Lisa A. Croen , PhD

lisa.a.croen@kp.org

Lisa Croen, PhD, is a senior research scientist at the Division of Research (DOR), Kaiser Permanente Northern California (KPNC), and the director of the Kaiser Permanente Autism Research Program. Her research interests include the epidemiology of autism and other neurodevelopmental disorders, environmental exposures and gene/environment interaction, and the delivery of health services to Autistic individuals across the life span. Currently, Dr. Croen is the co-principal investigator at Kaiser Permanente of the NIH-funded ECHO study, principal investigator of several NIH-funded studies including Early Markers for Autism study (EMA) and Immune and Metabolic markers during Pregnancy and Child Neurodevelopment (IMPaCT), and site principal investigator on several large federally funded autism studies including the Study to Explore Early Development (SEED), the Early Autism Risk Longitudinal Investigation (EARLI), the Autism Centers of Excellence ACTION Network, and the ECHO ASD-ER study. In collaboration with clinical colleagues, she is conducting mixed methods studies to evaluate autism treatments at KPNC, the transition from pediatric to adult healthcare among KPNC Autistic patients, barriers and facilitators of healthcare service use among Latino families affected by autism, and the health status and healthcare utilization of Autistic adults. Dr. Croen received her master’s degree in public health and her doctorate in epidemiology, both from the University of California, Berkeley.

Current Positions

Research Scientist III, Division of Research, Kaiser Permanente Northern California
Director, Autism Research Program

Section Affiliations

Women’s and Children’s Health

Primary Research Interests

Epidemiology of autism and neurodevelopmental disorders
Environmental exposures and gene/environment interactions

Related Websites

Autism Research Program

Studies

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

This is a 7-year renewal of our current ECHO Cohort Study Site Early Life Exposures and Child Growth, Adiposity, and Neurodevelopment. We plan to extend the capacity of the ECHO Cohort to further investigate the roles of endocrine disruptor chemicals and health behaviors on child growth, adiposity and neurodevelopment and to follow our 2,000 children and their mothers currently enrolled in our ECHO Cohort and implement the ECHO Cohort Protocol.

Investigator: Ferrara, Assiamira; Croen, Lisa; Hedderson, Monique

Funder: National Institutes of Health

GEARs Combining advances in Genomics and Environmental science to accelerate Actionable Research and practice in ASD

The Autism Centers of Excellence (ACE) program is a trans-NIH initiative that supports large-scale studies on autism spectrum disorder. A priority area for the ACE program is work that will advance our understanding of the biologic mechanisms underlying gene-environment interplay in autism. We intend to create a research consortium with infrastructure to enable the investigation of the interplay of environmental risks with genetic discoveries at scale; build infrastructure for experimental testing of functional biologic impacts of gene-environment interaction; and develop and implement a pipeline for dissemination of findings for primary and secondary prevention efforts.

Investigator: Croen, Lisa

Funder: National Institute of Environmental Health Sciences

Prenatal medication exposure in autism, birth complications and developmental disabilities

Systematically investigate the effects of maternal medication use in pregnancy on offspring autism spectrum disorder (ASD) risk. Test the mechanisms underlying the associations between maternal medication use and ASD. Establish the specificity and generalizability of maternal medication effects on ASD.

Investigator: Croen, Lisa

Funder: National Institute of Child Health and Human Development

SEED Follow-Up Study

SEED is a case-control study comparing children aged 2-5 years with autism spectrum disorder to children with other developmental disabilities. The SEED Follow-up Study is a longitudinal study designed to improve understanding of risk factors and expression of autism spectrum disorder from childhood through early adulthood. This study will help us better understand how adolescents and young adults with autism spectrum disorder differ from those with other developmental disabilities or from the general population in terms of: 1) Health service needs and utilization, community and social supports, bullying and discrimination, safety and suicide, family and financial impacts, and independence and adaptive behavior; 2) Other outcomes relevant to child age (e.g., planning for exit from high school and vocational training); 3) Self-report of various aspects relevant to relationships and quality of life in adolescence and early adulthood.

Investigator: Croen, Lisa

Funder: Centers for Disease Control and Prevention

Harnessing Electronic Health Records to Identify Participants and to Study Health Outcomes in Transition-Age Youth and Adults with Autism Spectrum Disorder

The goal of this K18 award is to determine changes in prevalence of common medical and psychiatric conditions and measures of health care utilization in an existing longitudinal cohort of autistic transition age youth (TAY) and adults within the Kaiser Permanente Northern California system.

Investigator: Croen, Lisa

Funder: National Institute of Mental Health

Maternal Health in Pregnancy and Autism Risk – Genetic and Non-genetic Mechanisms

This study will systematically identify maternal diagnoses in pregnancy associated with autism spectrum disorder (ASD) in offspring; test if the association between maternal diagnoses and ASD is due to shared genetic factors using family data; and test the association between maternal diagnoses in pregnancy and child’s genetic liability for ASD.

Investigator: Croen, Lisa

Funder: National Institute of Mental Health

Autism Specific Patterns of DNA Methylation from Birth to Age 5

This study will examine potential differences in DNA methylation (DNAm) in early life, from birth through age 5, between children who are ultimately diagnosed with autism spectrum disorder and those typically developing. Results from this work will inform whether a large-scale effort for evaluating longitudinal DNAm and epigenetic clock changes in ASD is necessary.

Investigator: Croen, Lisa

Funder: National Institute of Child Health and Human Development

Autism Intervention Research Network on Physical Health

Establish an interdisciplinary Autism Intervention Research Network on Physical Health node that will lead, promote, and coordinate national research activities to improve the physical health and well-being of individuals with autism spectrum disorder across the lifespan, including children and adolescents as they transition to adulthood. The focus of this node is gender, sexuality, and reproductive health of autistic adults.
Projects include needs assessments, design of multi-site intervention research studies, small grants funding to facilitate training and mentorship to diverse new investigators, and publication of annual research supplement.

Investigator: Croen, Lisa

Funder: Health Resources and Services Administration

COVID-19 Response Grant

Adults with intellectual or developmental disabilities may be especially impacted by the ways the COVID-19 pandemic has led to drastic changes in usual daily routines and the way healthcare encounters have been transitioned to virtual (video, telephone) visits. This project will characterize healthcare utilization and health status among adults with autism spectrum disorders (ASD) during the COVID-19 pandemic, comparing to similar indices in the pre-COVID period. Among adults with chronic health conditions that require ongoing management (such as diabetes, heart disease, or mental health conditions), we will also compare healthcare utilization between adults with and without ASD.

Investigator: Croen, Lisa

Funder: Special Hope Foundation

Maternal Inflammation during Pregnancy and Neurodevelopmental Disorders

This study will utilize the Pregnancy Cohort from the Kaiser Permanente Northern California Research Program on Genes, Environment and Health to characterize the maternal immune profile over pregnancy and evaluate whether there are specific longitudinal patterns that are associated with neurodevelopmental outcomes in the offspring. The project will identify factors that are associated with longitudinal patterns of maternal immune markers over pregnancy and examine whether there is variability in risk factors across different neurodevelopmental outcomes. Factors to be examined include maternal demographic, lifestyle, clinical, and genetic factors.

Investigator: Croen, Lisa

Funder: National Institute of Child Health and Human Development

Optimizing Social Communication Measurement with the Social Responsiveness Scale

This project aims to: 1) compare the psychometric characteristics (including distributional properties, agreement with gold-standard diagnostic measures, and sensitivity and specificity) of short versus full Social Responsiveness Scale (SRS) scores, using existing child SRS data from the Environmental influences on Child Health Outcomes (ECHO) study; 2) use existing SRS data in ECHO to compare the performance of short versus full SRS scores in analyses of established risk factors for autism spectrum disorder (gestational age and parental age), as well as in assessment of familiality of scores (previously established for the full scale) in cohorts with available parental scores; and 3) A) develop a computer-adaptive testing (CAT)-based SRS, and B) conduct a separate validation of the 16-item short form administered as a standalone questionnaire (rather than relying on short form scores derived from responses to the full SRS) and of the newly developed CAT-based SRS in separate clinical and general population samples of children aged 3 to 5 years.

Investigator: Croen, Lisa

Funder: National Institutes of Health, Office of the Director

Autism Adaptive Community-Based Treatment to Improve Outcomes Using Navigators (ACTION) Network

One of the greatest challenges in autism treatment is how to bridge the health care science-to-service gap and address disparities in access to evidence-based early intervention for children with autism spectrum disorder. This project will establish a new interdisciplinary network of eight institutions to blend implementation and clinical effectiveness research designs, with an overarching aim to study the individual and combined effects of three intervention components: 1) Infusing mobile technology for professional development and family education using the Autism Navigator collection of web-based courses and tools; 2) Engaging families to access resources and support when they first learn their child has autism spectrum disorder, using a brief engagement intervention by community healthcare workers as family navigators to accelerate access to care; and 3) Coaching families to embed evidence-based intervention strategies in everyday activities using the Early Social Interaction Parent Coaching model to improve outcomes for toddlers with autism spectrum disorder.

Investigator: Croen, Lisa

Funder: National Institutes of Health

Barriers to Health Care in a Latino Population with Autism Spectrum Disorder

This study will identify barriers to the use of recommended assessment, diagnostic, and treatment services among Latino children and adolescents with autism spectrum disorder. The study population will comprise Kaiser Permanente Northern California Latino members, and comparisons will be made between commercially insured versus federally insured (Medicaid) patients, and English versus Spanish speakers.

Investigator: Croen, Lisa; Gordon, Nancy

Funder: Northern California Community Benefit Programs

Prenatal Exposure to Metals and Risk for Autism Spectrum Disorder in MARBLES and EARLI

The peri-conceptual and prenatal periods of gestation are the most likely window of susceptibility for ASD; thus, maternal exposures and maternal genetic susceptibility are critical targets of investigation. Maternal exposure to heavy metals has been recognized for many years as a cause of fetal harm, particularly neurodevelopmental. In this study, we combine two prospective, enriched risk, pregnancy cohorts with available pregnancy and birth biosamples for metals and genetic measurement, with early-life developmental phenotype data, with age 3 ASD diagnosis status assessed by ASD researchers, and enough outcomes to provide adequate power given the enriched design. Further, we consider the utility of epigenetic measures in the study of these environmental risk factors, given evidence of the susceptibility of DNA methylation changes from metals exposure and the potential role of DNA methylation as a mediator of ASD risk or as a post-natal biomarker of metals exposure.

Investigator: Croen, Lisa

Funder: National Institute of Environmental Health Sciences

Health System Integration of Tools to Improve Primary Care for Autistic Adults

The objective of this project is to use a CBPR approach to understand how to best integrate the AASPIRE Healthcare Toolkit, an online healthcare toolkit aimed at improving primary care services for autistic adults, into the KP Northern CA healthcare system as we prepare for the larger effectiveness-implementation trial. We will do so by achieving the following specific aims: 1) To determine how to integrate use of the toolkit into the Kaiser systems. 2) To assess the acceptability and feasibility of both the intervention and the research protocols. 3) To further explore potential mechanisms of action.

Investigator: Croen, Lisa

Funder: National Institute of Mental Health

Understanding Family Economic Impact of Chronic Child Health Conditions

This study will address an important knowledge gap by estimating financial and time costs for families of children with autism. We will recruit 1,500 families of children 3-17 years old from geographically and ethnically diverse integrated health systems: Kaiser Permanente Northwest, Kaiser Permanente Northern California, Kaiser Permanente Georgia, Kaiser Permanente Hawaii and the OCHIN network of federally qualified health plans. Using the Family Economic Impact Interview, we will follow participating families for one year to collect information on family costs and examine what factors contribute to these costs.

Investigator: Croen, Lisa

Funder: National Institute of Child Health and Human Development

Prenatal SSRI Exposure, Maternal and Child Genotype, and Autism Spectrum Disorders

The prevalence of Autism Spectrum Disorders (ASD) has increased rapidly over recent decades. Among many environmental exposures that have also increased in frequency is the use of anti-depressant medications during pregnancy. Approximately 10% of pregnant women are prescribed selective seratonin reuptake inhibitors (SSRIs) SSRIs and other anti-depressant medication cross the placenta and are secreted in breast milk, thus raising concerns about adverse effects on the fetus or infant. This study will expand upon previous findings of an association between prenatal SSRI exposure and autism risk by utilizing data and biospecimens already collected in the SEED study to explore main and joint effects of maternal antidepressant use, maternal psychiatric disease history, and maternal and child genetic susceptibility.

Investigator: Croen, Lisa

Funder: National Institute of Child Health and Human Development

Prospective Evaluation of Air Pollution, Cognition and Autism from Birth Onward

This study will examine the relationship between perinatal and early life air pollution exposure and early longitudinal measures of cognitive ability and ASD in two prospective samples – Markers of Autism Risk in Babies, Learning Early Signs (MARBLES) and Early Autism Risk Longitudinal Investigation (EARLI). Aim 1 is to assign air pollutant exposure using geographic information systems (GIS) technology and novel biomarker measurements. Aim 2 is to examine the effect of air pollutant exposure on the trajectory of cognitive development. Aim 3 is to evaluate the effect of air pollution exposure on cross-sectional and longitudinal measures of autistic traits and ASD diagnoses.

Investigator: Croen, Lisa

Funder: National Institute of Environmental Health Sciences

Neurodevelopment of Cognitive Control in Autism: Adolescence to Young Adulthood

This study compares the developmental trajectory of behavioral measures of cognitive control from adolescence into young adulthood in typical individuals (TYP) and individuals with Autism Spectrum Disorder (ASD). We predict that approximately 2/3 of those with ASD will show a persistent lag in performance on cognitive control tasks through young adulthood, and that in those with ASD, cognitive control abilities will predict performance in complex information processing. We will also examine the development of the neural mechanisms of cognitive control from adolescence to young adulthood. We hypothesize that those with ASD will employ more reactive cognitive control than their TYP counterparts. Lastly, we will investigate relationships between the two modes of cognitive control, and functional and mental health outcomes between adolescence and young adulthood in the ASD group.

Investigator: Croen, Lisa

Funder: National Institute of Mental Health

Folic Acid Prevention Pathways for ASD in High Risk Families

Autism spectrum disorders affect 1 in 68 children in the US. There is evidence for a potentially large role for the early in-utero environment, including gestational nutrition, in ASD etiology. Maternal folic acid is one of the first modifiable factors with the potential to reduce occurrence of ASD. In addition to being essential for neurodevelopment, folate is a primary methyl-donor for methylation reactions. The time near conception is an especially critical period for adequate methyl supply during cycles of active de-methylation and re-methylation during embryogenesis, interactions with genetic and environmental risk factors, and the greatest reduction in ASD risk associated with higher maternal folic acid intake. Using data and samples from mother-child pairs in two large prospective studies, this study proposes to examine specific pathways for prevention of ASD through maternal dietary and supplemental folate intake.

Investigator: Croen, Lisa

Funder: National Institute of Environmental Health Sciences

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

We hypothesize that in-utero exposures to commonly used endocrine disrupting chemicals, such as PFCs and PBDEs, individually and/or in combination, have adverse effects on child obesity and neurodevelopment through possible common pathways. Our aims are:
Aim 1. To evaluate whether in-utero exposures to maternal PFCs and PBDEs, individually and/or in combination, are associated with infant growth, adiposity and neurodevelopment.
Aim 2. To evaluate whether in-utero PFCs and PBDEs exposures are associated with metabolic determinants of obesity and neurodevelopment .
Aim 3. To explore whether in-utero PFCs and PBDEs exposures are associated with infant patterns of DNA methylation.
Aim 4. To identify infant, maternal and paternal factors that modify the association of exposure to in-utero PFCs and PBDEs exposures and with infant growth, adiposity and neurodevelopment.

Investigator: Ferrara, Assiamira; Croen, Lisa

Funder: National Institutes of Health

Role of Pre-natal Vitamin D and Gene Interactions in Autism Spectrum Disorders: Leveraging an Existing Case-Control Study

This study is the first to investigate the role of perinatal vitamin D deficiency or insufficiency in ASD etiology, as modulated by race and genes involved in vitamin D metabolism and receptor activity, in a large, racially-diverse cohort. The role of vitamin D in a number of health conditions has gained recent attention, concurrent with high frequency of vitamin D deficiency/insufficiency being documented, attributed to changes in lifestyle. Evidence indicating higher risk of autism by factors shown to be related to lower vitamin D levels and recent advances in the understanding of the role of vitamin D on brain and immune function support a potential role in autism etiology that warrants rigorous investigation. A few studies of children with autism (or their mothers) have found lower vitamin D levels, but they all were limited by small samples and measurement of levels after the critical period of brain development.

Investigator: Croen, Lisa

Funder: National Institute of Child Health and Human Development

California CADDRE-SEED Phase II

The goal of this project is to continue the SEED study, a case-control study of genetic and environmental risk factors for autism. The major goal of the project is to conduct a multi-site collaborative epidemiologic study to investigate risk and causal factors for Autism Spectrum Disorders (ASD) and phenotypic subgroups of ASD using a population-based case-cohort study design.

Investigator: Croen, Lisa

Funder: Centers for Disease Control and Prevention

Publications

Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes

Authors: Maylott, Sarah E;Aschner, Judy;Avalos, Lyndsay A;program collaborators for Environmental influences on Child Health Outcomes (ECHO),;et al.

J Pediatr. 2023 Sep;260:113468. Epub 2023-05-13.

Lisa A. Croen , PhD

Current Positions

Section Affiliations

Primary Research Interests

Related Websites

Studies

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

GEARs Combining advances in Genomics and Environmental science to accelerate Actionable Research and practice in ASD

Prenatal medication exposure in autism, birth complications and developmental disabilities

SEED Follow-Up Study

Harnessing Electronic Health Records to Identify Participants and to Study Health Outcomes in Transition-Age Youth and Adults with Autism Spectrum Disorder

Maternal Health in Pregnancy and Autism Risk – Genetic and Non-genetic Mechanisms

Autism Specific Patterns of DNA Methylation from Birth to Age 5

Autism Intervention Research Network on Physical Health

COVID-19 Response Grant

Maternal Inflammation during Pregnancy and Neurodevelopmental Disorders

Optimizing Social Communication Measurement with the Social Responsiveness Scale

Autism Adaptive Community-Based Treatment to Improve Outcomes Using Navigators (ACTION) Network

Barriers to Health Care in a Latino Population with Autism Spectrum Disorder

Prenatal Exposure to Metals and Risk for Autism Spectrum Disorder in MARBLES and EARLI

Health System Integration of Tools to Improve Primary Care for Autistic Adults

Understanding Family Economic Impact of Chronic Child Health Conditions

Prenatal SSRI Exposure, Maternal and Child Genotype, and Autism Spectrum Disorders

Prospective Evaluation of Air Pollution, Cognition and Autism from Birth Onward

Neurodevelopment of Cognitive Control in Autism: Adolescence to Young Adulthood

Folic Acid Prevention Pathways for ASD in High Risk Families

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

Role of Pre-natal Vitamin D and Gene Interactions in Autism Spectrum Disorders: Leveraging an Existing Case-Control Study

California CADDRE-SEED Phase II

Publications

Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes

Prenatal depression and risk of child autism-related traits among participants in the Environmental influences on Child Health Outcomes program

Short report: Recommendations for education, clinical practice, research, and policy on promoting well-being in autistic youth and adults through a positive focus on sexuality and gender diversity

Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States

Examining Prenatal Dietary Factors in Association with Child Autism-Related Traits Using a Bayesian Mixture Approach: Results from 2 United States Cohorts

Prenatal ultrasound use and risk of autism spectrum disorder: Findings from the case-control Study to Explore Early Development

A Comparative Analysis of the Full and Short Versions of the Social Responsiveness Scale in Estimating an Established Autism Risk Factor Association in ECHO: Do we Get the Same Estimates?

The influence of loss to follow-up in autism screening research: Taking stock and moving forward

Associations of prenatal exposure to a mixture of persistent organic pollutants with social traits and cognitive and adaptive function in early childhood: Findings from the EARLI study

Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort

Neonatal immune signatures differ by sex regardless of neurodevelopmental disorder status: Macrophage migration inhibitory factor (MIF) alone reveals a sex by diagnosis interaction effect

Health conditions in autism: Defining the trajectory from adolescence to early adulthood

Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes

Opportunities for Inclusion and Engagement in the Transition of Autistic Youth from Pediatric to Adult Healthcare: A Qualitative Study

Prepregnancy BMI, gestational weight gain, and susceptibility to autism-related traits: the EARLI and HOME studies

Epigenetic changes in sperm are associated with paternal and child quantitative autistic traits in an autism-enriched cohort

Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age

Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study

The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort

Modifying the social responsiveness scale for adaptive administration

A framework for measuring the cost to families of caring for children’s health: the design, methodology, and study population of the r-Kids study

The impact of autism spectrum disorder on parent employment: Results from the r-Kids study

Accuracy of diagnostic codes for prenatal opioid exposure and neonatal opioid withdrawal syndrome

Effects of COVID-19 Financial and Social Hardships on Infants’ and Toddlers’ Development in the ECHO Program

Perinatal Anesthesia Exposure and Autism Spectrum Disorders

Examining shortened versions of the Social Responsiveness Scale for use in autism spectrum disorder prediction and as a quantitative trait measure: Results from a validation study of 3-5 year old children

Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults

Associations between accelerated parental biologic age, autism spectrum disorder, social traits, and developmental and cognitive outcomes in their children

Peri-Pregnancy Cannabis Use and Autism Spectrum Disorder in the Offspring: Findings from the Study to Explore Early Development

Maternal autoantibody profiles as biomarkers for ASD and ASD with co-occurring intellectual disability

Prenatal vitamin intake in first month of pregnancy and DNA methylation in cord blood and placenta in two prospective cohorts

Cardiometabolic Pregnancy Complications in Association with Autism-Related Traits as Measured by the Social Responsiveness Scale in ECHO

Coping strategies for COVID-19 pandemic-related stress and mental health during pregnancy

Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort

Maternal Dietary Patterns during Pregnancy and Child Autism-Related Traits: Results from Two US Cohorts

Placental morphology in association with autism-related traits in the EARLI study

Examining associations between prenatal biomarkers of oxidative stress and ASD-related outcomes using quantile regression

The Association of Prenatal Vitamins and Folic Acid Supplement Intake with Odds of Autism Spectrum Disorder in a High-Risk Sibling Cohort, the Early Autism Risk Longitudinal Investigation (EARLI)

Prenatal exposure to pesticide residues in the diet in association with child autism-related traits: Results from the EARLI study

The Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda

The Autism Intervention Research Network on Physical Health (AIR-P) Charter

Improving the Sexual and Reproductive Health and Health Care of Autistic People

Youth Well-being During the COVID-19 Pandemic

Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning

Maternal tobacco smoking and offspring autism spectrum disorder or traits in ECHO cohorts

Maternal blood metal concentrations and whole blood DNA methylation during pregnancy in the Early Autism Risk Longitudinal Investigation (EARLI)

Prenatal Exposure to Ambient Air Pollution and Epigenetic Aging at Birth in Newborns

Associations of COVID-19-Related Health, Healthcare and Economic Factors With Prenatal Depression and Anxiety

Contributions of COVID-19 Pandemic-Related Stressors to Racial and Ethnic Disparities in Mental Health During Pregnancy

Tooth biomarkers to characterize the temporal dynamics of the fetal and early-life exposome