You Suspect Your Child May Have Autism.
Here's Exactly What to Do Next.

Recognizing the Early Signs

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a person communicates, interacts, and perceives the world. Signs can appear as early as 6–12 months, though many families don't notice them until around age 2 or 3.

Trust your instincts. Research shows that parents who expressed concern about their child's development were right more than 80% of the time. If something feels off, it's worth exploring — not waiting.

Common Early Signs to Watch For

Social communication:

• Doesn't make eye contact consistently, especially while being held or spoken to
• Doesn't respond to their name by 12 months
• Doesn't point at things to share interest ("Look at that dog!") by 14 months
• Doesn't engage in pretend play by 18 months
• Has trouble understanding other people's feelings or talking about their own

Language and communication:

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

Behavior and sensory:

• Intense focus on narrow interests or objects (spinning wheels, specific videos)
• Repetitive movements (hand flapping, rocking, spinning)
• Unusual reactions to sounds, textures, lights, or tastes (extreme sensitivity or seeking)
• Rigid attachment to routines; significant distress when routines change
• Lining up objects rather than playing with them symbolically

Keep in mind: autism presents very differently from child to child. Some children are highly verbal; others are not. Some have intellectual disabilities; many do not. Some signs are subtle. What matters is the overall pattern across social, communication, and behavioral domains — not any single checklist item.

Read our full article on early signs of autism →

Speaking with Your Pediatrician

Your child's pediatrician is usually the first professional you'll talk to. The American Academy of Pediatrics (AAP) recommends routine developmental screening at every well-child visit, and formal autism-specific screening at 18 and 24 months. However, not every pediatric office is proactive about this — which means you may need to bring it up yourself.

What to Say at the Appointment

Be specific and concrete. Rather than "he seems different," say things like:

• "He doesn't respond when we call his name, even from close by."
• "She lost the few words she had around 18 months and hasn't gotten them back."
• "He becomes extremely distressed when we change our routine, like taking a different route to daycare."
• "She doesn't point at things to share excitement, even though her older sibling did that at the same age."

Questions to Ask Your Pediatrician

• Can you administer the M-CHAT-R screening tool today?
• Based on what I've described, what's your recommendation?
• Can you refer us to a developmental pediatrician or child psychologist for a full evaluation?
• Are there Early Intervention services we should be accessing now while we wait?
• How long is the wait typically for an evaluation in our area?

What If Your Pediatrician Dismisses Your Concerns?

Some parents hear "let's wait and see" or "boys develop slower." While this is sometimes appropriate advice, your instincts matter. If you feel strongly, you have every right to ask for a referral anyway, seek a second opinion, or contact your state's Early Intervention program directly — no referral needed.

Getting a Formal Evaluation

A diagnosis of autism can only be made by a qualified professional following a comprehensive evaluation. This is one of the most important — and often most time-consuming — steps of the entire journey. Understanding what to expect makes it far less intimidating.

Who Can Diagnose Autism in Missouri?

• Developmental pediatricians — Pediatricians with specialized training in developmental and behavioral conditions. Typically the most common source of autism diagnoses in children.
• Child psychologists or neuropsychologists — PhD-level clinicians who conduct extensive cognitive and behavioral testing.
• Child psychiatrists — Medical doctors (MDs) with psychiatric training who can evaluate and prescribe if co-occurring conditions like anxiety or ADHD are present.
• Pediatric neurologists — Specialists who focus on the brain and nervous system; often consulted when seizures or other neurological issues are also present.

Some evaluations are conducted by multidisciplinary teams (e.g., at the Thompson Center in Columbia, MO) — these are often the most comprehensive.

What Does an Evaluation Involve?

A thorough autism evaluation is not a single test. It typically includes:

• Parent interview — A detailed developmental history: pregnancy, birth, early milestones, behavioral history, family history
• Observation — The clinician observes your child in structured and unstructured play
• ADOS-2 — The Autism Diagnostic Observation Schedule, considered the "gold standard" autism assessment tool. It involves activities, conversations, and observations scored on specific criteria.
• ADI-R or similar — A structured parent interview about development history
• Standardized cognitive testing — Intelligence and adaptive behavior assessments
• Speech/language screening — Often included or followed by a separate SLP evaluation
• Sensory and motor screening — May include referral to an occupational therapist

The evaluation may be completed in one long appointment or spread across multiple visits. You'll typically receive a written report within 2–4 weeks detailing findings, scores, and recommendations.

Missouri Evaluation Resources

• Thompson Center for Autism — University of Missouri, Columbia. One of Missouri's leading autism evaluation centers.
• Mercy Kids Autism Center — St. Louis area, offers comprehensive pediatric evaluations
• Cardinal Glennon Children's Hospital — St. Louis, developmental pediatrics department
• Children's Mercy Kansas City — Developmental and behavioral pediatrics
• Private psychologists — Many clinical psychologists throughout Missouri conduct autism evaluations; private pay or insurance may apply

Understanding the Diagnosis

Receiving an autism diagnosis for your child can bring a complex mix of emotions — grief, relief, confusion, even hope. All of those feelings are valid. Here's what you need to know about what a diagnosis actually means.

What the Diagnosis Tells You

Under the DSM-5 (the diagnostic manual clinicians use), autism is diagnosed along two core domains:

• Social communication and interaction — Challenges in social-emotional reciprocity, nonverbal communication, and developing/maintaining relationships
• Restricted, repetitive patterns of behavior — Repetitive behaviors, inflexibility, fixated interests, sensory sensitivities

The diagnosis also specifies a support level (Level 1, 2, or 3) based on how much support the person requires in each domain. Level 1 requires support; Level 2 requires substantial support; Level 3 requires very substantial support. These levels can shift over time with intervention.

What the Diagnosis Does NOT Tell You

An autism diagnosis is a description of current presentation — not a ceiling or a life sentence. It does not predict:

• Whether your child will speak (many non-speaking children learn to communicate effectively through AAC and therapy)
• Whether they will live independently as an adult
• Their intellectual capacity (autism and intellectual disability are separate; many autistic individuals are average or above average in intelligence)
• Their potential for joy, relationships, and a meaningful life

"A diagnosis is the beginning of understanding, not the end of possibility. It's a map — not a destination."
— Archways ABA Clinical Team

Processing the Diagnosis as a Family

• Give yourself time to grieve the life you imagined — this is normal and healthy
• Talk to other parents who have been through this (see Missouri support groups in the Resources section below)
• Seek out autistic adults' perspectives — many have written powerfully about their experiences
• Be honest with siblings in age-appropriate ways
• Consider family counseling if the diagnosis creates significant stress in your household

Then, when you're ready — and you don't need to be completely ready — move to building your team.

Building Your Child's Support Team

Children with autism thrive when they have a coordinated team of professionals working toward shared goals. You — the parent — are the captain of that team. Understanding each professional's role helps you advocate effectively.

The Core Team Members

Board Certified Behavior Analyst (BCBA)
The BCBA is the clinical lead for ABA therapy. They conduct a comprehensive skills assessment, develop your child's individualized treatment plan (called a Behavior Intervention Plan or BIP), supervise therapy sessions, and conduct parent training. All Archways ABA programs are led by BCBAs.

Registered Behavior Technician (RBT)
The RBT is the hands-on therapist who works directly with your child — implementing the programs designed by the BCBA. Sessions can range from 10–40 hours per week depending on your child's needs and insurance authorization.

Speech-Language Pathologist (SLP)
SLPs work on verbal communication, language comprehension, pragmatics (social use of language), and augmentative and alternative communication (AAC) such as picture boards or speech-generating devices. Most children with autism benefit from SLP services alongside ABA.

Occupational Therapist (OT)
OTs address sensory processing, fine motor skills, self-care skills (dressing, feeding, hygiene), and handwriting. Sensory integration challenges are extremely common in autism, and OT can make a significant quality-of-life difference.

Developmental Pediatrician
Remains your medical anchor post-diagnosis. Monitors development, coordinates referrals, and may manage co-occurring conditions like ADHD, anxiety, epilepsy, or sleep disorders.

Special Education Teacher / IEP Team
Once your child is school-age (or approaching it), your school district's special education team becomes a key part of the picture. (See Step 8 for how to navigate the IEP process.)

How to Find Quality Providers in Missouri

• Ask your diagnosing clinician for referrals — they know who is good locally
• Check BACB.com to verify a BCBA's credentials and standing
• Contact your insurance company for a list of in-network ABA providers
• Ask other autism parents in your community — word-of-mouth is often the most reliable guide
• Missouri's Early Intervention (First Steps) program coordinates services for children under 3

Learn more about what ABA therapy involves →

Navigating Insurance and Funding in Missouri

Cost is one of the most common barriers families face when pursuing autism services. The good news: Missouri has strong insurance protections for autism treatment, and multiple funding streams exist to help families access services.

Private Insurance

Missouri's autism insurance mandate requires fully-insured health insurance plans to cover ABA therapy and other autism treatment. Key points:

• Coverage is required if your child has an autism diagnosis from a qualified provider
• Plans may require prior authorization — your ABA provider handles this
• Self-funded employer plans (governed by federal ERISA law) may not be subject to the state mandate — check your plan documents
• Annual and lifetime dollar limits on autism benefits are not permitted under the ACA for most plans

Missouri Medicaid (MO HealthNet)

Missouri Medicaid covers ABA therapy for children with an autism diagnosis who are enrolled in MO HealthNet. Coverage applies to:

• Children enrolled in standard Medicaid and Missouri Children with Special Health Care Needs (CSHCN)
• Children on managed care plans (Healthy Blue, UnitedHealthcare Community Plan, Missouri Care, Home State Health)
• Prior authorization is required; your BCBA will complete this paperwork on your behalf

Read our detailed guide to Missouri Medicaid and ABA coverage →

Additional Funding Sources

• Missouri Division of Developmental Disabilities (DD Waiver) — Medicaid waiver program for individuals with developmental disabilities; funding for a wide range of services including residential, day services, and therapies
• Missouri Children with Special Health Care Needs (CSHCN) — State program that can supplement Medicaid coverage for children with special health needs
• ABLE Accounts — Tax-advantaged savings accounts for individuals with disabilities; Missouri has the Missouri ABLE program
• Autism Speaks Family Services — Resource guide and limited financial assistance grants
• Local nonprofit grants — Organizations like The Miriam Foundation and Gateway Autism Center sometimes offer assistance

Starting ABA Therapy

Applied Behavior Analysis (ABA) is the most extensively researched and evidence-based treatment for autism. When delivered with fidelity by qualified professionals, it produces meaningful improvements in communication, social skills, adaptive behavior, and quality of life.

What Happens Before Therapy Begins

Before your child's first session, Archways ABA conducts a thorough intake process:

1. Initial consultation call — We discuss your child's needs, insurance, and logistics (in-home or center-based)
2. Insurance verification — We confirm your coverage and any co-pays or authorizations needed
3. Skills assessment — Your BCBA conducts a comprehensive assessment using validated tools (like the VB-MAPP, ABLLS-R, or AFLS) to establish your child's current skill levels
4. Goal-setting meeting — We meet with you to prioritize goals and create an individualized treatment plan
5. Authorization — We submit the plan to insurance and obtain authorization for hours
6. Matching and scheduling — We match your child with the right RBT(s) and establish a consistent schedule

This process typically takes 2–4 weeks from first call to first session.

What ABA Sessions Actually Look Like

Modern, high-quality ABA therapy doesn't look like the rigid, drill-based approach of decades past. Expect:

• Natural Environment Teaching (NET) — Learning embedded in play, daily routines, and real-life activities your child enjoys
• Discrete Trial Training (DTT) — Structured, brief practice of specific skills in a clear antecedent-response-consequence format
• Reinforcement-based learning — Skills are built through positive reinforcement — rewarding effort and success with things your child genuinely values
• Generalization — Skills are practiced across different settings, people, and materials so they carry over into real life
• Parent involvement — You'll receive regular coaching from the BCBA to carry strategies into your daily routines at home

What Progress Looks Like

Every child progresses differently. Some families see significant gains in 3–6 months; for others, progress is more gradual. Your BCBA tracks data at every session and adjusts the program regularly. Progress meetings (typically monthly or quarterly) give you a clear picture of where your child is and where they're headed.

Learn 5 ABA strategies you can use at home →

See how ABA builds communication skills →

Advocating at School and Beyond

As your child reaches school age (and sometimes as early as age 3), school becomes a major part of their world — and a major arena for advocacy. Understanding your rights is one of the most powerful things you can do as a parent.

Your Child's Rights Under Federal Law

IDEA (Individuals with Disabilities Education Act) guarantees every child with a disability the right to a Free Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE). For children under 3, Missouri's First Steps program provides Early Intervention services under IDEA Part C. For children 3–21, services are provided through the school district under IDEA Part B.

The IEP: Your Child's Educational Blueprint

An Individualized Education Program (IEP) is a legally binding document developed by a team that includes you, your child's teachers, special education staff, and any relevant therapists. It specifies:

• Your child's current levels of performance
• Annual goals across academic and functional domains
• Services to be provided (special ed, speech, OT, ABA-based support)
• Accommodations and modifications in the general education classroom
• Placement — how much time in general vs. special education settings
• Transition planning for students age 16+

How to Request an Evaluation

If your child is not yet receiving school-based services, you can request a special education evaluation in writing to your school district. The district has 60 days to complete the evaluation. You do not need a private diagnosis first — the school conducts its own evaluation. However, having a private evaluation can provide valuable data and recommendations to bring to the IEP meeting.

Your Rights at IEP Meetings

• You are a full member of the IEP team with equal decision-making rights
• You can bring an advocate or attorney to any meeting
• You can request any service you believe your child needs — the district must document and explain any denials in writing
• You have the right to disagree with the IEP and request mediation or a due process hearing
• You can request an Independent Educational Evaluation (IEE) at public expense if you disagree with the school's evaluation

Read our full guide to Missouri special education rights →

Long-Term: Community, Self-Care, and Thriving

The autism journey is a marathon, not a sprint. Taking care of yourself as a caregiver is not optional — it's essential. Connect with other parents (see resources below), lean on your clinical team for guidance, and remember that your child's story is still being written. Families who stay engaged, informed, and connected tend to see the best outcomes — for their children and themselves.