The crucial role pediatricians play in early autism diagnosis and why it matters

Krystina Way, MEd, BCBA, LBA, clinical assessment specialist, BlueSprig.

Early identification of autism spectrum disorder (ASD) is essential when it comes to giving children the best possible opportunities to thrive as they grow. Early diagnosis and subsequent intervention can significantly improve the quality of life for a child with autism.

Pediatricians hold the key to success by recognizing early signs of autism and ensuring families are supported with timely referrals and resources. However, because ASD symptoms and presentations can vary widely from child to child, it can be challenging to diagnose.

Understanding the impact of early diagnosis

Autism is a complex neurodevelopmental disorder characterized by pathological differences in social communication, restricted interests, and repetitive behaviors.¹ Research repeatedly demonstrates that early diagnosis of ASD, ideally before the age of 3, along with early intervention using evidence-based treatments such as Applied Behavior Analysis (ABA) therapy, leads to significantly enhanced long-term outcomes in communication, behavior, and adaptive skills.²

If children with autism begin ABA therapy before age three, they can see drastic improvement in developmental milestones, including language, communication, and social skills. Studies also show children with autism who receive 30+ hours of intensive ABA therapy weekly are twice as likely to close cognitive development gaps compared to kids who receive less than 12 hours.³ They are also three times as likely to achieve average everyday skills. Additionally, early intervention can decrease the need for more intensive services later on, saving families and systems time and money.

For a child to receive early intervention, they need an early diagnosis. Families that receive early referrals from their pediatricians are more likely to start services sooner, which can be life-changing. Many children with autism will show signs early on that can be clearly identified by someone familiar with the wide range of symptoms. One-third of parents recognize symptoms or cite concerns before their child’s first birthday, but unfortunately, many diagnoses are not made until after 4 years old.⁴ In our current system, even if a pediatrician refers a patient for developmental evaluation early in their life, many waitlists for the specialist appointments can be up to two years. The earlier a pediatrician recognizes the signs and makes a referral for diagnostic evaluation, the better the outcomes for the child to excel.

Developmental screening: A pediatrician’s starting point

The American Academy of Pediatrics (AAP) recommends routine developmental screenings at 9, 18, and 30 months old and autism-specific screenings at 18 and 24 months.⁵ These well-child visits are essential for pediatricians to observe and evaluate a child’s developmental milestones, social engagement, and communication behaviors.

Pediatricians should be looking for and asking parents about the signs and symptoms of ASD, which may include the following:

• Not following moving objects with their eyes
• Minimal or no smiling in response to others smiling at or talking to them
• Minimal or no pointing to communicate or share an interest
• Making quick or infrequent eye contact
• Minimal or not attempting to gain the attention of caregivers
• Displaying limited or no imitation skills
• Showing increased independence for their age
• Repeating words or phrases to themselves or others
• Developing unusual attachments to objects or routines
• Exhibiting sensory sensitivities (sounds, lights, textures)
• Engaging in toe-walking
• Showing little to no interest in other children
• Engaging in limited or no functional and/or imaginative play
• Having a low or no response to their name being called by 12 months of age
• Experiencing intense, frequent, and/or long tantrums

The CDC developmental milestones also provide more information on early signs of autism⁶. While any single one of these behaviors may not be cause for concern on its own, the presence of several, especially if persistent, should indicate the need for additional screening. It is also important to note that engagement in any of these skills, such as having consistent eye contact, should not rule out the need for further evaluation.

Using evidence-based screening tools

One of the most effective tools for identifying potential autism symptoms in toddlers is the Modified Checklist for Autism in Toddlers (M-CHAT). This parent-completed questionnaire is easy to administer during routine checkups and helps pediatricians assess risk by evaluating how a child communicates, plays, and interacts with others.

When used correctly, M-CHAT and similar tools help reduce subjectivity and provide a clear path for referring a child for a comprehensive evaluation. Pediatricians should not only consistently utilize these tools but also understand how to interpret the results and engage with parents in a supportive and informative conversation about the next steps.

Building a collaborative referral network

If screening tools indicate or signs of developmental concerns are present, referral to a specialist is the next step. Depending on the child’s age and the complexity of the case, referrals may be made to:

• Developmental-behavioral pediatricians
• Pediatric neurologists
• Child psychologists or psychiatrists
• Early intervention programs

These specialists can conduct formal evaluations to confirm a diagnosis and recommend intervention options. Establishing a network of trusted local providers ensures a smooth and timely referral process for families. Formal evaluations often include parent interviews, observation, cognitive and language ability tests, and interviews or questionnaires with other caregivers, like a daycare teacher.

Diagnosis may also bring to light comorbid disorders such as ADHD, OCD, dyslexia, dysgraphia, intellectual impairment, and other possible co-occurring conditions. This information is invaluable when formulating a support plan with family, educators, and employers for accommodating and managing ASD-related struggles.⁷

Barriers to early diagnosis and how to overcome them

Despite the availability of screening tools and guidelines, some children still do not receive an autism diagnosis until age four or later. Several factors can cause this delay:

• Inconsistent screening protocols: Not all practices conduct regular developmental and autism screenings.
• Cultural and language differences: Communication gaps can prevent families from expressing concerns or understanding recommendations.⁸
• Lack of provider training: Not all healthcare providers are confident in identifying subtle signs of autism or discussing them with families. Parent concerns may also be dismissed.
• Social stigma: Unwillingness on the parents’ part to address developmental concerns.
• Lack of access to ASD diagnostic services: Some geographic areas may have few providers qualified to diagnose, leading to long wait times.⁹

To address these challenges, pediatricians can participate in ongoing professional development, integrate standardized screening tools into their EHR systems, and develop culturally competent approaches to patient care.

Pediatric practices can also create informational materials or host educational sessions to help normalize conversations around developmental differences. These materials or sessions can also be provided in multiple languages to better reflect the demographics of patients in the areas the pediatrician serves. They can also help point families in the direction of ASD resources and support groups while they wait for screening and formal diagnosis.

The more informed and supported families feel, the more proactive they can be in pursuing evaluations and services.

Advising families post-diagnosis

After a diagnosis, families are often introduced to ABA therapy, a gold-standard, evidence-based approach designed to support the development of communication, social skills, and adaptive behaviors. Programs like Blue Sprig Pediatrics tailor ABA therapy to each child’s unique needs and collaborate closely with families to ensure progress across multiple environments.

Finding a facility like BlueSprig that offers comprehensive care is key for ABA therapy. Pediatricians should advise that patients look for the following:

• Individualized care, not cookie-cutter programs
• Specialty services, like those for children with severe behavior
• Caregiver support or training
• Options for home, school, and clinic-based care
• Crisis planning
• Advocacy in IEP planning with schools
• Water safety resources
• Additional assistance and guidance with other considerations, like dental visits or sensory needs

Pediatricians also play a key role in supporting families emotionally. Receiving news of a potential autism diagnosis can be overwhelming for parents. Providing empathetic guidance and emphasizing the benefits of early intervention can help families feel more confident and less isolated. A pediatrician may also encourage families to join support groups, either in-person or online, so they may benefit from the experiences and encouragement of others on the same path. Pediatricians can also connect patients to resources like those at Autism Speaks and the Autism Society. Finally, offering resources to parents and families, like how to find therapists or support for themselves, can be just as important as the services for the child with autism.

Conclusion

Diagnosing autism is not the sole responsibility of any one provider—it requires a coordinated effort among healthcare professionals, therapists, educators, and families. Pediatricians are the key—they interact regularly with the child and family during the early years, and, by conducting proper screenings and referring early, can ensure that no child misses the opportunity to thrive.

About the author: Krystina Way is a dedicated and experienced Board Certified Behavior Analyst (BCBA) and Licensed Behavior Analyst (LBA) based in Houston, Texas. With a strong educational foundation, Way holds a Bachelor of Arts in Psychology from Texas A&M University and a Master of Education in Special Education with a concentration in Autism and Developmental Disabilities from the University of Texas.

Since entering the field of behavior analysis in 2013, Way has amassed a wealth of experience across various settings, including homes, schools, rehabilitation centers, ABA clinics, and community environments. Through this diverse background, Way has gained exposure to the wide range of autism symptomology.

Through her work at Blue Sprig Pediatrics, Way is particularly passionate about neurodiversity-affirming care, caregiver support services and training, and mentoring fellow clinicians to provide high-quality ABA services. Her commitment to these areas underscores her dedication to improving the lives of individuals with developmental disabilities and supporting the broader community of behavior analysts.

References

1. National Institute of Mental Health. Autism Spectrum Disorder. National Institute of Mental Health. 2025. Accessed April 9, 2025. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd
2. Maksimović S, Marisavljević M, Stanojević N, et al. Importance of Early Intervention in Reducing Autistic Symptoms and Speech-Language Deficits in Children with Autism Spectrum Disorder. Children (Basel). 2023;10(1):122. Published 2023 Jan 6. doi:10.3390/children10010122
3. The Council of Autism Service Providers. Evidence About ABA Treatment for Young Children With Autism: The Impact of Treatment Intensity on Outcomes. Accessed April 9, 2025. https://assets-002.noviams.com/novi-file-uploads/casp/pdfs-and-documents/evidenceaboutabatreatment.pdf
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5. American Academy of Pediatrics. Developmental Surveillance and Screening. American Academy of Pediatrics. Updated February 28, 2025. Accessed April 9, 2025. https://www.aap.org/en/patient-care/developmental-surveillance-and-screening-patient-care/?srsltid=AfmBOopq33uCI5uuLBLCAzE6OcxGAcdwfNnnJvJ6UMxhsT_2f8dMA4fx
6. Centers for Disease Control and Prevention. CDC’s Developmental Milestones. CDC. Updated May 8, 2024. Accessed April 9, 2025. https://www.cdc.gov/ncbddd/actearly/milestones/index.html
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8. Guerrero MGB, Sobotka SA. Understanding the Barriers to Receiving Autism Diagnoses for Hispanic and Latinx Families. Pediatr Ann. 2022;51(4):e167-e171. doi:10.3928/19382359-20220322-03
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