Early Identification of Autism Using Cry Analysis: A Systematic Review and Meta-analysis of Retrospective and Prospective Studies

Cry analysis is emerging as a promising tool for early autism identification. Acoustic features such as fundamental frequency (F0), cry duration, and phonation have shown potential as early vocal biomarkers. This systematic review and meta-analysis aimed to evaluate the diagnostic value of cry characteristics and the role of Machine Learning (ML) in improving autism screening. A comprehensive search of relevant databases was conducted to identify studies examining acoustic cry features in infants with an elevated likelihood of autism. Inclusion criteria focused on retrospective and prospective studies with clear cry feature extraction methods. A meta-analysis was performed to synthesize findings, particularly focusing on differences in F0, and assessing the role of ML-based cry analysis. The review identified eleven studies with consistent acoustic markers, including F0, phonation, duration, amplitude, and voice quality, as reliable indicators of neurodevelopmental differences associated with autism. ML approaches significantly improved screening precision by capturing non-linear patterns in cry data. The meta-analysis of six studies revealed a trend toward higher F0 in autistic infants, although the pooled effect size was not statistically significant. Methodological heterogeneity and small sample sizes were notable limitations across studies. Cry analysis holds promise as a non-invasive, accessible tool for early autism screening, with ML integration enhancing its diagnostic potential. However, the findings emphasize the need for large-scale, longitudinal studies with standardized methodologies to validate its utility and ensure its applicability across diverse populations. Addressing these gaps could establish cry analysis as a cornerstone of early autism identification.