Prediction of Challenging Behaviors Associated with Profound Autism in a Classroom Setting Using Wearable Sensors

Body-focused repetitive behaviors, such as hair pulling and skin picking, are compulsive motor actions commonly associated with obsessive-compulsive and anxiety disorders. Their early, objective detection remains difficult because the movements are subtle and overlap with ordinary, non-pathological gestures. We developed and evaluated a multimodal deep learning framework to detect and classify these behaviors from wrist-worn sensor data. The data, collected by the Child Mind Institute using the Helios wrist-worn device, combine inertial measurement units, thermopile sensors, and time-of-flight sensors, capturing kinematic, thermal, and proximity information. The framework combined a convolutional neural network with a gated recurrent unit, alongside modality-specific autoencoders and a late-fusion classifier, to exploit temporal and spatial dynamics. It achieved an F1 score of 0.985 and an area under the receiver operating characteristic curve of 0.997 for binary detection, distinguishing these behaviors from other activities, and a macro-averaged F1 score of 0.700 with an area under the curve of 0.963 across a nine-class scheme that distinguished each individual behavior from a single grouped Non-Target class, improving over single-modality baselines. Post-hoc interpretability based on Shapley additive explanations showed that the time-of-flight and inertial modalities dominated discriminative power by capturing spatial proximity and dynamic movement, while hierarchical clustering indicated that misclassifications were driven primarily by the anatomical region of the gesture. These findings demonstrate that multimodal sensor fusion enables accurate, objective, and continuous behavioral monitoring. This work establishes a foundation for real-time, wearable-assisted mental health diagnostics and personalized interventions in biomedical research and clinical care.

The clinical management of autism spectrum disorder (ASD) faces a bottleneck in early screening, mainly because trained specialists are scarce and conventional assessment tools are subjective. Here, we introduce ASDchat, a multimodal large language model designed for evidence-based ASD screening, which takes video, audio, and dialogue as input. ASDchat adopts a dual-branch architecture, where the decision branch generates screening probabilities and the evidence branch generates traceable, timestamped behavioral evidence aligned with standardized clinical criteria (ADOS-2). The model was trained and evaluated on a dataset of 1,035 participants from 27 sites in China, which covered typically developing (TD) children, children with ASD, and children with other disorders. For ASD versus TD, ASDchat reached an area under the receiver operating characteristic curve (AUC) of 0.953 $\pm$ 0.021. On 9 held-out sites that were not used for training, the mean AUC was 0.932. Furthermore, unsupervised clustering of the behavioral dimensions split the ASD cases into six subtypes with different phenotypic profiles, and ASDchat suggests an intervention for each subtype. ASDchat provides a feasible path for large-scale, evidence-based early ASD screening in clinical practice.

Accurate Autism Spectrum Disorder (ASD) screening for school-age children is crucial to identify cases that may have been missed earlier and to enable timely interventions supporting social, cognitive, and academic development. Current ASD screening relies on subjective assessments and 2D analysis methods that fail to capture spatial displacement patterns characteristic of ASD behaviors. In this study, a novel 3D temporal analysis framework is presented, built on top of DECA (Detailed Expression Capture and Animation), a 3D modeling framework, to extract comprehensive head pose parameters (including translational components $T_x, T_y, T_z$) and facial expressions independent of pose variations. LSTM and GRU-based temporal classifiers were trained on the extracted 3D features from video data collected from 39 participants (19 ASD, 20 TD) aged 7-12 years during Virtual Reality-Continuous Performance Test tasks. The GRU-based models demonstrated superior performance, with 3D head pose features achieving 83.9% accuracy and 3D facial features reaching 81.4% accuracy, outperforming 2D baseline approaches by 10.7% and 7.5%, respectively. Furthermore, multimodal fusion of 3D head pose and facial features with PCA-based dimensionality reduction achieved the highest accuracy of 84.6%, outperforming unimodal approaches. This work establishes a foundation for objective, automated screening tools addressing current diagnostic limitations in ASD identification for school-age populations.