Autism detection and diagnosis

Research theme leader: Dr Josephine Barbaro

Researchers: Cheryl Dissanayake, Katy Unwin, Nancy Sadka, Rachel Jellett, Melissa Gilbert, Darren Hedley, Alison Lane

Studies under this theme aim to:

  • develop evidence-based strategies and tools to identify autism in children under 3 years,
  • Inform government policy on early childhood development,
  • educate health professionals and parents/carers in how to recognise the signs of autism as early as possible, and
  • improve the outcomes of autistic children.

OTARC studies have found that when Australian children are diagnosed with autism early in life, this reduces their need for ongoing support at school age by 30%. Australian children who receive an autism diagnosis and subsequent intervention in the early and critical years (aged 18-36 months) have better school-age developmental outcomes. And yet, the average age of autism diagnosis in children remains at about 3-4 years (Clark et al., 2017; Clark et al, 2018).

An early diagnosis:

  • enables children to begin participation in specialised intervention programs at younger ages, maximising their developmental opportunities,
  • promotes greater independence and better quality of life for autistic children and their families,
  • benefits the community by significantly increasing the chances of these children participating in society.

New research – Training New Zealand Well Child/Tamariki Ora Nurses on Early Autism Signs Using the Social Attention and Communication Surveillance-Revised (SACS-R)

Waddington, H., Shepherd, D., van der Meer, L., Powell-Hector, N., Wilson, E., & Barbaro, J. (2021). Journal of autism and developmental disorders, 1–8. Doi: 10.1007/s10803-021-05344-7

This study was the first to examine developmental surveillance training for NZ WCTO nurses.

Participants were 175 New Zealand Well-Child/Tamariki Ora nurses who attended 1-day training in the SACS-R. Nurses completed a survey measuring nurses' knowledge of typical development, early signs of autism, and general autism, and confidence in identifying and discussing early signs. Nurses were surveyed before training, on the day and 3-8 months post training.

The online survey found that:

  1. Nurses responded positively to the SACS-R training/tool.
  2. Nurse confidence in discussing early signs with parents increased following training.
  3. Nurse knowledge increased following training.

Read more

External Resources

Government-funded diagnosis services (for under 18s)

Autism in the early years

Support groups

Current studies


Social Attention and Communication Study-Revised (SACS-R)

Funding: Menzies Foundation; Autism CRC

Prospective identification of autism in infants, toddlers, and pre-schoolers using the Social Attention and Communication Surveillance-Revised and Preschool tools (SACS-R & SACS-PR) in Maternal and Child Health settings in Victoria.Josephine Barbaro
Lael Ridgway
Cheryl Dissanayake

Evaluation of ASDetect, a mobile application for autism

Funding: La Trobe University, School of Psychology and Public Health

The aim of this study is to determine the psychometric properties of ASDetect, a mobile application designed to enable parents and caregivers to assess their infant or toddler's likelihood for autism.Josephine Barbaro
Cheryl Dissanayake
Nancy Sadka
Lael Ridgway
Melissa Gilbert

A comparison of early development and symptoms of autistic children born preterm and full-term

Funding: La Trobe University

This study examines differences in key indicators of child development and characteristics of autism between autistic children born preterm (before 36 weeks gestation) and full-term. All children were aged 22-34 months at time of their diagnosis and were identified at high likelihood for autism in the community through the SACS and SACS-R studies.Jenny (Thuy Vi) Luu (honours graduate)
Rachel Jellett
Josephine Barbaro

ASDetectPRO training needs analysis

Funding: La Trobe University

This study examines the current autism knowledge and training needs of medical and primary health, allied health, and early childhood education professionals to inform the development of ASDetectPRO, an early autism education program and tool for professionals.Melissa Gilbert
Josephine Barbaro
Radhika Nair
Shannon Elgar (2020 honours candidate)

Maternal and child health nurse training for the early identification of autism

Funding: Victorian Government

Aims to provide professional development training for the Victorian Maternal and Child Health Workforce on the early identification of autism and the Social Attention and Communication Surveillance tool.Katherine (Kate) Gore (honours graduate)
Melissa Gilbert
Josephine Barbaro

Reducing the age of diagnosis of autism in Nepal: SACS-N

Funding: School of Psychology and Public Health, La Trobe University

The aim of this study is to implement social attention and communication surveillance of young children by female health nurse volunteers in order reduce the age of autism diagnosis in Nepal.Rena Shrestra
Cheryl Dissanayake
Josephine Barbaro

Early identification of ASD in Japan: Statutory infant health checkups and early screening tools

Funding: School of Psychology and Public Health, La Trobe University

The study aim is to enable earlier identification of autism within the statutory health check-ups for children in Japan.Hiroko Kawashima (PhD candidate)
Cheryl Dissanayake
Darren Hedley
Emiko Kezuka

Prospective identification of ASD in infants and toddlers: Social Attention and Communication Surveillance

Funding: Autism CRC

The aim of this study is to promote the early identification of children with autism by community service providers so that they may receive an early diagnosis. The study was undertaken in Victoria and Tasmania.Cheryl Dissanayake
Josephine Barbaro
Lyndsay Quarmby (University of Tasmania)
Tony Barnett (University of Tasmania)
Nancy Sadka
The SACS team
Brief Autism Detection in Early Childhood (BADEC)The aim of this study is to test the predictive validity of brief ASD Level 2 screen in a US sample.Darren Hedley
Rose Nevill (University of Virginia)
Robyn Young (Flinders University)
Micah Mazurek (University of Virginia)
Fei Nah (Singapore National University)
The production and validation of a Sensory Observation Autism Rating scale (SOAR) to map autism-specific sensory behaviours and improve early diagnosisThis study aims to create and validate a Sensory Observation Autism Rating scale (SOAR) in order to identify autism-specific sensory behaviours in young children (0-3 years).Katy Unwin
Josephine Barbaro
Alison Lane

Developmental surveillance for Autism Spectrum Disorder (ASD) in early childhood education settings

Funding: Autism CRC

Early identification of autism in infants and toddlers in Early Childhood Education settings using the Social Attention and Communication Surveillance-Revised (SACS-R) tool.Beth Mozolic-Staunton
Michelle Donelly
Jacqui Yoxall (Southern Cross University)
Josephine Barbaro

Examining the association between parental cultural and ethnic background and the diagnosis of autism in 12—42-month-old children

Funding: La Trobe University

This study investigates the association between parental cultural and ethnic background and the diagnosis of autism in 12–42-month-old children, identified via the early years program at OTARC.Jessica Scaletti (2020 honours candidate)
Ifrah Abdullahi
Josephine Barbaro
Nancy Sadka

State-wide implementation of the Social Attention and Communication Surveillance-Revised (SACS-R) in Tasmania

Funding: Autism CRC

The SACS-R is an autism developmental surveillance tool that has been utilised by Child Health and Parenting Service (CHaPS) nurses in Tasmania since 2016. This practice change was evaluated with the parent and their child at the centre of the process through the use of an innovative methodology, Design Thinking (DT). DT utilises a collaborative approach to aid understanding, development and evaluation of the needs of the stakeholders and their responses regarding the implementation of the SACS-R project.Josephine Barbaro
Nancy Sadka
Ali Morse
Lyndsay Quarmby
Tony Barnett (University of Tasmania)

A multistate trial of an early surveillance program for autism within general practices in Australia

Funding: Autism CRC

A cluster randomised controlled trial comparing usual care with an enhanced early autism surveillance protocol in general practice for children aged 18 to 24 months.Josephine Barbaro
Melissa Gillbert
Ifrah Abdullahi
Radhika Nair
Katy Unwin
& the UNSW team
Valsamma Eapen
Anne Masi
Antonio Mendozza Diaz
Aline Smith
Iqbal Hasan

A decade-long research project

Dr Josephine Barbaro, Senior Research Fellow at OTARC, has been working on the early signs of autism in babies and toddlers for more than 15 years. The method she developed in the Social Attention and Communication Study (SACS) identified a set of behaviours or 'early markers' that are characteristic of children on the autism spectrum, from as young as 12 months old.

Originally implemented in Maternal and Child Health services in Victoria, the SACS method is now used across more than 12 countries.

Social Attention and Communication Surveillance-Revised (SACS-R) Online Training

Social Attention and Communication Surveillance (SACS) online will equip all professionals working with 11- to 30-month-old children with the necessary skills to effectively identify children on the autism spectrum, discuss their findings with families as part of routine care, and provide a streamlined referral pathway for families. Relevant professionals include:

Practice Nurses
Speech pathologists

Occupational therapists
Paediatric physiotherapists
Paediatric audiologists
Social workers
Early intervention staff
Early childhood education staff

The specific approach to early identification of autism used in this training is based on the Social Attention and Communication Studies (SACS) conducted by Dr. Josephine Barbaro. The SACS-R is the most accurate and sensitive early detection method for autism available (Barbaro & Dissanayake, 2010; 2013; Mozolic-Staunton et al., 2020; 81%-83% Positive Predictive Value).

The SACS-R is observationally based, requires training of child-health and education professionals, and works best when implemented in a setting that routinely monitors child development.

This comprehensive training module includes:

  • Narrated PowerPoint presentation recorded at a recent workshop
  • Additional notes and resources on each of the topic areas
  • Clinical videos of autistic and non-autistic children
  • Downloadable resource sheets, brochures, and key additional readings

Learning Outcomes

  • Professionals who see infants and toddlers will have the required knowledge and tools to screen children for autism
  • Professionals will be confident in using the SACS-R tool to determine whether the children that present to their services demonstrate typical or atypical social attention and communication behaviours, relative to their developmental level
  • Professionals will be able to sensitively discuss the results of the SACS-R tool with parents and carers and refer children with a high likelihood of autism for further diagnostic assessment and intervention services. This will be possible as a result of:
    • confidence in the specificity, sensitivity and other psychometric properties of SACS-R checklists,
    • group work and role play on raising concerns with parents and addressing parents’ queries and concerns,
    • knowledge of the necessary referral pathways following a positive SACS-R result, and
    • understanding of the importance of proactive referral and intervention to maximise the developmental outcomes for children on the autism spectrum.

Enrol Now by clicking the link below! and take advantage of our introductory rate of $399 + GST

SACS Training Registration

Our Research and Outreach

This program is developed by Dr Josephine Barbaro, Senior Research Fellow and Registered Psychologist at the Olga Tennison Autism Research Centre at La Trobe University, and co-Founder and lead clinician in Australia's first 'Early Assessment Clinic' for Autism Spectrum Disorders (ASD).

Dr Barbaro's research interests are in the early identification and diagnosis of ASD in infants and toddlers, and family health and well-being following a diagnosis.

The Social Attention and Communication Surveillance (SACS) approach, developed during her PhD, has been translated in 8 languages and disseminated across 12 countries. The SACS was incorporated into the 7-year Tianjin Women and Child Health plan, China’s 4th largest city, where we trained 600 early childhood medical professionals in 2013 to monitor every baby born from 2013-2020 (700,000 in total). In Australia, the SACS has been used to monitor over 45,000 infants and toddlers in the Victorian and Tasmanian Maternal and Child Health (MCH) systems alone.

The efficacy of the SACS has been investigated in two large-scale studies in Victoria (SACS: 2006-08; SACS-Revised: 2013-18) where ~36,000 children were monitored as part of their routine MCH health checks between 12-24-months of age by ~400 trained MCH nurses. The children referred as having a “high likelihood” of autism (based on 3 of 5 “key” behaviours) were referred to the SACS team at La Trobe University for a diagnostic assessment, followed-up every 6 months until 24-months, and again at 3.5 years (Barbaro & Dissanayake, 2010; Mozolic-Staunton et al., 2020).

In September 2015, the Minister for Human Services in Tasmania (The Hon. Jacquie Petrusma) announced in Parliament that Tasmania was implementing SACS across the State. See this link for a summary of the training:

In September 2018, the Victorian Government announced that all 1250 Victorian Maternal and Child Health (MCH) nurses will be trained using the SACS method to monitor babies for autism at their routine health checks between 12- and 24-months-of-age. See:

A mobile application for parents and caregivers

Based on the SACS method, ASDetect is a free mobile app that guides parents through age-appropriate assessments, using videos of autistic and non-autistic children to illustrate questions about social communication milestones.  Parents receive an on-screen result of either 'low' or 'high' likelihood of autism, and a comprehensive formal assessment results email, which they can take to their family doctor.

With over 65,000 downloads since launch in February 2016, ASDetect is now being translated into Mandarin Chinese and Spanish, bringing this groundbreaking early detection research to parents and caregivers around the world.

'Early Markers' or the early signs of autism

In children under 2 years old, the ‘early markers’ include infrequent or inconsistent use of:

  • eye contact
  • gestures, like pointing at objects
  • response to being called by name
  • imitation or copying others' activities.

These and other social communication milestones have been incorporated into 3 SACS assessments for children aged 12 months,18 months and 24 months, and used by trained Victorian Maternal and Child Health Nurses.

The SACS method currently has the best psychometric properties of any autism identification tool, with an accuracy of 81 - 83%, more than seven times more accurate than the next-best early detection tool.

Read about the reliability of early signs of autism (PDF)

Hear more about Dr Barbaro’s recent research (Soundcloud)

Research papers

Research papers – developmental surveillance

Barbaro, J., Masi, A., Gilbert, M., Nair, R., Abdullahi, I., Descallar, J., Dissanayake, C., Eastwood, J., Hasan, I., Jalaludin, B., Karlov, L., Khan, F., Kohlhoff, J., Liaw, S. T., Lingam, R., Mendoza Diaz, A., Ong, N., Tam, C. W. M., Unwin, K., Woolfenden, S., & Eapen, V. (2021). A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia [Study Protocol]. Frontiers in Pediatrics, 9(260).

Mozolic-Staunton, B., Barbaro, J., Yoxall, J., & Donelly, M. (2021). Monitoring children’s development in early childhood education settings to promote early detection of autism. Australasian Journal for Early Childhood.

Mozolic-Staunton, B., Donelly, M., Yoxall, J., & Barbaro, J. (2020). Early detection for better outcomes: universal developmental surveillance for autism across health and early childhood education settings. Research in Autism Spectrum Disorders. 71, 101496.

Mozolic-Staunton, B., Donelly, M., Yoxall, J. & Barbaro, J. (2017). Interrater reliability of early childhood education professionals involved in developmental surveillance for autism spectrum disorder and related conditions. Australian Journal of Early Childhood, 42(2), 61-68.

Barbaro, J. & Dissanayake, C. (2013). Early markers of Autism Spectrum Disorders in infants and toddlers prospectively identified in the Social Attention and Communication Study (SACS). Autism: International Journal of Research and Practice, 17, 64-86.

Barbaro, J., Ridgway, L., & Dissanayake, C. (2011). Developmental surveillance of infants and toddlers by Maternal and Child Health nurses in an Australian community-based setting: Promoting the early identification of Autism. Journal of Pediatric Nursing, 26, 334-347.

Barbaro, J., & Dissanayake C. (2010). Prospective identification of Autism in infancy and toddlerhood using developmental surveillance: The Social Attention and Communication Study (SACS). Journal of Developmental and Behavioral Pediatrics, 31, 376-385.

ASDetect papers

Barbaro, J. & Yaari, M. (2020). Study Protocol for an Evaluation of ASDetect - A Mobile Application for the Early Detection of Autism. 20(1), 21. doi:10.1186/s12887-019-1888-6.

Research papers – intervention studies and outcomes of SACS identified children

Barbaro, J. & Dissanayake, C. (2012). Developmental profiles of infants and toddlers with Autism Spectrum Disorders identified prospectively in a community-based setting. Journal of Autism and Developmental Disorders, 42, 1939-1948.

Clark, M. L., Barbaro, J., & Dissanayake, C. (2017). Continuity and Change in Cognition and Autism Severity from Toddlerhood to School Age. Journal of Autism and Developmental Disorders47, 328-339. DOI: 10.1007/s10803-016-2954-7.

Clark, M. L., Vinen, Z., Barbaro, J., & Dissanayake, C. (2018). School age outcomes of children diagnosed early and later with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 48, 92-102.

Whitehouse, A. J. O., Varcin, K. J., Alvares, G. A., Barbaro, J., Bent, C., Boutrus, M., Chetcuti, L., Cooper, M. N., Clark, A., Davidson, E., Dimov, S., Dissanayake, C., Doyle, J., Grant, M., Iacono, T., Maybery, M., Pillar, S., Renton, M., Rowbottam, C., Sadka, N., Segal, L., Slonims, V., Taylor, C., Wakeling, S., Wan, M. W., Wray, J., Green, J., & Hudry, K. (2019). A randomised-controlled trial of a pre-emptive intervention for infants showing early behavioural risk signs of autism spectrum disorder. The Lancet Child and Adolescent Health3(9), 605-615.

Whitehouse, A. J. O. Varcin, K. J., Pillar, S., Billingham, W., Alvares, G. A., Barbaro, J., Bent, C. A., Blenkley, D., Boutrus, M., Chee, A., Chetcuti, L., Clark, A., Davidson, E., Dimov, S., Dissanayake, C., Doyle, J., Grant, M., Green, C., Harrap, M., Iacono, T., Matys, L., Maybery, M., Pope, D., Renton, M., Rowbottam, C., Sadka, N., Segal, L., Slonims, V., Smith, J., Taylor, C., Wakeling, S., Wan, M, W., Wray, J., Cooper, M. N., Green, J., & Hudry, K. (2021). Pre-emptive intervention for infants showing early behavioral signs of autism. JAMA Pediatrics.

Research papers – gender differences of SACS identified children

Hollier, L. P., Joshi, R., Barbaro, J., Dissanayake, C (2018). Gender Differences during Toddlerhood in Autism Spectrum Disorder: A Prospective Community-Based Longitudinal Follow-Up Study. Journal of Autism and Developmental Disorders, 48, 2619-2628.

Barbaro, J., & Freeman, N. (2021). Investigating gender differences in the early markers of Autism Spectrum Conditions (ASC) in infants and toddlers. Research in Autism Spectrum Disorders, 83, 101745. doi: 10.1016/j.rasd.2021.101745

Research papers – international implementation of SACS

Okuno, M., & Uehara, T. (2018). Early childhood behavioral features that discriminate autism from other developmental problems in Japan. Journal of Child and Adolescent Psychiatric Nursing 31(1):23-9. doi: 10.1111/jcap.12205

Mohd Zambri, N., Lau LHS., Koh, HC., Yeleswarapu, SP., Daniel, LM., & Wong, CM. (2019). Screening for Autism in Younger Siblings of Children with Autism: Preliminary Findings.  Asia Pacific Autism Conference; Resorts World Convention Centre Singapore 

Barbaro, J., Wang, C., Wang, J., Liu, G., Liang, Y., Wang, J., Abdullahi, I., & Dissanayake, C. (2020). A pilot investigation of the Social Attention and Communication Surveillance (SACS) tool for the early identification of autism in Tianjin, China (SACS-C). Frontier in Neurology, Paediatrics11, 1389. doi: 10.3389/fneur.2020.597790.

Shrestha, R., Barbaro, J. & Dissanayake, C. (2021). Changes in knowledge on the signs of autism in young children (11-30 Months) among Female Community Health Volunteers in Nepal. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-021-04944-7.

Shrestha, R., Dissanayake, C., & Barbaro, J. (2021). Implementing and evaluating Social Attention and Communication Surveillance (SACS) to prospectively identify autism in very young children in Nepal. Research in Developmental Disabilities.