Spokane startup Appiture is exploring new handheld technology for a fast and noninvasive way to screen for autism spectrum disorder in children.

The idea was born from research by Georgina Lynch, an associate professor in the Department of Speech and Hearing Sciences in the Washington State University Elson S. Floyd College of Medicine.

Lynch is also an Appiture co-founder and holds the role of scientific adviser within the company.

Lynch says her research explored the use of a physical biomarker known as the pupillary light reflex — or how the pupil grows and shrinks in response to light intensity — and its relation to identifying autism markers. More than 100 families have participated in the research, she adds. 

“The pupillary light reflex tells you a lot about how the brain is functioning in terms of your fight or flight response,” she says. “We know that in autism, the pupillary light reflex is atypical. That has provided the foundation for us to explore this as a potential screening tool to support medical providers.” 

Appiture also is the name of the company’s handheld camera-integrated device developed by former WSU students Lars Neuenschwander and TJ Goble, based off Lynch’s research. 

Neuenschwander and Goble entered the technology into the Holloman Health Innovation Challenge and were awarded the $10,000 Herbert B. Jones Foundation second-place prize and the Kent & Lisa Sacia Digital Health Prize of $2,500. 

The pair also entered the device in the WSU Business Plan Competition, where they took home the first-place prize, says Neuenschwander, who is co-founder and president of Appiture.

Lynch says that the research side of the project has been funded through the Elson S. Floyd College of Medicine. The startup currently is seeking funding from science and technology transfer grants and private funding that will be used for clinical trials and business operations and growth. 

Neuenschwander says preliminary software and hardware has been developed for Appiture, and an alpha prototype has been built. 

The next stage is to enter clinical trials and get feedback from area providers to determine what changes are needed to ensure the tool meets doctors’ needs, which Neuenschwander anticipates happening over the next two years. 

He adds that provider feedback is integral to the product development process.

“There have been previous companies that have tried to push technology to market that have dealt with trying to diagnose autism spectrum disorder, and they’ve done so without the support of the medical community,” Neuenschwander says. “We’re trying to focus on how we can get support from the providers.”

He adds, “How can we make sure we’re taking the time to do our due diligence?”

Lynch adds that provisional patents have been filed on the device and its software. Currently, Appiture is contracting out some of the product development, but she anticipates hiring staff in January to fill computer science, software engineering, biostatistician, and clinical expertise positions, as well as for software development.

Upon graduating from WSU with degrees in neuroscience and bioengineering, respectively, Goble headed to Texas for a job in software sales, while Neuenschwander relocated to Spokane to continue developing Appiture full time with Lynch. 

Neuenschwander says the goal is to develop a tool that will elicit and analyze the pupillary light reflex for specific biometrics that can be used as an indication of autism, or if one is at risk of developing autism during the developmental process.

“Many people have connections to this project, and many people feel passionately about this project,” he says.

Lynch adds that Appiture will be a faster, noninvasive device for objective autism screening. 

She says some doctors currently use multiple MRIs to assess risk for developing autism.

“We know that can identify your risk for later development of ASD as early as nine months, but that is a very invasive way to assess risk,” she contends. “What we know about pupillary light reflex is the response is rooted in the brain stem.” 

She adds that the pupillary light reflex is instantaneous, and the data can be gathered by the Appiture device in two to three minutes.  

“(Pupillary light reflex) is considered a relatively noninvasive way of measuring brain function in terms of typical versus atypical,” Lynch says. 

Lynch says she would like to see Appiture become part of general screening, much like height, weight, and blood pressure.

Behavioral tools such as questionnaires filled out by parents and subjective observation of a child’s behavior are the most common autism screening methods in medical practices currently, Lynch says.

“We know that in medical practice, you don’t have a lot of time to spend with families and kids at those well-child checks,” she says, adding that standard pupillary light reflex assessments also are subjective.

“There’s no documented, objective recording of that that goes into the medical record, so part of this new technology would provide those objective output measures so that it could be tracked over time in relation to development.” 

Lynch adds that a recent study conducted by the Children’s Hospital of Philadelphia found that a universal method of screening for autism, known as the Modified Checklist for Autism in Toddlers, was less than 15% accurate. 

The study, which was published in the journal Pediatrics, found that out of the just under 26,000 patients screened, M-CHAT only detected about 40% of children who went on to be diagnosed with autism spectrum disorder. 

The study also revealed significant disparities in detecting early autism symptoms in minority, urban, and low-income children.

“Part of what this is addressing is the fact that despite universal screening, over the last decade or so, the age of diagnosis is not decreasing, and we know that these behavioral tools lack that specificity that’s needed to help families get earlier access to intervention,” Lynch says.

She adds that the device already is receiving interest from health care institutions, such as the Seattle Children’s Hospital, as well as from local providers interested in participating in the study.