Tags Posts tagged with "Matthew Lerner"

Matthew Lerner

Hyunsik Kim and Erin Kang. Photo from Matthew Lerner’s lab

By Daniel Dunaief

This is the second half of a two-part series on autism research conducted by Hyunsik Kim and Erin Kang.

 Last week we focused on the work of Stony Brook University graduate student Hyunsik Kim, who used three criteria to diagnose autism. This week we will feature the work of another SBU graduate student in the Department of Psychology, Erin Kang, who specifically explored the types and severity of communication difficulties autistic children have. 

Words and the way people use them can offer clues about autism. Looking closely at pronoun reversals, speech delays, perseveration and 10 other characteristics, Kang determined that the number of features was a “powerful predictor of an autism spectrum disorder diagnosis.” 

In a paper published online in the Journal of Clinical Child & Adolescent Psychology, Kang grouped children from 6 to 18 years old into different subgroups based on their communication patterns and used a statistical method that allows the data to “speak for itself,” in terms of finding groups based on the patterns of how the communication difficulties are associated and to classify them.

According to Kang, heterogeneity is an important feature of autism spectrum disorder. “There has been a greater effort into understanding whether subgroups exist in ASD populations,” she explained in an email. By examining the atypical communication characteristics, she found four subgroups. These groups differed from each other, not only with autism, but on multiple measures, including the occurrence of anxiety or depression and with intellectual disabilities.

The communication difficulties occur at different rates within the autism children throughout Long Island that Kang studied.

Kang said her work has been “building on the previous literature,” although many of the previous studies focused on characterizing autism for children who were younger than 6.

“There are few studies on specific symptoms (e.g., stereotyped speech) across the body of literature,” she explained, adding that she’s passionate about exploring the trajectory of development over time with or without intervention. 

She and her co-authors, Ken Gadow and Matthew Lerner, who are also at Stony Brook University, are working on a follow-up paper that attempts to explore how changes in the pattern of communication challenges examined in the paper relate to other clinical aspects and outcomes.

Kang believes her results have clinical implications that will help in understanding autism. Atypical communication features are a good predictor of diagnostic status. “This can provide an advantage in assessing social communication profiles in autism,” she said. “It’s hopefully valuable in a low-resource setting.”

Parents might be asked 13 questions on a checklist, which could serve as an initial screening for more comprehensive autism evaluations, rather than a multiple checklist that could take a while for parents to complete. The different categories had specific features that distinguished them. 

“There’s been quite a bit of work in the speech and language field,” said Lerner, an associate professor of psychology, psychiatry and pediatrics in the Department of Psychology at Stony Brook University and Kang’s mentor. “This approach allowed us to ask about some of the specific types of language differences we often see.”

Lerner said what Kang found is that specific characteristics do tend to cluster together in “interesting and unique ways that can tell us more about the communicative phenotype of autism.”

One of the groups, which she called “little professors,” had speech patterns with considerable perseveration. In perseveration, a person repeats a word or phrase, even when a question or stimulus that might elicit that phrase no longer continues. As an example, Dustin Hoffman in the movie “Rain Man” frequently repeated the number of minutes until Judge Wapner was on TV.

“These kids would benefit more from a group-based social skills intervention that specifically integrated interacting with peers,” Kang said. People in this group had the highest percentage of wanting a friend, but difficulty with relating to peers.

“They will benefit especially from interventions that help them build skills in interacting with peers,” she explained.

She also suggested that the best way to make a reliable diagnosis is to collect as much information as possible, which could include observations and electrophysiological data.

Kang acknowledged that some of the responses from the parents or teachers of people with autism contain bias. “There can be a lot of potential especially in terms of these subjective measures,” she said.

Indeed, through Lerner’s lab, Kang has been trying to include more uses of neurological measures and other methodology that is less subject to biases.

“Hopefully, by looking at these more objective measures, we can help integrate information from these different levels,” she said.

A resident of East Northport, Kang lives with her husband, musician Sungwon Kim, who works as a freelancer on Broadway musicals. The couple, who have a young son, met in Boston when she was working at Boston Children’s Hospital and he was a student at Berklee College of Music. 

Kang’s first experience with autism was in high school, when she acted as a mentor to a second grader. When she entered college at the University of California at Berkeley, she studied molecular and cellular biology and psychology.

Lerner said that Kang is a “truly remarkable young scholar” and is “among the best I’ve seen at her stage to be able to look at her clinical experiences, which drive the questions that strike at the core of how we understand and treat autism.”

Lerner appreciates how she is driven to understand autism from neurons in the brain all the way up to the classification and treatment.

“She is somebody who is completely undaunted by taking on new questions or methodologies because she has an idea of what they’re going to mean,” Lerner said. “She has worked with [autistic children] and has tried to understand where they are coming from.”

Kang questions assumptions about what autism is, while also exploring its development.

“She is able to see and discover clinical strengths that manifest in the kinds of questions she asks,” explained Lerner. “She is a part of the next generation of where my field is going, and I hope we can catch up to her.”

Kang appreciates the work-life balance she has struck on Long Island, where she feels like the pace of life is “quiet and calm during the week,” while it’s close enough to New York City to enjoy the cultural opportunities.

From left, Hyunsik Kim, Associate Professor Matthew Lerner and Erin Kang. Photo from Lerner’s lab

By Daniel Dunaief

This is part one of a two-part series on autism research conducted by Hyunsik Kim and Erin Kang.

If someone in a family behaves in ways that are difficult to understand, the family might look for a support group of people with similar characteristics, visit a doctor or seek to document and understand patterns.

Finding a doctor who has seen these types of behaviors, speech patterns or actions before could provide comfort, as the physician may either engage in a course of treatment or provide context and understanding for the current behaviors. The doctor may also offer advice about any likely changes in behaviors in the near or distant future.

For researchers, understanding a range of symptoms, some of which might be below the threshold to meet a specific diagnosis, can lead to a more specific awareness of a condition, which could help guide patients toward an effective treatment.

Hyunsik Kim and Erin Kang, graduate students in the Department of Psychology at Stony Brook University, recently published papers examining autism, hoping to get a more specific understanding of subtle differences and symptoms.

Kim was looking for a better way to conceptualize autism. He used advanced statistical methods to compare three theoretical perspectives to find the one that best characterized the symptoms.

“According to my study, autism is not an all-or-nothing phenomenon, but is dimensional [and is] comprised of three related spectra of behaviors,” he explained. 

Researchers can characterize everyone’s autism symptoms through a combination of levels in each domain.

Each of these three areas can range from very mild to severe.         As an analogy, Kim suggested considering the quality of being introverted. A person can be mildly, moderately or highly introverted, which offers a continuum for the dimension of introversion.

In a dimensional approach that involves exploring these three different categories, researchers can get a better understanding of the symptom profiles.

“For decades, people thought of autism as purely categorical,” said Matthew Lerner, an associate professor of psychology, psychiatry and pediatrics in the Department of Psychology at Stony Brook University. “You either have it or you don’t. In fact, autism was thought of as the easiest diagnosis to make.”

Kim, however, has “a goal of answering the fundamental question: what are we talking about when we’re talking about autism?” Lerner said. “Slowly, autism has morphed from the most categorical to the most dimensional. Literally, people talk about the spectrum when they talk about autism.”

With a dimensional approach based on levels of the three major domains for diagnosing autism, Kim suggested that researchers and doctors could better understand people who fall just below the current diagnosis for autism.

“It’s especially important to identify individuals who show a borderline range of symptoms, who barely fail to meet the diagnostic criteria of a given disorder, and provide them with appropriate treatments,” Kim explained.

Ideally, he hopes a dimensional approach incorporates the severity of symptoms into the current diagnostic system to promote better treatment procedures and outcomes.

Kim recognized that he could have just as easily created a dimensional approach that incorporates a greater number of criteria. His statistical analysis, however, revealed that the three dimensions provide the parsimonious explanation about autism symptoms.

Kim analyzed data from a parent questionnaire. He recognized that self-reporting by parents may underestimate or overestimate the severity of symptoms. He believed the over and under estimate of symptoms likely “evened out.”

Lerner suggests this multidimensional approach has numerous implications. For starters, it can help capture more of the types of symptoms in a diagnosis. It can also highlight the specific area of autism a clinician might want to target.

“We should be focusing on the factors that are most relevant for the individual and which are getting in their way,” Lerner said.

Treating autism broadly, instead of focusing on specific symptoms, may be “misguided,” Lerner added. A more specific characterization of autism could also help advance the field of neurogenetic research. “With more contemporary genetic analysis, we can use findings like this as a road map for what those genetic differences mean,” he said.

For his next step, Kim hopes to expand this work to observational data, adding that to the existing pool of information from parental questionnaires.

“People go on a home visit and take video of autistic kids interacting with others,” Kim said. “We can have some people code their behavior.”

More broadly, Kim would like to answer fundamental questions about the classification and conceptualization of mental disorders by using advanced quantitative modeling and other data-driven approaches. He believes a factor may represent a person’s vulnerability to developing a specific mental disorder.

A high level of this factor, combined with life stressors or adversity, would make it more likely that a person develops a disorder. As someone who studies psychology, Kim said he is well aware of his own emotional patterns and he tries to use his training to help himself cope.

He is not particularly comfortable doing public speaking, but he tells himself that whatever anxiety he feels is normal and that his practice, knowledge and expertise should allow him to succeed.

A resident of Middle Island, Kim lives with his wife Jennifer. The couple has two young children. Kim describes his wife as a “really good” amateur baker, who bakes cakes, muffins, cookies, macaroons, chiffon cakes and more. He has encouraged her to start her own YouTube channel and one day they hope to open a bakery that is online and offline.

As for his autism work, he hopes the dimensional approach is “incorporated into the assessment stage so that individuals do not merely receive a diagnosis, but are informed of their unique symptom profiles, so that clinicians can take them into consideration.” 

Matthew Lerner, far right, with his lab group at Stony Brook University. Photo from Matthew Lerner

By Daniel Dunaief

An actor draws in members of an audience, encouraging them to understand, appreciate and perhaps even become sympathetic to a world created on a stage. The process of creating scenes for the actor, however, can also change his or her world off the stage.

A team of scientists from Vanderbilt University, University of Alabama at Tuscaloosa and Stony Brook University recently received $3 million in funding from the National Institutes of Mental Health for four years to study how participation in a theater production can help people with autism spectrum disorders.

Matthew Lerner. Photo by Graham Chedd from the Alan Alda Center for Communicating Science

“Theater is a venue for learning and gaining skills,” said Matthew Lerner, an assistant professor of psychology, psychiatry and pediatrics at the Department of Psychology at SBU who is leading the Long Island part of a study that will involve about 240 participants from age 10 through 16. “The process of putting on a play with others and being able to successfully produce and perform that has key benefits to learn and practice.”

Called SENSE Theatre (for Social Emotional NeuroScience Endocrinology), the shows were created by the project leader, Blythe Corbett, an associate professor of psychiatry and behavioral sciences and psychology and investigator at Vanderbilt Kennedy Center, who herself performed in stage plays before pursuing her scientific career.

Corbett writes the plays, which have themes she believes are important not only for autism but also for the general public. The topics include acceptance, belonging and diversity and offer a current of core ideas that are “part of having a condition that is unique,” she said. The plays, which typically have about 20 characters, include music and last about 45 minutes.

Tiffany Adams and Jane Goodwin participate in the SENSE Theatre program. Photo by Steve Green, Vanderbilt University

Corbett explained that the experience uses theater as a platform for teaching fundamental areas that could help people with autism spectrum disorders, including reciprocal social communication, flexible thinking and behavior and imagination.

“It also gives [the participants] an opportunity to be exposed to social situations and to engage with others in a safe and supportive environment,” she said. “They can be John today and Henry tomorrow, which allows them to expand their repertoire in a playful, fun way” which, she hopes, might help them assimilate lessons when the program ends.

Corbett has been developing SENSE Theatre for nine years. This specific multisite project will allow her to see how transportable this program is to other locations, where other investigators who have not been involved with this before can employ it with other participants.

The investigators, which include Corbett, Lerner and Susan White at the University of Alabama, will monitor the participants through psychological testing, social interaction and research EEG, or electroencephalography. This is a noninvasive way of monitoring electrical activity in the brain that involves placing electrodes on or below the scalp. The EEG testing takes about 45 minutes.

Participation is free, although members, who go through a screening process, need to contribute to the research program by completing the evaluations.

The theater program has a control study, calling Tackling Teenage Training, in which participants will “address some of the challenges of being a teen,” which include dating and puberty, knowing how to know if somebody likes or doesn’t like you and how to express desires or interests appropriately, Lerner said.

Savannah Bradley participates in the SENSE Theatre program. Photo from Steve Green , Vanderbilt University

Corbett chose to work with Lerner because of considerable overlap in their interests in using performance to provide clinical help for people with autism spectrum disorders. Lerner “has a very strong interest in theater and is able to understand the core approach” to the training and shows as a form of intervention. He is an “engaging, charismatic individual who is extremely hard-working” and is a “really good choice in terms of harnessing his energy and intelligence.”

Indeed, Lerner and Karen Levine, a licensed psychologist and the co-author of “Treatment Planning for Children with Autism Spectrum Disorders,” developed a model in 2004 for youths with disabilities to work on social skills called Spotlight, which utilized techniques of theater games and dramatic training. Spotlight is a program of Northeast Arc, a human services organization founded in 1954 and based in Massachusetts.

The Spotlight efforts started with nine students and has expanded to include hundreds of families each year.

In early high school, Lerner met someone who would change his life. He was having dinner with the family of a friend of his younger sister’s when he noticed a boy, Ben, playing on his own in another room. Lerner asked if he could play with Ben, who was 2 at the time and was running a car back and forth across the top of a toy playhouse.

Lerner mirrored what Ben did. “He looked at me curiously and kept doing what he was doing,” Lerner recalled. “I followed him around for over two hours.”

A scene from a performance by SENSE Theatre. Photo by Steve Green, Vanderbilt University

Up to that point in his life, Lerner thought the experience with Ben was “the most fascinating two hours of my life.” He had made a connection in which he “loved the joy and challenge of trying to meet him where he was, rather than behave in a way that was consistent with what the world expected.”

Lerner studied philosophy and music at Wesleyan University. After earning his doctorate at the University of Virginia, where his dissertation explored why youths with autism experience social problems, Lerner worked at the University of Chicago and then moved to SBU in 2013.

A native of Swampscott, Massachusetts, Lerner lives in Port Jefferson with his wife Chelsea Finn, a pediatric nurse practitioner in the Stony Brook Hospital Emergency Room and a nurse practitioner at SV Pediatrics in Patchogue. The couple has a 4-year-old son Everett and a 6-month-old son Sawyer.

Lerner is looking for people who would like to participate in the study. They can reach out to him by phone at 631-632-7857 or by email at lernerlab@stonybrook.edu. The first set of students will begin working in the SENSE Theatre program this spring and summer.

Corbett said the participants aren’t the only ones who benefit from the program.

“The overwhelming sentiment from those who come to see the performance is that it changes their perception of what it means to have autism,” Corbett said. After the show, some of the audience members “ask who are the children with autism.”

Parents of the actors are pleasantly surprised by the things their children are able to do, which exceed their expectations. “In one of our previous studies, parents reported that their stress went down” during the program, she said, “which appeared to be in response to the child participating in intervention.”

Participants at the SASI Family Fun Day held last month in Huntington. Photo by Rebecca Anzel

By Rebecca Anzel

A young scientist at Stony Brook University has received a $2.3 million grant to fund research he hopes will eventually lead to new therapies for the treatment of autism spectrum disorder.

Matthew Lerner, Ph.D., is an assistant professor of clinical psychology at Stony Brook University, and director of the Stony Brook Social Competence and Treatment Lab, the focus of which is learning to understand how children and teens with ASD form friendships.

“We use the word lab loosely, only because we collect data there,” he said. “It’s a fun space with games and activities for kids.”

“Matthew Lerner is sort of a pioneer in his thought process, and that’s what makes him special to me.”

— Priscilla Arena

His work thus far has ranged from lab-based studies — evaluating and developing tools to measure what is happening during social interactions and how the brain processes those interactions — to real-world applications. Lerner’s previous studies ask how, when and if kids make friends, and what helps them do so.

Efforts to link these two levels of analysis have never been done simultaneously — until now. Lerner won a highly competitive National Institute of Mental Health award to fund his innovative approach to studying social behaviors of children with ASD.

“It’s kind of remarkable that it really hasn’t been done in quite this way before,” he said. “We presume that these things — lab-based measures of how kids think about social interactions and real world interactions themselves — are linked, because otherwise, why would we look at them? But how they’re linked, and importantly, how we can understand how those links differ across individuals, hasn’t really been done thoroughly before.”

Priscilla Arena, the leader of a support group for parents of children with ASD, said Lerner is excited about the potential the grant gives his research.

“Matthew Lerner is sort of a pioneer in his thought process, and that’s what makes him special to me,” she said. “He sees potential in the future.”

It’s not far from her initial reaction after meeting with the Stony Brook researcher, who asked permission to speak to the parents in her group.

The Suffolk Aspergers/Autism Support and Information co-founder wanted to protect the parents, who have “already been beaten and kicked” by others looking for monetary donations and permission to study their children. But when she met Lerner, she said she knew almost immediately that he was different.

“He’s sincere, honorable, impassioned, smart and cerebral,” Arena said. “I don’t think my first impression of him has ever changed, and I think that’s why, from the get-go, I’ve had respect for him.”

The award, called Biobehavioral Research Awards for Innovative New Scientists, was created in 2009 as a way to provide younger scientists with financial support for research. It is for early-stage investigators who are on a tenure track and have no prior research project grants.

“BRAINS” is earmarked for “the most promising early investigators” and is “one of the most competitive [awards]” NIH offers, according to Lisa Gilotty, Ph.D., program officer of Lerner’s grant. Gilotty is also the chief of NIMH’s research program on autism spectrum disorder.

Matthew Lerner is enthusiastic about finding treatments for those with autism spectrum disorder. Photo from Matthew Lerner
Matthew Lerner is enthusiastic about finding treatments for those with autism spectrum disorder. Photo from Matthew Lerner

Lerner is examining how well various biological and social factors, both independently and jointly, can predict how teenagers aged 11 to 17, with and without ASD, socially interact outside of a laboratory. In the five-year project, he and his team are also studying how those factors correlate, and which best explain the resulting social behaviors.

They are hoping to use information gleaned by observing the teenagers inside and outside the lab to make precise predictions about how they make friendships.

Depending on the results, the team might be able to develop generalized patterns that can be applied to a large number of people on the spectrum and be used to create more targeted therapies.

“This is an extremely important study that will shed light on the wide variability observed in social function in ASD,” said James McPartland, director of the Yale Developmental Disabilities Clinic. “Presently, little is understood about the biological reasons for these individual differences. Dr. Lerner’s study will help us understand these differences from both behavioral and brain-based perspectives.”

Dozens of the 260 teenagers — 160 with ASD and 100 without — participating in this study are Three Village students. Lerner and his team have also connected with special educators in the area to see how participants are doing outside the lab in a classroom.

He and his team spend a lot of time in the community, at family events and meetings with parents and educators to introduce themselves, share information about their work and to learn what challenges children are experiencing. Because Lerner wants the work he does to matter to parents and community members, he calls them “stakeholders” in his research.

“The most impressive thing about him is how community-minded he is,” President and Executive Director of Asperger Syndrome and High Functioning Autism Association (AHA) Patricia Schissel said. “It is important that he’s not stuck in a lab. He’s excited to get out into the research community.”

Arena said quite a few study participants are from SASI as well — her son included. Besides hosting support groups, the program, which was co-founded by Arena with Stephanie Mendelson, provides resources and runs events and programs for special needs families.

Arena and her son were asked to complete a 500-question survey as part of the screening process, and have committed to 20 weeks of social groups.

What appealed to her about this study is Lerner’s concentration on trying to develop more effective treatments and therapies for ASD as opposed to looking for a cure.

“I always say, unless you’re going to do a lobotomy, [saying there is a cure] is baloney,” she said. “You can calm certain conditions of it down through behavior modification and therapy, but you cannot cure it. There’s no way to reverse how the brain has been formed. My son will have it forever.”

Schissel said Lerner’s study has the potential to change treatment options for those with autism as genome sequencing did for cancer.

Oncologists previously “threw the kitchen sink” at cancer and attacked tumors broadly. Once genome sequencing was developed, doctors could instead more easily treat tumors directly. Such an approach to ASD therapies would be more effective and “waste less time and enormous amounts of money,” she said.

Michael Greenberg, a social worker for outpatient child and adolescent psychiatry at Stony Brook Medicine, agreed that more specific treatments and therapies are more efficient and effective.

“It creates an opportunity to have the odds be the best the first time,” he said. “No one can predict what he’s going to find, but he’s trying to come up with something that can be replicated and benefit people more widely.”

The results from Lerner’s study might also be applicable to children without ASD. He said it is unclear whether the social patterns he and his team might uncover are unique to kids with autism. There is a potential for any treatments that stem from his findings to benefit any kid who struggles socially.