Australia develops ‘world’s most effective’ autism screening tool

The diagnosis of autism spectrum disorder (ASD) can be challenging, and often requires a lengthy and rigorous assessment process.
 
The average age of diagnosis in Australia is somewhere between four and six years old, with delays not uncommon.
 
Diagnostic delays can also restrict timely access to intervention services, which can have long-lasting consequences for those affected.
 
But this could soon change, with new research published in JAMA Open confirming just how effective an already existing screening tool can be.
 
While not new – it was developed 15 years ago by Associate Professor Josephine Barbaro from La Trobe University’s Olga Tennison Autism Research Centre (OTARC) – the Social Attention and Communication Surveillance-Revised (SACS-R) has been found to effectively cut the average age of diagnosis in half.
 
The five-year long Australian study, which looked at over 13,500 Victorian children, found the SACS-R screening tool to be extremely accurate in identifying very young children on the autism spectrum.
 
According to the research, 83% of children aged between 12–24 months and identified as having a ‘high likelihood’ of ASD by the tool were later confirmed to have the condition.
 
The study also found that when used alongside a SACS-Preschool health check, the resource was 96% effective at diagnosing children with ASD by the time they were three-and-a-half years old, which is much earlier than the current average.
 
Lead researcher and author of the tool, Associate Professor Barbaro, believes the research speaks for itself.
 
‘Not only is SACS-R the world’s most effective screening tool, unlike many [others], it can be used within the community on large populations, enabling early identification of very young children across the board,’ she said.
 
‘Early diagnosis improves developmental outcomes, increases participation in schooling, and allows children to understand their needs and identity from a young age.
 
‘Putting this extremely effective tool in the hands of a trained primary health professional, so that during their routine health checks they are also monitoring for autism, makes a huge difference to early diagnosis.’
 
The tool focuses on specific age-dependent behaviours that are characteristic in children on the spectrum, which includes infrequent or inconsistent use of behaviours such as eye contact, pointing and pretend play.
 
Chair of RACGP Specific Interests Child and Young Person’s Health, Dr James Best, welcomes the news and says the latest data is ‘quite ground-breaking’.
 
‘The prediction of an ASD diagnosis is really high, and much better than anything else around the world,’ he told newsGP.
 
‘More broadly, it shows that autism can be picked up much earlier on if using the right techniques.
 
‘This is extremely important because we know that early intervention makes a big difference. And this just reinforces the fact that we should be thinking about a child’s development, including social and communication development, at these very young ages.’
 
The tool has already been rolled out statewide in Victoria, after the Victorian Government funded training for maternal and child health (MCH) nurses in 2019.
 
That means Victorian children attending routine health checks with a MCH nurse at 12, 18 and 24 months are screened with the SACS-R tool and those identified at ‘high likelihood’ for autism are then referred to early intervention and for an autism assessment.
 
The tool is also used in Tasmania, and training of health professionals has occurred in New South Wales, Queensland, South Australia and Western Australia, as well as 10 other countries worldwide.
 
But practically, there are still some challenges that remain.
 
Speaking with newsGP, Associate Professor Barbaro acknowledged that every state and territory is different in its service delivery, and not every child will see a child health nurse for check-ups as they do in Victoria.
 
These differences are part of the reason why her team recently undertook a multi-state randomised-controlled trial of GPs implementing early developmental surveillance across general practices in NSW as well as Victoria.
 
Associate Professor Barbaro said a key piece of feedback from GPs is that it was difficult to fit additional behavioural screening into their usual work.
 
‘What we are really trying to advocate for, following the RCT, is for the [Federal] Government to have a separate Medicare item for developmental checks,’ she said.
 
‘But we know that can take many years.’
 
Until such time that the tool can be more widely funded for use in general practices across Australia, Associate Professor Barbaro encourages all GPs to be aware of the early signs of autism so that timely referrals can be made.
 
‘We really want GPs to be aware of the key behaviours that are predictive of autism and be open to training and education, as training is key to understanding how to identify and refer children who have a high likelihood of autism,’ she said.
 
‘The team at La Trobe University offers group training [face-to-face or virtual], as well as online, self-paced training.
 
‘When GPs have this information in the back of their mind and they do see these children, they’re essentially filling out that checklist mentally, and can refer onto a diagnostician for early assessment, as well as straight onto Early Childhood Intervention [ECI] of the NDIS for appropriate and timely management.’
 
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Autism child health screening tool