Specialists would base diagnosis on videos of children's behavior uploaded to a website.
Because of a shortage of specialists around the country, it can take as long as six months for parents who suspect their child might have autism to get confirmation and begin treatment.
To help with the problem, the Southwest Autism Research and Resource Center, a Phoenix-based autism research nonprofit, is developing a smartphone application that specialists would use to diagnose autism based on videos of children's behavior uploaded onto a website.
The app, the Naturalistic Observation Diagnostic Assessment, could shorten the diagnositic process so children can get treatment earlier, especially in rural communities where skilled specialists are difficult to find. If the app is successful, the diagnostic process that took Herrera three years could take a few weeks.
Parents still would have to arrange follow-up treatment and care with specialists, and there would be an unknown cost for the app-based diagnosis.
The autism center, which is funding the app development with a $2.2 million grant from the National Institutes of Health, is collaborating with Behavior Imaging Solutions, a Boise, Idaho, medical-technology company, and the Georgia Institute of Technology in Atlanta.
Christopher Smith, the autism center's vice president and director of research, said that testing will begin this summer with a few families and that the app will potentially be available as early as 2014.
"This is an exciting opportunity for the community to find new ways to at least help lower and help reduce the disparity of health care in this country," said Andy Shih, senior vice president of scientific affairs at Autism Speaks, one of the world's largest autism-advocacy organizations.
The use of smartphone apps in medicine is a growing trend.
Numerous apps exist for people with diabetes, allowing them to record blood-sugar measurements, track blood pressure and calculate insulin dosages. A Swedish company, iDoc24, recently developed STD Triage, an app to help doctors diagnose sexually transmitted infections using photos taken with smartphones.
"(Using smartphone apps) is a concept that is really gaining a lot of traction in the public health world, so from that perspective, this particular project is certainly a very welcomed addition," Shih said.
Signs of autism
People with autism have impaired social interaction. They may not interact with others during playtime, and they can appear not to be aware someone is standing in front of them.
Communication challenges, such as significantly delayed speech or incoherent babbling, are common with the disorder. It is not uncommon for a person with autism to never communicate audible sounds, or to develop speech much later than most people.
Restrictive and repetitive behavior, such as banging one's head on a wall or constantly stacking and aligning objects, is another common symptom of autism.
"He walked on time, but his speech was very delayed. His eating habits were sometimes weird," Herrera said of her son. "I was frustrated, and it was hard. I was scared because I didn't know what was going on, and I knew he was not doing things."
About one in 88 children nationwide has an autism spectrum disorder, according to the Centers for Disease Control and Prevention.
A lack of specialists
Smith said it's common for doctors — even specialists — to be cautious in diagnosing autism.
There's no blood test for the disorder, which is based on observing certain behaviors.
"Some are hesitant to say 'autism' because they don't want to be wrong. They think they're doing the parent a favor," Smith said. "One of the reasons might be they don't want to alarm parents. They don't want to be wrong and look at the child a year from now and (have) everything seem to be fine."
Early diagnosis allows children to enter therapy sooner and decreases the impact of the speech, social and physical challenges that many children face when they go years without treatment, Smith said.
"They're losing valuable intervention time. We want to connect parents with professionals as soon as possible," Smith said.
Ideally, that happens before a child turns 2.
Kamisha Herrera's son, Thomas, 4, and daughter Jayah, almost 3, were diagnosed only this year as autistic.
"I'd been trying to get them diagnosed since they started walking," said Herrera of Globe, Ariz.
As early as 11 months, Thomas displayed unusual behavior. He didn't like the textures of most food but relished eating dirt, sticks, leaves, grass and rocks.
Many times a day, every day, he'd jump up and down, pumping his arms up and down, squealing with his mouth open wide.
For three years, Herrera took Thomas to one medical professional after another: two psychiatrists, a psychologist, a speech therapist, a physical therapist and an occupational therapist. They all said Thomas was a typical toddler.
The average diagnosis for a child with autism is made when he or she is almost 6 years old, according to the CDC. Autism-center officials said that time line is too long, and they hope this app helps cut diagnosis time significantly.
How the app will work
Recording behavior and sending video to doctors can be complicated, Smith said. Current smartphone recording devices don't always easily upload — if at all — to the website specialists will use.
And recording with a camcorder takes time and steps that Southwest Autism officials hope to eliminate.
After the app is developed, when a parent notices his or her child is not showing signs of development, the parent and child can visit a pediatrician.
If the pediatrician is not trained to diagnose autism but suspects that the child has the disorder, the doctor will give the parent information about the app.
The information will tell parents what types of behaviors to look for, Smith said. Parents will then record four 10-minute videos of the behavior with a smartphone before uploading them to a website. Specialists will be able to access the video immediately.
After viewing the videos, specialists will go through a checklist used for diagnoses. The specialists will then send a report to a pediatrician, who will deliver the information to the parent.
"We estimate that, when it's all said and done, that making the video, uploading it to the website and getting the report back to the doctor could take less than a month," Smith said. "I think probably for 60 percent of the kids that are going to be referred to specialists, the diagnosis will be made easily, because they are going to have enough behaviors that are going to support a diagnosis."
An additional 20 percent will require more video analysis, Smith said. And the remaining 20 percent will likely require an in-office visit before a diagnosis is made.
Smith said specialists from one part of the country will be able to diagnose children thousands of miles away.
Video will allow specialists to see more patients in a shorter time, Smith said. They can log onto the website to analyze video that could provide answers to questions they often ask during in-office visits.
"The practitioner can assess more patients in a day than they could if they were seeing people in the office," he said.
Persistent challenges
After a diagnosis, a significant problem remains: Most rural families will still have to travel to metropolitan areas for treatment.
Shih, from Autism Speaks, said developers should be mindful of the challenges that families in rural areas may face.
"Having access to a cellphone signal is going to be important," he said. "Coverage, as far as a mobile network, especially in remote areas where this is supposed to be most helpful, could be a concern."
And not everyone has a smartphone. The learning curve could be steep for some parents to record video and upload it to a website.
"The parent may need the additional support to capture meaningful behavior or meaningful clips to share with the a professional," Shih said.
Smith recognizes the challenges of access in rural, low-income communities but hopes patients' pediatricians can help with them, including uploading the video.
Developers are optimistic that they can address challenges as they surface. They want to get the app to parents as quickly as possible, said Ron Oberleitner, chief executive and founder of Behavior Imaging Solutions.
"This could really change the face of how autism is diagnosed," he said.
Source : USA TODAY , 13th April 2013
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