The earlier autism is detected, the better the chances of helping a child overcome the difficulties associated with the disorder and adjust to the world. Only practitioners can provide a true diagnosis, but now a researcher at Ben-Gurion University of the Negev has devised a screening technique to facilitate early detection, based on how children watch movies featuring human interaction.
While it is early days, Dr. Ilan Dinstein believes the technique — which involves tracking the eye movements of children as they watch specific films — could be applicable from about 18 months of age, hopefully leading to earlier average diagnosis of the condition.
The study was published in Autism Research this week by Dinstein, supervising Inbar Avni, Gal Meiri, Asif Bar-Sinai, Doron Reboh, Liora Manelis, Hagit Flusser, Analya Michaelovski and Idan Menashe.
Presently, autism spectrum disorder is identified, on average, at age 2.5 to 3 in Israel and near 4 in the United States, Dinstein says. Thus, a method to identify children as evincing signs of autism, in order to start a formal diagnostic process at an earlier stage, would be helpful.
“The diagnosis has to be made by a doctor,” Dinstein stresses to Haaretz. “But these tests could be very helpful in screening.”
The method is based on the observation that non-ASD children watch films in a reliable and predictable manner, observing faces, gestures, body movements and objects that are relevant to the social interaction and its narrative. Children on the spectrum evince significantly more variable and idiosyncratic gaze patterns.
Autism is defined as a developmental disorder of variable severity, characterized by difficulty in social interaction and communication, and by restricted or repetitive patterns of thought and behavior.
“The specifics can differ across children,” Dinstein says. “There are many different forms of social communication difficulties. For example, some kids with autism have trouble making eye contact (a basic form of social communication), while others do not.”
Present diagnosis usually starts with a suspicion on the part of parent or caregiver, after which the child and parents consult a child neurologist or child psychiatrist who interviews them, tries to interact with the child, and decides whether the diagnosis is warranted, Dinstein explains.
The eye-tracking tool is not designed to compete with this process. Its purpose is to create a tool that could help identify kids who should start the diagnosis process.
“In many cases, the problem is that the children start the diagnosis process late, because the parents, kindergarten teacher, pediatrician hesitated,” he says. “In general, hesitation is not good — because the earlier the diagnosis, the earlier the treatment and the better the outcome.”
Screening by selfie
As proof of concept, children in two groups, diagnosed with ASD and non-ASD, were shown three clips, each shown twice. Two were animated and one was a realistic home video, and all contained social interactions between at least two people. The method accurately identified nearly half of the children diagnosed with ASD, the team says.
The nearly-half of ASD children that the method correctly identified looked at random parts of the movie instead of the locations where the social information is: Things like faces, hand gestures, interactions between individuals in the movie, etc., Dinstein tells Haaretz.
The other half of children with ASD that the method did not identify watched the movies in a manner not distinguishable from the typically developing children, he adds.
Yes, there were some false positives among the non-ASD children: “Interest is something that is very difficult to measure,” he explains. “All we know is that they’re watching the films but are looking at other locations of the images. It seems that they’re interested in other things within the films, which seem to be random. That’s why you always need the clinical assessment.”
Who might use this technique? Concerned parents could, with a little research. Caretakers, including kindergarten teachers, are another likely avenue, though naturally one would have to work out how the teachers communicate with parents over the issue. The mind could easily boggle at the difficulties and sensitivities involved.
“Often, the first concern arises during routine clinic checks or at preschool,” Dinstein points out. Part of the process would be to look for change in a child’s gaze patterns over time, he adds.
It’s true that in the lab the team could use eye trackers that are relatively highly accurate but expensive. But anybody can perform crude but serviceable eye tracking using any ordinary video camera — including via the selfie mechanism. “You can show the movies on any iPad or computer or other screen, meanwhile giving the smartphone to the child on selfie mode and film the child watching the movie,” he explains. You can tell whether he or she is watching the movie and roughly gauge their gaze pattern, he says.
The team didn’t work with toddlers but children aged from 2 to 8, and narrowing down the earliest effective use of the tool will take more research, Dinstein acknowledges. He believes it will be usable from about 18 months of age — and the earlier the better.
The reason the average diagnosis age is near 4 in the United States is because there is often a lot of hesitation by all sorts of elements, he explains. Parents may deny the problem; there may be long wait times to screening and diagnosis; and it can take a year before the child reaches an expert. The system is overloaded, he says.
In Be’er Sheva, where the university is located, the average time to diagnosis is two-and-a-half to three years of age, Dinstein says.
The definition and categories of autism have been changing. According to the U.S. Centers for Disease Control and Prevention, one in 59 children in the United States (about 1.7 percent) has been diagnosed with the disorder — double the 0.9 percent rate measured in 2006 (which is nine children per 1,000). The reasons include better diagnostics and a greater propensity to have one’s child checked when suspicion arises.
According to research by the Maccabi health care fund — for the year 2009, mark you — there were 4.5 diagnoses of autism per 1,000 Israeli children aged up to 12. That’s just half the rate in the United States three years earlier. But it bears adding that the condition itself is fuzzy, its diagnostics are fuzzier, and the only thing that’s certain is that if a child has any developmental condition, the earlier caught and treated, the better.
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