Getting your child tested for autism starts with your pediatrician, who should be screening for it at the 18-month and 24-month well-child visits. If you have concerns at any age, you don’t need to wait for those checkpoints. You can request a developmental screening at any appointment, ask for a referral to a specialist, or pursue a free evaluation through your state’s early intervention program or school district.
What Happens at Routine Screenings
The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-month, 18-month, and 30-month well-child visits. On top of that, every child should be specifically screened for autism at 18 months and again at 24 months. These screenings typically involve a short questionnaire you fill out in the waiting room, with questions about how your child communicates, responds to their name, makes eye contact, and plays with objects or other people.
A screening is not a diagnosis. It’s a quick check that flags whether your child needs a closer look. If the result is positive, your pediatrician should refer you for a full evaluation. If your child has a sibling with autism or you’ve noticed signs that concern you, additional screening outside those standard ages is recommended. You don’t need to justify your concern or wait until a specific birthday to bring it up.
The Full Diagnostic Evaluation
A formal autism evaluation is done by a specialist: a developmental pediatrician, child psychologist, child psychiatrist, or pediatric neurologist. The process combines direct observation of your child with an in-depth interview about their developmental history.
Two tools are considered the gold standard for this evaluation. The first is a structured observation session where a trained examiner interacts one-on-one with your child, using specific activities designed to reveal how they communicate, respond socially, and engage in play. The examiner is watching for differences in social interaction and repetitive patterns of behavior or interests. The second is a detailed parent interview that covers your child’s current behavior and their developmental history going back to infancy, focusing on social skills, communication, and repetitive behaviors.
Evaluations vary widely in length. Some centers complete the process in one to two hours, while others take over eight hours spread across multiple appointments. The evaluation may also include cognitive testing, language assessment, and observation of your child’s adaptive skills, depending on the specialist and your child’s age. To receive a diagnosis, a child must meet specific criteria for both social communication difficulties and restricted or repetitive behaviors, as defined in the DSM-5.
Where to Get an Evaluation
You have several pathways, and you can pursue more than one at the same time.
- Through your pediatrician. Ask for a referral to a developmental specialist. This is the most common route and the one your insurance is most likely to cover.
- Early intervention (birth to age 3). Every state runs a federally funded early intervention program under Part C of the Individuals with Disabilities Education Act. You can contact your state’s program directly and request a free evaluation without needing a doctor’s referral. Search for your state’s Part C early intervention program online or call your pediatrician’s office for the local contact number.
- Through your school district (age 3 and up). You can submit a written request to your local school district asking them to evaluate your child. The school must respond in writing within 10 school days. They can agree to evaluate or refuse, but a refusal must include a detailed written explanation of why, what information they used to make that decision, and a full explanation of your legal rights.
- University-affiliated autism centers and children’s hospitals. These often have dedicated diagnostic clinics and may accept self-referrals.
Medical Diagnosis vs. School Eligibility
These are two different things, and understanding the distinction matters. A medical diagnosis is made by a doctor or psychologist using DSM-5 criteria. Once you have it, it’s generally sufficient to access medical treatments and therapies through your insurance.
An educational determination of autism is separate. To qualify for special education services under IDEA, your child must meet the school’s criteria for autism (which vary by state) and the educational team must find that autism symptoms interfere with their learning enough to require special services. This means a child can have a medical diagnosis of autism but not qualify for special education, or vice versa. A medical diagnosis does not automatically guarantee school services, and a school eligibility determination is not the same as a clinical diagnosis. If your child needs both therapeutic support and school accommodations, you may want to pursue both pathways.
Expect a Wait
Long wait times are one of the biggest barriers families face. A survey of autism diagnostic centers across the U.S. found that nearly two-thirds had wait times longer than four months. About 15% reported waits of over a year, and some had stopped accepting new patients entirely.
There are a few things you can do to shorten or work around the wait. Get on multiple waitlists at once. Ask your pediatrician’s office if they know which local specialists have shorter wait times. Pursue a school district or early intervention evaluation in parallel, since those systems have their own timelines and can connect your child with services while you wait for a clinical appointment. Some families also find shorter waits at university training clinics, where supervised graduate students conduct evaluations under faculty oversight.
Insurance and Cost
Most states now have laws requiring health insurers to cover autism screening, diagnosis, and treatment. The specifics vary: some states cap coverage at a certain age (often 18 or 21), limit the number of annual visits, or set annual spending caps. States like Alabama, Colorado, Delaware, Florida, Illinois, New Jersey, and many others have explicit mandates requiring coverage for autism diagnosis.
If you have private insurance, call the number on your card and ask specifically whether diagnostic autism evaluations are covered, whether you need a referral or prior authorization, and which local providers are in-network. If you’re uninsured or underinsured, early intervention programs and school district evaluations are provided at no cost to families. Some children’s hospitals and autism centers also offer sliding-scale fees.
Signs That Prompt an Evaluation
Children can be reliably diagnosed with autism as young as 18 months, though many aren’t identified until later. Signs that typically lead parents to seek testing include limited or no response to their name by 12 months, absence of pointing or waving by 12 months, no two-word phrases by 24 months, loss of previously acquired speech or social skills at any age, limited eye contact, difficulty with back-and-forth conversation or play, intense focus on specific objects or topics, distress with minor changes in routine, and repetitive movements like hand flapping or rocking.
No single behavior on its own means a child is autistic. The evaluation looks at the overall pattern across social communication and repetitive behaviors. If you’re noticing several of these signs, requesting an evaluation is the right next step. Earlier identification leads to earlier access to interventions that can meaningfully support your child’s development.