Demand for autism assessment has increased substantially in recent years, while diagnostic capacity has not kept pace. As a result, alternative approaches to early screening and support for children with social communication difficulties are required. We conducted a convergent mixed-methods multiple case study evaluating three locally developed, school-based early identification models for autism in England. The models were responsive to local priorities and involved collaboration between education and health professionals, schools, families and children. Quantitative referral and diagnostic outcome data were analysed alongside qualitative data from focus groups and interviews with education and health professionals. Across the three cases, stakeholders perceived the models positively, particularly in relation to improved inter-professional collaboration, earlier access to support, and professional learning within schools, although concerns were raised in one area regarding potential over-identification. Involvement of school staff was viewed as essential, enhancing understanding of autism and confidence in working with families. Follow-up interviews demonstrated sustained commitment to, and further development of, the models despite the absence of continued funding. Overall, findings highlight the importance of locally responsive early identification systems that are not solely diagnosis-focused, alongside ongoing challenges relating to inconsistent assessment frameworks and long-term sustainability.
Physical activity (PA) is encouraged to promote mental health in autistic children, but its role among autistic children living in socioeconomic adversity is unclear. This study examined whether higher PA was associated with lower anxiety and depression severity, and whether PA moderated associations between economic hardship or cumulative adverse experiences and mental health among autistic children. This study used data from 5,750 children aged 6–17 with autism from the 2021–2024 National Survey of Children’s Health. Weighted regressions assessed main effects of PA on anxiety and depression severity. Interaction terms tested whether PA moderated associations between economic hardship or cumulative adverse experiences and anxiety/depression severity, plus exploratory interactions with medication use and behavioral treatment. Higher PA was not significantly associated with lower anxiety (β = – 0.07, p = 0.233) or depression severity (β = – 0.06, p = 0.525). Neither economic hardship nor cumulative adverse experiences was significantly associated with anxiety or depression severity in adjusted models. None of the eight PA interaction terms tested reached statistical significance (all p> 0.05). Male sex, current medication use, and current behavioral treatment were each significantly associated with higher anxiety severity. Higher PA was not significantly associated with lower anxiety or depression severity and did not significantly moderate associations between economic hardship or cumulative adverse experiences and mental health in this sample. Broader family and socioeconomic context may be important when interpreting mental health correlates in autistic children.
Despite growing global attention to neurodiversity, evidence on awareness, inclusion, and policy development within Arab healthcare systems remains limited and fragmented. This scoping review mapped progress and gaps in how Saudi Arabia, Qatar, the UAE, Oman, and Jordan—three being high-income countries—address neurodiversity within their healthcare systems. The review followed PRISMA-ScR guidelines. PubMed/MEDLINE, Arab World Research Source, Scopus, and Web of Science were systematically searched, supplemented by structured grey literature searches in English and Arabic through October 2025. Eligible studies addressed neurodiversity or neurodevelopmental conditions, including ASD, ADHD, intellectual disability, and learning disorders, within healthcare contexts and reported outcomes related to awareness, policy, service access, or inclusion. Two reviewers independently screened studies and extracted data using standardized methods. Findings were narratively synthesized by theme. Study quality was assessed using appropriate JBI Critical Appraisal Checklists, and grey literature using AACODS. Thirty-two peer-reviewed studies met the inclusion criteria, with most published between 2019 and 2025. Saudi Arabia contributed 10 studies, followed by Oman (6), Qatar (5), Jordan (4), and the UAE (3), alongside four multi-country or regional studies. Neurodiversity-related policies remained largely autism-specific. Qatar’s National Autism Plan (2017) and Saudi Arabia’s national autism program represented the most formalized initiatives; however, post-diagnostic intervention uptake remained approximately 5
Autism spectrum disorder (ASD) is diagnosed more frequently in males, with male-to-female ratios typically around 3:1 or 4:1. As such, autistic females are underrepresented in research, limiting the understanding of their unique profile. Sex differences contribute to diagnostic disparities, as females often present with either more subtle or impactful traits. This study aims to identify clinically meaningful subgroups of autistic youth and examine sex-based differences and co-occurring diagnoses across subgroups. This study included 13,543 autistic individuals (10,497 male, 3,046 female; ≤15 years) from the SPARK cohort. Latent profile analysis was conducted using age at ASD diagnosis, adaptive functioning, autism symptoms, repetitive behaviors, and motor coordination. Post hoc analyses examined subgroup differences in sex distribution and parent-reported co-occurring diagnoses, including ADHD, anxiety, depression, and intellectual/cognitive disability. Latent profile analysis revealed four distinct subgroups. Profile 1, with proportionally more females than other groups, had the latest age of diagnosis and highest rates of anxiety, depression, and ADHD. Other profiles did not differ in sex ratio. Profile 2 was clustered around the sample mean, Profile 3 had the highest support needs and the greatest prevalence of intellectual disability, and Profile 4 included individuals with lower support needs. Findings highlight heterogeneity in ASD and sex-related differences in functional profiles and diagnostic timing. Females with co-occurring conditions are at risk of diagnostic overshadowing, where mental health or attentional concerns delay autism identification. Results highlight the need for improved diagnostic tools and assessment approaches that differentiate autism from co-occurring conditions.
Digital tools can make academic participation more accessible while allowing effort or support underlying successful performance to remain unseen. This study examined configurations of compensation, masking, assimilation, and digital masking among gifted autistic students and students with learning difficulties and their associations with academic self-concept. The sample comprised 469 Saudi school students aged 16–18 years at Wave 1, with 394 completing Wave 2 approximately 20 weeks later. Participants completed measures of compensation, masking, assimilation, digital masking, and academic self-concept. Latent profile analyses were conducted separately at each wave using three Camouflaging Autistic Traits Questionnaire–Short Form dimensions and a six-item Digital Masking Behavioral Index. Academic self-concept was examined as an external correlate, while learner group and accommodation access were evaluated as predictors of profile membership. Four profiles emerged at Wave 1: Open Support/Low Masking, Supported Compensation, Hidden Digital Effort, and Pervasive Camouflaging. Three profiles emerged at Wave 2: Low Masking/Open Support, Moderate/Mixed, and Pervasive Camouflaging. Academic self-concept was highest in open-support profiles and lowest in pervasive-camouflaging profiles. Compensation alone was not associated with poorer academic self-concept, whereas masking, assimilation, and digital masking showed negative associations. Gifted autistic students had higher odds of Supported Compensation membership, while accommodation access was associated with lower odds of Hidden Digital Effort membership. GPA differences were smaller and less consistent. Similar academic performance may coexist with different patterns of compensation, masking, and digital effort. Findings support distinguishing supported compensation from masking-dependent compensation and highlight environments that facilitate accommodations.
