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Screening Tools “Extremely Effective” in Identifying Autism in Very Young Children
When used during well-child checkups, the Social Attention and Communication Surveillance–Revised (SACS-R) tool combined with the SACS-Preschool (SACS-PR) tool (SACS-R+PR) is highly accurate in detecting early autism in very young children, according to a study published online in JAMA Network Open.
“The SACS-R+PR has high diagnostic accuracy in prospectively identifying community-based infants, toddlers, and preschoolers on the autism spectrum,” researchers reported. “Furthermore, no children identified as being at high likelihood by the SACS-R or SACS-PR were typically developing; thus, all children required supports and services.”
The diagnostic accuracy study spanned 13,511 children in Melbourne, Australia, between the ages of 11 months and 42 months. Maternal and child health nurses were trained to use the SACS-R and SACS-PR tools at checkups, and children identified as being at high likelihood of autism were referred to the study team for diagnostic assessment.
The diagnostic accuracy of the SACS-R at 12 to 24 months was excellent, researchers reported. The study found an 82.6% positive predictive value, a 98.7% negative predictive value, and 99.6% specificity. Sensitivity was moderate, at 61.5%. However, when the SACS-PR was added at the 42-month assessment, the sensitivity increased to 96.1%.
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“These findings indicate that the SACS-R+PR has better psychometrics than other commonly used early autism screening tools, such as the Infant-Toddler Checklist, Brief Infant-Toddler Social and Emotional Assessment, and the Modified Checklist for Autism in Toddlers, with most studies not using purely community-based samples,” researchers wrote.
The SACS-R+PR investigation also identified the prevalence of autism in the study population: 1 in 50, or 2.0%, between 11 and 30 months of age, and 1 in 31, or 3.3%, between 11 and 42 months of age.
“Putting this extremely effective tool in the hands of a trained primary health professional, so that during their routine health checks they are also screening for autism, makes a huge difference to early diagnosis,” said lead author Josephine Barbaro, PhD, an associate professor at La Trobe University in Australia. “Not only is SACS-R the world’s most effective screening tool, unlike many it can be used within the community on large populations, enabling early identification of very young children across the board.”
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