NeuroApex / science

The science behind the funnel

NeuroApex is a screening system, not a diagnostic one. Each level is a cheap, imperfect test that narrows who needs the next, costlier step. This page shows the maths, every test we plan to use, the papers behind them, and what we still must prove.

Screening, not diagnosis. A NeuroApex result means “worth a closer look”, never “the child has X”. Diagnosis is made only by qualified clinicians after Level 3 and clinical/medical confirmation.

1 · The funnel as Bayesian narrowing

Start with how common a condition is (the prior). Each test result multiplies the odds by a likelihood ratio (LR). The product is the posterior: how likely the child is to have the condition given everything seen so far.

odds(prior) = p / (1 − p) LR+ = Sensitivity / (1 − Specificity) LR− = (1 − Sensitivity) / Specificity odds(posterior) = odds(prior) × LR(L1) × LR(L2) × LR(L3 …) (assumes conditional independence) p(posterior) = odds / (1 + odds) PPV = Se·p / (Se·p + (1 − Sp)(1 − p))

Caveat: tests of the same child are correlated (e.g. L1 CPT and L2 coding both load on attention and speed), so multiplying LRs overstates certainty. The validation plan therefore fits a joint model (logistic regression / calibrated ML) on real data rather than relying on the product rule. The calculator below is for intuition.

Indian prevalence figures used as priors

Estimates differ widely because of design, age band, screening tool and case definition. Each is shown with its source paper (linked in the library). Figures are the authors' own.

Interactive funnel calculator

Sensitivity/specificity sliders are design assumptions to explore trade-offs, not measured NeuroApex performance. Measured values will come from the validation study (section 5).

Worked example (default sliders)

Reading: with a ~7% base rate, a positive L1 alone leaves a posterior well under 50% (most L1 positives are false alarms), which is why L1 is designed for high sensitivity and is only a gate. Specificity is bought by L2 and L3, whose cost is acceptable because few children reach them. For a rare condition (ASD ≈0.2%), the same tests give a much lower PPV, so ASD relies more on parent/teacher red flags plus clinician review.

2 · Test catalogue: Levels 1 & 2

All 25 tests, using the fixed IDs from the test registry. Each card lists what it measures, how the app delivers it, which scoring features are extracted, which conditions it informs, linked evidence (abstract text is the authors' own words) and honest limitations.

Passive channels (consented, on-device)

Accelerometer/gyro (fidgeting), touch pressure/area, ambient audio level (no speech recorded), optional on-device camera attention metrics (no video stored), device/timing metadata. These are context signals and quality controls; they are treated as exploratory until validated.

3 · Level 3: the 100-test confirmation catalogue

Level 3 is delivered by clinicians, not the app. It is the pool of instruments from which a clinician chooses according to the L1/L2 profile. G = established clinical instrument or standard work-up used when indicated; R = research-only or exploratory, never used alone for diagnosis. Papers are linked where the library holds a relevant one. The G/R labels reflect general practice; the guideline-by-guideline mapping (ICMR, IAP, DSM-5, NICE etc.) is a to-do in the validation plan.

4 · Paper library

Searchable. Only the authors' own abstract text is shown, never our paraphrase of results. “PDF” opens a local open-access copy; papers without a PDF link to the open-access page (PMC) or DOI.

5 · Reliability & defensibility

A screener is only useful if it is reliable, valid, fair across languages and honestly reported. This is the plan, with what exists and what is still to do.

Psychometrics plan

  • Reliability: test–retest at 1–2 weeks (ICC ≥ 0.75 target for task scores; ≥ 0.70 for questionnaires), internal consistency (ω/α) for questionnaires, split-half for tasks.
  • Validity: convergent (against Conners/SNAP-IV/SDQ etc.), criterion (against clinician diagnosis), known-groups.
  • Structure: factor analysis / IRT for questionnaire items; adaptive difficulty tuned by IRT.
  • Device quality: timing calibration and latency checks per device model; reject low-quality sessions.
  • Methods anchored in COSMIN and scale-development best-practice papers (see library, tag STD).

India norming

  • Age-banded norms (8, 9, 10-year bands; half-year bands if sample allows) by sex.
  • Stratified sampling across states/languages, government/private/aided schools, urban/rural.
  • Norms published with confidence intervals; percentile and z-score cut-offs, not foreign cut-offs.
  • Evidence that foreign norms do not transfer: authors of an Indian SDQ normative paper (library) and cross-national SDQ comparisons are in the library.

Fairness: DIF across languages

  • Differential item functioning (DIF) by language, sex, school type and SES for every questionnaire item and task item (IRT-based or Rasch-based; see Hagquist 2017 in library).
  • Items showing meaningful DIF are rewritten or dropped, never just translated.
  • Phonological tests (L1-05, 06, 07) are built per language, since digit length and orthography differ.
  • Audit the false-positive rate per subgroup before release.

“Screening, not diagnosis”

  • Output is a risk tier plus suggested next step, not a label.
  • Parent-facing language is neutral and strength-based; no diagnosis term appears in results to families.
  • Every referral goes to a qualified clinician; app results are shared as context.
  • Known confounders (sleep, vision/hearing, language of instruction, device) are checked and shown with the result.

Validation study design

  1. Phase A: pilot (n≈150–300): usability, timing, item analysis, test–retest.
  2. Phase B: norming (n≈2,000–4,000): stratified Indian school sample; norms and DIF.
  3. Phase C: diagnostic accuracy: NeuroApex L1/L2 against independent clinician reference standard (blind to app score), with oversampling of screen-positives and a random sample of screen-negatives to correct for verification bias.
  4. Phase D: external/prospective validation in new schools and languages.
  5. Reporting follows STARD 2015 (diagnostic accuracy) and TRIPOD+AI principles for the prediction model; study design registered; ethics approval (institutional ethics committee, ICMR guidelines); DPDP-compliant verifiable parental consent.

Sample-size calculator (diagnostic accuracy)

n(cases) = Z² · Se · (1 − Se) / d² (precision of sensitivity) n(controls) = Z² · Sp · (1 − Sp) / d² (precision of specificity) N(total) = max( n(cases) / prevalence , n(controls) / (1 − prevalence) ) [Buderer-type formula]

See the sample-size paper in the library (tag STD) for the full discussion. Prevalence below is the prevalence in the validation sample (not in the population).

6 · Data & ML roadmap

Rule-based scoring first, ML later and only when validated data exists. Papers in the library that report ML on screening data show the idea is feasible, but their data and populations differ from ours, so none of their accuracy numbers are transferred to NeuroApex.

Stage 0: Rules (now)

Transparent z-score and percentile cut-offs per test, age-banded norms, simple risk tiers. Fully auditable.

Stage 1: Data collection

Consented, de-identified, on-device-first pipeline. Store features (not raw audio/video). Link to clinician outcome only with consent. Data dictionary and versioning from day one.

Stage 2: Calibrated models

Regularised logistic regression and gradient boosting on task features + questionnaires; calibration (Platt/isotonic), cross-validation grouped by school, reported with TRIPOD+AI. Handles correlated tests, unlike the naive LR product.

Stage 3: Kinematics & time-series

Touch-trajectory models for tracing (dysgraphia/DCD) and RT-distribution models (ex-Gaussian / drift-diffusion) for attention tasks.

Stage 4: Fairness & drift

Per-language/sex/school-type calibration and error audits; device-model drift monitoring; re-norming every 2–3 years.

Stage 5: Regulatory & deployment

Locked model versions, change control, human-in-the-loop review, documentation for software-as-medical-device review if claims expand. Explainable per-child “why this tier” output.

Related library papers carry the tag ML.