Polyvagal Theory

The Early Development of the
Autonomic Nervous System

Provides a Neural Platform for
Social Behavior:
A Polyvagal Perspective
Stephen W. Porges, Ph.D.
Brain-Body Center
University of Illinois at Chicago
Copyright 2010 Stephen W. Porges
Acknowledgments
Special thanks to:
C. Sue Carter, PhD
Keri Heilman, PhD

Larry Gray, MD
Elgiz Bal, MA
Emily Harden, BA
Greg Lewis, BA
Danielle Zageris, BA
Stephanie Aylward, BA
Danielle Coleman, BA
Funding provided by:

NIH Grants MH-60625, MH-67446, HD 53570
The Polyvagal Theory:

Adaptive Functions
Environment
outside the body
inside the body
Nervous System
Neuroception
Safety
Danger
Spontaneously engages others

eye contact, facial expression, prosody
supports visceral homeostasis
Life threat
Defensive strategies
death feigning/shutdown (immobilization)
Defensive strategies
fight/flight behaviors (mobilization)
The Vagal Paradox

Bradycardia are mediated by the vagus
and a risk index
Heart rate variability is primarily mediated
by the vagus and a protective factor
Functions of the Vagal System

The vagal system involved in the
regulation and coordination of
heart rate, sucking, swallowing,
digestion, vocalizations, and
breathing
The vagal system mediates apnea
and bradycardia!
The Polyvagal Theory

1. Evolution provides an organizing principle to
understand neural regulation of the human
autonomic nervous system.
2. Three neural circuits form a phylogeneticallyordered response hierarchy that regulate
behavioral and physiological adaptation to safe,
dangerous, and life threatening environments.
3. Neuroception of danger or safety or life threat
trigger these adaptive neural circuits.
Phylogenetic Organization of
the ANS: The Polyvagal Theory
head
old vagus
limbs
viscera
trunk
Apnea/Bradycardia
Corticospinal Pathways
Sympathetic Nervous
System
limbs
head
viscera
trunk
Mobilization:
Fight/Flight Behaviors
Corticobulbar pathways
limbs
head
new vagus
viscera
trunk
The Heart-Face Connection:

A Critical Component of a Social Engagement System
At birth, the face is hardwired to the neural
regulation of visceral state via a mammalian

neural circuit.
Metabolic demands, stress, trauma and
illness retract the mammalian neural circuit
with the resultant symptoms of a face that does
not work and social engagement behaviors are
absent.
The Mammalian Vagus and

Social Engagement System
cortex
brainstem
Muscles of
Mastication
Cranial Nerves
V,VII,IX,X,XI
Head Turning
Middle Ear
Muscles
Facial
Muscles
Bronchi
Larynx
Pharynx
Heart
environment
Social Engagement
Jeff Hunter/ The Image Bank
Social Engagement System:

Emergent Behaviors at Birth

Self Regulation
Heart Rate Rhythms

R
E
S
P
HP (ms)
8
0
0
9
0
0
R
S
A
0
.
1
0
6
0
B
P
M
1
0
0
0
H
P
V
1
1
0
0
1
2
0
0
0
3
0
6
0
9
0
1
2
0
S
E
C
O
N
D
S

Observable Deficits in Several Psychiatric and
Behavioral Disorders
Prosody
Gaze
Facial expressivity
Mood and affect
Posture during social engagement
State regulation
Auditory hypersensitivites
Social Engagement
Howard Dratch/ The Image Works
Violation of Face-to-Face:
An experimental manipulation
The Face-to Face Still Face Procedure
(Tronick, Als, Adamson, Wise, & Brazelton, 1978)
3 Phases:
2 minutes Social Play
2 minutes Still Face
2 minutes Reunion Play
Senta Furman (dissertation, in progress)
Reciprocal Interaction (play)
Still Face (1)
Still Face (2)
Still Face (3)
Violation Repaired
Porges & Furman (2010).
Ratio of Axon Densities During Early Infancy:

Unmyelinated to Myelinated Vagus Fibers (UVF/MVF)
8
7
6
5
4
3
2
1
0
0-3 months
3-6 months
6-9 months
9-12 months
Pereyra, Zhang, Schmidt & Becker (1992), Journal of Neurological Sciences, 10, 107-113.
Neural Platform for Social Behavior:

A Developmental Model
Porges & Furman (2010) Infant and Child Development.
Building Blocks of Self-Regulation

Environmental
interactions
Coordinated biobehavioral
processes
Coordinated neurophysiological
processes
Homeostatic functions
Hierarchical Model of
Self-Regulation
Level IV: Appropriate Social Interactions
Level III: Motor Behavior Control
Level II: Regulation of the Vagal Brake
Level I: Baseline Vagal Tone (RSA)
Level I Assessments
Homeostatic Functions
Homeostasis
30
Preterm (n=116)
Fullterm (n=125)
25
PERCENT
20
15
10
0
0
VAGAL TONE INDEX (RSA)
10
Porges (1992), Pediatrics

Neonatal Vagal Measures

and Outcome at 3 Years
Neonatal Measures
Outcome Measures
Social
Skills
(RSA) Vagal
maturation
Mental
Processing
Motor
Skills
Doussard-Roosevelt, Porges, Scanlon, Alemi, & Scanlon (1997), Child Development
Infant Vagal Tone (RSA) and

Temperament (12 wks)
1
2
Calming Required (BRP)
7
6
Negativity (BRP)
1
0
1
0
0
L
o
w
V
a
g
a
l
T
o
n
e
H
i
g
h
V
a
g
a
l
T
o
n
e
G
r
o
u
p
L
o
w
V
a
g
a
l
T
o
n
e
H
i
g
h
V
a
g
a
l
T
o
n
e
G
r
o
u
p
Huffman, et al., 1998, Child Development

Level II Assessments
Challenge to and Regulation

of Homeostasis
(The cost of doing business)
The Vagal Brake

an index of self-regulation
Vagal Regulation: Observed in

the Neonate During Feeding
3
.
0
4
1
0
2
.
5
Heart Period (msec)
Vagal Tone Index (VNA)
4
0
0
3
9
0
2
.
0
3
8
0
3
7
0
1
.
5
3
6
0
1
.
0
3
5
0
B
a
s
e
l
i
n
eF
e
e
d
i
n
g
P
o
s
t
f
e
e
d
i
n
g
Portales, et al., 1997, Developmental Psychobiology

RSA during Feeding:

Vagal Regulation of Metabolism, Ingestion, and Digestion
in Preterm Infants
Suess et al., 2000, Developmental Medicine and Child Neurology
Vagal Regulation at 9 months of age

and Preschool Behavior Problems
Depressive behavior
Social withdrawal
Atypical Vagal
Regulation
Aggressive behavior
Total Behavior
Problems
Porges, Doussard-Roosevelt, Portales, & Greenspan (1996), Developmental Psychobiology

Infant Crying and

Developmental Outcome:
A Biobehavioral Approach
NICHD Grant NIH Grant R01 HD053570
Research Team:
UIC: S.Porges, K.Heilman
Erikson Institute: Z.Boukydis, L.Gilkerson
Univ of Chicago: L. Gray
A Violation of Social Engagement
http://www.babyreference.com/nutritionconsultations.htm
Atypical Vagal Regulation:

Common Mechanisms
Difficulties in social behavior
Difficulties in state regulation
Defining A Fussy Infant

Group classification:
1. Infants defined as excessive criers, if they
manifest distress (fussing, crying, and/or
unsoothable crying) for more than 3 hours
per day for 3 or more days in one week
between 6 and 10 weeks of age.
2. Age when extreme fussiness is resolved (3
or 6 months).
Frequency of Excessive
Crying
Excessive crying at or before 3m 20%
Excessive crying NOT resolved by 3m 7%
Excessive crying NOT resolved by 6m 3%
Specific Aims
1.
2.
3.
To evaluate whether infants at 6-months, who are

prone to excessive crying (but not crying or fussing
while being tested), have a distinguishable
autonomic response profile that can be measured
during laboratory-based experimental procedures.
To evaluate whether infants, who are prone to
excessive crying, have a compromised
developmental outcome at 12 and 24 months.
To evaluate whether the autonomic response
profile at 6-months, with or without the behavioral
feature of persistent crying, is a marker for a
compromised developmental outcome at 12 and 24
months
Competing Hypotheses
Excessive Crying
Poor autonomic
& state regulation
Excessive Crying
Clinical Risk
Clinical Risk
Poor autonomic
& state regulation
Clinical Risk
Experimental Model
Excessive Crying
Parent reports
Cry Diary
Clinical history
Poor autonomic
& state regulation
Vagal brake
(neural mechanisms
of self-soothing &
calming)
Clinical Risk
ADD, PDD, LD, etc

(disorders associated
with state regulation
deficits)
Recruitment Model
Infants screened at 6-10 weeks
No excessive crying
Control
Excessive crying
Resolved by
3m
Resolved by
6m
Not resolved
by 6 m
EC-3M
EC-6M
EC-6M+
Cry Diaries
Estimated Marginal Means of MEASURE_1

Crying
300
Estimated Marginal Means
C
r
y
i
n
g
250
EC-6+
200
150
t 100
i
m 50
e
EC-6
EC-3
Control
1
6-10 weeks
age
3 months
6 months
EC infants have dampened

vagal reactivity
Never EC (n=94)
EC, resolved by 3mon (n=28)
EC, resolved by 6mon (n=23)
EC, persisted beyond 6mon (n=15)
3.7
3.5
3.3
3.1
2.9
2.7
2.5
2.3
Mother-Baby Preplay
Feeding
Mother-Baby Postplay

vagal reactivity
3.7
Never EC (n=94)
EC (n=66)
3.5
3.3
3.1
2.9
2.7
2.5
2.3
Mother-Baby Preplay
Feeding
Mother-Baby Postplay

heart rate reactivity
153
Never EC (n=93 )
Heart rate (bpm)
EC (n=69 )
148
143
138
133
Pre-play
Feeding
Post-play
12 month assessments
Infant Toddler Social Emotional Assessment
(ITSEA) (Carter & Margaret Briggs-Gowan)
Internalizing behaviors:
depression/withdrawal, general anxiety,
separation distress, inhibition to novelty
Externalizing behaviors:
activity/impulsivity, aggression/defiance, peer
aggression
Predictors of 12-month Behaviors

Model 1: Cry/Fuss 3 months* + Vagal Reactivity* =>
Internalizing
Model 2: Cry/Fuss 3 months* + Vagal Reactivity* =>
Externalizing
Conclusions
The Social Engagement System is an emergent
neurophysiological system that phylogenetically developed
to regulate contact with the external world and to modulate
physiological and behavioral state.
As the infant matures, the Social Engagement System
shifts from a reflexive brainstem system, to a system under
cortical control with an ability to initiate social behavior.
RSA, a measure of vagal regulation measured in infants,
is related to developmental outcome and especially to
behavioral and psychological processes associated with
social behavior, ingestion, and state regulation.
Fussy-difficult infants, who by definition have state
regulation problems and excessive bouts of crying, have
atypical vagal regulation that may deprive them from the
soothing effects of feeding.
Conclusions
During the first 6-months of life the measurement of
vagal regulation during feeding provides an early
marker of the developmental status of the neural
platform for social behavior.
During the first year of life, cortical pathways
develop that regulate the striated muscles of the
face and head and the vagus continue to myelinate
to form an integrated social engagement system the same circuits involved in feeding (ingestion) and
state regulation.
As the infant matures, social context displaces
feeding as the most important regulator of behavioral
state.

Polyvagal Theory

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The Early Development of the

Autonomic Nervous System

Copyright 2010 Stephen W. Porges

Keri Heilman, PhD

Funding provided by:

The Polyvagal Theory:

Spontaneously engages others

Copyright 2010 Stephen W. Porges

The Vagal Paradox

Copyright 2010 Stephen W. Porges

Functions of the Vagal System

The Polyvagal Theory

Copyright 2010 Stephen W. Porges

Copyright 2010 Stephen W. Porges

Copyright 2010 Stephen W. Porges

Copyright 2010 Stephen W. Porges

Copyright 2010 Stephen W. Porges

Copyright 2010 Stephen W. Porges

The Heart-Face Connection:

At birth, the face is hardwired to the neural

regulation of visceral state via a mammalian

The Mammalian Vagus and

Jeff Hunter/ The Image Bank

Social Engagement System:

Copyright 2010 Stephen W. Porges

Social Engagement System:

Heart Rate Rhythms

Copyright 2010 Stephen W. Porges

Social Engagement System:

Howard Dratch/ The Image Works

Senta Furman (dissertation, in progress)

Reciprocal Interaction (play)

Senta Furman (dissertation, in progress)

Still Face (1)

Senta Furman (dissertation, in progress)

Still Face (2)

Senta Furman (dissertation, in progress)

Still Face (3)

Senta Furman (dissertation, in progress)

Senta Furman (dissertation, in progress)

Porges & Furman (2010).

Ratio of Axon Densities During Early Infancy:

Neural Platform for Social Behavior:

Porges & Furman (2010) Infant and Child Development.

Building Blocks of Self-Regulation

Copyright 2010 Stephen W. Porges

VAGAL TONE INDEX (RSA)

Porges (1992), Pediatrics

Neonatal Vagal Measures

Doussard-Roosevelt, Porges, Scanlon, Alemi, & Scanlon (1997), Child Development

Copyright 2010 Stephen W. Porges

Infant Vagal Tone (RSA) and

Calming Required (BRP)

Huffman, et al., 1998, Child Development

Challenge to and Regulation

Copyright 2010 Stephen W. Porges

The Vagal Brake

Copyright 2010 Stephen W. Porges

Vagal Regulation: Observed in

Heart Period (msec)

Vagal Tone Index (VNA)

Portales, et al., 1997, Developmental Psychobiology

RSA during Feeding:

Suess et al., 2000, Developmental Medicine and Child Neurology