For children with autism, early intervention is critical. Therapies and education – especially in the first two years of life – can facilitate a child’s social development, reduce familial stress and ultimately improve quality of life.
But while we can reliably diagnose autism spectrum disorder (ASD) at 24 months, most children are diagnosed much later. This is largely due to a lack of resources, poor adherence to screening guidelines and the fact that primary care physicians are often uncomfortable talking about autism risk to parents.
But what if we could use a simple, routine test to screen every baby for autism? It’s not as far-fetched as it sounds. Larger-scale clinical trials for an eye-tracking device that could be used to predict autism are slated to begin this year.
This presents a new and unique set of ethical concerns. Technologies that predict the possibility of a neurological disorder have the weight of affecting conceptions of not just “what” these children have but “who” these children will become.
As a neuroethicist and autism researcher, we believe it is time to have a conversation about these technologies, and what it will mean for parents and children or for people with autism.
Why use eye-tracking to predict autism?
Many researchers have found that autistic children prefer to look at different things than typically developing children. This is called gaze preference. In fact, gaze preference changes can be detected prior to the onset of autism. Researchers have been using eye-tracking devices to record where babies gaze when viewing videos of social scenes. And they have been using this device not to diagnose autism, but to predict autism.
A 2013 study using an eye-tracking device found that differences in gaze preference can be detected in infants as young as two months. When viewing videos, the infants who look at mouths more than eyes and objects more than people are more likely to later be diagnosed with autism. These infants experienced a decline in attention to other people’s eyes.
The researchers from this study are working to replicate these findings in larger studies and are heading up the development of the eye-tracking device slated for clinical trials this year, and should the trials be successful, researchers will seek FDA approval for the device.
The device is noninvasive, relatively easy to use and portable. And it could provide a standardized, objective measure for predicting autism. In other words, it would be a pre-diagnostic tool. This means that, by identifying the possibility of autism early, eye-tracking devices could increase the chances that children will be officially diagnosed earlier. This would especially help children who tend to be diagnosed at later ages because of disparities related to race or geography.
In fact, researchers have suggested it could be used as part of a routine well baby checkup for 18- to 24-month-olds. And if the technology proves to be useful in predicting autism in infants, why wouldn’t the device one day be utilized even earlier for two- or six-months-olds? A pre-diagnostic assessment for autism could be easily built into regular checkups, instead of waiting for parents to report symptoms and get an appointment with a specialist. This could be a major leap forward for getting kids diagnosed early with ASD and started on therapy, or providing interventions even prior to the development of autistic traits.