Development and Validation of Objective and Quantitative Eye Tracking−Based Measures of Autism Risk and Symptom Levels

Abstract

Objective: The primary aim of this study was to develop and validate eye tracking-based measures for estimating autism spectrum disorder (ASD) risk and quantifying autism symptom levels. Method: Eye tracking data were collected from youth during an initial evaluation visit, with administrators blinded to all clinical information. Consensus diagnoses were given by the multidisciplinary team. Participants viewed a 5- minute video that included 44 dynamic stimuli from 7 distinct paradigms while gaze was recorded. Gaze metrics were computed for temporally-defined regions-of-interest. Autism risk and symptom indices aggregated gaze measures showing significant bivariate relationships with ASD diagnosis and Autism Diagnostic Observation Schedule 2 (ADOS-2) symptom severity levels in a training sample (75%, n=150). Receiver operating characteristic curve analysis and non-parametric correlations were used to cross-validate findings in a test sample (25%; n=51). Results: Most children (n=201, 92%) completed a valid eye tracking assessment (ages 1.6–17.6; 80% male; ASD n=91, non-ASD n=110). In the test sub-sample, the autism risk index had high accuracy for ASD diagnosis (area under the curve [AUC]=.86, 95%CIs=.75-.95), while the autism symptom index was strongly associated with ADOS-2 total severity scores (r=.41, p<.001). Validity was not substantively attenuated after adjustment for language, non-verbal cognitive ability, or other psychopathology symptoms (r=.40-.67, p>.001). Conclusion: Eye tracking measures appear to be useful quantitative, objective measures of ASD risk and autism symptom levels. If independently replicated and scaled for clinical use, eye tracking-based measures could be used to inform clinical judgment regarding ASD identification and to track autism symptom levels.

Children with autism observe social interactions in an idiosyncratic manner

“…Indeed, a common behavioral symptom of ASD is reduced eye contact [Senju & Johnson, 2009;Tanaka & Sung, 2016], and previous eye-tracking studies have reported that children with ASD exhibit weaker gaze preferences for people [Moore et al, 2018;Pierce et al, 2016], faces [Chawarska, Macari, & Shic, 2012;Chita-Tegmark, 2016;Constantino et al, 2017;Jones, Carr, & Klin, 2008;Jones & Klin, 2013;Papagiannopoulou, Chitty, Hermens, Hickie, & Lagopoulos, 2014;Riby & Hancock, 2009;Rice, Moriuchi, Jones, & Klin, 2012;Wang, Campbell, Macari, Chawarska, & Shic, 2018], biological motion [Falck-Ytter, Rehnberg, & Bölte, 2013;Klin, Lin, Gorrindo, Ramsay, & Jones, 2009], and following the gazes of others [Bedford et al, 2012]. These studies have suggested that quantifying gaze behavior with eye tracking may be a potent technique for estimating the initial severity of social symptoms in ASD and sensitively tracking their change over time or in response to treatments [Frazier et al, 2018;Sasson & Elison, 2012].…”

Children with autism observe social interactions in an idiosyncratic manner

“…Wang, Campbell, Macari, Chawarska, & Shic, 2018), biological motion (Falck-Ytter, Rehnberg, & Bölte, 2013;Klin, Lin, Gorrindo, Ramsay, & Jones, 2009), and following the gazes of others (Bedford et al, 2012). These studies have suggested that quantifying gaze behavior with eye-tracking may be a potent technique for estimating the initial severity of social symptoms in ASD and sensitively tracking their change over time or in response to treatments (Frazier et al, 2018;Sasson & Elison, 2012).…”

Autism in Ecuador

“…Eye-tracking measures are increasingly proposed as sensitive biomarkers for ASD, particularly convenient to assess the core social attention deficits contributing to ASD. Remote eye gaze tracking is a noninvasive technique not requiring participants' overt responses and has not significant technical or ethical limitations (Frazier et al 2018). Furthermore, measures can be rapidly collected across a wide range of ages and probably in different cultural settings.…”