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There continues to be an ongoing effort in pediatric practice to improve screening and referral rates of children with potential developmental disabilities including Autism Spectrum Disorder (ASD). Successes have been seen in practices relative to broad developmental screening efforts and increasing improvement in screening for ASD. However, gaps continue to occur in screening, referral for further evaluation, and follow-up that allows the practice (and treating provider) to know the outcome of the referral. This type of “closing the loop” between providers and referral sources is necessary for the practice to function as a medical home for the child and family. In addition, caregivers have highlighted many challenges in the early identification process in working with their primary care provider. This manuscript discusses some of the barriers to early identification for children and their families, successful strategies for more consistent screening and closing the loop following referral, and highlights parental perceptions about identification and referral. Further, practical approaches that could be used by pediatric providers are highlighted.