Step by step, from the first “something isn’t right”

Every child grows at their own pace, and one sign alone doesn’t mean autism. But if you see several, it’s worth getting checked. No one knows your child better than you: trust what you see.

Signs to bring up with the doctor

• Doesn’t turn when called by name.
• Doesn’t point to ask for something or to show you what interests them.
• Uses few or no words for their age.
• Makes little eye contact or prefers to play alone.
• Always plays the same way, like lining up or spinning objects.
• Gets very upset by noises, textures or changes in routine.

A questionnaire you can fill out at home

The M-CHAT-R/F is free, available in English and Spanish, and is for children from 16 to 30 months. It doesn’t give a diagnosis: it helps you decide whether to ask for an evaluation. Pediatricians recommend checking development at 18 and 24 months. Download it here.

Where to go

Start with their pediatrician or family doctor. They can refer you to a specialist: a pediatric neurologist, child psychiatrist or psychologist with experience in child development.

• IMSS (Mexican Social Security Institute): your family doctor gives you a referral to Pediatrics, and from there to Pediatric Neurology or Child Psychiatry. Without a referral they won’t see you.
• ISSSTE (health care for government workers), Centros de Salud (public health centers) and public hospitals in your state, if you don’t have social security.
• The DIF (Mexico’s family welfare agency) in your state or city, and public university clinics, which usually charge based on income.
• In Nuevo León: the DIF’s Centro TEA+ offers free diagnosis. See the directory.

What to bring: put together a folder

• Your notes and videos.
• Vaccination record and previous tests, especially hearing tests.
• Reports from daycare or school, if any.
• The written referral and your list of questions.

What to ask

• What is the diagnosis, and what does it mean for daily life?
• Which therapies do you recommend, how many times a week and where?
• Does my child need other tests, like a hearing test?
• Can you give me the diagnosis and a report in writing?
• If you plan to apply for the disability pension: does this certificate count? It has to come from a public health institution.

📄 How to read the evaluation report

When you get the report, it’s normal to feel a blow: it’s written for specialists and talks mostly about what your child doesn’t do yet. A report describes today’s difficulties; it doesn’t define your child or say how far they will go. Its purpose is to plan therapy.

Tests that often appear

Battelle Developmental Inventory

Measures how development is going in several areas (communication, social, adaptive, motor and cognitive), in children from 0 to 8 years.

Calendario del Desarrollo Infantil (Child Development Calendar)

Compares what your child does with what is expected at their age, area by area.

Filtro Mexicano para la Detección del TEA (Mexican Autism Screening Filter)

A questionnaire made in Mexico that shows whether autism is likely.

GARS-3 (Gilliam Autism Rating Scale)

Estimates how likely autism is and its level, based on the DSM-5.

IDEA (Ángel Rivière)

Describes how autism shows up in your child: relating to others, communication, play, imitation, flexibility.

DSM-5

The manual with the official criteria for diagnosis.

Forms and functions of communication

How your child communicates today: without a clear intention yet, using your hand or objects, with gestures, sounds or words. It’s the starting point for choosing how to support them, for example with pictures.

The scariest parts, explained

Level 1, 2 or 3

How much support your child needs today: “requiring support”, “requiring substantial support” or “requiring very substantial support”. It isn’t a grade or a prognosis, and it can change over the years.

Developmental age

For example, “language at 6 to 9 months” in a 5-year-old. It’s a way to measure where to start working, not a label forever.

Echolalia

Repeating words or phrases they heard. Often it’s their way of starting to use language.

Stereotypies (stimming)

Repeated movements, like hand-flapping or spinning. They usually help your child regulate.

“Central deafness”

It doesn’t mean they can’t hear: it means they don’t respond to language the way we’d expect yet. That’s why their hearing needs to be checked, to rule it out.

Functional mutism

They don’t use words to communicate yet. They can communicate in other ways, and that’s what pictures and apps like Mi Voz are for.

After you receive it

• Ask them to explain the report in person and give you specific recommendations: which therapies, how many times a week and what goals.
• Keep it in your folder and take a copy to their therapist and to school, if you want to.
• If the report is from a private center, it works to start therapy. For the pension you need a certificate from a public institution (step 5).
• Give yourself time to feel. Getting a diagnosis stirs up a lot, and that’s okay. See step 6.

You don’t have to wait for the diagnosis to start. While you wait, you can already look for speech therapy and give your child a way to communicate.

The most common types of therapy

• Speech and communication: with a speech-language therapist (in Mexico, often a licenciada en Comunicación Humana). Includes learning to communicate with pictures or an app.
• Occupational: daily living activities (eating, getting dressed, using the bathroom), movement, and how your child processes sounds, textures and lights.
• Behavioral and developmental: they teach skills through play and in real situations. Some are based on ABA and others on development, like the Denver model.
• Parent programs: they teach you strategies to use at home every day. You spend more time with your child than any therapist.

Using pictures doesn’t stop a child from talking. The American Academy of Pediatrics is clear: communicating with pictures or a device does not delay speech and can help words appear.

How to tell if a therapy is working

• There are clear goals in writing, for example: “ask for water with a picture”.
• They explain what they’re working on, let you watch and teach you to do it at home.
• They review progress every two or three months.
• Your child goes calmly most of the time.
• If months go by without any change, ask and request that the plan be adjusted.

Supports in public schools

• USAER (Special Education Support Unit): a special-education team that supports your child and their teacher inside the regular school.
• CAM (Centro de Atención Múltiple, a special-education school): for children who need more support. The decision is made together with the family.

What to ask the school for, in writing

• A USAER evaluation.
• Reasonable accommodations: a quiet place to calm down, visual supports, a gradual start, advance notice before changes, and permission to use Mi Voz or their cards.
• A meeting with the teacher to agree on how to support your child. Bring the “How I communicate” sheet.

If they turn your child away or want them out

1. Ask them to tell you in writing.
2. Talk to the school supervisor (supervisión escolar) and your state’s Secretaría de Educación (Department of Education). In Nuevo León: 81 2020 5050 ext. 52, [email protected].
3. File a complaint. For a public school: with your state’s human rights commission (in Nuevo León, the CEDH: 800 822 9113). For a private school: with CONAPRED, the National Council to Prevent Discrimination (800 543 0033). You have one year from when it happened.
4. If the problem is fees or tuition at a private school: PROFECO, the federal consumer protection agency (800 468 8722).

The laws that protect your child

• Ley General para la Atención y Protección a Personas con la Condición del Espectro Autista (General Law for the Care and Protection of Persons with Autism Spectrum Condition, 2015): the right to early diagnosis, therapies in the public health system and inclusive education. It forbids denying care, applying risky therapies or overmedicating.
• Ley General para la Inclusión de las Personas con Discapacidad (General Law for the Inclusion of Persons with Disabilities): forbids discrimination in schools and daycares.
• Mexican Constitution, article 4: since 2024 the disability pension is a right, with priority for rehabilitation of children under 18.

Disability certificate and ID card

• Disability certificate: issued by evaluation centers authorized by the Secretaría de Salud (Ministry of Health). It’s free and lasts 1 to 5 years.
• Credencial Nacional para Personas con Discapacidad (National Disability ID Card): issued by the DIF. They ask for the birth certificate, CURP, a current certificate, proof of address and the ID of the mother, father or guardian. In Nuevo León you apply at the DIF’s CREE (rehabilitation center).

In Nuevo León there is no state cash support for children: the state program is for people from 30 to 64. There is free diagnosis at Centro TEA+.

It’s a long road. If you’re okay, your child will be too. Your well-being is not negotiable.

• The exhaustion is real. Find moments to rest, even short ones, and take turns.
• Your relationship: tension is normal. Split the tasks, talk about how you feel and don’t blame each other. If needed, look for couples support.
• Siblings also need time and explanations. Give them some time just for them.
• Ask for help without guilt. From family, friends, other families. Here are ideas to involve the people around you.
• A psychologist for mom or dad, not just for the child. There are low-cost options at public universities.
• You’re not alone: a guide family can walk alongside you.

🛡️ When meltdowns hurt

During some meltdowns, a child may hit, bite, scratch or hurt themselves. It isn’t meanness and it isn’t your fault: in that moment they can’t control themselves. But there are things that help, and you don’t have to go through it alone.

During the meltdown

• Stay calm, talk little and lower the noise and the light.
• Stand to the side of or behind your child, not in front of their face, and an arm’s length away. Protect your face.
• Move anything that could hurt them, or others, out of reach.
• Hold them only if they or someone else is in danger, and carefully.

To prevent them

• Write down what happened before each meltdown: the time, the place, whether it was noisy, whether they were hungry, sleepy or in pain. That’s how patterns appear.
• A child who can’t say “it hurts” sometimes says it with a meltdown. Tooth pain, ear pain or constipation can trigger them. Check with their doctor.
• Learn their warning signs and offer their calm corner or Mi Voz’s “Break” button in time.
• Keep their nails short.

Ask for help

• Tell their neurologist and their therapist that there’s aggression. There are behavioral strategies and, sometimes, treatments that help a lot.
• If you get hurt, get care. Your health matters too.