Infant behavior, dyslexia and war orphans: A portrait of Peter Wolff, MD

Peter Wolff MD
Peter Wolff c. 1977 (Ed Fitzgerald/Boston Globe)

Peter Wolff, MD, recently retired from Boston Children’s Hospital after more than 60 years in service to clinical psychiatry, behavioral science research and ethical oversight of human subject research.

When he started as a psychiatrist at Boston Children’s Hospital in 1956, Peter H. Wolff, MD, was seeking a deeper understanding of infant behavior. At a time when psychoanalysis was the framework for understanding the infant psyche, Wolff applied scientific methods used to study animal behavior — carefully observing an animal in its natural environment and seeking to discern patterns. His approach would revolutionize our understanding of infancy.

“We knew a great deal about a stickleback fish, the graylag goose by just watching what they do in the field — field observations — but nobody had ever done that with humans,” Wolff shared in an interview in 2009, “and it seemed to me a logical thing to try to do that.”

Wolff observed and recorded infant behavior for extended periods of time, sometimes 12 hours or more. He introduced the idea of infant states of consciousness (“quiet alert,” active sleep, crying, etc.) and behavior patterns within these states. Wolff’s monograph, “The causes, controls, and organization of behavior in the neonate” bridged psychiatry and developmental biology and led to his being called the “Einstein of infant psychiatry.” His approach introduced a new field of inquiry in child psychology that remains robust today.

Peter Wolff MD
Wolff studies an infant in the intensive care nursery, c. 1977 (Ed Fitzgerald/Boston Globe)

Wolff was “able to take disparate ideas and put them together in a new way,” says developmental psychologist Eugene Goldfield, PhD, who counts Wolff as a mentor. “Peter did that multiple times.”

In the 1970s, Wolff looked to biology to explain child development. Neuropsychology (the study of brain-behavior relationships) had not yet emerged as a discipline; at the time, many people were focused on either psychoanalysis or learning theory. “The idea that biology had something to do with the mind was not on anybody’s radar at the time,” says Deborah Waber, PhD. As a developmental psychology student, she had been encouraged to come to Boston to do a postdoc with Wolff.

Now director of the Learning Disabilities Program at Boston Children’s, Waber credits Wolff with embedding skepticism in her professional consciousness — the practice of thinking about things differently and questioning the received thinking on an issue. “He likes to ask the trenchant question that other people might not think of… or when other people might not have the courage to go there.”

Timing and learning disabilities

Take motor development. Wolff believed that fundamental rhythms are foundational to behavioral development. In infants, he studied sucking rhythms. In older children, he studied children’s ability to tap their fingers in time to a metronome. He believed that disorganization in timing could be a marker for an emerging clinical problem, and went on to link motor timing — specifically, inconsistent rhythmic finger tapping patterns — with learning disabilities, including dyslexia, not only in poor readers but also in family members.

Peter Wolff MD
Wolff and research assistant Carolyn Cohen studying a child’s motor sequencing responses, c. 1977. (Ed Fitzgerald/Boston Globe)

Through these innovative studies, Wolff became a leading expert on the development and significance of motor timing control. “The data he collected are still fascinating and beg to be explained,” says Waber.

Wolff’s interest in learning disabilities extended into the clinic. Along with neuropsychologist Irving Hurwitz, Wolff was a founder of the Learning Disabilities Program at Boston Children’s Hospital. The program brings together neuropsychologists, neurologists, speech and language pathologists, clinical psychologists and educators to provide a comprehensive, “whole child” approach to diagnosis in children with learning problems. It continues to attract families from throughout New England as well as nationally and internationally.

Ethics and IRBs

In 1974, the U.S. government published The Belmont Report, launching ethical guidelines for research involving human subjects. Boston Children’s Hospital established the Institutional Review Board (IRB) to regulate clinical research, with Wolff as its first chair. Wolff served as chair for 35 years — the longest serving in the U.S. – making Boston Children’s IRB one of the most respected in the field and building the cultural foundation of human subject protection.

Peter Wolff MD
Wolff (at right, wearing tie) serving on Boston Children’s Hospital’s Clinical Investigative Committee, forerunner of the IRB, c. 1975

Susan Kornetsky, Senior Director of Clinical Research Compliance at Boston Children’s, says that when the human subject regulations were passed in 1981, there weren’t as many specific rules as there are today; it was about adhering to the principles of the Belmont Report. As leader of the IRB, Wolff respected the need to follow the ever-increasing regulations, but was driven by ethical integrity and the desire to protect children from harm. In deliberations about how to include families in the research consenting process, Wolff was the voice advocating for the children’s rights to be part of the decision-making. His understanding of child development and his commitment to respecting a child’s developing autonomy led to the policy of gaining assent from the children themselves, in addition to parental permission.

Improving the lives of war victims

Wolff’s ethical convictions saw no borders. In the 1970s, he worked with the Committee on Responsibility, which brought child victims of bombings in the Vietnam War to Boston for medical treatment. He also contributed to the efforts to get medical supplies and equipment to Vietnam to treat war victims — even as the U.S. was fighting a war in that country.

Peter Wolff MD
Wolff more recently (courtesy Susan Kornetsky)

“He has a passion for children who are victims of misguided political movements,” says Waber. “He was going into war zones because he wanted to find out what going on with the children.”

In the 1990s, Wolff became involved with the people of war-torn Eritrea and efforts to strengthen local medical systems. Not only did he study the effects of war on orphaned refugee children, but as a psychiatrist, he also advised those who were treating the children. His work directly impacted the psychological, medical and social health of more than 9,000 Eritrean orphans, abandoned victims of war.

In science and in politics, Wolff”s pioneering thinking benefited patients, families, researchers and the global community alike, by asking us to question and to have the courage to go where others may not. Although he never sought recognition for his remarkable achievements, his legacy speaks volumes.