YouTube videos don’t auto-play, so I don’t think Twitch embeds should either. Also, the display is small compared to YouTube (300x150 vs. 480x270). A consistent width for embeds would be cool.
Oh and the preview display for Twitch channels is kind of odd (it shows the channel’s profile image but only the embed is shown once the post is published).
Unfortunately this is what Twitch proves in their meta data that Discourse uses to embed.
It would require creating a custom Twitch Onebox parser which would do it’s own logic. That or similar to LazyYT, create a LazyTwitch which would make a better preview and click to play without actually loading the Twitch embed.