Current guidelines for toddlers at-risk on general developmental and autism screening in pediatric
primary care include referral to state-based Early Intervention (EI) and pertinent subspecialists. However, little is
known about trends in pediatricians’ referral practices and perceptions.
To examine trends from 2002-2016 in pediatrician EI referral practices, conditions leading to referral to
EI/specialists, and barriers to EI referral for children <36 months of age identified with a possible developmental
problem via screening and who are at-risk for developmental delay/autism.
Data were from nationally representative surveys of American Academy of Pediatrics U.S. members.
Responses on developmental and autism referral practices were compared across surveys from 2002 (n=392;
response rate=55%) and 2016 (n=377; 47%). Analysis was restricted to non-trainees who reported screening for
developmental delay/autism. Respondents reported having referred an at-risk patient to EI (2002 and 2016) or
specialist (2016), conditions leading to EI or specialist referral, and barriers to EI referral. T-tests were used to assess
differences across surveys.
From 2002-2016, pediatricians reporting having made referrals of children at-risk for developmental
delay/autism to EI increased from 91% to 97% (OR 3.46, 95% CI 1.74-6.91, p<.001). In 2016, 79% report having
referred at-risk patients to specialists prior to referring to EI (2002 not available). Pediatricians in 2016 were more
likely than in 2002 to report being “very likely” to refer a patient to EI with global developmental delay, milestone loss,
language delay, sensory impairment, motor delays, and family concern (p<.05). For referral to specialists, there was
an increase in the reported likelihood to refer for global developmental delay and those at risk of neglect (p<.05). Lack
of information about EI programs declined as a reported barrier to referral (18% “strongly agreeing” in 2002; 11% in
2016). Also, fewer in 2016 reported a lack of understanding of EI procedures as a barrier (p<.05).
More pediatricians are making referrals for children with concerns in developmental or autism
screening, as they consider a wider set of conditions that lead to referral and perceive fewer barriers to referral. While
challenges remain, this reflects growing awareness among pediatricians about current guidelines and the importance
of EI/specialist referrals to improving outcomes for at-risk children.