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February 4, 2019

Potential for Digital Behavioral Measurement Tools to Transform the Detection and Diagnosis of Autism Spectrum Disorder

Author Affiliations
  • 1Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
  • 2Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina
JAMA Pediatr. 2019;173(4):305-306. doi:10.1001/jamapediatrics.2018.5269

For more than a century, clinicians have used clinical observation to describe complex psychiatric disorders, such as autism spectrum disorder (ASD). From these observations, screening tools and diagnostic methods, such as the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), have been developed to predict and define overlapping and heterogeneous conditions that affect neurodevelopment. The current standard of care for screening for ASD involves asking caregivers to complete a questionnaire about their toddlers’ behavior during a pediatric well-child visit. If the caregivers indicate a certain number of symptoms, the toddlers are referred for diagnostic assessment by a trained clinician who observes the children’s behavior using semistandardized behavioral tasks. The clinician then decides whether symptoms are present and their severity. Because of the difficulty in establishing reliable clinical ratings based on subjective observations of behavior, diagnostic training requires extensive background knowledge about child development and several months of training by a criterion standard clinical expert. This rigorous training has influenced the field of autism research over the past several decades, allowing for replication and comparability among studies that was previously impossible.

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