In Conversation with Dr. Connie Kasari

Dr. Connie Kasari

Question: What led you to autism research?

Answer: I came to UCLA over 30 years ago to do my post-doctoral work with Dr. Marian Sigman, who at the time was one of the best known researchers in the early development of children with autism spectrum disorders (ASD). I overlapped with another of her post docs, Peter Mundy (currently at the UC Davis MIND Institute), who was studying early attention, particularly joint attention skills in young children with ASD, and other neurodevelopmental disorders. Before coming to UCLA, I had clinically worked with infants and children with neurodevelopmental disorders. During my PhD I studied early infant development, and parent child interactions, but it was in Dr. Sigman’s lab that I really learned about the early development of children with ASD---and what sets children with ASD apart from the ways in which other children develop, including children with Down syndrome and typical children.

Once I began my own academic position in the Graduate School of Education at UCLA, I furthered this line of research by developing an early intervention that could address some of the core impairments we had studied in the Sigman lab, namely joint attention and play difficulties of young children with ASD. We knew if we could improve these areas of development in the children, we could improve their language and cognitive outcomes. This goal was particularly important at the time, because nearly three-quarters of all children with autism were minimally verbal when they entered kindergarten. Now, however, with advances in early intervention, and greater access to services, only about one-third of children entering kindergarten are minimally verbal.

Question: What sets your intervention studies apart from others in the field?

Answer: I think one thing is that we try to push the boundaries of our knowledge with new study designs, and we try to study populations that are more difficult to reach. In this way, we begin to address important questions in the intervention field—such as how much intervention is needed to see benefit for which children, what types of interventions provide the most benefit to which children, and what sequence of intervention is necessary to see a benefit? With these questions in mind, we can begin to personalize interventions for individual children and their families.

Our intervention, JASPER, has now been tested with more than 700 children in multiple contexts, with several more studies currently in progress. We see the benefits of working on the core developmental impairments like joint attention, play, and joint engagement. But we also recognize the vast heterogeneity of autism. We rarely do simple randomized controlled trials anymore (where we might test JASPER against a control group of children who receive no specialized early intervention). Rather we are testing intervention methods that allow us to study the sequence of interventions, or the elements of intervention that are most important to a particular child. These elements could be dose (how often or how much intervention is needed to produce an effect), combinations of interventions, the addition of speech generating devices, and so on. We recognize that a single intervention is not effective for all children, and we want to better understand for whom an intervention works best, and why.

We also found that even when children did extremely well in preschool with interventions like JASPER, they would sometimes do poorly in school, especially with peer relationships. In the school context, the children needed a different intervention, and so we developed and studied several peer relationship interventions. The most studied is one named Remaking Recess, so named by an adult with ASD who told us we just needed to ‘remake recess’ as it was so difficult for her growing up. Remaking Recess has now been tested several times with positive outcomes on children’s peer engagement on the playground during recess, and in their classroom connections to peers as reported by the peers themselves in social network analyses.

Question: You’ve been heavily involved in working with community throughout the years. What have you learned and where is your work headed?

Answer: We do much of our intervention work in the community. This means we are in family homes, or in schools. Because Los Angeles is so diverse, our participant samples are likewise diverse. We have included a broad range of children and families, including those who speak different languages, so that our interventionists are also diverse, speaking the same language as needed for the child and family. One of the issues we have in intervention research is that most researchers only report on samples that are White and middle-class. Clearly, our evidence base is limited then, since most of the individuals with autism are likely not middle class nor White. We try to rectify this situation by including the vast heterogeneity of individuals with autism in our studies. It is one of the reasons we like seeing children in schools. Everyone sends their children to school, so that you can find a more diverse and representative population of children with ASD, and you see children in their natural environment.

The future of intervention research is thinking about how we implement evidence-based practices in community settings and one way to do that is through Community Partnered Participatory Research, or CPPR, which we’ve been heavily involved in through the Autism Intervention Research Network (AIRB network). We actually partner with community members such as teachers and then adapt interventions to fit their context. We are grateful for the opportunity to work in partnership with these amazing individuals and have learned a lot from them along the way, in terms of what solutions are viable and how realistically to shape an intervention that can be effectively implemented in the child’s day to day context, outside of the sterile environment of the clinic. In this way, interventions that work may be more sustainable and effective in the community.

Question: This year, you were elected the International Society for Autism Research (INSAR) president-elect to be followed by a two-year term as INSAR president. What plans do you have for INSAR during your term as president?

Answer: At INSAR, we have challenges ahead of us as we try to bring more diverse populations and types of researchers together. We want to bring in researchers from neuroscience to clinical researchers, from autistic researchers to researchers all over the world, and in many places where resources are quite limited. It’s an opportunity to both bring people together and to highlight the new discoveries in autism research.

Question: What challenges have you faced in your career as an autism researcher?

Answer: Funding, writing grants, balancing teaching, and family life. Researchers must take on a lot of different roles and shift among those roles. Finding the time to write grants and write papers is always a challenge for folks who are trying to balance out their life and their work, and the demands of their position. But we are also blessed in that we have the ability to have the varied experiences that we have, and that we love the work!

Question: What advice do you have for trainees entering this field?

Answer: One of the exciting areas of autism research is the number of amazing trainees involved in our center. Our field is interdisciplinary, and trainees have the opportunity to learn from many different fields that address issues related to autism. Our center provides opportunities to learn from the world’s experts in autism research, as well as to engage in the many clinical opportunities at UCLA and in the community. I would encourage trainees to take advantage of these opportunities!

Question: What don’t we know about Connie Kasari?

Answer: Probably many things What I can tell you is that I grew up on a farm in eastern Oregon, which was mostly tumbleweeds when I was growing up, but is now filled with great wineries. My home was near Pendleton Oregon, where Pendleton wool originated. I was involved in 4-H as a kid, mostly working with sheep, and later as an adult I learned how to spin wool into yarn. So, I would say I have great country roots.