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BACKGROUND Autism Spectrum Disorder (ASD) is a prevalent neurodevelopmental disorder encountered by 1 in 44 children in the United States of America. Autism patients face difficulty effectively communicating with peers, articulating feelings and emotions, and controlling behaviors. Rapid and early diagnosis leads to improved treatment outcomes, however current medical techniques often take years. Difficult, time-consuming diagnoses accompanied by the recent advances in computer vision have led to a surge of interest from researchers in developing models to streamline the autism diagnosis process. OBJECTIVE We aim to assess the viability of at-home autism diagnosis by leveraging video data collected from a mobile game app to train a computer vision model utilizing insights extracted from the change in emotion expression features over time. METHODS With our GuessWhat game-based mobile app, we collect a video dataset of 74 ASD and NT children actively playing in a natural home environment. To investigate and quantify the significance of facial emotion features for ASD detection, we develop a deep learning-based autism classifier with two components: a Convolutional Neural Network (CNN) attached to a Long Short Term Memory (LSTM). We pre-train our CNN backbone in two fashions: (1) on ImageNet or (2) on a compilation of Facial Expression Recognition (FER) datasets to analyze autism detection performance improvements utilizing emotion features. The output of each CNN is fed into an LSTM model to diagnose ASD from video data. RESULTS Our top-performing architecture utilizing a CNN backbone pre-trained on ImageNet obtained an accuracy of 45.8% and an F1 score of 62.8% while our corresponding top architecture employing a CNN backbone trained on the FER datasets achieved top accuracy of 91.2% and an F1 score of 90.6%. CONCLUSIONS We discovered the change in an individual's facial expression features over time as a relevant marker for autism detection. Extracting emotional features from each frame resulted in a 27.8% F1 score improvement when compared to non-emotion weights. Our study demonstrates the capability of mobile applications to collect a natural, diverse dataset for an improved autism diagnosis. These results demonstrate Deep Learning and Computer Vision based methods are instrumental for automated autism diagnosis from at-home recorded videos using unspecialized equipment.

BACKGROUND Implementing automated facial expression recognition on mobile devices could provide an accessible diagnostic and therapeutic tool for those who struggle to recognize facial expressions, including children with developmental behavioral conditions such as autism. Despite recent advances in facial expression classifiers for children, existing models are too computationally expensive for smartphone use. OBJECTIVE We explored several state-of-the-art facial expression classifiers designed for mobile devices, used posttraining optimization techniques for both classification performance and efficiency on a Motorola Moto G6 phone, evaluated the importance of training our classifiers on children versus adults, and evaluated the models’ performance against different ethnic groups. METHODS We collected images from 12 public data sets and used video frames crowdsourced from the GuessWhat app to train our classifiers. All images were annotated for 7 expressions: neutral, fear, happiness, sadness, surprise, anger, and disgust. We tested 3 copies for each of 5 different convolutional neural network architectures: MobileNetV3-Small 1.0x, MobileNetV2 1.0x, EfficientNetB0, MobileNetV3-Large 1.0x, and NASNetMobile. We trained the first copy on images of children, second copy on images of adults, and third copy on all data sets. We evaluated each model against the entire Child Affective Facial Expression (CAFE) set and by ethnicity. We performed weight pruning, weight clustering, and quantize-aware training when possible and profiled each model’s performance on the Moto G6. RESULTS Our best model, a MobileNetV3-Large network pretrained on ImageNet, achieved 65.78% accuracy and 65.31% F1-score on the CAFE and a 90-millisecond inference latency on a Moto G6 phone when trained on all data. This accuracy is only 1.12% lower than the current state of the art for CAFE, a model with 13.91x more parameters that was unable to run on the Moto G6 due to its size, even when fully optimized. When trained solely on children, this model achieved 60.57% accuracy and 60.29% F1-score. When trained only on adults, the model received 53.36% accuracy and 53.10% F1-score. Although the MobileNetV3-Large trained on all data sets achieved nearly a 60% F1-score across all ethnicities, the data sets for South Asian and African American children achieved lower accuracy (as much as 11.56%) and F1-score (as much as 11.25%) than other groups. CONCLUSIONS With specialized design and optimization techniques, facial expression classifiers can become lightweight enough to run on mobile devices and achieve state-of-the-art performance. There is potentially a “data shift” phenomenon between facial expressions of children compared with adults; our classifiers performed much better when trained on children. Certain underrepresented ethnic groups (e.g., South Asian and African American) also perform significantly worse than groups such as European Caucasian despite similar data quality. Our models can be integrated into mobile health therapies to help diagnose autism spectrum disorder and provide targeted therapeutic treatment to children.

Digitally-delivered healthcare is well suited to address current inequities in the delivery of care due to barriers of access to healthcare facilities. As the COVID-19 pandemic phases out, we have a unique opportunity to capitalize on the current familiarity with telemedicine approaches and continue to advocate for mainstream adoption of remote care delivery. In this paper, we specifically focus on the ability of GuessWhat? a smartphone-based charades-style gamified therapeutic intervention for autism spectrum disorder (ASD) to generate a signal that distinguishes children with ASD from neurotypical (NT) children. We demonstrate the feasibility of using "in-the-wild", naturalistic gameplay data to distinguish between ASD and NT by children by training a random forest classifier to discern the two classes (AU-ROC = 0.745, recall = 0.769). This performance demonstrates the potential for GuessWhat? to facilitate screening for ASD in historically difficult-to-reach communities. To further examine this potential, future work should expand the size of the training sample and interrogate differences in predictive ability by demographic.

BACKGROUND A formal autism diagnosis can be an inefficient and lengthy process. Families may wait several months or longer before receiving a diagnosis for their child despite evidence that earlier intervention leads to better treatment outcomes. Digital technologies that detect the presence of behaviors related to autism can scale access to pediatric diagnoses. A strong indicator of the presence of autism is self-stimulatory behaviors such as hand flapping. OBJECTIVE This study aims to demonstrate the feasibility of deep learning technologies for the detection of hand flapping from unstructured home videos as a first step toward validation of whether statistical models coupled with digital technologies can be leveraged to aid in the automatic behavioral analysis of autism. To support the widespread sharing of such home videos, we explored privacy-preserving modifications to the input space via conversion of each video to hand landmark coordinates and measured the performance of corresponding time series classifiers. METHODS We used the Self-Stimulatory Behavior Dataset (SSBD) that contains 75 videos of hand flapping, head banging, and spinning exhibited by children. From this data set, we extracted 100 hand flapping videos and 100 control videos, each between 2 to 5 seconds in duration. We evaluated five separate feature representations: four privacy-preserved subsets of hand landmarks detected by MediaPipe and one feature representation obtained from the output of the penultimate layer of a MobileNetV2 model fine-tuned on the SSBD. We fed these feature vectors into a long short-term memory network that predicted the presence of hand flapping in each video clip. RESULTS The highest-performing model used MobileNetV2 to extract features and achieved a test F1 score of 84 (SD 3.7; precision 89.6, SD 4.3 and recall 80.4, SD 6) using 5-fold cross-validation for 100 random seeds on the SSBD data (500 total distinct folds). Of the models we trained on privacy-preserved data, the model trained with all hand landmarks reached an F1 score of 66.6 (SD 3.35). Another such model trained with a select 6 landmarks reached an F1 score of 68.3 (SD 3.6). A privacy-preserved model trained using a single landmark at the base of the hands and a model trained with the average of the locations of all the hand landmarks reached an F1 score of 64.9 (SD 6.5) and 64.2 (SD 6.8), respectively. CONCLUSIONS We created five lightweight neural networks that can detect hand flapping from unstructured videos. Training a long short-term memory network with convolutional feature vectors outperformed training with feature vectors of hand coordinates and used almost 900,000 fewer model parameters. This study provides the first step toward developing precise deep learning methods for activity detection of autism-related behaviors.

Activity recognition computer vision algorithms can be used to detect the presence of autism-related behaviors, including what are termed “restricted and repetitive behaviors”, or stimming, by diagnostic instruments. Examples of stimming include hand flapping, spinning, and head banging. One of the most significant bottlenecks for implementing such classifiers is the lack of sufficiently large training sets of human behavior specific to pediatric developmental delays. The data that do exist are usually recorded with a handheld camera which is itself shaky or even moving, posing a challenge for traditional feature representation approaches for activity detection which capture the camera's motion as a feature. To address these issues, we first document the advantages and limitations of current feature representation techniques for activity recognition when applied to head banging detection. We then propose a feature representation consisting exclusively of head pose keypoints. We create a computer vision classifier for detecting head banging in home videos using a time-distributed convolutional neural network (CNN) in which a single CNN extracts features from each frame in the input sequence, and these extracted features are fed as input to a long short-term memory (LSTM) network. On the binary task of predicting head banging and no head banging within videos from the Self Stimulatory Behaviour Dataset (SSBD), we reach a mean F1-score of 90.77% using 3-fold cross validation (with individual fold F1-scores of 83.3%, 89.0%, and 100.0%) when ensuring that no child who appeared in the train set was in the test set for all folds. This work documents a successful process for training a computer vision classifier which can detect a particular human motion pattern with few training examples and even when the camera recording the source clip is unstable. The process of engineering useful feature representations by visually inspecting the representations, as described here, can be a useful practice by designers and developers of interactive systems detecting human motion patterns for use in mobile and ubiquitous interactive systems.

A formal autism diagnosis can be an inefficient and lengthy process. Families may wait months or longer before receiving a diagnosis for their child despite evidence that earlier intervention leads to better treatment outcomes. Digital technologies which detect the presence of behaviors related to autism can scale access to pediatric diagnoses. This work aims to demonstrate the feasibility of deep learning technologies for detecting hand flapping from unstructured home videos as a first step towards validating whether models and digital technologies can be leveraged to aid with autism diagnoses. We used the Self-Stimulatory Behavior Dataset (SSBD), which contains 75 videos of hand flapping, head banging, and spinning exhibited by children. From all the hand flapping videos, we extracted 100 positive and control videos of hand flapping, each between 2 to 5 seconds in duration. Utilizing both landmark-driven-approaches and MobileNet V2's pretrained convolutional layers, our highest performing model achieved a testing F1 score of 84% (90% precision and 80% recall) when evaluating with 5-fold cross validation 100 times. This work provides the first step towards developing precise deep learning methods for activity detection of autism-related behaviors., Comment: JMIR Biomedical Engineering '22, To Be Presented at DataBricks Conference '22

BACKGROUND Automated emotion classification could aid those who struggle to recognize emotions, including children with developmental behavioral conditions such as autism. However, most computer vision emotion recognition models are trained on adult emotion and therefore underperform when applied to child faces. OBJECTIVE We designed a strategy to gamify the collection and labeling of child emotion–enriched images to boost the performance of automatic child emotion recognition models to a level closer to what will be needed for digital health care approaches. METHODS We leveraged our prototype therapeutic smartphone game, GuessWhat, which was designed in large part for children with developmental and behavioral conditions, to gamify the secure collection of video data of children expressing a variety of emotions prompted by the game. Independently, we created a secure web interface to gamify the human labeling effort, called HollywoodSquares, tailored for use by any qualified labeler. We gathered and labeled 2155 videos, 39,968 emotion frames, and 106,001 labels on all images. With this drastically expanded pediatric emotion–centric database (>30 times larger than existing public pediatric emotion data sets), we trained a convolutional neural network (CNN) computer vision classifier of happy, sad, surprised, fearful, angry, disgust, and neutral expressions evoked by children. RESULTS The classifier achieved a 66.9% balanced accuracy and 67.4% F1-score on the entirety of the Child Affective Facial Expression (CAFE) as well as a 79.1% balanced accuracy and 78% F1-score on CAFE Subset A, a subset containing at least 60% human agreement on emotions labels. This performance is at least 10% higher than all previously developed classifiers evaluated against CAFE, the best of which reached a 56% balanced accuracy even when combining “anger” and “disgust” into a single class. CONCLUSIONS This work validates that mobile games designed for pediatric therapies can generate high volumes of domain-relevant data sets to train state-of-the-art classifiers to perform tasks helpful to precision health efforts.