@ as-dx | Using EEG-based Biometrics to Quantify Autism-based Symptomatology during Autism Diagnostic Interviews (ADI/ADI-Rs)
Including the importance of using the strength-based methodology for newly diagnosed ASD patients by providing accessible and efficient neuroelectrical data.
Author —
Disclaimer- This is not medical advice, nor am I a medical professional. The contents of this article feature the current implications of ASD testing diagnostics but do NOT serve as an actual medical diagnosis.
Table of Contents
- History
- Problem
- 2.1 — Gender Differences in Autism Diagnostics
- 2.2 — Social Communication Barriers to ASD Testing
- 2.3 — Addressing the Absence of Neurodiversity-Affirming Resources
3. Status Quo
- 3.1 — The Differences in Symptom Presentation
4. Utilizing Electroencephalography Emotion Testing Alongside ADI-R/ADI
- 4.1 — The ADI-R/ADI Scale
- 4.2 — EEG Emotion Recognition
- 4.3 — Utilizing a Mobile App Platform for Patient Data (as-dx)
5. Implementing “neuroclusive” alongside EEG Emotion Testing for ADI-R/ADI
- 5.1 — “neuroclusive” Backstory
- 5.2 — Future Iterations
History
The untimely and ableist history of autism seemingly perpetuates the usage of derogatory terminology. Autism was thought to be synonymous with schizophrenia. A Swiss psychiatrist — Eugen Bleuler, described the presentation of autism as somewhat “infantile” in 1911.
Unfortunately, as time progressed, the greater the negative connotations became. Luckily, by the 1960s, researchers finally discovered the developmental component of ASD. As mental illnesses and neurodevelopmental conditions became further integrated into medicine via psychiatry.
The publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 included sparse diagnostic criteria for autism.
“A lack of interest in people, severe impairments in communication and bizarre responses to the environment, all developing in the first 30 months of life.”
(Autism — DSM-III, 1980)
After various revisions and altercations, autism was eventually labelled as a “spectrum” in the release of the DSM-IV in 1994.
The current edition of the DSM-5/DSM-5-TR labels autism as “autism spectrum disorder,” focusing on two significant categories surrounding emotional and social behaviours.
“Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history.”
(Autism -DSM-5, 2013)
It’s important to note that autism does not exclusively represent impaired intellectual functioning.
While some individuals on the autism spectrum have been co-morbidly diagnosed with an intellectual disability, in the past, physicians have failed to recognize the separation between the two.
Problem
2.1 — Gender Differences in Autism Diagnostics
For female-identifying individuals, the presentation of their autism symptomatology tends to manifest differently than their male counterparts. Researchers at Bath and Cardiff universities observed the variations between the two genders. As a result of the study, they found that males tend to refrain from involving themselves in situations of in-depth emotion. On the other hand, females often have fewer challenges with emotional intelligence and expression. Due to these variations, females tend to end up being underdiagnosed with autism.
“80% of females remain undiagnosed at age 18, which has serious consequences for the mental health of young women.”
(McCrossin 2022)
Aside from male and female-identifying autistics, researchers at Cambridge University discovered that transgender and gender-fluid adults tend to be 3 to 6 times more likely to be diagnosed with ASD than cisgender adults.
2.2. Social Communication Barriers in ASD Testing
As mentioned in the first section of this article, social communication difficulties vary in complexity for each person on the spectrum. Regarding the diagnosis process, patients must socially engage during the diagnostic through the ADI-R/ADI (Autism Diagnostic Interview-Revised).
As communication can be verbal and non-verbal, misusing facial gestures can negatively impact screening results. Some individuals may go temporality non-verbal or overuse emotion. Regardless these actions can interpret adverse responses during the diagnostic process. Dr. Ruth Grossman of the Facial Affective and Communicative Expressions Lab at Emerson College analyzes the differences in misinterpreted social communication for young people on the spectrum.
In one study, they evaluated video responses from children on and off the spectrum as they watched stimuli to create emotional feedback. As a result, they realized that the subjects with ASD were “more expressive and emotionally responsive than the others.” The variation in emotional responses is often unrecognized during the ASD diagnosis process.
Hence, using an EEG device combined with oral communication in this interview, clinicians can better understand accurate emotional outputs from the patient.
2.3. Addressing the Absence of Neurodiversity-Affirming Resources
In my personal autism diagnosis story, I felt shamed and isolated, especially with the lack of surrounding resources. The internet content focused so much on my neurotypical deficits and less on accepting me. I eventually became familiarized with the “Neurodiversity Movement” on social media as I scrolled various autistic self-advocates. Neurodiversity embraces the differences in the functioning of the neurological system.
By valuing the strengths-based model in this movement, society can finally become more inclusive towards neuroatypical folks. Dr. Lawrence Fung and Nancy Doyle push medical settings to abandon the deficit model and value the strengths-based approach.
Strengths-Based Model of Neurodiversity (SBMN)
- Gardner’s Theory of Multiple Intelligences- By appreciating the variety of skill sets, we can gather a more holistic approach to measure intelligence instead of IQ tests.
- Positive Psychology — emphasizing one’s future ambitions, it aims to use personal strengths to optimize their life.
- Positive Psychiatry — focuses on decreasing co-morbid mental illnesses by valuing one’s unique strengths and talents.
- Chickering’s 7 Vectors of Development — features seven stages of growth through emotional regulation to gaining personal steps towards interdependence. Through a neurodiversity lens, this would be implemented by allowing for any necessary accommodations.
In contrast with the current division between deficit and strength-based language surrounding autism, introducing brain-computer interfaces to aid in ASD diagnostics is heavily favourable. Through utilizing applications of BCI technology with the DSM-5, we can finally accurately validate and appreciate members of the autistic community.
Status Quo
3.1. The Differences in Symptom Presentation
Unlike other medical conditions, ASD does not have one distinct neural biomarker. Physicians often struggle with concluding a diagnosis with some patients due to social stigma and behaviour variation. Typically, ASD is usually screened during child checkups from 9 to 30 months of age. Developmental screening is not to be confused with a developmental diagnostic test. At these appointments, the doctors look for behaviour abnormalities preventing the child from reaching the targeted developmental milestones. As mentioned earlier in this article, due to the differences in external mannerisms between genders (including those of gender-fluid and transgender individuals), a vast majority of ASD folks face a late diagnosis.
To combat the different emotional and external presentations of ASD symptoms, the presence of brain-computer interfaces to aid in diagnostics seems to be heavily favoured. Through utilizing applications of BCI technology alongside the DSM-5, we can finally accurately validate and appreciate members of the autistic community.
Utilizing Electroencephalography Emotion Testing Alongside ADI-R/ADI
4.1 The ADI-R/ADI Tool
Aside from the lengthy questionnaire from the DSM-5 to screen for autism spectrum disorder, the ADI/ADI-R is a crucial part of the diagnostic testing process. The Autism Diagnostic Interview (ADI-R) collects any evident issues surrounding their developmental growth. Compared to ADI, the ADI-R is more frequently used for children <18 months of age. The ADI is used in situations where the person is >5 yrs. Old.
The results are categorized into two sections, “lifetime” and “current,” for the following areas.
- Social Interaction
- Communication
- Restrictive/Repetitive Behaviours
- Personal Interests
Currently, for non-verbal individuals, a different format is available. The problem with this is it leaves an area for the examiner to express bias surrounding the form of communication that interpretation of the person might select. As mentioned in “2.2 Social Communication Barriers in ASD Testing,” without the opportunity to physically see live emotional neurofeedback, this problem will continue to persist.
4.2 — EEG for Emotion Recognition
Emotions are a vital component of our daily lives. As discussed in the prior sections, individuals on the autism spectrum struggle to represent their emotional states from the perspective of a neurotypical POV. This results in a default of misunderstanding and frustration for both parties involved. To prevent these mistakes from occurring during ASD diagnostics testing, we must acquire actual evident data to back up the presentation of these “absent” emotional remarks. The complexity of emotions in people with ASD is a positive reminder to value and recognize the differences in human expression. People on the spectrum can struggle with expressing similar facial remarks or areas of non-verbal as their neurotypical peers.
The ideology of social expression for non-neurotypicals is harmful due to the sole lack of understanding. Applying the same strength-based approach to facilitate inclusive settings is essential when categorizing emotions and phrases.
For this process, we must collect EEG data by measuring neuro-electrical activity via electrodes on one’s scalp. The neurofeedback is interpreted to analyze emotional cues as the device recognizes these signals. This data is regularly repurposed to improve the overall accuracy of this process. This could include removing data representing blinks or background noise to evaluate dynamic characteristics. The data must enter a classification model trained to identify emotions (i.e., happy, sad, angry, etc.) to recognize emotions from brain activity. The contents must be inputted and labelled with the correlated feeling to interpret the EEG signals data associated with the external stimuli.
In my youtube video, I demonstrate EEG feedback with my muse headset during the ADI questionnaire (pre-processing).
4.3 — Utilizing a Mobile App Platform for Patient Data (as-dx)
Instead of standard ASD diagnostics tools, I propose exploring the clinical applications of electroencephalogram data to bridge the gap and allow physicians to see live emotional responses during the Autism Diagnostic Interview process (ADI/ADI-R).
As a result, I developed and prototyped a mobile app entitled “as-dx” to help communicate neurofeedback data back-forth between patients and their doctors. While using the app interface, patient data will be kept confidential due to the 2-step verification process. Patients must be with their healthcare provider for the login process to allow them to sync accounts (see images below).
Implementing “neuroclusive” alongside EEG Emotion Testing for ADI-R/ADI
5.1 — “neuroclusive” Backstory
Through transforming the autism diagnostic process with the new implementation of BCI technology (EEG) for emotion recognition, I also plan to further neurodiversity-affirming advocacy through — “neuroclusive.”
‘Neuroclusive’ came after the prior neurodiversity movement I released in 2021. The positive support was overwhelming, and I impacted over 4000 people through our online efforts. In light of this technical project, I have re-created my neurodiversity organization to focus on the inclusion and unity of all neurological types. Currently, our primary goal is to focus on providing scientifically backed neurodiversity resources and support.
Interested in getting involved? Visit — neuroclusive.com or Contact neuroclusive@gmail.com for more info
5.1 — Future Iterations
Looking beyond, we hope to work alongside educators, physicians and companies to grow our impact exponentially. All the content appearing on this platform will undergo extensive expert review to be considered “approved” for us to endorse. Simultaneously, we aim to represent all forms of neurodiversity. We call upon the public to achieve this collective goal and aspire to consult with fellow neurodivergent folks.
