Right Kids, Right Time, Right Services: Translating Research to Practice in Early Detection of Developmental Challenges in Early Childhood Education Settings

Background:  Valid and reliable tools have recently been developed to accurately detect early signs of autism spectrum disorder (ASD) and other developmental challenges in children as young as 12 months of age. Translation of research findings to practice and policy through routine implementation of evidenced-based tools in the community, particularly early childhood education and care childcare settings is limited and a two year delay for young children with early signs of ASD in accessing diagnostic assessment and early intervention persists in many communities.

Objectives:   The study aimed to compare the effectiveness of current practice of developmental surveillance (PEDS; broadband open questions completed by parents) with the Social Attention and Communication Surveillance system (SACS-R; targeted checklist of key markers for ASD and developmental delay at multiple age points completed by educators or nurses) in both health and early childhood education settings in the early detection of ASD.

Methods:  A comparison of results of developmental surveillance using PEDS and SACS-R was conducted in two separate prospective, longitudinal cohort studies to establish reliability and validity of developmental surveillance procedures across health and education settings, urban and regional locations and sample across a range of demographic conditions.

Results:  This study established that the interrater reliability of early childhood educators in administering the SACS-R is similar to nurses and is very high (k = 0.909). Reliance on parent report alone via PEDS, as is current practice in many communities, has the potential to miss nearly half of children (48.2%) undergoing developmental monitoring. Sensitivity, specificity, positve and negative predictive values of SACS and PEDS are reported based on comprehensive developmental assessment and Autism Diagnostic Observation Schedule- 2nd edition (ADOS-2) for children referred from the health or early childhood education system (n=305).

Conclusions:  Highly likely cases of ASD or significant developmental challenges in this study would have gone undetected if SACS-R was not used during a child’s visit to a health check or in their childcare setting. Results support the implementation of the SACS-R across health and education settings as a reliable and valid method of early detection of children with ASD and informs policy and practice in the childcare sector which presents an ideal opportunity for ongoing developmental surveillance and appropriate, timely referral of young children to essential early intervention supports.