The Early Screening for Autism and Communication Disorders: Field-testing an autism-specific screening tool for children 12 to 36 months of age.

The sample was selected because children already had concern, referral, positive communication screens, or familial risk, so the ESAC may be more accurate in these higher-risk toddlers than in routine low-risk primary care. Developmental level differed between groups, and the autism group had lower developmental scores than the non-spectrum groups, which may have helped the ESAC separate the groups. Demographic data were missing for many children, and the sample was mainly male and White, with most mothers having a college education, so it may not represent diverse communities. Not all non-spectrum children completed the full diagnostic battery; some typical development children were classified using communication testing or clinical judgment. Some children with developmental delay were classified using clinical judgment because their concerns were not captured by the Mullen Scales of Early Learning. The ESAC could not be tested separately by site or by how children were recruited because some sites had small samples. Some children contributed more than one ESAC, and in the older age groups about a third of screens were repeats, which may bias accuracy. The study is a field-test; independent validation in low-risk primary care samples and further factor analysis are still needed.

Some authors receive royalties for related assessment tools, including the Communication and Symbolic Behavior Scales and the ADOS-2/ADOS-T, but not from this study. Other authors have no financial relationships relevant to this article to disclose. The research was supported by federal grants from NICHD, NIDCD, CDC, and NIMH.

Do not treat the ESAC as ready for routine low-risk primary care screening. It was tested in children already referred for concerns or selected from positive screens with concern, and the authors state its accuracy may be higher than in a low-risk sample.