title: Developing a classification system of social communication functioning of preschool children with autism spectrum disorder.
abstract: 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 (ACSF:SC) and to evaluate its consistency within and between parent and professional ratings.
  
  
  
  (1) ACSF:SC 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 ACSF:SC using weighted kappa (кw ).
  
  
  
  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 ACSF:SC 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.
  
  
  
  Perspectives from parents and professionals informed ACSF:SC 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 ACSF:SC can be used with acceptable consistency compared with other functional classification systems.
authors.affiliation: CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.|School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
authors.forename: Briano
authors.initials: B
authors.lastname: Di Rezze
authors.affiliation: CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenbaum
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Zwaigenbaum
authors.affiliation: Division of Communication Disorders, University of Wyoming, Laramie, WY, USA.
authors.forename: Mary Jo Cooley
authors.initials: MJ
authors.lastname: Hidecker
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Stratford
authors.affiliation: CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
authors.forename: Martha
authors.initials: M
authors.lastname: Cousins
authors.affiliation: Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Chantal
authors.initials: C
authors.lastname: Camden
authors.affiliation: CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Law
mesh_terms: D000067877:Autism Spectrum Disorder / Q000150:complications* / Q000523:psychology*; D002659:Child Development Disorders, Pervasive / Q000503:physiopathology / Q000523:psychology; D002675:Child, Preschool; D002965:Classification; D003142:Communication; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment; D012920:Social Behavior Disorders / Q000145:classification / Q000175:diagnosis / Q000209:etiology