These findings suggest that some aspects of the conversational discourse difficulties attributed to fragile X syndrome may be a function of the high rate of comorbidity between fragile X and autism, whereas some difficulties may be characteristic of fragile X syndrome.
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 proposed as an early efficacy biomarker for clinical trials targeting social communication skills. EGT measures have been shown to differentiate children with ASD from typical children; however, there is less known about their relationships with social communication outcome measures that are typically used in ASD clinical trials. In the present study, an EGT task involving viewing a videotape of an actor making bids for a child's attention was evaluated in 25 children with ASD aged 24-72 months. Children's attention to the actor during the dyadic bid condition measured via EGT was found to be strongly associated with five well-validated caregiver-reported outcome measures that are commonly used to assess social communication in clinical trials. These results highlight the convergent validity of EGT measures of social attention in relation to caregiver-reported clinical measures. EGT holds promise as a noninvasive, quantitative, and objective biomarker that is associated with social communication abilities in children with ASD. Autism Res 2018, 11: 166-174. V C 2017 International Society for Autism Research, Wiley Periodicals, Inc.Lay Summary: Eye-gaze tracking (EGT), an automated tool that tracks eye-gaze patterns, might help measure outcomes in clinical trials investigating interventions to treat autism spectrum disorders. In this study, an EGT task was evaluated in children with ASD, who watched a video with an actor talking directly to them. Patterns of eye-gaze were associated with caregiver-reported measures of social communication that are used in clinical trials. We show EGT may be a promising objective tool measuring outcomes.
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, feasible methods for measuring eye gaze.OBJECTIVE Using computational methods based on computer vision analysis, we evaluated whether an app deployed on an iPhone or iPad that displayed strategically designed brief movies could elicit and quantify differences in eye-gaze patterns of toddlers with ASD vs typical development. DESIGN, SETTING, AND PARTICIPANTSA prospective study in pediatric primary care clinics was conducted from December 2018 to March 2020, comparing toddlers with and without ASD. Caregivers of 1564 toddlers were invited to participate during a well-child visit. A total of 993 toddlers (63%) completed study measures. Enrollment criteria were aged 16 to 38 months, healthy, English-or Spanish-speaking caregiver, and toddler able to sit and view the app. Participants were screened with the Modified Checklist for Autism in Toddlers-Revised With Follow-up during routine care. Children were referred by their pediatrician for diagnostic evaluation based on results of the checklist or if the caregiver or pediatrician was concerned. Forty toddlers subsequently were diagnosed with ASD.EXPOSURES A mobile app displayed on a smartphone or tablet. MAIN OUTCOMES AND MEASURESComputer vision analysis quantified eye-gaze patterns elicited by the app, which were compared between toddlers with ASD vs typical development.RESULTS Mean age of the sample was 21.1 months (range, 17.1-36.9 months), and 50.6% were boys, 59.8% White individuals, 16.5% Black individuals, 23.7% other race, and 16.9% Hispanic/Latino individuals. Distinctive eye-gaze patterns were detected in toddlers with ASD, characterized by reduced gaze to social stimuli and to salient social moments during the movies, and previously unknown deficits in coordination of gaze with speech sounds. The area under the receiver operating characteristic curve discriminating ASD vs non-ASD using multiple gaze features was 0.90 (95% CI, 0.82-0.97). CONCLUSIONS AND RELEVANCEThe app reliably measured both known and new gaze biomarkers that distinguished toddlers with ASD vs typical development. These novel results may have potential for developing scalable autism screening tools, exportable to natural settings, and enabling data sets amenable to machine learning.
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