Diagnostic Accuracy of the Social Attention and Communication Surveillance–Revised With Preschool Tool for Early Autism Detection in Very Young Children

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Barbaro, J., Sadka, N., Gilbert, M., Beattie, E., Li, X., Ridgway, L., Lawson, L. P., & Dissanayake, C. (2022). Diagnostic Accuracy of the Social Attention and Communication Surveillance–Revised With Preschool Tool for Early Autism Detection in Very Young Children. JAMA Network Open, 5(3), e2146415. https://doi.org/10.1001/jamanetworkopen.2021.46415

Publication date: 11 Mar 2022 Added to AutiHub: 7 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
8
Publication authors identified as autistic
1 / 8 (12.5%)
  1. Josephine Barbaro *
  2. Nancy Sadka
  3. Melissa Gilbert
  4. Erin Beattie
  1. Xia Li
  2. Lael Ridgway
  3. Lauren P. Lawson
  4. Cheryl Dissanayake

Abstract

Importance: Early identification of children on the autism spectrum is crucial to facilitate access to early supports and services for children and families. The need for improved early autism identification tools is highlighted by the lack of sufficient diagnostic accuracy in current tools. Objectives: To examine the diagnostic accuracy of the Social Attention and Communication Surveillance-Revised (SACS-R) and SACS-Preschool (SACS-PR) tools when used with a large, community-based, convenience sample and identify the prevalence of autism in this sample. Design, Setting, and Participants: This diagnostic accuracy study was conducted in Melbourne, Australia, training maternal and child health nurses who monitored 13 511 children aged 11 to 42 months using the SACS-R and SACS-PR during their routine consultations (June 1, 2013, to July 31, 2018). Children identified as being at high likelihood for autism (12-24 months of age: n = 327; 42 months of age: n = 168) and at low likelihood for autism plus concerns (42 months of age: n = 28) were referred by their maternal and child health nurse for diagnostic assessment by the study team. Data analysis was performed from April 13, 2020, to November 29, 2021. Exposures: Children were monitored with SACS-R and SACS-PR at 12, 18, 24, and 42 months of age. Main Outcomes and Measures: Diagnostic accuracy of the SACS-R and SACS-PR was determined by comparing children's likelihood for autism with their diagnostic outcome using clinical judgment based on standard autism assessments (Autism Diagnostic Observation Schedule-Second Edition and Autism Diagnostic Interview-Revised). Results: A total of 13 511 children (female: 6494 [48.1%]; male: 7017 [51.9%]) were monitored at least once with the SACS-R at their 12-, 18-, and 24-month-old routine maternal and child health consultations (mean [SD] age, 12.3 [0.59] months at 12 months; 18.3 [0.74] months at 18 months; 24.6 [1.12] months at 24 months) and followed up at their 42-month maternal and child health consultation (mean [SD] age, 44.0 [2.74] months) with SACS-PR (8419 [62.3%]). At 12 to 24 months, SACS-R showed high diagnostic accuracy, with 83% positive predictive value (95% CI, 0.77-0.87) and 99% estimated negative predictive value (95% CI, 0.01-0.02). Specificity (99.6% [95% CI, 0.99-1.00]) was high, with modest sensitivity (62% [95% CI, 0.57-0.66]). When the SACS-PR 42-month assessment was added, estimated sensitivity increased to 96% (95% CI, 0.94-0.98). Autism prevalence was 2.0% (1 in 50) between 11 and 30 months of age and 3.3% (1 in 31) between 11 and 42 months of age. Conclusions and Relevance: The SACS-R with SACS-PR (SACS-R+PR) had high diagnostic accuracy for the identification of autism in a community-based sample of infants, toddlers, and preschoolers, indicating the utility of early autism developmental surveillance from infancy to the preschool period rather than 1-time screening. Its greater accuracy compared with psychometrics of commonly used autism screening tools when used in community-based samples suggests that the SACS-R+PR can be used universally for the early identification of autism.

Bibliography cited by this reference

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Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 12 Sep 2026 01:04.

Cited references
71
With a DOI
58
Without a DOI, from raw bibliography text
13
13 / 71 (18.3%) cited references include at least one author identified as autistic.
References with data to complete
9 / 71 (12.7%)
References with detected author names
68 / 71 (95.8%)
Without detected author names
3
Without a structured title
9
Without a stable identifier
13
References with raw author names still to review
3
References with external metadata lookup issues
2
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
380
From DOI or external metadata
380
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
7
102 / 380 (26.8%) names are linked to an author already present in AutiHub. 278 / 380 (73.2%) names are not yet linked.
Names linked to a person identified as autistic
13 / 380 (3.4%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 13 / 102 (12.7%). Distinct people identified as autistic: 1 / 305 (0.3%).
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