About Martha G, Welch, MD
Harnessing the Power of Family Nurture
Martha G. Welch has been a pioneer in the treatment of what are commonly referred to as childhood psychiatric disorders for more than 30 years. Her work has led her to question some of society's most basic assumptions about the nature of behavior.
Today as a Co-Director of the Nurture Science Program at Columbia University Medical Center, Dr. Welch leads a research team that is testing her approach to treatment and is helping to reveal a scientific explanation for the underlying biological phenomenon she believes is at the basis of her intervention, what she calls emotional co-regulation. Dr. Welch defines her theory as such: States of dysregulation are due to deficient co-regulation from close personal relationships and is opposed to the prevailing theory that such states are due to the inability to self-regulate.
In medical school, Dr. Welch was mentored by Columbia University pioneers: surgeon Hugh Auchincloss and J. Lawrence Pool, Chairman of Neurosurgery and Director of the Neurological Institute, both of whom recommended her for a psychiatric residency program at Albert Einstein College of Medicine. She was accepted into the program in 1972 and completed it in 1974. Following residency, Dr. Welch was recruited into the Child Psychiatry Fellowship Program at Albert Einstein College of Medicine which she completed in 1977. In 1977, she became a Diplomate of the American Board of Psychiatry and Neurology and was appointed Instructor in Child Psychiatry at Albert Einstein College of Medicine.
While at Albert Einstein College of Medicine, Dr. Welch began questioning the treatment methods used for autism. She became interested in the work of ethologist and Nobel laureate, Niko Tinbergen. Dr. Welch found parallels between Tinbergen’s descriptions of approach-avoidance conflict in animal behavior and her observations of approach and avoidance conflicts in autistic children with their mothers and grandmothers. Based upon Tinbergen’s thinking and her clinical observations, Dr. Welch conceived and tested an unconventional treatment for autism that involved prolonged mother-child holding and calming interactions. She observed that these interactions often helped affected children who previously avoided physical interaction become comfortable with close contact with family. When the intervention improved symptoms in the first three children treated, Dr. Welch contacted Tinbergen with her findings.
In 1975, she began a private practice and in 1978 founded the Mothering Center, a non-profit organization dedicated to the treatment of children with emotional, behavioral, and developmental disorders, including autism.
In 1979, Tinbergen visited Dr. Welch’s Mothering Centers in New York City and Greenwich to observe the therapy firsthand. At first skeptical, Tinbergen became convinced that the therapy was indeed successful in overcoming the child’s conflict and avoidance behavior. According to Tinbergen, he was especially struck by an autistic child’s ability to play cooperatively following a therapy session. A close collaboration between Dr. Welch and Tinbergen followed and resulted in the publication of two books: Tinbergen’s Autistic Children: New Hope for a Cure (Allen & Unwin, 1983) and Dr. Welch’s Holding Time (Simon & Schuster, 1988); both books were published in many languages.
Tinbergen believed that Dr. Welch’s work represented a paradigmatic shift from the prevailing ideas about behavior and a major advance in the treatment of autism and developmental disorders. He devoted his energy to bringing attention to her breakthrough intervention and engaged with her in thinking about its biological basis up until his death in 1988.
Following the publication of Holding Time, Dr. Welch’s approach was criticized in the media when it became confused and conflated with therapies by untrained "attachment therapists" using what they termed "holding therapy." Some attachment therapy therapists adapted the techniques described in "Holding Time" appropriately and reported the therapy to be helpful in treating behavioral disorders in adopted children. However, others used the book to justify unrelated, and in some cases, coercive and abusive therapies. There is no connection between the method of holding therapy developed by Dr. Welch and therapies connected to the abuse of children.
Dr. Welch remained committed to the central belief that her insights into the nurturing interactions between families and children would someday lead to new treatments and preventative medicine strategies for developmental disorders. In the late 1990s, she began a research career focused on investigating the biological underpinnings of emotional co-regulation and nurture.
During her residency and fellowship at Albert Einstein College of Medicine, Dr. Welch had been exposed to other researchers who would become important mentors and collaborators: Myron A. Hofer, MD, Michael M. Myers, PhD, and their group in Developmental Psychobiology. Hofer’s writings and ideas greatly influenced Dr. Welch’s initial thinking about the important interplay between biological and behavioral processes during infant and early childhood development. Eventually, the group migrated to Columbia University Medical Center where Drs. Myers and Welch would initiate clinical studies in prematurely born infants. Today the paths of Dr. Welch and the Hofer-Myers group have merged to create a dynamic and essential collaborative team in the Nurture Science Program research effort.
With the help of Dr. Hofer, Welch was given a faculty position in the Department of Psychiatry at Columbia University Medical Center in 1997. In collaboration with renowned neuroanatomist David A. Ruggiero, PhD, she began testing a hypothesis that she developed from clinical observation: that behavior was being mediated by signaling from the gut to the brain, as opposed to the opposite. The adverse behavior associated with emotional dysregulation might be coming from signals arising from a stressed or inflamed gut, not just the brain. The idea that the gut might be actually controlling certain types of behavior was contrary to prevailing thinking in psychiatry.
She tested a novel treatment for gut inflammation in an animal model. For years, following treatment sessions in her clinic, Dr. Welch heard mothers describe feeling as though they had just given birth or just nursed their child. As these two events were known to be associated with oxytocin release, she developed the hypothesis that peptidergic (here oxytocin) signaling was involved in the observed behavioral changes in both the mother and the child following her therapy. She was eager to explore this signaling together with the physiological and systemic manifestations associated with it.
Dr. Welch theorizes that the emotional co-regulation is primarily a visceral, as opposed to a cognitive, phenomenon and that emotional behavior is the product of Pavlovian conditioning, as opposed to operant conditioning. This may help explain why physical contact and communication between family members during the Family Nurture Intervention is so important.
Around that same time, another peptide, secretin, was receiving attention after a gastroenterologist published findings showing that three autistic children who had been given this gut hormone as a probe of abnormal pancreatic function spoke and made eye contact for the first time. Dr. Welch had observed that many of the gut problems of her autistic patients had resolved after her family nurture intervention and postulated that mother-child calming interactions might be releasing two peptides, oxytocin and secretin, and that these and possibly other hormones were leading to improved social behavior and improved gut status in the child.
Dr. Welch’s work in this area became the basis for a series of six publications. One of these showed that combined secretin and oxytocin treatment of experimentally-induced colitis in rats overcame inflammation in the gut. With the help of Columbia University’s Science and Technology Ventures she applied for a patent. This patent was issued in 2011 for the treatment of inflammatory bowel disease.
During this period, Dr. Welch also spearheaded a research program aimed at understanding brain-gut signaling and how it is involved in the mutual regulation of gut function and behavior. She was the first to demonstrate secretinergic neurons in the forebrain and that secretin activates visceral brain regions involved in both autism and inflammatory bowel disease. In 2004, Dr. Welch co-founded the Brain-Gut Initiative, along with Michael D. Gershon, MD, the Chairman of Anatomy and Cell Biology at Columbia. Their labs demonstrated for the first time that oxytocin receptors were present and developmentally regulated in the enteric nervous system and in the epithelium of the gut. Currently, their pioneering work is showing that mice lacking oxytocin receptors have abnormal barrier function of their gut epithelium, villus height, and crypt depth, and are more prone to inflammation.
More recently, Dr. Welch’s studies have moved from animal models to intracellular signaling and, along with Hadassah Tamir, PhD, and Benjamin Klein, MD and PhD, she has characterized responses of the PI3K/Akt and mTOR signaling pathways to oxytocin stimulation in enterocytes in vitro in a series of biochemical and molecular biological studies. Ongoing research seeks to understand the connection of these signaling pathways to altered gut development observed in oxytocin receptor knockout mice and modulation of gut inflammation demonstrated in this and other animal models.
Dr. Welch has collaborated with a number of other faculty members at Columbia University. With Harry Shair, PhD, she is testing her hypothesis that ultrasonic vocalizations in rat pups are mediated by gut signaling. Initial studies show that cutting the vagus nerve between the gut and brain abolishes potentiation of ultrasonic vocalizations in rat pups twice separated from their dams. Collaborations with Susan Brunelli, Frances Champagne, and James Curley focus on exploring differential central oxytocin receptor expression in selectively bred high-anxiety versus low-anxiety rat dams.
Thus far, Dr. Welch’s innovative research has been supported through private philanthropy. In 2008, the Einhorn Family Charitable Trust urged Dr. Welch to begin translating the promising results of her basic research into practicable clinical interventions that can be used to help infants, children, and families. With Michael M. Myers, PhD as co-principal investigator she initiated a randomized controlled trial of Family Nurture Intervention. This trial has examined early development in premature infants treated with either Family Nurture Intervention or standard care in the neonatal intensive care unit. To date, three papers have been published including a paper in Clinical Neurophysiology that describes robust increases in electroencephalographic power in the Family Nurture Intervention babies at near-to-term age. According to the research findings, there was a 36% increase in power in the frontal polar region of infants that received Family Nurture Intervention.
This finding is considered highly significant because an electroencephalographic power increase in the frontal polar region predicts better cognition, language, and attention as well as emotion regulation. Preterm infants often have deficits in these areas. The Family Nurture Intervention results also suggest positive effects on mothers’ levels of anxiety, depressive symptoms, and sensitivity to their infants during feeding.
The next step in the research is a replication study that is currently being initiated at the Children's Hospital of New Jersey at Newark Beth Israel Medical Center. It will be followed by an effectiveness trial to determine if this intervention can be effectively applied to all babies in a NICU. Our hope is that three or four years from now the Nurture Science Program will be ready to promote Family Nurture Intervention in NICUs around the country and help more children and families.
Martha Welch Awards and Honors
- 2014 Gold Medal for Meritorious Service to Columbia University, College of Physicians & Surgeons
- 2013 Physicians and Surgeons Alumni Lifetime Learning Award
- 2011 Columbia University Alumni Medal for Meritorious Service
- 1995 Middlebury College Distinguished Alumni Award
- 1985 Gold Medal Award in Community Psychiatry, American Psychiatric Association, Nominee
Further Reading and Research
- Oxytocin modulates markers of the unfolded protein response in Caco2BB gut cells. Cell Stress Chaperones. 2014 Jul;19(4):465-77. doi: 10.1007/s12192-013-0473-4. Epublished 2013 Nov 6.
- Electroencepalographic Activity of Preterm Infants is Increased by Family Nurture Intervention: A Randomized Controlled Trial in the NICU. Clinical Neurophysiology. 2014 Apr,125(4):675-84. doi: 10 1016/j.clinph.2013.08.021. Epublished 2013 Oct 17.
- Randomized Controlled Trial of Family Nurture Intervention in the NICU: Assessments of Length of Stay, Feasibility and Safety. BMC Pediatrics 2013, 13:148 doi:10.1186/1471-2431-13-148.
- Oxytocin Modulates mTORCI Pathway in the Gut. Biochem Biophys Res Commun. 2013 Mar 15;432(3):466-71. doi: 10.1016/j.bbrc.2013.01.121. Epub 2013 Feb 11.
- Family nurture intervention (FNI): methods and treatment protocol of a randomized controlled trial in the NICU. BMC Pediatrics 2012, 12:107. doi: 10.1186/1471-2431-12-107.
- Cutting the vagus nerve below the diaphragm prevents maternal potentiation of infant rat vocalization. Dev Psychobiol. 2012 Jan;54(1):70-6. doi: 10.1002/dev.20577. Epublished 2011 July 14.
- Pi3/Akt responses to oxytocin stimulation in Caco2BB gut cells. J Cell Biochem 2011 Nov;112(11):3216-26. doi: 101002/jcb.23243.
- Combined administration of secretin and oxytocin inhibits chronic colitis and associated activation of forebrain neurons. Neurogastroenterol Motil 2010 Jun;22(6):654-e202. doi: 10.1111/j.1365-2982.2010.01477. x. Epublished 2010 Mar 4.
- Expression and developmental regulation of oxytocin (OT) and oxytocin receptors (OTR) in the enteric nervous system (ENS) and intestinal epithelium. J Comp Neurol. Jan 10, 2009;512(2): 256-270. doi: 10.1002/cne.21872.
- Prolonged parent-child embrace therapy among 102 children with behavior disorders: Outcomes and underlying mechanisms. Complement Ther Clin Pract. 2006 Feb 12(1):3-12. Epublished 2005 Nov 23.
- Brain effects of chronic IBD in areas abnormal in autism and treatment by single neuropeptides secretin and oxytocin. J Mol Neurosci. 2005. 25(3):259-74.
- Secretin: Hypothalamic distribution and hypothesized neuroregulatory role in autism. Cell Mol Neurorbiol. 2004. Apr 24(2):219-41.
- Secretin activates visceral brain regions in the rat, including areas abnormal in Autism. Cell Mol Neurobiol. 2003 Oct 23(4-5):817-37.
- Welch M.G. (1988) Holding Time: How to Eliminate Conflict, Temper Tantrums, and Sibling Rivalry and Raise Happy, Loving, Successful Children. New York: Simon and Schuster. London: Century Hutchinson, 1989. New York: Fireside, 1989. Editions in German, 1991; Italian, 1991; Japanese, 1992; Finnish 1995.
- Welch M.G. (1983) “Retrieval from Autism Through Mother-Child Holding” in Tinbergen N. and Tinbergen E.A. Autistic Children - New Hope for a Cure. London and Boston: George, Allen and Unwin.