I do a Nipissing screening and an Ages and Stages screening at all developmental levels. I give it to the parents with a specific list of strengths and goals. If there are "red flags" I also write a letter outlining those items and suggest pedeatrician referral and I refer to a community agency who does drop-in screenings with resouce consultants/speech/OT etc. I have run into the same problem. I have several who I'm 99% sure are along the ASD lines, and the doctors say they're fine, but they miserably failed the Ages and Stages checklist. I have a child here who is 4, and is very similar-doesn't understand directions, can't use toilet, can't dress/undress anything, no role play, no verbal with peers etc. The child is headed off to school in the fall, and I hoped he would be identified before then to have supports in place, but doctor says he's fine, so parents won't go see community agency, who I know would pick up on all of this. I would do an ages and stages evaluation, as it is so much more thorough, and refer to a community agency(check your early years centre listings as they often will have clinics or can tell you who to refer to in your area)