Referral Pathway for Toddler with Biting Behavior, Developmental Delay, and Possible Autism
A toddler with biting behavior, developmental delay, and suspected autism should be referred to a developmental specialist (developmental-behavioral pediatrician, child neurologist, or child psychologist) for comprehensive autism-specific evaluation and early intervention services simultaneously.1
Primary Referral Options
Immediate Referrals (Should be made concurrently)
Developmental-Behavioral Pediatrician or Child Neurologist
- These specialists can perform comprehensive medical evaluations for ASD
- They can rule out other medical conditions that may present with similar symptoms
- Wait times may be long (often exceeding 6-12 months) 2
Early Intervention Services
- Do not wait for a formal diagnosis to begin intervention
- Services typically include:
- Speech-language therapy (critical for communication deficits)
- Occupational therapy (for sensory issues and motor skills)
- Behavioral therapy (to address biting and other challenging behaviors)
Child Psychologist with ASD Expertise
- Can perform standardized autism diagnostic assessments
- Uses tools like the Autism Diagnostic Observation Schedule (ADOS-2) 3
- May have shorter wait times than developmental pediatricians
Assessment Components
The comprehensive evaluation should include:
Standardized ASD-specific screening tools
Developmental assessment
- Evaluation of social communication skills
- Assessment of repetitive behaviors and restricted interests
- Evaluation of cognitive and adaptive functioning
Medical evaluation
- Hearing assessment (crucial for language development)
- Consideration of genetic testing
- Evaluation for co-occurring conditions (sleep disorders, gastrointestinal issues)
Addressing Biting Behavior
While waiting for specialist appointments:
- Behavioral strategies
- Identify triggers for biting behavior
- Implement positive reinforcement for appropriate behaviors
- Provide appropriate sensory input and alternatives to biting
- Consider referral to a behavior analyst for specific intervention
Important Considerations
Early intervention is critical - Research shows that children who receive intervention within the first 6 months of diagnosis show significantly better outcomes 4
Coordinated care approach - Some centers offer coordinated diagnostic pathways between developmental pediatrics and neurology that can significantly reduce wait times (mean of 50.89 days versus traditional 12+ months) 2
Siblings of children with ASD - If there are siblings with ASD in the family, this toddler should receive intensified surveillance as siblings have an estimated 14-18% recurrence risk 1
Developmental surveillance - The American Academy of Pediatrics recommends continuous developmental surveillance and standardized screening at specific ages 4, 5
Co-occurring conditions - Children with ASD often have higher rates of other conditions including sleep difficulties (13%), anxiety (11%), and other behavioral challenges that should be addressed 3
Pitfalls to Avoid
- Waiting for diagnosis before intervention - This delays critical early intervention services
- Focusing only on biting behavior - The biting may be a manifestation of communication difficulties, sensory issues, or frustration
- Overlooking medical causes - Ensure hearing and other medical evaluations are completed
- Single-discipline approach - A multidisciplinary team assessment provides the most comprehensive evaluation 5
Remember that children with global developmental delay have a high prevalence (62.3%) of comorbid ASD 6, making comprehensive evaluation particularly important for this toddler.
AI Assistant: I've provided a clear referral pathway prioritizing developmental specialists and early intervention services, with specific guidance on addressing the biting behavior while awaiting specialist evaluation. The recommendation emphasizes the critical importance of not delaying intervention while pursuing diagnosis.