Presented by Professor Martha G. Welch

This webinar was presented live on Wednesday December 6th, 2023 at 4pm US Eastern time. Through the kindness of the presenter, a recording of the webinar is available here.

In this webinar, I will first review results from two randomized controlled trials among  mothers and their prematurely born infants and mothers and their preschool aged-children using interventions that aim to restore autonomic emotional connection (AEC) between the two. Second, I will review a novel calming cycle change theory and autonomic theory of emotions that may account for the significant changes brought about by the interventions. Finally, I will review a novel assessment tool, the Welch Emotional Connection Screen, that we developed to measure the behavior associated with the autonomic nervous systems of the mother and child.

For preterm infants, we designed and tested Family Nurture Intervention (FNI) to overcome mother and infant autonomic stress and dysregulation while the dyad is still in the NICU. Our group at Columbia University Medical Center conducted an RCT of FNI at Children’s Hospital of New York and a multi-site replication RCT in New York and at Texas Children’s Hospital of San Antonio comparing FNI with standard care. FNI included approximately six weeks of facilitated mother-infant interactions in the NICU aimed at achieving mother-infant AEC, a novel construct that describes the emotional mother-baby relationship at the level of the autonomic nervous system. We have documented significant positive short- and long-term effects that FNI had on infant neurobehavioral functioning, developmental trajectories and both mother and child autonomic health through five years.

For preschool children, we designed and tested the mother-child emotional preparation program (MCEP), based on our novel autonomic nervous system learning mechanism. Like FNI, MCEP is hypothesized to condition the child's autonomic nervous system to better meet socioemotional challenges throughout development. We conducted a randomized controlled trial of MCEP, comparing a group of children receiving standard curriculum with children receiving standard curriculum plus MCEP. We found that the MCEP mother-child dyads were more emotionally connected at six months post intervention and MCEP children displayed better socioemotional behavior at home and in the classroom. We also found that MCEP children showed better autonomic regulation following a stressor, as measured by lower heart rate and increased high frequency respiratory sinus arrhythmia (RSA) or vagal tone, with large effect sizes. In addition, we found significant correlations, also with with large effect sizes, between autonomic measures and scores on the Welch Emotional Connection Screen (WECS). These findings support the conclusion that MCEP had a significant positive impact on child autonomic regulation in response to stress, which correlates with behavioral assessments of emotional connection.

Many studies have documented the profound impact that the mother-child relationship has on child sociality and behavior. However, the biological mechanisms that govern the relationship are poorly understood. To explain the profound and long-term impact of our interventions, we have developed a novel autonomic theory of emotions. The theory requires a new interpretation of neonatal developmental biology.  Briefly, we believe FNI emotionally connects the mother and baby by re-engaging innate or primary mother and Infant autonomic socioemotional reflexes (ASRs). These reflexes develop during gestation. This occurs by way of autonomic conditioning or learning. After birth, these learned reflexes assure that the bodies of the mother and baby are attracted to one another automatically, without requiring thought. Neither the baby nor mother should be expected to “self-regulate” their emotional responses to each other following birth. Both are naturally able to “co-regulate” one another’s autonomic physiology, unless disrupted, as happens with preterm birth. Co-regulation can be reinstated through “autonomic conditioning” (FNI calming sessions), which involves retraining the body’s internal organ reflexes (heart, lungs and GI tract) to react positively upon close socioemotional contact. We believe FNI changes the ASR from avoidant to attraction when mother expresses her feelings and deepest emotions directly to her baby. When the mother and infant are able to connect emotionally at this physiological level, we describe this observable behavioral state as “autonomic emotional connection”.

To measure the behavior associated with autonomic state we created the Welch Emotional Connection Screen (WECS). The WECS was validated on a sample of preterm infants with our first FNI trial, showing correlation between emotional connection and physiological state as measured by vagal tone. Furthermore, the WECS was used in a full-term population in which 4-month WECS predicted 3-year old behavior on the Child Behavior Checklist. Next, in the preschool population we validated the Universal WECS or uWECS in Spanish. Because the original English language Welch Emotional Connection Screen (English oWECS) led to challenges for English speakers to agree on the words used to describe emotional connection and, because the oWECS proved difficult to translate into many languages, we translated it into the universal WECS (uWECS). Using clear explicit translatable language, we translated the English oWECS into a new universal language instrument, the uWECS. In this study, we accomplished two aims: to establish concurrent validity of the uWECS by comparing scores on a Spanish uWECS coded by primary Spanish speaking coders with scores on the Spanish oWECS coded by bilingual secondary Spanish speaking coders; and to establish criterion-related validity by demonstrating that the uWECS accurately measures the underlying autonomic emotional connection (AEC) construct.

Martha G. Welch, MD, DFAPA is Professor of Psychiatry In Pediatrics and In Pathology & Cell Biology at the Columbia University Irving Medical Center (CUIMC) in New York City. She is a Diplomate of the American Board of Psychiatry and Neurology and a Distinguished Fellow of the American Psychiatric Association.  She currently serves as the co-founder of the Martha Welch Legacy Program in Pediatrics at CUIMC. Previously, Dr. Welch founded and co-directed the BrainGut Initiative in Pathology & Cell Biology and the Nurture Science Program in the Department of Pediatrics, where she has been conducting basic and clinical research aimed at elucidating the mechanisms of parent-infant and parent-child autonomic co-regulation.  Dr. Welch has spent 50-years in medicine, the first 25 years treating mother/infant and mother/child relational health and pioneering a treatment for emotional, behavioral, and developmental disorders and optimal development centered on parent-child emotional co-regulation. For the last 25 years, Dr. Welch has been conducting pioneering molecular, animal and human research at Columbia University. She has served as principal investigator on numerous randomized controlled clinical trials that tested her calming cycle theory of change among mothers and their preterm infants and mothers with their preschool-aged children. Dr. Welch’s body of work across multiple fields of scientific discipline has led to the development of a novel autonomic theory of emotions, which proposes a fundamentally new way of viewing and measuring emotional behavior through the Welch Emotional Connection Screen (WECS). Most recently, Dr. Welch and her team founded the Martha G. Welch Center for Emotional Connection (emotionalconnection.org) to provide direct help to families with children aged zero to five.

A recording of the webinar is available here.