided into 2 treatment groups

Group A: Emotion-Focused Shared Picturebook ReadingExperimental treatment 1 intervention

Group B: Standard Dialogic Picturebook ReadingActive comparator 1 intervention

Trial outcomes

Primary outcomes

1

Change in Child Emotion Regulation

Caregiver report using the Emotion Regulation Checklist (ERC) The ERC Adaptive Emotion Regulation total scores range from 23 to 92, higher scores indicating better emotion regulation.

Time frame

Baseline and 12-month follow-up

2

Change in Child Emotion Regulation

Self-Assessment of Young children's FEELings and emotion regulation - SAY-FEEL Adaptive Emotion Regulation scores range from 11 to 33, higher scores indicating stronger self-reported emotion regulation.

Time frame

Baseline and 12-month follow-up

3

Neural Correlates of Emotion Regulation electroencephalography (EEG) recordings

Resting-state frontal alpha asymmetry. Resting-state electroencephalography (EEG) recordings will be collected during eyes-open, eyes-closed, and passive video-viewing conditions. Frontal alpha asymmetry, calculated from alpha-band power at homologous frontal electrode sites, will serve as the primary EEG-derived outcome measure. Frontal alpha asymmetry has been associated with emotion regulation, affective control, and emotional reactivity in early childhood.

Time frame

Baseline and 12-month follow-up

Secondary outcomes

1

Child Inhibitory Control Accuracy: Flanker Visual Filtering Task

Each trial children will indicate the direction of a centre fish while ignoring surrounding fish. Incompatible trials are trials where the surrounding fish face the opposite direction to the centre fish. The reported score is the percentage of incompatible trials answered correctly, ranging from 0% to 100%. Higher scores indicate better inhibitory control.

Time frame

Baseline and 12- month follow-up

2

Change in Child Cognitive Flexibility Accuracy Assessed by the Dimensional Change Card Sort Task

Child cognitive flexibility will be assessed using the Dimensional Change Card Sort task, a behavioural measure of flexible rule use in early childhood. Children are asked to sort bivalent stimuli according to one rule, such as colour, before switching to a conflicting rule, such as shape. The reported outcome will be the percentage of trials sorted correctly on trials requiring flexible rule use, including post-switch and, where administered, border or mixed-rule trials. Scores range from 0% to 100%. Higher scores indicate stronger cognitive flexibility performance.

Time frame

Baseline and 12-month follow-up

3

Change in Child Working Memory Accuracy Assessed by the Working Memory Span Task

Child working memory will be using the Working Memory Span task, a behavioural task that indexes working memory in early childhood. Children are shown visual stimuli containing animals, colours and houses, and are asked to hold animal information in mind while completing a naming demand. The reported outcome will be the percentage of working memory recall trials answered correctly, ranging from 0% to 100%. Higher scores indicate stronger working memory performance.

Time frame

Baseline and 12-month follow-up

4

Change in Caregiver-Reported Child Executive Function Assessed by the Childhood Executive Functioning Inventory

The Childhood Executive Functioning Inventory is a 26-item questionnaire assessing everyday executive function behaviours, particularly working memory and inhibition. Items are rated on a 1 to 5 scale, giving a total score range of 26 to 130. Higher scores indicate greater executive function difficulties. Change from baseline to 12-month follow-up will be compared between trial arms.

Time frame

Baseline and 12-month follow-up

Other outcomes

1

Mean Weekly Number of Shared Reading Sessions Paused or Stopped Due to Child Unwillingness as Assessed by Weekly Caregiver Feedback Form

Child willingness to continue shared reading will be assessed using a weekly caregiver feedback form. Caregivers will report whether any session was paused or stopped because the child did not wish to continue. Where this occurred, caregivers will report the number of affected sessions. Scores range from 0 to 3 sessions per week. Higher scores indicate more frequent session discontinuation due to child unwillingness.

Time frame

Weekly during the 8-week intervention period

2

Intervention Fidelity and Engagement

Intervention fidelity and engagement will be assessed using weekly caregiver feedback forms and audio recordings of the first and final home shared-reading sessions. These data will be used to describe intervention dose, engagement, adherence to assigned condition and differentiation between the emotion-focused and standard dialogic reading conditions.

Time frame

Weekly during the 8-week intervention period, with audio recordings from the first and final home shared-reading sessions

3

Rate of Caregiver Emotion Talk During Caregiver-Child Shared Reading

Caregiver emotion talk will be defined as caregiver verbal references to emotions, feelings, emotional causes, emotional consequences or emotion regulation strategies. The reported outcome will be the rate of caregiver emotion talk, calculated as the number of coded caregiver emotion-talk utterances divided by the duration of the shared-reading interaction in minutes. Scores have a minimum value of 0, with no fixed maximum. Higher values indicate more frequent caregiver emotion talk during shared reading.

Time frame

Baseline and 12-month follow-up laboratory shared-reading interaction tasks, with additional process data from the first and final home shared-reading sessions during the 8-week intervention period

4

Rate of Joint Attention Episodes During Caregiver-Child Shared Reading

Joint attention will be assessed through observational coding of caregiver-child shared-reading interactions. Joint attention episodes will be defined as coded instances in which the caregiver and child show coordinated attention to the same book-related object, image, character or event. The reported outcome will be the rate of joint attention episodes, calculated as the number of coded joint attention episodes divided by the duration of the shared-reading interaction in minutes. Scores have a minimum value of 0, with no fixed maximum. Higher values indicate more frequent joint attention during shared reading. Time Frame:

Time frame

Baseline and 12-month follow-up laboratory shared-reading interaction tasks, with additional process data from the first and final home shared-reading sessions during the 8-week intervention period

Sharing Tales That Teach: Shared Picturebook Reading for Early Childhood Emotional and Cognitive Development

About this trial

Eligibility criteria

Qualifiers

Disqualifiers

Trial design

Treatments tested in this trial

Treatment groups

Trial outcomes

Primary outcomes

Secondary outcomes

Other outcomes

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