Sanford School of Medicine School of Medicine

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Children & Research Flourish

Avera Wellness Student Recital Avera Wellness Emily Quanbeck

Four-year-old Emily Quanbeck was withdrawn and hardly ever spoke, not even to her family. But her parents, Renee and Eric, say she has changed dramatically thanks to the Avera Family Wellness Program.


"It's just like night and day," Renee said of the change in Emily since she joined the program this school year. "The way she's blossomed, it's a priceless thing."

Emily's development has drawn her out of her shell. "She likes the violin," Eric said. "She tells us at home."

"She bows," Renee adds.

The musical instrument is part of the Suzuki Principle Violin Training, a core component of the program.

On a recent December day in a Head Start classroom at Hayward Elementary in Sioux Falls, one of the instructors plays a brief musical interlude on his violin for Emily and the rest of the children in the program as the daily half-hour training session begins. Then the children break into three groups. Each child receives an individual lesson on how to properly hold a violin, or at least one built for children. They are instructed on how to correctly stand while playing. Later in the school year, the children will learn basic musical rhythms.

The violin training is aimed at helping children reach milestones in brain development and emotional and social growth. It culminates in a musical performance for friends and family. "This is a very special program for these kids," Yuko Saito, violin instructor, said. "It's an opportunity not a lot of kids get to have, and it really improves self-esteem." The violin training is the core of two initiatives. It provides immediate help to the children and families. And the training and results are being tracked as part of a research project being conducted by the Avera Institute for Human Behavioral Genetics.

"We had a platform through which we could further our understanding of emotional-behavioral problems through genetic research," said Ryan Hansen, administrative director of the Institute. "At the same time, we strongly felt we could tailor a program to meet the needs of the local community."

The Institute's partners include Avera McKennan Hospital and the medical school's Department of Psychiatry, The University of South Dakota and South Dakota State University's College of Pharmacy as well as several community partners. Avera McKennan has committed $1.5 million over three years to the project, which is in its second year. All services are free for the families.

Nature vs. Nuture

Some studies suggest that one in five children experience behavioral problems that place them at risk of failing in school and in life. The hope is that the musical training will help the children's development and avoid any mental health concerns.

"This is an opportunity to see if non-pharmaceutical methods like music make a difference," said Timothy Soundy, M.D., professor and chairman of the medical school's psychiatry department and child and adolescent psychiatrist with Avera University Psychiatry Associates.

At the heart of the research is the "nature versus nurture" debate. But the reality is that no psychiatric illness from depression to anxiety to bipolar disease is purely genetic or purely environmental, said James Hudziak, M.D., an internationally-known child psychiatrist and genetic researcher, who is a scientific consultant for the Institute. "We're never going to have genes that diagnose ADHD or genes that diagnose depression," Hudziak said. "We're going to have genes that tell you the relative risk that the child or family has to develop these outcomes."

While the presence of a certain gene can increase the chances of developing an illness, it doesn't guarantee that outcome, Hudziak said. Some type of environmental factor must also be present to act as a trigger. Negative environmental factors include trauma, abuse, conflict in the home, depressed parents or even watching too much violence on TV.  Positive factors are believed to include a peaceful home, involvement in sports and music, good nutrition and quality family time.

"We don't understand everything about the development of illness yet, but it's our very strong belief that it is a combination of genetic and environmental impacts," said Matthew Stanley, M.D., psychiatrist with Avera University Psychiatry Associates.  

Help for Families

Beyond the violin training, a key component of the program is parental involvement. All families are assigned a personal health coach to assist them in reaching their goals. The focus is empowering parents to find their own solutions as well as to make good choices regarding health and wellness.

A central core of child behavior specialists, educators and therapists are available to provide care as needed. A database has been created so that enrolled children and families will be followed over a period of three to five years.

"Our goal is to keep the well healthy," said Manish Sheth, M.D., Ph.D., director of clinical operations for the Institute. "We will have the resources available for children and their families so that if anything is noticed, we can intervene before it becomes an illness."  


Last school year, a pilot project for the program was held at Garfield Elementary School. In addition to violin training, the pilot also included expressive therapies using creative activities like art as well as mind and body techniques like relaxation and movement coordinated with breathing.

In expanding to Hayward this year, the program was fine-tuned to solely focus on the violin training, from which the first-year data was the most encouraging. Children enrolled in the program demonstrated a decrease in negative behaviors. "It's becoming much more evident that this type of musical training at this age could affect at-risk children," violin instructor Jay Reeve said.

The program is focused on children of preschool age. "We are told that by the time these children are going to kindergarten, it's already too late," Sheth said.

The Institute has ambitious goals, hoping its research can lead to improved mental health diagnosis and treatment for young children throughout the country. "What I would love to be able to do is see people early enough, and have enough information from their genetic profile to be able to prescribe an environmental change so they will be well," Stanley said.

Eric and Renee Quanbeck hope the program becomes a  national model so it can help more children like their daughter, Emily.  "I am just very grateful," Renee said. "My sisters live in other states, and I know the things like this program available to me are not available to them."

"We're just lucky," Eric said.