Caregiver-Child Interaction as an Effective Tool for Identifying Autism Spectrum Disorder: Evidence from EEG Analysis

Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects individuals across their lifespan. Early diagnosis and intervention are crucial for improving outcomes. However, current diagnostic methods are often time-consuming, and costly, making them inaccessible to many families. In the current study, we aim to test caregiver-child interaction as a potential tool for screening children with ASD in clinic. Methods We enrolled preschool children, including ASD children with or without developmental delay (DD), and typical development (TD) children, along with their caregivers. Behavioral indicators were derived from video encoding of caregiver-child interaction, including social involvement of children (SIC), interaction time (IT), response of children to social cues (RSC), time for caregiver initiated social interactions (GIS) and time for children initiated social interactions (CIS)). Power spectral density (PSD) values were calculated by EEG signals simultaneously recorded. ASD core symptoms were evaluated by Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule-Calibrated Severity Scores (ADOS-CSS). Partial Pearson correlation analysis was used in both ASD groups to investigate the correlation between behavioral indicators scores and ASD symptom severity/PSD values. Receiver operating characteristic (ROC) analysis was used to describe the discrimination accuracy of behavioral indicators. Results We enrolled 85 participants (Mean age: 4.90 ± 0.65 years, 70.6% male). SIC scores negatively correlated with CARS ( p  = 0.006) and ADOS-CSS ( p  = 0.023) in the ASD with DD group. PSD values elevated in ASD groups compared to TD (all p  < 0.05), associated with SIC (theta band: p  = 0.005; alpha band: p  = 0.003) but not IQ levels. SIC was effective in identifying both ASD groups (sensitivity/specificity: ASD children with DD, 76.5%/66.7%; ASD children without DD, 82.6%/82.2%). Conclusion Our results verified the behavioral paradigm of caregiver-child interaction as an efficient tool for early ASD screening, further validated by the PSD of alpha and theta bands.