Factors Associated with the Utilization of Services for Children with Autism in Saudi Arabia

Background:   Services for children with autism spectrum disorders (ASD) are limited in Saudi Arabia and little attention has been directed towards examining the factors associated with the use of available ones.

Objectives:  The aim of this study is to provide an estimate of services use among children with ASD in Saudi Arabia and to examine family and child characteristics associated with the utilization of ASD services.

Methods:  An online parent survey was developed and its link was distributed by local professionals and through parent support groups in Saudi Arabia.  A total of 205 caregivers, mostly fathers (61%), of children who had ASD and were younger than 21 (M = 7.9) years submitted usable forms during the 3-month survey period. (See table 1 for sample characteristics). Multivariate regression analysis was used to examine the characteristics of family (e.g., SES, city of residence, knowledge about autism) and children (e.g., severity of the child autistic symptoms) with ASD services use (i.e., age at start of the first treatment and the number of treatments utilized).

Results:  The average age at starting the first treatment was 3.3 years. The average age of starting the first treatment increased 0.8 for each year of age of diagnosis and decreased 0.5 years for parents with high educational attainments. With respect to the use of ASD treatments, the majority of parents reported utilizing non-medical treatments (NMD; 94%; e.g., speech therapy, applied behavior analysis therapy, occupational therapy) followed by biomedical treatments (MD; 88%; vitamin and supplements, Hyperbaric Oxygen Therapy, special diets) and cultural/religious treatment (CR; 86%; e.g., reciting Quran, honey, visiting religious/traditional healers). While the average number of NMD treatments decreased 1.1 treatments for children who were diagnosed in non-major cities, it increased 1.5 treatments for mothers who were 45 years or older, 1.2 for children who received at least one treatment out of Saudi Arabia, 1.0 for families with household incomes above the mean of Saudi population’s household income, and 0.3 for each MD treatment. The average number of biomedical treatments decreased 0.1 treatments for parents who were more knowledgeable about children with ASD’s social and communicative features whereas it increased 0.6 treatments for children who received treatments out of city of residence, 0.5 treatments for fathers of high educational attainment, 0.4 for comorbidity, 0.2 for the number of CR treatments, 0.1 for the number of NMD treatment, and 0.1 for parents who were more knowledgeable about children with ASD cognitive features. The average number of cultural/religious treatments associated with 0.1 treatments for parents who were more knowledgeable about children with ASD social and communicative features. (See table 2 for linear regression modeling).

Conclusions:  Disparities in service utilization associated with SES factors and cities where services were received point to the need to develop policy, practice and family-level interventions that can mitigate the limited services for children with ASD in Saudi Arabia. Further, understanding the decision-making processes that underlie treatment selection by parents of children with autism in Saudi Arabia is critical for future implementation research.