Autism Spectrum Disorder Clinical Trial
Official title:
Toward Early Autism Assessment: A Prospective Diagnostic Accuracy Study
The primary aim of this study is to compare the diagnostic accuracy of an iPad application
(Play.Care assessment) with the current clinical "gold standard" diagnosis for diagnosis of
Autism Spectrum Disorder (ASD) in children. Recent evidence has suggested that movement
abnormalities are one of the early markers of ASD. However, current clinical diagnostic
assessments fail to take this into account. Further, the current "gold standard" clinical
tests take a number of hours to administer, require extensive clinical training and are
subject to a certain level of subjectivity. Alternatively, by assessing a child's interaction
with an iPad screen as they play, an objective measurement of movement can be obtained, which
can aid in the diagnostic process.
This study aims to recruit a total of 760 children (Typically Developing (TD), Other
Neurodevelopmental Disorders (OND) and ASD groups) to assess the diagnostic accuracy of
tablet game play in ASD. Children who have been diagnosed with ASD will perform the Play.Care
assessment to assess if the tablet result matches their clinical diagnosis. Results from the
clinical assessment and Play.Care assessment will then be compared to assess the sensitivity
(the proportion of participants with ASD who test positive for ASD as a result of the
Play.Care assessment) and specificity (the proportion of participants without ASD who test
negatively for ASD as a result of the Play.Care assessment assessment) of the Play.Care
assessment.
Autism Spectrum Disorder (ASD) has, historically, been described as primarily a
socio-cognitive disorder. While it has been noted that individuals with ASD may exhibit
movement abnormalities such as altered gait or increased clumsiness, recent evidence has
suggested the possible presence of an underlying motor disruption, common to individuals with
ASD. By using smart tablet technology with built in 3 dimensional gyroscopes and
accelerometers, we are now able to assess the movement of children with ASD as they interact
with tablet screens during game play. It is proposed that this could be an enlightening
avenue for assessment or even diagnosis of ASD.
The primary aim of this study is to clinically validate the ability of a new iPad game
(called Play.Care) for diagnosis of ASD in children aged 30 months to 5 years (inclusive).
Three groups of participants will be recruited: children with a clinical diagnosis of ASD,
children with a clinical diagnosis of an Other Neurodevelopmental Disorder (OND) and children
developing typically (TD). A total of 760 children will be recruited between two cities,
Glasgow, Scotland, United Kingdom and Gothenburg, Sweden. Gothenburgh will recruit 180
participants diagnosed with ASD, 60 participants diagnosed with OND and 100 typically
developing participants. Glasgow will recruit 100 participants diagnosed with ASD, 140
participants diagnosed with OND and 180 participants developing typically.
Children developing typically will be recruited from local private nurseries. Children
diagnosed with ASD or OND will be recruited from clinical diagnostic centres and specialist
or inclusive schools.
Parents of children will be given a Participant Information Sheet and sign a Consent Form
under protocol approved by health services (Glasgow and Gothenburg) and University ethics
committees.
If the family is happy to participate, the child can either complete the Play.Care game in
the clinic, during preschool hours in the preschool, or, if it is more suitable for the
family, the researcher can come to their home. In either case, at the start of the data
collection appointment, the parents must sign the consent form. Further information about the
child's emotional state on the day of data collection will be recorded (e.g. mood, arousal,
cooperativity). If the parents consented to their child being video recorded, a video camera
will be setup prior to game play. This will give more information about the overall movement
of the child as they play. The iPad will then be introduced to the child. Two games will be
played. The first game is called 'Sharing' and requires the child to tap a piece of food to
split it into 4 pieces and share it amongst game characters. The second game is called
'Creativity' and requires the child to choose an animal or object to trace and colour in.
Each game has a two minute training phase followed by a five minute assessment phase. While
the child is playing the games, or at an appropriate time, parents will be asked to complete
3 questionnaires about their child's everyday behaviour. These are standard assessments for
children with ASD or OND and will help us understand how the information from Play.Care
relates to everyday behaviour. These are the Strengths and Difficulties Questionnaire (SDQ),
the Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations
Questionnaire (ESSENCE-Q) and the Adaptive Behaviour Assessment Scale (ABAS). In some cases,
information gathered during normal clinical assessment will also be gathered, namely but not
exclusively the Vinelands Adaptive Behaviour Scale (VABS) and the Wechsler Preschool &
Primary Scale of Intelligence (WPPSI). Once the questionnaires and the Play.Care assessment
are complete, no further participation is required.
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