Autism Screening and Referral — Additional Referrals to Consider — Clinical Pathway: Primary Care

Additional Referrals to Consider
Genetics Consultation	Consider referral for pediatric genetics evaluation Comprehensive family history and physical examination: If syndrome diagnosis or metabolic disorder is suspected, refer to genetics and/or metabolism Discuss and offer laboratory studies: Chromosomal microarray Fragile-X testing Consider evaluation for Rett syndrome with MECP2 testing if patient is female If these studies do not reveal etiology, consider referral for whole exome sequencing at CHOP Individualized Medical Genetics Center (IMGC)
Neurology Consultation	Referral if clinical concern for: Seizures or altered consciousness Cerebral anomalies Dysmorphic features Atypical regression (occurring later than 2 years of age, motor regression, or multiple regressions) Microcephaly or macrocephaly Abnormal or asymmetric neurologic exam Active neurologic disorder If Neurology is consulted, they will order imaging if appropriate
Neuroimaging and/or EEG No routine order unless clinically indicated (see above)	Brain MRI may be indicated in the evaluation of atypical regression, microcephaly, macrocephaly, seizures, intracranial manifestations of genetic disorders, or abnormal neurologic examination EEG may be indicated if there is clinical concern about seizures, atypical regression, or other neurologic symptoms on history or examination
Sensory Assessment	Can consider referral for assessment if sensory differences appear to interfere with a child’s functioning. The assessment is often conducted by occupational therapy and can evaluate sensory differences relative to smell, taste, vision, hearing, and touch.
Social Work	To assist with obtaining or referring for services
Child and Adolescent Psychiatry	Consider for children ≥ 5 yrs presenting with comorbid and complex psychopathology

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.