Getting your child tested for autism starts with raising your concerns to your pediatrician, who can perform an initial screening and refer you to a specialist for a full diagnostic evaluation. The process typically involves multiple steps, and wait times at specialty centers average four to six months or longer, so starting early matters. Here’s what to expect at each stage and how to navigate the system efficiently.
Start With Your Pediatrician
Your child’s pediatrician is the first stop. The American Academy of Pediatrics recommends autism screening at the 18-month and 24-month well-child visits, but you can request a screening at any time if you have concerns. The most widely used tool for toddlers is the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R/F), a parent questionnaire valid for children between 16 and 30 months. It takes just a few minutes and flags whether your child may be at risk.
A screening is not a diagnosis. It tells you whether a more thorough evaluation is warranted. If the screening suggests elevated risk, or if your pediatrician shares your concerns based on what they observe, the next step is a referral to a specialist. If your pediatrician dismisses your concerns but your gut says otherwise, you have every right to request a referral or seek one on your own. Parents are often the first to notice the subtle signs.
Who Can Diagnose Autism
Several types of professionals are qualified to formally diagnose autism spectrum disorder. According to Children’s Hospital of Philadelphia, these include:
- Developmental pediatricians: pediatricians with advanced training in developmental and behavioral medicine. They’re often the go-to for young children.
- Pediatric neurologists: specialists in neurological conditions who can diagnose autism alongside other concerns like seizures or motor delays.
- Child and adolescent psychiatrists: physicians focused on thinking, feeling, and behavioral disorders in children. Many specialize in autism.
- Psychologists, clinical psychologists, and neuropsychologists: doctoral-level professionals who often administer the standardized assessment tools used in diagnosis, such as play-based and interview-based evaluations.
You don’t necessarily need a specific type of specialist. What matters is that the person has direct experience evaluating children for autism and uses validated diagnostic tools. When calling to schedule, ask what assessment instruments they use and how many autism evaluations they conduct per year.
What Happens During the Evaluation
A comprehensive autism evaluation is not a single quick test. No center in a federal survey of 111 diagnostic sites was able to complete an individual assessment in under one hour, and a quarter of centers reported that each evaluation takes more than eight hours total, often spread across multiple appointments.
The evaluation typically includes several components. The most common standardized tool is the Autism Diagnostic Observation Schedule (ADOS-2), a 40- to 60-minute session where a clinician observes your child’s social and communication behaviors through structured and unstructured activities. Five different versions of the ADOS-2 exist, tailored to your child’s age and language level, from nonverbal toddlers to verbally fluent older children. The clinician creates situations designed to prompt social interaction, then rates both spontaneous and prompted responses.
Alongside the ADOS-2, many evaluators use the Autism Diagnostic Interview, Revised (ADI-R), a detailed interview with you as the parent. You’ll be asked about your child’s developmental history, communication patterns, social behavior, and repetitive or restricted interests. Expect this to be thorough. Evaluators also commonly assess your child’s cognitive ability, language skills, and adaptive functioning to build a complete picture. The goal is not just to determine whether autism is present but to identify your child’s specific strengths and support needs.
Be Prepared for Long Wait Times
Demand for autism evaluations far outpaces the supply of qualified evaluators. A federal survey of autism diagnostic centers found that nearly two-thirds had wait times longer than four months. About 15% reported waits of over a year, and 3% had stopped accepting new referrals entirely. Only 13% of centers could see a child within four weeks.
The biggest drivers are workforce shortages (cited by 69% of centers), high referral volumes (61%), and the time required to complete evaluations and write reports for insurance (54%). Nearly half of surveyed centers did not accept Medicaid, further narrowing options for many families.
To shorten your wait, consider these strategies. Get on multiple waitlists simultaneously. Ask to be placed on a cancellation list for earlier openings. Look beyond major children’s hospitals to private practices and university-affiliated clinics, which sometimes have shorter queues. Some centers now offer telehealth evaluations for portions of the assessment, though about 70% of centers still require in-person visits for at least part of the process. Starting the process through your school district or Early Intervention program (described below) can also get services flowing while you wait for a clinical diagnosis.
Free Evaluations for Children Under 3
Every state has an Early Intervention (EI) program funded by the federal government that provides free developmental evaluations for infants and toddlers from birth through age 2. You do not need a doctor’s referral or a prescription. You can contact your state or county’s Early Intervention program directly and request an evaluation.
Once you make the referral, the EI program assigns a service coordinator who arranges the evaluation at no cost to you, regardless of your income or insurance status. If your child qualifies, services like speech therapy, occupational therapy, and developmental support can begin while you’re still waiting for a formal clinical diagnosis. This is one of the most underused resources available to parents of young children, and it can save months of waiting.
If your child is approaching their third birthday, timing matters. Children who turn three within 45 days of being referred should instead be directed to their local school district’s preschool special education committee, since EI services end at age 3.
School Evaluations for Children 3 and Older
Once your child turns 3, your local school district is legally required to evaluate them for disabilities, including autism, if you request it in writing. This is a right under the Individuals with Disabilities Education Act (IDEA), and the evaluation is free. You do not need a doctor’s referral. Simply write a letter to your school’s special education department requesting an evaluation and keep a copy for your records.
Federal law requires the school to use multiple assessment tools, not a single test, and to evaluate your child in all areas related to the suspected disability. That can include social and emotional functioning, communication, cognitive ability, academic performance, motor skills, and adaptive behavior. Assessments must be administered in your child’s native language by trained personnel. Most states require the school to complete the evaluation within 60 days of receiving your consent, though some states set shorter timelines.
Medical Diagnosis vs. School Eligibility
This is a distinction that catches many parents off guard: a medical diagnosis of autism and a school’s determination of educational eligibility are two separate things. A medical diagnosis is made by a clinician using the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A school eligibility determination is made by a team of school professionals and parents, and it asks a different question: does this child’s autism interfere with their ability to learn and make academic progress?
Because of this difference, it is entirely possible for a child to have a medical diagnosis of autism but not qualify for special education services at school. The reverse can also happen. A school may identify a child under the educational category of autism without the child having a formal clinical diagnosis. The two systems serve different purposes. A medical diagnosis opens doors to clinical therapies and insurance-covered treatment. Educational eligibility opens doors to classroom accommodations, an Individualized Education Program (IEP), and school-based services like speech or occupational therapy.
For the most complete support, many families pursue both paths. If your child needs services in both settings, having both a medical diagnosis and a school eligibility determination gives you the broadest range of options.
Insurance Coverage for Autism Evaluations
Most states now require health insurers to cover the screening, diagnosis, and treatment of autism spectrum disorder. These mandates vary by state in their specifics, including age limits and coverage caps, but the trend over the past decade has been toward broader coverage. If your insurance denies coverage for a diagnostic evaluation, check your state’s specific autism insurance mandate, as the denial may violate state law.
Out-of-pocket costs for a private autism evaluation can range widely depending on your location, the evaluator, and the depth of testing involved. If cost is a barrier, university training clinics sometimes offer evaluations on a sliding scale. Your state’s Early Intervention program (for children under 3) and your school district (for children 3 and older) both provide evaluations at no cost, regardless of your financial situation.