Social determinants of autism spectrum disorder diagnosis timing in Saudi Arabia: a socioecological perspective

Purpose This study aims to examine factors associated with age at Autism Spectrum Disorder (ASD) diagnosis in Saudi Arabia using the Socioecological Model as a guiding framework. Design/methodology/approach A cross-sectional quantitative design was used with parent-reported data from an online non-probability sample of 356 parents and primary caregivers of children formally diagnosed with ASD. Age at diagnosis was measured in ordered categories and examined in relation to access to diagnostic services, combined parental educational level, prior parental knowledge of ASD, geographic region and child gender. Spearman correlation, Kruskal–Wallis testing and adjusted ordinal logistic regression were used. Findings Most children were diagnosed between 3 and < 6 years, while a notable proportion were diagnosed between 6 and < 9 years. Access to diagnostic services was the only factor significantly associated with diagnostic timing in both bivariate and adjusted analyses, with better access linked to earlier diagnosis. This study did not detect statistically significant associations for parental education, prior parental knowledge, child gender or geographic region, although regional findings require caution because of uneven subgroup sizes. Research limitations/implications This study is limited by its cross-sectional design, self-reported data, non-probability online sampling, uneven regional subgroup sizes and categorical measurement of age at diagnosis. The Access and Knowledge scales were also study-specific and require further validation. These limitations mean that findings should be interpreted as associations rather than causal effects. Future research should use larger, regionally balanced samples, collect exact age at diagnosis in months and examine additional factors such as symptom severity, family income, provider practices and referral quality. Practical implications The findings of this study indicate that improving access to diagnostic services is the most actionable lever for reducing diagnostic delay in Saudi Arabia. Health and education authorities should prioritize expanding diagnostic infrastructure beyond major cities, strengthening referral pathways between primary care and specialist services and reducing financial barriers to assessment. Training general practitioners and school staff to recognize early ASD indicators may also shorten the pathway to formal diagnosis. These system-level improvements are likely to yield greater impact on diagnostic timing than awareness campaigns targeting parental knowledge or education levels alone. Social implications ASD diagnosis delay carries broader social consequences for children and families. Earlier diagnosis enables timely access to educational support, behavioral intervention and family guidance during critical developmental periods. This study highlights that diagnostic inequity in Saudi Arabia is largely system-driven rather than family-driven, meaning that social disparities in diagnosis timing are tied to where families live and what services are available to them. Addressing these structural gaps may reduce inequalities in autism outcomes across regions and socioeconomic groups. Raising public and professional awareness of autism remains valuable, but systemic reform of diagnostic service delivery is essential for meaningful social change. Originality/value This study contributes Saudi parent-reported evidence on ASD diagnosis timing by examining family-level, service-system and contextual predictors using both bivariate and adjusted analyses.