**6. Conclusion**

bled the physicians to develop better communication with local referral resources and re‐

An additional lesson learned by clinics implementing an effective referral-tracking system was that many families did not seem to understand the reason for their child's referral [51]. The parents' limited understanding is concerning, not only because it reduces the chances that the parent will follow through with the pediatrician's referral but also because a com‐ prehensive ASD evaluation will progress more efficiently if parents are familiar with the be‐ havioral characteristics of children with ASD and if they can report accurately about their child's behavioral red flags of ASD [6]. Finally, by educating the parents about ASD at the time when the referral is made, families have the opportunity to prepare themselves emo‐

tionally for the evaluation and the possibility that their child may have autism.

**3.** Early Intervention administrators need to be informed that ASD is suspected

**5.2. Novel approaches to prevent delays between referral and onset of services**

Several recent projects aiming to implement general developmental or autism-specific screening in the primary care setting found it necessary to create a dedicated staff position, a developmental or autism specialist, to provide second-stage screening services to prevent over-referral, and/or information, support, resources and referrals to families identified with developmental concerns [61, 104]. Other projects provided families with access to a develop‐ mental/autism specialist by creating a partnership with a local research group [3, 56]. Al‐ though this is a rather novel approach in the context of developmental and autism screening, the idea of a patient navigation program has been popular in other medical fields

The American Cancer Society supported the nation's first patient navigation program in 1990 at the Harlem Hospital Center. Founded by Dr. Harold Freeman, patient navigation originally aimed to promote access to timely cancer diagnosis and treatment and to ensure coordinated

In determining eligibility for Early Intervention services, evaluations may cover multiple areas of development, including (1) physical, including vision and hearing, (2) cognitive, (3) communication, (4) social or emotional, and/or (5) adaptive. The developmental profile of many toddlers with ASD is strikingly uneven with possible strengths in physical and cogni‐ tive development and specific delays in several social and communication milestones. Given that ASD symptoms may be observed in the absence of global developmental delays, it is important that the evaluation team is specifically charged with the task to 'rule out ASD'. If ASD symptoms are not specifically addressed during the evaluation, toddlers with ASD who also have strengths in global development may be missed and as a result may not be

ceive more consistent feedback on the children they referred.

**2.** Parents need to be educated about ASD

18 Recent Advances in Autism Spectrum Disorders - Volume I

considered eligible for services.

for several decades.

*5.2.1. The patient navigation program*

During the last decade, research on early identification, diagnosis and intervention for toddlers with ASD has made tremendous progress. Moreover, during recent years, the topic of community implementation of best practice strategies has risen to the forefront. In order to develop a sustainable service infrastructure for toddlers with ASD, systems for public awareness, early identification, and early intervention need to be scaled up in tandem with updated priorities in public policy and funding allocation. Eventually, efforts to increase early identification of children with ASD will only be successful if identified children have access to effective Early Intervention services.
