The Social Communication Assessment for Toddlers with Autism (SCATA): An Instrument to Measure the Frequency, Form and Function of Communication in Toddlers with Autism Spectrum Disorder

Abstract

The Social Communication Assessment for Toddlers with Autism (SCATA) was designed to measure non-verbal communication, including early and atypical communication, in young children with autism spectrum disorder. Each communicative act is scored according to its form, function, role and complexity. The SCATA was used to measure communicative ability longitudinally in two samples of toddlers with autism spectrum disorder. Overall frequency of non-verbal communicative acts did not change between the two assessments. However, the form and complexity, the function and the role the child took in the interaction did change with time. Both frequency and function of communicative acts in toddlerhood were positively associated with later language ability: social acts, comments and initiations showed greater predictive association than requests and responses.

Appendix 1

Coding Definitions for the Social Communication Assessment for Toddlers with Autism (SCATA)

Each communicative action from the child to the examiner is scored on 4 axes:

• (i) Form: What the child is physically doing.

• (ii) Function: Communicative function of the act.

• (iii) Role: How the communication was initiated: whether the child’s communicative action is spontaneous or in response to some action/communication by the examiner.

• (iv) Complexity: Whether the communicative act consists of a single form, or whether the child combines forms either simultaneously or sequentially (based on the number of forms that have been scored for that act).

Forms should be coded down if uncertain. For example, if it is unclear from the tape whether a child’s look meets the examiner’s gaze, do not code it as “eye contact” but as “look without eye contact”. Eye contact must definitely be made for a gaze switch to be made be coded.

Only actions directed at the examiner are coded. Actions directed at parents or the camera operator are not coded, and neither are self-directed actions such as vocalising to self. In order for any communication to be coded, there must be some sense that the child is directing it at the examiner or doing it in response to the examiner’s presence. For example, smiling and vocalising at a toy is not coded as communicative if the child would be acting in the same way if the examiner wasn’t there. This doesn’t mean that every communication needs to be accompanied by eye contact, but by some apparent awareness of the examiner’s presence and some kind of engagement or responsiveness.

FORM
Vocalisations	Only one vocalisation can be coded for any one communication—code the highest form observed. For example, if a string of babble contains one recognisable word then code as “single word” only. Laughing would not usually be coded, unless it was definitely used in a communicative way.
Phrase	String of words (errors in pronunciation or grammar do not matter).
Single word	Single, identifiable real word (as long as it is identifiable, pronunciation errors are not important).
Babble	Language-like strings and combinations of syllables, either different syllables or the same ones repeated. Sounds like language but not identifiable as any real words.
Sound	Single syllable vocalisation, e.g. “ba”; also include non-syllabic noises that are commonly used in speech, e.g. “hmm”, and non-speech like vocalisations if they are used in a communicative way.
Looks
Gaze switch	Triadic gaze switch of object-person-object or person-object-person; must make eye contact rather than just looking to person’s face, and the whole sequence must take place within 3 seconds to be sure it is a gaze switch rather than just repeated attention shifts. Because of this, the whole sequence must be initiated by the child: for example, if the child is looking at an object, makes eye contact because the examiner calls his name then looks back at the object, this is credited as eye contact but not as a gaze switch. Eye contact must definitely be made for a gaze switch to be coded; a look from object to the examiner to object that does not meet gaze can only be scored as “look without eye contact”.
Eye contact	Eye contact with the examiner, visible from the tape or commented by the examiner.
Look to the examiner without eye contact	A look to monitor the examiner’s actions or a look to the examiner’s face that doesn’t meet eye contact. the examiner often comments this as a look “through” rather than at her.
Joint attention gestures	Proto-joint attention gestures: the child’s attempts to draw adult’s attention to an object.
Index finger point	A well-formed index finger point to a distal or proximal object.
Index finger touch-point	A well-formed index finger point that touches the target object, picture or person.
Bring and show	Taking an object to adult and obviously attempting to draw attention to it, e.g. by lifting it. This also includes giving an object to an adult by holding it where the adult can see it and waiting for the adult to take it.
Bring and dump	Taking an object to adult for the purpose of showing or giving it, but not making any attempt to draw attention to it or lift it to adult’s line of vision, just placing it on the floor, on adult’s lap etc.
Other gestures
Enactive	Gestures describing an object, e.g. its use, shape or size, or tracing its path with an index finger point in order to describe where it went. Also include here badly-formed points: attempts to indicate the position of an object using a whole hand gesture rather than an index-finger point etc.
Conventional	Learnt gestures, e.g. nodding, shaking head, thumbs up etc.
Instrumental	Most commonly an open-handed “give-me” gesture to request. Be careful to differentiate this kind of communicative gesture from an unsuccessful attempt to reach for and take an object (which would be coded as “act on object”).
Deviant	Abnormal gesture, character or origin not obvious; idiosyncratic gestures that a child uses to communicate e.g. shaking hands by side of body, stereotypies—only code when communicative.
Other	Recognisably communicative gesture that is not clearly abnormal but not well captured by any of the above categories.
Actions	Only code if communicative.
Acts on object	Acts on object e.g. pushes toy car while making eye contact and smiling to share the game with the examiner, or peeps at the examiner from behind chair to play peep-bo. Taking an object from the examiner to request it would be counted here, but the child giving an object would be coded as “bring and show” or “bring and dump”.
Acts on person	e.g. manipulates the examiner’s hand to request an action, pushes the examiner away to signal rejection, leans head on the examiner’s knee for comfort.
Movement	Physical movement around the room, e.g. running away to reject the examiner, or moving whole body to communicate in a way that cannot be classified as a gesture, e.g. leaning towards the examiner, jumping up and down to request an object in the examiner’s hands.
Stand and wait	Used as a form of request: child stands by adult in attentive/expectant posture.
FUNCTION	The purpose of the child’s action, what the child is attempting to communicate. For the purposes of this study we are only coding a single function for each action. If an action’s function seems ambiguous, then code what seems to be the primary function, or code as “not obvious”. It may help to watch more of the tape and see if the communication is repeated and what the outcomes are.
Request	Asking for an object or action; this includes any way of communicating a want or desire, such as nodding head yes when a game is suggested, or taking a toy from the examiner (whether it is offered first or just snatched).
Comment	Remark about an object or event etc, which has no obvious instrumental function but is more conversational, e.g. “look at that”, “I’ve got a car like that”, “I like the bubbles”. For non-verbal children this includes e.g. saying “oh!” when the bubbles appear or “uh-oh” if a toy is knocked over, or catching the examiner’s eye or pointing, in response to a specific object or action that has just happened or appeared.
Naming	A comment whose only function is to name an object, whether spontaneously or prompted by the examiner.
Question	Asking for information, not for an object or action, e.g. “when are we going to play bubbles?” but NOT “can we play bubbles now?” For non-verbal children this is harder to code but can include obvious questioning looks, e.g. a look with questioning face while the examiner is winding the top, as if to ask the examiner what she is doing.
Social/shared pleasure	A communication which is purely social, e.g. a gaze switch and smile when the music box is operated, an affectionate gesture. This includes all attempts to share an activity with another person, except where this could be classified as a comment: e.g. if, the first time a musical toy is activated, the child says “oh” and points to it, that could be classed as a comment, but any definite attempts to draw an adult’s attention to an ongoing activity or to encourage them to share in watching or playing a game should be classed as social. As a very rough rule, in general the first reaction to something counts as a comment, unless the child is obviously smiling and sharing pleasure with the adult; from then on any sharing counts as social.
Monitoring	A look at the examiner that is only for the purpose of seeing what is happening, with no attempt to engage her. When children first enter the room they often look briefly but repeatedly at the examiner before settling into the situation: the length of the gaze and whether there is any attempt to engage the examiner or to respond to her should determine whether these are counted as monitoring or social. Only single looks (with or without EC) can be coded as monitoring, so if the child smiles or vocalises while looking at the examiner that automatically becomes social rather than monitoring.
Response	An action that happens purely in response to another person, e.g. giving an object to the examiner because she has asked for it, making eye contact because the examiner has called the child’s name but without any social engagement. If the function of the communication can be interpreted as anything other than simply a response, the other function should take precedence.
Rejection	Definite rejection of adult. Do not include unawareness or lack of interest e.g. a child wandering off to play with something else, but definite and targeted rejection, e.g. pushing a toy away when the examiner offers it, running away and hiding when the examiner requests child to sit down and play, refusing to give the top when the examiner tries to take it to operate it. Rejections will usually be in response to the examiner’s attempts to initiate interaction, but can also be initiated by the child, e.g. the child approaches the examiner and pushes her away from the toys.
Not obvious	Function is ambiguous but action is definitely communicative.
ROLE	What triggers the child to act, who initiates the interaction
Initiation	Child’s action is not obviously prompted by anything the examiner has done; this includes the child changing the form of an ongoing interaction. For example if he has been slamming the lid of the music box and making eye contact with the examiner each time, each time after the first is counted as a social response because it is the continuation of an ongoing game that both the examiner and the child are maintaining, but if the child then shuts the lid quietly while looking and smiling this counts as an initiation because he has change the nature of the interaction.
Response	Communication triggered by something the examiner has done, e.g. child replies to a question, gives an object when asked to, makes eye contact when the examiner calls his name, takes a turn in an established game of peep-bo.
Imitation	Immediate imitation of the examiner’s last action forms the major part of the communication (e.g. repeating what the examiner has just said while smiling and making eye contact, copying the examiner blowing bubbles as a way of requesting more).
COMBINATION
Simultaneous combination	When more than one form is coded, they occur simultaneously. If many forms are coded as part of a single communication, it’s possible that some will be simultaneous and some will not: if there is any doubt focus on whether eye contact or other looks are simultaneous with other forms in the communication, or if there is no look then focus on whether the majority of the forms being coded are combined simultaneously.
Sequential combination	When more than one form is coded, they are strung together sequentially, but are all part of the same communicative action. Be careful not to include for example an initiation followed by a response, e.g. child holds out an object to the examiner, the examiner says “shall I help with that?” and the child makes eye contact - this would be coded as an initiation of bring-show and a response of eye contact, both single forms.
Single form	Only one form has been coded for that communication.