The therapeutic program must begin as early as possible—at the first sign that something is wrong—because the more quickly the child is engaged and interactive, the more quickly she'll start learning and the fewer maladaptive behaviors she'll develop to cope with her difficulties.

Despite parents' best efforts, it is often hard to get a child into therapy. Often a parent senses something wrong, only to be pooh-poohed by relatives and sometimes even by professionals: "All babies are different. Wait and see what happens." However, children with severe disorders can't afford to wait, because months or years lost waiting will be very difficult to regain.

It typically takes eight months from the time a parent seeks help until the time intensive therapy starts. This is too long. When a child exhibits difficulties in relating or communicating, the situation should be evaluated as soon as possible. Assessment should begin within days, and intensive therapy should begin while the assessment is in progress. Only in that way can the process of decline be halted and the child spared months of lost development.

The best way to catch problems early is to have pediatricians, educators, and parents act as an early warning system. Pediatricians are in an especially strategic position; they are close to families and have the training and perspective to catch problems that parents may miss. If at each well-baby checkup pediatricians routinely examined infants for age-appropriate developmental skills, including subtle emotional, cognitive, language, sensory, and motor patterns, potentially severe disorders could be caught before they derailed a child's development. For instance, by 18 months a child should be warmly engaged and capable of initiative and two-way communication. She should also be able to use complex gestures to communicate what she wants—taking her mother's hand and leading her to the door or toy chest, or pointing, for example. Without the use of words she should be communicating with her parents, clearly understanding much of what they say to her, and communicating many of her own wishes back. If by 18 months the child can do these things, her gestural communication is developing on track and the building blocks of symbolic expression and language are present. But if she is not communicating gesturally in an age-appropriate way, the assessment and, if needed, the intervention, should begin immediately. It does not make sense to wait until she is 24 months to see if language is delayed. The child who has a circumscribed language problem that will take care of itself will be mastering these preverbal gestural communication patterns. The child who is not using gestures and behaviors to communicate needs and wishes and solve problems often is showing the signs of significant challenges.