Grace Gengoux
Clinical Professor, Psychiatry and Behavioral Sciences - Child & Adolescent Psychiatry and Child Development
Bio
Grace Gengoux, Ph.D., BCBA-D, is a Clinical 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. 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.
Clinical Focus
- Wellness Programs
- Autism Spectrum Disorder
- Social Behavior
- Parent-Child Relations
- Clinical Child and Adolescent Psychology
Academic Appointments
Administrative Appointments
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Associate Chair, Faculty Engagement and Well-being, Stanford Department of Psychiatry and Behavioral Sciences (2021 - Present)
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Autism Intervention Clinic Director, Stanford Division of Child & Adolescent Psychiatry (2019 - Present)
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Psychiatry Department Well-being Director, Stanford University School of Medicine (2019 - Present)
Boards, Advisory Committees, Professional Organizations
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Board Member, AbilityPath (formerly Gatepath) (2011 - 2020)
Professional Education
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Board Certification: Behavior Analyst Certification Board, Behavior Analyst (2009)
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PhD Training: University of California Santa Barbara (2008) CA
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Fellowship: Yale University Child Study Center (2009) CT
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Internship: Yale University Child Study Center (2008) CT
Contact
Additional Clinical Info
https://orcid.org/0000-0002-6942-9513Links
Research Interests
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Child Development
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Early Childhood
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Leadership and Organization
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Literacy and Language
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Motivation
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Parents and Family Issues
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Professional Development
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Psychology
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Special Education
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, 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 AbilityPath (formerly Gatepath/Abilities United), Dr. Gengoux also led an innovative inclusive social skills research program focused on improving peer initiations made by children with ASD (Social SUCCESS).
Our group also recently 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
Dr. Gengoux leads a vibrant and diverse group of faculty, staff, and trainees 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 3 years.
Our focus is on tangible action we can take to enhance connection and belonging, self-compassion and leadership development, and meaningful work consistent with our professional values.
Clinical Trials
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A Center Based Study of Pivotal Response Treatment for Preschoolers with Autism
Recruiting
The purpose of this study is to examine the effectiveness of pivotal response training (PRT) in an intensive center-based environment to treat social communication deficits in children with autism spectrum disorder (ASD).
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Improving Access to Pivotal Response Treatment (PRT) Via Telehealth Parent Training
Recruiting
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.
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Neuroimaging Predictors of Improvement to Pivotal Response Treatment (PRT) in Young Children with Autism
Recruiting
Autism spectrum disorder (ASD) is a very heterogeneous disorder with limited empirically validated behavioral and biological interventions. The goal of this pilot investigation is to apply a biologically-based approach to identify predictors of treatment response in children with ASD who are receiving Pivotal Response Treatment (PRT), an evidence-based behavioral intervention. Specifically, the investigators propose to identify neuroimaging biomarkers of treatment response to a PRT program (PRT-P) targeting language deficits in young children with ASD who will be randomized to either PRT-P or to a delayed treatment group (DTG).
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An Evaluation of a Developmentally-Based Parent Training Program for Children With Autism
Not Recruiting
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.
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Online Pivotal Response Treatment Training in Autism Spectrum Disorder
Not Recruiting
This is a research study that will assess the effects of a Pivotal Response Treatment Online Training Course (PRT-O) for training parents of children with Autism Spectrum Disorder (ASD). The study will specifically investigate whether participants can learn to deliver PRT effectively following participation in the Online training.
Stanford is currently not accepting patients for this trial. For more information, please contact Estefania Millan, MA, (650) 736-1235.
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Parent Training to Enhance Social Success for Children With Autism Spectrum Disorder
Not Recruiting
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.
Stanford is currently not accepting patients for this trial. For more information, please contact Grace Gengoux, 650-736-1235.
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Social Motivation Intervention for Children With Autism Spectrum Disorder: Improving Peer Initiation
Not Recruiting
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.
2024-25 Courses
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Independent Studies (5)
- Directed Reading in Psychiatry
PSYC 299 (Aut, Win, Spr, Sum) - Graduate Research
PSYC 399 (Aut, Win, Spr, Sum) - Medical Scholars Research
PSYC 370 (Aut, Win, Spr, Sum) - Teaching in Psychiatry
PSYC 290 (Aut, Win, Spr, Sum) - Undergraduate Research, Independent Study, or Directed Reading
PSYC 199 (Aut, Win, Spr, Sum)
- Directed Reading in Psychiatry
All Publications
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Adherence and Opportunity Frequency as Predictors of Communication Outcomes from Pivotal Response Parent Training.
Journal of autism and developmental disorders
2024
Abstract
Access to intervention is a barrier for children with autism. As parent-mediated interventions have emerged to address this need, understanding implementation components contributing to child gains is critically important. Existing literature documents relationships between parent treatment adherence and child progress; however, less is understood about components, such as frequency of learning opportunities, which could also affect child outcomes.This study is a secondary analysis of data from a randomized controlled trial evaluating Pivotal Response Treatment group parent training (PRTG) compared to psychoeducation. Linear regression and mediational models were employed to identify potential predictors and mediators of outcome.PRTG produced large increases in adherence and learning opportunities. In general, greater frequency of learning opportunities and adherence predicted better child outcomes. The best-fitting cross-sectional mediational models indicated at least partial mediational effects, whereby increased learning opportunities mediated the relationship between greater adherence and improved child outcomes.This study provides preliminary evidence of how early gains in adherence may support parents to provide more frequent learning opportunities, which, in turn, yield positive effects on child social communication. Future large-scale research, with greater granularity of measurement, is needed to further understand the temporal relationships between these variables.
View details for DOI 10.1007/s10803-024-06447-7
View details for PubMedID 38976103
View details for PubMedCentralID 2213686
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A Pilot Randomized Controlled Trial of Motivation-Based Social Skills Group Treatment with Parent Training.
Journal of autism and developmental disorders
2024
Abstract
Despite the popularity of social skills groups, there remains a need for empirical investigation of treatment effects, especially when targeting pivotal aspects of social functioning such as initiations to peers. The goal of the present study was to conduct a randomized controlled trial of a 12-week social intervention (SUCCESS), which combined an inclusive social group with a parent education program. Twenty-five 4- to 6-year-olds with Autism Spectrum Disorder (ASD) were randomized to SUCCESS (N=11) or to treatment as usual (N=14). Combining a peer group model with a parent training program, the SUCCESS intervention used naturalistic behavioral techniques (e.g., environmental arrangement, natural reinforcement) to increase social initiations to peers. After 12 weeks, children participating in the SUCCESS program made more frequent initiations to peers than children in the treatment-as-usual group, including more prompted and unprompted initiations to request. Additional gains in clinician-rated social functioning were observed in children randomized to SUCCESS, while differential treatment effects were not detected in parent-rated measures. However, lower baseline social motivation was associated with greater parent-reported initiation improvement. This study provides preliminary support for the efficacy of a naturalistic, behavioral social skills intervention to improve peer initiations for children with ASD. The findings suggest that using a motivation-based social skills group was effective in increasing both prompted and spontaneous initiations to peers, and highlights the need for further research into the role of baseline social motivation in predicting social skills treatment response.
View details for DOI 10.1007/s10803-024-06302-9
View details for PubMedID 38446265
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Clinician Delivery of Virtual Pivotal Response Treatment with Children with Autism during the COVID-19 Pandemic
SOCIAL SCIENCES-BASEL
2021; 10 (11)
View details for DOI 10.3390/socsci10110414
View details for Web of Science ID 000724053400001
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Resilience Intervention for Parents of Children with Autism: Findings from a Randomized Controlled Trial of the AMOR Method.
Journal of autism and developmental disorders
2021
Abstract
Parents of children with autism spectrum disorder (ASD) experience elevated stress, yet parent-specific interventions are sparse. Thirty-five parents of children with ASD were randomized to the novel 8-week AMOR (Acceptance, Mindfulness, Optimism, Resilience) Method parent group or waitlist control group. Significant gains in resilience were reported by AMOR parents only (d=1.42, p<0.001, 95% CI [2.152, 10.083]). AMOR parents exhibited significant gains in stress management and reductions in mental health symptoms, along with parent-reported improvements in martial, family, and child functioning. AMOR group follow-up data showed some maintenance of treatment gains. Findings demonstrate promise for resilience interventions in parents of children with ASD. The trial was registered (clinicaltrials.gov; NCT03513419; May 1, 2018) and approved by the Stanford University Institutional Review Board.
View details for DOI 10.1007/s10803-021-04977-y
View details for PubMedID 33774741
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Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism.
Journal of autism and developmental disorders
2021
Abstract
Deficits in social skills are common in children with Autism Spectrum Disorder (ASD), and there is an urgent need for effective social skills interventions, especially for improving interactions with typically developing peers. This study examined the effects of a naturalistic behavioral social skills intervention in improving social initiations to peers through a randomized controlled trial. Analyses of multimethod, multi-informant measures indicated that children in the active group (SIMI) demonstrated greater improvement in the types of initiations which were systematically prompted and reinforced during treatment (i.e., behavior regulation). Generalization to joint attention and social interaction initiation types, as well as collateral gains in broader social functioning on clinician- and parent-rated standardized measures were also observed.
View details for DOI 10.1007/s10803-020-04787-8
View details for PubMedID 33387236
- Professional Well-Being: Enhancing Wellness Among Psychiatrists, Psychologists, and Mental Health Clinicians American Psychiatric Association. 2020
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Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi.
Autism : the international journal of research and practice
2020: 1362361320944011
Abstract
Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians' uncertainty about choosing the "right" intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.
View details for DOI 10.1177/1362361320944011
View details for PubMedID 32731748
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A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT.
Pediatrics
2019
Abstract
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
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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
View details for DOI 10.1016/j.jpsychires.2019.02.001
View details for Web of Science ID 000466252700020
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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
2018
Abstract
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
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Enhancing Wellness and Engagement Among Healthcare Professionals
ACADEMIC PSYCHIATRY
2018; 42 (1): 1–4
View details for PubMedID 29297148
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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
Abstract
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
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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
Abstract
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
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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
View details for DOI 10.1177/1098300714561862
View details for Web of Science ID 000355766000006
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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
Abstract
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
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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
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Toward improved understanding and treatment of self-injurious behaviors in autistic individuals with profound intellectual disability.
Autism research : official journal of the International Society for Autism Research
2024
Abstract
Self-injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self-inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate-profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate-profound ID. We highlight the key role of difficulties in emotion regulation (ER) and co-occurring internalizing symptoms in the manifestation of self-harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate-profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co-occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed.
View details for DOI 10.1002/aur.3289
View details for PubMedID 39688125
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Giving Friendship Proper Emphasis in Academic Medicine
ACADEMIC MEDICINE
2023; 98 (12): 1341-1343
View details for DOI 10.1097/ACM.0000000000005470
View details for Web of Science ID 001111214200024
View details for PubMedID 38029307
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Predictors of self-reported resilience in parents of autistic children
RESEARCH IN AUTISM SPECTRUM DISORDERS
2022; 94
View details for DOI 10.1016/j.rasd.2022.101954
View details for Web of Science ID 000793720900009
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Parenting stress in autism spectrum disorder may account for discrepancies in parent and clinician ratings of child functioning.
Autism : the international journal of research and practice
2021: 1362361321998560
Abstract
LAY ABSTRACT: Elevated parenting stress among parents of children with autism spectrum disorder is well-documented; however, there is limited information about differences in parenting stress and potential relationships with parent ratings of child functioning. The aim of this study was to explore profiles of parenting stress among 100 parents of young children with autism spectrum disorder enrolled in two clinical trials and to explore relationships between parenting stress level and parent ratings of child functioning before treatment. Secondary aims examined differential patterns of association between parenting stress profiles and parent versus clinician ratings of child functioning. We show that stress may influence parent ratings of certain child behaviors (e.g. problem behaviors) and not others (e.g. language), yet clinician ratings of these same children do not differ. This new understanding of parenting stress has implications for parent-rated measures, tracking treatment outcome, and the design of clinical trials.
View details for DOI 10.1177/1362361321998560
View details for PubMedID 33691519
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A Longitudinal Study of Language Trajectories and Treatment Outcomes of Early Intensive Behavioral Intervention for Autism.
Journal of autism and developmental disorders
2021
Abstract
The present study examined language trajectories and placement outcomes for children with autism spectrum disorder (ASD) receiving early intensive behavioral intervention (EIBI). Language measures were collected at baseline and 6, 12, 18, 24, and 36months or until exit from EIBI in 131 children with ASD. Growth models estimated overall and subgroup language trajectories. Overall, children receiving EIBI showed substantial increases in language relative to normative expectations. Earlier age at EIBI start, higher baseline cognitive function, and lower baseline ASD severity predicted better language trajectories. Although there was significant variability in language trajectories and educational outcomes, most children showed significant increases in language scores, relative to normative expectations. Additional research, in more representative samples, is needed to understand this variability.
View details for DOI 10.1007/s10803-021-04900-5
View details for PubMedID 33559016
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Language Improvement Following Pivotal Response Treatment for Children With Developmental Disorders.
American journal on intellectual and developmental disabilities
2021; 126 (1): 45–57
Abstract
Given the high prevalence of communication deficits in developmental disorders, there is need for efficient early interventions. The aim of this pilot study is to examine benefits of pivotal response treatment (PRT) for improving language in young children with developmental disorders without autism spectrum disorder. Parents of 15 children with developmental disorders received weekly PRT parent training for 12 weeks. Standardized parent-rated assessments were administered at baseline and post-treatment to measure changes in language. Structured laboratory observation indicated children demonstrated significantly greater frequency of utterances and improvement on standardized questionnaires measuring expressive language and adaptive communication skills following PRT. Findings suggest that PRT may be efficacious in improving language abilities among children with developmental disorders.
View details for DOI 10.1352/1944-7558-126.1.45
View details for PubMedID 33370790
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TEACHING PARENTS TO FACILITATE INTERACTION BETWEEN YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER AND TYPICALLY DEVELOPING PEERS
ELSEVIER SCIENCE INC. 2021: S164-S165
View details for DOI 10.1016/j.jaac.2021.09.094
View details for Web of Science ID 000707082800541
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SUPPORTING WORKING PARENTS IN AN ACADEMIC PSYCHIATRY DEPARTMENT DURING THE COVID-19 PANDEMIC: THE VIRTUAL CHILD ENGAGEMENT PROGRAM
ELSEVIER SCIENCE INC. 2021: S207
View details for DOI 10.1016/j.jaac.2021.09.237
View details for Web of Science ID 000707082801083
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Social Skills Training for Autism Spectrum Disorder: a Meta-analysis of In-person and Technological Interventions.
Journal of technology in behavioral science
2020: 1–15
Abstract
Social skills training (SST) for autism spectrum disorder (ASD) has traditionally focused on face-to-face (F2F-SST) interventions. Recently, Behavioral Intervention Technologies (BITs-SST) have been utilized to target social skills deficits using computer-based programs, avatars, and therapeutic robots. The present meta-analysis reviews recent evidence and compares the efficacy of 14 F2F-SST and four identified BITs-SST intervention trials for youth with ASD. These preliminary analyses did not indicate significant differences between F2F-SST and BITs-SST, with effect sizes consistently in the medium to high range (g=0.81 and g=0.93, respectively). These findings provide initial support for the continued investigation of BITs for providing SST to youth with ASD.
View details for DOI 10.1007/s41347-020-00177-0
View details for PubMedID 33225056
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PIVOTAL RESPONSE TREATMENT: APPLICATION TO NEW POPULATIONS AND SERVICE-DELIVERY MODELS
ELSEVIER SCIENCE INC. 2020: S271–S272
View details for DOI 10.1016/j.jaac.2020.07.566
View details for Web of Science ID 000579844101295
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NOVEL EARLY INTERVENTION IN AUTISM SPECTRUM DISORDER: BASIC PRINCIPLES AND NEW RESEARCH
ELSEVIER SCIENCE INC. 2020: S271
View details for DOI 10.1016/j.jaac.2020.07.565
View details for Web of Science ID 000579844101294
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A RANDOMIZED CONTROLLED TRIAL OF A DEVELOPMENTAL RECIPROCITY TREATMENT PROGRAM IN YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER
ELSEVIER SCIENCE INC. 2020: S272–S273
View details for DOI 10.1016/j.jaac.2020.07.569
View details for Web of Science ID 000579844101298
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In Reply to Kassam and Ellaway.
Academic medicine : journal of the Association of American Medical Colleges
2020; 95 (1): 10
View details for DOI 10.1097/ACM.0000000000003035
View details for PubMedID 31860620
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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
2020: 1362361320903138
Abstract
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
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Effects of a parent-implemented Developmental Reciprocity Treatment Program for children with autism spectrum disorder
AUTISM
2019; 23 (3): 713–25
View details for DOI 10.1177/1362361318775538
View details for Web of Science ID 000464503900017
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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
Abstract
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
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Parent-Child Interaction Synchrony for Infants At-Risk for Autism Spectrum Disorder
JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
2018; 48 (10): 3562–72
Abstract
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
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Effects of a parent-implemented Developmental Reciprocity Treatment Program for children with autism spectrum disorder.
Autism : the international journal of research and practice
2018: 1362361318775538
Abstract
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
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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
Abstract
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
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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
Abstract
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
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Semantic and letter fluency in Spanish-English bilinguals
NEUROPSYCHOLOGY
2002; 16 (4): 562-576
Abstract
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//0894-4105.16.4.562
View details for Web of Science ID 000178440800011
View details for PubMedID 12382994