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Eligibility Survey

Page 1 of 2

Date Completed

A Prospective, Multi-Center, Longitudinal Study of Dynamic Quantification of Social-Visual Engagement (DQSVE) For Treatment Monitoring In Children with Autism Spectrum Disorder (ASD)

Thank you for your interest in this study. Below is a detailed description of the study procedures and eligibility
criteria:

The purpose of this study is to look at an investigational medical device, the EarliPoint™ Evaluation for Autism Spectrum Disorder treatment.

The device tracks where children are looking while watching videos. This shows us how typically developing children and those with autism explore the world differently. The goal is to see if the device can track treatment progress for autism in children 1 to 7 years (15-84 months) in a way comparable to current diagnostic tests.

If your child is enrolled, they will watch some social videos on the device and undergo gold-standard diagnostic assessments in the first study visit. The visit can take up to 4 hours. After completing the first visit, there will be follow-up visits to track progress.

This study is being conducted solely for research purposes and your participation is strictly voluntary. If you are interested in taking part, we will ask you to sign a form to indicate that you consent to taking part in the study. If you consent to participate, you may withdraw from the study at any time. You will receive compensation for participation.

Your child may be eligible if they are:

15 - 84 months of age.
Diagnosed with ASD or related developmental delays (DD)
Are physically able to sit at a table and watch age-appropriate videos.
Able to understand instructions given in English.
Have normal to corrected-to-normal vision and hearing.

*Please note that enrollment for typically developing children (i.e., children without ASD/DD) has been closed. However, typically developing children can still participate in our other Measure ASD study. You can find more information about that study at https://www.unmc.edu/mmi/research/active/measure-asd.html .

*Enrollment for children with ASD who are 31-84 months of age has been closed. We are still recruiting Children with ASD who are 15-30 months of age for this study.

If you are interested in participating in this study and believe you meet the eligibility criteria, you will need to answer several short questions. These questions will take about 5 minutes to complete.

Would you like to continue with the eligibility questions?

* must provide value

Yes

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How did you hear about the study?

Is your child between the ages of 15 - 78 months?
If needed, enter the child's date of birth below and the following field will calculate the age in months.

* must provide value

Yes

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Date of Birth

M-D-Y

Age in months

View equation

Is your child typically developing or has a diagnosis of ASD and/or related developmental delays?

* must provide value

Typically Developing

Autism Spectrum Disorder and/or related developmental delays

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Has your child been suspected of, or have they exhibited signs of, autism or developmental delays?

* must provide value

Yes

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Has your child been established in treatment (e.g., a treatment plan has been developed and the child is undergoing treatment or will immediately begin treatment) and do you intend for your child to remain in treatment continuously throughout the duration of the study (6 months)?

* must provide value

Yes

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How does your child typically communicate? (Select all that apply).

Gestures

Leadings adults (i.e., grabbing an adult and leading them to get access)

Single word or word approximations

Phrase speech (e.g., "give me milk," "I want ball")

Fluent speech ("I want to go to the store because I want a new toy" or "I wanted to eat pancakes for breakfast but we did not have any at home.")

Do you have any developmental or behavioral concerns for your child?

Yes

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Does your child have any severe visual impairments that are not corrected by glasses?

Yes

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If yes, would this impact their ability to watch short videos?

Yes

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Does your child use corrective lenses?

Yes

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If corrective lenses are used, what is the prescription?

Does your child have any severe hearing impairments?

Yes

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If yes, would this impact their ability to hear short videos with social interactions?

Yes

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Does your child have an uncontrolled seizure disorder?

Yes

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Would your child be able to watch about 20 minutes worth of videos?

Yes

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Is your child currently participating in another research study?

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.