University of Southern California
University of Southern California
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Faculty
Faculty

Leah Stein Duker PhD, OTR/L

Leah Stein Duker

Assistant Professor of Research

Room: CHP 222U
Phone: (323) 442-0371
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Biography

Leah Duker completed her undergraduate education at Emory University where she earned her Bachelor of Science degree in Neuroscience and Behavioral Biology. She received her MA in Occupational Therapy degree from the University of Southern California with a focus on pediatrics including school-based practice and sensory integration interventions. She worked in the field of pediatrics (primarily school-based and sensory integration) before coming back to the USC to complete her PhD in Occupational Science to examine, with her advisor Dr. Sharon Cermak, the impact of the sensory environment on children with autism spectrum disorders receiving oral care. She remained at USC for her postdoctoral fellowship in Training in Rehabilitation Efficacy and Effectiveness Trials, a NIH-funded T32 Postdoctoral Training Program at the USC Chan Division of Occupational Science and Therapy (5T32HD064578-03; co-PIs Florence Clark, PhD, OTR/L, FAOTA and James Gordon, EdD, PT, FAPTA).
 
Dr. Duker is currently funded by a Southern California Clinical and Translational Science Institute (SC-CTSI) Institutional Career Development Award and a USC Zumberge Individual Fund Grant in order to investigate the environmental predictors of stress in children with cancer undergoing outpatient chemotherapy infusions. Dr. Duker is also a co-investigator on a National Institute of Dental and Craniofacial Research grant (DE024978-01, PI Sharon Cermak, EdD, OTR/L, FAOTA) to explore the efficacy of adapting the sensory environment of the dental office in order to decrease behavioral and physiological distress in children with autism spectrum disorders.

Research Interests

Dr. Duker's research is focused on designing and studying the efficacy of tailored environmental modifications to alleviate behavioral stress, physiological distress and pain in children undergoing difficult healthcare procedures and in their caregivers. Her research interests include autism, pediatric oncology, sensory processing, Multisensory Environments and both traditional wired and innovative wireless techniques for measuring psychophysiological stress and anxiety.

Education

T32 Postdoctoral Fellowship in Training in Rehabilitation Efficacy and Effectiveness Trials
University of Southern California
2015

Certificate in Clinical, Biomedical, and Translational Investigations
University of Southern California
2014

Doctor of Philosophy (PhD) in Occupational Science
University of Southern California
2013

Master of Arts (MA) in Occupational Therapy
University of Southern California
2006

Bachelor of Science (BS) in Neuroscience and Behavioral Biology
Emory University
2004

Publications

Book Chapters

Pfeiffer, B., & Stein Duker, L. I. (2016). The impact of the sensory environment on patient care for individuals with autism spectrum disorders. In E. Giarelli & K. M. Fisher (Eds.), Integrated health care for people with autism spectrum disorder: Interdisciplinary planning and delivery of care (pp. 69-92). Springfield, IL: Charles C. Thomas Publisher, LTD.

Journal Articles

Sleight, A. G., & Stein Duker, L. I. (2016). Toward a broader role for occupational therapy in supportive oncology care. American Journal of Occupational Therapy, 70, 7004360030p1-8. doi:10.5014/ajot.2016.018101 Abstract →← Abstract 

Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care.

Chaspari, T., Tsiartas, A., Stein, L. I., Cermak, S. A., & Narayanan, S. S. (2015). Sparse representation of electrodermal activity with knowledge-driven dictionaries. IEEE Transactions on Bio-Medical Engineering, 62, 960-971. doi:10.1109/TBME.2014.2376960 Abstract →← Abstract 

Biometric sensors and portable devices are being increasingly embedded into our everyday life, creating the need for robust physiological models that efficiently represent, analyze, and interpret the acquired signals. We propose a knowledgedriven method to represent electrodermal activity (EDA), a psychophysiological signal linked to stress, affect, and cognitive processing. We build EDA-specific dictionaries that accurately model both the slow varying tonic part and the signal fluctuations, called skin conductance responses (SCR), and use greedy sparse representation techniques to decompose the signal into a small number of atoms from the dictionary. Quantitative evaluation of our method considers signal reconstruction, compression rate, and information retrieval measures, that capture the ability of the model to incorporate the main signal characteristics, such as SCR occurrences. Compared to previous studies fitting a predetermined structure to the signal, results indicate that our approach provides benefits across all aforementioned criteria. This paper demonstrates the ability of appropriate dictionaries along with sparse decomposition methods to reliably represent EDA signals and provides a foundation for automatic measurement of SCR characteristics and the extraction of meaningful EDA features.

Cermak, S. A., Stein Duker, L. I., Williams, M. E., Dawson, M. E., Lane, C. J., & Polido, J. C. (2015). Sensory adapted dental environments to enhance oral care for children with autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, 45, 2876-2888. doi:10.1007/s10803-015-2450-5 Abstract →← Abstract 

This pilot and feasibility study examined the impact of a sensory adapted dental environment (SADE) to reduce distress, sensory discomfort, and perception of pain during oral prophylaxis for children with autism spectrum disorder (ASD). Participants were 44 children ages 6-12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE, administered in a randomized and counterbalanced order 3-4 months apart. Outcomes included measures of physiological anxiety, behavioral distress, pain intensity, and sensory discomfort. Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE, indicating a beneficial effect of the SADE.

Cermak, S. A., Stein Duker, L. I., Williams, M. E., Lane, C. J., Dawson, M. E., Borreson, A. E., & Polido, J. C. (2015). Feasibility of a sensory-adapted dental environment for children with autism. American Journal of Occupational Therapy, 69, 6903220020p1-6903220020p10. doi:10.5014/ajot.2015.013714 Abstract →← Abstract 

OBJECTIVE: To provide an example of an occupational therapy feasibility study and evaluate the implementation of a randomized controlled pilot and feasibility trial examining the impact of a sensory-adapted dental environment (SADE) to enhance oral care for children with autism spectrum disorder (ASD).
 
METHOD: Twenty-two children with ASD and 22 typically developing children, ages 6-12 yr, attended a dental clinic in an urban hospital. Participants completed two dental cleanings, 3-4 mo apart, one in a regular environment and one in a SADE. Feasibility outcome measures were recruitment, retention, accrual, dropout, and protocol adherence. Intervention outcome measures were physiological stress, behavioral distress, pain, and cost.
 
RESULTS: We successfully recruited and retained participants. Parents expressed satisfaction with research study participation. Dentists stated that the intervention could be incorporated in normal practice. Intervention outcome measures favored the SADE condition.
 
CONCLUSION: Preliminary positive benefit of SADE in children with ASD warrants moving forward with a large-scale clinical trial.

Stein, L. I., Lane, C. J., Williams, M. E., Dawson, M. E., Polido, J. C., & Cermak, S. A. (2014). Physiological and behavioral stress and anxiety in children with autism spectrum disorders during routine oral care. BioMed Research International, 2014(Article ID 694876), 10 pages. doi:10.1155/2014/694876 Abstract →← Abstract 

BACKGROUND: Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children's behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress.
 
METHODS: Participants were 44 children (typical, ASD) aged 6-12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleaning.
 
RESULTS: Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group.
 
CONCLUSIONS: Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic.

Stein, L. I., Polido, J. C., & Cermak, S. A. (2013). Oral care and sensory over-responsivity in children with autism spectrum disorders. Pediatric Dentistry, 35, 230-235. Full text Abstract →← Abstract 

PURPOSE: The purpose of this study was to investigate the relationship between sensory sensitivities and oral care difficulties in children with autism spectrum disorders (ASDs) or typical development (TD).
 
METHODS: Participants included 396 parents of 2- to 18-year-old children with ASDs or TD who completed a questionnaire about oral care in the home and dental office. Descriptive and bivariate analyses were conducted to examine the association between sensory sensitivities and oral care variables.
 
RESULTS: Both hypotheses were supported: (1) ASDs children vs. TD children were reported to have a significantly greater prevalence of sensory over-responsivity across all sensory domains; and (2) ASDs children characterized as "sensory over-responders" exhibited a significantly greater prevalence of oral care difficulty in the home and dental office vs. ASDs children who responded more typically to sensory stimuli ("sensory not over-responders").
 
CONCLUSIONS: This study provides further evidence for the impact of sensory processing problems on oral care, both in the home and dental office. Methods to best serve children with autism spectrum disorders may include strategies that alter the sensory characteristics of the dental environment as well as interventions to reduce children's sensory sensitivities.

Peterson, E., Stein, L., & Cermak, S. A. (2013). Helping children with autism spectrum disorders participate in oral care. Sensory Integration Special Interest Section Quarterly, 36(3), 1-4. Full text

Stein, L. I., Polido, J. C., Najera, S. O., & Cermak, S. A. (2012). Oral care experiences and challenges in children with autism spectrum disorders. Pediatric Dentistry, 34, 387-391. Full text Abstract →← Abstract 

PURPOSE: The purpose of this study was to investigate the differences between children with autism spectrum disorders (ASD) and their typically developing peers in relation to aspects of oral care.
 
METHODS: Participants included 396 parents of ASD children or typically developing 2- to 18-year-olds. Parents completed a 37-item questionnaire designed by authors to elicit information about oral care in the home and dental office. Descriptive, bivariate, and multivariate regression analyses were conducted to examine the association between diagnostic group and oral care variables.
 
RESULTS: Significantly more parents of ASD children than parents of typically developing children reported difficulty across almost all oral care variables explored, including oral care in the home, oral care at the dentist, and access to oral care. Following multivariate regression to control for possible confounders—including age, gender, Hispanic status, and paternal education level—all previously significant variables remained significant.
 
CONCLUSION: This study indicates that children with autism spectrum disorders experience greater difficulties and barriers to care in both the home and dental office settings than their typically developing peers.

Stein, L. I., Polido, J. C., & Cermak, S. A. (2012). Oral care and sensory concerns in autism [Brief report]. American Journal of Occupational Therapy, 66, e73-e76. doi:10.5014/ajot.2012.004085 Abstract →← Abstract 

We examined sensory-related aspects of oral care at home and the dentist’s office in children with autism spectrum disorders (ASD) and their typically developing (TD) peers. Results from parent questionnaires (n = 196 ASD, n = 202 TD) and one focus group were analyzed to determine whether sensory experiences were different between groups. Significantly more parents of children with ASD reported difficulties with sensory-related oral care variables in the home and dental office; this finding was supported by qualitative data. Using sensory strategies to modify the environment may enhance the dental experience and improve quality of life for children with ASD and their families.

Stein, L. I., Foran, A. C., & Cermak, S. A. (2011). Occupational patterns of parents of children with autism spectrum disorders: Revisiting Matuska and Christiansen’s Model of Lifestyle Balance. Journal of Occupational Science, 18, 115-130. doi:10.1080/14427591.2011.575762 Abstract →← Abstract 

We synthesized selected literature from psychology, neuroscience, occupational therapy, nursing, and other fields regarding parents of children with ASD and utilized Matuska and Christiansen's Model of Lifestyle Balance to organize the literature to present a theoretically grounded and occupation-based picture of the life experiences of parents of children with ASD. In doing so, we discerned a complex relationship among the five dimensions suggested by Matuska and Christiansen, prompting a refinement of their model to address this complexity. Overall, a variety of factors associated with caring for children with ASD have the potential to cause or contribute to negative psychological consequences such as stress, anxiety, and depression, as well as functional limitations and other health problems such as hypertension or diabetes. In order to promote health and general well-being, lifestyle changes to enhance balance may be necessary for many parents of children with ASD.

Stein, L. I., Polido, J. C., Mailloux, Z., Coleman, G. G., & Cermak, S. A. (2011). Oral care and sensory sensitivities in children with autism spectrum disorders. Special Care in Dentistry, 31, 102-110. doi:10.1111/j.1754-4505.2011.00187.x Abstract →← Abstract 

Children with autism spectrum disorders (ASD) are at high risk for oral disease. The aim of this study was to examine the contribution of sensory processing problems to challenges in receiving oral care for children with ASD. A questionnaire was sent to the parents of 206 children with disabilities to test the hypotheses that children with ASD, relative to children with other disabilities, experience greater difficulty with home-based and professional oral care, and that these difficulties may relate in part to sensory processing problems. The results partially supported these hypotheses. Compared to children with other disabilities, those with ASD had greater behavioral difficulties and sensory sensitivities that parents believed interfered with their child's oral care. Among children with ASD, sensory sensitivities were associated with oral care difficulties in the home and dental office, and with behavioral difficulties in the dental office. Utilizing strategies to modify the sensory environment may help facilitate oral care in children with ASD.