Autism Screening Clinical Pathway — Primary Care
Autism Screening Clinical Pathway — Primary Care
Developmental Surveillance
Soliciting Parental Concern
- Ask parent developmental/behavioral surveillance questions during every visit.
- “Do you have any concerns about your child’s development, behavior?”
- Note spontaneously expressed concerns by parent/caregiver/teacher, etc.
Provider Concern
Evaluate developmental/behavioral surveillance or other factors that increase the risk of ASD (or DD) at every preventive care visit:
- Sibling with ASD
- Features/signs of ASD (such as non-response to name, not pointing, or unusual social responsiveness)
- Genetic disorders, especially Fragile X syndrome, tuberous sclerosis, 22Q11.2
- History of prematurity
- Prenatal exposures (toxins or infections)
Note any of the following features or behaviors:
- Avoids eye contact and may want to be alone
- Has trouble understanding other people’s feelings or talking about their feelings
- Has delayed speech and language skills
- Repeats words or phrases over and over (echolalia)
- Gives unrelated answers to questions
- Gets upset by minor changes
- Has obsessive interests
- Makes repetitive movements like flapping hands, rocking, or spinning in circles
- Has unusual reactions to the way things sound, smell, taste, look or feel
Presence of any parental or provider concerns (with or without screening) should trigger referral to:
- Early intervention/school district (depending on age)
- Specialist for autism diagnostic evaluation: medical or psychology specialist with training in diagnosis, evaluation and management of children with ASD
- Additional assessments:
- Audiology evaluation (for children with language delay or inattention to language)
- Vision assessment (for children who are visually inattentive, have stereotypical behaviors such as eye poking or close visual scrutiny, or do not make eye contact).