Underdiagnosed and Overlooked: A Community-Based Study of Autism Spectrum Disorder Prevalence and Screening Outcomes Among 4–11-Year-Old Children in Gujrat, Pakistan

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with increasing global prevalence estimates. However, community-based epidemiological data from low- and middle-income countries, including Pakistan, remain critically scarce, contributing to widespread underdiagnosis and delayed intervention. This study aimed to estimate the screening prevalence of ASD traits among children aged 4–11 years in Gujrat, Pakistan, and to examine potential gender-based differences in screening outcomes. A quantitative cross-sectional research design was employed. A sample of 1,000 children (491 boys, 509 girls) aged 4–11 years was recruited from public mainstream schools, private mainstream schools, and special education centers in Gujrat using a stratified convenience sampling approach. Screening for autistic traits was conducted using the Childhood Autism Spectrum Test (CAST), a validated 37-item parent-report instrument. Data were analyzed using descriptive statistics and chi-square tests of independence.

Based on the established CAST cutoff score (≥15), 11.0% (n = 110) of the total sample screened positive for clinically significant autistic traits. Gender-wise analysis revealed that 10.2% of boys (n = 50) and 11.8% of girls (n = 60) fell within the at-risk range. A chi-square test indicated no statistically significant association between gender and screening outcome, χ²(1, N = 1,000) = 0.647, p = .421. A significant association was observed between institution type and screening outcome, with special education centers demonstrating a higher proportion of positive screens (17.4%) compared to mainstream schools (p = .033). The findings reveal a substantial proportion of children in Gujrat exhibit elevated autistic traits warranting comprehensive diagnostic assessment. The absence of significant gender disparity underscores the importance of universal screening irrespective of sex. These results highlight an urgent need for scalable community-based screening programs and enhanced diagnostic services in Pakistan.

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