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News

Fond caresses, loving squeezes shape social brain

by  /  19 November 2014

Comforting care: A therapy that includes gentle touch to build emotional bonds lowers the risk of autism in premature babies.

Loving touch and physical proximity to other people wire the social brain right from the earliest days after birth, and problems in the response to touch may play a fundamental role in autism. This picture emerges from unpublished results presented by several teams at the 2014 Society for Neuroscience annual meeting in Washington, D.C.

The findings have implications for how premature infants are treated. It suggests that a therapy that emphasizes touch to build emotional bonds could act as the brain equivalent of steroid shots given to protect the infants’ lungs. The studies also challenge how scientists understand autism.

Much of autism research tends to focus on complex features such as language and social behavior. But this complexity may stem from something basic and fundamental: Researchers are discovering that the sense of touch literally binds members of our species together.

One powerful example is an intervention for preterm infants that includes several components. Mothers of preterm infants place cloths that smell like their own skin in the baby’s incubator, and receive cloths that smell like their babies. If her baby is too fragile to hold in her arms, the mother can gently touch the baby’s palm with one hand to trigger the grasp reflex. She can also gently but firmly press both hands around her baby’s torso, which often calms babies. Also crucial, mothers speak in emotional tones while touching the baby in these ways.

All of this builds emotional connections between the mothers and their infants, setting the babies’ brains on a positive developmental path.

A number of studies have found that children born prematurely are at higher-than-average risk of autism, although the mechanisms underlying this finding are unclear. Preliminary data presented Sunday suggest that this approach lowers the babies’ risk of autism at 18 months.

Only 10 percent of children who were part of this program scored high on the Modified Checklist for Autism in Toddlers (M-CHAT), a common screening tool for the disorder, compared with 25 percent of the children who received standard care.

Slow touch:

If touch strengthens social bonds, atypical responses to touch can disrupt them, a phenomenon that may play a role in autism.

Many individuals with autism dislike being touched, especially in gentle ways such as with a caress or a hug. “This is not just another example of a sensory abnormality in autism,” says Francis McGlone, professor of neuroscience at Liverpool John Moores University in the U.K. “This is the precursor to everything we see downstream.”

McGlone has spent the past 25 years working to establish the fundamental importance of a class of nerve fibers called c-tactile afferents in human social bonds. These nerve fibers are found in hairy skin, such as on the back and the forearm. And the best way to activate them is with a slow, gentle stroke of about 3 centimeters per second — or, to put it in everyday terms, a fond caress. (More broadly, any touch that activates c-tactile afferents is called emotional or affective touch.)

McGlone’s unpublished research, presented Monday at the conference, shows that adults who scored in the top third on the Autism Spectrum Quotient (AQ) — a 50-item questionnaire designed to measure autism-related traits in the general population — respond differently to touch than do those who scored in the bottom third.

Both groups find slow strokes on the arm more pleasant than faster strokes of about 30 centimeters per second. But the 25 people who scored high on the AQ have a less pronounced preference for the slow touch than the 52 people with low scores.

McGlone’s team also placed electrodes on the participants’ fingers to record their galvanic skin response, a general measure of the nervous system’s arousal, when being touched. They assessed the participants’ response to the slow and fast touches, as well as to a light touch on the shoulder. (The shoulder touch also activates c-tactile afferents, though less strongly than forearm stroking, McGlone says.)

In 24 individuals who scored low on the AQ, the slow forearm strokes produce a much stronger galvanic skin response than do the other two touches. But 12 individuals who scored high on the AQ show relatively little difference in their responses to the three types of touch.

This may be because their c-tactile fibers are themselves different or because something is awry in how their brain processes information from them.

Intriguingly, the degree to which a person finds slow forearm-stroking pleasant depends on a network of regions, including the superior temporal sulcus and the mirror neuron system, according to another unpublished study presented Monday. Both of these areas have been strongly implicated in autism.

“Now we have a hypothesis that dysfunction in this system may lie behind the altered touch perception in people with autism,” says Monika Davidovic, a graduate student working with Håkan Olausson at the University of Gothenburg in Sweden, who presented the work.

Early awakening:

C-tactile fibers are at work within the first few weeks of life, according to another unpublished study presented Monday. Olausson and his colleagues used functional near infrared imaging (fNIRs) to show that the brains of infants who are 6 to 10 weeks old respond differently to different speeds of forearm stroking.

“The infant brain can distinguish between slow, social touch and fast, nonsocial touch,” says Olausson, who is McGlone’s longtime collaborator in the effort to understand c-tactile afferents.

No one has directly tested whether the nerve fibers also function in preterm infants. “That would be really interesting,” Olausson says.

But other results from the preterm intervention study suggest that even in these infants, social touch shapes the brain. In that study, the researchers used electroencephalography to record babies’ brain activity at about 35 weeks gestation and again at 40 weeks, or full term.

Scientists have known for several decades that preterm infants have patterns of brain activity called cortical bursting, brief surges of high-frequency brain waves distributed broadly across the cortex.

“They’re thought to wire up the different sensory areas that need infrastructure laid down before the baby comes out,” says developmental electrophysiologist Philip Grieve, a member of the research team.

Among infants who receive standard care, those who have less bursting activity at 35 weeks gestation go on to have lower cortical power at 40 weeks, the researchers found. Cortical power is a measure of brain function that is linked to children’s better cognitive function as toddlers. Infants who have lower bursting activity at 35 weeks also have higher M-CHAT scores, indicating greater risk for autism, when they are 18 months old.

Early bursting activity at 35 weeks gestation could therefore be used as a screen for autism risk in preterm infants, the researchers say.

More importantly, infants who receive the intervention don’t show the association between cortical bursting and autism risk. In that group, early bursting activity at 35 weeks predicts neither cortical power at 40 weeks nor M-CHAT scores at 18 months.

“With our intervention, even if you have low bursting, you still have high power,” says study leader Martha Welch, co-director of the Nurture Science Program at Columbia University Medical Center in New York and chief architect of the intervention.

Touch is not the only component of this therapy. The program is aimed more broadly at creating emotional engagement between mother and baby, which also comes from sight, sound and smell. And the exact mechanisms by which the therapy changes brain activity and lowers autism risk are unknown. “We’re going to try to tease out what the secret sauce is,” says Robert Ludwig, managing director of the Nurture Science Program.

The researchers don’t emphasize the kind of gentle stroking that best activates c-tactile fibers. Welch says that mothers of preterm infants often have trouble touching their babies in this way, perhaps because they are too anxious about the baby’s well-being. Instead, they tend to give the baby fast, feathery strokes, which the baby withdraws from, an experience that frustrates the mother and disrupts emotional bonding.

Welch says these observations led her to suggest that the mothers put their hands gently but firmly around the baby’s torso. “The ventrum is chockablock full with pressure receptors,” Welch says. In the absence of a fond caress, it’s no surprise they respond so strongly to a loving squeeze.

For more reports from the 2014 Society for Neuroscience annual meeting, please click here.


  • Marie Percecault

    Martha Welch, the inventor of the infamous “holding therapy” in the 70’s? Is this a joke? How can such a serious scientific institution such as SFARI report on such a person?

    • Robert Ludwig

      I understand your concern, Ms. Percecault. Please know that the Welch Method Holding Time was misunderstood and co-opted by others immediately after it was published. None of the controversial therapies has ever been linked to Dr. Welch or her therapy, though that may be hard to tell by some of the media coverage back then.

      As background, Dr. Welch left private practice in 1997 and turned all of her efforts to research to better understand the underpinnings of mother-child nurture. This led to research on neuropeptides of nurture and calming cycle in animal models, and the Family Nurture Intervention mentioned in the article. This new field has in common with her prior work some lessons learned about the power of emotional enrichment to ameliorate and to prevent behavioral and developmental disorders. Family Nurture Intervention restores the missing mother-infant touch, talk, cuddling, and holding – all biologically relevant interactions and an integral part of normal behavior of full term infants and mothers – that are thwarted by preterm birth.

    • adelaidedupont

      More to the point – what was it doing at a Society of Neuroscience meeting in 2014?

  • Sue Gerrard

    Isn’t there a missing link in this theory? I can see how touch could be experienced as pleasant or unpleasant, or could be calming. But how is touch connected to ’emotions’ and ‘bonding’?

    • Robert Ludwig

      This is an important question Sue. Tiffany Field sees the same missing link that you do. She has been a leading researcher in the benefits of infant massage since the 1990s. She may be the world expert on the subject. She has just published an article entitled “Massage therapy research review” in the Journal of Complimentary Therapies in Clinical Practice (http://www.ncbi.nlm.nih.gov/pubmed/25172313). She writes in her abstract that moderate pressure massage has contributed to many positive effects including increased weight gain in preterm infants, reduced pain in different syndromes including fibromyalgia and rheumatoid arthritis, enhanced attentiveness, reduced depression and enhanced immune function (increased natural killer cells and natural killer cell activity).Surprisingly, these recent studies have not been reviewed, highlighting the need for the current review. When moderate and light pressure massage have been compared in laboratory studies, moderate pressure massage reduced depression, anxiety and heart rate, and it altered EEG patterns, as in a relaxation response. Moderate pressure massage has also led to increased vagal activity and decreased cortisol levels. Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex, all areas involved in stress and emotion regulation. Further research is needed to identify underlying neurophysiological and biochemical mechanisms associated with moderate pressure massage.

  • Amie Hane

    In my research with mothers and full-term infants, quality of touch in particular has emerged as the most robust predictor of reduced infant stress. In one study, we rated quality of maternal caregiving behavior during routine bathing in the home when infants were 4-8 weeks. We also collected saliva samples from infants before bathing and 20-minutes after removal from the bath water to measure the level of cortisol in the infants’ systems. Cortisol is stress hormone that increases for all newborns following the earliest experiences of a tub bath, where the challenge of thermoregulation and the sensory experience of being washed produces some stress, even for healthy, full-term newborns. We found that mothers who were more sensitive to their infants during the bath showed lower levels of cortisol 20-minutes after the bath. Most importantly, among the types of maternal behavior we observed (overall sensitivity to infant cues, maternal intrusiveness, and quality of touch), the most robust factor that was associated with decreased infant stress was quality of touch. Hence, mothers who supported their infants during the bath with gentle, loving, supportive, and non-invasive handling had infants who were less stressed by the experience of early tub bathing (this article is available at: http://psychology.williams.edu/files/Hane-Philbrook-advanced-online-June-14.pdf). This research and the FNI findings join a growing body of both animal and human research demonstrating that quality of touch plays an important role in reducing stress and facilitating an emotional connection with caregivers beginning very early in life.

  • usethebrainsgodgiveyou

    “Holding Therapy” is abuse. In a misguided effort to try to help my son to ‘bond’ to me, I attempted it at age four months. After 3 hours, my son did not “look me in the eye with warm, puppy dog eyes” because I couldn’t “break his spirit” or whatever the object was supposed to be. My husband told me if I ever did that again, he would leave me. Thank God somebody had some sense in our household.

    Touch therapy, Klin’s eye-gaze therapy, cause my heart to go out. They both are evil under the guise of kindness. Have you ever noticed that not one child has been cured of autism, even after thousands of hours of therapy. If you want to emotionally bond with your child, here is a clue: love them for who they are, and treat them with kindness. There is more evil done in the name of “therapy”, and we have the victims to tell us—-autistic adults.

    I say, chuck the “experts”, and get with the real experts, who are changing the world for good, even as we speak.

  • Philip Grieve

    I am a developmental electrophysiologist and one of the authors on a paper reporting the brain effects of FNI. The strategy behind Family Nurture Intervention in the NICU is to pair mother’s communication of feeling with interactions that calm both mother and infant. These included sensitive, loving touch and holding. In a peer reviewed journal article (Welch et al., Clinical Neurophysiology 2013), we reported the results of brain activity, as measured by electroencephalogram (EEG). We found that following the hospital intervention and by the time they reach term age, FNI infants showed robust increases in EEG power in the frontal regions of the brain. These regions are most affected by preterm birth. The effects of the intervention were independent of gestational age or weight at birth, gender or twin status. Frequency-specific increases in this region have been shown by others to correlate with better neurodevelopment at later ages. In fact, we found just this same outcome. The FNI infants had better development at 18 months, as reported here by SFARI. What we have found supports the importance of early mother–infant nurture, including sensitive touch and holding, in the NICU.

  • Mary McKiernan, RNC

    Thank you for your heart-felt comment and I agree with you when you say “love them for who they are, and treat them with kindness”. No one can argue with that. I am one of the Nurture Specialists / Neonatal ICU Nurses administering the Family Nurture Intervention in the NICU. The intervention involves very sensitive and loving holding and touching of premature infants by their mothers, fathers and family members. Even grandparents are included. The baby’s and the mother’s emotional response to this intervention is a joy to behold. Using the best available scientific objective methods to assess the effectiveness of this intervention Dr. Welch and our team of researchers found that the infants who received this therapy in the hospital were on a much better developmental and behavioral trajectory at 18 months of age than their counterparts who did not receive the intervention. In my experience as a nurse for over twenty years, this is certainly a positive advancement in the care of these premature infants and their families. They seem to have benefited from just the sort of loving kindness you prescribe.

  • Megheen Goos

    My first born was came to us at 23 weeks. I was able to be at the hospital from 6:45 am until 11:00pm taking breaks only to eat. I participated in “kangaroo care”, “skin-to-skin” and on days I couldn’t hold him I held my hands over his torso like suggested. My husband also participated in all of the aforementioned and my son is now a vibrant, cognitively on level, vivacious, social five year old. I firmly believe touch and all associated with this emotional bonding is what not only helped us as parents cope through this roller coaster ride but is the main reason my son is functioning (as of date) with no problems. True advocate and living proof that this is true.

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