Abstract
Atypical eye gaze is an established clinical sign in the diagnosis of autism spectrum disorder (ASD). We propose a computerized diagnostic algorithm for ASD, applicable to children and adolescents aged between 5 and 17 years using Gazefinder, a system where a set of devices to capture eye gaze patterns and stimulus movie clips are equipped in a personal computer with a monitor. We enrolled 222 individuals aged 5–17 years at seven research facilities in Japan. Among them, we extracted 39 individuals with ASD without any comorbid neurodevelopmental abnormalities (ASD group), 102 typically developing individuals (TD group), and an independent sample of 24 individuals (the second control group). All participants underwent psychoneurological and diagnostic assessments, including the Autism Diagnostic Observation Schedule, second edition, and an examination with Gazefinder (2 min). To enhance the predictive validity, a best-fit diagnostic algorithm of computationally selected attributes originally extracted from Gazefinder was proposed. The inputs were classified automatically into either ASD or TD groups, based on the attribute values. We cross-validated the algorithm using the leave-one-out method in the ASD and TD groups and tested the predictability in the second control group. The best-fit algorithm showed an area under curve (AUC) of 0.84, and the sensitivity, specificity, and accuracy were 74, 80, and 78%, respectively. The AUC for the cross-validation was 0.74 and that for validation in the second control group was 0.91. We confirmed that the diagnostic performance of the best-fit algorithm is comparable to the diagnostic assessment tools for ASD.
Highlights
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by atypicality in social communication, and restricted and repetitive behaviors
The lowest value was 47.4% of a child belonging to the ASD group, but this was the only record below 60%
The diagnostic performance was tested in two ways: one was a machine-learning procedure called the LOO method and the other was a test in a different, independent sample of the same age range
Summary
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by atypicality in social communication, and restricted and repetitive behaviors. A recent Australian study reported that only a small proportion of children were assessed using these tools when parents raised concerns over the possibility of their children having ASD, and a “wait-and-see” approach was advised instead [10]. This has likely happened in Japan as well, where only 32% of children confirmed to have a diagnosis of ASD at 5 years had had a history of clinical diagnosis of ASD until the fifth birthday [1]. Many children with ASD are left undiagnosed and are not provided appropriate interventions even at school age
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