Lauren Kenworthy

• PhD
• Chief Pediatric Neuropsychology at Children's National Medical Center

Executive function (EF) challenges, including difficulties with cognitive flexibility, planning/ organization, and emotional control, are common in neurodivergent children. We developed the Behavioral Observation of Classroom Executive Functioning (BOCEF) tool to examine observable EF-related behaviors of elementary students and EF-supporting strat...

Age at autism diagnosis is associated with sex assigned at birth (hereafter, “sex”), such that girls/women are more likely to be delayed or “missed” entirely in the diagnostic process compared to boys/men. Later diagnosed individuals, especially girls/women, demonstrate increased anxious/depressive symptoms. Data on autistic youth from clinic-based...

The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of...

Objective: Situated in Children’s National Hospital (CNH)’s Neuropsychology Division, the Gender and Autism Program (GAP) is the first clinical service dedicated to the needs of autistic gender-diverse/transgender youth. This study describes GAP clinical assessment profiles and presents a multi-perspective programmatic review of GAP evaluation serv...

Every year, an increasing number of autistic youth enter a complex and underfunded adult service system after graduating from high school. Executive function (EF) challenges commonly co-occur with autism, especially related to flexible problem-solving and planning, and are linked to poor outcomes in post-secondary education and employment. The educ...

Mental health conditions such as anxiety, depression, aggression, and inattention are common in autistic youth and are challenging to treat by community providers. We aim to parse the heterogeneity of autism based on dimensions of executive function and determine whether specific executive function profiles are differentially related to psychiatric...

Later autism diagnosis is associated with increased mental health risks. Understanding disparities in diagnostic timing is important to reduce psychiatric burden for autistic people. One characteristic associated with later autism diagnosis is female sex assigned at birth. However, literature to date does not characterize, differentiate, or account...

OBJECTIVES/GOALS: Childhood psychopathology is a worsening public health crisis leading to negative life outcomes, including self-harm and suicide. Difficulty in self-control as early as 3 years old predicts psychopathology, but the mediating mechanisms of brain function are unknown. Here, we tested one mechanism: functional connectivity (FC) integ...

Objective: Researchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating...

Executive function challenges are linked to important outcomes in adulthood, including mental and physical health and employment. Executive function skills can be taught but require support for generalization into home and school settings. The present study examined the feasibility of a series of brief videos (e.g., animations, expert and caregiver...

Objective The present study aims to better understand learning strategies and difficulties in autistic youth. Previous studies have found that autistic youth have difficulties with executive function skills and poorer performance in memory and learning tasks, especially those that require spontaneous retrieval of information compared to memory task...

Objective Executive functioning (EF) is impaired in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), and EF challenges are exacerbated in youth with ASD and ADHD (ASD+ADHD), which may impact diagnostic timing. We hypothesized youth with ASD+ADHD would be more impaired in EF (as opposed to other functional domains)...

Objective The Rey Osterreith Complex Figure (ROCF) is a neuropsychological task used to measure visual-motor integration, visual memory, and executive functioning (EF) in autistic youth. The ROCF is a valued clinical tool because it provides an insight into the way an individual approaches and organizes complex visual stimuli. The constructs measur...

Objective Autistic youth have impaired executive functioning (EF) and these challenges increase throughout adolescence. Deficits in EF have been associated with poor adult outcomes, decreased availability for learning, and linked to academic outcomes. Specifically, flexible problem solving is greatly reduced in autistic youth. We aim to investigate...

Objective Childhood obesity is a serious health epidemic affecting the world today. Children who are obese earlier in life are more likely to stay obese and have an increased risk of poorer health outcomes later in life, such as diabetes and cardiovascular diseases. Obesity is also associated with deficits in executive function. Executive function...

Cognitive flexibility differences are common for autistic individuals and have an impact on a range of clinical outcomes. However, there is currently a lack of well validated measurement tools to assess flexibility in adulthood. The Flexibility Scale was originally designed as a parent‐report measure of real‐world flexibility challenges in youth. T...

Investigating the role of puberty on executive function (EF) development is important for understanding how maturation and its related changes can impact neural systems underlying EF in autistic (AT) adolescents. Studies document chronological age-related differences in EF among AT youth, but the impact of puberty is understudied. We examined the r...

OBJECTIVES/GOALS: Childhood psychiatric symptoms are highly comorbid. Their co-occurrence and association with negative life outcomes is partially explained by deficits in executive control, or processes enabling self-regulation. Here, we test a novel executive neural target in three fMRI tasks and its relevance to shared psychopathology. METHODS/S...

There is an urgent need for targeted efforts to better translate effective, evidence-based interventions (EBIs) to community settings. EBI adaptations or modifications that respond to community members’ needs and recommendations are critical to improve fit and use in publicly funded children’s mental health services. The current mixed-methods study...

Objective: Later autism diagnosis is associated with increased mental health risks. Thus, understanding factors related to disparities in diagnostic timing is important to reduce psychiatric burden for autistic people at disproportionate risk for mental health problems. “Sex” has captured attention in relation to differences in timing in autism rec...

The common intersection of autism and transgender identities has been described in clinical and community contexts. This study investigates autism-related neurophenotypes among transgender youth. Forty-five transgender youth, evenly balanced across non-autistic, slightly subclinically autistic, and full-criteria autistic subgroupings, completed res...

Gender identity is a core component of human experience, critical to account for in broad health, development, psychosocial research, and clinical practice. Yet, the psychometric characterization of gender has been impeded due to challenges in modeling the myriad gender self-descriptors, statistical power limitations related to multigroup analyses,...

Autism Spectrum Disorder (ASD) is a developmental condition characterized by social and communication differences. Recent research suggests ASD affects 1-in-44 children in the United States. ASD is diagnosed more commonly in males, though it is unclear whether this diagnostic disparity is a result of a biological predisposition or limitations in di...

Current tools for identifying autism are critiqued for their lack of specificity and sensitivity, especially in autistic people who are older, have higher verbal ability or significant compensatory skills, and are not cisgender boys. This may reflect the following: the historical focus of autism research on White (cisgender) male, upper and middle...

This randomized trial compared the first online parent training program for an evidence-supported executive function intervention for autism to in-person parent training with the same dose and content. Parents of autistic children (8–12 years-old; Full Scale IQ above 70) were randomized to in-person (n = 51) or online (n = 46) training. Training ac...

BACKGROUND Covariation among psychiatric symptoms is being actively pursued for transdiagnostic dimensions of psychopathology with predictive utility. A superordinate dimension, p-factor, reflects overall psychopathology burden and has support from genetic and neuroimaging correlates. However, the neurocognitive correlates which link elevated p-fac...

Prior research suggests that Black children are at risk for delays in diagnosis of autism, but factors that influence diagnostic timing across races remain unclear. This study analyzed data from Black and White children who received a first-time autism diagnosis at a specialty clinic. Black youth were under-represented in the group who received a f...

Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive-functioning skills exist and there are ongoing efforts to implement these interventions in routine community-based care. However, there is limited research characterizing therapist perspecti...

Objectives School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. Methods Parents (N = 124) o...

Background Sex chromosome aneuploidies (SCAs) are a collectively common family of genetic disorders that increase the risk for neuropsychiatric and cognitive impairment. Beyond being important medical disorders in their own right, SCAs also offer a unique naturally occurring model for studying X- and Y-chromosome influences on the human brain. Howe...

Background Conceptual knowledge frameworks termed schemas facilitate memory formation and are posited to support flexible behavior. In adults, the medial temporal lobe (MTL) and medial prefrontal cortex (mPFC) trade-off in supporting schema-based memory formation, such that encoding of subsequently remembered schema-congruent information relies on...

PCORI-funded videos DI-2019C2-17605

Si su hijo(a) tiene problemas con el funcionamiento ejecutivo, tales como atascarse o sentirse sobrecargado o dificultades en seguir instrucciones, estos videos ofrecen estrategias que son fácil de usar inmediatamente. Estos videos y animaciones, que son cortos y divertidos, presentan situaciones de la vida real, consejos prácticos de expertos, y p...

Executive functions are related to key outcomes. Studies of autistic youth self-report of other nonsocial traits indicate that their insights into their own functioning and internal experiences provide important information that is not captured by their parents’ report, but youth self-report of executive function has not been researched in autism....

Executive function (EF) underlies broad health and adaptive outcomes. For transgender youth, navigating gender discernment and gender affirmation demand EF. Yet, factors associated with transgender youth EF are unknown. We investigate hypothesized predictors of EF: over-represented conditions among transgender youth (anxiety and depression symptoms...

Objective: Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date...

Background Sex chromosome aneuploidies (SCAs) are a collectively common family of genetic disorders that increase risk for neuropsychiatric and cognitive impairment. Beyond being important medical disorders in their own right, SCAs also offer a unique naturally-occurring model for X- and Y-chromosome influences on the human brain. However, it remai...

Background Anxiety occurs at elevated rates in developmental disorders and has been linked to executive functioning (EF) deficits. EF is strongly related to academic outcomes, but the relationship between anxiety and EF in the classroom has not been examined. Method We explored this relationship in two neurodevelopmental disorders, autism spectrum...

Children with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) possess challenges with executive functioning (EF) and behavior problems. Their caregivers report higher levels of stress compared to those of neurotypical children which may relate to these problems. Few studies have examined both child and caregiver o...

Abstract Neurodevelopmental conditions and associated disabilities such as autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), and learning disorders (LD) become apparent in childhood. These conditions often come with difficulties in cognitive functions, e.g., executive functions (EFs). Targeting EFs in an intervention...

Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that...

Objective: A series of studies report elevated rates of autism and autistic characteristics among gender-diverse youth seeking gender services. Although youth with the co-occurrence present with complex care needs, existing studies have focused on co-occurrence rates. Further, clinical commentaries have emphasized provider-centered interpretations...

Autism and psychosis share overlapping clinical features and can occur comorbidly. Given growing recognition that early identification of psychosis risk symptoms may lead to better functional outcomes, the field needs valid tools for use in the assessment of psychosis risk symptoms within autism. This study employed a multi-method approach to evalu...

Background: Youth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with A...

Executive functioning is thought to contribute to adaptive behavior skills development in individuals with autism spectrum disorder (ASD). However, supporting data are largely based on caregiver reports of executive functioning. The current study evaluated whether performance-based measures of executive functioning (working memory and inhibition) e...

Objective Executive functions (EF) drive health and educational outcomes and therefore are increasingly common treatment targets. Most treatment trials rely on questionnaires to capture meaningful change because ecologically valid, pediatric performance-based EF tasks are lacking. The Executive Function Challenge Task (EFCT) is a standardized, trea...

More dual language learners (DLLs) are being identified early with autism spectrum disorder (ASD). However, many families are still being advised against dual language exposure, despite a lack of evidence of negative impacts on language development in ASD. Research in typically developing children has noted advantages for bilinguals in domains such...

Co-occurring psychiatric conditions are extremely common among people who have autism spectrum disorder (ASD). The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions presents a compilation of the latest research in this area, summarized by internationally renowned experts. Each chapter presents an overview of the problem or disorder...

Cognitive and behavioral flexibility are important predictors of adaptive behavior in school-age autistic youth. While prior research has utilized broad measures of flexibility, the current study uses the multi-dimensional Flexibility Scale-Revised to examine which specific flexibility skills relate to adaptive functioning. Through parent-report me...

Background: There are high rates of comorbidity between ADHD and ASD; however, there has been limited work parsing rates by ADHD presentation. In addition, commonly used questionnaires have demonstrated reduced utility in capturing ADHD symptoms in individuals with ASD. We examined the prevalence of comorbid Attention-Deficit/Hyperactivity Disorder...

Background Impairment of executive function (EF), the goal‐directed regulation of thoughts, actions, and emotions, drives negative outcomes and is common across neurodevelopmental disorders including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). A primary challenge to its amelioration is heterogeneity in sympto...

Date Presented 04/04/19 Participants will learn about an innovative, dynamic web-based parent education program (e-Unstuck) that helps parents understand executive functions (EF) and the autism spectrum as well as how to integrate EF strategies into daily life. This session will share our research methods and results that allowed us to conclude tha...

Autism spectrum disorder (ASD) is more prevalent in males than females, but the underlying neurobiology of this sex bias remains unclear. Given its involvement in ASD, its role in sensorimotor, cognitive, and socio-affective processes, and its developmental sensitivity to sex hormones, the cerebellum is a candidate for understanding this sex differ...

Background: Children with neurodevelopmental disabilities, such as Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD), often experience behavioral challenges that inhibit their success in mainstream school settings. When a student exhibits aggressive behavior in the classroom, it can have unwanted social and acade...

Conversation is an important and ubiquitous social behavior. Individuals with Autism Spectrum Disorder (autism) without intellectual disability often have normal structural language abilities but deficits in social aspects of communication like pragmatics, prosody, and eye contact. Previous studies of resting state activity suggest that intrinsic c...

The presence of attention deficit/hyperactivity disorder (ADHD) symptoms in children with autism spectrum disorder (ASD) is associated with worse cognitive control. Children with ASD and ADHD often respond poorly to medications, thus we need alternative treatments. We examined the feasibility, acceptability, and preliminary efficacy of Project Evo—...

Amygdala dysfunction has been implicated in numerous neurodevelopmental disorders, including autism spectrum disorder (ASD). Previous studies in mice and humans, respectively, have linked Pac1r/PAC1R function to social behavior and PTSD‐susceptibility. Based on this connection to social and emotional processing and the central role played by the am...

Despite research exploring autism in gender-diverse adolescents, no studies have elicited these individuals’ perspectives. In-depth interviews with 22 well-characterized autistic gender-diverse adolescents revealed critical themes, including: recollections of pre-pubertal gender nonconformity; vivid experiences of gender dysphoria; a fear of social...

Systematic reviews and national standards indicate that behavioral classroom management and parent training is the standard of care for attention-deficit/hyperactivity disorder (ADHD; Evans et al, 2017; SAMHSA National Registry of Evidence-based Programs and Practices) and autism spectrum disorder (ASD; National Standards Project 2009 & 2015). Howe...

Turban and van Schalkwyk assert in their Translations article, “‘Gender Dysphoria’ and Autism Spectrum Disorder: Is the Link Real?,”¹ that an over-representation of autism spectrum disorder (ASD) in gender dysphoria is unsupported based on current evidence. They suggest that increases on ASD-related measures in transgender and gender-diverse groups...

Despite research exploring autism in gender-diverse adolescents, no studies have elicited these individuals' perspectives. In-depth interviews with 22 well-characterized autistic gender-diverse adolescents revealed critical themes, including: recollections of pre-pubertal gender nonconformity; vivid experiences of gender dysphoria; a fear of social...

Conversation is an important and ubiquitous social behavior. Individuals with Autism Spectrum Disorder (autism) without intellectual disability often have normal language abilities but deficits in social aspects of verbal interaction like pragmatics, prosody, and eye contact. Previous studies of resting state activity suggest that intrinsic connect...

Now tested with both ADHD and ASD! It now comes as a kit with game boards and posters, making it easier to use.

Oral presentation as a part of the panel "The Co-occurrence of Autism and Gender Dysphoria or Gender Incongruence" chaired by Dr. John Strang.

There is growing evidence of a camouflaging effect among females with autism spectrum disorder (ASD), particularly among those without intellectual disability, which may affect performance on gold-standard diagnostic measures. This study utilized an age- and IQ-matched sample of school-aged youth (n = 228) diagnosed with ASD to assess sex differenc...

Supplemental Methods, Supplemental Results, Tables S1-S3.

Selective or ‘picky’ eating habits are common among those with autism spectrum disorder (ASD). These behaviors are often related to aberrant sensory experience in individuals with ASD, including heightened reactivity to food taste and texture. However, very little is known about the neural mechanisms that underlie taste reactivity in ASD. In the pr...

Title: Linguistic Diversity in Neurodevelopmental Disorders: Dual Language Exposure Relates to Cognitive Flexibility in Children with ASD but Not ADHD Authors: Powers, M.D., Kenworthy, L., Anthony, L.G., Verbalis, A.D., Seese, S., and Safer-Lichtenstein, J., & Ratto, A.B. Objective: To substantiate recent findings that dual language exposure (DLE...

The current study examined possible teacher biases on executive function (EF) ratings of students with various neurodevelopmental disorders.

Purpose: The objective of this study was to assess transgender youth and parent attitudes regarding (1) the potential impact of gender-affirming hormone therapy on fertility and (2) fertility preservation (FP) options. Methods: The Transgender Youth Fertility Attitudes Questionnaire was developed through a multistage participatory process with g...

For individuals with autism spectrum disorder (ASD), long-term outcomes have been troubling, and intact IQ has not been shown to be protective. Nevertheless, relatively little research into adaptive functioning among adults with ASD has been completed to date. Therefore, both adaptive functioning and comorbid psychopathology were assessed among 52...

Many children with autism spectrum disorder display challenging behaviors. These behaviors are not limited to those with cognitive and/or language impairments. The Collaborative and Proactive Solutions framework proposes that challenging behaviors result from an incompatibility between environmental demands and a child’s “lagging skills.” The prima...

Flexibility is a key component of executive function, and is related to everyday functioning and adult outcomes. However, existing informant reports do not densely sample cognitive aspects of flexibility; the Flexibility Scale (FS) was developed to address this gap. This study investigates the validity of the FS in 221 youth with ASD and 57 typical...

This study is the largest to date examining executive function and adaptive skills in females with autism spectrum disorder (ASD). Its primary aim was to utilize parent ratings of real-world executive functioning and adaptive behavior to better understand whether females with ASD differ from males with ASD in these areas of everyday functioning. We...