Waiting for an Autism Evaluation? Here's What to Do at Home in the Meantime
If you're waiting for an autism evaluation, the most useful things to do in the meantime are, in order: refer your child to your state's Early Intervention program today (you can do this yourself, with no diagnosis and no doctor's order), get a hearing test and an autism screening on the calendar, start documenting what you see the way an evaluator would, and begin a handful of parent-led strategies that research shows help toddlers whether or not the eventual answer is autism. The wait is long and it feels like lost time. It doesn't have to be. The book this site is built around opens with a line I've said to hundreds of families: you don't need a diagnosis to start helping your child.
This page is the plan for the wait.
The wait is real, and it isn't wasted time
Diagnostic waitlists for toddlers in the United States are long enough that most families reading this have already been told "six months," "a year," or "we're not accepting new referrals." A 2023 survey of 111 autism diagnostic centers across the country (Krafta and colleagues) found that nearly two-thirds reported waits longer than four months, and roughly one in seven reported waits over a year or had closed their lists. Nationally, the CDC's most recent surveillance report (2025) puts the median age of diagnosis at about 47 months, even though the signs that prompt the referral typically appear before the second birthday and Pierce and colleagues (2019) found diagnoses from about 14 months were largely stable.
So the gap is real, and it falls in the stretch of development when the brain is most responsive. The good news is that an evaluation is a gate for a diagnosis and for certain insurance-funded therapies, and a gate for nothing else. Early Intervention doesn't require it. Speech and occupational therapy don't require it. And the interventions with the strongest evidence for toddlers are delivered by parents in ordinary moments, which requires nothing but you and a plan.
You don't need a diagnosis to start
Two lines of research back up that sentence.
The first is about timing. The toddler and preschool years are a period of rapid brain growth and heightened plasticity; Courchesne and colleagues (2007, Neuron) describe the atypical early brain development seen in autism, and the book's Chapter 2 frames the first three to five years as a sensitive period when the brain is unusually responsive to experience. Simple, repeated interactions (naming what your child sees, pausing to wait for a response, mirroring their gestures) are doing real work during this window.
The second is about who delivers the intervention. Kasari, Freeman, and Paparella (2006) showed in a randomized trial that targeted joint attention and symbolic play intervention produced gains in young children with autism, and Kasari and colleagues (2010) then showed that parents coached to deliver the same kind of play-based intervention (the model known as JASPER) produced measurable improvements in their toddlers' joint engagement. The book draws on this work, describing JASPER, PACT, and similar programs as evidence that when parents follow their child's lead, expand their play, and respond consistently, children gain in communication, attention, and regulation. Its summary line is the one to remember: the most impactful intervention your child can receive is you.
Step 1: things to set in motion today
These are phone calls, and all three can happen this week.
Refer your child to Early Intervention yourself. Every state runs an Early Intervention program under Part C of the Individuals with Disabilities Education Act for children from birth to age three. Parents are a primary referral source, which means you call directly; you don't need a pediatrician's referral or a diagnosis of anything. The program evaluates your child across all developmental areas at no cost to you, and federal rules require that evaluation and, if your child qualifies, the initial service planning meeting to happen within 45 days of your referral. Services often include speech-language therapy, occupational therapy, and developmental therapy, frequently in your home. Search your state's name plus "early intervention Part C" to find the number. If your child is already three, call your school district's special education office and request a preschool evaluation.
Ask your pediatrician for the M-CHAT-R/F. If your child is 16 to 30 months, this 20-question screener (validated by Robins and colleagues, 2014, Pediatrics) takes about five minutes and is what the American Academy of Pediatrics recommends at the 18- and 24-month visits (Hyman, Levy, and Myers, 2020). A positive screen strengthens your case for an expedited evaluation and for Early Intervention eligibility. Ask directly: "Do you see signs that could suggest autism or a developmental delay? I'd like a formal screening." If you're told to wait and see, you can say you'd prefer to screen now and revisit later.
Get a hearing test. A formal audiology evaluation, rather than the office screening, rules out hearing loss and chronic ear fluid, both of which can produce late speech and inconsistent response to name. Every evaluator will ask whether it's been done.
While you're on the phone, ask the diagnostic clinic to put you on a cancellation list and whether any affiliated clinics have shorter waits. It doesn't always help, but it costs nothing.
Step 2: document like an evaluator
Evaluators have a short window with your child, on an unfamiliar day, in an unfamiliar room. The history you bring often shapes the conclusion as much as what they observe. The book's "Tools for Tracking Concerns" section recommends short video clips of five things:
- Response to name (one clear call, no gesture, five seconds of waiting)
- Eye contact and gestures during ordinary play
- Reactions to change or to a disrupted routine
- Play with toys (what your child does with them)
- Communication attempts, including the unconventional ones
Add a running log in a notes app: what you saw, when, how often. If you've noticed a loss of skills, write down what your child used to do and roughly when it changed, because regression is a specific thing evaluators ask about. The kit's tracking pages, especially the Progression of Joint Attention chart, double as evaluation notes: fill them in weekly and you'll walk in with a dated record of what your child does and doesn't yet do. For a structured list of what to watch for, the signs of autism in toddlers page is organized by area and age.
Step 3: five things to start at home this week
These are the book's core parent-led strategies. Each has its own page with the full how-to; here's the shape of each and why it comes first.
Joint attention games
Joint attention, the ability to share focus on something with another person, is described by Mundy and Newell (2007) as one of the earliest and most reliable markers of autism and one of the strongest predictors of later language. It's also teachable. Get face to face, bring a toy up near your face, add a sound effect, and wait for any glance before continuing (count to five silently before prompting again). Point at things and wait for your child to follow. Hand your child things and wait for them to hand things back. The joint attention activities page has the full progression, and the kit's Progression of Joint Attention chart tracks which of its six stages your child is in, from responding to name through pointing to share interest.
Communication temptations
A communication temptation is a situation engineered so that your child has a reason to communicate: a favorite snack in a clear jar they can't open, bubbles with the lid closed, a wind-up toy that's stopped, a tickle game that pauses. Then you wait, and you reward whatever comes (a look, a reach, a sound, a point) with the thing they wanted. The book lays out six home setups, the kit has twenty scenarios, and the communication temptations page explains how to run them.
Follow the lead and narrate
Rather than directing play or quizzing ("What's this? What color?"), sit down and join whatever your child is already doing. Imitate it. Describe it in short phrases pitched just above your child's current level, with the book's three-comments-to-one-question rule. A child spinning a lid has a parent beside her spinning a lid and saying "round and round." This is the heart of the parent-mediated models the research supports, and it's where parents most often report the first "he looked at me" moment.
Visual routines
Toddlers who struggle with transitions do better when they can see what's coming. A first/then board (the kit has one) and a simple picture schedule for the two or three hardest routines of the day reduce the number of surprises, and fewer surprises mean fewer meltdowns. Start with the routine that's currently the worst.
The sensory toolkit
Many toddlers with social communication concerns also have sensory differences, and a child who's overloaded or under-aroused can't attend to any of the above. The book's Home Sensory Toolkit and the idea of scheduling heavy work before transitions are covered in the autism sensory diet guide. If your child doesn't seem to notice their name, the touch-cue approach in toddler not responding to name is the sensory version of a social strategy.
Start tonight: the two pages to print first.
The Progression of Joint Attention chart and the 20 Communication Temptation Scenarios from the kit, so you can begin before the book arrives.
One email with the PDF, plus occasional early-intervention tips from Andrea. Unsubscribe anytime.
Step 4: one routine at a time
Five strategies is a lot to read about at 11pm and far too many to start on Monday. The book's advice for parents who are still catching their breath is to start with one routine. Pick the single daily moment that's either the hardest (dinner, bath, leaving the house) or the one where you already have your child's attention (bath time is often best for this), and put one strategy into it. Narrate bath time with short phrases and wait for glances. Set up one communication temptation at snack. Add a first/then board to getting dressed.
Run that for a week. When it feels automatic, add a second routine or a second strategy. Parents who try to transform the whole day at once tend to burn out by Thursday; parents who build one routine at a time tend to still be doing it in six months, and six months is roughly how long you may be waiting.
Step 5: the parent is part of the plan
Everything above runs through you, which means your capacity is a clinical variable. The book's final chapter is about this, and it isn't a bubble-bath chapter. Co-regulation, the process by which a calm adult helps a child's nervous system settle (defined in the research literature by Murray and colleagues, 2015), only works if the adult has something left to offer. Toddlers borrow regulation from the people around them, and a parent running on three hours of sleep and a stomach full of dread has less to lend.
Practically: tell the people around you what's going on rather than carrying it alone; ask your Early Intervention coordinator about parent support groups; protect one block of time each week that has nothing to do with any of this; and notice that the strategies on this page are also a way of reconnecting with your child during a period when worry can crowd out enjoyment. The first time your child turns to their name or hands you the bubbles to open is a good moment, and you're allowed to have it fully.
Your first two weeks
A simple version, assuming you start on a Monday.
Days 1 to 2. Make the three calls: Early Intervention referral, pediatrician (M-CHAT-R/F and audiology referral), diagnostic clinic (cancellation list). Record the first five video clips. Read the joint attention and communication temptations pages.
Days 3 to 7. Pick one routine. Add one strategy to it, usually narration plus waiting for glances, or one communication temptation at snack time. Keep the notes log. Do a few clean response-to-name trials each day and tally them.
Days 8 to 10. Add a second strategy to the same routine, or the first strategy to a second routine. Fill in the Progression of Joint Attention chart for the first time. If transitions are the hardest moments, introduce a first/then board for one of them.
Days 11 to 14. Keep going. Look at your tally and your notes for anything that's changed, however small. Set up the sensory basket if your child seems overloaded or under-aroused. If Early Intervention has called to schedule the intake, have your log and videos ready.
By the end of two weeks you'll have started the evaluation process on every available track, assembled the documentation evaluators want, and begun the home strategies with the best evidence. The wait will still be a wait, but with momentum.
What the evaluation will look like
Autism evaluations for toddlers vary by clinic, but most include a detailed developmental history with you (this is where your log and videos matter), direct observation and structured play with your child, often using a standardized tool like the ADOS-2, and sometimes assessments of language, cognition, and adaptive skills. You'll typically get a feedback session and a written report that drives eligibility for services.
Evaluators will ask about response to name, pointing, eye contact, pretend play, imitation, repetitive behaviors, sensory reactions, any loss of skills, and what you've already tried. Nothing you do at home in the meantime will skew the result; evaluators expect parents to be interacting with their children. If the question on your mind is whether what you're seeing is autism or an isolated speech delay, the speech delay vs autism page explains how clinicians think about that distinction.
Frequently asked questions
Can I get services before an autism diagnosis?
Yes. Early Intervention (Part C, under age three) determines eligibility based on developmental delay or risk, with no diagnosis required, and parents can refer directly. Speech-language and occupational therapy can also be accessed through Early Intervention or, depending on your insurance, through a pediatrician's referral for the delay itself. A diagnosis is mainly required for autism-specific insurance-funded therapies such as ABA.
Will starting at home mess up the evaluation?
No. Evaluators assess your child's current skills and history, and they expect engaged parents. If your child has gained skills in the months before the evaluation, that's information about how your child learns and will shape recommendations. There's no benefit to your child in arriving with fewer skills, and no evaluator would suggest holding back.
How long are autism evaluation waitlists?
It varies widely by region and clinic. In a 2023 survey of U.S. autism diagnostic centers, most reported waits longer than four months, and a meaningful minority reported waits over a year or closed lists. Ask every clinic you call about cancellation lists and affiliated sites, and get Early Intervention and speech therapy started in parallel so the wait for the diagnosis isn't a wait for help.
What should I do if my pediatrician says to wait and see?
You can screen now and still revisit later; the AAP recommends autism-specific screening at 18 and 24 months regardless of concern. Ask for the M-CHAT-R/F and a developmental referral, and in parallel make the Early Intervention referral and hearing appointment yourself, since neither requires the pediatrician's agreement.
Start tonight: the two pages to print first.
The Progression of Joint Attention chart and the 20 Communication Temptation Scenarios from the kit, printable, so the first strategy can start before bedtime tomorrow.
One email with the PDF, plus occasional early-intervention tips from Andrea. Unsubscribe anytime.
The start now guide is the condensed two-week version of this page, and the book and kit bundle has all nine chapters and the twenty printable resources behind every strategy here, including the tracking charts that become your evaluation notes.