A Six‐Minute Measure of Vocalizations in Toddlers with Autism Spectrum Disorder

Abstract

To improve early identification of autism spectrum disorder (ASD), we need objective, reliable, and accessible measures. To that end, a previous study demonstrated that a tablet‐based application (app) that assessed several autism risk behaviors distinguished between toddlers with ASD and non‐ASD toddlers. Using vocal data collected during this study, we investigated whether vocalizations uttered during administration of this app can distinguish among toddlers aged 16–31 months with typical development (TD), language or developmental delay (DLD), and ASD. Participant's visual and vocal responses were recorded using the camera and microphone in a tablet while toddlers watched movies designed to elicit behaviors associated with risk for ASD. Vocalizations were then coded offline. Results showed that (a) children with ASD and DLD were less likely to produce words during app administration than TD participants; (b) the ratio of syllabic vocalizations to all vocalizations was higher among TD than ASD or DLD participants; and (c) the rates of nonsyllabic vocalizations were higher in the ASD group than in either the TD or DLD groups. Those producing more nonsyllabic vocalizations were 24 times more likely to be diagnosed with ASD. These results lend support to previous findings that early vocalizations might be useful in identifying risk for ASD in toddlers and demonstrate the feasibility of using a scalable tablet‐based app for assessing vocalizations in the context of a routine pediatric visit. Lay Summary Although parents often report symptoms of autism spectrum disorder (ASD) in infancy, we are not yet reliably diagnosing ASD until much later in development. A previous study tested a tablet‐based application (app) that recorded behaviors we know are associated with ASD to help identify children at risk for the disorder. Here we measured how children vocalize while they watched the movies presented on the tablet. Children with ASD were less likely to produce words, less likely to produce speechlike sounds, and more likely to produce atypical sounds while watching these movies. These measures, combined with other behaviors measured by the app, might help identify which children should be evaluated for ASD. Autism Res 2020, 13: 1373–1382. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Digital Behavioral Phenotyping Detects Atypical Pattern of Facial Expression in Toddlers with Autism

“…While a difference in facial expression is one core feature of ASD, the heterogeneity in ASD means we do not expect all children with ASD to display this sign of ASD. As such, our next step is to combine the current results with other measures of autism risk assessed through the current digital screening tool, including response to name [Campbell et al, 2019], postural sway [Dawson et al, 2018], and differential vocalizations [Tenenbaum et al, 2020], among other features, to develop a risk score based on multiple behaviors [Dawson & Sapiro, 2019]. Since no one child is expected to display every risk behavior, a goal is to determine thresholds based on the total number of behaviors, regardless of which combination of behaviors, to asses for risk.…”

Infant vocalizing and phenotypic outcomes in autism: Evidence from the first 2 years

“…Total recording durations were shorter for the AOSI videos ( M = 13.29 min, SD = 4.94) than the CSBS videos ( M = 20.16, SD = 3.81) at 12 months ( t (7.94) = −3.81, p = .005), but there were no differences in average recording duration by diagnostic group at 12 months or the other two timepoints (Table 2). Research suggests that even brief vocalization samples (e.g., 6 min) can be used to identify group differences in vocalizing in toddlers with and without ASD (Tenenbaum et al, 2020). Our primary analyses were re‐run without 12‐month AOSIs included and the pattern of results did not change.…”

Infants later diagnosed with autism have lower canonical babbling ratios in the first year of life

“…However, this study was not able to disentangle consonant use from the likelihood of producing communicative vocalizations. In a recent study, vocalizations from 16- to 31-month-old children were collected via a 6-min tablet-based app [ 61 ]. Toddlers with ASD demonstrated a lower ratio of syllabic vocalizations (canonical vocalizations and vowel-only words such as “I”) compared to TD toddlers, but not developmentally delayed toddlers.…”

“…Three studies directly compared babbling in autism versus developmental delays, with no differences reported [ 55 , 61 , 65 ]. This is not surprising, as differences in canonical babbling are associated with a range of developmental conditions.…”

“…One recent study assessed the utility of 6-min samples of vocalizations collected via a tablet app to predict current diagnosis in 18–31-month-old toddlers [ 61 ]. The syllabic vocalization ratio showed high discriminability between ASD and TD toddlers, with an area under the curve (AUC) of 85.3.…”