When should I get my child tested for autism?

Should I wait to have my child tested for autism?

Parenthood is filled with difficult decisions. It can be daunting to know how to meet your child's needs and help them grow and develop into their best self. This is especially true when faced with concerns about your child’s development and the many options ahead. For parents whose concerns center around autism spectrum disorder, the first question is often, "when is it time to get my child tested?"

Autism Spectrum Disorder is a neurodevelopmental disorder, which means that it involves brain differences that impact how a child develops. It can be diagnosed in children as young as 18 months old (with some able to be diagnosed even earlier at 12 months). Many parents first notice differences in the pace at which their child meets early developmental milestones, particularly those related to language and social interaction. Some parents may notice that their child doesn't begin to talk as early as others their age, their child uses language but not in ways that help them get their needs met, or their child seems less engaged with other children or adults than expected. Pediatricians routinely assess young children's developmental milestones and may notice if they are not met at the expected ages.

The challenge often begins here, with both parents and pediatricians finding themselves "on the fence" about whether a child failing to meet early developmental milestones warrants more time (some children truly do hit milestones later than others) or if further evaluation is needed. It is an important decision and here are some things to consider:

Is it autism or developmental delay?

Some children exhibit developmental delays that, usually with therapeutic support, improve and allow the child to “catch up.” For children on the autism spectrum, other symptoms are commonly seen in early childhood (birth to 3 years old) that help distinguish autism from developmental delay. Here is what research suggests is most predictive of an autism diagnosis in children under 3 years old:

1. Eye contact: Child may rarely or never make direct eye contact with others, particularly during interactions such as watching an adult make silly faces or looking toward a caregiver when upset.

2. Lack of social smiling: This includes smiling in response to someone else smiling at them or smiling toward someone to share enjoyment.

3. Name response: Child may not respond when their name is called or only respond after multiple attempts. The child may only respond to their name when their name is coupled with a familiar and motivating phrase (e.g., "let's go" or "want a snack?") or physical touch (e.g., patting their shoulder).

4. Lack of Joint Attention: This is a big one. Joint attention refers to shared attention between two people toward the same object or event. It includes eye contact, pointing, and following where others look or point. A typically developing child might find interest in a toy, look toward a parent, and then look back at the toy or point to it. In toddlers with autism, parents may join the child’s enjoyable activity, but the child continues independently without looking toward the parent, sharing the moment, or attempting to maintain the parent’s attention, suggesting limited awareness of the parent as a social partner.

5. Communication Differences: While some children with autism have delayed language, this alone does not reliably distinguish autism from developmental delay. More relevant signs include limited use of nonverbal communication such as eye contact, pointing, gestures, and facial expressions. When language is used, toddlers with autism may be more likely to label objects rather than use words to request or share.

Early Intervention is EFFECTIVE

Research has repeatedly demonstrated that early intervention improves developmental outcomes. Why? Young children benefit from something called neuroplasticity. This is the brain’s ability to change, adapt, and “rewire” itself based on experiences, learning opportunities, and environment. Early childhood is a period when the brain is rapidly forming connections that support development. Intervention during this window can significantly support skill growth. Research consistently shows that intervention within the first three years of life leads to better outcomes.

Where does an evaluation fit into early intervention? An evaluation helps determine a child’s individual needs. Additionally, many funding sources (such as insurance) require a diagnosis to cover certain interventions.

What does my child get out of an evaluation?

An autism evaluation determines whether a child shows symptoms consistent with autism according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This is considered a medical diagnosis, which is often required in order to access some forms of early intervention services (such as ABA therapy). A comprehensive autism also examines development in areas such as cognitive and adaptive levels.

The report can also be helpful when shared with your local school system. Special education services are not just available to child upon starting kindergarten. Starting at age 3 years old, children can be evaluated by their local public school system to determine eligibility for an Individualized Education Program (IEP). If eligible, services may include speech therapy, occupational therapy, and specialized instruction. While an existing diagnosis of autism does not automatically mean a child is eligible for special education services, the evaluation report may cover some aspects of the school's process that do not need to be repeated.

Finally, an evaluation provides some baseline information about a child's functioning. Over time, you may be able to see through actual data the extent to which your child is improving!

Wait Lists are Common

A final consideration is that therapy and early intervention services often have waitlists. Families may even wait for the diagnostic evaluation itself, especially in rural areas. After diagnosis, beginning autism-specific therapy such as ABA may take several months to two years or more. This can be incredibly frustrating for parents, especially when early intervention is strongly recommended. For this reason, seeking diagnostic clarification as soon as concerns arise can be important.

Ultimately, the decision about how to proceed belongs to you as the parent. You know your child best. However, it may be reassuring to know that many professionals are ready to help you navigate these decisions, uncover important information, and support your child as they grow into the amazing person they are meant to be.