Right Kids, Right Time, Right Services: Developmental Surveillance in Early Childhood Education Settings

Background:   Children who are at risk for autism spectrum disorder (ASD) would benefit from early identification and access to early intervention, as this takes advantage of children’s early brain plasticity and improves outcomes for families and children.  ASD can be reliably detected in children as young as 18 months of age, although developmental surveillance practices are inconsistent in community health settings and many developmentally vulnerable children are not identified until late preschool or school age. Childcare settings present an ideal yet underutilized opportunity for ongoing developmental surveillance and appropriate, timely referral of young children to allied health supports.

Objectives: This study aims to implement and evaluate a system for identifying young children who have early signs of Autism Spectrum Disorder (ASD) and other developmental challenges in early childhood education and care centers in regional Australia.  Using the Social Attention and Communication Surveillance (SACS; Barbaro & Dissanayake, 2010), a highly reliable developmental monitoring system which has recently been developed and validated with maternal child health nurses in Australia, this study aims to improve the health and wellbeing of children who are showing early signs of ASD by increasing the capacity of those professionals working closely with young children and families on a daily basis to accurately and efficiently identify which children would most benefit from specialized early intervention services.

Methods: Early childhood educators were trained and supported to completed developmental surveillance using SACS-R in their centres every 6 months over an 18 month period.  Any child identified as being at risk for developmental challenges received comprehensive developmental assessment including Autism Diagnostic Observation Schedule (ADOS-2). Specificity, sensitivity, positive and negative predictive values of SACS-R and common parent report measures was determined using regression and receiver operating characteristic (ROC) curve analysis.  Qualitative survey and interview data collected from participating educators and families provides information related to the perspective of educators on their role in the process of developmental surveillance and a deeper understanding of the nature of any barriers preventing families from accessing evidence-based early intervention supports in a timely manner.  

Results:   The inter-rater reliability of early childhood educators compared with maternal child health nurses is high (98%). Specificity, sensitivity and positive predictive value of SACS-R administered prospectively in natural groups of young children by early childhood educators is significantly higher when compared with commonly used parent report measures in accurately detecting the early signs of ASD in children aged 12 months- 4 years.  

Conclusions:  Understanding the effectiveness of current and emerging screening and surveillance tools and processes available to early childhood educators is critical in supporting their involvement in early identification of young children with ASD and has implications for policy and practice across the health and early childhood education sectors for timely, efficient and widely available early detection.