Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism.
Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism.
复制标题
社会视觉参与客观测量的发展和复制，以帮助自闭症的早期诊断和评估。
DOI：
10.1001/jamanetworkopen.2023.30145
复制
发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Klin, Ami
中科院分区：
文献类型：
--
作者：
Jones, Warren;Klaiman, Cheryl;Richardson, Shana;Lambha, Meena;Reid, Morganne;Hamner, Taralee;Beacham, Chloe;Lewis, Peter;Paredes, Jose;Edwards, Laura;Marrus, Natasha;Constantino, John N.;Shultz, Sarah;Klin, Ami
能否开发和复制社会视觉投入的客观测量，以帮助在3岁之前对自闭症进行早期诊断和评估？在两项前瞻性双盲研究中，1089名16~30个月的儿童，719名发现儿童和370名复制儿童，基于眼动跟踪的社会视觉投入相对于专家临床诊断的测量结果在接受者操作特征曲线下的面积为0.90，敏感度为81.9%，特异度为89.9%；复制的曲线下面积为0.89，敏感度为80.6%，特异度为82.3%。这些结果提供了一个客观的生物标志物的前景，以帮助自闭症的诊断和评估。自闭症谱系障碍是一种常见的早期神经发育疾病。虽然80%的父母报告说，他们的孩子在2岁之前就有过发育方面的担忧，但许多孩子直到4到5岁或更晚才被确诊。开发一种基于客观表现的工具，以帮助3岁以下儿童自闭症的早期诊断和评估。在两项前瞻性、连续登记、广谱、双盲研究中，我们为16至30个月的儿童开发了一种基于客观眼球跟踪的指数测试，将其表现与自闭症的最佳实践参考标准诊断进行比较(发现研究)，然后在独立样本中重复研究结果(重复研究)。发现和复制研究在自闭症诊断和治疗专业中心进行。参考标准诊断是由专家使用最佳实践标准化方案进行的，对眼睛跟踪结果视而不见。眼球跟踪测试由工作人员进行，他们对临床结果视而不见。从2013年4月27日到2017年9月26日，儿童入学。分析了2018年3月28日至2019年1月3日的数据。预先指定的主要终点是基于眼球跟踪的指数测试相对于参考标准的敏感性和特异性。预先指定的次级终点测量了基于眼球跟踪的指数和社会残疾、言语能力和非言语能力的参考标准评估之间的趋同有效性。数据收集自1089名儿童：719名儿童(平均[SD]年龄，22.4[3.6]个月)和370名儿童(平均[SD]年龄，25.4[6.0]个月)。在发现中，雌性224只(31.2%)，雄性495只(68.8%)；复制时，雌性120只(32.4%)，雄性250只(67.6%)。按参考标准专家临床诊断，发现期非孤独症386例(53.7%)，孤独症333例(46.3%)；复制诊断非孤独症184例(49.7%)，孤独症186例(50.3%)。在发现性研究中，受试者工作特征曲线下面积为0.90(95%CI，0.88~0.92)，敏感性为81.9%(95%CI，77.3%~85.7%)，特异性为89.9%(95%CI，86.4%~92.5%)。在重复性研究中，受试者工作特征曲线下面积为0.89(95%CI，0.86~0.93)，敏感性为80.6%(95%CI，74.1%~85.7%)，特异性为82.3%(95%CI，76.1%~87.2%)。眼动测试结果与专家对儿童个体能力水平的临床评估相关，分别解释了社会残疾、言语能力和非语言认知能力参考标准评估的68.6%(95%CI，58.3%~78.6%)、63.4%(95%CI，47.9%~79.2%)和49.0%(95%CI，33.8%~65.4%)的变异。在两项针对3岁以下儿童的诊断性研究中，基于客观眼球跟踪的社交视觉投入度测量量化了自闭症的诊断状态以及社交残疾、言语能力和非言语能力的个人水平。这些发现表明，社会视觉投入的客观测量可以用来帮助自闭症的诊断和评估。这项诊断性研究开发了一种基于客观表现的工具，并评估了其在3岁以下儿童自闭症早期诊断和评估中的能力。
Can objective measurements of social visual engagement be developed and replicated to aid in early diagnosis and assessment of autism before age 3 years? In 2 prospective double-blind studies of diagnostic performance in 1089 children aged 16 to 30 months, 719 in discovery and 370 in replication, eye-tracking–based measurements of social visual engagement relative to expert clinical diagnosis had area under the receiver operating characteristic curve of 0.90, sensitivity of 81.9%, and specificity of 89.9% in discovery; and area under the curve of 0.89, sensitivity of 80.6%, and specificity of 82.3% in replication. These results offer the prospect of an objective biomarker to aid in autism diagnosis and assessment. Autism spectrum disorder is a common and early-emerging neurodevelopmental condition. While 80% of parents report having had concerns for their child’s development before age 2 years, many children are not diagnosed until ages 4 to 5 years or later. To develop an objective performance-based tool to aid in early diagnosis and assessment of autism in children younger than 3 years. In 2 prospective, consecutively enrolled, broad-spectrum, double-blind studies, we developed an objective eye-tracking–based index test for children aged 16 to 30 months, compared its performance with best-practice reference standard diagnosis of autism (discovery study), and then replicated findings in an independent sample (replication study). Discovery and replication studies were conducted in specialty centers for autism diagnosis and treatment. Reference standard diagnoses were made using best-practice standardized protocols by specialists blind to eye-tracking results. Eye-tracking tests were administered by staff blind to clinical results. Children were enrolled from April 27, 2013, until September 26, 2017. Data were analyzed from March 28, 2018, to January 3, 2019. Prespecified primary end points were the sensitivity and specificity of the eye-tracking–based index test compared with the reference standard. Prespecified secondary end points measured convergent validity between eye-tracking–based indices and reference standard assessments of social disability, verbal ability, and nonverbal ability. Data were collected from 1089 children: 719 children (mean [SD] age, 22.4 [3.6] months) in the discovery study, and 370 children (mean [SD] age, 25.4 [6.0] months) in the replication study. In discovery, 224 (31.2%) were female and 495 (68.8%) male; in replication, 120 (32.4%) were female and 250 (67.6%) male. Based on reference standard expert clinical diagnosis, there were 386 participants (53.7%) with nonautism diagnoses and 333 (46.3%) with autism diagnoses in discovery, and 184 participants (49.7%) with nonautism diagnoses and 186 (50.3%) with autism diagnoses in replication. In the discovery study, the area under the receiver operating characteristic curve was 0.90 (95% CI, 0.88-0.92), sensitivity was 81.9% (95% CI, 77.3%-85.7%), and specificity was 89.9% (95% CI, 86.4%-92.5%). In the replication study, the area under the receiver operating characteristic curve was 0.89 (95% CI, 0.86-0.93), sensitivity was 80.6% (95% CI, 74.1%-85.7%), and specificity was 82.3% (95% CI, 76.1%-87.2%). Eye-tracking test results correlated with expert clinical assessments of children’s individual levels of ability, explaining 68.6% (95% CI, 58.3%-78.6%), 63.4% (95% CI, 47.9%-79.2%), and 49.0% (95% CI, 33.8%-65.4%) of variance in reference standard assessments of social disability, verbal ability, and nonverbal cognitive ability, respectively. In two diagnostic studies of children younger than 3 years, objective eye-tracking–based measurements of social visual engagement quantified diagnostic status as well as individual levels of social disability, verbal ability, and nonverbal ability in autism. These findings suggest that objective measurements of social visual engagement can be used to aid in autism diagnosis and assessment. This diagnostic study develops an objective performance-based tool and assesses its ability to aid in the early diagnosis and assessment of autism in children younger than 3 years.
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影响因子：
2.5
作者：
Burdick, RK;Larsen, GA
通讯作者：
Larsen, GA
影响因子：
120.7
作者：
Jones, Warren;Klaiman, Cheryl;Klin, Ami
通讯作者：
Klin, Ami
影响因子：
1.8
作者：
Agresti, A;Coull, BA
通讯作者：
Coull, BA
DOI：
10.1111/j.1469-7610.2009.02101.x
发表时间：
2009-10-01
影响因子：
7.6
作者：
Chawarska, Katarzyna;Klin, Ami;Volkmar, Fred
通讯作者：
Volkmar, Fred
影响因子：
64.8
作者：
Constantino JN;Kennon-McGill S;Weichselbaum C;Marrus N;Haider A;Glowinski AL;Gillespie S;Klaiman C;Klin A;Jones W
通讯作者：
Jones W