How to talk with a family when you notice signs of autism

When should you raise a concern with a family?

Raise it once you have watched the child for a few weeks and can describe a pattern, not after one hard day. You don't need to be sure: your part is to share what you see so the family can decide what to do. CDC's advice to parents is "Don't wait" if a child isn't meeting milestones, has lost skills or there are other concerns (CDC).

CDC's tip sheet for staff suggests talking with families about development regularly, not only when you have concerns (CDC tip sheet). CDC's free "Learn the Signs. Act Early." materials for early care and education providers include milestone checklists, the Milestone Tracker app and the tip sheet, in English and Spanish, with checklists in other languages too (CDC, reviewed December 30, 2024).

How do you prepare for the conversation?

Preparing keeps the conversation about facts. Over two to four weeks:

1. Write down what you see. Note what the child did, where, when, how often, what happened just before, and how it affected them. "Covered her ears and cried at music time on 3 of 5 days" helps. "Seems autistic" doesn't.
2. Fill in a milestone checklist for the child's age, as you would for any child, so the family knows you are "basing your comments on facts and not just feelings" (CDC tip sheet).
3. List the child's strengths and favorite things.
4. Talk to your director or school team first. Agree who will lead, check your program's policy, and find your state's early intervention contact or your school district's Child Find contact.
5. Plan a private time, not at drop-off or pickup and not in front of the child. Ask the family who they would like to bring.
6. Book a trained interpreter if the family would prefer another language. Never ask the child or a sibling to interpret.

What should you say, and what should you avoid?

Start with the child as a person. CDC suggests highlighting the child's strengths and keeping the conversation positive (CDC tip sheet). Then:

• Describe what you see, not labels. Give two or three examples from your notes.
• Ask what the family notices at home. Parents know their child best, and children can act differently in different places.
• Never say or imply that the child is autistic. CDC reminds staff that "it's not your role to make or even suggest a diagnosis" (same tip sheet). That includes hints such as "on the spectrum".
• Explain that support starts now, and that you will keep doing what helps whatever the family decides (see supporting an autistic child in child care or preschool).
• Agree next steps and a date to talk again. CDC suggests following up in a few weeks (same tip sheet).

Can a teacher diagnose autism?

No. Child care providers and teachers notice, record and share what they see. A medical diagnosis comes from a diagnostic evaluation, which the child's pediatrician can help the family arrange; some evaluations use a team of psychologists, speech therapists, occupational therapists and physicians (AAP). A school evaluation is different: it decides whether a child is eligible for special education. Federal law doesn't require schools to classify children by their disability, and states may use a "developmental delay" category for some or all children aged 3 to 9 (federal Child Find rule).

How might the family react?

Families react in many ways: relief that someone else has noticed, worry, shock, anger or disagreement. Many need time, and that's OK.

If the family disagrees, CDC suggests saying: "Sometimes children behave differently at home than they do at school. I'm only able to share with you what I've seen during our time together" (CDC tip sheet). If they're upset, acknowledge it and ask whether they would like to keep talking now or meet again in a few days. If a doctor has said to wait and see, CDC suggests reminding the family that they can contact early intervention directly, without a doctor's referral (same tip sheet).

Culture and language

"Not all cultures place the same value on particular developmental milestones," CDC notes, and it asks staff to be aware of their own cultural biases (same tip sheet). Ask what the family hopes for their child, and listen. If the family goes on to early intervention or a school evaluation, the evaluation must be given in the child's native language unless that is clearly not feasible (34 CFR 303.321; 34 CFR 300.304).

Keeping the door open

If the family isn't ready, don't push. Keep supporting the child, keep sharing good news, keep your notes, and make sure the family knows they can come back to you at any time.

What if the family raises it first, or is already waiting?

If a parent asks "Do you think he's autistic?", thank them for asking. You can't answer that, but you can share what you've seen, ask what they've noticed and talk through the next steps below. Never brush the worry off, even if you haven't seen it yourself: in a study of 388 autistic children and teenagers, parents of autistic girls reported more autistic traits than teachers did (Putnam and colleagues, 2025).

If the family is already waiting for an evaluation, ask what would help. With their written permission, share your notes with the evaluator: the AAP says it helps when people such as teachers "share what they see when spending time with your child" (AAP). Our parent guides on waiting for an autism evaluation and on whether an autistic child will talk are written for families.

Where can the family go next?

It depends mainly on the child's age. None of these routes needs a medical diagnosis first: early intervention eligibility includes children with developmental delays, as each state defines them (ECTA).

For early intervention, federal rules list parents as a primary referral source (34 CFR 303.303), and CDC says "A doctor's referral is not necessary" (CDC). The timelines are in 34 CFR 303.310 and 34 CFR 300.301. For a child of 3 or older, CDC suggests calling any local public elementary school, even one the child doesn't attend (same CDC page). Child Find covers every child with a disability living in the state who needs special education, including children in private schools, "regardless of the severity of their disability" (federal Child Find rule), so it reaches children in child care and private preschools too.

If you work in child care or early learning

The same rule lists "Child care programs and early learning programs" as primary referral sources. Each state's procedures must provide for referring a child under 3 "as soon as possible, but in no case more than seven days, after the child has been identified" (34 CFR 303.303). The rule doesn't mention parental consent. In 2011, the Education Department said Part C's own privacy rules don't apply to referral sources, but that a referral source "may be required to obtain parental consent prior to making a referral" under other laws, including state laws (Federal Register, 2011). Ask your director what your state's procedures say. Wherever you can, refer with the family's agreement or help them call, and note the date.

If you work in Head Start

Head Start programs must, with the parent's consent, complete or obtain a developmental screening within 45 calendar days of a child first attending (30 days in programs that run for 90 days or less). Where warranted, and with guidance from a mental health or child development professional, they must refer the child, with the parent's consent, to the local agency responsible for IDEA (45 CFR 1302.33, in effect on October 1, 2026). An August 7, 2026 proposal would rescind that section, though the Administration for Children and Families says programs would still have to screen children under the Head Start Act. Comments close October 6, 2026 (Federal Register).

If you teach in a public school

Talk to your principal or special education team first. The school can propose an evaluation, and parents can ask for one themselves (34 CFR 300.301). Child Find includes children who are "advancing from grade to grade" (federal Child Find rule). In guidance from January 2011, still posted on October 1, 2026, the federal Office of Special Education Programs said RTI (response to intervention, a tiered support process) "cannot be used to delay or deny" an evaluation (OSEP Memo 11-07). For what comes next, see our guide for K to 3 teachers, the IEP or 504 plan and your part.

What should you write down, and who can see it?

Keep short, dated, factual notes, written as if the family will read them:

• your observations and milestone checklists;
• a record of each conversation: the date, who was there, what was shared and what you agreed;
• any consent form the family signs, and the date of any referral.

Share notes with anyone outside your program only with the family's permission, ideally in writing, and follow your program's or school's privacy policy. The exception is your duty as a mandated reporter: every state's law names people who must report suspected child abuse or neglect, and many states name child care providers and teachers (Child Welfare Information Gateway, laws as of May 2023). A developmental concern and a report of abuse or neglect are separate things.

What does the research say?

Research on how best to raise a concern is limited. The studies we found used interviews, focus groups and surveys, not trials.

• Families need time. In interviews with 32 mothers in Ontario, Canada, parents came to understand their child was autistic gradually, at different speeds, and for many, some information about signs came from professionals such as daycare providers. Professionals who couldn't diagnose often avoided the label and prompted parents' own questions, while playing signs down often delayed understanding (Gentles and colleagues, 2020).
• Families want their child valued. In US focus groups, 22 parents of autistic children in preschool and child care said that above all they wanted teachers to love and accept their children. One said: "I wanted someone to love them first" (Mereoiu and colleagues, 2015).
• The words can be practiced. In an Australian study of 302 parents and 118 educators, most parents were satisfied with how educators had discussed concerns with them. The authors stress "active skills-based training" for educators (Almendingen and colleagues, 2022).
• Following up matters. From focus groups with 23 parents of autistic children about their children's doctors, researchers suggested responding promptly, helping families weigh options and checking in as they move through services (Locke and colleagues, 2020).

Where can you and the family get more help?

For families:

• Early intervention programs by state, for children under 3.
• Parent Centers, which work with families of children with disabilities from birth to 26. Find one by state through CPIR.
• The Autism Society National Helpline, for information and referrals (Autism Society).

For you and your team:

• CDC's "Learn the Signs. Act Early." resources for early care and education and the Watch Me! training.
• Your state's early intervention program, listed on CDC's contacts page, and your local school district's Child Find office.
• Free online training: AFIRM modules, the IRIS Center's autism module and Pyramid Model resources from NCPMI.