Evaluation of the Acceptability and Feasibility of the Social Attention and Communication Surveillance-Revised (SACS-R) Tool for Early Identification of Autism in Preterm Infants: The Identify and Act Study

Introduction: Preterm birth is associated with a 3.3-fold increased likelihood of autism diagnosis, with lower gestational age conferring higher likelihood. In Australia, autism is typically diagnosed at around age four, potentially missing the optimal neuroplasticity window before age two. The Social Attention and Communication Surveillance—Revised (SACS-R) tool identifies early autism signs in children aged 11–30 months, enabling pre-emptive intervention. Aims: This quality improvement (QI) study assessed the acceptability, and feasibility of SACS-R for early detection of autism traits in 12-month-old infants born very preterm/VP (gestation < 32 weeks), from both caregiver and clinician perspectives. Methods: From September 2024 to February 2025, 47 VP infants attending the 12-month Neonatal Follow-up Clinic (NNFU) at King Edward Memorial Hospital (KEMH), Western Australia, were assessed using SACS-R. Caregivers completed acceptability and feasibility questionnaires; clinicians completed similar surveys. Forty-seven infants met inclusion criteria; 12 clinicians provided responses. Results: Of 47 infants, 4 (8.5%) were identified as having a high likelihood of autism and referred for early intervention. Among caregivers, 29 (61%) provided complete acceptability responses and 28 (59%) feasibility responses, both predominantly positive. Clinicians reported high satisfaction (83%) and ease of use (91%), with 74% supporting routine implementation. Concerns included parental understanding and overlap with other assessments. Conclusions: Our QI study indicates that the SACS-R is highly acceptable and feasible in neonatal follow-up for preterm infants. Larger-scale evaluation of diagnostic accuracy and practical refinements based on feedback are warranted to support routine integration in early surveillance programs.