Investigating a "Wait and See" Mindset Among Pediatric Health Care Providers Missed Opportunities to Refer Toddlers With Autism Spectrum Disorder to Part C Early Intervention

In the United States, there is a widespread concern with not referring more infants and toddlers with a risk of or identified autism spectrum disorder (ASD) to Early Intervention (EI) under Part C of the Individuals with Disabilities Education Act (IDEA, 2004). Despite early signs and screening initiatives, most children with ASD are not referred for services covered by IDEA until after the age of 4 years. To explore the prevalence of and factors correlated with a potential "wait and see" mindset among one group of stakeholders influencing referral decisions, we disseminated an expert-reviewed survey to pediatric health care providers in a southeastern metro area (n = 99). They self-reported views on waiting to refer, perceived roadblocks to screening and referral, and viable recommendations. Most participants reported using a "wait and evaluate further" approach instead of "wait and see," and the large majority were not very comfortable discussing suspected ASD with parents of young children (birth to 5 years of age). Those with more years of experience reported being less likely to wait to refer an infant/toddler and more comfortable speaking with parents about suspected signs of ASD. We discuss findings and implications for a comprehensive, multisector approach to outreach and referral.