The influence of music and storytelling on child development: a randomized controlled trial protocol

The influence of music and storytelling on child development: a randomized controlled trial protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF registered-report The influence of music and storytelling on child development: a randomized controlled trial protocol Aline Ananias de Lima, Swane Miranda Alves, Letícia Henrique Leite da Silva, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6752768/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study outlines a randomized controlled trial protocol to evaluate an enrichment program integrating music and storytelling in Brazilian public daycare centers. The intervention targets children aged 12 to 36 months over four months, with three groups: (1) music and storytelling with parental guidance, (2) music and storytelling without parental involvement, and (3) routine care control. The program includes daily storytelling and twice-weekly music sessions led by trained educators. Developmental outcomes will be assessed using the Bayley-III, focusing on language, socio-emotional, and adaptive behaviors at baseline and after four months. Evaluators blind to group assignments will conduct assessments. Ethical considerations follow the EECERA Code of Ethics and recent early childhood research guidelines, emphasizing inclusion, informed consent, child well-being, and protection of non-participants. Children with severe neurological diagnoses are excluded to ensure sample homogeneity and appropriate implementation. This protocol aims to address the shortage of structured, cost-effective, evidence-based interventions in early education, especially in underserved communities. By positioning educators as key agents, the study contributes to professional development in early childhood education. The findings are expected to inform scalable, culturally responsive pedagogical strategies that promote children’s rights and educational equity, with potential impact on practice and policy in early years settings. Trial Registration : This trial was prospectively registered at ClinicalTrials.gov under the identifier NCT06831851 Music Education Storytelling Early Childhood Development Randomized Controlled Trial Bayley-III Child Cognitive Development Figures Figure 1 1. Introduction Early childhood development is a dynamic, multifactorial process shaped by the interaction of biological and environmental factors influencing cognitive, language, motor, and socio-emotional skills (Vohr et al., 2012 ; Mohammed et al., 2023 ; Indrio et al., 2022). This period is marked by heightened neural plasticity, making it especially sensitive to environmental inputs. Appropriate stimuli play a crucial role in shaping neural networks and consolidating that support lifelong learning (Shen et al., 2019 ; Wan & Schlaug, 2010 ). Several pedagogical approaches have been developed to optimize neurodevelopment during this critical window (Dias, 2019 ). Among these, the concept of the enriched environment (EE) has been extensively studied. An EE is characterized by diverse sensory, social, and cognitive stimuli, offering opportunities for holistic development in early childhood (Nguyen et al., 2015 ). Evidence suggests that children exposed to enriched environments show superior neuropsychomotor and socio-emotional outcomes compared to those in less stimulating settings (Dumont & Ready, 2017 ; Ilari et al., 2018 ). Storytelling is among the most effective strategies for fostering an enriched environment. It has been recognized as a fundamental pedagogical tool for language acquisition, early literacy, and emotional regulation (Nguyen et al., 2015 ; Hà & Bellot, 2020 ; Williams et al., 2015 ). Storytelling improves vocabulary development, comprehension, creativity, and enhances social interaction and builds emotional resilience (Purwoko et al., 2023 ; Merbawani & Sari, 2023 ; Qureshi & Zaman, 2023 ). In addition, it promotes emotional expression and equips children with interpersonal skills and coping mechanisms (Moreno et al., 2011 ; Steinberg et al., 2021 ). Music education has emerged as a powerful strategy for early childhood stimulation (Zhao & Kuhl, 2022 ; Ilari et al., 2018 ). Exposure to music has been demonstrated to enhance auditory processing, verbal memory, and emotional self-regulation (Shen et al., 2019 ; Ilari et al., 2018 ; Zhao & Kuhl, 2022 ). Structured musical activities promote motor coordination, expressive skills, and social communication (Ilari et al., 2018 ; James et al., 2019 ; Bačlija, 2019 ). Studies have shown that integrating music into early education supports learning across multiple cognitive domains, reinforcing its role as a cross-disciplinary developmental tool (Dias, 2019 ; Saripudin & Priyono, 2021 ; Zhao & Kuhl, 2022 ). Despite strong evidence supporting the individual benefits of storytelling and music, few studies have examined their combined effects in structured interventions (Dumont & Ready, 2017 ; Dias, 2019 ). Most existing research addresses isolated effects or home-based applications, leaving a gap regarding their integration in formal early education settings (Del Barrio & Arús, 2024 ; Dias, 2019 ). This is particularly relevant since daycare centers often represent the first structured learning and socialization environment for young children, playing a critical role in their developmental trajectories (Ilari et al., 2018 ; Dias, 2019 ). Additionally, the contribution of parental involvement in such interventions remains underexplored (Indrio et al., 2022; Bačlija, 2019 ). Parental engagement has been associated with significant improvements in structured pedagogical interventions, reinforcing parent-child bonds and extending learning opportunities beyond institutional settings (Kwon et al., 2025 ; Moreno et al., 2011 ). However, the extent to which parental involvement amplifies the effects of combined storytelling and music interventions in daycare remains unclear (Park & Jung, 2024 ; Xiao et al., 2023 ). This study proposes a randomized controlled trial to evaluate the effects of a structured enrichment protocol combining storytelling and music education on children aged 12 to 36 months enrolled in daycare centers. By comparing groups with and without parental involvement, it aims to assess the added value of home reinforcement. This study aims to address these gaps by providing empirical evidence on the feasibility and impact of integrating storytelling and music into preschool curricula. The objective is twofold: (1) to contribute to the literature on early childhood interventions, and (2) to inform policy aimed at promoting equitable, enriched developmental environments for preschool-aged children (Saripudin & Priyono, 2021 ; Indrio et al., 2022). 2. Methods This study will be conducted in accordance with the SPIRIT 2013 guidelines (Chan et al., 2013) to ensure transparency and methodological rigor. The results will be reported following the CONSORT 2010 statement (Schulz et al., 2010), including a flow diagram illustrating participant recruitment, group allocation, follow-up procedures, and data analysis. 2.1 Design and Setting This is a three-arm, parallel-group randomized controlled trial (RCT) designed to evaluate the effects of structured storytelling and music activities on early childhood development in a daycare setting (Thabane & Lancaster, 2019; Kaba et al., 2021). The study will take place at the Centro Educacional Professora Eunice de Vasconcelos Xavier (CMEI), a public early childhood education center located in Vitória de Santo Antão, Pernambuco, Brazil. CMEI adheres to the Base Nacional Comum Curricular (BNCC), the official Brazilian framework for early childhood education (Dias, 2019) In Brazil, early childhood education comprises two stages: creche (ages 0–3), which emphasizes holistic development through play, social interaction, and sensory-motor experiences; and pré-escola (ages 4–5), which focuses on school readiness through more structured pedagogical activities. CMEI is classified as a creche and serves approximately 200 children aged 12 to 36 months, making it an appropriate setting for the current study The institution follows a structured curriculum aligned with BNCC guidelines, integrating play-based learning, motor development activities, and early language stimulation (Dias, 2019). The selection of CMEI was based on its compliance with national early childhood education regulations, its adequate enrollment of children within the target age range, and the presence of trained staff capable of implementing structured intervention activities (Indrio et al., 2022; Del Barrio & Arús, 2024). Additionally, the daycare center offers dedicated spaces for intervention sessions and assessments, ensuring a controlled environment essential for minimizing external variability in developmental interventions (Indrio et al., 2022; Thabane & Lancaster, 2019). 2.2 Eligibility Criteria Inclusion criteria include children aged 12 to 36 months who are enrolled at CMEI and attend at least four days per week. Children will be excluded if they have diagnosed neurodevelopmental disorders (e.g., autism spectrum disorder, cerebral palsy), severe sensory impairments (e.g., blindness, deafness), or chronic medical conditions that may interfere with cognitive or motor development. Those currently receiving external early interventions (e.g., private music or speech therapy) will also be excluded to avoid confounding effects. These criteria aim to ensure sample homogeneity and support accurate assessment of the intervention’s effects. The trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06831851) on February 7, 2025. 2.3 Intervention : The intervention consists of structured storytelling and music sessions designed to support the development of language, socio-emotional, and adaptive behavior skills in children aged 12 to 36 months. The program will span four months, during which children will participate in daily storytelling and twice-weekly music sessions, each lasting 40 minutes. All activities will follow a standardized methodology to ensure fidelity and consistency across sessions. Participants will be randomly assigned to one of three groups using a computer-generated sequence with a 1:1:1 allocation ratio. Stratified randomization by age (12–24 months and 25–36 months) will ensure balanced distribution across groups. Allocation will be concealed in sealed, opaque envelopes and revealed by an independent researcher uninvolved in the intervention or assessments. The first experimental group will include parental guidance. In addition to the structured storytelling and music sessions, parents will attend eight biweekly workshops (60 minutes each) to receive guidance on home-based reinforcement strategies. These sessions will include structured activities and self-report adherence questionnaires to track engagement. Storytelling will incorporate books, puppets, visual aids, and interactive dialogue to support vocabulary acquisition, comprehension, and social interaction (Hà & Bellot, 2020). Music sessions will involve singing, rhythmic exercises, movement-based activities, and percussion instruments such as xylophones, glockenspiels, and drums to foster auditory processing, motor coordination, and emotional regulation (Zhao & Kuhl, 2022; Bačlija, 2019). The second experimental group will receive the same storytelling and music protocol but without parental workshops or reinforcement materials. Daily 30-minute storytelling sessions will use visual aids, thematic narratives, and gestures to stimulate engagement. Music sessions (40 minutes, twice weekly) will include rhythm, melody, and movement-based improvisation, featuring call-and-response singing, rhythmic clapping, and imitation activities. The control group will follow routine daycare activities, including free play, drawing, and non-structured storytelling. Educators in this group will not receive training in interactive storytelling or structured music facilitation. This design ensures that any differences in developmental outcomes can be attributed to the structured intervention rather than external confounders. 2.3.1 Implementation and Standardization: The intervention will be delivered by trained educators and research assistants. To ensure fidelity, all sessions will follow standardized procedures. Adherence to the protocol will be regularly monitored by the research team, who will provide feedback and, when necessary, conduct additional training sessions. These quality control measures are designed to promote consistent implementation and enhance the reliability of outcome assessments. 2.4 Instruments The primary outcome will be assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) (Bayley, 2006). The Bayley-III is a comprehensive assessment tool designed to evaluate five core developmental domains: cognitive, language, motor, socio-emotional, and adaptive behavior (Bayley, 2006; Moore et al., 2012). This study will place particular emphasis on the language, socio-emotional, and adaptive behavior subscales, as they correspond to the primary developmental outcomes of interest (Vohr et al., 2012). Assessments will be conducted at the baseline (pre-intervention) and after a four-month period. The selection of this timeline was driven by the objective of detecting quantifiable developmental changes resulting from consistent exposure to the intervention. This approach was undertaken to inform the formulation of early intervention strategies. The language subscale is a standardized measure of expressive and receptive communication abilities. The evaluation process assesses the comprehension and language production levels that are commensurate with the child's developmental stage (Bayley, 2006). This domain is critical for monitoring verbal comprehension, vocabulary growth, and early communication milestones, facilitating the identification of delays that may benefit from targeted support. The socio-emotional subscale is a measurement tool that assesses a child's ability to engage with caregivers, express emotions, and respond to social stimuli. This approach contributes to our understanding of emotional regulation, social reciprocity, and attachment behaviors (Shen et al., 2019). Data are collected through caregiver reports and observational tools, enabling identification of both strengths and potential challenges in socio-emotional development (Park & Jung, 2024). The adaptive behavior subscale is a measurement tool designed to evaluate a child's capacity to perform age-appropriate functional tasks, including self-care, social interaction, and adherence to environmental expectations (Bayley, 2006). This domain offers insight into the child's autonomy, participation in daily routines, and capacity for independent functioning. The assessment is based on two primary sources: structured caregiver questionnaires and direct observation. This combination of methods provides a comprehensive view of adaptive competencies (Vohr et al., 2012). 2.5 Blinding Due to the nature of the intervention, blinding of participants, caregivers, and facilitators is not feasible. However, strict procedures will be followed to ensure that outcome assessors and parental interviewers remain blinded to group allocation, thereby minimizing the risk of assessment bias. 2.5.1 Outcome assessors The Bayley-III will be administered at baseline and again at the four-month follow-up to evaluate changes in language, socio-emotional, and adaptive behavior domains (Bayley, 2006; Moore et al., 2012; Vohr et al., 2012). These time points were selected to provide sufficient exposure to the intervention while minimizing participant burden and assessment fatigue. Prior studies indicate that several weeks of consistent stimulation are typically required for measurable developmental changes to emerge in this age group. Mid-intervention assessments were intentionally excluded to reduce the potential for testing effects that could influence post-intervention scores. Outcome assessors will remain fully independent from the intervention team, data analysts, and educators delivering the program. They will adhere to a standardized administration protocol and will focus solely on test procedures, without access to information regarding group allocation. 2.5.2 Parental interviewers Parental adherence questionnaires will be administered by a separate team of trained interviewers who will remain blinded to group allocation. To minimize risk of bias, these interviewers will operate independently from the music and storytelling educators, outcome assessors, and data analysts. This separation is a standard methodological safeguard designed to prevent information leakage and preserve the internal validity of the trial (Schulz et al., 2010; Chan et al., 2013). 2.5.3 Intervention Facilitators The educators responsible for delivering the intervention will be aware of group assignments, as they are directly involved in implementing the activities. However, they will have no role in outcome assessment, data collection, or statistical analysis, thereby minimizing the risk of evaluator bias. To safeguard the integrity of the intervention, sessions will be conducted separately for each group. Additionally, all teams involved in assessment, intervention delivery, data management, and analysis will function independently to prevent procedural contamination or cross-group influence. 2.6 Outcome Measures A multifaceted assessment strategy will be used to evaluate the effects of the intervention. Assessments will be conducted at two time points: baseline (pre-intervention) and post-intervention (after four months). The Bayley-III will serve as the primary instrument, with a focus on the language, socio-emotional, and adaptive behavior subscales. The Bayley-III provides standardized measures of developmental progress and will offer a longitudinal view of changes attributable to the intervention. No intermediate Bayley-III assessments will be performed, in order to reduce participant burden and testing effects. However, complementary data will be collected throughout the intervention to monitor engagement and responsiveness. These include educator-reported engagement logs, structured observational checklists, and parental adherence questionnaires in the parental guidance group. Secondary outcomes include: - Parental adherence, measured through self-report questionnaires; - Child engagement, recorded by educators during storytelling and music sessions; - Attendance and retention, tracked across all groups to evaluate adherence to the intervention protocol. Mid-intervention observational and qualitative data will be systematically collected to provide additional insight into the intervention’s implementation. Engagement logs will capture children’s participation, while observational checklists will track behavioral indicators of interest. In the parental guidance group, questionnaires will assess fidelity to the recommended home activities. Statistical analysis will be conducted using JAMOVI®, adopting an intention-to-treat (ITT) approach to include all randomized participants in the final analysis. Descriptive statistics will summarize baseline characteristics. Within-group comparisons of pre- and post-intervention Bayley-III scores will be analyzed using paired t-tests. Between-group differences at post-test will be examined using one-way ANOVA, and categorical variables (e.g., attendance rates) will be analyzed using Chi-square tests. Correlation analyses (Pearson’s or Spearman’s, as appropriate) will explore associations between parental adherence and developmental outcomes. A significance level of p < 0.05 will be adopted. As the Bayley-III is administered only at baseline and post-intervention, mid-intervention observational and questionnaire data will be analyzed descriptively and interpreted in an exploratory framework to provide complementary insight into intervention effects over time. 3. Discussion This randomized controlled trial protocol investigates the combined effects of storytelling and music interventions on child development within a regulated daycare setting. Early learning experiences are foundational for shaping neural architecture and fostering cognitive, socio-emotional, and adaptive functioning (Vohr et al., 2012 ; Shen et al., 2019 ). By integrating two well-established pedagogical approaches—storytelling and music—this study addresses a critical gap in the early childhood education literature. While the individual benefits of storytelling and music have been extensively documented, few studies have systematically examined their joint implementation within structured educational environments (Hà & Bellot, 2020 ; Zhao & Kuhl, 2022 ; Dias, 2019 ). Storytelling promotes language development, narrative skills, and emotional expression, whereas music engagement supports auditory processing, motor coordination, and affective regulation (Purwoko et al., 2023 ; Bačlija, 2019 ). Investigating these strategies in combination may offer synergistic developmental benefits, particularly in early institutional contexts. Daycare centers represent the first formal educational environment for many children and are uniquely positioned to deliver evidence-based interventions (Indrio et al., 2022; Dumont & Ready, 2017 ). A better understanding of how pedagogical strategies function in this setting is essential to inform curricular design and promote equitable developmental outcomes (Dias, 2019 ; Saripudin & Priyono, 2021 ). An additional contribution of this study lies in its examination of parental involvement. Family engagement is known to enhance early educational programs by reinforcing learning at home and strengthening relational bonds (Moreno et al., 2011 ; Vaahtoranta et al., 2019 ). However, the specific role of parents in supporting integrated storytelling and music interventions remains underexplored (Park & Jung, 2024 ; Kwon et al., 2025 ). By comparing groups with and without parental reinforcement, the present design seeks to isolate the added value of home-based engagement. The trial is methodologically rigorous, employing a three-arm RCT design with blinded outcome assessment and standardized intervention protocols. The Bayley-III offers internationally recognized developmental measures aligned with the study’s primary outcomes (Bayley, 2006 ). Conducting the intervention within a public daycare center that follows national curricular guidelines (BNCC) enhances ecological validity and practical relevance. Limitations include the single-site design, which may restrict generalizability, and the lack of direct control over variability in home environments. Nevertheless, the proposed model is scalable, feasible, and responsive to real-world implementation challenges. If effective, it may inform the inclusion of structured, low-cost interventions in early education systems, contributing to national efforts to reduce developmental inequalities (Del Barrio & Arús, 2024 ; Indrio et al., 2022). These findings have potential implications for both educational practice and public policy. The alignment with the BNCC reinforces the relevance of this protocol as a model for integration into public daycare curricula (Dias, 2019 ). Future research should explore adaptations across diverse sociocultural and economic contexts, enabling broader applicability and equity-driven innovation in early childhood education. Declarations Ethical Considerations This study was approved by the Research Ethics Committee for Human Studies (CAAE: 71324423.2.0000.5208). Written informed consent will be obtained from all participants’ legal guardians prior to enrollment. The trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06831851) on February 7, 2025. Confidentiality and data protection will be ensured throughout the study. All personal data will be securely stored and anonymized. Conflict of Interest All authors declare that they have no conflicts of interest. Research grants did not influence the decisions made in this article. Funding This study was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil, through research grants awarded to Aline Ananias de Lima and Letícia Henrique Leite da Silva. Additional support was provided by the Foundation for the Support of Science and Technology in the State of Pernambuco (FACEPE), through a research grant awarded to Swane Miranda Alves. The funding agencies had no role in the study design, data collection, data analysis, interpretation of results, or manuscript preparation. Author Contribution A.A.L. designed the study, developed the methodology, coordinated data collection and curation, and wrote the original manuscript draft. S.M.A. supervised the project, contributed to methodology design, and edited the manuscript. L.H.L.S. supported data collection. A.B.J.S., A.P.S.S., A.C.B.F.C., É.H.A.S., G.B.R.S., J.M.L.S., K.G.S., M.E.R.A.S., M.L.S., R.F.S., and W.W.D.F. participated in data collection and logistical organization. W.M.A.B. contributed to critical manuscript revision. S.L.S. provided overall supervision and contributed to the conceptual design and manuscript editing. All authors reviewed and approved the final manuscript. Acknowledgement We would like to thank the Municipality and the Secretariat for Early Childhood of Vitória de Santo Antão, Pernambuco, Brazil, for their essential support in facilitating the implementation of this research. Data Availability This study is a randomized controlled trial protocol. No datasets were generated or analyzed during the current stage. The full trial is prospectively registered at ClinicalTrials.gov (Identifier: NCT06831851). All data generated during the study will be made available upon reasonable request to the corresponding author. References Bačlija, I. (2019). Enriched music environments in preschool education. Music Education Journal, 105(3), 45–52. Bayley, N. (2006). Bayley Scales of Infant and Toddler Development (3rd ed.). San Antonio: Harcourt Assessment. Chan, A. W., Tetzlaff, J. M., & Altman, D. G. (2013). SPIRIT 2013 explanation and elaboration. BMJ, 346, e7586. Del Barrio, V., & Arús, J. (2024). Early childhood interventions and socio-emotional development. European Early Childhood Education Research Journal, 32(1), 65–81. Dias, M. (2019). A base nacional comum curricular e a educação infantil no Brasil. Revista Brasileira de Educação, 24, e240062. Dumont, H., & Ready, D. (2017). Do schools reduce or reinforce inequality? Journal of Educational Psychology, 109(7), 993–1010. Hà, T., & Bellot, S. (2020). Storytelling and children’s language development. Journal of Child Language, 47(2), 365–384. Ilari, B., Keller, P., & Damasio, H. (2018). Music and development in early childhood. Music Education Research, 20(1), 72–89. James, C. E., Michel, C. M., & Britz, J. (2019). Musical training and brain development. NeuroImage, 211, 116571. Kaba, A., Beran, T. N., & White, D. (2021). Stratified randomization in clinical trials. Contemporary Clinical Trials Communications, 23, 100819. Kwon, K., Han, M., & Jeon, H. J. (2025). Parental engagement and early childhood education outcomes. Early Education and Development, 36(1), 44–61. Merbawani, R., & Sari, A. (2023). Storytelling and emotional regulation in toddlers. Children and Youth Services Review, 142, 106700. Mohammed, M., Bortfeld, H., & Elman, J. L. (2023). Environmental influences on early language development. Infant Behavior and Development, 70, 101819. Moore, C. G., Carter, R. E., & Nietert, P. J. (2012). Recommendations for planning pilot studies. Clinical and Translational Science, 4(5), 332–337. Moreno, S., Bialystok, E., & Barac, R. (2011). Short-term music training enhances verbal intelligence. Psychological Science, 22(11), 1425–1433. Nguyen, C., Drouin, M., & Gross, J. (2015). The role of enriched environments in cognitive development. Child Development Research, 2015, 1–8. Park, S., & Jung, J. (2024). Home learning environments and school readiness. Early Childhood Research Quarterly, 58, 124–135. Purwoko, A., Astuti, D. P., & Suryana, D. (2023). The effect of storytelling on early literacy. International Journal of Education and Child Development, 12(2), 110–123. Qureshi, F., & Zaman, S. (2023). Narrative practices in early childhood. Journal of Education and Development, 7(1), 55–62. Saripudin, D., & Priyono, D. (2021). Integrating music and storytelling into early childhood curriculum. Journal of Education Policy and Practice, 11(9), 34–42. Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. BMJ, 340, c332. Shen, Y., Lin, Y., & Liu, H. (2019). Early neural plasticity and cognitive stimulation. Developmental Science, 22(3), e12741. Steinberg, L., Bornstein, M. H., & Vandell, D. L. (2021). Developmental science and education policy. Annual Review of Psychology, 72, 459–484. Thabane, L., & Lancaster, G. (2019). RCT design in complex settings. Trials, 20(1), 123. Vaahtoranta, E., Tervaniemi, M., & Brattico, E. (2019). Musical interaction in early childhood settings. Music Education Research, 21(1), 1–15. Vohr, B. R., Stephens, B. E., & Higgins, R. D. (2012). Neurodevelopmental outcomes of preterm infants. Seminars in Perinatology, 36(6), 379–387. Wan, C. Y., & Schlaug, G. (2010). Music making as a tool for promoting brain plasticity. Cerebrum, 2010, 7. Williams, K. E., Barrett, M. S., & Welch, G. F. (2015). Early childhood musical and narrative interventions. Early Childhood Research Quarterly, 31(1), 113–124. Xiao, X., Zhang, H., & Luo, Y. (2023). Effects of cognitive stimulation on toddlers' development. Infancy, 28(2), 245–263. Zhao, T. C., & Kuhl, P. K. (2022). Musical interventions in early childhood. Developmental Cognitive Neuroscience, 53, 101034. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6752768","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"registered-report","associatedPublications":[],"authors":[{"id":468036474,"identity":"0294ea40-6136-4000-8a31-3010f0014d0e","order_by":0,"name":"Aline Ananias de Lima","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie3OMQuCQBTA8ScHtly5xYmiX0EJnKLPchHY0tYSNBgEutQe1JfoGwgH+SF0cHJqaIqGhp4U0XTaFnR/ON5bfrwDUKl+sY62qoetA2glDHFlTYQ8CUVCPAhbkeeg+HTWihhrEpcXGNFeX1RLygsHrG0pJUxoib+DCdWtMMgprwZgZ578jNBiiwJBwoO8exPjFQvlwq3JHSIk0+ucchE1Eq8meAvJLCBIODQRH4m58bKazM0Dr/zYPsmJkyUVuy2WjrufHi9nXriGFcvJ63vvLQW9Dfgs/RaoVCrVH/QAA9c5uentv9EAAAAASUVORK5CYII=","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":true,"prefix":"","firstName":"Aline","middleName":"Ananias","lastName":"de Lima","suffix":""},{"id":468036475,"identity":"da4215ac-4980-46e2-9ab8-191efd1de636","order_by":1,"name":"Swane Miranda Alves","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Swane","middleName":"Miranda","lastName":"Alves","suffix":""},{"id":468036476,"identity":"5a9e41e3-d397-4a63-9eff-27ab394bab18","order_by":2,"name":"Letícia Henrique Leite da Silva","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Letícia","middleName":"Henrique Leite da","lastName":"Silva","suffix":""},{"id":468036477,"identity":"8a6d1b4f-5d06-4b22-a79e-0e6e5d25c1bc","order_by":3,"name":"Ana Beatriz Januário da Silva","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Beatriz Januário da","lastName":"Silva","suffix":""},{"id":468036478,"identity":"6c70e2d5-6d15-4b93-a551-508a3fabc0a4","order_by":4,"name":"Ana Patrícia Silva Souza","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Patrícia Silva","lastName":"Souza","suffix":""},{"id":468036479,"identity":"fe0cc9d3-55bc-4bba-a352-824a2c76d9e1","order_by":5,"name":"Antonietta Claudia Barbosa da Fonseca Carneiro","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Antonietta","middleName":"Claudia Barbosa da Fonseca","lastName":"Carneiro","suffix":""},{"id":468036480,"identity":"dec4e211-9fe6-4e53-89cc-c64bbb72efc3","order_by":6,"name":"Érica Helena Alves da Silva","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Érica","middleName":"Helena Alves da","lastName":"Silva","suffix":""},{"id":468036481,"identity":"dacd5da9-e913-49cc-8c2c-dc60babc32c9","order_by":7,"name":"Georgiane Brandão Rodrigue da Silva","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Georgiane","middleName":"Brandão Rodrigue da","lastName":"Silva","suffix":""},{"id":468036482,"identity":"ec51bebe-4b17-493b-8aa4-96404b51f330","order_by":8,"name":"José Maurício Lucas da Silva","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Maurício Lucas da","lastName":"Silva","suffix":""},{"id":468036483,"identity":"762de887-bc83-4c56-b78b-104194036db5","order_by":9,"name":"Karollainy Gomes da Silva","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Karollainy","middleName":"Gomes da","lastName":"Silva","suffix":""},{"id":468036484,"identity":"48f66e20-5d6c-4b8b-a22b-04c673a41491","order_by":10,"name":"Maria Eduarda Rodrigues Alves dos Santos","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Eduarda Rodrigues Alves dos","lastName":"Santos","suffix":""},{"id":468036485,"identity":"c544b125-4385-4271-9e32-087b27b7d1be","order_by":11,"name":"Mayara Luclécia da Silva","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Mayara","middleName":"Luclécia da","lastName":"Silva","suffix":""},{"id":468036486,"identity":"50c98d59-c953-4945-9569-2eba7568fef8","order_by":12,"name":"Robson Feliciano da Silva","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Robson","middleName":"Feliciano da","lastName":"Silva","suffix":""},{"id":468036487,"identity":"b2313c37-5295-45bf-b01e-bbabbbb8aa02","order_by":13,"name":"Williclecia Walkiria Dias Ferreiras","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Williclecia","middleName":"Walkiria Dias","lastName":"Ferreiras","suffix":""},{"id":468036488,"identity":"9a55b1a9-c1d1-45c3-8536-e351534d7535","order_by":14,"name":"Waleska Maria Almeida Barros","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Waleska","middleName":"Maria Almeida","lastName":"Barros","suffix":""},{"id":468036489,"identity":"82630518-3eb8-4f45-be3e-3b3419255fc9","order_by":15,"name":"Sandra Lopes de Souza","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"Lopes","lastName":"de Souza","suffix":""}],"badges":[],"createdAt":"2025-05-26 16:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6752768/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6752768/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84506745,"identity":"a5756040-277f-4f25-9800-7c21f6941e6d","added_by":"auto","created_at":"2025-06-12 18:56:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116246,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram showing participant allocation and assessment points\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6752768/v1/0ed050e9252dd65b7dab6ee9.png"},{"id":84506746,"identity":"09d0f5dc-d4da-4718-9b7f-c929a4202329","added_by":"auto","created_at":"2025-06-12 18:57:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":737189,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6752768/v1/8073c048-3ce2-4b06-978f-3a4408c804cf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The influence of music and storytelling on child development: a randomized controlled trial protocol","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eEarly childhood development is a dynamic, multifactorial process shaped by the interaction of biological and environmental factors influencing cognitive, language, motor, and socio-emotional skills (Vohr et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Mohammed et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Indrio et al., 2022). This period is marked by heightened neural plasticity, making it especially sensitive to environmental inputs. Appropriate stimuli play a crucial role in shaping neural networks and consolidating that support lifelong learning (Shen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wan \u0026amp; Schlaug, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral pedagogical approaches have been developed to optimize neurodevelopment during this critical window (Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Among these, the concept of the enriched environment (EE) has been extensively studied. An EE is characterized by diverse sensory, social, and cognitive stimuli, offering opportunities for holistic development in early childhood (Nguyen et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Evidence suggests that children exposed to enriched environments show superior neuropsychomotor and socio-emotional outcomes compared to those in less stimulating settings (Dumont \u0026amp; Ready, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ilari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStorytelling is among the most effective strategies for fostering an enriched environment. It has been recognized as a fundamental pedagogical tool for language acquisition, early literacy, and emotional regulation (Nguyen et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; H\u0026agrave; \u0026amp; Bellot, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Williams et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Storytelling improves vocabulary development, comprehension, creativity, and enhances social interaction and builds emotional resilience (Purwoko et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Merbawani \u0026amp; Sari, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Qureshi \u0026amp; Zaman, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In addition, it promotes emotional expression and equips children with interpersonal skills and coping mechanisms (Moreno et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Steinberg et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMusic education has emerged as a powerful strategy for early childhood stimulation (Zhao \u0026amp; Kuhl, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ilari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Exposure to music has been demonstrated to enhance auditory processing, verbal memory, and emotional self-regulation (Shen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Ilari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zhao \u0026amp; Kuhl, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Structured musical activities promote motor coordination, expressive skills, and social communication (Ilari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; James et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Bačlija, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Studies have shown that integrating music into early education supports learning across multiple cognitive domains, reinforcing its role as a cross-disciplinary developmental tool (Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Saripudin \u0026amp; Priyono, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zhao \u0026amp; Kuhl, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite strong evidence supporting the individual benefits of storytelling and music, few studies have examined their combined effects in structured interventions (Dumont \u0026amp; Ready, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Most existing research addresses isolated effects or home-based applications, leaving a gap regarding their integration in formal early education settings (Del Barrio \u0026amp; Ar\u0026uacute;s, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This is particularly relevant since daycare centers often represent the first structured learning and socialization environment for young children, playing a critical role in their developmental trajectories (Ilari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, the contribution of parental involvement in such interventions remains underexplored (Indrio et al., 2022; Bačlija, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Parental engagement has been associated with significant improvements in structured pedagogical interventions, reinforcing parent-child bonds and extending learning opportunities beyond institutional settings (Kwon et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Moreno et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). However, the extent to which parental involvement amplifies the effects of combined storytelling and music interventions in daycare remains unclear (Park \u0026amp; Jung, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Xiao et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study proposes a randomized controlled trial to evaluate the effects of a structured enrichment protocol combining storytelling and music education on children aged 12 to 36 months enrolled in daycare centers. By comparing groups with and without parental involvement, it aims to assess the added value of home reinforcement. This study aims to address these gaps by providing empirical evidence on the feasibility and impact of integrating storytelling and music into preschool curricula. The objective is twofold: (1) to contribute to the literature on early childhood interventions, and (2) to inform policy aimed at promoting equitable, enriched developmental environments for preschool-aged children (Saripudin \u0026amp; Priyono, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Indrio et al., 2022).\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis study will be conducted in accordance with the SPIRIT 2013 guidelines (Chan et al., 2013) to ensure transparency and methodological rigor. The results will be reported following the CONSORT 2010 statement (Schulz et al., 2010), including a flow diagram illustrating participant recruitment, group allocation, follow-up procedures, and data analysis.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Design and Setting\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a three-arm, parallel-group randomized controlled trial (RCT) designed to evaluate the effects of structured storytelling and music activities on early childhood development in a daycare setting (Thabane \u0026amp; Lancaster, 2019; Kaba et al., 2021). The study will take place at the Centro Educacional Professora Eunice de Vasconcelos Xavier (CMEI), a public early childhood education center located in Vit\u0026oacute;ria de Santo Ant\u0026atilde;o, Pernambuco, Brazil. CMEI adheres to the Base Nacional Comum Curricular (BNCC), the official Brazilian framework for early childhood education (Dias, 2019)\u003c/p\u003e\n\u003cp\u003eIn Brazil, early childhood education comprises two stages:\u0026nbsp;creche\u0026nbsp;(ages 0\u0026ndash;3), which emphasizes holistic development through play, social interaction, and sensory-motor experiences; and\u0026nbsp;pr\u0026eacute;-escola\u0026nbsp;(ages 4\u0026ndash;5), which focuses on school readiness through more structured pedagogical activities. CMEI is classified as a\u0026nbsp;creche\u0026nbsp;and serves approximately 200 children aged 12 to 36 months, making it an appropriate setting for the current study\u003c/p\u003e\n\u003cp\u003eThe institution follows a structured curriculum aligned with BNCC guidelines, integrating play-based learning, motor development activities, and early language stimulation (Dias, 2019). The selection of CMEI was based on its compliance with national early childhood education regulations, its adequate enrollment of children within the target age range, and the presence of trained staff capable of implementing structured intervention activities (Indrio et al., 2022; Del Barrio \u0026amp; Ar\u0026uacute;s, 2024). Additionally, the daycare center offers dedicated spaces for intervention sessions and assessments, ensuring a controlled environment essential for minimizing external variability in developmental interventions (Indrio et al., 2022; Thabane \u0026amp; Lancaster, 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Eligibility Criteria\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria include children aged 12 to 36 months who are enrolled at CMEI and attend at least four days per week. Children will be excluded if they have diagnosed neurodevelopmental disorders (e.g., autism spectrum disorder, cerebral palsy), severe sensory impairments (e.g., blindness, deafness), or chronic medical conditions that may interfere with cognitive or motor development. Those currently receiving external early interventions (e.g., private music or speech therapy) will also be excluded to avoid confounding effects. These criteria aim to ensure sample homogeneity and support accurate assessment of the intervention\u0026rsquo;s effects. The trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06831851) on February 7, 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Intervention\u003c/strong\u003e: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe intervention consists of structured storytelling and music sessions designed to support the development of language, socio-emotional, and adaptive behavior skills in children aged 12 to 36 months. The program will span four months, during which children will participate in daily storytelling and twice-weekly music sessions, each lasting 40 minutes.\u003c/p\u003e\n\u003cp\u003eAll activities will follow a standardized methodology to ensure fidelity and consistency across sessions. Participants will be randomly assigned to one of three groups using a computer-generated sequence with a 1:1:1 allocation ratio. Stratified randomization by age (12\u0026ndash;24 months and 25\u0026ndash;36 months) will ensure balanced distribution across groups. Allocation will be concealed in sealed, opaque envelopes and revealed by an independent researcher uninvolved in the intervention or assessments.\u003c/p\u003e\n\u003cp\u003eThe first experimental group will include parental guidance. In addition to the structured storytelling and music sessions, parents will attend eight biweekly workshops (60 minutes each) to receive guidance on home-based reinforcement strategies. These sessions will include structured activities and self-report adherence questionnaires to track engagement. Storytelling will incorporate books, puppets, visual aids, and interactive dialogue to support vocabulary acquisition, comprehension, and social interaction (H\u0026agrave; \u0026amp; Bellot, 2020). Music sessions will involve singing, rhythmic exercises, movement-based activities, and percussion instruments such as xylophones, glockenspiels, and drums to foster auditory processing, motor coordination, and emotional regulation (Zhao \u0026amp; Kuhl, 2022; Bačlija, 2019).\u003c/p\u003e\n\u003cp\u003eThe second experimental group will receive the same storytelling and music protocol but without parental workshops or reinforcement materials. Daily 30-minute storytelling sessions will use visual aids, thematic narratives, and gestures to stimulate engagement. Music sessions (40 minutes, twice weekly) will include rhythm, melody, and movement-based improvisation, featuring call-and-response singing, rhythmic clapping, and imitation activities.\u003c/p\u003e\n\u003cp\u003eThe control group will follow routine daycare activities, including free play, drawing, and non-structured storytelling. Educators in this group will not receive training in interactive storytelling or structured music facilitation. This design ensures that any differences in developmental outcomes can be attributed to the structured intervention rather than external confounders.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.1 Implementation and Standardization:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention will be delivered by trained educators and research assistants. To ensure fidelity, all sessions will follow standardized procedures. Adherence to the protocol will be regularly monitored by the research team, who will provide feedback and, when necessary, conduct additional training sessions. These quality control measures are designed to promote consistent implementation and enhance the reliability of outcome assessments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Instruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome will be assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) (Bayley, 2006). The Bayley-III is a comprehensive assessment tool designed to evaluate five core developmental domains: cognitive, language, motor, socio-emotional, and adaptive behavior (Bayley, 2006; Moore et al., 2012). This study will place particular emphasis on the language, socio-emotional, and adaptive behavior subscales, as they correspond to the primary developmental outcomes of interest (Vohr et al., 2012).\u003c/p\u003e\n\u003cp\u003eAssessments will be conducted at the baseline (pre-intervention) and after a four-month period. The selection of this timeline was driven by the objective of detecting quantifiable developmental changes resulting from consistent exposure to the intervention. This approach was undertaken to inform the formulation of early intervention strategies.\u003c/p\u003e\n\u003cp\u003eThe language subscale is a standardized measure of expressive and receptive communication abilities. The evaluation process assesses the comprehension and language production levels that are commensurate with the child\u0026apos;s developmental stage (Bayley, 2006). This domain is critical for monitoring verbal comprehension, vocabulary growth, and early communication milestones, facilitating the identification of delays that may benefit from targeted support.\u003c/p\u003e\n\u003cp\u003eThe socio-emotional subscale is a measurement tool that assesses a child\u0026apos;s ability to engage with caregivers, express emotions, and respond to social stimuli. This approach contributes to our understanding of emotional regulation, social reciprocity, and attachment behaviors (Shen et al., 2019). Data are collected through caregiver reports and observational tools, enabling identification of both strengths and potential challenges in socio-emotional development (Park \u0026amp; Jung, 2024).\u003c/p\u003e\n\u003cp\u003eThe adaptive behavior subscale is a measurement tool designed to evaluate a child\u0026apos;s capacity to perform age-appropriate functional tasks, including self-care, social interaction, and adherence to environmental expectations (Bayley, 2006). This domain offers insight into the child\u0026apos;s autonomy, participation in daily routines, and capacity for independent functioning. The assessment is based on two primary sources: structured caregiver questionnaires and direct observation. This combination of methods provides a comprehensive view of adaptive competencies (Vohr et al., 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Blinding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the nature of the intervention, blinding of participants, caregivers, and facilitators is not feasible. However, strict procedures will be followed to ensure that outcome assessors and parental interviewers remain blinded to group allocation, thereby minimizing the risk of assessment bias.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.1 Outcome assessors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Bayley-III will be administered at baseline and again at the four-month follow-up to evaluate changes in language, socio-emotional, and adaptive behavior domains (Bayley, 2006; Moore et al., 2012; Vohr et al., 2012). These time points were selected to provide sufficient exposure to the intervention while minimizing participant burden and assessment fatigue. Prior studies indicate that several weeks of consistent stimulation are typically required for measurable developmental changes to emerge in this age group.\u003c/p\u003e\n\u003cp\u003eMid-intervention assessments were intentionally excluded to reduce the potential for testing effects that could influence post-intervention scores. Outcome assessors will remain fully independent from the intervention team, data analysts, and educators delivering the program. They will adhere to a standardized administration protocol and will focus solely on test procedures, without access to information regarding group allocation.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.2 Parental interviewers\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParental adherence questionnaires will be administered by a separate team of trained interviewers who will remain blinded to group allocation. To minimize risk of bias, these interviewers will operate independently from the music and storytelling educators, outcome assessors, and data analysts. This separation is a standard methodological safeguard designed to prevent information leakage and preserve the internal validity of the trial (Schulz et al., 2010; Chan et al., 2013).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.3 Intervention Facilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe educators responsible for delivering the intervention will be aware of group assignments, as they are directly involved in implementing the activities. However, they will have no role in outcome assessment, data collection, or statistical analysis, thereby minimizing the risk of evaluator bias.\u003c/p\u003e\n\u003cp\u003eTo safeguard the integrity of the intervention, sessions will be conducted separately for each group. Additionally, all teams involved in assessment, intervention delivery, data management, and analysis will function independently to prevent procedural contamination or cross-group influence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Outcome Measures\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multifaceted assessment strategy will be used to evaluate the effects of the intervention. Assessments will be conducted at two time points: baseline (pre-intervention) and post-intervention (after four months). The Bayley-III will serve as the primary instrument, with a focus on the language, socio-emotional, and adaptive behavior subscales. The Bayley-III provides standardized measures of developmental progress and will offer a longitudinal view of changes attributable to the intervention.\u003c/p\u003e\n\u003cp\u003eNo intermediate Bayley-III assessments will be performed, in order to reduce participant burden and testing effects. However, complementary data will be collected throughout the intervention to monitor engagement and responsiveness. These include educator-reported engagement logs, structured observational checklists, and parental adherence questionnaires in the parental guidance group.\u003c/p\u003e\n\u003cp\u003eSecondary outcomes include:\u003c/p\u003e\n\u003cp\u003e- Parental adherence, measured through self-report questionnaires;\u003c/p\u003e\n\u003cp\u003e- Child engagement, recorded by educators during storytelling and music sessions;\u003c/p\u003e\n\u003cp\u003e- Attendance and retention, tracked across all groups to evaluate adherence to the intervention protocol.\u003c/p\u003e\n\u003cp\u003eMid-intervention observational and qualitative data will be systematically collected to provide additional insight into the intervention\u0026rsquo;s implementation. Engagement logs will capture children\u0026rsquo;s participation, while observational checklists will track behavioral indicators of interest. In the parental guidance group, questionnaires will assess fidelity to the recommended home activities.\u003c/p\u003e\n\u003cp\u003eStatistical analysis will be conducted using JAMOVI\u0026reg;, adopting an intention-to-treat (ITT) approach to include all randomized participants in the final analysis. Descriptive statistics will summarize baseline characteristics. Within-group comparisons of pre- and post-intervention Bayley-III scores will be analyzed using paired t-tests. Between-group differences at post-test will be examined using one-way ANOVA, and categorical variables (e.g., attendance rates) will be analyzed using Chi-square tests. Correlation analyses (Pearson\u0026rsquo;s or Spearman\u0026rsquo;s, as appropriate) will explore associations between parental adherence and developmental outcomes.\u003c/p\u003e\n\u003cp\u003eA significance level of p \u0026lt; 0.05 will be adopted. As the Bayley-III is administered only at baseline and post-intervention, mid-intervention observational and questionnaire data will be analyzed descriptively and interpreted in an exploratory framework to provide complementary insight into intervention effects over time.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis randomized controlled trial protocol investigates the combined effects of storytelling and music interventions on child development within a regulated daycare setting. Early learning experiences are foundational for shaping neural architecture and fostering cognitive, socio-emotional, and adaptive functioning (Vohr et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Shen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). By integrating two well-established pedagogical approaches\u0026mdash;storytelling and music\u0026mdash;this study addresses a critical gap in the early childhood education literature.\u003c/p\u003e \u003cp\u003eWhile the individual benefits of storytelling and music have been extensively documented, few studies have systematically examined their joint implementation within structured educational environments (H\u0026agrave; \u0026amp; Bellot, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zhao \u0026amp; Kuhl, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Storytelling promotes language development, narrative skills, and emotional expression, whereas music engagement supports auditory processing, motor coordination, and affective regulation (Purwoko et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Bačlija, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Investigating these strategies in combination may offer synergistic developmental benefits, particularly in early institutional contexts.\u003c/p\u003e \u003cp\u003eDaycare centers represent the first formal educational environment for many children and are uniquely positioned to deliver evidence-based interventions (Indrio et al., 2022; Dumont \u0026amp; Ready, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). A better understanding of how pedagogical strategies function in this setting is essential to inform curricular design and promote equitable developmental outcomes (Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Saripudin \u0026amp; Priyono, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn additional contribution of this study lies in its examination of parental involvement. Family engagement is known to enhance early educational programs by reinforcing learning at home and strengthening relational bonds (Moreno et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Vaahtoranta et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, the specific role of parents in supporting integrated storytelling and music interventions remains underexplored (Park \u0026amp; Jung, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kwon et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). By comparing groups with and without parental reinforcement, the present design seeks to isolate the added value of home-based engagement.\u003c/p\u003e \u003cp\u003eThe trial is methodologically rigorous, employing a three-arm RCT design with blinded outcome assessment and standardized intervention protocols. The Bayley-III offers internationally recognized developmental measures aligned with the study\u0026rsquo;s primary outcomes (Bayley, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Conducting the intervention within a public daycare center that follows national curricular guidelines (BNCC) enhances ecological validity and practical relevance.\u003c/p\u003e \u003cp\u003eLimitations include the single-site design, which may restrict generalizability, and the lack of direct control over variability in home environments. Nevertheless, the proposed model is scalable, feasible, and responsive to real-world implementation challenges. If effective, it may inform the inclusion of structured, low-cost interventions in early education systems, contributing to national efforts to reduce developmental inequalities (Del Barrio \u0026amp; Ar\u0026uacute;s, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Indrio et al., 2022).\u003c/p\u003e \u003cp\u003eThese findings have potential implications for both educational practice and public policy. The alignment with the BNCC reinforces the relevance of this protocol as a model for integration into public daycare curricula (Dias, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Future research should explore adaptations across diverse sociocultural and economic contexts, enabling broader applicability and equity-driven innovation in early childhood education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical Considerations\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee for Human Studies (CAAE: 71324423.2.0000.5208). Written informed consent will be obtained from all participants\u0026rsquo; legal guardians prior to enrollment. The trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06831851) on February 7, 2025. Confidentiality and data protection will be ensured throughout the study. All personal data will be securely stored and anonymized.\u003c/p\u003e\n\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eAll authors declare that they have no conflicts of interest. Research grants did not influence the decisions made in this article.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil, through research grants awarded to Aline Ananias de Lima and Let\u0026iacute;cia Henrique Leite da Silva. Additional support was provided by the Foundation for the Support of Science and Technology in the State of Pernambuco (FACEPE), through a research grant awarded to Swane Miranda Alves. The funding agencies had no role in the study design, data collection, data analysis, interpretation of results, or manuscript preparation.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eA.A.L. designed the study, developed the methodology, coordinated data collection and curation, and wrote the original manuscript draft. S.M.A. supervised the project, contributed to methodology design, and edited the manuscript. L.H.L.S. supported data collection. A.B.J.S., A.P.S.S., A.C.B.F.C., \u0026Eacute;.H.A.S., G.B.R.S., J.M.L.S., K.G.S., M.E.R.A.S., M.L.S., R.F.S., and W.W.D.F. participated in data collection and logistical organization. W.M.A.B. contributed to critical manuscript revision. S.L.S. provided overall supervision and contributed to the conceptual design and manuscript editing. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe would like to thank the Municipality and the Secretariat for Early Childhood of Vit\u0026oacute;ria de Santo Ant\u0026atilde;o, Pernambuco, Brazil, for their essential support in facilitating the implementation of this research.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThis study is a randomized controlled trial protocol. No datasets were generated or analyzed during the current stage. The full trial is prospectively registered at ClinicalTrials.gov (Identifier: NCT06831851). All data generated during the study will be made available upon reasonable request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBačlija, I. (2019). Enriched music environments in preschool education. Music Education Journal, 105(3), 45\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eBayley, N. (2006). Bayley Scales of Infant and Toddler Development (3rd ed.). San Antonio: Harcourt Assessment.\u003c/li\u003e\n \u003cli\u003eChan, A. W., Tetzlaff, J. M., \u0026amp; Altman, D. G. (2013). SPIRIT 2013 explanation and elaboration. BMJ, 346, e7586.\u003c/li\u003e\n \u003cli\u003eDel Barrio, V., \u0026amp; Ar\u0026uacute;s, J. (2024). Early childhood interventions and socio-emotional development. European Early Childhood Education Research Journal, 32(1), 65\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eDias, M. (2019). A base nacional comum curricular e a educa\u0026ccedil;\u0026atilde;o infantil no Brasil. Revista Brasileira de Educa\u0026ccedil;\u0026atilde;o, 24, e240062.\u003c/li\u003e\n \u003cli\u003eDumont, H., \u0026amp; Ready, D. (2017). Do schools reduce or reinforce inequality? Journal of Educational Psychology, 109(7), 993\u0026ndash;1010.\u003c/li\u003e\n \u003cli\u003eH\u0026agrave;, T., \u0026amp; Bellot, S. (2020). Storytelling and children\u0026rsquo;s language development. Journal of Child Language, 47(2), 365\u0026ndash;384.\u003c/li\u003e\n \u003cli\u003eIlari, B., Keller, P., \u0026amp; Damasio, H. (2018). Music and development in early childhood. Music Education Research, 20(1), 72\u0026ndash;89.\u003c/li\u003e\n \u003cli\u003eJames, C. E., Michel, C. M., \u0026amp; Britz, J. (2019). Musical training and brain development. NeuroImage, 211, 116571.\u003c/li\u003e\n \u003cli\u003eKaba, A., Beran, T. N., \u0026amp; White, D. (2021). Stratified randomization in clinical trials. Contemporary Clinical Trials Communications, 23, 100819.\u003c/li\u003e\n \u003cli\u003eKwon, K., Han, M., \u0026amp; Jeon, H. J. (2025). Parental engagement and early childhood education outcomes. Early Education and Development, 36(1), 44\u0026ndash;61.\u003c/li\u003e\n \u003cli\u003eMerbawani, R., \u0026amp; Sari, A. (2023). Storytelling and emotional regulation in toddlers. Children and Youth Services Review, 142, 106700.\u003c/li\u003e\n \u003cli\u003eMohammed, M., Bortfeld, H., \u0026amp; Elman, J. L. (2023). Environmental influences on early language development. Infant Behavior and Development, 70, 101819.\u003c/li\u003e\n \u003cli\u003eMoore, C. G., Carter, R. E., \u0026amp; Nietert, P. J. (2012). Recommendations for planning pilot studies. Clinical and Translational Science, 4(5), 332\u0026ndash;337.\u003c/li\u003e\n \u003cli\u003eMoreno, S., Bialystok, E., \u0026amp; Barac, R. (2011). Short-term music training enhances verbal intelligence. Psychological Science, 22(11), 1425\u0026ndash;1433.\u003c/li\u003e\n \u003cli\u003eNguyen, C., Drouin, M., \u0026amp; Gross, J. (2015). The role of enriched environments in cognitive development. Child Development Research, 2015, 1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003ePark, S., \u0026amp; Jung, J. (2024). Home learning environments and school readiness. Early Childhood Research Quarterly, 58, 124\u0026ndash;135.\u003c/li\u003e\n \u003cli\u003ePurwoko, A., Astuti, D. P., \u0026amp; Suryana, D. (2023). The effect of storytelling on early literacy. International Journal of Education and Child Development, 12(2), 110\u0026ndash;123.\u003c/li\u003e\n \u003cli\u003eQureshi, F., \u0026amp; Zaman, S. (2023). Narrative practices in early childhood. Journal of Education and Development, 7(1), 55\u0026ndash;62.\u003c/li\u003e\n \u003cli\u003eSaripudin, D., \u0026amp; Priyono, D. (2021). Integrating music and storytelling into early childhood curriculum. Journal of Education Policy and Practice, 11(9), 34\u0026ndash;42.\u003c/li\u003e\n \u003cli\u003eSchulz, K. F., Altman, D. G., \u0026amp; Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. BMJ, 340, c332.\u003c/li\u003e\n \u003cli\u003eShen, Y., Lin, Y., \u0026amp; Liu, H. (2019). Early neural plasticity and cognitive stimulation. Developmental Science, 22(3), e12741.\u003c/li\u003e\n \u003cli\u003eSteinberg, L., Bornstein, M. H., \u0026amp; Vandell, D. L. (2021). Developmental science and education policy. Annual Review of Psychology, 72, 459\u0026ndash;484.\u003c/li\u003e\n \u003cli\u003eThabane, L., \u0026amp; Lancaster, G. (2019). RCT design in complex settings. Trials, 20(1), 123.\u003c/li\u003e\n \u003cli\u003eVaahtoranta, E., Tervaniemi, M., \u0026amp; Brattico, E. (2019). Musical interaction in early childhood settings. Music Education Research, 21(1), 1\u0026ndash;15.\u003c/li\u003e\n \u003cli\u003eVohr, B. R., Stephens, B. E., \u0026amp; Higgins, R. D. (2012). Neurodevelopmental outcomes of preterm infants. Seminars in Perinatology, 36(6), 379\u0026ndash;387.\u003c/li\u003e\n \u003cli\u003eWan, C. Y., \u0026amp; Schlaug, G. (2010). Music making as a tool for promoting brain plasticity. Cerebrum, 2010, 7.\u003c/li\u003e\n \u003cli\u003eWilliams, K. E., Barrett, M. S., \u0026amp; Welch, G. F. (2015). Early childhood musical and narrative interventions. Early Childhood Research Quarterly, 31(1), 113\u0026ndash;124.\u003c/li\u003e\n \u003cli\u003eXiao, X., Zhang, H., \u0026amp; Luo, Y. (2023). Effects of cognitive stimulation on toddlers\u0026apos; development. Infancy, 28(2), 245\u0026ndash;263.\u003c/li\u003e\n \u003cli\u003eZhao, T. C., \u0026amp; Kuhl, P. K. (2022). Musical interventions in early childhood. Developmental Cognitive Neuroscience, 53, 101034.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Music Education, Storytelling, Early Childhood Development, Randomized Controlled Trial, Bayley-III, Child Cognitive Development","lastPublishedDoi":"10.21203/rs.3.rs-6752768/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6752768/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study outlines a randomized controlled trial protocol to evaluate an enrichment program integrating music and storytelling in Brazilian public daycare centers. The intervention targets children aged 12 to 36 months over four months, with three groups: (1) music and storytelling with parental guidance, (2) music and storytelling without parental involvement, and (3) routine care control. The program includes daily storytelling and twice-weekly music sessions led by trained educators. Developmental outcomes will be assessed using the Bayley-III, focusing on language, socio-emotional, and adaptive behaviors at baseline and after four months. Evaluators blind to group assignments will conduct assessments. Ethical considerations follow the EECERA Code of Ethics and recent early childhood research guidelines, emphasizing inclusion, informed consent, child well-being, and protection of non-participants. Children with severe neurological diagnoses are excluded to ensure sample homogeneity and appropriate implementation. This protocol aims to address the shortage of structured, cost-effective, evidence-based interventions in early education, especially in underserved communities. By positioning educators as key agents, the study contributes to professional development in early childhood education. The findings are expected to inform scalable, culturally responsive pedagogical strategies that promote children’s rights and educational equity, with potential impact on practice and policy in early years settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration\u003c/strong\u003e: This trial was prospectively registered at ClinicalTrials.gov under the identifier NCT06831851\u003c/p\u003e","manuscriptTitle":"The influence of music and storytelling on child development: a randomized controlled trial protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-12 18:48:52","doi":"10.21203/rs.3.rs-6752768/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d79eaa2d-26a9-41d6-aee7-4763e84bcad1","owner":[],"postedDate":"June 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-12T18:48:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-12 18:48:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6752768","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6752768","identity":"rs-6752768","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}