• Caregivers named a wide range of concerns, including externalizing behaviors such as aggression (61.8%), social differences (36.3%), and attention difficulties (35.4%).
• Over half (54.7%) identified autism-specific social responsiveness challenges.
• Concerns varied by service setting, even after accounting for child age and caregiver ethnicity.
• For mental health settings, caregivers more often named externalizing behaviors, meaning they were more likely to talk about big, outward behaviors—things like hitting, yelling, meltdowns, or other behaviors that feel disruptive or hard to manage at home or in the community.

• For school settings, caregivers more often named restricted and repetitive behaviors and social differences—things like getting “stuck” on certain routines or interests, having trouble joining in with peers, or finding social interactions confusing or overwhelming.
• These differences don’t mean caregivers care about only one set of concerns; they reflect what feels most pressing in each environment and what each system tends to ask about or pay attention to.
• Family characteristics—including child age, caregiver race/ethnicity, and number of children in the home—were associated with the types of concerns reported. 

• Practitioners should expect different caregiver priorities depending on the system in which they work.

• Setting-specific intervention planning is essential: mental health providers may need to focus more on behavior regulation, while school-based teams may need to address social communication and repetitive behavior concerns.

• A shared framework for understanding caregiver priorities can support cross-system coordination, reducing fragmentation for families navigating multiple services.

• Using open-ended caregiver input (rather than only standardized checklists) can surface nuanced, context-dependent concerns that shape more meaningful goal-setting.

Caregiver perspectives are one of the clearest windows into what feels most important for a child’s day‑to‑day well‑being, and this study shows how those priorities shift depending on the setting families are navigating. When we understand that caregivers highlight different concerns in schools than they do in mental health programs, it becomes easier to design support that feels relevant, respectful, and coordinated rather than fragmented. This matters because families often move between multiple systems, and when each system interprets caregiver concerns differently, children can end up with mismatched goals or duplicated efforts. Recognizing these patterns helps practitioners respond in ways that are more aligned with what families are actually experiencing, ultimately creating more coherent, equitable, and meaningful support for autistic children.

Simple Play (Sensorimotor & Exploratory)

These activities focus on cause-and-effect, sensory exploration, and basic motor skills—like banging, mouthing, or dropping—just to see what happens.

• Roll & Watch — Sit facing the child and gently roll the ball toward them. Pause so they can watch it approach, touch it, or roll it back in their own way.

• High Drop / Low Drop — Hold the ball up high, then low, then to the side, and let it fall. Notice the sound it makes and how it bounces (or doesn’t).

• Ball Peek‑A‑Boo — Hide the ball under a cup, behind your back, or under a cloth. Reveal it slowly or let the child lift the cover.

• Spin & Wiggle — Spin the ball in place on the floor or wobble it between your hands. Let the child explore the texture, weight, and movement.

• Push‑Away Game — Place the ball near the child’s hand or foot and gently nudge it so it rolls away. Many children enjoy repeating this simple “cause → movement” loop.

• Bounce on Different Surfaces — Try bouncing or dropping the ball on carpet, tile, a couch cushion, or a blanket. Notice how the movement changes.

• Body Taps — Gently tap the ball on your head, shoulders, knees, or feet while naming the body part. Offer the ball for the child to tap on you or themselves.

Combination Play (Functional & Constructive)

These activities involve using materials together with intention—building, matching, or organizing.

• Roll to a Target — Place a bowl, box, or hoop on the floor and invite the child to roll the ball toward it. Celebrate any attempt, not just “success.”

• Ball Pathways — Use books, pillows, or cardboard to create a simple lane or tunnel. Roll the ball through and adjust the path together.

• Color Match Roll — If you have multiple balls or colored containers, match the ball to the same‑colored bin or spot on the floor.

• Ramp Rolling — Prop a book or tray to make a ramp. Roll the ball down and experiment with steep vs. gentle slopes.

• Stop & Go Game — Roll the ball, then place your hand in front to stop it. Invite the child to try stopping it with their hand, foot, or a toy.

• Ball in a Box — Offer a small box or basket and invite the child to place the ball in, dump it out, and refill. Add a second container for simple “sorting.”

• Obstacle Roll — Place a few soft obstacles (stuffies, blocks, cushions) and roll the ball around or between them. Narrate the path (“around,” “through,” “under”).

• Ball Train — Line up a few small containers or cups and place the ball in each one like “train cars.” Move them along the floor together.

• Matching Movements — You roll the ball fast, slow, zig‑zag, or stop‑and‑go. Invite the child to copy the movement or create their own for you to match.

Symbolic Play (Pretend & Representational)

These activities support imagination, role play, and storytelling.

• Baby Ball Care — Pretend the ball is a tiny baby. Wrap it in a cloth, rock it, “shhh” it to sleep, or give it a gentle ride in a box “crib.” Invite the child to help with feeding, tucking in, or carrying.

• Ball Picnic — Set out a small blanket and pretend the ball is food (apple, orange, scoop of ice cream). Offer plates, cups, or spoons and take turns “tasting,” sharing, or serving stuffed animals.

• Animal Ball — Turn the ball into an animal by giving it a sound or movement (a hopping bunny, a rolling turtle, a bouncing frog). Let the child choose what the ball becomes next.

• Ball Doctor Visit — Pretend the ball is a patient. Use a spoon as a “thermometer,” a cloth as a “bandage,” or your hand as a “stethoscope.” Narrate simple needs: “The ball has a tiny cough—can you help?”

• Ball Delivery Truck — Place the ball in a small box or container and pretend it’s a package. Drive it around the room and “deliver” it to different spots or people.

• Ball Birthday Party — Sing “Happy Birthday” to the ball, blow pretend candles, and offer pretend cake slices. Stuffed animals or dolls can come to the party.

• Ball Superhero — Give the ball a simple power (flying, glowing, super‑rolling). Make a tiny cape from a tissue or cloth. Create a short story about who the superhero helps.

• Ball Pet — Treat the ball like a pet that needs gentle pats, a place to sleep, or a little walk. Offer a small box as a “bed” and narrate what the pet likes or needs.

• Ball Weather Reporter — Pretend the ball is the sun, moon, or a storm cloud. Move it across the sky, hide it behind a pillow “cloud,” or make it “rain” by tapping it gently.

• Ball Chef — Pretend the ball is an ingredient (dough, fruit, soup). Stir it in a bowl, “cut” it with a toy knife, or serve it on a plate. Invite the child to choose what you’re cooking next.