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Using Machine Learning with Real-World Data to Identify Autism Risk in Children

SIEFL Core ⟩ DREAmS Lab ⟩

Delayed diagnosis and under-identification of autism spectrum disorder (ASD) have significant personal, public health, and economic impacts; and girls and Latino children are disproportionately impacted by this problem, in part because clinicians are less likely to recognize ASD risk factors in them and refer them for an ASD evaluation. In this research proposal, we will use real-world data to (1) develop a computable phenotype for ASD using both structured (i.e., diagnosis codes) and unstructured (i.e., physician notes) electronic health record (EHR) data from two diverse locations (Children’s Hospital Los Angeles and the OneFlorida Data Trust), and (2) develop a machine-learning risk prediction model for ASD. This will lay the foundation for a clinical decision support tool, to be integrated into EHRs to notify a clinician when a child warrants ASD evaluation, that will be easily expandable into a next steps, large scale study to the overall PCORnet, which provides healthcare to over 24 million children.

Abstract

Early and accurate identification of autism spectrum disorder (ASD) is important because ASD interventions can support positive long-term developmental outcomes, but there is a delay of >2 years between the age children can reliably be diagnosed and the average age of diagnosis; and 1 in 4 U.S. children aged 8 with ASD have not been diagnosed. Girls and Latino children are disproportionately impacted by the problem of delayed diagnosis and under-identification of ASD, in part because clinicians are less likely to recognize ASD risk factors in them and refer them for an ASD evaluation. Therefore, predicting ASD risk at a population level is needed to enhance early and accurate detection, particularly in these underserved populations. Researchers are beginning to harness clinical informatics methods to identify ASD from real-world data in electronic health records (EHRs), using both structured (e.g., diagnosis codes) and unstructured data (e.g., physician notes). However, existing algorithms suffer from multiple major flaws, including non-representativeness of training samples, outdated diagnosis codes and natural language processing (NLP) methods, and a lack of ‘verified’ ASD diagnosis in their gold standard datasets.

This proposed research addresses these gaps by developing a contemporary ASD risk model that uses state-of-the-art machine learning and NLP methods. Using EHR data from Children’s Hospital Los Angeles (including a gold standard dataset with ‘verified’ ASD diagnoses from the Boone Fetter Clinic) and the OneFlorida Data Trust (a Florida state-wide EHR database), we will (1) develop a computable phenotype for ASD using both structured and unstructured EHR data (including parent-reported ASD discriminators and features associated with ASD that are often found in free text in children’s records), and (2) develop a machine-learning risk prediction model for ASD. This will lay the foundation for a clinical decision support tool, to be integrated into EHRs to notify a clinician when a child warrants ASD evaluation.

This has potential to improve ASD identification in all children, but it may particularly benefit girls and Latino children, reducing sex and ethnic disparities. Further, it will be easily expandable into a ‘next steps’ study to the overall PCORnet, which provides healthcare to over 24 million children. By using EHRs, this proposal holds promise for future cost-effective health systems interventions that can help to correct a sociodemographic ‘imbalance’ in ASD research by reaching girls and Latino children at risk for ASD.

Funding

Type	Source	Number	Amount
Federal	NIH National Institute of Mental Health	1R21MH129682-01	$467,187

USC Chan Division of Occupational Science and Occupational Therapy
1540 Alcazar Street, CHP 133, Los Angeles, CA 90089-9003

ACOTE accreditation | NBCOT certification

The USC entry-level master’s degree program (cost of attendance) is fully accredited by the Accreditation Council for Occupational Therapy Education® (ACOTE®) of the American Occupational Therapy Association (AOTA). The USC entry-level doctorate in occupational therapy (OTD) degree program (cost of attendance) has applied for accreditation and has been granted Preaccreditation Status by ACOTE®. View our program’s ACOTE® standards public data. ACOTE® c/o the American Occupational Therapy Association, Inc.®, 7501 Wisconsin Avenue, Suite 510E, Bethesda, MD 20814, (301) 652-AOTA, www.acoteonline.org. The program must complete an on-site evaluation and be granted Accreditation Status before its graduates will be eligible to sit for the national certification examination for the occupational therapist administered by the National Board for Certification in Occupational Therapy, Inc.® (NBCOT®).

Professional program graduates are eligible to apply for certification by National Board for Certification in Occupational Therapy, Inc.® (NBCOT®), nbcot.org. Program results from the NBCOT® can be found online at www.nbcot.org/Educators-Folder/SchoolPerformance.