Autism Digital Phenotyping in Preschool- and School-Age Children.

There is a critical need for scalable and objective tools for autism screening and outcome monitoring, which can be used alongside traditional caregiver and clinical measures. To address this need, we developed SenseToKnow, a tablet- or smartphone-based digital phenotyping application (app), which uses computer vision and touch data to measure several autism-related behavioral features, such as social attention, facial and head movements, and visual-motor skills. Our previous work demonstrated that the SenseToKnow app can accurately detect and quantify behavioral signs of autism in 18-40-month-old toddlers. In the present study, we administered the SenseToKnow app on an iPad to 149 preschool- and school-age children (45 neurotypical and 104 autistic) between 3 and 8 years of age. Results revealed significant group differences between autistic and neurotypical children in terms of several behavioral features, which remained after controlling for sex and age. Repeat administration with a subgroup demonstrated stability in the individual digital phenotypes. Examining correlations between the Vineland Adaptive Behavior Scales and individual digital phenotypes, we found that autistic children with higher levels of communication, daily living, socialization, motor, and adaptive skills exhibited higher levels of social attention and coordinated gaze with speech, less frequent head movements, higher complexity of facial movements, higher overall attention, lower blink rates, and higher visual motor skills, demonstrating convergent validity between app features and clinical measures. App features were also significantly correlated with ratings on the Social Responsiveness Scale. These results suggest that the SenseToKnow app can be used as an accessible, scalable, and objective digital tool to measure autism-related behaviors in preschool- and school-age children.