Estimating autism prevalence among children in the Kingdom of Saudi Arabia

ABSTRACT

Objectives:

To provide an accurate estimate of autism spectrum disorder (ASD) prevalence among children in the Kingdom of Saudi Arabia (KSA) by benchmarking against international and regional data, addressing the limitations of the currently reported prevalence rate of 0.6%.

Methods:

We conducted a comparative benchmarking analysis using ASD prevalence data from countries with advanced monitoring systems (United Kingdom, United States, Denmark, South Korea, Italy, Singapore) and regional comparators (United Arab Emirates, Qatar, Jordan). We assessed differences in healthcare infrastructure, diagnostic frameworks, and screening intensity, and reviewed recent KSA-based studies. Methodological limitations such as underreporting, cultural stigma, and diagnostic inconsistencies were also considered.

Results:

The official General Authority for Statistics estimate of 0.6% underrepresents the actual prevalence of ASD in KSA. International benchmarks suggest higher prevalence, with the UK at 1.8%, the US at 3.2%, and South Korea at 2.6%. Regional studies in Qatar and the UAE show rates of 1.1% and 0.6%, respectively. KSA-specific studies report prevalence ranging from 1.3% (systematic review and meta-analysis across 24,000 children) to 2.5% (hospital-based screening in Riyadh). Integrating these findings, we estimate that the realistic prevalence in KSA lies between 1.7% and 1.8%.

Conclusion:

The prevalence of ASD among children in KSA is substantially higher than the official estimate of 0.6%. A calibrated range of 1.7% to 1.8% better reflects the true prevalence and provides a foundation for evidence-based public health planning, early screening initiatives, and resource allocation for autism services in KSA.

Rationale for country selection

We created a set of countries for comparative benchmarking based on their healthcare system maturity, autism spectrum disorder (ASD) screening intensity and data reliability, and demographic comparability.

The selections reflect a geographically diverse mix, including countries from Europe, North America, Asia, and the Middle East/Gulf Cooperation Council to ensure a well-rounded global perspective. Countries in South America and Africa were excluded, as many rank lower on healthcare system performance and have limited national ASD data, resulting in significant underdiagnosis and underreporting.

Selected set of countries and rationale for selection

• Several selected countries rank highly on the health subindex of the Legatum Prosperity Index - Singapore (1st), South Korea (3rd), Denmark (16th), and Italy (17th) - and offer structured healthcare systems, standardized ASD diagnostic frameworks, robust national diagnostic surveillance mechanisms, and ongoing therapeutic support. These attributes make them strong global benchmarks for calibration.

• The United Kingdom (DK), though ranked slightly lower on the Legatum Prosperity Index, was included due to its comprehensive ASD tracking systems and longstanding institutional expertise in autism diagnosis and reporting.

• The United States (US) was selected for its depth and breadth of available ASD data, despite systemic factors that may contribute to overreporting.

• The United Arab Emirates (UAE) and Qatar were included as regional comparators due to their genetic, geographic, and cultural proximity to KSA, offering important local context despite systemic underreporting driven by diagnostic capacity constraints.

• Jordan was also chosen for its regional relevance, though data limitations and reliance on projected figures, rather than empirically validated figures, suggest a cautious interpretation and the need for further research.

This carefully selected mix provides a balanced foundation, combining global best practices with regionally relevant contexts to inform a more accurate prevalence estimate for KSA.

Commentary on reported ASD prevalence across countries

The reported ASD prevalence rates across countries show significant variability, likely influenced by screening intensity, diagnostic definitions, and population structure. Some countries report notably high prevalence, such as the US and South Korea, probably due to broad diagnostic definitions, proactive screening programs, and systemic incentives that may contribute to overdiagnosis. Others, like the UAE and Singapore, report low prevalence, likely due to lower screening coverage. Meanwhile, countries such as the UK provide more reliable benchmarks, supported by standardized national healthcare systems and long-term ASD monitoring.

Below, we examine each selected country in detail, outlining the reported prevalence, data source, and rationale for upward or downward adjustment based on structural and methodological considerations.

The UK (prevalence of 1.8%) serves as a key benchmark due to its structured National Healthcare System (NHS) and standardized ASD reporting mechanisms. A 2021 study conducted by Roman-Urrestarazu et al¹ at Cambridge University showed that ASD prevalence in the UK has been consistently monitored through large-scale national studies, making the 1.8% statistic a robust reference point.

The reported ASD prevalence rates across countries show significant variability. Denmark’s reported estimate of 1.2%, from a 2024 study by Jensen de López and Mølle² in Neuropsychiatric Disease and Treatment, and Italy’s reported estimate of 1.4%, from a 2023 review by Scattoni et al³ in Child and Adolescent Psychiatry and Mental Health, rely on datasets created between 2016 and 2018. During that time frame, screening practices, awareness levels, and diagnostic frameworks were less developed than they are today.

In April 2025, the US Center for Disease Control’s (CDC’s) Autism and Developmental Disabilities Monitoring Network estimated a prevalence of 3.2%, or one in 31 children, making the country’s ASD prevalence rate among the highest globally.² While this estimate is based on comprehensive multistate surveillance, several systemic factors potentially contribute to an overrepresentation of ASD cases: a) Broadening diagnostic criteria under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has resulted in individuals - especially children over the age of 3 - being diagnosed with ASD if symptoms are present, regardless of when they emerge. In contrast, under the CDC’s International Classification of Diseases (ICD-10), symptoms must be evident before the age of 3 for a diagnosis of pervasive developmental disorder (which includes autism), meaning that clinicians may exclude children who show signs later from ASD classification. b) An ASD diagnosis provides access to special education programs, financial aid, and medical benefits, creating financial and educational incentives for diagnosis. Access to these services has raised concerns about diagnostic inflation, where borderline developmental delays may be categorized as ASD to secure benefits. Furthermore, strong parental advocacy, legal considerations, and early intervention laws may contribute to a diagnostic culture that favors overdiagnosis.

South Korea (prevalence of 2.6%) reported a notably high ASD prevalence, drawing on a widely cited 2011 study by Kim et al⁴ in the American Journal of Psychiatry that placed an estimated one in 38 South Korean children on the autism spectrum. This represented a dramatic rise from earlier estimates of 0.04% in the 1970s, reflecting a combination of factors including methodological evolution, increased awareness, and broader diagnostic practices.⁶ The study used a 2-stage population-based screening method in a specific region of South Korea. However, subsequent evaluations have raised concerns about the study’s methodology, particularly the oversampling of high-risk populations, reliance on broad screening instruments, and extrapolation from a small, high-probability subsample to the wider population. These limitations likely contributed to an inflated prevalence estimate. In that study, clinicians flagged children for follow-up, but only 30% completed the assessments. As noted by Kathleen Merikangas, Chief of Genetic Epidemiology Research at the National Institute of Mental Health (NIMH), a minimum follow-up rate of 70% is generally required to support reliable prevalence estimates, which highlighted a significant methodological limitation.

In the Journal of Tropical Pediatrics, Eapen et al⁷ found an ASD prevalence of 0.6% in the UAE (in 2007), while Alshaban et al⁸ identified a rate of 1.1% in Qatar in a 2019 study in the Journal of Child Psychology and Psychiatry. Both findings reflect a lower-than-expected ASD prevalence. In both countries, the primary limitations relate to the timing of the studies and the diagnostic environment during that period. The data from the UAE study is over 15 years old, when ASD awareness, diagnostic tools, and clinical training lagged behind current standards across the region.

Similarly, although the Qatar study is more recent, systematic nationwide screening and diagnostic capacity were still evolving in 2019. Given the global trend of increasing ASD prevalence with improved detection and diagnostic clarity, these figures likely underestimate the true prevalence in both countries, as researchers conducted these older studies during a period of limited ASD awareness, narrower diagnostic criteria, and less mature screening infrastructure, all of which likely led to under-identification.

Jordan has a prevalence of 2% and limited nationally representative studies on ASD, but a 2023 study conducted by Hyassat et al⁹ in Children suggested that one in 50 children may be affected, which would equal approximately 10,000 children in the country with ASD. However, it is important to interpret this number with caution. The estimate seems to rely on projections rather than large-scale epidemiological screening and may reflect data from specialized clinical centers or parent-reported surveys, which tend to capture higher-probability cases.

Singapore (prevalence of 1.1%), reported by Zheng et al¹⁰ has a structured healthcare system with reliable ASD diagnostic tools. A 2023 study by the National University Hospital (NUH) estimated ASD prevalence at 1.1%. However, we believe this figure underestimates the true prevalence due to several structural limitations. The authors designed the study using data collected through screening at primary care clinics, which may have missed undiagnosed cases, particularly among children not actively engaged with healthcare services. Additionally, while Singapore has made strides in ASD services, national screening coverage, parental awareness, and diagnostic penetration are still evolving. As with many early-stage prevalence studies, the figure may reflect a baseline rather than a fully matured estimate.

KSA-specific studies and adjustments

General Authority for Statistics (GASTAT) currently reports a prevalence of 0.6%, likely relying on the first national autism prevalence study published in 2007 conducted by Aljarallah et al¹¹ for King Abdulaziz City for Science and Technology. This statistic aligned with the prevalence rate in the US at that time. The following data comes from 2 recent studies estimating ASD prevalence in KSA; they represent the only peer-reviewed, methodologically sound research available nationally: 1) A systematic review and meta-analysis of ASD studies in KSA, conducted in 2024 by Alsulami et al¹² for the International Journal of Medicine in Developing Countries, reported a prevalence of 1.3%. This review, based on a sample of approximately 24,000 children across Riyadh, Jeddah, Makkah, and Taif, represents the most comprehensive national ASD estimate. Unlike GASTAT’s 0.6% prevalence figure, this study made clinically diagnosed cases a core reference point. The study also adhered to reporting guidelines, ensuring a rigorous and transparent methodology in synthesizing existing national data. Based on its diverse geographic coverage, broad age range (2 years to 12 years), and large sample size, the study offers a more representative and reliable baseline for national prevalence, despite its conservative estimate resulting from its reliance on published studies, which may underrepresent undiagnosed or milder cases not captured in clinical settings.

2) A study of KSA children between the ages of 2 and 4 in Riyadh, conducted in 2022 by AlBatti et al¹³ for the Asian Journal of Psychiatry, reported an ASD prevalence of 2.5%. This study assessed 398 children in a hospital-based setting.

Social sigma discourages families from seeking diagnoses. Its higher-than-expected outcome is likely due to selection bias, as tertiary healthcare facilities naturally concentrate ASD cases. The study employed the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), and the Autism Diagnosis Observation Schedule, Second Edition (ADOS-2). Both are known for their high sensitivity, which may have further elevated the detection rate, thus requiring a downward adjustment.

Despite its designation as the most comprehensive national estimate to date, the 1.3% prevalence figure uncovered in 2024 may still underrepresent actual ASD rates in KSA due to systemic barriers in early detection. Social stigma discourages families from seeking diagnoses, particularly outside major cities. While screening at well-baby clinics is mandatory, compliance is inconsistent and clinicians often underuse tools such as the M-CHAT. This contributes to a reporting gap that likely suppresses authentic identification.

Moreover, diagnostic and treatment facilities are largely concentrated in a few major cities, primarily Riyadh, Jeddah, and Dammam, creating regional disparities in access. This limited geographic availability of services constrains early identification and formal diagnosis in other parts of the country, further contributing to underreporting.

When we combine the findings, we estimate that the actual prevalence rate in KSA likely falls within the range of 1.3% to 2.5%.

Conclusion

Kingdom of Saudi Arabia autism prevalence estimated at 1.7% to 1.8%.The current prevalence variations between countries appear to be driven more by systematic factors. There is growing international consensus that the observed rise in ASD prevalence across countries can be largely attributed to increased awareness, improved screening practices, and broader diagnostic criteria, particularly under the DSM-5. While genetic and environmental variables may contribute to autism risk at an individual level, we found that systemic factors-such as the intensity of national screening programs, diagnostic thresholds, and data-reporting practices-drive most of the prevalence variations between countries, rather than fundamental population differences.

Considering international patterns, regional comparators, and KSA-specific data, a calibrated prevalence range of 1.7% to 1.8% has emerged as a realistic and grounded benchmark, based on our analysis of data from the aforementioned countries. This estimate integrates evolving diagnostic capacity within KSA with lessons from comparable health systems, providing a strong foundation for future planning, policy development, and expanding autism-related services.