Prospective Identification of Autism Spectrum Disorder in Infancy and Toddlerhood in an Australian Community-Based Sample: The Social Attention and Communication Study (SACS)

Background: In Australia, children with an Autism Spectrum Disorder (ASD) typically do not receive a diagnosis until 3-years of age, despite many parents suspecting a problem within the first year of life. Although early markers of ASD have been found as early as 6-months, there is little research to date on the prospective identification of these children prior to 18-months.

Objectives: The overall objective in this longitudinal study was to determine whether routine monitoring within the Victorian Maternal and Child Health (MCH) service of a set of social attention and communication behaviours can facilitate the prospective identification of infants who will receive a diagnosis of Autistic Disorder (AD)/ASD, in a community based sample.

Methods: Two-hundred and forty one MCH nurses from 17 Local Government Areas in metropolitan Melbourne were trained on developmental markers of ASDs in infancy. Approximately 22,000 children were then monitored at regular intervals on key items during four routine check-ups (at 8-, 12-, 18-, and 24-months) at their local MCH centre. All children deemed to be ‘at risk’ of an ASD by showing a ‘pattern’ of failure on the key items were referred to the SACS. A thorough developmental and behavioural assessment was undertaken at referral, and all referred children were followed up at 6-monthly intervals until 24-months when the ADOS and ADI-R were administered.

Results: Data on the referred sample to date (100 children so far) will be presented, including ascertainment rates for AD/ASD (currently 80%), and the developmental profiles of the three groups of children (developmental and/or language delay; AD; ASD) at 12-, 18- and 24-months.

Conclusions: The results from this unique data set are very promising, and indicate that it is possible to prospectively identify children with an AD/ASD as early as 12-months via routine monitoring by community service providers in a community based sample of infants.