ABSTRACT – Overall The overall goal of the Duke Autism Center of Excellence is to use an innovative, translational digital health and computational approach to address the critical need for more effective autism screening tools, objective outcome measures, and brain-based biomarkers that can be used in clinical trials with young autistic children. An Administrative Core, Dissemination and Outreach Core, and Data Management and Analysis Core will support three Projects. Project 1 will recruit a large population of 16- to 30-month-old toddlers through primary care clinics to evaluate the accuracy of a remotely administered novel digital phenotyping application (app) for detecting early signs of autism. The app automatically quantifies observations of children’s behavior using computer vision analysis and is deployed on widely available devices. The usability of the app for longitudinal outcome monitoring will be assessed at 16-30, 36, and 48 months of age. The feasibility of using computer vision analysis to measure patterns of caregiver-child interactions from videos recorded at home will be explored. Project 2 will develop a complementary autism screening approach by using North Carolina Medicaid and Blue Cross Blue Shield claims data (N ~ 230,000, autism cases ~6,000) to create a generalizable autism prediction model based on routine health data collected from birth to 18 months. Then, using Duke University Health System electronic health records (EHR; N ~ 64,000, autism cases ~ 800), this Project will use natural language processing to assess the added predictive value of EHR elements not captured in claims data (e.g., clinician notes). Both data sets will be leveraged to gain insight into the nature and prevalence of medical conditions in infants and toddlers who are later diagnosed with autism. Projects 1 and 2 will collaboratively engage primary care providers and other stakeholders to design an automated clinical decision support tool for autism screening that, in the future, could be integrated into the primary care provider’s clinical workflow. Project 3 will use an innovative machine learning computational method to develop a multimodal biomarker that combines features of electroencephalographic (EEG) activity and synchronized measures of children’s behavior (e.g., social attention) automatically coded via computer vision analysis, with a focus on neural connectivity measured via traditional methods (coherence, phase-lag index) and novel neural network analysis methods (discriminative cross-spectral factor analysis) developed by our team. This multimodal approach will be evaluated in 3–6-year-old autistic children without intellectual disability (ID), age- and sex-matched neurotypical children, and autistic children with ID (IQ <= 70). Across Projects, our Center’s team will share cutting-edge computational methods to develop new tools that can address long-standing barriers to optimal care and enhanced quality of life for autistic children and their families.

PROJECT NARRATIVE – Overall The purpose of the renewal of the Duke Autism Center of Excellence is to apply cutting-edge, translational digital health and computational methods to develop more effective tools for early autism screening and for objectively monitoring changes in children’s behavior, and to discover novel, brain-based biomarkers that can be used for stratification and to assess target engagement in clinical trials with young autistic children. Our long-term vision is to transform how clinical care is delivered by providing innovative solutions that address long-standing barriers in access to care and enhance our ability to evaluate interventions that will improve quality of life of autistic children and their families.