Getting an Autism Diagnosis: What the Evaluation Involves
A step-by-step look at the autism evaluation, including wait times and what insurers require for ABA.
Who Can Diagnose
A diagnosis can come from a developmental pediatrician, a child psychologist, or a child psychiatrist. Some neurologists and licensed clinical social workers with specialized training also diagnose. The key is that the evaluator has experience with autism in children.
Your primary care doctor can refer you, but they usually do not do the formal evaluation themselves. You can also self-refer to a clinic, though some require a referral for insurance.
What the ADOS-2 Involves
The ADOS-2 is a standardized, play-based assessment. It is not a questionnaire. The evaluator interacts with your child using specific toys and activities to observe social communication, play, and repetitive behaviors.
The session lasts 40 to 60 minutes. For younger children, it looks like play. For older children, it includes conversation and problem-solving tasks. The evaluator scores behaviors against a set of criteria, and the result is one piece of the diagnosis.
The Developmental History
You will sit down with the evaluator for an interview about your child's early development. They will ask about when your child first smiled, babbled, pointed, and said first words. They will also ask about social interactions, play habits, and any unusual behaviors.
Bring any baby books, videos, or notes you have. If you have concerns from daycare or preschool, share those. The evaluator will also ask about family history of autism or related conditions.
Typical Wait for an Evaluation
Wait times vary widely. In urban areas with multiple clinics, you might get an appointment in 2 to 4 months. In rural areas or during high-demand periods, it can take 6 to 12 months.
Some clinics have cancellation lists. Ask to be added. You can also call your state's early intervention program, which sometimes has shorter timelines or can point you to faster options.
What the Report Must Say for ABA
Insurers require a formal diagnosis and a prescription for ABA. The report should state 'Autism Spectrum Disorder' and list the specific DSM-5 criteria your child meets. It should also recommend ABA as medically necessary.
Ask the evaluator if they will include a specific recommendation for the number of hours per week. Many insurers want to see a recommended range, like 10 to 25 hours, based on your child's needs. Without that, your ABA provider may have to go back for more documentation.
Keep a copy of the report. You will need it for insurance, early intervention, and school services.
Part C Early Intervention
If your child is under 3, you do not need a diagnosis to start early intervention through Part C of IDEA. You can request an evaluation from your state's early intervention program directly.
That evaluation is free and does not require a medical referral. It looks at your child's development across areas like communication, motor skills, and social-emotional growth. If your child qualifies, services can start while you wait for a medical diagnosis.