What is the Nurture Science Program?
The Nurture Science Program is a multidisciplinary team of researchers and clinicians working to test family nurture-based interventions in infants and children aged 0-5 and define the biological mechanisms underlying nurture. Our understanding is that the well-being of the infant is closely tied to the emotional relationship with the mother. Our goal is to rigorously test family interventions that repair and maintain that emotional relationship, to help prevent and overcome emotional, behavioral and developmental difficulties faced by millions of children and families.
What makes the Nurture Science Program unique?
The Nurture Science Program is unique in bringing together a multidisciplinary research team that combines the talents and perspectives of basic, translational and clinical scientists. Insights from the fields of cell biology and neurobiology are combined with behavioral physiology and pediatrics to focus on the biology of nurture, and translate findings into effective clinical treatment. Also, Nurture Science Program work is based on two new ideas. First, that the entire body, not just the brain, is an important regulator of emotional behavior in the individual. And second, that individual emotional behavior is co-regulated by other individuals. At the beginning of life, the emotional co-regulation between mother and infant is the key to the future emotional well-being of both.
What is the mission of the Nurture Science Program?
The Nurture Science Program’s mission is to develop, test and promote nurture-based therapies, rooted in rigorous scientific research, to help families everywhere use the healing power of nurture to address emotional, behavioral and developmental difficulties.
What has the Nurture Science Program accomplished?
The Nurture Science Program has amassed considerable evidence to support interventions based on family emotional connection, with important findings in both clinical and basic research.
Clinical research findings:
The first clinical trial of Family Nurture Intervention was conducted in the neonatal intensive care unit of New York-Presbyterian’s Morgan Stanley Children’s Hospital between 2008-2014, with 150 infants and their mothers randomized to either Family Nurture Intervention or standard care. The findings revealed distinctly different developmental tracks for the two groups: At term age, Family Nurture Intervention infants showed dramatically improved brain activity in the prefrontal cortex, an area whose functions are known to be adversely affected by premature birth. The overall change in developmental trajectory was confirmed at 18 months. The Family Nurture Intervention infants had fewer attention problems, better cognition and language, and lower scores on a measure of risk for autism spectrum disorders. Additionally, Family Nurture Intervention increased the quality of maternal caregiving behaviors and decreased symptoms of maternal anxiety and depression.
Basic research findings:
The Nurture Science Program has made major strides in identifying the molecular processes associated with nurturing behavior and brain-gut signaling. For example, the Nurture Science Program discovered that oxytocin receptors are present in in the neonatal mammalian gut, and that oxytocin may play a key role in gut function and development. 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 that 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 kinds of projects does the Nurture Science Program do?
Our study of Family Nurture Intervention with preterm infants produced highly significant results that demonstrate better cognition, language, attention and emotional regulation. Multi-site replication studies are currently being conducted at Morgan Stanley Children’s Hospital in New York City and the Children’s Hospital at the University of Texas Health Science Center San Antonio. These studies will be followed by effectiveness trials to determine if this intervention can be effectively applied to all babies in NICUs. A study of Family Nurture Intervention with preschool-aged children who are struggling with behavioral difficulties is also underway. In addition to clinical studies, we conduct basic science research into the relationship between nurturing behaviors, the molecules through which nurture manifests its effects, and the development of the brain and gut.
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 many of these families. Scientific research on the healing power of nurture has been underfunded, under-explored, and under-utilized as a basis for intervention and prevention of emotional, behavioral, and developmental disorders of young children. The Nurture Science Program has completed a study of a Family Nurture Intervention with preterm infants that produced highly significant results that predict better cognitive, language, attention, and emotional regulation - all areas where preterm infants as a group are known to suffer deficits. Therefore, Family Nurture Intervention should be tested in infants born less prematurely as well as with infants born at term that show deficits in these functions at later ages. Funding is required to carry out these studies. 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?
We are testing whether Family Nurture Intervention can improve neurodevelopment and behavior in preterm infants. Preterm infants are at high risk for emotional, behavioral, and developmental disorders, including autism. The negative effects of separation between mother-infant associated with preterm birth and hospitalization have been well documented for decades. But relatively little rigorous research has been conducted on interventions designed to overcome the separation. Finding early interventions for this population that are effective, affordable and scalable is a high priority for hospitals, families and society at large.
Why are these infants described as “high-risk”?
This refers to the probability that an infant will suffer neurodevelopmental or socio-emotional problems later in childhood. Preterm infants are known to be at high risk for emotional, behavioral, and developmental disorders. Research and treatments are generally aimed at identified cognitive risk factors for these kinds of problems. We think a major risk factor is disruption to the autonomic nervous system – the part of the nervous system that controls basic bodily functions such as breathing, heart rate and digestion – that occurs with traumatic separation from the mother and family at such a critical age in development. Our therapy, Family Nurture Intervention, aims to restore autonomic co-regulation and shared calming between infant and mother through repeated reciprocal calming interactions as soon as possible following birth.
Who might benefit from Family Nurture Intervention?
An infant who experiences physical separation from its parents early in life is at risk for emotional, behavioral, and developmental difficulties. Mothers who are experiencing physical and emotional separation from loved ones, or have experienced these separations in the past, are also at increased risk for difficulties that can affect both their own mental health and their infants development. Preterm infants are a group at high risk for effects of prolonged separation due to the NICU hospital care they often require. Family Nurture Intervention in the NICU is a strategy to overcome this separation, and help prevent future problems. Family Nurture Intervention is also being tested with mothers, infants and children with adverse developmental symptoms, common to those with separation histories.
Is Family Nurture Intervention being designed for all babies, regardless of risk factors, even if there are none?
Family Nurture Intervention may be a helpful for many or all families. Physical and emotional separations are part of life – caused by stressful environments or even just every day comings and goings. Babies are especially vulnerable to the stress of these separations. We hypothesize that building increased capacity for resilient response to stress will be the most effective and cost effective strategy to prevent emotional, behavioral and developmental difficulties. 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 by improving the baby’s stress response.
Is there a difference in how effective Family Nurture Intervention is for boys compared to girls, since boys seem to be at higher risk for neurodevelopmental disorders?
Our findings in the first study of preterm infants showed that the effects of were independent of sex differences.
Mechanisms and Terminology
- 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 intervention is designed to facilitate a physiological state of co-regulation between the mother and infant. This is accomplished by means of repeated mutual calming sessions.
This is based on Dr. Martha G. Welch and Robert Ludwig’s Calming Cycle Theory, which describes the mechanisms underlying emotional behavior. The theory states that emotional behavior is the result of subconscious co-controlled learning mechanisms within the visceral/autonomic nervous systems of two or more individuals. This conditioning begins between mother and infant during pregnancy. This is a radical departure from the long-held view that emotional behavior is the result of conscious self-controlled learning mechanisms within the central nervous system of the individual. According to the new theory, the emotional relationship between mother and infant or child produces two distinct and measurable sub-conscious reflexes; a physiological reflex and a behavioral reflex. Together, these two responses reflect the psychological, physiological and emotional well-being of the mother and the infant.
What biological mechanisms are at work in Family Nurture Intervention?
Calming Cycle theory proposes that early emotional behavior is shaped by subcortical visceral (gut)/autonomic nervous system co-conditioning between mother and infant. Two new constructs, emotional connection and visceral/autonomic co-regulation, are defined within a functional Pavlovian conditioning framework, and are theorized to be part of an evolutionarily conserved mammalian phenomenon.
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 benefit from longer gestation; however, birthing can have a significant impact on those mechanisms. There are many aspects of modern birthing that can put infants and mothers at risk for separation, which interferes with the biological mechanisms that naturally calm and bond baby and mother.
How do you measure emotional connection?
To demonstrate that emotional connection is observable and measurable, and to show that the construct has predictive power and clinical use, the Nurture Science Program is in the process of validating a new instrument – the Welch Emotional Connection Scale (WECS). The Nurture Science Program is refining and validating the WECS in multiple studies and correlate the findings with physiological and behavioral outcomes.
Treating Different Age Groups
Do parents need a different approach for different aged children?
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 healthy development.
Do you have a plan for testing separate, developmentally appropriate treatment interventions for different age groups?
Yes. In addition to ongoing replication studies of Family Nurture Intervention in the NICU we are testing Family Nurture Intervention with families with preschool aged children who are having emotional, behavioral and developmental difficulties. While the intervention is delivered in a manner appropriate for the child’s age and setting (for example, preschool aged children at a community center instead of premature infants in a NICU) the goal of using close physical and emotional contact to strengthen emotional connection and autonomic co-regulation remains the same.
Protocols are developed for each study to 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. It is the role of the Nurture Specialist to help the family overcome obstacles and 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 Family Nurture Intervention in the NICU, we are doing replication trials at other hospitals. Assuming those trials show the same promising results as the first, we will expand this intervention to other NICUs. We are also conducting a Family Nurture Intervention preschool trial at a community center. If that is successful, we will expand to many more.
What developmental events, challenges, and capacities are likely to require some tailoring of your intervention? Or the need for a different intervention?
Family Nurture Intervention is currently designed to treat problems early. For the most part, the problems that emerge prior to age 5 are treatable within the family with Family Nurture Intervention.
Family Nurture Intervention is not meant to treat all developmental problems. Many developmental problems, especially behavioral ones, will disappear on their own with increased family nurture, while other problems may persist. Family Nurture Intervention serves as an important opportunity to identify potential problems that need special treatment. The therapist would evaluate the child’s development, physical coordination, language and eye contact because they are important indicators of emotional connection. Where appropriate, the child could be referred for specialized therapy.
How will you establish safety, feasibility, and acceptability, and provide detailed assurance that you have carefully looked for adverse effects?
We work with the Institutional Review Board and a Safety Monitoring Committee to monitor the safety of the participants. All studies fall under the domain of the Institutional Review Board, and protocols are developed with their help. We handle each of the potential risks sequentially as we design each study.
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 might propose 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 might be recommended 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 continue to develop 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 Scope of this Approach
Family Nurture Intervention can’t cure all problems, but nurture is powerfully beneficial in its presence and powerfully harmful in its absence. The scientific literature is clear on this. We think that family nurture is an agent of healing has not been utilized sufficiently in healthcare. Nurture should be thought of as the third leg of a stool, one of the keys to good health, alongside nutrition and exercise. The basis for human sociability lies in the family.
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 human biology. The Nurture Science Program research is designed to provide the most rigorous scientific evidence. 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 conducting randomized, controlled clinical trials to test Family Nurture Intervention. In the end, only the most rigorous scientific evidence will determine if our approach is effective.
We do not view Family Nurture Intervention as a panacea; it will not cure all ills. But as scientists have increasingly become aware of the importance of stress in the origins of physical and mental disorders, interventions that can provide increased capacity to buffer stress responses are 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 who 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.
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.
Our central hypothesis is that optimal nurturing interactions can help prevent and overcome emotional, behavioral, and developmental disorders. Treating children with a wide range of behavioral and developmental problems provides an opportunity to understand the power of this approach to address a variety of 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 in 1997 to begin to investigate, that molecular mechanisms would explain the benefits of Family Nurture Intervention, and, once validated by scientific research, support disseminating Family Nurture Intervention as a prevention.
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.
At this time, children diagnosed with autism are not enrolled in Nurture Science Program studies.
Family Nurture Intervention can serve as a powerful adjunct therapy for families who are struggling with children with emotional, behavioral, or developmental problems. The Nurture Science Program does keep track of which therapies each child has received or is receiving.
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, Director, Nurture Science Program. Dr. Welch has nearly 40 years of experience treating children and families with emotional, behavioral, and developmental disorders. She has been the Director of the Nurture Science Program since 2013, when the program was founded. Dr. Welch also directed the Brain-Gut Initiative (BGI), which started in 2006 and is now the basic research arm of the Nurture Science Program.
- Michael M. Myers, PhD, Co-Director Nurture Science Program. Dr. Myers has over 40 years of research experience in the field of Developmental Psychobiology, and served as the Director of the Division of Developmental Neuroscience at the New York State Psychiatric Institute. He joined the Brain-Gut Initiative in 2008, and became Co-Director of the Nurture Science Program at its inception in 2013, bringing his extensive research experience to this multidisciplinary effort.
- Robert Ludwig, Associate Director, Nurture Science Program. Mr. Ludwig has nearly 20 years of experience in the field of Family Nurture Intervention and nurture science. He has extensive knowledge of the scientific theories underlying this approach, as well as ongoing research.
How was the current research team formed?
The current Nurture Science Program management team has evolved from the Brain-Gut Initiative. Additional team members have been added for the Family Nurture Intervention clinical studies, and to expand the basic research aspect of the program’s work.
What are the distinct skills of each member of the research team?
- Dr. Martha G. Welch: clinical experience; preclinical brain-gut research, design, implementation and oversight of the clinical studies
- Dr. Michael M. Myers: preclinical animal research, preterm and term infant physiology
- Mr. Robert J. Ludwig: Theoretical basis of nurture science, scientific writing, business management
- Dr. Manon Ranger: cross-disciplinary translational research, integrating basic animal studies with clinical studies; identifying biomarkers of risk for suboptimal neurodevelopment
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 are used to find personnel. The senior level members are selected based on experience and qualification.
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?
Mid-level research assistants may advance to senior leadership positions.