The first thing that struck Nathan Fox ’70 was the silence. In the drab room of an orphanage in Bucharest, Romania, the developmental psychologist saw dozens of infants lying awake in their cribs. Not a single one was crying. “They were on their backs, doing nothing except maybe looking at their hands,” he says. “These were babies who had learned that no one was going to come soothe their distress.”
Fox had gone to conduct research that could bring much-needed understanding to the effects of neglect on brain development. Seeing the orphans in person, though, he and fellow researchers Charles Nelson and Charles Zeanah realized they might have a chance to help some of the infants as well.
Starting with 136 children living in six Bucharest orphanages, the researchers conducted electroencephalogram (EEG) tests of their brains. They found the signals to be weaker than those recorded from similarly aged children living in the general population. They randomly selected half to go into foster homes, where they would be held, played with and talked to.
Fox, Nelson and Zeanah then monitored the children over several years, comparing their development, and the results were astounding. By the age of 8, children who were placed with foster families before their second birthdays were virtually indistinguishable from typical 8-year-olds in terms of EEG brain patterns. Those who remained institutionalized past age 2 continued to have weaker EEGs and lag behind their peers. “It was as if a dimmer switch had been turned down in the brains of these children,” Fox says.
The findings from the Bucharest Early Intervention Project, published over the past 10 years, changed forever the parameters of the nature vs. nurture debate. It’s a wellspring from which developmental psychologists—a surprising number of them connected to Williams—have drawn. That connection is due in part to Amie Hane, an associate professor of psychology at the college, who studies interactions between mothers and babies. Hane began as a postdoctoral student in Fox’s University of Maryland lab, and together the two are mentoring a new generation of Williams students who are beginning to contribute meaningfully to the field.
Nature versus nurture. Instinct versus experience. The argument has been a throughline of philosophy and psychology from the time of Locke and Hobbes to that of Chomsky and Skinner.
In 1997, two years before Fox visited Bucharest, Newsweek published a special issue called “Your Child,” reporting the latest findings in neuroscience that, by age 3, brain development is essentially over. The inevitable backlash came just two years later, with publication of John Bruer’s book The Myth of the First Three Years. Since then, two decades of research, including that of Fox and Hane, has stopped the pendulum on the either/or debate in favor of a both/and explanation. The latest on epigenetics (from the Greek root “on top of ” or “in addition to”) argues for a more complex interplay between genetic code and experience, with organisms containing a DNA blueprint but the environment determining which genes are expressed and how.
“There’s no clean way to disentangle nature and nurture—they are intertwined,” Hane says. “When the environment is shaping the expression of genes, all bets are off.”
Hane studies this interplay in her lab in Brinsmade House, a two-story lavender building named for the beloved Williams music professor who once lived there. Hane’s research subjects are moms—mostly—from northern Berkshire County who come to play with their infants and perform specific care-giving tasks like bathing and diapering.
Hane guides and monitors the interactions, which take place in a living room with comfortable sofas and soft, purple carpeting. Cameras mounted discretely on the walls capture every contented coo and angry wail, and electrodes attached to both mom and baby record their heart rates on an electrocardiogram (EKG). Hane also measures the level of cortisol—the so-called “stress hormone”—in the infant’s saliva. Later, Hane and her students meticulously review the videos and EKG data, noting how connected and attentive the mom was and how the baby responded. Each pair is monitored until age 4.
It’s a protocol she refined in Fox’s lab as a postdoctoral student, and the two have been working and publishing together ever since. Their most recent article, a wide-ranging review in the journal Current Opinion in Behavioral Sciences, draws upon studies of rats, humans and other animals that show insensitive early caregiving can lead to stress, which can cause health problems later in life. The good news, they argue, is that the human brain is more malleable than we give it credit for, and, with the proper interventions, those changes can be undone.
“Our primary goal at a basic level is to demonstrate there are components of maternal behavior and mother-baby interactions that ultimately influence a child’s physiological response,” Hane says. “And, in Nathan’s lab, neuroimaging provides a critically important window into how early care and temperament influence the developing brain.”
Fox, now a Distinguished University Professor at the University of Maryland, became interested in child development as a Williams student, when he volunteered at a day care center in Bennington, Vt.
There he observed children from similar working-class backgrounds who nevertheless behaved quite differently from one another. “There were sparks of motivation to learn in all of them, but how you brought that out varied from child to child,” he says.
The question of why puzzled him, and he began to look for answers at Harvard, where he studied with Jerry Kagan. A legendary figure in the field of child development, Kagan went on to pioneer the idea of temperament—that there are certain innate personality types visible at an early age that remain remarkably consistent throughout life. In particular, Kagan was interested in children with an “inhibited” temperament who withdrew from unfamiliar stimuli. These children tended to grow up to be adults who were shy or, in extreme cases, developed social anxiety disorder. The notion flew in the face of the dominant ideas of Freud and B.F. Skinner, who argued that experience, not environment, was key to changing behavior.
In Fox’s early work on stranger anxiety and memory, Kagan saw his student’s potential. “I recognized at once his talent, curiosity and motivation,” he says. “I sensed he was marked to make a major contribution to psychology.”
Kagan didn’t have to wait long to see that contribution. In the late 1970s, as Kagan was starting his research on temperament, Fox was working as a postdoc at St. Luke’s Roosevelt Hospital in New York City, studying the development of infants born prematurely. At the time, doctors used EEG to measure infants’ brain patterns during sleep. Fox decided to observe babies who were alert and awake, exposing them to different stimuli—pictures of happy faces, their mothers and strangers—to see how their brains responded.
The results were clear, and groundbreaking. Children who smiled or reacted positively to new stimuli displayed more activity in the left frontal lobe of the brain. Those who turned away or fussed showed more activation in the right frontal region. More importantly, Fox was able to show that this EEG asymmetry in the brain could actually predict whether a child would respond favorably or unfavorably to the new stimuli. From the earliest days of their lives, something seemed to predispose babies to smile or fuss in response to new stimuli.
From the earliest days of their lives, something seemed to predispose babies to smile or fuss in response to new stimuli. Fox applied the same techniques to the temperament work Kagan was conducting and found that the children his mentor identified as having inhibited temperament showed the same pattern of right frontal asymmetry as those who fussed in Fox’s study.
It was the first time research had shown a specific pattern of brain activation associated with a specific, defined personality type that remained consistent over time. Fox’s work lent credence to the notion that certain people were “hard-wired” for certain temperaments.
Starting in 1990, Fox began replicating Kagan’s temperament experiments, recruiting a new cohort of about 100 inhibited infants, tracking them across development and subjecting them to more sophisticated tests, including EEG monitoring. In addition, he added new stimuli, having children in the lab play games with their parents or a friend, for instance, or introducing them to an unfamiliar child of the same age. He also tested them at age 4 and 7 to better understand whether temperament is fixed or can change over time.
Fox found that as the years went by and children were tested multiple times, some seemed to outgrow their shyness and become calmer in the face of unfamiliar territory. Others continued to be inhibited and, in some cases, developed signs of social anxiety and depression.
“Nathan put the flesh on the bones of the concept of temperament,” says one of his collaborators, Megan Gunnar, a psychology professor and director of the Institute of Child Development at the University of Minnesota. “For Jerry Kagan, you start that way and end that way; what Nathan brought to the table was an understanding of why some kids change and outgrow that behavior and some kids don’t.”
By the mid-1990s, media attention and public confusion around child brain development was at a high point, and the John D. and Catherine T. MacArthur Foundation funded a research network to get to the bottom of the issue. The chair of the group, Charles Nelson, invited Fox and Zeanah to Bucharest to see what they could learn.
It was late 1998, and orphanages throughout Romania were overflowing with 100,000 abandoned children—4,200 in Bucharest alone—the result of policies put in place decades before to boost the population.
After witnessing the silent orphans in their cribs, Fox, Nelson and Zeanah were taken to a room where 2-year-olds listlessly played with toys. Several children immediately ran to embrace the three men.
“They jumped into our arms and hung on to us for dear life,” Fox says. “We were taken aback. You would not expect 2-year-olds to see a total stranger and respond this way.”
The researchers recognized an opportunity. “We had to find a way to enhance the lives of the children we were studying,” Fox says. The Bucharest Early Intervention Project was formed.
Romania didn’t have a foster care system at the time, so Fox, Nelson and Zeanah set up one of their own, funding the care for four-and-a-half years, after which the government agreed to pick up the tab. While Fox’s research on temperament pointed to the fact that children could change, it was unclear whether they’d be able to overcome severe neglect and form the types of loving relationships with their foster parents crucial for intellectual and emotional development. But they did, and the improvement was profound.
“We found a sensitive period,” Fox says. “Children taken out of an institution and placed in foster care before 24 months of age developed secure and strong relationships with their foster parents that looked no different than our community children. Their social behavior was significantly better than that of children who remained in the institution or those who were placed into foster care after the age of 2. That’s the hopeful message of the Bucharest study.”
The less hopeful one was that spending the first years of one’s life in an institution had significant consequences for brain and behavioral development. The longer a child lived in an institution, the worse his or her outcome.
Partly as a result of the research, Romania set up its own foster care system and banned the institutionalization of any child under age 2. Fox, Nelson and Zeanah’s findings have been used worldwide as an argument against early institutionalization and cast light on the importance of early experiences in development, highlighting how malleable the brain is and how crucial caregiving is in the first years of life.
Fox’s data from the temperament research confirmed that inhibited children were at a greater risk for social anxiety disorder and depression, but the level of data simply wasn’t detailed enough to explain why. In the dozen years since the study began, brain imaging had made great strides. With a 10-year grant from the National Institute of Child Health and Human Development, Fox recruited a new cohort of children, tripling the size of the sample from 100 to 300 to create what he called the Temperament Over Time Study (TOTS).
For the new study, Fox would record brain activity using EEG and measure brain responses to different stimuli starting in infancy and through childhood. And he added fMRI, functional magnetic resonance imaging, to show what regions of the brain are activated. With the results from the Bucharest study emerging, the grant called for another addition—a look at how the quality of parental caregiving affected the outcomes of children in the study. For that, Fox turned to Hane, who had just entered his lab as a postdoc.
In high school, Hane read Jerry Kagan’s The Nature of the Child for a class assignment. The book ignited her interest in studying childhood development, first at the University of Maryland, Baltimore County. As a graduate student, she used a coding system created by developmental psychologist Mary Ainsworth to rate maternal sensitivity and intensively studied quality of mother-infant interaction across a variety of situations, including in the home and laboratory. Hane also examined associations between quality of mother-infant interaction and infant development across the first two years.
In 2002, she joined Fox’s lab at University of Maryland’s main campus in College Park. By then, she had a 2-year-old of her own; her second and third children also were born while she worked there.
“I’d done enough parenting of infants and observing of mothers and infants to know there were many differences in how mothers connect to their babies,” Hane says.
The play-based interactions often observed in labs showed only a fraction of the variation that can occur in the day-to-day routines of mothers and infants. So Hane began observing basic activities like diapering and bathing.
“Babies can become uncomfortable during these tasks, and their comfort depends on how mothers respond,” she says. “It seemed to me that basic care tasks were important and worth examining closely.”
Fox encouraged her to read the work of neuroscientist Michael Meaney, who studied maternal caregiving in rats. Within the normal variation of care—licking, feeding and grooming—rats seemed to have a big effect on their offspring. “Rat moms that did a lot of caregiving had rat pups that grew up to be less stressed out, and rat moms that did little caregiving had rat pups that were much more stressed and fearful,” Fox says. It’s one thing to code behavior in rats, which only live an average of a year or two; it’s another to code the infinite variety of interactions between adult humans and their babies—and follow it diligently enough to show effect years down the line.
Hane set to work developing her own protocol within the TOTS study, including visits to subjects’ homes starting at 9 months old. There she asked mothers to perform several tasks, including making a snack, undressing a baby and applying lotion. At every stage, she videotaped the activities, reviewing the tapes later to code how connected and attentive the mother was. “Baby is reaching for a bottle. Does mom notice? Baby is turning away. Will mom give baby space? Baby peed on mom. Is mom frustrated or tolerant?” Hane says. “We coded every nuance of these basic care tasks.”
She applied Meaney’s analysis on rat data to her human data. Meanwhile, Fox was continuing temperament tests and brain scans, exposing the children in his studies to toys that made startling sounds or pictures of unfamiliar people. When they correlated the data, writing a landmark paper together in 2006, they found the same results with humans as with rats: Mothers who were less sensitive to a baby’s needs—who were rougher in their caregiving style or paid less attention during tasks—had babies who were fussier and more reactive when presented with unfamiliar stimuli.
Says Catherine Monk, an associate professor of clinical psychology at Columbia University, “It’s such a huge contribution to show how everything from cognitive development to social development is influenced by the reliability and reciprocity of care.”
In Fox and Hane’s meticulous coding and scanning, three factors stood out in identifying children who were more inhibited and at-risk for developing anxiety and depression. First, these children seemed to be more vigilant than their peers, particularly when it came to potential threats. Second, they tended to show greater cognitive self-control—usually a good thing because it helps children keep impulsive behavior in check. But in this case the children seemed to be overregulating themselves.
Finally, while some children were naturally more vigilant and self-controlled, their parents seemed to exacerbate the situation with the type of care they gave. Parents who were more sensitive in their caregiving could reverse their children’s natural inclination to be anxious, while those who were overly harsh or anxious themselves seemed to make those tendencies worse in their children. Put another way, “Behaviorally inhibited infants need a different kind of parenting than non-fearful children,” says Fox. “That parenting can have a significant impact on whether infants are calm and regulated or not.”
Hane finished her postdoc and came to Williams in 2006, drawn by the connections between the campus and surrounding community and the chance to work closely with talented undergraduates.
“At Williams I have access to the resources I need to recruit infants and children, including a laboratory that feels like a home environment and talented students as research assistants,” Hane says. “The honors theses Williams undergraduates produce are on par with the master’s theses at research institutions.” She was particularly excited about the college’s summer science research program, which places two or more students in her lab for 40 hours per week each summer.
Hane’s assistants are engaged in the research at every step, recruiting subjects, running experiments, performing home visits, analyzing data and publishing papers. With help from Hane, Chelsey Barrios ’12 developed a coding system to gauge infant discomfort during bathing. She also measured cortisol, a common indicator of stress, that’s secreted in babies’ bloodstreams and saliva. When Barrios analyzed the data for her senior thesis, she found that extremely subtle variations in care—such as the mother having a towel ready before starting the baby’s bath or taking care not to scrub too hard—could lower cortisol levels.
Barrios is now pursuing a Ph.D. at the University of Maryland, working in Fox’s lab on the TOTS study. “It was a natural transition,” she says, in part because, like Hane, Fox is extremely supportive even as he encourages independence.
In addition to Barrios, four of Hane’s students have gone on to do graduate work in Fox’s lab—and Hane keeps in touch with them all. Mike Kirwan ’08 finished his master’s degree but found a better fit in public policy. He now works at the Robin Hood Foundation, managing grants to research and fund early childhood interventions for impoverished children in New York City.
Alexandra Hoff ’09 is a Ph.D. student on the child/family track in clinical psychology at Temple University. Willa Marquis Shemmassian ’09 is pursuing a Ph.D. in clinical psychology at UCLA. Her research looks at differences in parenting styles between Latino and Anglo parents in California. And Emily Barrios ’10, Chelsey’s sister, became interested in children’s health and enrolled in medical school at the University of Pennsylvania.
Hane received tenure in 2012 and, in February 2015, was also appointed as faculty in developmental neuroscience and named director of behavioral coding of the Nurture Science Program at Columbia University Medical Center. Several of her students are now assisting her with a new line of research, coding the interactions between mothers and prematurely born babies in the neonatal intensive care unit (NICU) there.
“Often, it’s difficult for moms and preemies to establish an emotional and physical connection,” Hane says. “Babies in the NICU are attached to a host of life supports that make even a simple diaper change extremely complicated. Monitors beep and sound with alarming frequency. It’s a far cry from the safety and shelter of the womb.”
Like Fox, Hane recognized an opportunity to help the population she’s researching. After completing a two-year fellowship at UMass-Boston in Infant-Parent Mental Health, funded by Williams, she joined Columbia University researchers Martha Welch and Michael Myers, who were developing a protocol called the Family Nurture Intervention (FNI). The protocol has been implemented in the NICU at New York-Presbyterian Morgan Stanley Children’s Hospital and helps moms and pre-term infants establish a “calming cycle” routine including skin-to-skin care, vocal soothing and eye contact.
Hane and her students coded the quality of maternal care during holding and feeding in the NICU and found that FNI helped moms improve the care they gave their newborns prior to discharge. “That is a monumental accomplishment given the many barriers to caregiving on the unit,” Hane says.
She and her students have continued to collaborate with Welch and Myers to track the babies through 18 months of age. They’ve found that FNI significantly improves babies’ cognitive development and lowers their risk of autism and attention problems. Their mothers, meanwhile, are at a lower risk of postpartum depression and anxiety symptoms.
With both the NICU and Bucharest interventions, Hane and Fox have put their research into action to help change outcomes for children facing extreme challenges early in life. And through their careful nurturing of students in their labs, they’re preparing the next generation to tackle the important challenges in understanding how nature and nurture combine to make us who we are.
Michael Blanding ’95 is a Boston-based freelance writer.
1. Photos by Mark McCarty unless otherwise noted
2. Photo courtesy of Nathan Fox, University of Maryland Child Development Lab
3. Photo courtesy of Bucharest Early Intervention Project