Eye-Tracking-Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism.

Researchers tested whether eye-tracking technology could help diagnose autism by measuring how young children (16-30 months) look at social scenes. The technology correctly identified autism in 71% of cases and correctly ruled it out in 81% of cases when compared to expert clinical diagnoses. The eye-tracking results also matched well with clinicians' assessments of social skills and cognitive abilities. While promising, more research is needed before this technology could be used routinely.

This large multi-center study evaluated eye-tracking technology as a diagnostic tool for autism in 475 children aged 16-30 months referred to specialty clinics. The technology measured social visual engagement patterns and compared results to expert clinical diagnoses using standardized protocols. Overall sensitivity was 71% and specificity was 81%, improving to 78% sensitivity and 85% specificity in children with certain autism diagnoses. The eye-tracking results strongly correlated with clinical assessments of social disability (r=-0.75), verbal ability (r=0.65), and nonverbal cognitive ability (r=0.65).

The study demonstrates potential for eye-tracking as an objective diagnostic biomarker, though further evaluation in routine clinical practice is needed.

Eye-tracking shows promise as an objective diagnostic aid that could reduce diagnostic delays and subjectivity. However, moderate sensitivity means it cannot replace clinical assessment. Further research needed to validate performance in routine clinical practice and diverse populations before implementation.

Study conducted only in specialty clinics with referred children, limiting generalizability to broader populations. Technology failed in 4.8% of participants. Performance may differ in community settings or with children not already suspected of having autism.

In the US, children with signs of autism often experience more than 1 year of delay before diagnosis and often experience longer delays if they are from racially, ethnically, or economically disadvantaged backgrounds. Most diagnoses are also received without use of standardized diagnostic instruments. To aid in early autism diagnosis, eye-tracking measurement of social visual engagement has shown potential as a performance-based biomarker. To evaluate the performance of eye-tracking measurement of social visual engagement (index test) relative to expert clinical diagnosis in young children referred to specialty autism clinics.

In this study of 16- to 30-month-old children enrolled at 6 US specialty centers from April 2018 through May 2019, staff blind to clinical diagnoses used automated devices to measure eye-tracking-based social visual engagement. Expert clinical diagnoses were made using best practice standardized protocols by specialists blind to index test results. This study was completed in a 1-day protocol for each participant. Primary outcome measures were test sensitivity and specificity relative to expert clinical diagnosis.

Secondary outcome measures were test correlations with expert clinical assessments of social disability, verbal ability, and nonverbal cognitive ability. Eye-tracking measurement of social visual engagement was successful in 475 (95.2%) of the 499 enrolled children (mean [SD] age, 24.1 [4.4] months; 38 [8.0%] were Asian; 37 [7.8%], Black; 352 [74.1%], White; 44 [9.3%], other; and 68 [14.3%], Hispanic). By expert clinical diagnosis, 221 children (46.5%) had autism and 254 (53.5%) did not. In all children, measurement of social visual engagement had sensitivity of 71.0% (95% CI, 64.7% to 76.6%) and specificity of 80.7% (95% CI, 75.4% to 85.1%).

In the subgroup of 335 children whose autism diagnosis was certain, sensitivity was 78.0% (95% CI, 70.7% to 83.9%) and specificity was 85.4% (95% CI, 79.5% to 89.8%). Eye-tracking test results correlated with expert clinical assessments of individual levels of social disability (r = -0.75 [95% CI, -0.79 to -0.71]), verbal ability (r = 0.65 [95% CI, 0.59 to 0.70]), and nonverbal cognitive ability (r = 0.65 [95% CI, 0.59 to 0.70]). In 16- to 30-month-old children referred to specialty clinics, eye-tracking-based measurement of social visual engagement was predictive of autism diagnoses by clinical experts. Further evaluation of this test's role in early diagnosis and assessment of autism in routine specialty clinic practice is warranted.

ClinicalTrials.gov Identifier: NCT03469986.