title: Development of an Objective Autism Risk Index Using Remote Eye Tracking.
abstract: OBJECTIVE
  Abnormal eye gaze is a hallmark characteristic of autism spectrum disorder (ASD), and numerous studies have identified abnormal attention patterns in ASD. The primary aim of the present study was to create an objective, eye tracking-based autism risk index.
  
  
  METHODS
  In initial and replication studies, children were recruited after referral for comprehensive multidisciplinary evaluation of ASD and subsequently grouped by clinical consensus diagnosis (ASD n = 25/15, non-ASD n = 20/19 for initial/replication samples). Remote eye tracking was blinded to diagnosis and included multiple stimuli. Dwell times were recorded to each a priori-defined region of interest (ROI) and averaged across ROIs to create an autism risk index. Receiver operating characteristic curve analyses examined classification accuracy. Correlations with clinical measures evaluated whether the autism risk index was associated with autism symptom severity independent of language ability.
  
  
  RESULTS
  In both samples, the autism risk index had high diagnostic accuracy (area under the curve [AUC] = 0.91 and 0.85, 95% CIs = 0.81-0.98 and 0.71-0.96), was strongly associated with Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) severity scores (r = 0.58 and 0.59, p < .001), and not significantly correlated with language ability (r ≤| -0.28|, p > .095).
  
  
  CONCLUSIONS
  The autism risk index may be a useful quantitative and objective measure of risk for autism in at-risk settings. Future research in larger samples is needed to cross-validate these findings. If validated and scaled for clinical use, this measure could inform clinical judgment regarding ASD diagnosis and track symptom improvements.
authors.affiliation: Center for Autism, Cleveland Clinic, Cleveland. Electronic address: fraziet2@ccf.org.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.affiliation: Center for Autism, Cleveland Clinic, Cleveland.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Klingemier
authors.affiliation: Center for Autism, Cleveland Clinic, Cleveland.
authors.forename: Mary
authors.initials: M
authors.lastname: Beukemann
authors.affiliation: Center for Autism, Cleveland Clinic, Cleveland.
authors.forename: Leslie
authors.initials: L
authors.lastname: Speer
authors.affiliation: Center for Autism, Cleveland Clinic, Cleveland.
authors.forename: Leslie
authors.initials: L
authors.lastname: Markowitz
authors.affiliation: Pediatric Neurology, Cleveland Clinic.
authors.forename: Sumit
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Pediatric Institute, Cleveland Clinic.
authors.forename: Steven
authors.initials: S
authors.lastname: Wexberg
authors.affiliation: Pediatric Institute, Cleveland Clinic.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Giuliano
authors.affiliation: Pediatric Institute, Cleveland Clinic.
authors.forename: Elaine
authors.initials: E
authors.lastname: Schulte
authors.affiliation: Pediatric Institute, Cleveland Clinic.
authors.forename: Carol
authors.initials: C
authors.lastname: Delahunty
authors.affiliation: Pediatric and Neurologic Institutes, Cleveland Clinic.
authors.forename: Veena
authors.initials: V
authors.lastname: Ahuja
authors.affiliation: Genomic Medicine Institute, Cleveland Clinic.
authors.forename: Charis
authors.initials: C
authors.lastname: Eng
authors.affiliation: Center for Pediatric Behavioral Health, Cleveland Clinic.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Manos
authors.affiliation: Stanford University, Stanford, CA.
authors.forename: Antonio Y
authors.initials: AY
authors.lastname: Hardan
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.affiliation: University of Pittsburgh.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Strauss
mesh_terms: D001288:Attention; D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D058998:Remote Sensing Technology / Q000379:methods*; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D012919:Social Behavior
keywords: autism spectrum disorder; autism symptoms; objective measure; remote eye tracking; risk