AUTHOR=Dotzer Maria , Kachel Ulrike , Huhsmann Jan , Huscher Hendrik , Raveling Nils , Kugelmann Klaus , Blank Stefanie , Neitzel Isabel , Buschermöhle Michael , von Polier Georg G. , Radeloff Daniel 

TITLE=Identification of smile events using automated facial expression recognition during the Autism Diagnostic Observation Schedule (ADOS-2): a proof-of-principle study

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1497583

DOI=10.3389/fpsyt.2025.1497583

ISSN=1664-0640

ABSTRACT=IntroductionThe diagnosis of autism spectrum disorder (ASD) is resource-intensive and associated with long waiting times. Digital screenings using facial expression recognition (FER) are a promising approach to accelerate the diagnostic process while increasing its sensitivity and specificity. The aim of this study is to examine whether the identification of smile events using FER in an autism diagnosis utilisation population is reliable.MethodsFrom video recordings of children undergoing the Autism Diagnostic Observation Schedule (ADOS-2) due to suspected ASD, sequences showing smile and non-smile events were identified. It is being investigated whether the FER reliably recognizes smile events and corresponds to a human rating.ResultsThe FER based on the facial action unit mouthSmile accurately identifies smile events with a sensitivity of 96.43% and a specificity of 96.08%. A very high agreement with human raters (κ = 0.918) was achieved.DiscussionThis study demonstrates that smile events can in principle be identified using FER in a clinical utilisation population of children with suspected autism. Further studies are required to generalise the results.