Harnessing the power of machine learning for earlier autism diagnosis
When Grayson Kollins was two and a half years old—just shortly after the birth of his younger sister—his parents noticed that he had all but stopped uttering the sentences and phrases that up until then he had been using to communicate. In addition, his daycare provider mentioned that Grayson had begun repeating phrases over and over, and lacked interest in playing with other children.
Grayson’s father Scott Kollins, Ph.D., a clinical psychologist and professor of psychiatry and behavioral sciences in the School of Medicine at Duke, was well aware of the symptoms of autism spectrum disorder, or ASD, a neurodevelopmental disorder that affects the ability to socially interact and communicate with others. Although it usually manifests early in life, it is a lifelong condition and can have profound effects on learning, employment, and personal relationships.
Prompted by these early symptoms, Grayson’s parents subsequently had him assessed, and he received a clinical diagnosis of ASD. Around the same time in 2013, Duke was recruiting Geraldine (Geri) Dawson, Ph.D., to join the faculty. Dawson is a clinical psychologist whose pioneering work on the early diagnosis and treatment of ASD, together with that of her colleague Sally Rogers, had resulted in the creation of the first comprehensive behavioral intervention for toddlers with ASD.
“Her book was sitting on my nightstand,” recalls Kollins, referring to An Early Start for Your Child with Autism, a book that Dawson co-authored in 2012. “Now,” he remembers thinking, “I have this world expert rock star to bounce things off of.”
As its name suggests, ASD encompasses a spectrum of possible symptoms and behaviors, ranging from relatively mild difficulties with social interactions in some, to a complete inability to verbalize in others. Persons with ASD manifest difficulty in interacting with other people and reading social cues. They may also engage in repetitive behaviors, or become fixated on particular things or interests, or experience an extreme sensitivity to environmental stimuli such as loud noises. But the cues that hint at ASD are not always obvious, especially in younger children, and often emerge in different ways in different people.
ASD affects roughly one in every 59 children in the United States and occurs more often in boys than girls. Although ASD is seen in all races and ethnic groups, children from ethnic and racial minority backgrounds tend to get diagnosed at a later age than white children, and thus often miss out on early intervention.
“If you’ve met one person with ASD, you’ve met one person with ASD,” says Dawson, who in addition to being a professor of psychiatry in the School of Medicine is also director of the Duke Center for Autism and Brain Development and the Duke Institute for Brain Sciences. “It’s a very heterogeneous disorder.”
“One of the first symptoms of autism is that an infant does not pay attention to the social world,” Dawson notes. “Right after birth, most infants are really interested in faces and voices, but infants with autism don’t develop that natural preference.”
Instead, she continues, infants with autism tend to be more drawn to the world of objects. But this dynamic can disrupt the normal pathway of brain development.
“During the infant-toddler period, the brain is rapidly developing—the brain systems that allow us to read facial expressions and understand language develop throughout this time,” says Dawson.
During this period, babies need social interaction and language input from their parents and others around them to fuel that development.
“If the babies aren’t paying attention, then they are not getting stimulation to those brain systems.”
Dawson first became involved in the field of autism research decades ago. Since then, a great deal has been discovered about the symptoms, development, and prevalence of what was once thought to be a very rare disorder.
