Link Between Language, Cognition Drives Pediatric Research

March 2, 2017

Most two year olds have a PhD in play.

They’ve graduated from crawling and finding their first words to imagining that a ball is an apple or an empty cup is full of tea.

Parents don’t often note the earliest signs of symbolic play, but they represent a milestone in typical cognitive development.

“By 24 months, kids can express some of the highest forms of play,” says Megan Roberts, the Jane Steiner Hoffman and Michael Hoffman Assistant Professor of Communication Sciences and Disorders. “We call it ‘pretending,’ but teaching kids that one thing can represent something else is often the link to language.”

The relationship between language development, cognition, and play allows Roberts and colleagues at the Northwestern University Center for Audiology, Speech, Language, and Learning to evaluate children who may have deficits in communication or cognitive ability.

“We use play-based measures as a way to assess where children are developmentally, but also as a context for intervention,” says Roberts, a speech-language pathologist and developmental therapist. “If we know a child can’t conceptualize a wooden block as anything other than a wooden block — a literal interpretation that many children on the autism spectrum struggle with — we can customize our approach.”

Roberts is leading a pair of play-based clinical trials at the Evanston-based center, which has been designed to interweave clinical expertise and pioneering research. In one study, she is exploring if language and play skills can be simultaneously improved in children with autism to positively affect long-term outcomes. The second trial investigates parental characteristics that may inhibit the ability to play with and/or teach language to their child.

“It’s extremely important for us to empower and teach parents how to best interact with their children because parents are a child’s primary communication partner,” says Roberts.

The theoretical foundation for this research is that language and social communication develop on a platform of joint engagement with people and objects, and that those interactions happen within the context of daily life, which for a child involves a lot of play.

“We know that play is not just play; it represents early cognition, early communication, and early social relationships,” says Sarah Bauer, a developmental and behavioral pediatrician at the Ann & Robert H. Lurie Children’s Hospital of Chicago and the Center for Audiology, Language, and Learning. “These are the foundations for learning because they are the basis for language.”

Typically, play’s different layers go largely unnoticed, Bauer says. It’s when development seems “off” that patients are referred to the center where clinicians can conduct an in-depth evaluation, try to pinpoint where things may be going wrong, and pursue possible remedies.

Language Makes Us Human

Sandra Waxman, the Louis W. Menk Professor of Psychology and faculty fellow at the Institute for Policy Research, has been studying early language and cognitive development for more than 20 years.

“In comparison to other mammals, humans are the most helpless at birth. We’re highly dependent on those around us,” says Waxman, director of Northwestern’s Project on Child Development, a developmental psychology lab that studies how children think and learn. “The second half of this equation, however, is that our brains are tailored for acquiring new knowledge, and play is one of our greatest tools for learning.” Waxman’s research, which focuses on language and cognitive development in infants and very young children, points to the benefits of social interaction in playing with preverbal children.

“The mind is so capacious as to allow for babies to entertain different concepts of the world around them,” she says. “Letting infants and children experiment and play allows them to guide their own discovery, enhancing cognitive and language development.”

And it turns out that it matters far less what a child plays with than the social context of that play.

“You don’t have to buy the perfect toy, because children learn the most from doing,” says Waxman. “A baby could play with plastic cups or silver spoons; it’s the direct hands-on experience that matters, coupled with the language and social support provided by others.”

Cultural Influence

How children play affects their understanding of the natural world, and also reflects their knowledge, Waxman has found.

Together with colleagues and collaborators at Northwestern and in the Menominee Indian Tribe of Wisconsin, Waxman’s team has compared children growing up in urban Chicago with those living rurally on the Menominee Reservation.

In a recent study, the team observed children playing with a woodland-scene diorama. Although city-dwelling majority-culture kids typically had access to many more toys than their Menominee peers, those living on the Menominee Reservation were just as capable — or more capable — when it came to their knowledge of the relations among plants and animals in the natural world.

“These children’s spontaneous play shed light on the powerful effect that children’s communities have on learning and play,” Waxman says. “The children from both communities knew a lot about individual objects in the diorama. But only the Menominee children revealed in their spontaneous play that they understood the ecological relationship among plants and animals. This is information that they learn within their communities.”

In another set of experiments, Waxman has compared how 24-month-old infants from the United States and China deploy their attention to objects and actions in dynamic scenes. Prior research had suggested that people in these two communities differ in their attention to objects versus events: people in the United States focused more on objects than events, while people in China showed the opposite tendency. Waxman wanted to identify the developmental
origin of this cross-cultural difference.

In the experiment, infants watched a series of repeated scenes — a girl petting a dog, for example. Then, infants watched two new scenes. In one, the object was switched (the girl petting a pillow). In the other, the action was
switched (the girl kissing a dog). Infants from China preferred looking at the scenes featuring a new action. In contrast, US infants preferred scenes featuring a new object.

“The results suggest that by the time they reach their second birthdays, infants may be on their way to becoming ‘native lookers,’” says Waxman. “We know that children have this powerful and innate capacity for cognition, which is boosted by listening to language. We are now beginning to understand that their surroundings may play a larger role in the manner in which they think about and digest information.”

Play as Therapy

At the Northwestern University Center for Audiology, Speech, Language, and Learning, Megan Roberts is among the most enthusiastic proponents of play-based intervention.

During a recent autism assessment, Roberts observed a young child playing with a doll. When he stopped, picked up a ball, and pretended to feed it to the toy baby, she couldn’t help but smile.

“It meant that he understood symbolic play, which allows us to cater an intervention that further teaches about the symbol of words,” says Roberts. “Clinicians can be so focused on outcomes and not the process, but when it comes to children, they learn through the process of play.”

Northwestern researchers continue to strengthen the connection between the cognitive capabilities necessary for certain types of play and the ability to develop language. That link may be most apparent in a child who can complete two sequential tasks with a toy — a train stops at a station and then takes passengers to work — and then also string together two consecutive words, says Judy Roman, communication sciences and disorders. “The sophistication mirrors each other,” says Roman, a board-certified childhood language specialist and lecturer at the School of Communication. “It’s not necessarily that one is driving the other, but they
are connected.”

She notes that there is an art to picking the right toy for some kids. Play, by its nature, has to be freely chosen. Once a child is prescribed play, the task becomes work.

“One of the things that we have the privilege of doing as clinicians in an academic setting is teaching evidence- based practices to graduate students,” says Roman. “We’re not just advising them to preach play because it seems like a good idea; we’re sharing with them this robust level of research that shows how play can be used as a tool for social, cognitive, and language development.”