March 26, 2019

1

Martha G. Welch, MDDirector

Nurture Science ProgramDepartment of Pediatrics

Columbia University Medical Center

Emotional Connection

and the

Welch Emotional Connection Screen

• 40% kids not school ready

• 5 million EBDs

• Current evaluations costly and not easily accessible

• Treatments not keeping up with growing problem

• Hard to engage parents in treatment

The Problem

New Concepts from Nurture Science

Autonomic Co-regulationo Begins in utero between mother and infanto Pavlovian co-conditioning mechanism

Emotional Connectiono Forms at birth – the basis of “nurture”o Breaks in emotional connection can lead to impaired

developmento Breaks can be repaired to overcome and prevent

emotional disorders.

Alaska 4-19 FNI 6 slide handouts

Time

High

Low

SEPARATIONSTRESS

REUNION

Level of Stress

INFANT

MOTHER

Over time Calming Cycle interactions lower levels of stress in both the mother and the infant, and do so in less and less time

The Calming Cycle

Facilitating Emotional Connection

Alaska 4-19 FNI 6 slide handouts

Alaska 4-19 FNI 6 slide handouts

36 wks FNI Moms Better Caregiving behavior (Hane et al, 2015)

40 wks FNI Infants Increased prefrontal EEG Power (Welch et al, 2013)

FNI Infants Better EEG coherence (Welch et al, 2013)

FNI Infants Increased conscious state (Isler et al, 2018)

FNI Infants Higher vagal efficiency (Porges et al, submitted)

4 mos FNI Moms Decrease in depressive symptoms

FNI Moms Decrease in anxiety

FNI Infants Lower heart rate under stress (Welch et al, 2013)

FNI Infants Better face-to-face facilitation (Beebe et al, 2018)

(Welch et al,2014)

Alaska 4-19 FNI 6 slide handouts

March 26, 2019

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18 mos FNI Infants Better language (Bayley III) (Welch et al, 2015)

FNI Infants Better cognition (Bayley III) “

FNI Infants Better Attention (CBCL) “

FNI Infants Decreased risk for autism (MCHAT) “

4 &5 yr FNI Infants Higher vagal tone (EKG) (In prep)

FNI Infants Cognitive empathy (Theory of Mind) “

FNI-NICU RCT – Findings

Alaska 4-19 FNI 6 slide handouts

The Welch Emotional Connection Screen(WECS)

• Measure new construct – Emotional Connection

• Measure new concept - Relational Health

• Apply to all parents and children 0-5

• Replace lengthy evaluations

• Make it available to all childcare professionals

Goals of the WECS

Alaska 4-19 FNI 6 slide handouts

Clinical use of the WECS

To quickly assess parent/child emotional connection

• Practicable screen for relational health for immediate intervention or referral

• Can be performed in as little as 3 minutes

• Works on

• Preterm infants

• Parents and infants (0-2)

• Parents and Children (2-5)

Advantages of the WECS

WECS

Alaska 4-19 FNI 6 slide handouts

• Sound psychometric properties

• Valid instrument for assessing the Emotional Connection in mother-preterm infant dyads

• Associated with observed behavior tracked in real-time, supporting the validity of our global screening approach

• High correlation with conventional labor-intensive coding method

• Scores are correlated with infant physiology (vagal tone)

WECS research findings – 4-month dyads

Hane et al 2018, Acta Paediatrica

Alaska 4-19 FNI 6 slide handouts

March 26, 2019

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4-month WECS predicts 18-month outcomes

Clinical Referral Instrument WECS Sensitivity

Modified Checklist for Autism in Toddlers

75%

Child Behavior Check List (behavior problems)

88%

Bayley Cognitive 78%

Summary

• Measure new construct – Emotional Connection

• Predict neurodevelopmental outcome and risk for ASD

• We now have a team of reliable Pediatric Clinic Providers

Future Directions

• WECS for large-scale longitudinal studies

• WECS for assessing trends in relational health over time

• WECS as a relational health screen in the pediatric clinic

• WECS in pediatric residency training

Summary and future directions

Diana LitsasErica Liu

Mary McKiernanElizabeth Markowitz

Mai MitsuyamaChris Musial

Beatriz PreterManon Ranger

Connie Rubenstein Hadassah TamirKatherine Velez

Developmental NeuroscienceMyron A. Hofer

Harry Shair

Pathology & Cell BiologyBenjamin Klein

Michael D. GershonKara Gross Margolis

Sam LiWanda Sedlik

U of Texas San AntonioAlice Gong

Umber GarelickCheryl Farner

Strategic PartnersEinhorn Family Charitable Trust

Childrens Learning Centers, Stamford, CTNorwalk Housing Authority

Nurture Science Program in Pediatrics

NeonatologyRichard A. Polin, Chief

Raymond I. StarkPhilip GrieveJoseph Isler

Behavioral Coding Amie Hane, Director

Joy V. BrowneBeatrice Beebe

IHN Masters CandidatesTony AnzivinoJessica Kariuki

NUSURAJim ChesnuttLeslie LillardAnna Vigran

Meredith Eldon-Ross

Michael M. Myers Martha G. Welch Robert J. LudwigCo-Director Director Associate Director

Jasmine LaCoursiereAssistant Clinical Director

FundingEinhorn Family Charitable Trust

Deki Stephenson Fleur Fairman Family

Morgan Rutman Family

Muhammad AnwarJudy Austin

Maryann AustinJoseph BaroneSuzanne BryjakSean Dabney

Ewelina Fiedor Morgan FiresteinJasmine Kaidbey

Erin Holahan

Welch Lab

Alaska 4-19 FNI 6 slide handouts

Pre-school 4-year lap test

Pre-school 4-year lap test