Stanford, CA 94305
Yale University Child Study Center, New Haven, CT, 06/30/2008
Yale University Child Study Center, New Haven, CT, 06/30/2009
Behavior Analyst, Behavior Analyst Certification Board
View details for DOI 10.3390/socsci10110414
View details for Web of Science ID 000724053400001
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
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
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
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
View details for DOI 10.1016/j.jpsychires.2019.02.001
View details for Web of Science ID 000466252700020
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
View details for PubMedID 29297148
This study's objective was to assess maintenance of treatment effects 3months 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 12weeks 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 12weeks post treatment.
View details for DOI 10.1007/s10803-015-2452-3
View details for Web of Science ID 000360545800018
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 6years old were randomized to PRTG (N=27) or psychoeducation group (PEG; N=26) for 12weeks. 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 12weeks. 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
View details for DOI 10.1177/1098300714561862
View details for Web of Science ID 000355766000006
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
View details for DOI 10.2511/rpsd.30.2.93
View details for DOI 10.1016/j.rasd.2022.101954
View details for Web of Science ID 000793720900009
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
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
View details for DOI 10.1016/j.jaac.2021.09.094
View details for Web of Science ID 000707082800541
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
View details for DOI 10.1016/j.jaac.2021.09.237
View details for Web of Science ID 000707082801083
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
View details for DOI 10.1016/j.jaac.2020.07.566
View details for Web of Science ID 000579844101295
View details for DOI 10.1016/j.jaac.2020.07.569
View details for Web of Science ID 000579844101298
View details for DOI 10.1016/j.jaac.2020.07.565
View details for Web of Science ID 000579844101294
View details for DOI 10.1097/ACM.0000000000003035
View details for PubMedID 31860620
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 24weeks 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 12weeks of intervention. However, after 24weeks 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
View details for DOI 10.1177/1362361318775538
View details for Web of Science ID 000464503900017
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
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 ahigher 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 aneed 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
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
Early detection methods for autism spectrum disorder (ASD) in infancy are rapidly advancing, yet the development of interventions for infants under twoyears 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 24months 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
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
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