Structured interactive play for autism spectrum disorder screening in toddlers: a primary care-based cohort study

Area of Science:

• Developmental Pediatrics
• Child Psychology
• Diagnostic Tools

Background:

• Early identification of autism spectrum disorder (ASD) is critical for better outcomes but often delayed.
• Primary care faces challenges in ASD diagnosis due to limited tool accuracy and specialist access.
• A novel, structured interactive play protocol was evaluated as an early behavioral screening tool for ASD.

Purpose of the Study:

• To evaluate the feasibility of a structured examiner-child interactive play protocol for early ASD screening.
• To assess the effectiveness of behavioral indicators during play in differentiating toddlers with ASD.
• To determine the potential of this method for enhancing early ASD detection in primary care.

Main Methods:

• Recruited 260 toddlers (18-36 months) for a prospective cohort study.
• Coded behavioral indicators (e.g., eye contact, symbolic play) from video recordings of interactive play sessions.
• Used clinical assessments (CARS, Bayley-4) for diagnosis and receiver operating characteristic (ROC) analysis for validity.

Main Results:

• Toddlers with ASD showed significantly poorer performance on all behavioral indicators compared to typically developing peers.
• Eye contact frequency (AUC=0.915) and duration (AUC=0.899) were strong discriminators for ASD.
• Behavioral indicators correlated with cognitive/language abilities and symptom severity.

Conclusions:

• Structured interactive play, especially eye contact observation, effectively differentiates toddlers with ASD.
• This objective, low-cost method shows promise as a primary screening tool for early ASD detection.
• The protocol can potentially improve early ASD identification in primary care settings.