ESCS Reliability in Children with ASD: Exploratory Application in Visual Rehabilitation for Co-Occurring Visual Difficulties

Importance Visual difficulties are common in children with autism spectrum disorder (ASD) and may limit access to socially informative cues, affecting early social engagement. Reliable observational measures are needed to assess social communication and monitor rehabilitation outcomes. Objectives To examine the inter-rater reliability of the Early Social Communication Scales (ESCS) in children with ASD and explore its clinical applicability for monitoring social-communication change following visual rehabilitation (VR) in children with ASD and co-occurring visual difficulties. Design Multiphase methodological study with cross-sectional reliability analysis and an exploratory pre–post case series. Setting Healthcare institution. Participants Thirty-three children with ASD participated in the reliability analysis; nine children with ASD and co-occurring visual difficulties participated in the VR case series. Intervention Individualized VR delivered in 10 weekly 1-h sessions using computer-based visual training games and visual perceptual activities. Outcomes and Measures The ESCS was the primary social-communication measure; the Visual Function Battery for Children with Special Needs assessed visual function. Intraclass correlation coefficients (ICCs) and minimal detectable change values were calculated. Results ESCS inter-rater reliability ranged from poor to excellent (ICC = 0.464–0.951), with lower reliability for advanced initiating behavioral requests. In the VR case series, the ESCS captured changes in responding to behavioral requests, alongside improvements in visual function and visual attention. Conclusions and Relevance The ESCS demonstrated acceptable inter-rater reliability for assessing early social communication in children with ASD and showed preliminary clinical applicability for monitoring social-communication change in VR contexts. Larger controlled studies are needed to confirm these findings. What This Article Adds This study provides evidence that the ESCS can be reliably scored by trained occupational therapists when assessing early social communication in children with ASD. It also illustrates how the ESCS may be used in VR contexts to monitor changes in interaction-based social-communication behaviors among children with co-occurring visual difficulties.