Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by repetitive behaviors, narrow interests, and deficits in social interaction and communication ability. An increasing emphasis is being placed on the development of innovative digital and mobile systems for their potential in therapeutic applications outside of clinical environments. Due to recent advances in the field of computer vision, various emotion classifiers have been developed, which have potential to play a significant role in mobile screening and therapy for developmental delays that impair emotion recognition and expression. However, these classifiers are trained on datasets of predominantly neurotypical adults and can sometimes fail to generalize to children with autism. The need to improve existing classifiers and develop new systems that overcome these limitations necessitates novel methods to crowdsource labeled emotion data from children. In this paper, we present a mobile charades-style game, Guess What?, from which we derive egocentric video with a high density of varied emotion from a 90-second game session. We then present a framework for semi-automatic labeled frame extraction from these videos using meta information from the game session coupled with classification confidence scores. Results show that 94%, 81%, 92%, and 56% of frames were automatically labeled correctly for categories disgust, neutral, surprise, and scared respectively, though performance for angry and happy did not improve significantly from the baseline.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that results in altered behavior, social development, and communication patterns. In recent years, autism prevalence has tripled, with 1 in 44 children now affected. Given that traditional diagnosis is a lengthy, labor-intensive process that requires the work of trained physicians, significant attention has been given to developing systems that automatically detect autism. We work toward this goal by analyzing audio data, as prosody abnormalities are a signal of autism, with affected children displaying speech idiosyncrasies such as echolalia, monotonous intonation, atypical pitch, and irregular linguistic stress patterns. Objective: We aimed to test the ability for machine learning approaches to aid in detection of autism in self-recorded speech audio captured from children with ASD and neurotypical (NT) children in their home environments. Methods: We considered three methods to detect autism in child speech: (1) random forests trained on extracted audio features (including Mel-frequency cepstral coefficients); (2) convolutional neural networks trained on spectrograms; and (3) fine-tuned wav2vec 2.0—a state-of-the-art transformer-based speech recognition model. We trained our classifiers on our novel data set of cellphone-recorded child speech audio curated from the Guess What? mobile game, an app designed to crowdsource videos of children with ASD and NT children in a natural home environment. Results: The random forest classifier achieved 70% accuracy, the fine-tuned wav2vec 2.0 model achieved 77% accuracy, and the convolutional neural network achieved 79% accuracy when classifying children’s audio as either ASD or NT. We used 5-fold cross-validation to evaluate model performance. Conclusions: Our models were able to predict autism status when trained on a varied selection of home audio clips with inconsistent recording qualities, which may be more representative of real-world conditions. The results demonstrate that machine learning methods offer promise in detecting autism automatically from speech without specialized equipment.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: 1 in 59 children have autism. While similar rates of autism are reported in rural and urban areas, rural families report greater difficulty in accessing resources. An overwhelming number of families experience waitlists for diagnostic and therapeutic services. Objective: To accurately identify gaps in access to autism care using GapMap: a mobile platform that connects families with local resources while continuously collecting up-to-date autism resource epidemiology information. Methods: Resources were extracted from various resource databases. Resources were deduplicated, validated, and allocated into seven categories based on keywords identified on the resource website. The average distance between individuals from a simulated autism population and the nearest autism resource in our database was calculated for each U.S. county. Resource load, an approximation of demand over supply for diagnostic resources, was calculated for each U.S. county. Results: There are approximately 28,000 U.S. resources validated on the GapMap database, each allocated into one or more of seven categories. States with the greatest distances to autism resources include Alaska, Nevada, Wyoming, Montana, and Arizona. Of the seven resource categories, diagnostic resources are the most underrepresented, comprising only 8.83% of all resources. Alarmingly, 83.86% of all U.S. counties lack any diagnostic resource. States with the highest diagnostic resource load include West Virginia, Kentucky, Maine, Mississippi, and New Mexico. Conclusions: Results from this study demonstrate the sparsity and uneven distribution of diagnostic resources in the U.S., which may contribute to the lengthy waitlists and travel distances often necessary to receive diagnosis in specific regions. More data is needed on autism diagnosis demand to better quantify resource needs across the U.S.

Mobilized telemedicine is becoming a key, and even necessary, facet of both precision health and precision medicine. In this study, we evaluate the capability and potential of a crowd of virtual workers—defined as vetted members of popular crowdsourcing platforms—to aid in the task of diagnosing autism. We evaluate workers when crowdsourcing the task of providing categorical ordinal behavioral ratings to unstructured public YouTube videos of children with autism and neurotypical controls. To evaluate emerging patterns that are consistent across independent crowds, we target workers from distinct geographic loci on two crowdsourcing platforms: an international group of workers on Amazon Mechanical Turk (MTurk) (N = 15) and Microworkers from Bangladesh (N = 56), Kenya (N = 23), and the Philippines (N = 25). We feed worker responses as input to a validated diagnostic machine learning classifier trained on clinician-filled electronic health records. We find that regardless of crowd platform or targeted country, workers vary in the average confidence of the correct diagnosis predicted by the classifier. The best worker responses produce a mean probability of the correct class above 80% and over one standard deviation above 50%, accuracy and variability on par with experts according to prior studies. There is a weak correlation between mean time spent on task and mean performance (r = 0.358, p = 0.005). These results demonstrate that while the crowd can produce accurate diagnoses, there are intrinsic differences in crowdworker ability to rate behavioral features. We propose a novel strategy for recruitment of crowdsourced workers to ensure high quality diagnostic evaluations of autism, and potentially many other pediatric behavioral health conditions. Our approach represents a viable step in the direction of crowd-based approaches for more scalable and affordable precision medicine.

Background: Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social communication and interaction, and restricted and repetitive behaviors and interests. The incidence of ASD has increased in recent years; it is now estimated that approximately 1 in 40 children in the United States are affected. Due in part to increasing prevalence, access to treatment has become constrained. Hope lies in mobile solutions that provide therapy through artificial intelligence (AI) approaches, including facial and emotion detection AI models developed by mainstream cloud providers, available directly to consumers. However, these solutions may not be sufficiently trained for use in pediatric populations. Objective: Emotion classifiers available off-the-shelf to the general public through Microsoft, Amazon, Google, and Sighthound are well-suited to the pediatric population, and could be used for developing mobile therapies targeting aspects of social communication and interaction, perhaps accelerating innovation in this space. This study aimed to test these classifiers directly with image data from children with parent-reported ASD recruited through crowdsourcing. Methods: We used a mobile game called Guess What? that challenges a child to act out a series of prompts displayed on the screen of the smartphone held on the forehead of his or her care provider. The game is intended to be a fun and engaging way for the child and parent to interact socially, for example, the parent attempting to guess what emotion the child is acting out (eg, surprised, scared, or disgusted). During a 90-second game session, as many as 50 prompts are shown while the child acts, and the video records the actions and expressions of the child. Due in part to the fun nature of the game, it is a viable way to remotely engage pediatric populations, including the autism population through crowdsourcing. We recruited 21 children with ASD to play the game and gathered 2602 emotive frames following their game sessions. These data were used to evaluate the accuracy and performance of four state-of-the-art facial emotion classifiers to develop an understanding of the feasibility of these platforms for pediatric research. Results: All classifiers performed poorly for every evaluated emotion except happy. None of the classifiers correctly labeled over 60.18% (1566/2602) of the evaluated frames. Moreover, none of the classifiers correctly identified more than 11% (6/51) of the angry frames and 14% (10/69) of the disgust frames. Conclusions: The findings suggest that commercial emotion classifiers may be insufficiently trained for use in digital approaches to autism treatment and treatment tracking. Secure, privacy-preserving methods to increase labeled training data are needed to boost the models’ performance before they can be used in AI-enabled approaches to social therapy of the kind that is common in autism treatments.