Pediatricians are conducting routine checks for autism, but new research suggests they frequently fail to act when screenings show cause for concern.

A study looking at medical records for children who visited 290 doctors between 2014 and 2016 shows that the vast majority were screened for autism at ages 18 and 24 months as recommended by the American Academy of Pediatrics.

However, in cases where children were flagged by the screening test, just 31 percent of providers made a referral to an autism specialist, according to findings published this month in the journal Pediatrics.

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For the study, researchers reviewed 23,514 screenings conducted with what’s known as the Modified Checklist for Autism in Toddlers, or M-CHAT. Of them, 530 children failed their check at 18 months, 24 months or both.

The researchers then tracked the children for two to four years to find out what types of referrals were made or completed and how the kids fared.

Even when children were referred to an autism specialist, only about half of families followed through, the study found. Ultimately, 18 percent of kids who failed the M-CHAT screening were diagnosed with autism and 59 percent were found to have another neurodevelopmental disorder.

Though autism can be reliably identified at age 2, fewer than half of children with the developmental disorder are diagnosed by age 4, according to the Centers for Disease Control and Prevention. Spotting autism early is considered important because research has shown that intervention is most successful when started young.

“There needs to be action by pediatricians following that failed screening,” said Robin Kochel, an associate professor of pediatrics and psychology at Baylor College of Medicine who worked on the study. “Whether that action is immediately evaluating for autism themselves, or making those appropriate referrals if they are not sure a child meets the criteria for autism.”