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Delays in identifying pediatric autism spectrum disorder (ASD) remain problematic despite directives aimed at improving early detection and intervention. Caregiver mental health concerns could be one explanation for this documented delay, necessitating further inquiry into mental health factors that predict delayed age of ASD diagnosis. This study investigated the impact of caregiver mental health concerns, diagnoses within the three-generation family history, and demographic data on delayed ASD diagnosis using a sample of caregivers of children with ASD (N = 63). Factors that predicted a delayed response between the time when a child was suspected of having developmental delay and when the child presented for a developmental diagnostic evaluation were examined. Mental health concerns were assessed by using standardized screening tools for traumatic childhood experiences, depression, and anxiety. The average time between suspicion of developmental delay and the child's presentation for a diagnostic evaluation was 36 months. Female gender of the child and family histories that contain intellectual disability, learning concerns, neurological concerns, or Tourette's syndrome predicted prolonged time to diagnostic evaluation. Adverse childhood events (ACEs) experienced by caregivers were identified as predictors of generalized anxiety disorder and depression. A positive correlation was found between caregiver generalized anxiety disorder and depression. Caregiver type, child gender, and child ethnicity predicted generalized anxiety but not depression. Health care providers should address identified predictors for delayed ASD diagnostic evaluations with caregivers upon initial suspicion of developmental delay. Practice recommendations for health care providers include assessing a three-generation family history and evaluating caregiver mental health concerns. Further, identifying protective factors to improve caregiver resiliency may reduce this disparity. [ABSTRACT FROM AUTHOR]