Over the past year, Dr. Gengoux's research has continued to focus on the design and evaluation of effective naturalistic behavioral treatment programs for young children with autism. Dr. Gengoux oversees the supervision of a team of therapists providing parent training and in-home treatment for a randomized controlled trial of Pivotal Response Treatment (PI: Hardan) which is nearing completion. Dr. Gengoux has also continued to strengthen the community partnership with Abilities United where she leads an innovative inclusive social skills research program (PI: Gengoux) focused on improving peer initiations made by children with ASD. A parent training program will be added in the coming year to enhance the program's effectiveness in fostering meaningful friendships for children. Preliminary findings from both projects have been presented at national and international conferences.
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.
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.
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.
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
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
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
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 10.1177/1362361318775538
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 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
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
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
View details for PubMedID 29297148
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
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