Geographic Inequities in Physical Health and Neurodiversity-Affirming Practices for Autistic Adolescents and Young Adults in Saudi Arabia: A Post-Pandemic Study

Abstract

Background:

Autistic adolescents and young adults experience high rates of co-occurring physical health challenges, particularly sleep disturbances and gastrointestinal (GI) symptoms, which likely reflect underlying structural barriers to timely and appropriate healthcare. In countries with urban and remote service gaps, such as Saudi Arabia, these inequities are more visible in the post-pandemic context. Neurodiversity-affirming approaches emphasize modifiable systems, accessibility, and supportive environments that can promote more equitable healthcare experiences; however, evidence applying this lens to physical health inequities in the Arab region remains limited.

Methods:

We conducted a cross-sectional survey of 198 primary caregivers of autistic adolescents and young adults (aged 13–25 years) living in urban (61%) and remote (39%) regions of Saudi Arabia. Caregivers completed measures of sleep disturbance (using age-specific instruments), GI symptom severity, healthcare access barriers, autism traits, neurodiversity-affirming practices, and digital health utilization. Analyses included group comparisons, hierarchical and multivariate regression, and mediation and moderation models using PROCESS.

Results:

Remote residence was associated with greater sleep disturbance and higher GI symptom severity compared with urban residence. Caregivers in remote regions reported substantially higher healthcare access barriers and lower neurodiversity-affirming practices, while telehealth utilization did not significantly differ by geographic region. Healthcare access barriers significantly mediated the association between geographic region and sleep outcomes. Neurodiversity-affirming practices were independently associated with better physical health and attenuated the negative impact of access barriers on sleep outcomes.

Conclusions:

Physical health inequities among autistic adolescents and young adults in Saudi Arabia were more strongly associated with modifiable structural barriers, including healthcare access barriers and regional inequities in service availability. Strengthening neurodiversity-affirming practices and embedding affirming principles across in-person and digital services may support more equitable and context-sensitive care.

Community Brief

Why is this issue important?

Many autistic people experience health problems, especially difficulties with sleep and stomach or digestion problems. In Saudi Arabia, many autism-related services are mainly available in major cities. This can make it harder for autistic young people living far from cities to get the healthcare and support they need. This study looked at how location may affect health and used an approach that respects autistic ways of thinking, communicating, and experiencing the world.

What was the purpose of this study?

This study had three main goals. First, we compared sleep and digestion-related health problems among autistic young people living in major cities and those living farther from cities. Second, we examined the difficulties families face when trying to access healthcare services. Third, we explored whether supportive and respectful practices at home may help improve health and well-being.

What did the researchers do?

We recruited 198 families from across Saudi Arabia, including 120 families living in major cities and 78 living in areas farther from cities. Caregivers, most of whom were mothers, answered questions about health, access to healthcare, and the daily support practices they used with their autistic family member.

What are the results and conclusions of the study?

We found three main results. First, autistic young people living farther from cities experienced more sleep and digestion problems than those living in major cities. Second, these differences were strongly linked to difficulties in getting healthcare. Families living farther from cities often had to travel longer distances, pay higher costs, and had fewer opportunities to access autism specialists. Third, supportive and respectful practices at home were linked to better health and appeared to reduce some of the negative effects of these challenges, especially for sleep.

What is new or controversial about these findings?

The study suggests that poorer health outcomes in areas farther from cities were more strongly associated with healthcare access barriers and regional inequities in service availability. The findings also suggest that telehealth alone may not fully address disparities if services are not designed in ways that are accessible, respectful, and responsive to autistic needs.

What are the potential weaknesses of the study?

We collected information from caregivers at one point in time only. The study did not directly include autistic individuals’ own views in the main analyses, which remains an important goal for future research. In addition, many participating families were already connected to healthcare or support services, so the findings may not fully reflect the experiences of more isolated families.

How will these results help autistic people now or in the future?

These findings show how healthcare systems can provide fairer and more supportive care for autistic people across different regions. Policymakers can improve services in areas farther from cities and provide better training for healthcare professionals. Healthcare planners can also work together with autistic people and families to improve telehealth services. Families may also benefit from supportive practices at home when access to services is limited. Overall, improving health requires reducing barriers and providing respectful and supportive care across all regions.