Measuring language impairment, health and well-being among children with autism spectrum disorder in Ghana: An integrated assessment model

Background Autism Spectrum Disorder (ASD) is a multidimensional neurodevelopmental condition affecting communication, psychological well-being, social participation, and quality of life. However, it appears limited research in Sub-Saharan Africa has examined these domains within an integrated framework. The study developed and tested an Integrated Assessment Model (IAM) for measuring language impairment, health, and well-being among children with ASD in Ghana. Methods A quantitative cross-sectional design guided the study. Data were collected from 150 children with ASD using the Integrated Language and Well-being Assessment Battery (ILWAB), which assessed structural language, functional communication, neuro-communication functioning, psychological health, physiological well-being, and social adaptability. Data were analyzed using descriptive and inferential statistics. Results Findings showed that language impairment among children with ASD was predominantly concentrated in functional-social communication domains. Strong negative relationships were found between language impairment and psychological as well as social well-being, while physiological well-being showed comparatively weaker associations. SEM results indicated that functional language significantly associated psychological health (β = −0.79, p < .001) and social adaptability (β = −0.88, p < .001), with psychological health serving as a significant mediating pathway. Network analysis identified social interactional competence, pragmatic skills, expressive language, and communicative intent as dominant hub variables within the ASD communication system. The IAM demonstrated strong psychometric quality and associative performance, with excellent model fit and high classification accuracy across outcome domains (AUC = 0.89–0.95). Conclusion The study demonstrates that ASD-related language impairment is best understood as an interconnected system of communication, psychological functioning, and social participation. The findings support the need for integrated and context-responsive assessment and intervention frameworks for children with ASD in Ghana and similar low-resource settings.