This pre-referral guideline covers communication problems - unusual socialization (potential Autism spectrum disorders - Aspergers disorder) in children from 2-15 years of age.

Initial work-up

• Standard history and physical exam. Include history from parents/caregivers regarding onset and course of symptoms, family history of similar problems.
• Developmental progression e.g.
  • single words = 12-15 m
  • 2 word sentences = 2 yr
  • conversations = 3-4 yr
  • shared attention e.g. pointing = 12 m
  • imaginative pretend play = 18 m
  • eye contact, warm interaction
• Differential diagnosis e.g. consider language disorder, intellectual disability, hearing loss.
• Consider administration of  PEDS Screening Tool
• If child has been previously diagnosed, in addition toRCH referral, consider referral to community based services e.g  Early Intervention Disability Intake and Response Service 

Recommended pre-referral treatment

• Demographic data
• Birth, developmental and medical history
• Family and social history
• Copies of previous mental health, language, cognitive, audiology assessments
• Early Intervention / Treatments: recommended and delivered
• Response to treatment
• Audiology results

When to refer

• Significant parent concern PEDS Screening Tool 
• Significant language delay.
• Unusual repetitive behaviors.
• Poor social responsiveness.
• Concern from other agencies (MCH Nurses, childcare, preschool).