Start by bringing up your concerns with your child’s pediatrician, who can perform a formal screening and refer you to a specialist for a full evaluation. The entire process, from that first conversation to a diagnosis, typically involves three stages: monitoring, screening, and a comprehensive diagnostic evaluation. Depending on where you live, the wait for that final evaluation can range from a few weeks to well over a year, so getting the process started early matters.
Start With Your Pediatrician
The American Academy of Pediatrics recommends that all children be screened specifically for autism at their 18-month and 24-month well-child visits. These screenings happen whether or not anyone has raised a concern. But if you’ve noticed something that worries you before or between those visits, you don’t need to wait. Call your pediatrician and describe what you’re seeing. Specific observations are more useful than vague worry: mention if your child isn’t responding to their name, doesn’t point at things to share interest, avoids eye contact, has lost words they used to say, or reacts intensely to certain sounds or textures.
At the visit, your pediatrician will likely use a standardized screening questionnaire. The most common one for toddlers is a 20-question checklist that parents fill out about their child’s behavior. Scores fall into three risk levels: low risk (0 to 2), medium risk (3 to 7), and high risk (8 to 20). Children who score in the high-risk range are typically referred immediately for a diagnostic evaluation. Medium-risk scores trigger a follow-up questionnaire to clarify the results. A screening is not a diagnosis. It’s a quick, evidence-based way to determine whether a deeper evaluation is warranted.
Who Can Diagnose Autism
If the screening suggests your child should be evaluated further, your pediatrician will refer you to one or more specialists. The professionals qualified to diagnose autism in children include developmental-behavioral pediatricians, child psychologists, child psychiatrists, and pediatric neurologists. Developmental-behavioral pediatricians are the most common choice, as autism and related developmental conditions are their primary focus. In some cases, a team of specialists works together, and the evaluation may also involve a speech-language pathologist or occupational therapist who assesses specific skill areas.
You can also seek a referral on your own. If your pediatrician is dismissive of your concerns, or if you simply want to move faster, you’re within your rights to contact a developmental specialist or autism evaluation center directly. Some accept self-referrals; others require a referral from a primary care provider. Check with your insurance plan first, since many require pre-authorization for specialty evaluations.
What Happens During the Evaluation
A formal autism evaluation is a thorough look at your child’s development, not a single test with a pass-or-fail result. Evaluations range from one to two hours at some centers to eight or more hours at others, sometimes split across multiple appointments. The specialist will observe your child directly, interact with them using specific activities designed to create natural social situations, and watch how your child responds. You’ll be asked detailed questions about your child’s developmental history, daily behavior, and how they interact with family and peers. You may also fill out additional questionnaires.
One widely used assessment tool, the ADOS-2, takes 40 to 60 minutes and involves structured and unstructured activities chosen based on your child’s age and language level. There are five different versions of this tool, ranging from modules for nonverbal toddlers to ones for verbally fluent older children and adults. The examiner watches for specific patterns in social interaction, communication, and repetitive behaviors, then scores what they observe.
To receive a diagnosis, a child must show persistent difficulties in all three areas of social communication: back-and-forth social interaction, nonverbal communication like eye contact and gestures, and developing and maintaining relationships. They must also show at least two of four types of repetitive or restricted behaviors, which include repetitive movements or speech, rigid insistence on routines, intensely focused interests, and unusual reactions to sensory input like sounds, textures, or lights. These patterns need to be present from early in development, though they sometimes don’t become obvious until a child faces greater social demands at preschool or school age.
The Wait Can Be Long
This is the hardest part for many families. A survey of autism diagnostic centers across the U.S. found that roughly 61% had wait times longer than four months. About 14% reported waits of more than a year, and some had stopped accepting new patients entirely. Only 13% of centers could see a child within four weeks.
There are several things you can do while waiting. Get on multiple waitlists if more than one center is available in your area. Ask to be placed on a cancellation list. Some university-affiliated clinics and children’s hospitals offer evaluations through training programs, which can sometimes have shorter waits. Telehealth-based autism evaluations have also expanded access in many states.
You Don’t Need to Wait for a Diagnosis to Get Help
For children under age 3, every state has a federally funded early intervention program (known as Part C under IDEA) that provides developmental services like speech therapy, occupational therapy, and behavioral support. You do not need a doctor’s referral or a diagnosis to access these services. Parents are considered a primary referral source, meaning you can contact your state’s early intervention system directly, explain your concerns, and request an evaluation. The evaluation through early intervention is free and must be completed within a specific timeframe set by your state.
For children ages 3 and older, your local school district is required to evaluate your child for special education eligibility if you request it in writing. This is also free.
School Evaluations and Medical Diagnoses Are Different
A medical diagnosis and a school eligibility determination serve different purposes, follow different criteria, and produce different outcomes. A medical diagnosis is made by a clinician using the standardized criteria described above. That diagnosis alone is usually enough to access therapies through your health insurance or medical providers.
A school evaluation, by contrast, is conducted by a team of school professionals along with the parents. The team must determine that the child has a qualifying disability (autism is one of 14 categories under federal law) and that the disability interferes with learning to the point where special services are needed. Because of that second requirement, it’s entirely possible for a child to have a medical diagnosis of autism but not qualify for special education, or vice versa. The definition of autism used by schools also varies from state to state. Some follow the medical criteria; others use their own.
If your child needs both classroom support and medical therapies, pursuing both pathways is worthwhile. A medical diagnosis opens access to insurance-covered treatments like behavioral therapy, speech therapy, and occupational therapy. An educational eligibility determination opens access to an Individualized Education Program with school-based services and accommodations.
Insurance Coverage for Testing
All 50 states have some form of autism insurance mandate, though what’s covered varies significantly. Many plans cover diagnostic evaluations, but coverage may be subject to pre-authorization, copays, deductibles, age limits, or caps on the number of visits. Before scheduling an evaluation, call the number on the back of your insurance card and ask specifically whether autism diagnostic evaluations are covered, whether you need pre-authorization, and whether the specialist you’ve been referred to is in-network.
If you’re uninsured or underinsured, the early intervention system and school district evaluations are provided at no cost. Some children’s hospitals and university clinics also offer sliding-scale fees. Medicaid covers autism evaluations in all states, though availability of providers who accept Medicaid varies by region.