CAMI – One minute video game could transform autism diagnoses.
Researchers from Kennedy Krieger Institute in the US and Nottingham Trent University in the UK have developed a one-minute video game, which, according to a recent study can correctly identify children with autism with an 80 per cent success rate. The tool, called the Computerised Assessment of Motor Imitation (CAMI), uses motion-tracking technology to detect differences in motor imitation skills. People on the autistic spectrum find it harder to imitate others. Imitating others’ actions is central to the development of social skills. Here we talk to Dr Stewart Mostofsky Professor of Neurology and of Psychiatry and Behavioural Sciences at the Johns Hopkins University School of Medicine who is a lead researcher.
1. When is autism typically diagnosed?
Diagnosis is typically made in early childhood, although can be made into adulthood. It is most often during preschool and early school years (mean age of diagnosis being approximately 5 years). It can be challenging to make a confident diagnosis before 2 years of age, with increasing recognition over the past decade that there are some signs in early childhood that raise suspicion for diagnosis and might help with earlier diagnosis.
2. What are the barriers to diagnosis?
There can be many. The most important barrier is access to comprehensive, expert clinical evaluation, which is needed for accurate diagnosis.
Autism is a highly heterogeneous diagnosis, meaning people with autism can have a wide range of differences in their overall presentation. As just a few quick examples: some with autism have high levels of intellectual ability and some do not; some people with autism have fairly intact language and some do not; some people with autism also have ADHD and some do not; some people with autism struggle with anxiety and some do not.
Diagnosis therefore requires careful and fairly lengthy, clinical assessment – both to determine appropriateness of autism diagnosis and, also crucially, determine whether other diagnoses are present (e.g., ADHD, anxiety disorders, speech/language/intellectual disabilities). The latter is crucial, as these diagnoses are at the same time differential diagnoses for autism and yet also often co-occurring with autism. The evaluation therefore requires: 1) gathering a detailed history (usually from parents) about multiple aspects of a child’s development, birth/other medical history, family history and 2) a comprehensive in-person assessment of the child’s motor, social, communicative (language and nonverbal/gestural), cognitive/intellectual functions as well as behaviour.
Consequently, families accessing diagnosis can be very challenging. There are many underserved (e.g., rural) areas where expert clinicians aren’t nearby. Even for urban/suburban areas, there still aren’t enough trained clinicians – waiting lists are often being very long and sometimes there is high expense.
3. Why is it so important that autism is diagnosed early?
Earlier diagnosis helps ensure earlier intervention, in particular provision of speech/language, cognitive and behavioural therapies both to address autism as well as co-occurring conditions, as discussed above. Child development is an unfolding process with critical time windows for establishing brain-behavioural functions needed to support acquiring a wide range of skills and abilities. Earlier intervention therefore helps ensure children grow and develop in ways that provide improved opportunities for better long-term cognitive, social, mental-health and other behavioural outcomes.
4. How could CAMI help?
We developed CAMI (computerized assessment of motor imitation) as a brief (one-minute), highly-engaging (videogame) and highly-scalable assessment of motor imitation ability. We did so because there existed decades of research, including from our own lab (and dating back to the 1950s – within 10 years of autism first being described by Leo Kanner) that found that children (and adults) with autism show difficulty with imitation others’ actions – both reduced amounts of imitation as well as less accurate imitation. Imitation is crucial to developing social (and communicative) skills – both the ability to smoothly execute social actions as well as the ability to understand those actions as performed by others.
For decades, autism researchers were evaluating imitation using cumbersome methods that required subjective (biased) scoring. Addressing this, we leveraged recent advances in computer vision technology (which applies machine learning/AI methods to determine precise accuracy of movements) to develop CAMI – This provides a much more child-friendly approach (fun videogame that only takes one minute) to more accurately quantify how well someone can imitate “dance-like” movements of a person (“avatar” video of a person) they see on a screen in front of them.
Given the importance of imitation to social-communicative development and the difficulty autistic people have with imitation, CAMI offers a brief, child-friendly approach for assessing this crucial feature of autism, which could help guide diagnosis and address autism heterogeneity in ways that lead to better individualized intervention.
Regarding diagnosis, our studies, including this most recent study in Br J Psychiatry, reveal that this one-minute CAMI videogame can distinguish children with autism from neurotypical children with ~80-90% accuracy. Importantly, this most recent study shows CAMI can also distinguish children with autism from those with ADHD with ~70% accuracy.
CAMI has potential to thereby serve as a tool that could help clinicians screen for autism diagnosis. This could help with CAMI could also guide precision diagnosis and help address autism heterogeneity in way that help with more individualized therapeutic intervention. For instance, if a child with autism has a lot of difficulty with imitation, you might want to both: 1) try to teach them skills (eg, gestures, body language) in more “hands-on” ways rather than through imitation, and 2) help the child improve their ability to imitation others’ actions.
5. How can it tell the difference between ASD and ADHD? What’s your theory?
While both ASD and ADHD are associated with difficulties with motor development, there are some clear distinctions. Decades of research from our lab and others has found that while both autism and ADHD children show difficulties with motor coordination and control, those with autism show particular difficulty with motor skills that involve rapid/dynamic visual-motor integration (VMI). This includes skills such as catching balls as well as imitating others’ actions. These autism-associated difficulties with VMI may thereby contribute to core autism diagnostic features of impaired development of social skills and communicative skills (as well as associated difficulties with also developing motor skills).
Director, Center for Neurodevelopmental and Imaging Research
Kennedy Krieger Institute
Professor of Neurology and of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine
- CAMI – One minute video game could transform autism diagnoses - 20th March 2025
