{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T05:30:21Z","timestamp":1791955821969,"version":"4.3.4"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Autism spectrum disorder is a common and early-emerging neurodevelopmental condition. While 80% of parents report having had concerns for their child\u2019s development before age 2 years, many children are not diagnosed until ages 4 to 5 years or later.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To develop an objective performance-based tool to aid in early diagnosis and assessment of autism in children younger than 3 years.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In 2 prospective, consecutively enrolled, broad-spectrum, double-blind studies, we developed an objective eye-tracking\u2013based index test for children aged 16 to 30 months, compared its performance with best-practice reference standard diagnosis of autism (discovery study), and then replicated findings in an independent sample (replication study). Discovery and replication studies were conducted in specialty centers for autism diagnosis and treatment. Reference standard diagnoses were made using best-practice standardized protocols by specialists blind to eye-tracking results. Eye-tracking tests were administered by staff blind to clinical results. Children were enrolled from April 27, 2013, until September 26, 2017. Data were analyzed from March 28, 2018, to January 3, 2019.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Prespecified primary end points were the sensitivity and specificity of the eye-tracking\u2013based index test compared with the reference standard. Prespecified secondary end points measured convergent validity between eye-tracking\u2013based indices and reference standard assessments of social disability, verbal ability, and nonverbal ability.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Data were collected from 1089 children: 719 children (mean [SD] age, 22.4 [3.6] months) in the discovery study, and 370 children (mean [SD] age, 25.4 [6.0] months) in the replication study. In discovery, 224 (31.2%) were female and 495 (68.8%) male; in replication, 120 (32.4%) were female and 250 (67.6%) male. Based on reference standard expert clinical diagnosis, there were 386 participants (53.7%) with nonautism diagnoses and 333 (46.3%) with autism diagnoses in discovery, and 184 participants (49.7%) with nonautism diagnoses and 186 (50.3%) with autism diagnoses in replication. In the discovery study, the area under the receiver operating characteristic curve was 0.90 (95% CI, 0.88-0.92), sensitivity was 81.9% (95% CI, 77.3%-85.7%), and specificity was 89.9% (95% CI, 86.4%-92.5%). In the replication study, the area under the receiver operating characteristic curve was 0.89 (95% CI, 0.86-0.93), sensitivity was 80.6% (95% CI, 74.1%-85.7%), and specificity was 82.3% (95% CI, 76.1%-87.2%). Eye-tracking test results correlated with expert clinical assessments of children\u2019s individual levels of ability, explaining 68.6% (95% CI, 58.3%-78.6%), 63.4% (95% CI, 47.9%-79.2%), and 49.0% (95% CI, 33.8%-65.4%) of variance in reference standard assessments of social disability, verbal ability, and nonverbal cognitive ability, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In two diagnostic studies of children younger than 3 years, objective eye-tracking\u2013based measurements of social visual engagement quantified diagnostic status as well as individual levels of social disability, verbal ability, and nonverbal ability in autism. These findings suggest that objective measurements of social visual engagement can be used to aid in autism diagnosis and assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.30145","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T11:15:31Z","timestamp":1693912531000},"page":"e2330145","source":"Crossref","is-referenced-by-count":44,"title":["Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism"],"prefix":"10.1001","volume":"6","author":[{"given":"Warren","family":"Jones","sequence":"first","affiliation":[{"name":"Marcus Autism Center, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"},{"name":"Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Center for Translational Social Neuroscience, Emory University, Atlanta, 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Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Paredes","sequence":"additional","affiliation":[{"name":"Marcus Autism Center, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"},{"name":"Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Edwards","sequence":"additional","affiliation":[{"name":"Marcus Autism Center, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"},{"name":"Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Marrus","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri"},{"name":"Intellectual and Developmental 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