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, Article 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 behaviors. Despite an increased global prevalence, little remains known about early detection and diagnosis of autism in Mainland China. Our aim was to conduct a pilot investigation of the implementation of an Australian tool, Social Attention and Communication Surveillance (SACS), in Tianjin, China (SACS-C) by trained professionals to identify autism early compared to the Checklist for Autism in Toddlers-23 (CHAT-23) completed by parents and professionals. Materials and Methods: A total of 10,514 children were monitored across 61 Community Health Service Centres in six Tianjin districts on the SACS-C at 12, 18, and 24 months of age following a half-day training of 225 child health practitioners. Children deemed at "high likelihood" for autism on either the SACS, CHAT-23, or both, were referred for developmental assessments at the Tianjin Women and Children's Health Centre (TWCHC). Results: A total of 87 children (0.8%) were identified at "high likelihood" on the SACS-C, of whom 57 (66%) were assessed for autism; 24 children were subsequently diagnosed with autism (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 autism on the CHAT-23 (0.2%), over four times fewer children than the SACS-C, with 14 children assessed for autism (66%); nine were diagnosed with autism (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 autism in 12-24-month-old children in China. We ascertained the feasibility of training community health practitioners to monitor infants and toddlers for the early signs of autism, and determined the effectiveness of their use of SACS-C which had a better balance between accuracy and sensitivity in detecting autism in contrast to the CHAT-23 which missed the majority of children with autism (72.7%) vs. the SACS-C (46.7%). Given the emphasis on identifying as many children with autism as possible in Mainland China, SACS-C was identified as the tool of choice by the TWCHC. However, more work is needed to improve the psychometric properties in using the SACS-C in Mainland China so that it is comparable to its use in Australia.

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Cited references
47
With a DOI
40
Without a DOI, from raw bibliography text
7
7 / 47 (14.9%) cited references include at least one author identified as autistic.
References with data to complete
1 / 47 (2.1%)
References with detected author names
46 / 47 (97.9%)
Without detected author names
1
Without a structured title
0
Without a stable identifier
4
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
266
From DOI or external metadata
266
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
54 / 266 (20.3%) names are linked to an author already present in AutiHub. 212 / 266 (79.7%) names are not yet linked.
Names linked to a person identified as autistic
7 / 266 (2.6%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 7 / 54 (13.0%). Distinct people identified as autistic: 1 / 218 (0.5%).
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