{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:16:43Z","timestamp":1770279403993,"version":"3.49.0"},"reference-count":50,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Observing how children manipulate objects while they are playing can help detect possible autism spectrum disorders (ASD) at an early stage. For this purpose, specialists seek the so-called \u201cred-flags\u201d of motor signature of ASD for more precise diagnostic tests. However, a significant drawback to achieve this is that the observation of object manipulation by the child very often is not naturalistic, as it involves the physical presence of the specialist and is typically performed in hospitals. In this framework, we present a novel Internet of Things support in the form factory of a smart toy that can be used by specialists to perform indirect and non-invasive observations of the children in naturalistic conditions. While they play with the toy, children can be observed in their own environment and without the physical presence of the specialist. We also present the technical validation of the technology and the study protocol for the refinement of the diagnostic practice based on this technology.<\/jats:p>","DOI":"10.3390\/s21061971","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T05:38:22Z","timestamp":1615441102000},"page":"1971","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Towards Motor-Based Early Detection of Autism Red Flags: Enabling Technology and Exploratory Study Protocol"],"prefix":"10.3390","volume":"21","author":[{"given":"Mariasole","family":"Bondioli","sequence":"first","affiliation":[{"name":"Department of Computer Science, University of Pisa, Largo Pontecorvo 3, 56127 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1248-9478","authenticated-orcid":false,"given":"Stefano","family":"Chessa","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Pisa, Largo Pontecorvo 3, 56127 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3996-3827","authenticated-orcid":false,"given":"Antonio","family":"Narzisi","sequence":"additional","affiliation":[{"name":"Department of Child Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56018 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanna","family":"Pelagatti","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Pisa, Largo Pontecorvo 3, 56127 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Zoncheddu","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Pisa, Largo Pontecorvo 3, 56127 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]. (DSM-5).","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6904a1","article-title":"Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years\u2014Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016","volume":"69","author":"Maenner","year":"2020","journal-title":"Mmwr Surveill. Summ."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chiarotti, F., and Venerosi, A. (2020). Epidemiology of Autism Spectrum Disorders: A Review of Worldwide Prevalence Estimates Since 2014. Brain Sci., 10.","DOI":"10.3390\/brainsci10050274"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S2045796018000483","article-title":"Prevalence of Autism Spectrum Disorder in a large Italian catchment area: A school-based population study within the ASDEU project","volume":"29","author":"Narzisi","year":"2020","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1093\/ptj\/pzz114","article-title":"Multidimensional devel-opments and free-play movement tracking in 30- to 36-month-old toddlers with autism spectrum disorder who were full term","volume":"99","author":"Yang","year":"2019","journal-title":"Phys. Therapy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1111\/j.1469-7610.2008.01904.x","article-title":"Repetitive and stereotyped movements in children with autism spectrum disorders late in the second year of life","volume":"49","author":"Morgan","year":"2008","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/aur.142","article-title":"Restricted and repetitive behaviors in toddlers and preschoolers with autism spectrum disorders based on the Autism Diagnostic Observation Schedule (ADOS)","volume":"3","author":"Kim","year":"2010","journal-title":"Autism Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1007\/s10803-011-1434-3","article-title":"Brief Report: Repetitive Behaviors in Young Children with Autism Spectrum Disorder and Developmentally Similar Peers: A Follow Up to Watt et al. (2008)","volume":"42","author":"Barber","year":"2012","journal-title":"J. Autism Dev. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ridd.2017.10.025","article-title":"Comparing motor performance, praxis, coordination, and interpersonal synchrony between children with and without Autism Spectrum Disorder (ASD)","volume":"72","author":"Kaur","year":"2018","journal-title":"Res. Dev. Disabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/1469-7610.00054","article-title":"The severity and nature of motor impairment in Asperger\u2019s syndrome: A comparison with Specific Developmental Disorder of Motor Function","volume":"43","author":"Green","year":"2002","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.rasd.2006.12.003","article-title":"Relationship between motor skill impairment and severity in children with Asperger syndrome","volume":"1","author":"Hilton","year":"2007","journal-title":"Res. Autism Spectr. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.braindev.2007.03.002","article-title":"Prevalence of motor impairment in autism spectrum disorders","volume":"29","author":"Ming","year":"2007","journal-title":"Brain Dev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1007\/s10803-010-0981-3","article-title":"Motor Coordination in Autism Spectrum Disorders: A Synthesis and Meta-Analysis","volume":"40","author":"Fournier","year":"2010","journal-title":"J. Autism Dev. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"31107","DOI":"10.1038\/srep31107","article-title":"Toward the Autism Motor Signature: Gesture patterns during smart tablet gameplay identify children with autism","volume":"6","author":"Anzulewicz","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_15","first-page":"49","article-title":"Autism as a developmental disorder in intentional movement and affective engagement","volume":"7","author":"Etrevarthen","year":"2013","journal-title":"Front. Integr. Neurosci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s10803-012-1574-0","article-title":"Motor Abilities in Autism: A Review Using a Computational Context","volume":"43","author":"Gowen","year":"2013","journal-title":"J. Autism Dev. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15220","DOI":"10.1073\/pnas.1416797111","article-title":"Autism as a disorder of prediction","volume":"111","author":"Sinha","year":"2014","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.dr.2013.09.001","article-title":"Sensorimotor intentionality: The origins of intentionality in prospective agent action","volume":"33","author":"Gangopadhyay","year":"2013","journal-title":"Dev. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1469-8749.2008.03242.x","article-title":"Impairment in movement skills of children with autistic spectrum disorders","volume":"51","author":"Green","year":"2009","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_20","unstructured":"Mullen, E. (1995). Mullen Scales of Early Learning, AGS."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1111\/cdev.12262","article-title":"Limited Fine Motor and Grasping Skills in 6-Month-Old Infants at High Risk for Autism","volume":"85","author":"Libertus","year":"2014","journal-title":"Child Dev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"798","DOI":"10.3389\/fpsyg.2015.00798","article-title":"Atypical object exploration in infants at-risk for autism during the first year of life","volume":"6","author":"Kaur","year":"2015","journal-title":"Front. Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/1362361312464826","article-title":"Object exploration at 6 and 9 months in infants with and without risk for autism","volume":"18","author":"Leezenbaum","year":"2014","journal-title":"Autism"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.infbeh.2015.12.003","article-title":"Differences in object sharing between infants at risk for autism and typically developing infants from 9 to 15 months of age","volume":"42","author":"Srinivasan","year":"2016","journal-title":"Infant Behav. Dev."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lanini, M., Bondioli, M., Narzisi, A., Pelagatti, S., and Chessa, S. (2018). Sensorized Toys to Identify the Early \u2018Red Flags\u2019 of Autistic Spectrum Disorders in Preschoolers. Adv. Intell. Syst. Comput., 190\u2013198.","DOI":"10.1007\/978-3-030-01746-0_22"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bondioli, M., Chessa, S., Narzisi, A., Pelagatti, S., and Piotrowicz, D. (2019). Capturing Play Activities of Young Children to Detect Autism Red Flags. Adv. Intell. Syst. Comput., 71\u201379.","DOI":"10.1007\/978-3-030-24097-4_9"},{"key":"ref_27","unstructured":"Zoncheddu, M. (2020). Development of the Sensors Data Stream Analysis Module of MoVEAS. [Bachelor\u2019s Thesis, University of Pisa]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1007\/s10803-010-1102-z","article-title":"Automated Detection of Stereotypical Motor Movements","volume":"41","author":"GoodwinNStephen","year":"2011","journal-title":"J. Autism Dev. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Pl\u00f6tz, T., Hammerla, N.Y., Rozga, A., Reavis, A., Call, N., and Abowd, G.D. (2012, January 5\u20138). Automatic assessment of problem behavior in individuals with developmental disabilities. Proceedings of the 2012 ACM Conference on Ubiquitous Computing, Pittsburgh, PE, USA.","DOI":"10.1145\/2370216.2370276"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Goncalves, N., Rodrigues, J., Costa, S., and Soares, F. (2012, January 9\u201313). Automatic detection of stereotyped hand flapping movements: Two different approaches. Proceedings of the 2012 IEEE RO-MAN: The 21st IEEE International Symposium on Robot and Human Interactive Communication, Paris, France.","DOI":"10.1109\/ROMAN.2012.6343784"},{"key":"ref_31","unstructured":"Kang, J.Y., Kim, R., Kim, H., Kang, Y., Hahn, S., Fu, Z., Khalid, M., Schenck, E., and Thesen, T. (2016). Automated Tracking and Quantification of Autistic Behavioral Symptoms Using Microsoft Kinect, IOS Press."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1109\/TBME.2003.812189","article-title":"Ambulatory system for human motion analysis using a kinematic sensor: Monitoring of daily physical activity in the elderly","volume":"50","author":"Najafi","year":"2003","journal-title":"Ieee Trans. Biomed. Eng."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Sukor, A.S.A., Zakaria, A., and Rahim, N.A. (2018, January 9\u201310). Activity recognition using accelerometer sensor and machine learning classifiers. Proceedings of the 2018 IEEE 14th International Colloquium on Signal Processing & Its Applications (CSPA), Batu Feringghi, Malaysia.","DOI":"10.1109\/CSPA.2018.8368718"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1007\/s11760-018-1293-x","article-title":"Novel approaches to human activity recognition based on accelerometer data","volume":"12","author":"Jordao","year":"2018","journal-title":"SignalImage Video Process."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S1350-4533(00)00041-2","article-title":"Classification of waist-acceleration signals in a continuous walking record","volume":"22","author":"Sekine","year":"2000","journal-title":"Med Eng. Phys."},{"key":"ref_36","unstructured":"Lee, S., Park, H.D., Hong, S.Y., Lee, K.J., and Kim, Y.H. (2003, January 17\u201321). A study on the activity classification using a triaxial accelerometer. Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439), Cancun, Mexico."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1088\/0967-3334\/27\/10\/001","article-title":"Classification of a known sequence of motions and postures from accelerometry data using adapted Gaussian mixture models","volume":"27","author":"Allen","year":"2006","journal-title":"Physiol. Meas."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ha, S., and Choi, S. (2016, January 24\u201329). Convolutional neural networks for human activity recognition using multiple accelerometer and gyroscope sensors. Proceedings of the 2016 International Joint Conference on Neural Networks (IJCNN), Vancouver, BC, Canada.","DOI":"10.1109\/IJCNN.2016.7727224"},{"key":"ref_39","first-page":"2438","article-title":"CNN based approach for activity recognition using a wrist-worn accelerometer","volume":"Volume 2017","author":"Panwar","year":"2017","journal-title":"Proceedings of the 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/1362361315622410","article-title":"PACT Consortium Play complexity and toy engagement in preschoolers with autism spectrum disorder: Do girls and boys differ?","volume":"21","author":"Harrop","year":"2017","journal-title":"Autism"},{"key":"ref_41","first-page":"113","article-title":"An efficient orientation filter for inertial and inertial\/magnetic sensor arrays","volume":"25","author":"Madgwick","year":"2010","journal-title":"Rep. X-Io Univ. Bristol (UK)"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Lord, C., Luyster, R., Gotham, K., and Guthrie, W. (2012). (ADOS-2) Manual (Part II): Toddler Module. Autism Diagnostic Observation Schedule, Western Psychological Services. [2nd ed.].","DOI":"10.1007\/978-1-4419-1698-3_2011"},{"key":"ref_43","unstructured":"Schopler, E., Van Bourgondien, M.E., Wellman, G.J., and Love, S.R. (2010). The Childhood Autism Rating Scale (CARS-2) Manual, Western Psychological Services."},{"key":"ref_44","unstructured":"Achenbach, T.M., and Rescorla, L. (2000). Manual for the ASEBA Preschool Forms and Profile, University of Vermont."},{"key":"ref_45","unstructured":"Folio, M., and Fewell, R. (2000). Peabody Developmental Motor Scales\u2014Second Edition (PDMS-2): Examiner\u2019s Manual, Pro-Ed."},{"key":"ref_46","unstructured":"Griffiths, R. (2021, March 08). The Griffiths Mental Developmental Scales, Extended Revised. UK: Association for Research in Infant and Child Development, The Test Agency. Available online: www.hogrefe.com."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s10803-006-0213-z","article-title":"The Repetitive Behavior Scale-Revised: Independent Validation in Individuals with Autism Spectrum Disorders","volume":"37","author":"Lam","year":"2007","journal-title":"J. Autism Dev. Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/19411243.2011.573245","article-title":"The Sensory Processing Measure\u2013Preschool (SPM-P)\u2014Part One: Description of the Tool and Its Use in the Preschool Environment","volume":"4","author":"Glennon","year":"2011","journal-title":"J. Occup. Sch. Early Interv."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sparrow, S.S., Balla, D.A., Cicchetti, D.V., and Doll, E.D. (2005). Vineland-II: Vineland Adaptive Behavior Scales: Survey Forms Manual, American Guidance Service.","DOI":"10.1037\/t15164-000"},{"key":"ref_50","unstructured":"Balboni, G., Belacchi, C., Bonichini, S., and Coscarelli, A. (2016). Vineland-II. Vineland Adaptive Behavior Scales Second Edition Survey Interview Form, Giunti OS Organizzazioni Speciali."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/21\/6\/1971\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:34:00Z","timestamp":1760160840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/21\/6\/1971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,11]]},"references-count":50,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["s21061971"],"URL":"https:\/\/doi.org\/10.3390\/s21061971","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,11]]}}}