Scholars@Duke
Lauren Franz

Lauren Franz

Associate Professor of Psychiatry and Behavioral Sciences
Psychiatry, Child & Family Mental Health & Community Psychiatry
lauren.franz@duke.edu
Box 3837 Med Ctr, Durham, NC 27710
Dept of Psychiatry, Durham, NC 27710

Scholarly Works - Journal articles

Brief Report: Relationships Between Caregiver-Reported Externalizing and Internalizing Behaviors and the Modified Checklist for Autism in Toddlers.

Journal article J Autism Dev Disord · September 2026 PURPOSE: Early detection and intervention are associated with improved outcomes for autistic children. Thus, it is important to understand factors influencing early screening tools designed to detect autism. This study examined the relationship between car ... Full text Link to item Cite

Understanding end-user contexts and identifying design preferences of an artificial intelligence-based clinical decision support tool for early autism detection.

Journal article JAMIA Open · August 2026 OBJECTIVES: Building on innovations for autism detection-where artificial intelligence (AI)-based models monitor clinical data within electronic health records-this study evaluates the context for clinical decision support (CDS) deployment and identifies d ... Full text Link to item Cite

Using clinical notes to identify children with speech-language delay and understand differences in diagnostic timing.

Journal article JAMIA Open · June 2026 Featured Publication OBJECTIVE: Speech-language delay (SLD) is a developmental condition often identified by pediatricians. While early intervention is recommended, it is common for pediatricians to take a "watch and wait" approach. We sought to assess whether there is discord ... Full text Link to item Cite

The Relationship Between the Survey of Well-being of Young Children and Speech-language Delay Diagnosis.

Journal article J Dev Behav Pediatr · May 2026 OBJECTIVE: The Survey of Well-being of Young Children (SWYC) supports developmental screening at well-child visits. However, a US Preventive Services Task Force report suggests insufficient evidence for this approach for speech-language delay identificatio ... Full text Link to item Cite

Cognitive Disengagement Syndrome in Young Autistic Children, Children with ADHD, and Autistic Children with ADHD.

Journal article J Clin Child Adolesc Psychol · 2026 OBJECTIVE: Cognitive Disengagement Syndrome (CDS; previously called Sluggish Cognitive Tempo) refers to a constellation of cognitive and motor behaviors characterized by a predisposition toward mind wandering (cognitive subdomain) and slowed motor behavior ... Full text Link to item Cite

Assessment of Attention-Deficit/Hyperactivity Disorder in Young Autistic Children.

Journal article J Clin Child Adolesc Psychol · 2026 OBJECTIVE: Co-occurring attention-deficit/hyperactivity disorder (ADHD) is present for many autistic children and is associated with increased impairments, unique treatment needs, and decreased response to autism-specific interventions. Diagnosing ADHD in ... Full text Link to item Cite

Tele-delivered caregiver coaching for autism in South Africa – A mixed-methods study of acceptability, appropriateness and feasibility

Journal article Digital Health · January 1, 2026 Featured Publication Objective: Tele-delivered interventions can benefit autistic children and families in low-resource settings, but the digital divide may worsen existing disparities. To address this, we adapted a Naturalistic Developmental Behavioural Intervention (NDBI)-ba ... Full text Cite

Multimodal Training to Unimodal Deployment: Leveraging Unstructured Data During Training to Optimize Structured Data Only Deployment.

Journal article AMIA Jt Summits Transl Sci Proc · 2026 Unstructured Electronic Health Record (EHR) data-such as clinical notes-contain clinical contextual observations that are not directly reflected in structured data fields. This additional information can substantially improve model learning. However, due t ... Link to item Cite

Detecting change in a caregiver-mediated autism intervention using the Joint Engagement Rating Inventory.

Journal article S Afr J Commun Disord · September 26, 2025 BACKGROUND:  The Joint Engagement Rating Inventory (JERI) can be used to measure response to early autism intervention. However, little is known about the utility of the JERI outside the United States, where it was developed. A South African study found th ... Full text Link to item Cite

Attentional and electrophysiological associations with executive function ability in young autistic children.

Journal article Sci Rep · July 10, 2025 Difficulties in executive functioning (EF) have been consistently reported in autistic individuals, but less is known about the attentional and neural mechanisms driving these difficulties. We explored the associations between EF abilities and sustained at ... Full text Link to item Cite

Autism Digital Phenotyping in Preschool- and School-Age Children.

Journal article Autism Res · June 2025 There is a critical need for scalable and objective tools for autism screening and outcome monitoring, which can be used alongside traditional caregiver and clinical measures. To address this need, we developed SenseToKnow, a tablet- or smartphone-based di ... Full text Link to item Cite

Adapting an early autism caregiver coaching intervention for telehealth delivery in low-resource settings: A South African study of the 'what' and the 'why'.

Journal article Autism · May 2025 The COVID-19 pandemic required in-person interventions to be adapted for remote delivery all over the globe. In South Africa, an in-person cascaded task-sharing naturalistic developmental behavioural intervention was adapted for telehealth delivery in a lo ... Full text Link to item Cite

Behavioral characteristics of toddlers later identified with an autism diagnosis, ADHD symptoms, or combined autism and ADHD symptoms.

Journal article J Child Psychol Psychiatry · February 2025 BACKGROUND: Autism commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD), but less is known regarding how ADHD symptoms impact the early presentation of autism. This study examined early behavioral characteristics of a community sample of ... Full text Link to item Cite

Factors Associated with Caregivers' Decisions to Pursue a Diagnostic Evaluation After a Positive Autism Screen in Primary Care.

Journal article J Autism Dev Disord · October 7, 2024 PURPOSE: We sought to understand whether a child's sex, age, race, ethnicity, caregiver education, family income, and/or number of endorsed autism signs are associated with a caregiver's decision to pursue an autism diagnostic evaluation after their child ... Full text Link to item Cite

Automated Video Tracking of Autistic Children's Movement During Caregiver-Child Interaction: An Exploratory Study.

Journal article J Autism Dev Disord · October 2024 Objective, quantitative measures of caregiver-child interaction during play are needed to complement caregiver or examiner ratings for clinical assessment and tracking intervention responses. In this exploratory study, we examined the feasibility of using ... Full text Link to item Cite

Adaptive Behavior in Young Autistic Children: Associations with Irritability and ADHD Symptoms.

Journal article J Autism Dev Disord · September 2024 Attention-deficit/hyperactivity disorder (ADHD) symptoms affect 40-60% of autistic children and have been linked to differences in adaptive behavior. It is unclear whether adaptive behavior in autistic youth is directly impacted by co-occurring ADHD sympto ... Full text Link to item Cite

Computer Vision Analysis of Caregiver-Child Interactions in Children with Neurodevelopmental Disorders: A Preliminary Report.

Journal article J Autism Dev Disord · June 2024 We report preliminary results of computer vision analysis of caregiver-child interactions during free play with children diagnosed with autism (N = 29, 41-91 months), attention-deficit/hyperactivity disorder (ADHD, N = 22, 48-100 months), or combined autis ... Full text Link to item Cite

Prevalence of bias against neurodivergence-related terms in artificial intelligence language models.

Journal article Autism Res · February 2024 Given the increasing role of artificial intelligence (AI) in many decision-making processes, we investigate the presence of AI bias towards terms related to a range of neurodivergent conditions, including autism, ADHD, schizophrenia, and obsessive-compulsi ... Full text Link to item Cite

Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial.

Journal article PLoS One · 2024 BACKGROUND: While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non- ... Full text Link to item Cite

Automated movement tracking of young autistic children during free play is correlated with clinical features associated with autism.

Journal article Autism · November 2023 Play-based observations allow researchers to observe autistic children across a wide range of ages and skills. We recorded autistic children playing with toys in the center of a room and at a corner table while a caregiver remained seated off to the side a ... Full text Link to item Cite

Associations between executive function and attention abilities and language and social communication skills in young autistic children.

Journal article Autism · October 2023 Executive functioning describes a set of cognitive processes that affect thinking and behavior. Past research has shown that autistic individuals often have delays in the acquisition of executive function abilities. Our study explored how differences in ex ... Full text Open Access Link to item Cite

Early detection of autism using digital behavioral phenotyping.

Journal article Nat Med · October 2023 Early detection of autism, a neurodevelopmental condition associated with challenges in social communication, ensures timely access to intervention. Autism screening questionnaires have been shown to have lower accuracy when used in real-world settings, su ... Full text Link to item Cite

Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial.

Journal article medRxiv · September 11, 2023 BACKGROUND: While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non- ... Full text Link to item Cite

Relationship between quantitative digital behavioral features and clinical profiles in young autistic children.

Journal article Autism Res · July 2023 Early behavioral markers for autism include differences in social attention and orienting in response to one's name when called, and differences in body movements and motor abilities. More efficient, scalable, objective, and reliable measures of these beha ... Full text Link to item Cite

Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa.

Journal article Child Adolesc Psychiatry Ment Health · May 20, 2023 BACKGROUND: Despite the high number of children living with neurodevelopmental disabilities in sub-Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that c ... Full text Link to item Cite

Blink rate and facial orientation reveal distinctive patterns of attentional engagement in autistic toddlers: a digital phenotyping approach.

Journal article Sci Rep · May 3, 2023 Differences in social attention are well-documented in autistic individuals, representing one of the earliest signs of autism. Spontaneous blink rate has been used to index attentional engagement, with lower blink rates reflecting increased engagement. We ... Full text Link to item Cite

Eye-tracking measures of social versus nonsocial attention are related to level of social engagement during naturalistic caregiver-child interactions in autistic children.

Journal article Autism Res · May 2023 Eye-tracking (ET) measures indexing social attention have been proposed as sensitive measures related to autism, but less is known about the relationship between social and nonsocial attention and naturalistic measures of social engagement and whether sex ... Full text Link to item Cite

Conducting caregiver focus groups on autism in the context of an international research collaboration: Logistical and methodological lessons learned in South Africa.

Journal article Autism · April 2023 Most of the autism research to date has been conducted in high-income countries, with children and families typically from White, upper-middle-income backgrounds. However, we know there are significant inequalities that exist which influence how autistic i ... Full text Link to item Cite

A tablet-based game for the assessment of visual motor skills in autistic children.

Journal article NPJ Digit Med · February 3, 2023 Increasing evidence suggests that early motor impairments are a common feature of autism. Thus, scalable, quantitative methods for measuring motor behavior in young autistic children are needed. This work presents an engaging and scalable assessment of vis ... Full text Open Access Link to item Cite

Complexity analysis of head movements in autistic toddlers.

Journal article J Child Psychol Psychiatry · January 2023 BACKGROUND: Early differences in sensorimotor functioning have been documented in young autistic children and infants who are later diagnosed with autism. Previous research has demonstrated that autistic toddlers exhibit more frequent head movement when vi ... Full text Link to item Cite

Neurodiversity and Early Autism-Reply.

Journal article JAMA Pediatr · December 1, 2022 Full text Link to item Cite

Early intervention for very young children with or at high likelihood for autism spectrum disorder: An overview of reviews.

Journal article Dev Med Child Neurol · September 2022 Featured Publication AIM: To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes. METHOD: We conducted an overview of reviews to s ... Full text Link to item Cite

Shorter average look durations to dynamic social stimuli are associated with higher levels of autism symptoms in young autistic children.

Journal article Autism · August 2022 Many studies of autism look at the differences in how autistic research participants look at certain types of images. These studies often focus on where research participants are looking within the image, but that does not tell us everything about how much ... Full text Link to item Cite

Bringing Parent-Child Interaction Therapy to South Africa: Barriers and Facilitators and Overall Feasibility-First Steps to Implementation.

Journal article Int J Environ Res Public Health · April 7, 2022 There is a large assessment and treatment gap in child and adolescent mental health services, prominently so in low- and middle-income countries, where 90% of the world's children live. There is an urgent need to find evidence-based interventions that can ... Full text Link to item Cite

Pragmatic adaptations of telehealth-delivered caregiver coaching for children with autism in the context of COVID-19: Perspectives from the United States and South Africa.

Journal article Autism · January 2022 Featured Publication COVID-19 caused many autism spectrum disorder caregiver-coaching studies to move to telehealth. Telehealth can increase the diversity of people who take part in research. This matters because most autism spectrum disorder studies have included people who h ... Full text Link to item Cite

A scalable computational approach to assessing response to name in toddlers with autism.

Journal article J Child Psychol Psychiatry · September 2021 BACKGROUND: This study is part of a larger research program focused on developing objective, scalable tools for digital behavioral phenotyping. We evaluated whether a digital app delivered on a smartphone or tablet using computer vision analysis (CVA) can ... Full text Link to item Cite

Computational Methods to Measure Patterns of Gaze in Toddlers With Autism Spectrum Disorder.

Journal article JAMA Pediatr · August 1, 2021 IMPORTANCE: Atypical eye gaze is an early-emerging symptom of autism spectrum disorder (ASD) and holds promise for autism screening. Current eye-tracking methods are expensive and require special equipment and calibration. There is a need for scalable, fea ... Full text Link to item Cite

Educational classifications of autism spectrum disorder and intellectual disability among school-aged children in North Carolina: Associations with race, rurality, and resource availability.

Journal article Autism Res · May 2021 Featured Publication Disparities exist in the recognition of autism spectrum disorder (ASD) and intellectual disability (ID) in racial/ethnic minorities in the United States. This study examined whether rurality, race/ethnicity, and low resource availability are associated wit ... Full text Link to item Cite

Traditional Healers and Mental Health in Nepal: A Scoping Review.

Journal article Cult Med Psychiatry · March 2021 Despite extensive ethnographic and qualitative research on traditional healers in Nepal, the role of traditional healers in relation to mental health has not been synthesized. We focused on the following clinically based research question, "What are the pr ... Full text Link to item Cite

Gastrointestinal problems are associated with increased repetitive behaviors but not social communication difficulties in young children with autism spectrum disorders.

Journal article Autism · February 2021 Individuals with autism spectrum disorder are more likely than typically developing individuals to experience a range of gastrointestinal abnormalities, including chronic diarrhea, constipation, food sensitivities, and abdominal pain. These gastrointestina ... Full text Link to item Cite

The route to autism spectrum diagnosis in pediatric practice in Bulgaria

Journal article Diagnostics · January 1, 2021 Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practi ... Full text Cite

Infusion of human umbilical cord tissue mesenchymal stromal cells in children with autism spectrum disorder.

Journal article Stem Cells Transl Med · October 2020 Ongoing neuroinflammation may contribute to symptoms of autism spectrum disorder (ASD) in at least a portion of affected individuals. Mesenchymal stromal cells (MSCs) have demonstrated the capacity to modulate neuroinflammation, but safety and feasibility ... Full text Open Access Link to item Cite

A Phase II Randomized Clinical Trial of the Safety and Efficacy of Intravenous Umbilical Cord Blood Infusion for Treatment of Children with Autism Spectrum Disorder.

Journal article J Pediatr · July 2020 OBJECTIVE: To evaluate whether umbilical cord blood (CB) infusion is safe and associated with improved social and communication abilities in children with autism spectrum disorder (ASD). STUDY DESIGN: This prospective, randomized, placebo-controlled, doubl ... Full text Open Access Link to item Cite

Sustainable implementation of early intervention for autism spectrum disorder through caregiver coaching: South African perspectives on barriers and facilitators

Journal article Pediatric Medicine · August 1, 2019 Featured Publication Background: A lack of specialists, and insufficient infrastructure and funding to scale early interventions for autism spectrum disorder (ASD) characterize low-resource settings. Integration of early intervention methods that utilize non-specialists, and i ... Full text Open Access Cite

Caregiver descriptions of joint activity routines with young children with autism spectrum disorder in South Africa.

Journal article Pediatr Med · March 2019 Featured Publication BACKGROUND: Coaching caregivers to deliver Naturalistic Developmental Behavioral Intervention (NDBI) strategies to their young child with autism spectrum disorder (ASD) could help address the provider capacity barrier in sub-Saharan Africa. However, the be ... Full text Open Access Link to item Cite

White Matter Tract Changes Associated with Clinical Improvement in an Open-Label Trial Assessing Autologous Umbilical Cord Blood for Treatment of Young Children with Autism.

Journal article Stem Cells Transl Med · February 2019 Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by social communication deficits and the presence of restricted interests and repetitive behaviors. We have previously reported significant improvements in behavior ... Full text Open Access Link to item Cite

The importance of context in early autism intervention: A qualitative South African study.

Journal article Autism · November 2018 Featured Publication The majority of individuals with autism spectrum disorder live in low- and middle-income countries and receive little or no services from health or social care systems. The development and validation of autism spectrum disorder interventions has almost exc ... Full text Link to item Cite

Providing early detection and early intervention for autism spectrum disorder in South Africa: stakeholder perspectives from the Western Cape province.

Journal article J Child Adolesc Ment Health · November 2018 Featured Publication We set out to examine key stakeholder perspectives on early detection and intervention for autism spectrum disorder (ASD) in South Africa. Early detection and intervention improves child and family outcomes and lessens long-term costs. We focused on stakeh ... Full text Link to item Cite

Validation of eye-tracking measures of social attention as a potential biomarker for autism clinical trials.

Journal article Autism Res · January 2018 UNLABELLED: Social communication impairments are a core feature of autism spectrum disorder (ASD), and this class of symptoms is a target for treatments for the disorder. Measures of social attention, assessed via eye-gaze tracking (EGT), have been propose ... Full text Link to item Cite

Autism spectrum disorder in sub-saharan africa: A comprehensive scoping review.

Journal article Autism Res · May 2017 Featured Publication Autism spectrum disorder (ASD) is recognized as a global public health concern, yet almost everything we know about ASD comes from high-income countries. Here we performed a scoping review of all research on ASD ever published in sub-Saharan Africa (SSA) i ... Full text Link to item Cite

Autologous Cord Blood Infusions Are Safe and Feasible in Young Children with Autism Spectrum Disorder: Results of a Single-Center Phase I Open-Label Trial.

Journal article Stem Cells Transl Med · May 2017 Despite advances in early diagnosis and behavioral therapies, more effective treatments for children with autism spectrum disorder (ASD) are needed. We hypothesized that umbilical cord blood-derived cell therapies may have potential in alleviating ASD symp ... Full text Open Access Link to item Cite

Child mental health and maternal depression history in Pakistan.

Journal article Soc Psychiatry Psychiatr Epidemiol · January 2016 PURPOSE: We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with ... Full text Link to item Cite

Psychological and Psychosocial Impairment in Preschoolers With Selective Eating.

Journal article Pediatrics · September 2015 OBJECTIVE: We examined the clinical significance of moderate and severe selective eating (SE). Two levels of SE were examined in relation to concurrent psychiatric symptoms and as a risk factor for the emergence of later psychiatric symptoms. Findings are ... Full text Link to item Cite

Effect of an early perinatal depression intervention on long-term child development outcomes: follow-up of the Thinking Healthy Programme randomised controlled trial.

Journal article Lancet Psychiatry · July 2015 BACKGROUND: Perinatal depression has been linked with deleterious child development outcomes, yet maternal depression interventions have not been shown to have lasting effects on child development, and evidence is not available from countries of low or mid ... Full text Link to item Cite

Perceived family impact of preschool anxiety disorders.

Journal article J Am Acad Child Adolesc Psychiatry · April 2014 OBJECTIVE: We examined the perceived impact of child anxiety disorders on family functioning, because such impact is a key predictor of mental health service receipt. In addition, we examined the relative impact of preschool anxiety compared to that of oth ... Full text Link to item Cite

Preschool anxiety disorders in pediatric primary care: prevalence and comorbidity.

Journal article J Am Acad Child Adolesc Psychiatry · December 2013 OBJECTIVE: We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia in preschool-aged children. METHOD: The Duke Preschool Anxiety Study, a screen-stratified ... Full text Link to item Cite

Identification of provider characteristics influencing prescription of analgesics: a systematic literature review.

Journal article Pain Pract · July 2013 PURPOSE: Pain is a comorbid and aggravating symptom that in many conditions can be perceived differently and should therefore be managed accordingly. Numerous factors, both social and cultural, are thought to influence the analgesic prescription. However, ... Full text Link to item Cite

Social functioning in urban, predominantly African American, socially disadvantaged patients with first-episode nonaffective psychosis.

Journal article Schizophr Res · June 2010 BACKGROUND: Social functioning impairments develop and accumulate even prior to initial treatment-seeking for first-episode psychosis. This study, the first to examine social functioning in low-income, urban, predominantly African American first-episode pa ... Full text Link to item Cite

Stigma and treatment delay in first-episode psychosis: a grounded theory study.

Journal article Early Interv Psychiatry · February 2010 AIM: A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis-generating study explored the effects of stigma, as perceived by family members, on DUP. METHODS: Qual ... Full text Link to item Cite

Prevalence, factorial structure, and clinical correlates of first rank symptoms in urban, African-American patients with first-episode nonaffective psychosis

Journal article Clinical Schizophrenia and Related Psychoses · April 1, 2008 Rationale: Given the dearth of research on the prevalence and clinical correlates of first rank symptoms in first-episode psychosis samples, this study focused on a relatively homogenous sample of hospitalized, first-episode, urban, African-American patien ... Full text Cite

The period of untreated psychosis before treatment initiation: a qualitative study of family members' perspectives.

Journal article Compr Psychiatry · 2008 AIM: This study used a qualitative research methodology to explore common themes pertaining to the period of untreated psychosis before treatment initiation in hospitalized, urban, African American, first-episode psychosis patients. METHODS: Twelve family ... Full text Link to item Cite