A Pilot Investigation of the Social Attention and Communication Surveillance (SACS) Tool for the Early Identification of Autism in Tianjin, China (SACS-C)

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Barbaro, J., Wang, C., Wang, J., Liu, G., Liang, Y., Wang, J., Abdullahi, I., & Dissanayake, C. (2020). A Pilot Investigation of the Social Attention and Communication Surveillance (SACS) Tool for the Early Identification of Autism in Tianjin, China (SACS-C). Frontiers in Neurology, 11, 597790-597790. https://doi.org/10.3389/fneur.2020.597790

Publication date: 16 Nov 2020 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. Chongying Wang
  3. Jing Wang
  4. Gongshu Liu
  1. Ying Liang
  2. Ji Wang
  3. Ifrah Abdullahi
  4. Cheryl Dissanayake

Abstract

Introduction: Autism spectrum disorder (ASD) comprises difficulties in social communication and restrictive and repetitive behaviours. Despite an increased global prevalence, little remains known about detection and diagnosis of ASD in mainland China. Our aim was to conduct a pilot investigation of Social Attention and Communication Surveillance in Tianjin, China (SACS-C) to identify ASD early by professionals, compared to the Checklist for Autism in Toddlers-23 (CHAT-23) completed by parents and professionals. Methods: A total of 10,514 children were monitored at the Tianjin Women and Children’s Health Centre (TWCHC) on the SACS-C at 12 - 24 months of age following a half-day training of 225 child health practitioners. Children deemed at “high likelihood” for ASD on either the SACS, CHAT-23, or both, were referred for developmental assessments at TWCHC. Results: A total of 87 children (0.8%) were identified at “high likelihood” on the SACS-C, of whom 57 were assessed for ASD (66%); 24 children were subsequently diagnosed with ASD (42.1%), and the remaining 33 (57.9%) were diagnosed with developmental and/or language delays. The SACS-C had a positive predictive value (PPV) of 42.1%, a negative predictive value (NPV) of 99.8%, and sensitivity and specificity of 53.3% and 99.7%, respectively. Only 21 children were identified at “high risk” for ASD on the CHAT-23 (.2%), with 14 children assessed for ASD (66%); nine were diagnosed with ASD (64.3%) and the remaining five children were diagnosed with developmental and/or language delays. The CHAT-23 had an overall PPV of 64.3%, NPV of 99.6%, sensitivity of 27.3%, and specificity of 99.9%. Conclusion: This was the first large-scale study identifying ASD in 12-24-month-old children in Tianjin, China. We ascertained the feasibility of training community health practitioners to monitor infants and toddlers for the early signs of ASD, and determined the effectiveness of SACS-C. Furthermore, the SACS-C had a better balance between accuracy and sensitivity in detecting ASD, with the CHAT-23 missing the majority of children on the spectrum (72.7%) vs the SACS-C (46.7%). However, more work is needed to improve the psychometric properties in using the SACS-C in mainland China to make it comparable to its use in Australia.

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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
47
With a DOI
38
Without a DOI, from raw bibliography text
9
7 / 47 (14.9%) cited references include at least one author identified as autistic.
References with data to complete
2 / 47 (4.3%)
References with detected author names
45 / 47 (95.7%)
Without detected author names
2
Without a structured title
0
Without a stable identifier
6
References with raw author names still to review
0
References with external metadata lookup issues
3
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
262
From DOI or external metadata
262
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
49 / 262 (18.7%) names are linked to an author already present in AutiHub. 213 / 262 (81.3%) names are not yet linked.
Names linked to a person identified as autistic
7 / 262 (2.7%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 7 / 49 (14.3%). Distinct people identified as autistic: 1 / 216 (0.5%).
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