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April 2, 2014

Brooke Ingersoll: Finding her calling

April 2, 2014

Brooke Ingersoll is an associate professor of psychology and an expert in autism treatment. Her research focuses on the development, evaluation, and dissemination of social communication interventions for individuals with autism. She also conducts research on the impact of ASD on the family and the broader autism phenotype. A major emphasis of her current work is on the development of community-focused, parent-mediated interventions for young children with ASD.

When I was a senior in college in the mid-90s, I answered an ad in the school newspaper for an in-home applied behavior analysis (ABA) therapist to work with a four-year-old boy with autism. I liked the idea of applying some of the concepts I was learning in my psychology classes, but I knew almost nothing about autism. Indeed, at the time, autism was much less common that it is today, and public awareness of the condition was minimal. My psychology courses barely touched on it; no one I knew had autism, and most people I knew had never heard of it.

The family who ran the ad had come across the book, “Let me hear your voice,” written by a mother of two children with ASD. The book, published in 1993, described her children’s dramatic improvement in response to an in-home ABA program based on Dr. Ivar Lovaas’s work with children with autism at UCLA. This book was instrumental in bringing his research to the public, and perhaps for the first time, offered hope to parents of children diagnosed with autism that their children could improve. The family, unhappy with the lack of evidence-based services in the community, hired me along with a handful of other college students to work with their son, day in and day out, breaking complex tasks down into simple steps, and teaching them one at a time. I found my calling.

After I graduated, I moved to Atlanta and took a job as a therapist at an autism lab school at Emory University. The intervention approach was completely different. Rather than providing treatment in a structured, one-to-one setting in the home, treatment was provided in a preschool classroom alongside typically developing children. This was the first time I had the opportunity to observe multiple children with autism. I was struck by the difference in their response to treatment; many children made amazing gains, but a few made almost no improvement over the course of the year. It made me wonder whether the children whose response was so minimal would have done better with a different type of intervention. Could we identify ways to improve outcomes by matching children with specific treatment approaches? My interest in research began to grow and I decided to go to graduate school at UCSD to study experimental psychology under Dr. Laura Schreibman.

In graduate school, I focused my research on treatment efficacy, designing novel treatments and evaluating whether they worked, under what conditions, and for whom. I worked with a number of ABA-based intervention models, and developed a particular interest in parent training. After graduating, I worked for several years in a community-based intervention program in Portland, OR. I was amazed that the interventions that I had implemented and researched over the years, many of which had been initially evaluated in research settings in 1980s, were still not in routine practice in the community in the mid-2000s. How could it be that community-based intervention providers were still not using these treatments? This was particularly the case with parent training. Despite multiple studies and national expert guidelines indicating the benefits of teaching parents to support their child with autism’s learning, no one was doing it in the community.

This realization led to a shift in my thinking about treatment research in autism. The treatments that were being developed in research settings were highly promising in terms of efficacy, but not necessarily practical for use in community settings, where funding, staffing and training needs are quite different. I began to focus on understanding barriers to the use of research-based interventions in the community. My colleague, Anna Dvortscak, and I published, “Teaching Social Communication to Children with Autism,” a parent-training curriculum designed to overcome these barriers. Since coming to MSU in 2007, I have continued to focus my research on the development and evaluation of interventions that are sustainable in community settings.

The landscape of autism has changed dramatically since I was an undergrad. Public awareness of autism is now quite high. When I ask my undergrads what they know about autism, almost everyone knows someone with autism or has recently seen something about it in the news. Special education and other professional training programs now offer specialized training in autism. There is now insurance funding for in-home ABA services in Michigan and many other states. But the use of cutting-edge, research-based interventions in the community still lags behind, especially in rural and under-resourced areas.

The field needs better models of disseminating and implementing treatments with empirical support in community settings. My current work is examining the use of telehealth to provide parent training to families immediately after diagnosis as a way of closing the research-to-practice gap. It is my goal to increase access to evidence-based interventions so that all families can benefit from the advances in treatment research.