Development and Validation of a Short Version Eye-Tracking Paradigm for the Screening and Diagnosis of Autism...

Objective behavioral assessments for autism spectrum disorder (ASD) are often time-intensive and require substantial clinical expertise. Eye-tracking-based paradigms offer quantifiable measures of social attention that can complement traditional tools. The current study builds on our previously validated Arabic-language Autism Index (AI) by developing and validating a 4 min short version designed to improve feasibility in clinical and community settings while maintaining diagnostic accuracy. A total of 236 participants (127 with ASD, 109 non-autistic controls including those with developmental delays (DD)) aged 1-16 years were assessed using an eye-tracking paradigm consisting of 19 short dynamic videos depicting social and non-social scenes. The AI was computed as the ratio of dwell time toward social versus non-social stimuli. Diagnostic classification was established using ADOS-2 and SCQ. Reliability and validity were assessed using Cronbach's α, Pearson's r, and ROC analyses, including age-stratified performance and comparison with the original 10 min version. Feasibility was assessed by the proportion of valid stimuli. The short-version AI demonstrated excellent internal consistency (α = 0.91) and test-retest reliability (r = 0.83). Diagnostic accuracy was high (AUC = 0.878, SE = 0.023), with age-stratified AUCs ranging from 0.846 to 0.939. AI scores correlated strongly with ADOS-2 severity (r = 0.54, p < 0.001) and SCQ total scores (r = 0.43, p < 0.001). Compared with the 10 min original version (AUC = 0.73), the short paradigm achieved higher accuracy and feasibility (valid stimuli: 89% vs. 80%). The current eye-tracking paradigm demonstrates promising diagnostic performance while substantially reducing assessment time and cognitive demand. The findings provide initial evidence supporting its potential as a scalable and cross-cultural tool for ASD screening and diagnosis, with further validation in independent and clinical cohorts supporting its translation into routine clinical practice.