What is the Nurture Science Program?
The Nurture Science Program is a team consisting of outstanding scientists and clinicians who are dedicated to the exploration of the biological and behavioral basis of the beneficial effects of nurture. The members of the Nurture Science Program believe that the establishment and maintenance of optimal parent-child interactions (nurture) affects subsequent physiological and psychological development of the child and the well-being of the family.
What makes the Nurture Science Program unique?
The Nurture Science Program is unique in bringing together a multidisciplinary team that combines the talents and perspectives of basic, translational, and clinical scientists. Insights derived from the fields of cell biology and neurobiology are combined with behavioral physiology and psychiatry to focus on the biology of nurture and to devise practical therapies that harness it. Such a group with a similar focus exists nowhere else. Our group has already completed a study of a Family Nurture Intervention with preterm infants that has produced highly significant results that predict better cognitive, language, attention, and emotional regulation in a group (preterm infants) that is known to suffer from deficits in these functions.
What is the mission of the Nurture Science Program?
The core mission of the Nurture Science Program is to make it possible for nurture-based therapy to become widely utilized and accepted to benefit children and families throughout the US and the world. This will require that the molecular and physiological effects of nurture be investigated so that it is clear that their therapeutic application is based on a scientific rationale. Dissemination of effective treatments in medicine requires an understanding of the underlying biology (a rationale with a firm basis in experimental evidence) and demonstration of efficacy. The goal of the Nurture Science Program is to anchor nurture-based therapy firmly in evidence-based medicine.
What has the Nurture Science Program accomplished?
The Nurture Science Program has made major strides in identifying the molecules related to nurture and brain-gut signaling and in the application of nurture-based therapy to premature infants. The Nurture Science Program's nurture-based therapy provides striking and statistically valid benefits in a surrogate marker of brain development (the electroencephalogram). The Nurture Science Program also has identified a physiological basis for the common gastrointestinal dysfunction that frequently accompanies autism. A mutation in a molecule (the serotonin re-uptake transporter) that terminates the action of serotonin, a critical brain-gut messenger which is found in subsets of patients with autism, was expressed in mice. Not only do the animals carrying the mutated serotonin re-uptake transporter show repetitive behavior and defects in communication, but they also have slow gastrointestinal motility, abnormal responses to intestinal inflammation, and defects in the development of the intrinsic nervous system of the bowel. This is the first animal model to mimic both gastrointestinal and central properties of the autistic spectrum disorders.
What are the long-term goals of the Nurture Science Program?
The mission of the Nurture Science Program is to create, validate and disseminate strategies for preventing adverse infant and child development outcomes through family nurture activities.
What kinds of projects does the Nurture Science Program do?
- As a follow up to our study of the Family Nurture Intervention with preterm infants (that produced highly significant results that predict better cognitive, language, attention and emotional regulation), multi-site replication studies are currently being set up at Morgan Stanley Children’s Hospital in New York City and Children’s Hospital at the University of Texas Health Science Center San Antonio.
- We tested the efficacy of Family Nurture Intervention in the Neonatal Intensive Care Unit (NICU). Infants receiving enhanced mother-infant and family nurture were compared to infants receiving standard NICU care.
- We will replicate the NICU Follow-Up Clinic program (a program that monitors the development of low birth weight and other high-risk newborns from infancy into later childhood for the identification of developmental disabilities including motor disorders, learning disorders, and behavior problems).
- We conducted an investigation into the relationship between nurture, and the molecules through which nurture manifests its effects, and the development of the brain and gut.
How has the strategy changed from the previous BrainGut Initiative programs?
The Nurture Science Program's work is the next step, building on the what was achieved in the BrainGut Initiative. The goal of the BrainGut Initiative was to develop a body of evidence that supported the beneficial effects of nurture. The models were:
- To treat a rodent model of inflammation in the gastrointestinal tract with a combination of secretin and oxytocin (two hormones involved in nurture interactions such as breastfeeding)
- To test the effects of mother-infant nurture interactions of a Family Nurture Intervention on infant brain development, maternal and infant physiology, and well-being in preterm infants
Now that the findings are robust and highly significant, the strategy has been enlarged to test replication in another unit and its clinic. These models will be disseminated to a network of other hospitals with NICUs, first in the state of New Jersey and then in a national network of NICUs.
Why should I donate to the Nurture Science Program?
There are millions of families and children suffering from emotional problems, behavior disorders, and developmental disabilities, and the current treatment strategies and behavioral therapy are not effectively meeting the needs of those families. Nurture as a field of scientific inquiry has been underfunded, under-explored, and under-utilized as a basis for intervention and prevention of emotional, behavioral, and developmental disorders of young children. Our group has completed a study of a Family Nurture Intervention with preterm infants that has produced highly significant results that predict better cognitive, language, attention, and emotional regulation in a group (preterm infants) that is known to suffer from deficits in these functions. Therefore, Family Nurture Intervention should be tested in infants born less prematurely and those born at term that show deficits in these functions at later ages. In order to carry out these studies, a fully functioning clinic is required and the funds to sustain it. Our hope is that three to 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.
Why study preterm infants?
Our overarching goal is to test Family Nurture Intervention's ability to enhance child development. Preterm infants are at high risk for emotional, behavioral, and developmental disorders including autism and eating disorders. The requisite life-saving care for these infants causes mother-infant separation just at the time that the mother normally inoculates her baby against stress through continuous physical reciprocal calming interactions. Preterm infants offer an opportunity to establish a true prevention model of early intervention through mother-infant nurture interactions in the very first days of their lives.
What is meant by high-risk?
This refers to the probability an infant will suffer many medical and/or developmental problems later in childhood. Preterm infants are known to be at high risk for emotional, behavioral, and developmental disorders. Much research is aimed at identified risk factors. We think the biggest risk factor is the emotional separation from the mother and family. Our therapy, therefore, is focused on overcoming the separation through mother-infant reciprocal calming activities. Preterm infants are “high risk” because of the traumatic separation at such a critical age in development. Family Nurture Intervention aims to provide mother and infant with repeated reciprocal interactions of calming as soon as possible following birth.
Are specific groups being identified with specific risk factors for which the Family Nurture Intervention has significant beneficial effects?
A child who suffers separation from its mother early in life is at risk for emotional, behavioral, and developmental problems. Preterm infants are a group collectively at high risk for effects of prolonged separation during NICU hospital care. Family Nurture Intervention-NICU is a preventive strategy. Many late pre-term and term infants also have histories of prolonged separation from their mothers. Importantly, the Family Nurture Intervention is more than prevention. It will be tested as a treatment for other infants or children with adverse developmental symptoms common to those with separation histories. The mother/infant Calming Cycle therapy will be tested as an intervention strategy to overcome symptomatic behavior.
Is Family Nurture Intervention being established for all babies, regardless of risk factors, even if there are none?
Yes, Family Nurture Intervention may be a valid prevention strategy for many or all families. We hypothesize that building increased capacity for resilient response to stress will be the best preventive strategy and the most cost effective. Most parents understand that there are many circumstances that put their baby at risk for emotional, behavioral, and developmental problems. One of the biggest risk factors is physical, or even emotional, separation. If there is adverse behavior or development, the calming activities of Family Nurture Intervention might have a beneficial effect on current behavior and future development if the baby’s stress response is improved. Because babies are vulnerable to separation which occurs commonly, all families might benefit from Family Nurture Intervention's focus on enhancing the family’s ability to meet the infant/child’s emotional needs.
Can Family Nurture Intervention benefit full-term infants without risk factors?
Family Nurture Intervention may theoretically be beneficial to infants born at full term. The Nurture Science Program is planning to test the intervention in this population in the future.
What biological mechanisms are at work in Family Nurture Intervention?
The biological mechanisms that underlie mother-infant nurture are complex and interconnected. Current research is focused on the neurohormone oxytocin and gut signaling via the vagus nerve as a likely mediators of the effects of nurture.
What is meant by mother-infant co-regulation?
For purposes of the Family Nurture Intervention, the mother and infant are considered a single, interdependent behavioral system. The object of the intervention is to facilitate a physiological state of co-regulation between the mother and infant. This is accomplished by means of repeated mutual calming sessions.
What do the biological mechanisms look like in full-term infants? To what extent can they be further optimized when there are no risk factors?
The biological mechanisms in full-term infants are the same as those in preterm infants. Term infants can benefit from longer gestation; however, birthing can have a big environmental impact on those mechanisms. There are many aspects of modern birthing that can put infants and mothers at risk for separation including interference with the biological mechanisms that naturally calm and bond baby and mother.
Do parents need a different approach for different aged children?
No, we do not believe so. There are certainly different stages of development that children progress through during their first few years, however, at every stage there is need for mother-child and family reciprocal calming. Family Nurture Intervention focuses on building increased capacity for resilient response to stress as a strategy for ensuring good development.
Do you have a plan for testing separate, developmentally appropriate treatment interventions for different age groups?
Yes, we are planning to test Family Nurture Intervention on preterm infants as they reach older ages. To begin with, preterm infants not treated in the NICU will be brought in at age 1 for a follow-up exam. Infants will be screened according to standardized assessments for developmental problems. From this group, families will be recruited to a randomized, controlled clinical trial and randomized to Family Nurture Intervention or a standard care service. This study will take approximately one year.
What are the predictable developmental differences across these ages that might allow you to expect greater measurable impact at one age than another?
Based upon Dr. Welch’s clinical experience, we have developed an Emotional, Behavioral, & Developmental Screen. We will be validating this screen as a tool for pediatricians, parents, and teachers. The Emotional, Behavioral, & Developmental Screen is designed to select those infants aged 0-5 who are at risk for developmental problems. It is this group that will be tested in randomized, controlled clinical trials.
How will you break down the 0-5 year age range, so that you can look at your results for each group separately?
The randomized, controlled clinical trial studies for each staged treatment will require careful planning. As with the neonatal intensive care unit study, each randomized, controlled clinical trial will require submission of the proposed study to the Institutional Review Board and the hospital. We do not anticipate any problems. Each application to the Institutional Review Board will occur sequentially.
Will you create distinct protocols for each age group? What are the commonalities within these broad groups and what differences do you need to account for?
Protocols will be developed for each study and will be appropriate for each age group. However, it is important to emphasize that Family Nurture Intervention does not differentiate between ages. Rather than treating the child, Family Nurture Intervention treats the family. It is designed to help the family identify its own needs. In that sense, the intervention comes out of the Family Nurture Intervention family sessions. It is the role of the therapist to help the family overcome the obstacles and to increase the level of nurture within the family so that the family can meet the needs of the child.
How do you plan to disseminate Family Nurture Intervention for each age group, assuming your studies show significant positive effects?
Most hospitals have a preterm infant follow-up clinic, where infants are assessed. Most of these clinics do not have an intervention program. This is true at NewYork-Presbyterian Hospital. We will first conduct the necessary research in our clinic. Then, with the help of Morris Cohen, the Director of the Neonatal Intensive Care Unit at Children's Hospital of New Jersey at Newark Beth Israel Medical Center, we will disseminate the model to New Jersey and its 17 NICU follow-up clinics.
What developmental events, challenges, and capacities are likely to require some tailoring of your intervention? For instance, when a child begins to crawl, walk, talk, etc.?
Family Nurture Intervention is not meant to treat all developmental problems. Many problems, especially behavioral ones, will disappear with increased nurture while other problems may not manifest until another behavior is ameliorated. Family Nurture Intervention serves as an important opportunity to diagnose potential problems that need special treatment. The therapist evaluates the child’s neurological development; coordination and language are important indicators of development. Where appropriate, the child will be referred for specialized therapy.
Are there periods when the child’s capacity might suggest a different intervention or a need to present the intervention differently?
Family Nurture Intervention is currently designed to treat problems early. For the most part, the problems that emerge prior to age 5 are treatable by the family. However, facilitating Family Nurture Intervention requires a special sensitivity and skill; therapists will be trained to identify those situations that may require specialized therapy so that the family can be appropriately supported.
How will you establish safety, feasibility, and acceptability, and provide detailed assurance that you have carefully looked for adverse effects?
It is the job of the Institutional Review Board to monitor the safety of the patients. All studies fall under the domain of the Institutional Review Board, and protocols will be developed with their help. We will handle each of the potential risks sequentially as we design each study. The protocol will be developed with the Institutional Review Board to address any concerns.
Your approach is different from other treatment methods. Is its implementation adjusted in any way based on age?
We understand that other infant/child researchers and clinicians would propose, or have already proposed, different approaches to the treatment and/or prevention of developmental disorders. Some would argue that high-risk infants, even within the category of preterm infants, vary with regard to the specific nature of their vulnerabilities, the degree to which they are at risk, and their responsiveness to intervention. Thus, specific interventions are needed for specific groups with specific risk factors. Clearly there are vast changes in behavior and biologic function from 34 weeks post-conception to 5 years; this will require tailoring specific aspects of Family Nurture Intervention to these different age ranges. We are developing new protocols for new studies. Prior to their implementation, we know that the Institutional Review Board and our Performance and Safety Monitoring Board will provide critical feedback and suggestions with regard to the evaluation of the safety and effectiveness of these new protocols.
The Family Nurture Intervention appears to be effective for a wide range of problems, is that correct?
Nurture can’t cure all, but it is powerfully beneficial in its presence and powerfully harmful in its absence. The scientific literature is clear on this. We think that family nurture as an agent of healing has not been utilized sufficiently in healthcare. Nurture should be thought of as one of the keys to good health, alongside diet and exercise. The basis for human sociability is the family.
Is Family Nurture Intervention a “one size fits all” approach?
Our basic premise is that the experience of feeling a mother’s love and the reciprocal experience of the mother feeling the acceptance of her love will be of benefit to all children at all ages. It is our belief that these experiences shape neurobiological systems to enhance resilience to subsequent stress and, in turn, resilience to developmental disorders. In this way, we view nurture interventions not as a sweater that requires refitting at every age but more as a blanket that is appropriate for all children.
We believe that there is a certain universality of Family Nurture Intervention. This is because it is based upon sound human biology. The Nurture Science Program research is designed to provide the most rigorous scientific evidence to back the claims of Family Nurture Intervention. New approaches almost always prompt caution and even skepticism. We believe it is important to address serious concerns and criticism directly and from a scientific perspective. That is why we are subjecting Family Nurture Intervention to randomized, controlled clinical trials. In the end, only the most compelling scientific evidence will determine if our approach is effective.
There is a lot of excitement related to your research. Do you think the Family Nurture Intervention is a panacea?
We do not view Family Nurture Intervention as a panacea; it will not cure all ills. But as scientists have increasingly incorporated notions of allostatic load and stress-diathesis as ways of understanding the importance of stress in the origins of physical and mental disorders, interventions that can provide increased capacity to buffer stress responses become ever more attractive. The groundbreaking work of Seymour Levine, Victor Denenberg, Myron Hofer and many others showed that early life experiences in research animals, particularly those experiences embedded in mother/infant nurturing interactions, play a profound role in the physiology, behavior regulation, and in shaping lifelong responses to stress. Dr. Martha Welch’s clinical experience shows these concepts work in humans as well. The key point for those that would question our approach of adapting these findings to early human intervention is that we will continue to subject all of our protocols to critical testing before promoting wide-scale implementation.
Will differentiating between treatment protocols, measurement tools, and findings for specific groups or developmental challenges help encourage more research and further study?
Yes. This will be an important part of on-going data analysis and strategic focus of the Nurture Science Program. We believe that through open partnerships we will bring about the most change. We intend to collaborate with a wide range of researchers and therapists in order to determine best practices.
What are the pros associated with treating children with a wide range of behavioral and developmental problems?
Our central hypothesis is that optimal nurturing interactions can prevent and overcome emotional, behavioral, and developmental disorders. Dr. Welch was compelled to turn to research by the positive results of using Family Nurture Intervention in treating a broad range of childhood behavioral and developmental problems over a 25-year period. The beneficial effects she observed led her to hypothesize, and later in 1997 to begin to investigate, that molecular mechanisms would support a platform for disseminating Family Nurture Intervention as a prevention, if validated by scientific evidence.
What are the cons to designing your clinical trials to include a heterogeneous group of disorders or separate homogenous ones?
Heterogeneous disorders have some elements in common, mainly those involving poor infant or child physiologic regulation. Experience suggested, and evidence is being sought as validation, that establishing a mother's and child’s abilities to create reciprocal calm through nurturing interactions leads to enhanced brain activity in regions known to affect emotional and behavioral regulation. When disorders have other components not resolved by these efforts, they must be treated with ancillary therapies such as auditory processing for deficits in processing spoken language or developmental optometry for dysfunction of processing written language.
How will children be screened in the Nurture Science Program Clinic?
Children will be assessed by trained, qualified professionals using history, standard assessment tools, and clinical judgment.
What will be done if a child is diagnosed with emotional, behavioral or developmental problems such as autism?
Children with emotional, behavioral, or developmental problems for which there is a treatment program available will be referred to that program.
Could children with emotional, behavioral, or developmental problems benefit from Family Nurture Intervention?
Yes. Family Nurture Intervention can serve as a powerful adjunct therapy for families who are struggling with children with emotional, behavioral, or developmental problems. Therefore, it is possible we could design a study to test whether Family Nurture Intervention is an effective adjunct therapy in a group of children with emotional, behavioral, or developmental problems. Subjects could be recruited into a randomized, controlled clinical trial using Family Nurture Intervention. Like the NICU intervention, the interventions for older infants will be developed by our clinical team with Dr. Welch’s guidance. Each intervention will receive Institutional Review Board approval to ensure safety.
If a child with emotional, behavioral or developmental problems was treated would Family Nurture Intervention be adapted to take into account those needs?
Yes, the child would receive other services for the emotional, behavioral, or developmental problems.
What would the predicted benefits be of treating children with emotional, behavioral, or developmental problems receiving separate therapy in addition to Family Nurture Intervention?
Families with children with emotional, behavioral, or developmental problems often experience a great deal of stress, anxiety, and conflict. Often the children suffer from poor parent-child regulation. Family Nurture Intervention enables the family to better regulate the child as well as to process and better handle their stress. Family Nurture Intervention is a multi-generational therapy. As such, it can help bring the family together and identify ways family members can help to regulate the child through enhanced calming activities of nurture.
The Leadership Team
Who are the senior management staff?
- Martha G. Welch, MD, Co-Director Nurture Science Program. Dr. Welch has been overseeing the Brain-Gut Initiative (BGI) for six years and has more than 35 years of experience treating children and families with emotional, behavioral, and developmental disorders.
- Michael M. Myers, PhD, Co-Director Nurture Science Program. Dr. Myers has served as the Director of the Division of Developmental Neuroscience and published many scientific papers.
- Michael D. Gershon, Co-Director Gastrointestinal Research. Gershon has published many scientific papers.
How was the current research team formed?
The current Nurture Science Program management team has evolved from the Brain-Gut Initiative team and has added members for the clinical study in the NICU.
What are the distinct skills of each member of the research team?
- Dr. Martha G. Welch: clinical experience; preclinical brain-gut research, design and implementation of the NICU study
- Dr. Michael M. Myers: preclinical animal research, preterm and term infant physiology, the NICU study
- Michael D. Gershon: preclinical animal research
Are there team transition plans in place?
Yes, we have plans to hire several senior level management personnel and several mid-level post-doctoral research assistants.
How are new team members found, recruited, mentored, and integrated?
Career job postings within and without Columbia University will be used to find personnel. The senior level members will be selected based on experience and qualification.
Have any senior leadership left the Nurture Science Program in the last five years?
No, the same senior leadership has been in place for the last 6 years.
Are senior leadership involved in any businesses outside the Nurture Science Program?
No, all senior leadership are working full time for Columbia University.
What is the path to senior leadership in the Nurture Science Program?
Midlevel research assistants may advance to senior leadership positions.