Publications | DuBay Lab

Exploring the Experiences of Latina Mothers in a Culturally Tailored Early Parent-Mediated Neurodevelopmental Intervention

ABSTRACT: Children begin to show symptoms of neurodevelopmental disorders early on in their development. Providing early intervention that is culturally responsive to both families and the child receiving the service is vital for the child’s growth. The purpose of this study was to qualitatively explore 14 Latin American Spanish-speaking parents’ reactions to and perceptions of Communication Interaction Training on Autism for Spanish-speaking caregivers (CITAS), a waitlist-style parent-mediated program that focuses on teaching parents strategies to support their child’s language development and enhance learning. Focus group, interview, and field note data were analyzed using the Ecological Validity Framework to determine areas of cultural fit and cultural misalignment. Notably, participants demonstrated appreciation for the CITAS program, including several specific elements that provided unique cultural fit. Some logistical and contextual challenges were also identified. Implications for research and practice are discussed.

Citation: DuBay, M., Rios, K., Montenegro, D., & Guerra, K. (2024). Exploring the experiences of Latina mothers in a culturally tailored early parent-mediated neurodevelopmental intervention. Infants & Young Children, 37(4), 273–293.

COVID and Autism 2023: lessons learnt and future

ABSTRACT: The COVID-19 pandemic profoundly impacted autistic individuals and their caregivers globally, leading to significant disruptions in mental health, service access, and daily routines. This editorial introduces a collection of research examining the challenges and opportunities that arose during the pandemic, with contributions from multiple countries. Key themes include the negative effects of service delivery disruptions, increased caregiver stress, and disparities in care based on socioeconomic and geographic factors. The rapid shift to telehealth highlighted both challenges and innovative approaches to service delivery for autistic individuals. As the world moves beyond the acute phases of the pandemic, the lessons learned can inform future preparedness strategies for public health emergencies. This includes the development of evidence-based interventions tailored to autistic individuals' needs during periods of disruption. Future research should explore long-term mental health impacts and the effectiveness of telehealth services to enhance resilience and care in the face of potential future crises. The findings from this research topic provide critical insights for improving care and support for autistic individuals globally.

Citation: Perez, L. G., DuBay, M., & Montiel-Nava, C. (2024). Editorial: COVID and autism 2023: Lessons learnt and future directions for research. Frontiers in Psychiatry, 15, 1476002.

An observational study of parental language during play and mealtime in toddlers at variable likelihood for autism

ABSTRACT: Parental language input influences child language outcomes but may vary based on certain characteristics. This research examined how parental language differs during two contexts for toddlers at varying likelihood of autism based on their developmental skills. Parental language (quantity, quality, and pragmatic functions) was analyzed during dyadic play and mealtime interactions as a secondary data analysis of observational data from a study of toddlers at elevated and lower likelihood of autism. Child developmental skills and sensory processing were also assessed. Parents used more words per minute, directives, and verbs during play and more adjectives, descriptions, and questions during mealtime. Parental language differed based on child fine motor skills, receptive language, and levels of sensory hyporesponsiveness but not autism likelihood. Overall, this study found that parental language varies based on context and child developmental skills. Future research examining parental language should include pragmatic functions and context across developmental trajectories.

Citation: Thompson, K., Choi, E., Artis, J., DuBay, M., Baranek, G. T., & Watson, L. R. (2024). An observational study of parental language during play and mealtime in toddlers at variable likelihood for autism. Journal of Child Language, 51(3), 681–709.

Evidence map of Spanish language parent-and self-report screening and diagnostic tools for autism spectrum disorder

ABSTRACT: As interest in diagnosing autism spectrum disorder (ASD) grows globally, various screening and diagnostic tools have been developed and translated, particularly into Spanish to meet the needs of large Spanish-speaking populations. This review assesses the quality of these Spanish-language tools, focusing on translation processes and empirical testing. A total of 48 Spanish versions of 21 ASD instruments were analyzed, revealing that many translations lacked detailed documentation, with most relying on a traditional forward-backward translation approach rather than cultural adaptation. Additionally, about half of the tools did not provide empirical evidence to support their clinical utility. Future efforts should prioritize culturally adaptive translations and testing in local populations to ensure validity and reliability.

Citation: DuBay, M., Lee, H., & Palomo, R. (2023). Evidence map of Spanish language parent- and self-report screening and diagnostic tools for autism spectrum disorder. Research in Autism Spectrum Disorders, 102, 102117.

Is traditional back translation enough? Comparison of translation methodology for an ASD screening tool

ABSTRACT: Early identification of autism spectrum disorders (ASD) in non-English speaking children often relies on translation of English ASD screening measures. Most measures employ a forward-back translation approach, despite data suggesting that this method may result in poor psychometric properties. Some studies in nonASD fields have suggested that a rigorous method of translation with cultural adaptation may yield better psychometric properties, but no studies in the ASD field have compared the two approaches directly. This investigation compares these two translation methodologies to determine if they produce psychometrically similar or dissimilar measures. Three hundred and eighty US-based Spanishspeaking caregivers of children 8–16 months old were randomly assigned to complete either a forward-back Spanish translation or a rigorous translation with cultural adaptation of a parent-report ASD screening tool. Measurement invariance analyses determined that the two translations were psychometrically dissimilar. Additional qualitative explanatory methods using cognitive interviews examined textual differences and participant preferences between non-invariant items.

Citation: DuBay, M., Sideris, J., & Rouch, E. (2022). Is traditional back translation enough? Comparison of translation methodology for an ASD screening tool. Autism Research, 15(10), 1868–1882.

Cultural adaptations to parent-mediated autism spectrum disorder interventions for Latin American families: A scoping review

ABSTRACT: This scoping review explores parent-mediated autism spectrum disorder (ASD) interventions culturally adapted for Latin American populations, providing an overview of existing evidence and identifying research gaps. A systematic search of six databases and hand searches yielded 21 articles representing 19 unique implementations of 16 different interventions. The majority of adaptations were surface-level, addressing dimensions such as language, concepts, methods, context, and people. However, few studies employed large sample sizes or robust methodological designs, and international studies were limited. The review highlights promising intervention adaptations for clinical use and encourages clinicians to engage in open discussions with Latin American families when selecting and adapting strategies to meet their specific needs.

Citation: DuBay, M. (2022). Cultural adaptations to parent-mediated autism spectrum disorder interventions for Latin American families: A scoping review. American Journal of Speech-Language Pathology, 31(3), 1517–1534.

Perceptions on Screening for Developmental Disabilities and Autism in Childcare Settings

This qualitative study explored the knowledge and perceptions about early screening for developmental disabilities and autism spectrum disorder (ASD) in childcare settings using semistructured interviews with directors, teachers, and parents at 12 childcare centers. Results indicated that most of the directors and teachers, who were interviewed, were cautiously open to implementing screening programs but wanted additional training in recognizing early signs of ASD and other developmental disabilities, as well as communicating with families about concerns. All interviewed parents reported wanting childcare professionals to communicate with them if they had developmental concerns for their child, and all but one parent was open to the idea of universal screening at their child's center.

Citation: Uzonyi, T. E., Page, J. M., DuBay, M., & Crais, E. R. (2022). Perceptions on screening for developmental disabilities and autism in childcare settings. Infants & Young Children, 35(2), 133–149.

Psychometric Comparison of the Western-Hemisphere Spanish Version of the Modified Checklist for Autism in Toddlers - Revised

ABSTRACT: Objectives: Parent-report screening tools for autism spectrum disorder (ASD) are widely used to promote early identification of children with or at risk for ASD. Most screening tools have been developed in English in the United States or United Kingdom; thus, translated versions are needed for use with culturally and linguistically diverse populations. Traditional translation methods include a forward translation, back translation, and review. However, when used in new cultural and linguistic contexts, this “forward-back” approach may have limitations, including differing psychometric properties compared with original instruments. This study presents a psychometric analysis of the forward-back translation methodology of an ASD screening tool. Methods: A retrospective chart review design was used to examine Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R; Robins et al.) records from 2974 toddlers. Data were compared between caregivers who completed the original English M-CHAT-R and caregivers who completed its forward-back “Spanish-Western Hemisphere” translation to compare select psychometric properties of the 2 instruments. Results: Significant differences were observed between the 2 versions, including a higher overall risk score, higher initial screen-positive rate, and increased likelihood of leaving items blank amongst Spanish speaking respondents. Conclusion: Traditional translation methods seemed to affect select psychometric properties between translations of the M-CHAT-R. A more rigorous cultural adaptation approach may be necessary to maintain equivalence with the original instrument. Until new rigorous translations are available, it is recommended that language-specific screening tools continue to be used, along with recommended follow-up interviews, to avoid exacerbating existing health disparities.

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Citation: DuBay, M., Watson, L., Mendez, L., Rojevic, C. (2021). Psychometric comparison of the Western-Hemisphere Spanish version of the Modified Checklist for Autism in Toddlers – Revised. Journal of Developmental and Behavioral Pediatrics. Advance Online Publication.

Rigorous Translation and Cultural Adaptation of an Autism Screening Tool: First Years Inventory as a Case Study

ABSTRACT: Screening tools for autism spectrum disorders serve a vital role in early identification of all children who may need evaluation and support. Recent studies suggest that traditional methods used in this field to translate such tools may be insufficient for maintaining linguistic, construct, or technical equivalence, resulting in screening tools that do not meet high psychometric standards in the new population. This study implemented a rigorous translation and cultural adaptation process by translating the First Years Inventory v3.1 (Baranek et al. First year inventory (FYI) 3.1. University of North Carolina at Chapel Hill Chapel Hill, NC, 2003) for a US-based Spanish-speaking population. A description of this process is provided with results from data collected during each phase. The unique challenges that were identified and addressed are detailed for future translation teams.

Citation: DuBay, M., Watson, L. R., Baranek, G. T., Lee, H., Rojevic, C., Brinson, W., Smith, D., Sideris, J. (2021). Rigorous translation and cultural adaptation of an autism screening tool: First Years Inventory as a case study. Journal of Autism and Developmental Disorders, 51, 3917-3928.

Translation and Cultural Adaptation of Parent-Report Developmental Assessments: Improving Rigor in Methodology

ABSTRACT: Most parent-report autism screening and assessment tools are developed and validated in English. Tools developed in one language with a specific culture require translation and cultural adaptation for use with a culturally or linguistically different population. Traditional translation methods are not sufficient to maintain the validity of these tools in the new population. A more rigorous methodology that maintains linguistic, construct, and technical equivalence is recommended. This article summarizes the basic stages in this translation and cultural adaptation process along with descriptions and rationales for various possible strategies used to complete each stage. A quality appraisal checklist is provided to allow readers to systematically analyze the quality of a translation or to guide instrument developers in the translation process.

Citation: DuBay, M., Watson, L. R. (2019). Translation and cultural adaptation of parent-report developmental assessments: Improving rigor in methodology. Research in Autism Spectrum Disorders, 62, 55-65.

Cascading effects of attention disengagement and sensory seeking on social symptoms in a community sample of infants at-risk for a future diagnosis of autism spectrum disorder

ABSTRACT: Recent work suggests sensory seeking predicts later social symptomatology through reduced social orienting in infants who are at high-risk for autism spectrum disorder (ASD) based on their status as younger siblings of children diagnosed with ASD. We drew on extant longitudinal data from a community sample of at-risk infants who were identified at 12 months using the First Year Inventory, and followed to 3–5 years. We replicate findings of Damiano et al. (in this issue) that a) high-risk infants who go on to be diagnosed with ASD show heightened sensory seeking in the second year of life relative to those who do not receive a diagnosis, and b) increased sensory seeking indirectly relates to later social symptomatology via reduced social orienting. We extend previous findings to show that sensory seeking has more clinical utility later in the second year of life (20–24 months) than earlier (13–15 months). Further, this study suggests that diminished attention disengagement at 12–15 months may precede and predict increased sensory seeking at 20–24 months. Findings add support for the notion that sensory features produce cascading effects on social development in infants at risk for ASD, and suggest that reduced attention disengagement early in life may set off this cascade.

Citation: Baranek, G. T., Woynaroski, T. G., Nowell, S., Turner-Brown, L., DuBay, M., Crais, E. R., & Watson, L. R. (2018). Cascading effects of attention disengagement and sensory seeking on social symptoms in a community sample of infants at-risk for a future diagnosis of autism spectrum disorder. Developmental Cognitive Neuroscience, 29, 30–40.

In Search of Culturally Appropriate Autism Interventions: Perspectives of Latino Caregivers

ABSTRACT: Most evidence-based autism spectrum disorder (ASD) interventions are tested with primarily White, mid-upper class, English-speaking populations, despite the increase in Latino children with ASD in early intervention programs throughout the United States. Unfortunately, interventions that are incongruent with a target population’s culture may be relatively ineffective. This mixedmethods study explored how culturally appropriate, feasible, and acceptable Latino caregivers perceived intervention models, strategies, and targets. Survey data were compared for 28 Latino and 27 non-Latino White parents of young children with ASD. Further, 20 Latino caregivers participated in focus groups to describe their challenges, perspectives and preferences for intervention strategies and models, and unmet needs from providers. These findings underscore the need for culturally modified interventions for Latino children and families.

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Citation: DuBay, M., Watson, L. R., Zhang, W. (2018). In search of culturally appropriate autism interventions: Perspectives of Latino caregivers. Journal of Autism and Developmental Disorders, 48, 1623-1639.

Unilateral forced nostril breathing and aphasia—Exploring unilateral forced nostril breathing as an adjunct to aphasia treatment: A case series

ABSTRACT: Unilateral forced nostril breathing (UFNB), a yogic pranayama technique, has been shown to improve verbal and spatial cognition in healthy adults, but its potential role in aphasia recovery remains unexplored. This study investigated the effects of combining UFNB with conventional speech-language therapy in individuals with post-stroke aphasia. Using a multiple baseline single-subject AB design, three participants practiced 40 minutes of UFNB daily and received speech therapy. Pre- and post-intervention assessments, including the Western Aphasia Battery-R (WAB-R) and Communication Abilities of Daily Living-2 (CADL-2), showed increases in CADL-2 scores for two participants and slight improvements in WAB-R aphasia quotients for two participants. Language sample analyses revealed some improvements in Correct Information Units (CIUs) and word productivity for two participants, although attention did not markedly improve. These findings suggest that UFNB may enhance language production and functional communication when used alongside traditional therapy, warranting further research.

Citation: Marshall, R. S., Laures-Gore, J., DuBay, M., Williams, T., & Bryant, D. (2015). Unilateral forced nostril breathing and aphasia: Exploring unilateral forced nostril breathing as an adjunct to aphasia treatment: A case series. Journal of Alternative and Complementary Medicine, 21(2), 91–99.

Coping resources in individuals with aphasia

ABSTRACT: Individuals with aphasia (IWA) often experience heightened stress and perceive fewer coping resources compared to neurologically intact individuals. This study aimed to identify which coping resources are perceived as available or unavailable to IWA compared to individuals with right brain damage (RBD) and neurologically intact individuals. A total of 31 IWA, 12 individuals with RBD, and 14 neurologically intact individuals completed the Coping Resources Inventory for Stress, with assistance from a caregiver or companion. Results showed that IWA perceived fewer resources in stress monitoring and tension control compared to the other groups, though all groups reported similar resources in social support and financial freedom. Both IWA and those with RBD perceived fewer resources related to acceptance. These findings suggest that IWA could benefit from counseling that leverages retained coping resources like social support and financial freedom while addressing areas like stress monitoring, tension control, and acceptance to help manage chronic stress and facilitate recovery.

Citation: DuBay, M. F., Laures-Gore, J. S., Matheny, K., & Romski, M. A. (2011). Coping resources in individuals with aphasia. Aphasiology, 25(9), 1016–1029.

Identifying behavioral measures of stress in individuals with aphasia

ABSTRACT: This study aimed to develop valid stress indicators in individuals with aphasia (IWA) by examining the relationship between language variables—error frequency (EF) and word productivity (WP)—and cortisol reactivity. Fourteen IWA and 10 controls participated in a speaking task, during which salivary cortisol was collected before and after the task. WP and EF were calculated from the language samples. As expected, IWA showed lower WP and higher EF compared to controls, with these effects related to aphasia severity. A moderate association was found between WP and cortisol reactivity in IWA, indicating that higher WP was linked to greater cortisol reactivity. No such relationship was observed in controls, and no link between EF and cortisol was found in either group. These findings suggest that WP may serve as a potential behavioral indicator of stress in individuals with aphasia.

Citation: Laures-Gore, J. S., DuBay, M. F., Duff, M. C., & Buchanan, T. W. (2010). Identifying behavioral measures of stress in individuals with aphasia. Journal of Speech, Language, and Hearing Research, 53(5), 1394–1400.