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

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.