Eye-Tracking-Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism
Eye-Tracking-Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism
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DOI：
10.1001/jama.2023.13295
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发表时间：
2023-09-05
影响因子：
120.7
通讯作者：
Klin, Ami
中科院分区：
文献类型：
--
作者：
Jones, Warren;Klaiman, Cheryl;Klin, Ami
在美国，有自闭症迹象的儿童在诊断前通常会经历1年以上的延迟，如果他们来自种族，民族或经济上处于不利地位的背景，则通常会经历更长的延迟。大多数诊断也是在没有使用标准化诊断仪器的情况下得到的。眼动测量社会视觉投入有助于自闭症的早期诊断，并显示出作为一种基于表现的生物标志物的潜力。目的评价眼动测量社会视觉投入的性能（指数测试）相对于专家临床诊断的幼儿转介到专业自闭症诊所。设计，设置，在这项研究中，16至30个月大的儿童从2018年4月到2019年5月在美国6个专业中心注册，对临床诊断一无所知的工作人员使用自动化设备来测量基于眼动跟踪的社交视觉参与。专家临床诊断是由专家使用最佳实践标准化协议盲目指数测试结果。主要结果和测量主要结果测量是相对于专家临床诊断的测试灵敏度和特异性。次要结果指标是与社会残疾、语言能力和非语言认知能力的专家临床评估的相关性。（95.2%）的499名入学儿童（平均[SD]年龄：24.1 [4.4]个月; 38例[8.0%]为亚裔; 37例[7.8%]为黑人; 352例[74.1%]为白色; 44例[9.3%]为其他; 68例[14.3%]为西班牙裔）。经专家临床诊断，221名儿童（46.5%）患有自闭症，254名儿童（53.5%）没有。在所有儿童中，社会视觉参与测量的敏感性为71.0%（95%CI，64.7%至76.6%），特异性为80.7%（95%CI，75.4%至85.1%）。在335名自闭症诊断明确的儿童中，敏感性为78.0%（95%CI，70.7%至83.9%），特异性为85.4%（95%CI，79.5%至89.8%）。眼动追踪测试结果与专家对个人社会残疾水平的临床评估相关（r=-0.75 [95% CI，-0.79至-0.71]），言语能力（r=0.65 [95%CI，0.59 - 0.70]），非语言认知能力（r=0.65 [95%CI，0.59至0.70]）。结论和相关性在转诊到专科诊所的16至30个月大的儿童中，基于眼动追踪的社交视觉参与测量可预测临床专家对自闭症的诊断。进一步评估该测试在早期诊断和评估常规专业临床实践中自闭症的作用是必要的。ClinicalTrials.gov
Importance 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.Objective 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.Design, Setting, and Participants 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.Main Outcomes and Measures 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.Results 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]).Conclusions and Relevance 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.Trial Registration ClinicalTrials.gov Identifier: NCT03469986