Grace Gengoux, Ph.D., BCBA-D, is a Clinical Associate Professor, Director of the Autism Intervention Clinic, and the Well-being Director within Stanford University’s Department of Psychiatry and Behavioral Sciences. Along with colleagues at Stanford, Dr. Gengoux has written a new book focused on professional well-being and practical strategies to promote resilience for providers of mental health care. Dr. Gengoux is also a licensed clinical psychologist with expertise in training parents to promote the healthy development of social skills in their children and manage challenging behavior using positive behavioral approaches. Dr. Gengoux has published peer-reviewed journal articles and book chapters on treatments for autism. She has specialized training in Pivotal Response Treatment (PRT), having completed her doctoral studies under the mentorship of Drs. Robert and Lynn Koegel. Dr. Gengoux oversees the PRT group parent training program at Stanford, supervises postdoctoral fellows providing PRT clinical treatment, and has completed multiple clinical trials evaluating the effects of PRT on the social-communication competence of young children with autism. Dr. Gengoux serves as Associate Editor for the Journal of Positive Behavior Interventions and serves on the Board of Directors for Gatepath, one of the largest non-profits serving individuals with developmental disabilities in San Mateo and Santa Clara Counties. Dr. Gengoux received her Ph.D. in Clinical Psychology from the University of California Santa Barbara and completed her clinical internship and postdoctoral fellowship at the Yale Child Study Center, before joining the Stanford University School of Medicine clinical faculty in 2010.
- Wellness Programs
- Autism Spectrum Disorder
- Social Behavior
- Parent-Child Relations
Clinical Associate Professor, Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry
Autism Intervention Clinic Director, Stanford Division of Child & Adolescent Psychiatry (2019 - Present)
Psychiatry Department Well-being Director, Stanford University School of Medicine (2019 - Present)
Boards, Advisory Committees, Professional Organizations
Board Member, Gatepath (2011 - Present)
Board Certification: Behavior Analyst, Behavior Analyst Certification Board (2009)
PhD Training: University of California Santa Barbara (2008) CA
Fellowship: Yale University Child Study Center (2009) CT
Internship: Yale University Child Study Center (2008) CT
Leadership and Organization
Literacy and Language
Parents and family issues
Current Research and Scholarly Interests
Stanford Autism Intervention Clinic
The Autism Intervention Clinic is founded on a commitment to family-focused evaluation and treatment using the best available evidence-based methods. Our treatment philosophy embodies an emphasis on improving parent empowerment and providing parent training to make meaningful improvements in family quality of life. We are particularly interested in designing and evaluating cost-effective treatments which can be easily implemented in community settings.
For treatment of young children with Autism Spectrum Disorder (ASD), we have developed effective group-based programs for treatment of core communication and social deficits in the preschool years using naturalistic developmental behavioral interventions such as Pivotal Response Treatment (PRT) and we have investigated the delivery of these treatments in home and community settings in several randomized controlled trials.
Following the success of the PRT program, several additional parent training program models have been developed at Stanford and are currently being tested, including a clinical trial of a Developmental Reciprocity Treatment program (PI: Hardan) and a pilot program evaluating telehealth delivery of PRT. In partnership with the community agency, Gatepath/Abilities United, Dr. Gengoux also leads an innovative inclusive social skills research program focused on improving peer initiations made by children with ASD (Social SUCCESS).
Over the past year, our group completed in initial investigation of a novel group program using evidence-based strategies (Acceptance, Mindfulness, Optimism, Resilience; AMOR) to reduce parent stress and improve well-being. In partnership with Board Certified Behavior Analyst, Devon White, Drs. Gengoux and Hardan have launched the PAL program (Preschool Autism Lab) for investigation of novel therapies for young children with ASD in a center-based early intervention classroom.
Department of Psychiatry Well-being Workgroup
This past year has been one of accelerated activity focused on Wellness. A vibrant and diverse group of faculty, staff, and trainees are engaged in initiatives focused on enhancing broad aspects of professional fulfillment, including culture of wellness, efficiency of practice, and personal resilience. Dr. Grace Gengoux represents our department in the School of Medicine Well-being Directors Council and has been leading efforts to enhance well-being for all members of our Department community over the past year.
Our focus has been on tangible action we can take to enhance connection and belonging, self-compassion and leadership development, and meaningful work consistent with our professional values. Together, we are engaged in projects to enhance efficiency of our practices so that our highly trained faculty and staff can devote their time to their most meaningful professional contributions. In November, a Speed-Mentoring Reception provided an opportunity for faculty to network with mentors across the Department’s five mission areas. We have also organized Camaraderie Groups, based on data suggesting that a regular opportunity to connect with colleagues over a meal and discuss the challenges and virtues of their professional roles can improve physician sense of fulfillment and reduce burnout.
In March 2020, in response to the novel coronavirus pandemic, our group developed a “Listening Form” to facilitate rapid communication between members of our Department and leadership teams on a wide range of topics impacting personal and professional well-being. We have also been able to rapidly organize webinars and panel discussions focused on critical well-being topics and to partner with Stanford’s WellMD/WellPhD Center to establish a network of peer support resources for health care workers affected by the outbreak.
Improving Access to Pivotal Response Treatment (PRT) Via Telehealth Parent Training
There is an urgent need for improved access to effective autism treatments. With advances in technology, distance learning models have particular promise for families who cannot access evidence-based parent training locally or may be on long wait-lists for behavioral treatments. Pivotal Response Treatment (PRT) is an established treatment for autism spectrum disorder (ASD); however, a telehealth PRT model has not yet been evaluated in a controlled trial. This study will examine the effects of training parents in PRT via secure video conferencing and investigate 1) whether parents can learn via telehealth to deliver PRT in the home setting (PRT-T) and 2) whether their children will show greater improvement in functional communication skills compared to children in a waitlist control group. Participants will include 40 children age 2 to 5 years with ASD and significant language delay. Eligible children will be randomly assigned to either PRT-T (N=20) or waiting list (N=20). Weekly 60-minute parent training sessions will be delivered for 12 weeks via secure video conferencing software by a PRT-trained study therapist. The effects of PRT-T on parent fidelity of PRT implementation, child communication deficits including frequency of functional verbal utterances, and parent-report of communication skills on standardized questionnaires will be evaluated. This research will provide a foundation for wider dissemination of technology-based solutions to improve access to ASD treatment.
Parent Training to Enhance Social Success for Children With Autism Spectrum Disorder
Children with autism spectrum disorder (ASD) exhibit characteristic deficits in social initiation and there are no empirically validated treatments specifically for this core deficit. While parent training is known to be a critical intervention component, few social skills programs involve parents. This study will capitalize on an existing social skills group already established at the community agency Abilities United, with the goal of enhancing the program's effectiveness by adding a parent component. Specifically, the proposed study will investigate whether a novel parent mediated social skills program (Social SUCCESS), which provides parent training in conjunction with a social skills group intervention, will result in more frequent initiations during play with typically developing peers. Participants will include 50 children with ASD age 4:0 to 6:11 years. Children will be randomly assigned to either Social SUCCESS (N=25) or waiting list (N=25). Treatment will be provided for 8 weeks during a weekly 120-minute social skills group at Abilities United. The study will evaluate the effects of Social SUCCESS on areas of core social deficit including frequency of peer initiations using parent ratings, observational measures, standardized questionnaires, and a social eye tracking task. Outcomes will be compared to a waiting list control group. Findings will be disseminated through presentations and publications to aid clinicians in providing more effective social skills treatment for children with ASD and to enhance the scientific knowledge-base related to evidence-based social skills treatments. This research designed with the goal of stimulating additional scientific inquiry in the area of treatment for core social deficits in ASD and will provide a strong foundation for larger scale grants to study motivation-based interventions to improve social functioning.
An Evaluation of a Developmentally-Based Parent Training Program for Children With Autism
The purpose of this study is to assess the efficacy of a parent training program in the treatment of social and communication deficits in children with autism. Specifically, this study will evaluate a developmentally based parent delivered intervention in the community developed by Pacific Autism Center for Education (PACE).
Stanford is currently not accepting patients for this trial. For more information, please contact Christina Ardel, MA, 650-736-1235.
Social Motivation Intervention for Children With Autism Spectrum Disorder: Improving Peer Initiation
The purpose of this study is to investigate whether a social initiation motivation intervention (SIMI) focused on training children with ASD to initiate to peers during structured play activities will result in more frequent initiations to typically developing peers during free play. The SIMI approach under investigation uses behavioral strategies based in Applied Behavior Analysis and Pivotal Response Treatment to motivate children with ASD to initiate to peers. Children with ASD will be randomly assigned to either the SIMI or a waiting list. Treatment will be provided for 8 weeks in the context of a weekly social skills group.
Stanford is currently not accepting patients for this trial. For more information, please contact Rachel Schuck, 650-736-1235.
- Professional Well-Being: Enhancing Wellness Among Psychiatrists, Psychologists, and Mental Health Clinicians American Psychiatric Association. 2020
A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT.
OBJECTIVES: Our aim was to conduct a randomized controlled trial to evaluate a pivotal response treatment package (PRT-P) consisting of parent training and clinician-delivered in-home intervention on the communication skills of children with autism spectrum disorder.METHODS: Forty-eight children with autism spectrum disorder and significant language delay between 2 and 5 years old were randomly assigned to PRT-P (n = 24) or the delayed treatment group (n = 24) for 24 weeks. The effect of treatment on child communication skills was assessed via behavioral coding of parent-child interactions, standardized parent-report measures, and blinded clinician ratings.RESULTS: Analysis of child utterances during the structured laboratory observation revealed that, compared with the delayed treatment group, children in PRT-P demonstrated greater improvement in frequency of functional utterances (F1,41 = 6.07; P = .026; d = 0.61). The majority of parents in the PRT-P group (91%) were able to implement pivotal response treatment (PRT) with fidelity within 24 weeks. Children receiving PRT-P also demonstrated greater improvement on the Brief Observation of Social Communication Change, on the Clinical Global Impressions Improvement subscale, and in number of words used on a parent-report questionnaire.CONCLUSIONS: This is the first 24-week randomized controlled trial in which community treatment is compared with the combination of parent training and clinician-delivered PRT. PRT-P was effective for improving child social communication skills and for teaching parents to implement PRT. Additional research will be needed to understand the optimal combination of treatment settings, intensity, and duration, and to identify child and parent characteristics associated with treatment response.
View details for DOI 10.1542/peds.2019-0178
View details for PubMedID 31387868
- A pilot investigation of neuroimaging predictors for the benefits from pivotal response treatment for children with autism JOURNAL OF PSYCHIATRIC RESEARCH 2019; 111: 140–44
Ethical Use of Student Profiles to Predict and Prevent Development of Depression Symptoms During Medical School.
Academic medicine : journal of the Association of American Medical Colleges
Research investigations have repeatedly shown that medical school can be a period of high stress and deteriorating mental health for many students. There is a critical need for systematic guidance on how to personalize prevention and treatment programming to help those students at highest risk. The authors of this Invited Commentary respond to the report by Dyrbye and colleagues, published in this issue of Academic Medicine, that proposes a prognostic index to predict risk of developing depression symptoms in medical students. The commentary authors applaud Dyrbye and her co-authors for their innovative approach: their findings provide substantial insights relevant to the critical goal of enhancing medical student wellbeing. However, evidence indicates that students who identify as members of racial, ethnic, sexual and/or gender minority groups are at heightend risk of depression, so any program that profiles students in relation to their mental health symptoms must be proactive in ensuring that its efforts do not perpetuate stigma, marginalization, and discrimination for these underrepresented and potentially vulnerable groups. The commentary authors suggest practices for ethically implementing recommended wellnesss programs while maintaining an inclusive learning environment that respects personal privacy and incorporates transparent consent practices.
View details for PubMedID 30188366
Enhancing Wellness and Engagement Among Healthcare Professionals
2018; 42 (1): 1–4
View details for PubMedID 29297148
Pivotal Response Treatment Parent Training for Autism: Findings from a 3-Month Follow-Up Evaluation
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2015; 45 (9): 2889-2898
This study's objective was to assess maintenance of treatment effects 3 months after completion of a 12-week Pivotal Response Treatment (PRT) parent education group. Families who completed the active treatment (N = 23) were followed for an additional 12 weeks to measure changes in language and cognitive skills. Results indicated a significant improvement in frequency of functional utterances, with maintenance at 3-month follow-up [F(2, 21): 5.9, p = .009]. Children also made significant gains on the Vineland Communication Domain Standard Score [F(2, 12):11.74, p = .001] and the Mullen Scales of Early Learning Composite score [F(1, 20) = 5.43, p = .03]. These results suggest that a brief PRT parent group intervention can lead to improvements in language and cognitive functioning that are maintained 12 weeks post treatment.
View details for DOI 10.1007/s10803-015-2452-3
View details for Web of Science ID 000360545800018
A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism.
Journal of child psychology and psychiatry, and allied disciplines
2015; 56 (8): 884-892
With rates of autism diagnosis continuing to rise, there is an urgent need for effective and efficient service delivery models. Pivotal Response Treatment (PRT) is considered an established treatment for autism spectrum disorder (ASD); however, there have been few well-controlled studies with adequate sample size. The aim of this study was to conduct a randomized controlled trial to evaluate PRT parent training group (PRTG) for targeting language deficits in young children with ASD.Fifty-three children with autism and significant language delay between 2 and 6 years old were randomized to PRTG (N = 27) or psychoeducation group (PEG; N = 26) for 12 weeks. The PRTG taught parents behavioral techniques to facilitate language development. The PEG taught general information about ASD (clinical trial NCT01881750; http://www.clinicaltrials.gov).Analysis of child utterances during the structured laboratory observation (primary outcome) indicated that, compared with children in the PEG, children in the PRTG demonstrated greater improvement in frequency of utterances (F(2, 43) = 3.53, p = .038, d = 0.42). Results indicated that parents were able to learn PRT in a group format, as the majority of parents in the PRTG (84%) met fidelity of implementation criteria after 12 weeks. Children also demonstrated greater improvement in adaptive communication skills (Vineland-II) following PRTG and baseline Mullen visual reception scores predicted treatment response to PRTG.This is the first randomized controlled trial of group-delivered PRT and one of the largest experimental investigations of the PRT model to date. The findings suggest that specific instruction in PRT results in greater skill acquisition for both parents and children, especially in functional and adaptive communication skills. Further research in PRT is warranted to replicate the observed results and address other core ASD symptoms.
View details for DOI 10.1111/jcpp.12354
View details for PubMedID 25346345
- Priming for Social Activities: Effects on Interactions Between Children With Autism and Typically Developing Peers JOURNAL OF POSITIVE BEHAVIOR INTERVENTIONS 2015; 17 (3): 181-192
Pivotal Response Treatment for Infants At-Risk for Autism Spectrum Disorders: A Pilot Study
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2013; 43 (1): 91-102
Presently there is limited research to suggest efficacious interventions for infants at-risk for autism. Pivotal response treatment (PRT) has empirical support for use with preschool children with autism, but there are no reports in the literature utilizing this approach with infants. In the current study, a developmental adaptation of PRT was piloted via a brief parent training model with three infants at-risk for autism. Utilizing a multiple baseline design, the data suggest that the introduction of PRT resulted in increases in the infants' frequency of functional communication and parents' fidelity of implementation of PRT procedures. Results provide preliminary support for the feasibility and utility of PRT for very young children at-risk for autism.
View details for DOI 10.1007/s10803-012-1542-8
View details for Web of Science ID 000313073700009
View details for PubMedID 22573001
View details for PubMedCentralID PMC3571709
The Effectiveness of Contextually Supported Play Date Interactions Between Children With Autism and Typically Developing Peers
Research and Practice for Persons with Severe Disabilities
2005; 30 (2): 93-102
View details for DOI 10.2511/rpsd.30.2.93
- In Reply to Kassam and Ellaway. Academic medicine : journal of the Association of American Medical Colleges 2020; 95 (1): 10
Effects of pivotal response treatment on reciprocal vocal contingency in a randomized controlled trial of children with autism spectrum disorder.
Autism : the international journal of research and practice
A recent randomized controlled trial found that children with autism spectrum disorder who received a pivotal response treatment package showed improved language and social communication skills following the intervention. The pivotal response treatment package includes clinician-delivered and parent-implemented strategies. Reciprocal vocal contingency is an automated measure of vocal reciprocity derived from daylong audio samples from the child's natural environment. It may provide stronger and complementary evidence of the effects of the pivotal response treatment package because it is at lower risk for detection bias than parent report and brief parent-child interaction measures. The current study compared reciprocal vocal contingency for 24 children with autism spectrum disorder in the pivotal response treatment package group and 24 children with autism spectrum disorder in the control group. The pivotal response treatment package group received 24 weeks of the pivotal response treatment package intervention. The control group received their usual intervention services during that time. The groups did not differ in reciprocal vocal contingency when the intervention started or after 12 weeks of intervention. However, after 24 weeks the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group. These findings are consistent with results from parent report and parent-child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.
View details for DOI 10.1177/1362361320903138
View details for PubMedID 32054315
- Effects of a parent-implemented Developmental Reciprocity Treatment Program for children with autism spectrum disorder AUTISM 2019; 23 (3): 713–25
A pilot investigation of neuroimaging predictors for the benefits from pivotal response treatment for children with autism.
Journal of psychiatric research
2019; 111: 140–44
Children with autism spectrum disorder (ASD) frequently exhibit language delays and functional communication deficits. Pivotal response treatment (PRT) is an effective intervention for targeting these skills; however, similar to other behavioral interventions, response to PRT is variable across individuals. Thus, objective markers capable of predicting treatment response are critically-needed to identify which children are most likely to benefit from this intervention. In this pilot study, we investigated whether structural neuroimaging measures from language regions in the brain are associated with response to PRT. Children with ASD (n = 18) who were receiving PRT to target their language deficits were assessed with MRI at baseline. T1-weighted images were segmented with FreeSurfer and morphometric measures of the primary language regions (inferior frontal (IFG) and superior temporal (STG) gyri) were evaluated. Children with ASD and language deficits did not exhibit the anticipated relationships between baseline structural measures of language regions and baseline language abilities, as assessed by the number of utterances displayed during a structured laboratory observation (SLO). Interestingly, the level of improvement on the SLO was correlated with baseline asymmetry of the IFG, and the size of the left STG at baseline was correlated with the level of improvement on standardized parental questionnaires. Although very preliminary, the observed associations between baseline structural properties of language regions and improvement in language abilities following PRT suggest that neuroimaging measures may be able to help identify which children are most likely to benefit from specific language treatments, which could help improve precision medicine for children with ASD.
View details for PubMedID 30771619
Parent-Child Interaction Synchrony for Infants At-Risk for Autism Spectrum Disorder
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2018; 48 (10): 3562–72
This study investigated interactions between parents and 12-month-old infants at high (HR-SIBS; n = 27) and low (LR-SIBS; n = 14) familial risk for autism spectrum disorder (ASD). The contributions of parental variables, as well as child's autism symptom severity and verbal skills, to the parent interaction style were examined. Parents of HR-SIBS exhibited a higher level of synchronous-demanding behaviors, which was associated with parental report of atypical mood in the infant, but not with autism symptom severity, verbal skills, or parental depressive symptoms. These preliminary findings suggest a need for further investigation into HR-SIBS' emotional development and parental perception of that development, as these factors may shape parent-child interaction and influence the effectiveness of parent-assisted early intervention programs.
View details for PubMedID 29858714
Effects of a parent-implemented Developmental Reciprocity Treatment Program for children with autism spectrum disorder.
Autism : the international journal of research and practice
Developmental approaches to autism treatment aim to establish strong interpersonal relationships through joint play. These approaches have emerging empirical support; however, there is a need for further research documenting the procedures and demonstrating their effectiveness. This pilot study evaluated changes in parent behavior and child autism symptoms following a 12-week Developmental Reciprocity Treatment parent-training program. A total of 22 children with autism spectrum disorder between 2 and 6years (mean age=44.6months, standard deviation=12.7) and a primary caregiver participated in 12 weekly sessions of Developmental Reciprocity Treatment parent training, covering topics including introduction to developmental approaches, supporting attention and motivation, sensory regulation and sensory-social routines, imitation/building nonverbal communication, functional language development, and turn taking. Results indicated improvement in aspects of parent empowerment and social quality of life. Improvement in core autism symptoms was observed on the Social Responsiveness Scale total score (F(1,19): 5.550, p=0.029), MacArthur-Bates Communicative Development Inventories number of words produced out of 680 (F(1,18): 18.104, p=0.000), and two subscales of the Repetitive Behavior Scale, Revised (compulsive, p=0.046 and restricted, p=0.025). No differences in sensory sensitivity were observed on the Short Sensory Profile. Findings from this pilot study indicate that Developmental Reciprocity Treatment shows promise and suggest the need for future controlled trials of this developmentally based intervention.
View details for PubMedID 29775078
Feasibility and Effectiveness of Very Early Intervention for Infants At-Risk for Autism Spectrum Disorder: A Systematic Review
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2015; 45 (3): 778-794
Early detection methods for autism spectrum disorder (ASD) in infancy are rapidly advancing, yet the development of interventions for infants under two years with or at-risk for ASD remains limited. In order to guide research and practice, this paper systematically reviewed studies investigating interventions for infants under 24 months with or at-risk for ASD. Nine studies were identified and evaluated for: (a) participants, (b) intervention approach (c) experimental design, and (d) outcomes. Studies that collected parent measures reported positive findings for parent acceptability, satisfaction, and improvement in parent implementation of treatment. Infant gains in social-communicative and developmental skills were observed following intervention in most of the reviewed studies, while comparisons with treatment-as-usual control groups elucidate the need for further research. These studies highlight the feasibility of very early intervention and provide preliminary evidence that intervention for at-risk infants may be beneficial for infants and parents.
View details for DOI 10.1007/s10803-014-2235-2
View details for Web of Science ID 000350306600015
View details for PubMedID 25218848
Predicting Developmental Status from 12 to 24 Months in Infants at Risk for Autism Spectrum Disorder: A Preliminary Report
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2012; 42 (12): 2636-2647
The study examined whether performance profiles on individual items of the Toddler Module of the Autism Diagnostic Observation Schedule at 12 months are associated with developmental status at 24 months in infants at high and low risk for developing Autism Spectrum Disorder (ASD). A nonparametric decision-tree learning algorithm identified sets of 12-month predictors of developmental status at 24 months. Results suggest that identification of infants who are likely to exhibit symptoms of ASD at 24 months is complicated by variable patterns of symptom emergence. Fine-grained analyses linking specific profiles of strengths and deficits with specific patterns of symptom emergence will be necessary for further refinement of screening and diagnostic instruments for ASD in infancy.
View details for DOI 10.1007/s10803-012-1521-0
View details for Web of Science ID 000310746300010
View details for PubMedID 22484794
View details for PubMedCentralID PMC3565427
Semantic and letter fluency in Spanish-English bilinguals
2002; 16 (4): 562-576
Spanish-English bilinguals and English monolinguals completed 12 semantic, 10 letter, and 2 proper name fluency categories. Bilinguals produced fewer exemplars than monolinguals on all category types, but the difference between groups was larger (and more consistent) on semantic categories. Bilinguals and monolinguals produced the same number of errors across all category types. The authors discuss 2 accounts of the similarities and differences between groups and the interaction with category type, including (a) cross-language interference and (b) relatively weak connections in the bilingual lexical system because of reduced use of words specific to each language. Surprisingly, bilinguals' fluency scores did not improve when they used words in both languages. This result suggests that voluntary language switching incurs a processing cost.
View details for DOI 10.1037//0894-4184.108.40.2062
View details for Web of Science ID 000178440800011
View details for PubMedID 12382994