🧠 AI Summary:

The moment a parent first notices something different about their child’s development — and begins to wonder if it might be autism — is one of the most disorienting moments in family life. What do you do next? Who do you call? Do you wait? Do you act? This blog walks families through every step of the journey from first concern to action, following the framework of Autism Speaks’ First Concern to Action resources. From learning the signs and completing a screening, to getting an evaluation, accessing early intervention before a diagnosis, and taking the first steps with ABA therapy — this is the practical, compassionate guide that every autism family needs.

The Moment Everything Changes

Maybe it is the way your child does not turn toward your voice the way you expected. Maybe it is a speech milestone that has not arrived, even though the books say it should have by now. Maybe it is the intensity of their reaction to something that seems small — a texture, a sound, a change in routine. Maybe it is the way they play alone with the same object for hours, or the way they look through people rather than at them.

The feeling that something is different. The question you are almost afraid to ask. The night-time Google searches you close before your partner can see them.

If you have had this feeling — if you are sitting with a concern about your child’s development right now — this blog is for you.

Not to alarm you. Not to diagnose your child from a webpage. But to tell you clearly and practically what to do next. Because knowing what to do — having a roadmap when you are in the fog of not knowing — is one of the most powerful things we can offer.

If you have concerns about how your child is communicating, interacting or behaving, you are probably wondering what to do next. This guide follows the framework of the Autism Speaks First Concern to Action resources to give you a clear, step-by-step path forward.

Step 1: Learn the Signs

Before any screening or evaluation, the most important first step is building awareness of what autism looks like in young children — and understanding the developmental milestones that can signal a concern worth acting on.

Autism spectrum disorder affects development across communication, social interaction, and behavior. Signs may be noticeable as early as 12–18 months, and a specialist can reliably diagnose autism as early as 18 months of age in many children. The earlier a concern is identified, the sooner a child can access the support that makes the most difference.

Here are some early signs that may warrant further evaluation:

In communication:

• No babbling by 12 months
• No single words by 16 months
• No two-word spontaneous phrases by 24 months
• Loss of any previously acquired language or social skills at any age

In social interaction:

• Limited or no eye contact
• Not responding to their name by 9–12 months
• Not pointing, waving, or reaching by 12 months
• Little interest in other children or in playing with others
• Not looking where someone else points
• Limited or no imitation of others

In behavior:

• Repetitive movements — hand flapping, rocking, spinning
• Intense or unusual attachment to specific objects or routines
• Significant distress at small changes
• Unusual sensory responses — extreme sensitivity or apparent indifference to sounds, textures, temperatures, or pain

It is important to say clearly: the presence of one or more of these signs does not mean your child has autism. Developmental variation is real and wide. But these signs are worth taking seriously and discussing with a professional — because if autism is present, acting now changes everything.

Step 2: Complete a Free Screening

Before calling a doctor, you can take an important step right now: complete the M-CHAT-R™.

The M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) is a free, validated, and widely used autism screening tool designed for children between 16 and 30 months of age. It takes just a few minutes to complete — around 20 yes/no questions about your child’s behavior — and you can use the results as the starting point for a conversation with your pediatrician.

You can complete the M-CHAT-R online at autismspeaks.org/screen-your-child.

A few important things to understand about screening:

Screening is not the same as diagnosis. A positive screening result does not mean your child has autism. It means your child’s responses warrant a closer look — and that the next steps are worth taking promptly.

You don’t need to wait for a scheduled appointment to screen. You can request an autism screening anytime from your doctor or your state’s Early Intervention program. The American Academy of Pediatrics recommends that all children be screened for autism at their 18-month and 24-month exams — and whenever a parent or doctor has concerns.

Your concerns are clinically significant. Parental observation is one of the most important inputs into the screening and evaluation process. You know your child better than any professional. If you have a concern, it deserves to be heard.

Step 3: Talk to Your Healthcare Provider

After completing a screening — or even before, if your concern is significant — the next step is a conversation with your child’s pediatrician.

Here is how to make that conversation as productive as possible:

Come prepared with specific observations. Rather than saying “something seems off,” describe what you have observed: “She doesn’t respond to her name most of the time.” “He has lost words he had at 18 months.” “She lines up her toys every day and becomes very upset if I move them.” Specific, concrete observations are more actionable for your doctor than general impressions.

Bring the M-CHAT-R results. If you have completed the screening, bring the results to the appointment. They provide a structured starting point for the conversation.

Ask directly for a referral. If your pediatrician recommends “watching and waiting,” you are not obligated to do so. You can ask directly: “I would like a referral for a comprehensive developmental evaluation.” You have the right to request this — and waiting when your concern is significant is a choice that has real costs.

Know that simultaneous referrals are best practice. Experts who suspect autism in a young child should not delay in talking to the family and referring simultaneously to diagnostic experts and early intervention. You do not have to wait for a diagnosis before beginning services.

Step 4: Access Early Intervention — You Don’t Need a Diagnosis to Start

This is one of the most important and least-known facts in the autism space: your child does not need a formal autism diagnosis to begin receiving intervention services.

Federal law requires states to provide therapy whenever screening identifies developmental delays or learning challenges. This is guaranteed by IDEA — the Individuals with Disabilities Education Improvement Act — which mandates that children with developmental delays have access to early intervention services regardless of diagnostic status.

For children under 3: Early Intervention services are available through each state’s program. In Ohio, this is Help Me Grow. In Utah, it is Baby Watch Early Intervention. These programs provide free or low-cost evaluations and services — including speech therapy, occupational therapy, and developmental support — for children from birth to age 3. You can self-refer; you do not need a doctor’s referral to contact these programs.

For children ages 3–21: Services are available through your school district’s Special Education office. A child who is identified with developmental delays is entitled to an Individualized Education Program (IEP) and the services it includes — regardless of whether autism has been formally diagnosed.

This matters enormously because comprehensive diagnostic evaluations often have significant waitlists — sometimes months long. The guidance is clear: do not wait for a diagnosis before beginning services. Begin Early Intervention now. A diagnosis can follow while your child is already receiving support.

Step 5: Pursue a Comprehensive Diagnostic Evaluation

While Early Intervention begins, the parallel track is pursuing a formal autism diagnostic evaluation. This is a more in-depth process than a screening — and it is the step that produces a formal diagnosis, if one is warranted.

Who conducts evaluations?
A comprehensive autism evaluation is typically conducted by a team that may include a developmental pediatrician, a child psychologist, a speech-language pathologist, and an occupational therapist.

The physician’s exam focuses on possible medical and genetic issues associated with your child’s symptoms. The psychologist administers developmental and cognitive tests. The speech-language pathologist evaluates communication and social skills. The occupational therapist can further evaluate sensory and motor issues.

What does an evaluation include?
A comprehensive evaluation includes talking with parents about their concerns, reviewing the child’s medical and developmental history, interacting with the child — often using a tool like the Autism Diagnostic Observation Schedule (ADOS) — and evaluating the child’s autism symptoms against Diagnostic and Statistical Manual of Mental Disorders criteria.

What happens after?
Following the diagnostic evaluation, the team should provide the family with comprehensive feedback, including a written report that fully explains all test results. This feedback session and report should be presented in understandable language. If autism is diagnosed, that report is the key document for accessing ABA therapy and other services.

On Target ABA offers on-site autism evaluations. For families in Ohio and Utah, you do not need to navigate a long referral chain or wait months for a clinic appointment. Contact us directly to learn about our evaluation process.

Step 6: Download the Free Resources

Autism Speaks has developed a suite of free resources specifically designed for families at different stages of the journey from first concern to action:

The First Concern to Action Tool Kit guides parents on how to seek an autism evaluation for their child. It provides specific resources and tools to help guide you on the journey from your first concern to action. Download it at autismspeaks.org/tool-kit/first-concern-action-tool-kit.

The First Concern to Action Roadmap is a downloadable visual guide that maps the steps from initial concern through evaluation and services. Download it at autismspeaks.org/roadmap/first-concerns-action-roadmap.

The M-CHAT-R Screening Tool is available free at autismspeaks.org/screen-your-child.

The 100 Day Kit (Young Children) is specifically designed for families of children aged 4 and under who have recently received a diagnosis. It helps families make the best possible use of the first 100 days after diagnosis.

The 100 Day Kit (School Age Children) serves families of children between 5 and 13 who have just received a diagnosis.

All of these resources are free, evidence-informed, and available in both English and Spanish.

Step 7: Begin ABA Therapy

Once an autism diagnosis is in hand, the most important next step for most families is beginning ABA therapy — Applied Behavior Analysis — as quickly as possible.

Research shows that early diagnosis of and interventions for autism are more likely to have major long-term positive effects on symptoms and later skills. Early interventions occur at or before preschool age, as early as 2 or 3 years of age. In this period, a young child’s brain is still forming — more plastic, or changeable, than at older ages. Because of this plasticity, treatments have a better chance of being effective in the longer term. The sooner a child gets help, the greater the chance for learning and progress.

With early intervention, some children with autism make so much progress that they are no longer on the autism spectrum when they are older.

ABA therapy is the most extensively researched and evidence-based intervention for autism. It supports the development of communication, social skills, daily living skills, and behavioral flexibility — and when it begins early, the outcomes are often remarkable.

At On Target ABA, we serve children ages 2–12 across Ohio and Utah. We accept most major insurance plans and Medicaid. Our team can guide families through the process of beginning ABA therapy — from the initial intake to the first session and beyond.


What to Do While You Wait

One of the most painful realities of the autism diagnosis process is the waiting. Waitlists for evaluations can stretch for months. The gap between first concern and first session can feel impossibly long.

Here is what you can do right now, while you wait:

Contact your state’s Early Intervention program.

For children under 3 in Ohio: Help Me Grow (1-800-755-4769).
For children under 3 in Utah: Baby Watch Early Intervention (1-800-961-4226).

You do not need a referral or a diagnosis to contact these programs.

Contact your school district’s Special Education office if your child is 3 or older. Request an evaluation under IDEA. Services begin before a diagnosis, not after.

Complete the Autism Speaks First Concern to Action Tool Kit. Download it and follow each step. It is organized specifically to help families move efficiently through this process.

Learn about the Caregiver Skills Training (CST) Program — a free, evidence-based program from the World Health Organization and Autism Speaks that teaches parents to use everyday play and home routines to support their child’s development. It is completely free and accessible online.

Contact On Target ABA. We can discuss the evaluation process, our therapy approach, and what the path to beginning services looks like for your family — before a diagnosis is in hand.

A Note for Families on the Journey

If you have read this far, you already know something important: you are taking this seriously. You are acting. That instinct — to find the concern, to not dismiss it, to move toward answers rather than away from questions — is one of the most valuable things you can do for your child right now.

Not all concerns result in a diagnosis of autism or a specific developmental disability — but being proactive can make a world of difference.

The difference between a family that acted on their first concern at 18 months and a family that waited until age 5 is measured in years of early intervention at the most critical window of brain development. It is measured in skills built, in communication opened, in independence grown.

You cannot go back. But you can act now.

At On Target ABA, we are here for the whole journey — from the first conversation about a concern, through evaluation, through the first session of therapy, and through every milestone that follows. Reach out. The next step is closer than it feels.

Frequently Asked Questions

Q: My pediatrician says to wait and see. What should I do?
You have the right to request a formal referral for a developmental evaluation regardless of your pediatrician’s recommendation. If you have significant concerns, you can also contact your state’s Early Intervention program directly — no doctor’s referral is required.

Q: Can my child get services before they have an autism diagnosis?
Yes. Federal law requires states to provide therapy whenever screening identifies developmental delays or learning challenges — regardless of diagnostic status. Do not wait for a diagnosis to begin services.

Q: What if the evaluation shows my child does not have autism?
A negative result is not a failed process. It provides clarity and may point toward other supports that could benefit your child. Either way, getting an evaluation is the right step when you have concerns.

Q: How long does the evaluation process take?
This varies significantly by provider and location. Hospital-based developmental clinics often have long waitlists. On Target ABA offers on-site evaluations in Ohio and Utah, which can significantly reduce the time between first concern and first answer.

Q: What does ABA therapy cost, and does insurance cover it?
ABA therapy is covered by most major insurance plans and Medicaid in Ohio and Utah. Coverage for autism therapy is required by law in most states. Our intake team can help you understand your specific coverage before your child’s first session.

On Target ABA serves children ages 2–12 across Ohio and Utah with center-based, home-based, and school-based ABA therapy. We accept most major insurance plans and Medicaid and offer on-site autism evaluations.

→ Contact us to take the first step toward evaluation and therapy
→ Access the Autism Speaks First Concern to Action Tool Kit at autismspeaks.org
→ Complete the free M-CHAT-R screening at autismspeaks.org/screen-your-child
→ Read: Early autism screening — why it matters
→ Read: Does insurance cover ABA therapy? A complete guide