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Short home videos may become a powerful tool for diagnosing autism, according to a study by Dennis Wall, PhD, associate professor of pediatrics in systems medicine at the Stanford University School of Medicine.
On average, children with autism are diagnosed at age 4, though their parents often suspect it for years before diagnosis. Long wait times and the lengthy tests required often cause diagnoses to be delayed beyond the ages of 2 or 3, the windows of time in which early interventions are most effective.
In Wall’s study, research assistants with only brief training were able to accurately score autistic-type behaviors in home videos of children in natural settings. Since short videos can be shared over the Internet and evaluated quickly, using them to aid diagnosis could reduce families’ need to travel long distances or wait — in many cases for over a year — for a medical evaluation.
For the study, Wall’s team found 100 videos on YouTube that showed kids from 1 to 15 years old at play. Forty-five of the videos had been tagged by their creators with “autism,” “ASD,” “Asperger’s,” or “hand-flapping/stimming;” these were classified by the researchers as showing children with autism. The remaining 55 videos did not have such tags and were classified as not depicting autism spectrum disorder.
Then, a group of undergraduate students was trained to score the behavior of the children in the videos. The rating scale they used was based on the Autism Diagnostic Observation Schedule, which is widely considered the gold standard for diagnosing autism. For example, the raters tracked whether children showed eye contact and picked up on social cues from others in the video, whether they played with toys appropriately, and whether they engaged in repetitive behaviors.
The researchers found that the students accurately classified children in the videos 97 percent of the time.
The finding raises several interesting possibilities for future clinical applications. Although video-based evaluations are unlikely to completely replace standard diagnostic methods in which a trained clinician spends several hours evaluating a child, they could augment standard approaches.
“For instance, we could use this system for clinical triage, as a way to channel traffic so that children can get the kind of attention they need as early as possible,” Wall notes. Children who clearly have autism might be diagnosed primarily with videos and quickly started on therapy, freeing clinicians to spend more time evaluating children whose diagnosis is less clear-cut.
In addition, video evaluations could be used to track a child’s development and improve the watchful-waiting period prior to diagnosis, Wall says. Autism cannot usually be diagnosed prior to 2 years of age; some children who will never develop autism have early oddities in their social and language skills that resolve by age 2. However, if parents suspect that their 18-month-old has autism, a video evaluation at that age could provide a baseline for “informed watchful waiting” and later assessments at 24 or 36 months. Similarly, scored home videos could provide a simple way to track progress after children begin receiving behavioral therapy.
“Our goal is to bridge the gap between families in need and the services they require,” Wall says.
Reprinted with permission from the School of Medicine’s Office of Communication & Public Affairs.