INNOVATION FUND The Future of Academic Medicine Maternal, Child & Mental Health SHOWCASE 2023

Autism Classification System of Functioning: Social Communication (ACSF:SC) – Expansion, Testing, and Feasibility for Charting of Early Trajectories from Toddlers to School-Aged Children

Maternal, Child & Mental Health

Peter Rosenbaum


Hamilton Health Sciences Organization


Briano Di Rezze



CanChild Centre for Childhood Disability Research, School of Rehabilitation Science, McMaster University


The applicability of the ACSF to an expanded age-range to toddlers and school-aged children will better identify a child’s ‘social communication’ functioning and map their social communication trajecory throughout their childhood. The ACSF will enable parents, caregivers, and professionals to monitor the ‘social communication’ abilites and explore factors that impact on their functioning. This information can inform best practices in health services and intervention research. Also, having a function-focused classification system for young children and adolescents that is completed consistently (i.e., reliable) and accurately (i.e., valid) would enable families to have a ‘common language’ to use with professionals who provide services for their children (e.g., clinicians, therapists, teachers). In this context, this work will have a meaningful impact on interdisciplinary ASD services and facilitate partnerships between families, clinicians and researchers.


The Autism Classification System of Functioning: Social Communication (ACSF) describes 5-levels of social communication. Objectives: Initially developed for preschool children with ASD, this study developed and tested the reliability and validity of the ACSF with an expanded age (2-to-18 years). Methods: ACSF was adapted using qualitative methods from parent and clinician perspectives and analyzed by content analysis. An international online survey followed. ACSF intra- and inter-rater reliability testing with parents and professionals at 2 time points, and construct validity (testing convergent and discriminant validity with two measures), using correlation coefficients. Results: Parents (n=90) and professionals (n=41) were involved in reliability testing. Content validity from qualitative data supported the applicability, clarity and usability of the ACSF. Ratings were provided for children with ASD (2-15 years). Results showed good-to-very good intra-rater agreement for parents and professionals, and good inter-rater agreement. For construct validity testing, participants reported on 117 children with ASD (2-19 years). Significant correlations were reported between ACSF and the Social Communication and Interaction, Functional Communication, and Social Skills. Discriminant analyses showed weaker correlations between the ACSF and Externalizing and Attentional Problems. Conclusions: Our findings demonstrate that ACSF can be used as a reliable and valid social communication classification system in children with ASD 2-15 years of age. Challenges: Recruitment. Next Steps: The ACSF is being used internationally to track social communication abilities from diagnosis into school-age. This can empower caregivers and help in ongoing clinical, educational, and research contexts to assist with goal-setting and understanding barriers and facilitators that impact social communication. This can also help improve health services based on interventions and meaningful outcomes.


1. Tajik-Parvinchi D, Rosenbaum P, Hidecker MJC, Duku E, Zwaigenbaum L, Roncadin C, Georgiades S, Gentles S, Fang H, Di Rezze B. Construct Validity of the Autism Classification System of Functioning: Social Communication (ACSF:SC) Across Childhood and Adolescence. J Autism Dev Disord. 2022 Jun 6. doi: 10.1007/s10803-022-05608-w. Epub ahead of print. PMID: 35666330. Jun 6, 2022.
2. Di Rezze B, Gentles SJ, Hidecker MJC, Zwaigenbaum L, Rosenbaum P, Duku E, Georgiades S, Roncadin C, Fang H, Tajik-Parvinchi D, Viveiros H. Adaptation, Content Validity and Reliability of the Autism Classification System of Functioning for Social Communication: From Toddlerhood to Adolescent-Aged Children with Autism. J Autism Dev Disord. 2022 Dec;52(12):5150-5161. doi: 10.1007/s10803-022-05621-z. Epub 2022 Jun 8. PMID: 35676381. Jun 8, 2022.
3. Di Rezze B, Rosenbaum P, Zwaigenbaum L, Hidecker MJC, Stratford P, Cousins M, Camden C, and Law M. Developing a classification system of social communication functioning of preschool children with autism spectrum disorder. Developmental Medicine and Child Neurology. 2016;58(9):942-8.
4. Di Rezze B, Rosenbaum P, Zwaigenbaum L. What Attributes Determine Severity of Function in Autism? A Web-Based Survey of Stakeholders. Focus on Autism and Other Developmental Disabilities. 2012;27(1):39-41.

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