Supporting an autistic child in child care or preschool: a guide for staff

What can autism look like in a 2 to 5 year old in a group?

Every autistic child is different, with strengths as well as differences in communication, play and coping with noise or change.

The National Institute of Mental Health lists signs such as rarely pointing at or showing things, being slow to respond to their name, repeating words or phrases, becoming "upset by slight changes in a routine", and being more or less sensitive to "light, sound, clothing, or temperature" (NIMH, revised 2025). Its list of strengths includes "Being strong visual and auditory learners" and being able to "learn things in detail and remember information for long periods of time".

Some children are easy to miss, especially girls, who may mask their differences. In a study of 96 elementary school children at recess, autistic girls stayed close to other children and wove in and out of games, which "appeared to mask their social challenges" (Dean et al. 2017). In another study of 388 autistic young people aged 4 to 17, parents of girls reported more autistic traits than teachers did (Putnam et al. 2025). A quiet child who seems to fit in may be working hard to cope, and the family may see a different child at home.

Support never waits for a diagnosis: visual supports, steady routines and responsive play help many children, with or without a label. Your part is to notice, write down what you see and talk with the family. CDC's tip sheet for early educators says: "Remember it's not your role to make or even suggest a diagnosis" (CDC). How to talk with a family when you notice signs of autism covers raising a worry kindly.

How do we get to know the child and the family?

Start with the family, who know their child best, ideally before the child starts. Ask:

• How does your child say "yes", "no", "help" and "all done"? Do they use signs, pictures, a device or another language?
• What do they love? Favorite toys, songs and topics (focused interests) are great ways in.
• What is hard: noise, crowds, clothes, foods, waiting, changes?
• What are the first signs of overwhelm, and what calms them?
• How do eating, sleep and the bathroom work at home?
• Who else is involved, such as early intervention, and may you talk with them?

Put the answers in a one-page profile, such as our free printable. Fill it in with the family, add a photo, and keep it where every adult, including substitutes, can see it.

Agree how you'll keep in touch, and share good moments as well as hard ones. Share the child's information with other professionals only with the family's written permission, following your program's policy. The exception is a report under your state's mandated reporter law.

How can we make the room and the day work for the child?

Make the day predictable and easy to see. Most of what helps an autistic child helps the whole group.

• Keep the order of the day steady, and show it with a visual schedule at the child's eye level. For hard moments, a first-then board shows just two steps. See our guide to visual schedules, first-then boards and calm-down spaces in the classroom; our parent guides on first-then boards and visual schedules help families match them.
• Help with transitions, not only warnings. A 2026 review of 19 small experiments found that advance notice on its own often did not make transitions easier (Kim et al. 2026). Show the picture of what comes next, give the child a job or something to carry, and let them finish or save what they were doing.

Never take away food, outdoor play or a comfort item as a consequence.

A calm space the child chooses

A calm space is a quiet corner with soft things, books or comfort items, where any child can go to feel better. The child chooses to go, an adult stays close, and the child can always leave. It is never a punishment and never a locked or guarded room: keeping a child somewhere they can't leave is seclusion. See also our guide on meltdowns, behavior plans and what to avoid and, for families, helping your child understand feelings and find calm.

How do we support communication and play?

Join the child's play, wait, and treat every attempt to communicate as real.

1. Follow the child's lead. Get down to their level and join what they are doing.
2. Wait. Pause and look interested. Hanen suggests waiting "up to 10 seconds" (Hanen).
3. Comment more than you question. Say "Big tower" rather than "What color is it?".
4. Model without testing. Sign and point to pictures as you talk, without asking the child to copy.
5. Don't ask for eye contact, and let stims be. In one study, teens and adults who described themselves as autistic said eye contact could be overwhelming, with "feelings of being invaded" (Trevisan et al. 2017), and autistic adults describe stimming as "a self-regulatory mechanism" (Kapp et al. 2019).

Signs, pictures and AAC

Children don't have to earn AAC (augmentative and alternative communication). ASHA, the national association for speech-language pathologists, says "There are no prerequisites for AAC intervention" and that AAC "does not affect motivation to use natural speech" (ASHA).

• Put simple picture boards where they're needed, such as snack and the bathroom, with the same signs and symbols as home and therapy.
• Point to symbols as you talk. A review of 28 studies found this aided language modeling "highly effective" (O'Neill, Light and Pope 2018).
• Keep the child's board or device with them all day, and never take it away as a consequence.
• If the child has a device, ask their speech-language pathologist to show your team how it works.

Our parent guide Will my autistic child talk? explains AAC for families.

Echolalia, repeating words or phrases, is communication too. In recordings of four children, immediate echoes served seven purposes, "far more than a meaningless behavior" (Prizant and Duchan 1981). Answer what the child means: "Want a cookie?" with a reach may mean "I want a cookie."

Helping other children join in

Set up games for two or three children around the autistic child's favorite things, and show classmates simple moves: offer a toy, wait, take turns, use the child's signs or pictures. A review of 56 school studies found inclusion approaches made activities more accessible, but friendships "were not necessarily improved" (Tsou et al. 2026). Aim for shared fun, not for making the child act like everyone else.

How can early intervention and preschool special education work in our program?

Specialist services can come to your room: welcome visiting staff and use their ideas all week.

Under 3: early intervention

States must ensure early intervention services are provided "To the maximum extent appropriate, in natural environments" (34 CFR 303.126), which "may include the home or community settings" (34 CFR 303.26). The family's IFSP must state "The location of the early intervention services" (34 CFR 303.344).

Expect coaching. The Early Childhood Technical Assistance Center (ECTA) says "The primary role of a service provider in early intervention is to work with and support family members and caregivers in children's lives" (ECTA, updated February 18, 2026). Ask the provider to show you a strategy during snack, play or diapering, then watch you try it.

Federal rules list "Child care programs and early learning programs" as primary referral sources, and require state procedures for referring a child "as soon as possible, but in no case more than seven days, after the child has been identified" (34 CFR 303.303). Talk with the family first and follow your program's policy and your state's procedures. Parents can also call their state program themselves.

Age 3 to 5: preschool special education

From age 3, special education usually comes through the local school district. Districts must ensure a child leaves regular classes only if education there "with the use of supplementary aids and services cannot be achieved satisfactorily" (34 CFR 300.114), and this applies to preschool children too (34 CFR 300.116). The Education Department's preschool guidance letter (January 2017, modified October 2023, still posted) says services may be provided in a "community-based child care facility", among other settings, and that "IDEA presumes that the first placement option considered" is the regular public preschool the child would otherwise attend (OSEP). In Head Start, the placement group "may determine that the Head Start classroom is the LRE" (OSEP, October 2022).

Practice lags behind. In fall 2024, 48.4% of children aged 3 to 5 (not yet in kindergarten) served under IDEA's autism category were in a separate special education class, by our calculation from Education Department data. For all preschoolers served under IDEA, it was 26.9%.

With the family's permission, ask to join IFSP and IEP meetings. The 2023 Education Department and HHS policy statement on inclusion says policies should encourage involving "child care providers" on these teams "with parental permission" (ED and HHS). It is guidance, not law, and was still posted with no rescission notice on October 1, 2026 (Education Department).

What does the law expect of our program?

Almost all child care providers, "Even small, home-based centers", must follow the Americans with Disabilities Act, or ADA (DOJ, last updated February 28, 2020). Head Start and subsidized child care have extra rules. For turning away or excluding a child, see Can a child care program or preschool turn away or expel an autistic child?

Centers actually run by religious organizations, such as churches, are exempt. A center "cannot just assume that a child's disabilities are too severe": it "must make an individualized assessment" of whether it can meet the child's needs (same source). And "If the service is required by the ADA, you cannot impose a surcharge for it" (same source; 28 CFR 36.301).

Diapers and the bathroom. The Justice Department says centers that diaper or help young children with toileting "must reasonably modify their policies and provide diapering services for older children who need it due to a disability" (DOJ). Agree on a toileting plan with the family, using the same words and pictures as home, such as our toileting sequence. Our parent guide on potty training helps families.

How do we plan the move to kindergarten?

Start in the year before kindergarten, with the family and the school district, and share information only with the family's written consent.

1. Ask the family what they want. If the child has an IEP, the district's IEP team plans the move: ask to take part, with the family's permission.
2. No plan yet? If the family has concerns, they can ask the district for an evaluation through Child Find.
3. Share what works, with consent: the one-page profile, the schedule pictures, how the child communicates and what calms them.
4. Prepare the child with photos of the new school and teacher, a visit if possible, and a picture story of the new day.
5. Keep in touch with the family and new teacher in the first weeks.

A review of 27 studies of autistic students moving to a new school found useful strategies included individualized support and communication "both between the sending and receiving schools, and school and home" (Nuske et al. 2019).

What does the research say?

Evidence is strongest for visual structure, moderate for play-based teaching by classroom staff, and weak for sensory products.

• Visual structure: strong. A review of 31 studies judged visual activity schedules evidence-based, "especially when used in combination with systematic instructional procedures" (Knight et al. 2015).
• Play-based teaching by classroom staff: moderate. In a randomized trial in 12 preschool classrooms with 66 autistic children, staff trained in JASPER, a play-based approach, improved children's joint attention, language and play compared with a waitlist (Chang et al. 2016). In 56 inclusive preschool classrooms, LEAP with two years of coaching led to bigger gains in thinking, language and social skills than manuals alone (Strain and Bovey 2011).
• Wider outcomes: small. Classroom programs mostly improve what they target. ASAP, tested in 78 classrooms, made no difference to its main outcomes, though children were more engaged (Boyd et al. 2018). Another program's effects on receptive language and teacher-rated social skills were small (effect sizes 0.13 and 0.19) (Young et al. 2016).
• The Pyramid Model: moderate, not autism-specific. In two randomized trials (40 preschool teachers and 494 children, then 92 teachers and 997 children), children whose teachers had coaching-based training showed better social skills and fewer challenging behaviors (Hemmeter et al. 2016; Hemmeter et al. 2021).
• Coaching in the room beats courses: moderate. Across 60 studies, many of them of literacy coaching for US prekindergarten and elementary teachers, it improved teaching by 0.49 standard deviations (Kraft et al. 2018).
• Sensory products: weak. A review of seven studies concluded weighted vests "cannot be recommended" (Stephenson and Carter 2009), and a 2025 review found moderate evidence that alternative seating "did not improve attention" (Piller et al. 2025). If you use one, note what changes for that child.

Where can we get more help and free training?

Ask visiting early intervention or district staff for coaching in your room, then add free training.

For staff:

• CDC's Learn the Signs. Act Early. has free milestone checklists and a tip sheet on talking with parents (CDC), plus Watch Me!, a free four-module course for early care and education providers, with continuing education credits (CDC).
• The National Center for Pyramid Model Innovations explains the Pyramid Model, "a framework of evidence-based practices for promoting young children's healthy social and emotional development" (NCPMI).
• AFIRM, from the University of North Carolina, has free autism practice modules, including some "designed specifically for paraeducators, early interventionists, and caregivers", with no login needed (AFIRM).
• The IRIS Center at Vanderbilt University has free modules, including "Autism (Part 1): An Overview for Educators" (IRIS).
• ECTA has practice guides based on the Division for Early Childhood's Recommended Practices, in English and Spanish (ECTA).

For families:

• Early intervention programs by state for children under 3, and the school district's Child Find from age 3.
• Parent Centers, for free help with early intervention, IEPs and rights.
• The Autism Society National Helpline, for information and referral.