Implementing and evaluating Social Attention and Communication Surveillance (SACS) to prospectively identify autism in very young children in Nepal

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Shrestha, R., Dissanayake, C., & Barbaro, J. (2021). Implementing and evaluating Social Attention and Communication Surveillance (SACS) to prospectively identify autism in very young children in Nepal. Research in Developmental Disabilities, 115, 104013. https://doi.org/10.1016/j.ridd.2021.104013

Publication date: 15 Jun 2021 Added to AutiHub: 7 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
3
Publication authors identified as autistic
1 / 3 (33.3%)
  1. Rena Shrestha
  2. Cheryl Dissanayake
  3. Josephine Barbaro *

Abstract

BACKGROUND: Although Autism Spectrum Disorder (ASD) can be identified as early as 12 months and diagnosed by 24 months, the mean age of diagnosis of ASD in Nepal is ∼58 months, with children missing the opportunity for early intervention. AIMS: This study implemented and evaluated a Nepali version of the Social Attention and Communication Surveillance (SACS-N) tool, to identify children between 11-30 months who are at "high likelihood" of ASD in a local community in Nepal. METHODS: Sixty Female Community Health Volunteers (FCHVs) were trained to monitor and identify the early signs of ASD using SACS-N. RESULTS: Overall, 1926 children were monitored with the SACS-N, with 11 children (0.57 %) referred for further assessments at 11-15 months (n = 4), 16-21 months (n = 4), and 22-30 months (n = 3). Of these children, 10 children had a developmental disorder, including ASD and Global Developmental Delay; no information was available on one child who migrated. Hence, the positive predictive value (PPV) of SACS-N for all developmental disorders was 100 %. Of seven children attending a gold standard diagnostic/ developmental assessment, three had ASD (43 % PPV for ASD). The estimated prevalence of ASD ranged between 0.16 % to 0.26 %. CONCLUSION: Community-based developmental monitoring of ASD and other developmental delays by FCHVs is a feasible, cost-effective and sustainable approach to promoting early identification of ASD in Nepal. Further training and awareness of autism is needed for more accurate and increased referral rates using the SACS-N, including regular supervision of FCHVs.

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Cited references
90
With a DOI
71
Without a DOI, from raw bibliography text
15
8 / 90 (8.9%) cited references include at least one author identified as autistic.
References with data to complete
1 / 90 (1.1%)
References with detected author names
90 / 90 (100.0%)
Without detected author names
0
Without a structured title
1
Without a stable identifier
15
References with raw author names still to review
0
References with external metadata lookup issues
1
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
415
From DOI or external metadata
415
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
72 / 415 (17.3%) names are linked to an author already present in AutiHub. 343 / 415 (82.7%) names are not yet linked.
Names linked to a person identified as autistic
8 / 415 (1.9%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 8 / 72 (11.1%). Distinct people identified as autistic: 1 / 360 (0.3%).
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