Developing a classification system of social communication functioning of preschool children with autism spectrum disorder.

ABSTRACT

AIM: Impairments in social communication are the hallmark of autism spectrum disorder (ASD). Operationalizing 'severity' in ASD has been challenging; thus, stratifying by functioning has not been possible. The purpose of this study is to describe the development of the Autism Classification System of Functioning Social Communication (ACSFSC) and to evaluate its consistency within and between parent and professional ratings. METHOD: (1) ACSFSC development based on focus groups and surveys involving parents, educators, and clinicians familiar with preschoolers with ASD; and (2) evaluation of the intra- and interrater agreement of the ACSFSC using weighted kappa (кw ). RESULTS: Seventy-six participants were involved in the development process. Core characteristics of social communication were ascertained communicative intent; communicative skills and reciprocity; and impact of environment. Five ACSFSC levels were created and content-validated across participants. Best capacity and typical performance agreement ratings varied as follows intrarater agreement on 41 children was кw =0.61 to 0.69 for parents, and кw =0.71 to 0.95 for professionals; interrater agreement between professionals was кw =0.47 to 0.61, and between parents and professionals was кw =0.33 to 0.53. INTERPRETATION: Perspectives from parents and professionals informed ACSFSC development, providing common descriptions of the levels of everyday communicative abilities of children with ASD to complement the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Rater agreement demonstrates that the ACSFSC can be used with acceptable consistency compared with other functional classification systems.