Diminished Rate of Response to Name in Autism Spectrum Disorder: Using a Smartphone Application to Provide a Quantitative Measure of Behavior

Background: Previous research suggests that children with autism spectrum disorder (ASD) show limited response to their name, though they may orient easily to other sounds (Dawson et al., 2004). A child’s response to name (RtN) is included in most screening and diagnostic tools because of its high sensitivity as an early indicator of ASD (Miller et al., 2017). However, current measures of RtN rely on parent report that only allows for yes/no ratings or on brief clinical observation of 1-5 name calls. A quantitative measure of RtN can provide information on the rate of response, which may improve screening or help us measure treatment response.

Objectives: To use a novel smartphone application to systematically measure RtN within a child’s natural environments and to generate a quantitative measure of a child’s rate of RtN.

Methods: Participants were parents of 83 children between 18-48 months (M= 35.68 months, SD= 8.82), reported to have a diagnosis of ASD (n=29), a developmental delay/disorder (DD; n=24), or typical development (TD; n=30). Through the RtN app, parents were instructed to complete up to 30 name call trials over 1-2 weeks. The app prompted parents to stand 5 feet behind the child, call the child’s name, and then rate yes/no on the app to indicate whether the child responded to his/her name. Parent ratings and video recordings of the child’s response were both collected through the app, allowing the team to examine parent accuracy. Cumulative rate was calculated after 1-5, 10, 15, and 20 trials.

Results: Rate of RtN plateaued near 15 trials for all groups (Fig. 1). Significant group differences were not observed in the first trial; ASD, DD, and TDC groups showed similar rates of response (77%, 97%, and 92% respectively), suggesting that a small number of trials may not be sufficient for detecting statistically significant differences in RtN. After 3 trials, the ASD group showed a significantly lower rate of RtN than the TDC group (62% vs 84%, p=.02), though differences for the DD group (79%) were not significant. Significant differences between the ASD and DD groups did not emerge until 10 trials (50% vs 73%, p=.005), and remained through 20 trials (p=.007).

Conclusions: Results indicate that one name call trial was not sensitive enough to detect group differences; most (77%) children with ASD responded to the first trial. In fact, none of the children with ASD showed a complete lack of response to name, as the average response rate after 20 trials was ~50%. Instead, differences were observed in the ASD group’s rate of response rather than whether a child responded to an individual bid. These results, and use of a smartphone app to generate quantitative data, have important implications for how RtN is measured during clinical observations and through parent report questionnaires. A scalable measurement tool, such as this app, could open new horizons to community-based studies of ASD by providing a feasible way to screen large samples and identify infants at risk of developing ASD because of a low RtN rate.