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Will you use Digital Health to Contribute to Autism Research?

In the last decade, autism spectrum disorder (ASD) prevalence in the U.S. increased by over 200%, affecting 1 in 40 children.1,2 Autism is estimated to affect 2% of children worldwide,2,3 and has become one of the most pressing pediatric health concerns globally.4,5,6,7 Standard approaches to diagnosis, such as the Autism Diagnostic Observation Schedule (ADOS)8 and the Autism Diagnostic Interview (ADI-R),9,10 and to therapy, such as Applied Behavioral Analysis (ABA), are difficult to access due to shortages of clinical practitioners, particularly in lower-income countries.9,11,12 The average age of diagnosis in the U.S. is 5 years of age for high-income and 8 years of age for low-income families. 2,13,14 Roughly 27% of U.S. children over the age of 8 remain undiagnosed.15

There is a high urgency to resolve these widespread problems with access to care. Research has shown that behavioral therapy by 5 years of age 17-21 can lessen or even eliminate core autism deficits including restricted and/or repetitive behaviors, difficulty with language, poor social attention, inability to understand facial expressions, and disinterest with social interactions.17,19,22-28 Worse, the impact of the interventions degrades after the age of 5, and by 8 years of age, children often do not respond as effectively. Therefore, early detection and therapy are both of vital importance.

Arguably, the most potent way to address this health crisis is via digital technologies. Children with ASD have shown high engagement with gamified systems which present an exciting opportunity for the development of novel diagnostic and therapeutic platform.29 As one example, researchers at King’s College London recently developed an interactive game, ECHOES, which allowed children to acquire social communication and emotional regulation skills through guided interactions with an intelligent virtual avatar.30 Multiple similar interventions have emerged over the past decade leveraging the latest technological developments in multitouch and interactive interfaces,31-34 humanoid-robot design,35 virtual and augmented reality systems.36-38

Virtually all interactive technological developments rely on extensive libraries of labeled images of human emotion. Nonetheless, children are significantly underrepresented in these sources and thus the classifiers trained on these databases are not optimized for pediatric autism research.39 Embracing the challenge, our team recently developed a Charades-style mobile game GuessWhat.stanford.edu, which engages children with autism and their families in a fun and convenient interaction that reinforces prosocial learning while simultaneously generating data for diagnostic and therapeutic AI development.39, 40 This is where you come in.

We need your help to develop the app’s capabilities! In an effort to corroborate and further increase GuessWhat?’s clinical efficacy, we are currently enrolling parents of children with Autism Spectrum Disorder (ASD) to participate in a fun research study!

Interested? Find out more by signing up on kidsfirst.stanford.edu/guesswhat!

Not a parent of a child with ASD? We need you too! Help us by simply playing the app (available for iOS and Android) and sharing with friends and family.

To stay tuned for updates, follow us on https://www.facebook.com/TheWallLab/

References



Hertz-Picciotto I, Delwiche L. The Rise in Autism and the Role of Age at Diagnosis. Epidemiology 2009; 20(1): 84-90. Kogan MD, Vladutiu CJ, Schieve LA, et al. The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics 2018; 142(6): e20174161. Hahler E-M, Elsabbagh M. Autism: A Global Perspective. Current Developmental Disorders Reports 2015; 2(1): 58-64. Dawson G. Why it’s important to continue universal autism screening while research fully examines its impact. JAMA pediatrics 2016; 170(6): 527-8. Piccininni C, Bisnaire L, Penner M. Cost-effectiveness of Wait Time Reduction for Intensive Behavioral Intervention Services in Ontario, Canada. JAMA Pediatrics 2017; 171(1): 23-30. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349(9064): 1498-504. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The lancet 2013; 382(9904): 1575-86. Gotham K, Risi S, Pickles A, Lord C. The Autism Diagnostic Observation Schedule: revised algorithms for improved diagnostic validity. J Autism Dev Disord 2007; 37(4): 613-27. Lord C, Rutter M, Le Couteur A. Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord 1994; 24(5): 659-85. Poustka F, Lisch S, Ruhl D, Sacher A, Schmotzer G, Werner K. The standardized diagnosis of autism, Autism Diagnostic Interview-Revised: interrater reliability of the German form of the interview. Psychopathology 1996; 29(3): 145-53. Koegel LK, Koegel RL, Ashbaugh K, Bradshaw J. The importance of early identification and intervention for children with or at risk for autism spectrum disorders. 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A Multidimensional Approach to the Study of Emotion Recognition in Autism Spectrum Disorders. Front Psychol 2015; 6: 1954. Kalantarian H, Washington P, Schwartz J, Daniels J, Haber N, Wall DP. Guess What? Towards Understanding Autism from Structured Video Using Facial Affect. J Healthcare Informatics Research 2019; 3: 43-66. Bernardini S, Porayska-Pomsta K, Smith TJ (2014) Echoes: an intelligent serious game for fostering social communication in children with autism. Inf Sci 264:41–60 Battocchi A, Pianesi F, Tomasini D, Zancanaro M, Esposito G, Venuti P, Ben Sasson A, Gal E, Weiss PL (2009) Collaborative puzzle game: a tabletop interactive game for fostering collaboration in children with autism spectrum disorders (asd). In: Proceedings of the ACM International Conference on Interactive Tabletops and Surfaces, ACM, pp 197–204 Feil-Seifer D, Matari´c MJ (2009) Toward socially assistive robotics for augmenting interventions for children with autism spectrum disorders. 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