Most parents who call us did not start with a diagnosis. They started with a feeling: a toddler who does not turn when called, who has stopped using a word they used to say, who plays next to other children but never with them. This guide explains the signs pediatricians look for between 12 and 36 months, why "wait and see" is usually the wrong advice, and what to do next in Miami-Dade.
What pediatricians screen for
The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well visits, usually with a short parent questionnaire called the M-CHAT. The questions cluster around a few skills:
- Joint attention. Does your child point to show you something interesting (not just to ask for it)? Do they follow your point and look back at you?
- Response to name. By 12 months, most children turn consistently when called from behind.
- Imitation and pretend play. Copying your gestures, feeding a doll, "talking" on a toy phone.
- Gestures. Waving, reaching up to be picked up, nodding and shaking the head.
- Words. First words around 12 months, two-word combinations around 24 months. Losing words or skills at any age is always worth a call.
- Social interest. Bringing you toys, looking at your face during play, enjoying peek-a-boo.
No single item means autism. The pattern matters, and so does a change over time. A child who was babbling and waving at 10 months and is quiet and turned inward at 16 months needs a closer look regardless of how any checklist scores.
What is normal variation
Toddlers develop at different speeds, bilingual children often mix languages or start speaking a little later, and a shy child in a new room can look withdrawn. None of that is a red flag on its own. What separates typical variation from something to evaluate is usually breadth: a late talker who points, plays and shares attention is different from a late talker who also does not respond to their name or look at people.
Repetitive behaviors like hand-flapping, spinning wheels, lining up cars, or intense reactions to sounds and textures are also common in autism, but many typically developing toddlers do some of these too. Again, look at the whole picture.
Why earlier is better
The reason clinicians push for early evaluation is not to label a child. It is that the years between one and five are when the brain builds the circuits for communication and social learning, and intervention during that window produces the biggest changes. Research on early intensive behavioral intervention consistently shows larger gains in language, play and daily living skills when therapy starts before age three or four, compared with the same therapy started later.
Waiting six months for a "let's see at the next visit" can cost a family a year once you add the evaluation wait and the insurance authorization.
What to do this week
- Write down what you see. Three or four concrete examples with ages ("stopped waving at 14 months", "doesn't look up when I call from the kitchen") are far more useful to a doctor than "I'm worried."
- Ask your pediatrician for a screening and a referral. In Florida, Medicaid plans require a comprehensive diagnostic evaluation by a licensed practitioner and a referral from the child's doctor before ABA can be authorized. Ask for both at the same visit.
- Call Early Steps if your child is under 3. Florida's Early Steps program (the state's early-intervention system for birth to 36 months) is free, does not require a diagnosis, and can run alongside ABA.
- Talk to a BCBA now, not after the evaluation. We can tell you which evaluators in Miami-Dade have the shortest waits, what your specific plan requires, and start the paperwork so therapy can begin the week the report arrives.
You do not need to be sure. A 15-minute call is the cheapest, fastest way to find out whether there is something to look into.