What if one minute spent playing a game in the pediatrician’s waiting room could help more children with autism spectrum disorder (ASD) access earlier intervention and support?
Researchers at Kennedy Krieger Institute and Nottingham Trent University (NTU)—an award-winning, high-performing university in the United Kingdom—have developed a new tool called the Computerized Assessment of Motor Imitation (CAMI) that may make that possible. CAMI uses motion tracking to detect differences in motor imitation skills.
While CAMI is still a long way from the waiting room, a 2025 study from Kennedy Krieger and NTU shows that the tool was able to correctly distinguish children with autism from neurotypical children with an 80% success rate.
Their research study included 183 children whose ages ranged from 7 to 13 years old.
An 80% success rate holds special significance when talking about autism spectrum disorders because of how diverse the presentation of the condition can be, according to Dr. Stewart Mostofsky, one of the participating research scientists and the director at the Center for Neurodevelopmental and Imaging Research at Kennedy Krieger.
Kennedy Krieger is an internationally recognized nonprofit specializing in providing care, education, research and support for children and young adults with developmental disabilities and neurological disorders.
Mostofsky is also a professor of neurology at Johns Hopkins School of Medicine.
“Autism is a very heterogeneous disorder—very, very variable in its presentation as well as its causes … There are many, many things that have been associated with autism, and there’s a wide array of presentation,” Mostofsky says. “For a large subset of people with autism, it’s been theorized for decades that maybe imitation is a core problem that then starting early in life contributes to difficulty acquiring social skills and communication skill.”
The study also examined the CAMI scores of children with attention deficit hyperactivity disorder (ADHD) and children with both ADHD and ASD.
Mostofsky says he found the results of that comparison to be particularly interesting because they showed that children with ASD had difficulty with imitation regardless of whether they struggled with inattention.
Mostofsky notes that while differences in motor function are not part of the diagnostic criteria for diagnosing autism, it has been well established that many people with autism or their caregivers report problems with motor development.
A review published in the official journal of the American Academy of Pediatrics in 2021 analyzed 25 studies on early motor impairments reported in children with neurodevelopmental disorders.
This large-scale analysis found that children who are later diagnosed with ASD do often show motor difficulties early in life, but more research would be needed to determine whether spotting those difficulties early would be helpful in predicting or identifying neurodevelopmental disorders.
How does CAMI work?
In the game, a dancing avatar appears on-screen and starts moving. The player has to copy these moves to the best of their ability.
The avatar’s motions include the arms, legs, whole body movements and seated actions. The moves of the participant are tracked using cameras, and CAMI’s algorithms determine how accurately the participant is copying the avatar, Mostofsky explains.
After the child finishes playing, the results of the short game produce what the researchers call a “CAMI score.” This score shows how the player’s imitation ability compares with that of their peers.
“We’ve been investigating imitation in autism for years because imitation is crucial to social skill development and communicative abilities,” Mostofsky says.
While a CAMI score can’t be used to diagnose autism on its own, the score can indicate that further assessment or supports may be beneficial. Researchers hope that this indication could help children by identifying those who might need support sooner rather than later.
“I think it will be helpful for screening, but it—just as importantly—could help with guiding [the] best appropriate intervention,” Mostofsky says.
Early interventions for autism are more likely to have long-term positive effects on symptoms and later skills, according to the National Institute of Child Health and Human Development. These interventions often include speech therapy, occupational therapy, Applied Behavioral Analysis (ABA) and other therapies depending on the needs of the individual.
Mostofsky says that knowing that a child struggles with imitating movements could help caregivers and medical providers adapt their approaches in these interventions to meet that child’s needs more effectively.
What’s next?
While the 2025 study yielded intriguing results, researchers acknowledged the limitations of the small study in their analysis. The analysis also suggested that future studies should adapt CAMI for use with younger children and simplify instructions to make sure the tool is accessible to those with an intellectual disability.
Mostofsky is continuing to enroll children and adults for his study of motor imitation.
Those who are interested in participating can email [email protected] or call 443-923-9258
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