Babies may begin pointing at objects at about nine months, and while this might seem like a cute but routine stage in their growth, to Jana Iverson, it’s much more important than that. Iverson, associate dean for research and Christopher A. Moore Professor of Pediatric Rehabilitation, studies the connections between early motor development and emerging communication and language skills in infants and toddlers.
In one study, she found that the earlier children begin to make gesture-word combinations—pointing at something and saying a word, for example—the earlier they will start to say their first two-word utterances. “When infants are at the stage where they can say a few words, but the words aren’t easily understood by the adults around them, they use gestures to help clarify their message, and sometimes they even use gestures to add information to what they say with their words,” says Iverson, who also leads Sargent’s Infant Communication Lab. “It turns out that when they convey one piece of information in gesture and one piece in language, that’s a really important phenomenon where they’re exercising their ability to combine two ideas into a single communication.” She adds that this kind of skill is an important entryway into the development of grammar in a child’s second year.
In Iverson, Sargent has brought on an internationally respected scientist who studies the ways kids grow and develop. Her published work includes groundbreaking research on motor and language skill development in infants who have an older sibling with autism, and she is leading a new study on improving motor development in babies with Down syndrome. Her expertise will amplify Sargent’s interdisciplinary pediatric research and its dedication to improving rehabilitation outcomes.
Connecting Speech and Movement
Iverson has long been fascinated by how we communicate. Growing up in a military family, she lived in Italy for two years. Babysitting neighbor kids there, she says she “was really struck by how these little children were masters of this language that was so hard for me to figure out.”
″…If learning language is going to be challenging for you, and you’re already constrained in your ability to interact with the environment, it’s setting you up for additional challenges along the way. So, early motor delays are a big thing to really attend to and take seriously.”
—Jana Iverson
As an undergraduate psychology student at Bryn Mawr College, she discovered a professor whose research focused on how children learn language, and knew that was the field she would work in. Her graduate training—she received her MA and PhD from the University of Chicago—centered on how children communicate before they learn language, and how older children and adults use hand gestures to support their communication. She wanted to learn more about the motor system in order to understand how the coordination between speech production and hand movements develops in infancy. During a postdoctoral fellowship at Indiana University, she studied with the late Esther Thelen, an expert on infant motor development. “I was really fascinated by the fact that so many things happen in a child’s first year. Babies roll over, they sit, they crawl, they stand, and then they walk. While infants are learning to do those things, they’re also laying the groundwork for language,” says Iverson. “So, I started to think about the question of how does motor development create opportunities for infants to access situations and learning opportunities that are useful for building skills for language?”
Iverson has focused much of her research on how infants who have language delays use gestures. In one study, she found that infants with Down syndrome use gestures to compensate for difficulties they have producing words. At the University of Pittsburgh, where she taught before joining Sargent’s faculty, she researched infant siblings of children with autism in order to find early indicators that they might also be diagnosed with autism later. Iverson’s research on vocal-motor development in children and families affected by autism goes back to 2003. “There was this increasing awareness of the fact that many parents of autistic children would go to the pediatrician when their children were very young and express concern about their child’s development,” she says. “But the pediatrician would say, ‘Well, we’ll have to wait and see.’” Parents, she says, would then be left with few resources because they weren’t able to get a diagnosis until their child was three or older. That was in part because the diagnostic criteria were largely based on skills that emerged in a child’s second and third years of life. “The idea was that if we could identify these [autistic] infants really early, we might be able to develop some sort of intervention or do something that might eliminate this long gap between initial identification and services,” Iverson says.
Siblings of autistic children are more likely than other children to develop autism. “One of the things that we found was that in that subgroup of infants who eventually receive an autism diagnosis, you start to see differences in gesture production as early as 14 months,” she says. “In particular, one of the things that’s very different [in their motor and language development] is how they combine gestures and speech into these little combinations—they do it much less frequently, and their production of those combinations doesn’t really increase over time. It stays relatively flat.”
Iverson says the studies she has done on children with autism emphasize the significance of early motor delays. “That was shoved aside for a long time. There was this wait-and-see approach,” she says. “But in fact, for these infants who have an elevated likelihood for a neurodevelopmental disorder, an early motor delay is really very problematic—if learning language is going to be challenging for you, and you’re already constrained in your ability to interact with the environment, it’s setting you up for additional challenges along the way. So, early motor delays are a big thing to attend to and take seriously.”
Movement creates opportunities
In April 2023, Iverson received a grant from the National Institutes of Health to study motor development in babies with Down syndrome. In preparation for a clinical trial, Iverson will provide bodyweight-supported harnesses to families with infants with Down syndrome. Depending on the child’s level of postural control, the harness can give them more or less support. She hopes that by providing these infants with the harnesses, they’ll have more opportunities to move around and explore their surroundings. In turn, this could improve not only their motor skills but also their opportunities for interacting with their caregivers.
The idea, Iverson says, is that parents will set up in their homes soft seats suspended from a lightweight frame, allowing the infants to move freely around a space like a living room. Iverson and her fellow investigators will observe the infants to see how the harnesses change their navigation around their daily environment, their everyday activities, and their interactions with caregivers. Iverson will note data points such as how far an infant travels while in the harness, how often they vocalize and use gestures, and how they engage with objects. “This grant will help us do these detailed longitudinal observations in order to come up with the best outcome variables—how are we going to measure change? What are the best behaviors to look at? Then we can move into a clinical trial,” she says.
“Babies with Down syndrome have really significant motor delays early on, and they’re very stationary for a long time—many don’t walk until they’re two or three years old. The hope is that getting infants in the harness should open up opportunities to get [more] items, and to move around and approach a caregiver with a toy, and then for the caregiver to talk about it,” Iverson says. “It should enrich the environment in ways that we think are going to be beneficial for development very broadly.”