R37MH132924

Testing the accuracy of eye tracking as a screening tool for ASD in the general population - The field of ASD screening is at a crossroads: the sensitivity of the most popular screening tool is only 33%-38%1,3, and pediatricians consistently refer only about a third of children who fail a screening tool for an evaluation4,5 - citing a lack of confidence in screening results as the primary reason for non-referral5.

Within this context, it is not entirely surprising that the mean age of ASD diagnosis and eventual treatment remains at ~52 months6 - years beyond the disorder's prenatal origins7, and beyond the age when it can be reliably diagnosed in many cases8. Clearly, new approaches need to be tested.

Eye-tracking, which generates biologically-relevant, objective, and quantifiable metrics of social and non-social visual attention patterns, is a technology that holds considerable promise as a tool to dramatically change how screening is implemented. With the help of NIH funding, we developed 6 novel eye tracking tests that tap into key challenge areas for children with ASD including visual social attention, gaze shifting, and auditory social attention.

Leveraging our large legacy eye tracking dataset collected from >2,000 toddlers spanning multiple diagnostic groups including ASD, non-ASD delay, and TD, we determined optimal eye tracking metrics and cut-off values for each test that result in very high specificity and PPV (~97% & ~90%) but modest sensitivity (~20% per test). Combining across all 6 tests, however, dramatically improves sensitivity (~90%) and results in high classification accuracy (AUC .95).

These findings, however, were demonstrated in a laboratory setting with utility in real-world clinical settings unknown. Thus, in Aim 1, we take the bold step of testing whether eye-tracking administered across 8,000 12, 18, & 24 month well-baby check-ups (from ~5,2000 unique toddlers) serving families from a wide range of racial, ethnic, and SES backgrounds can improve ASD early screening when implemented by medical staff in pediatric offices.

Toddlers who fail eye-tracking using researcher-defined criteria, and a percentage who pass, will be evaluated by a licensed psychologist blind to eye tracking scores, and diagnostic classification accuracy of eye-tracking computed. Relationships between eye tracking profiles and clinical phenotype will also be examined.

In order to fully understand the accuracy of eye tracking as a screening tool, diagnostic outcomes of the entire screened cohort need to be determined. Thus, in Aim 2 electronic health records (EHRs) will be leveraged to allow us to not only determine the true sensitivity, specificity, PPV and NPV of eye tracking for detecting ASD, but to also compare results to rates of ASD detection using the CSBS, a parent report screening tool used as standard of care in San Diego as part of our GET SET EARLY model9.

State-of-the-art bioinformatics will allow us to further determine if combining eye-tracking with parent report is superior relative to either approach alone. Statistical modeling will reveal whether or not factors such as age at screening, sex, race, ethnicity or SES impacts eye tracking scores.

Finally, in Aim 3, pediatricians and parents will rate their satisfaction with eye tracking.

San Diego University Of California

THE MISSION OF THE NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) IS TO TRANSFORM THE UNDERSTANDING AND TREATMENT OF MENTAL ILLNESSES THROUGH BASIC AND CLINICAL RESEARCH, PAVING THE WAY FOR PREVENTION, RECOVERY, AND CURE. WE FULFILL THIS MISSION BY SUPPORTING AND CONDUCTING RESEARCH ON MENTAL ILLNESSES, HEALTH SERVICES, AND THE UNDERLYING BASIC SCIENCE OF THE BRAIN AND BEHAVIOR; SUPPORTING THE TRAINING OF SCIENTISTS TO CARRY OUT BASIC AND CLINICAL MENTAL HEALTH RESEARCH; AND COMMUNICATING WITH SCIENTISTS, PATIENTS, PROVIDERS, AND THE PUBLIC ABOUT MENTAL HEALTH RESEARCH ADVANCES AND PRIORITIES. IN MAY 2024, NIMH RELEASED ITS STRATEGIC PLAN FOR RESEARCH. THE STRATEGIC PLAN BUILDS ON THE SUCCESSES OF PREVIOUS NIMH STRATEGIC PLANS BY PROVIDING A FRAMEWORK FOR SCIENTIFIC RESEARCH AND EXPLORATION, AND ADDRESSING NEW CHALLENGES IN MENTAL HEALTH.THE NEW STRATEGIC PLAN OUTLINES FOUR HIGH-LEVEL GOALS: GOAL 1: DEFINE THE BRAIN MECHANISMS UNDERLYING COMPLEX BEHAVIORS GOAL 2: EXAMINE MENTAL ILLNESS TRAJECTORIES ACROSS THE LIFESPAN GOAL 3: STRIVE FOR PREVENTION AND CURES GOAL 4: STRENGTHEN THE PUBLIC HEALTH IMPACT OF NIMH-SUPPORTED RESEARCH THESE FOUR GOALS FORM A BROAD ROADMAP FOR THE INSTITUTES RESEARCH PRIORITIES OVER THE NEXT FIVE YEARS, BEGINNING WITH THE FUNDAMENTAL SCIENCE OF THE BRAIN AND BEHAVIOR, AND EXTENDING THROUGH EVIDENCE-BASED SERVICES THAT IMPROVE PUBLIC HEALTH OUTCOMES.

93.242 - Mental Health Research Grants

National Institute of Mental Health (NIMH) [HHS - NIH]

La Jolla, California 920930041 United States

Single Zip Code

Research on Autism Spectrum Disorders (R01 Clinical Trial Optional) (PA-21-201)

Amendment Since initial award the total obligations have increased 385% from $778,398 to $3,773,305.