Background
Early intervention in autism spectrum disorder (ASD) improves outcomes, but treatment access depends on early identification. Despite reliability of most autism diagnoses by age 24 months, the majority of children with autism do not receive comprehensive evaluations until after age 36 months. Although many possible reasons exist for delayed evaluations, the referral decision process itself is not clearly defined nor understood. In particular, little is known about how perceptions of early childhood symptoms of ASD interact with decision criteria to ultimately refer a child for comprehensive diagnostic assessment.

Method
To better understand pre-referral perceptions and decision factors involved, we provided multiple video clips from early comprehensive autism evaluations as prompts, then asked early childhood clinicians and educators (n = 346) to make decisions about autism referral, then to identify factors considered when making decisions.

Results
Decision factors cited most often were play, social interactions/engagement, and verbal behaviors, but none were cited by a clear majority. Some important early signs were infrequently mentioned: absence of joint attention, social reciprocity and gestures. Accuracy of referral decisions was similar across disciplines, indicating a broad range of professionals capable of identifying early signs of autism.

Conclusions
Autism training across early childhood professional disciplines should emphasize importance of early signs involving significant absences of behaviors, such as low joint attention, gestures, and social reciprocity in addition to odd social, verbal, and play behaviors. Such targeted training may encourage earlier referrals when autism is suspected in young children.

Core deficits in autism spectrum disorder (ASD) center around social communication and behavior. For individuals with ASD, these deficits complicate the task of learning how to cope with and manage complex social emotional issues. Although individuals with ASD may receive sufficient academic and basic behavioral support in school settings, supports for dealing with complex social emotional issues are more difficult to access, even though these issues significantly impact student learning. When addressing these challenging social- and emotional-based issues, school and professional personnel need more specific instructional skill sets and resources to effectively and compassionately support students with ASD. In this article, we address three challenging areas of social emotional development that are commonly experienced by individuals with ASD: anxiety, social isolation, and grief. We briefly explore the existing research on these three topics, identify evidence-based practices and learning strategies to support social emotional learning in individuals with ASD, and include descriptive lists of practical resources that address anxiety, social isolation, and grief.

This interactive, online resource provides a pathway for clinicians seeking information on how to prepare for medical visits with patients who have autism spectrum disorders using a three-tiered system of preparation and responses.

OBJECTIVE: The goal of this study was to investigate the feasibility and outcome of a systematic autism screening process for all toddlers (aged 14–30 months) in a large, community-based pediatric practice.

METHODS: All toddlers who presented to the clinic during the 6-month screening period were eligible. We used 2 screening questionnaires and allowed physicians to refer directly to capture as many children as possible. Receptionists and medical assistants distributed and collected screening questionnaires; research staff did all scoring and follow-up, either by telephone or in person when indicated.

RESULTS: We obtained a high rate of screening (80% of eligible children). Of the 796 children screened, 3 had already been diagnosed with an autism spectrum disorder (ASD); an additional 10 children who showed signs of early ASD that warranted further evaluation or intervention were identified. Formal screening measures identified more children with ASD than did clinical judgment or caregiver concerns; however, no single method (ie, questionnaire, caregiver concerns, provider concerns) identified all children with signs of early ASD. We had excellent participation from racially and ethnically diverse families, including Spanish-speaking families. Thirty-two percent of the children who were screened did not present for a well-child visit during the study period and were screened at a sick visit, follow-up visit, or injection appointment.

CONCLUSIONS: A partnership between pediatricians and autism specialists resulted in effective, systematic autism screening. Future studies should examine how to create effective systems of care.