The Childhood Prevalence, Gender Ratio, and Characteristics of Autism Spectrum Disorder in Cyprus Using School Report: A Cross-Sectional Study

Abstract

Abstract Objectives To determine the childhood prevalence and characteristics of ASD in Cyprus and identify the factors associated with it. Methods This was a large-scale cross-sectional study of children 5 to 12 years of age attending schools across all Cyprus districts. Data were collected between February 20, 2023, and June 23, 2023, through a school questionnaire obtaining school information, student demographics, ASD characteristics, and language information, based on schools’ special education databases. Results Out of 9990 participants from 117 schools, a 1.8% prevalence of ASD was identified, with a substantial male predominance (80.3%, gender ratio 4.1). ASD prevalence was significantly lower in primary schools (1.3%, p<0.001) and markedly higher in special schools (41.9%, p<0.001) compared to pre-primary schools (2.7%, p<0.001). No significant differences were observed across age groups or school types (p>0.05). Most children with ASD (90.4%) received support primarily through speech-language therapy and special education (93.8%). Approximately 55.6% were reported as nonverbal/minimally verbal. Common comorbidities included attention-deficit/hyperactivity disorder (37.6%) and intellectual disability (10.7%). Multivariate logistic regression analysis highlighted gender (OR 0.26, 95% C.I. 0.18–0.38), school system (OR 21.04, 95% C.I. 9.94–44.26), and school level (OR 0.48, 95% C.I. 0.34–0.67) as significant factors associated with ASD prevalence (p<0.001). Conclusions A 1.8% prevalence of ASD was identified, with 80.3% male representation and a 4.1 gender ratio. The likelihood of ASD was greater among males and those attending pre-primary or special schools. We displayed the need for ASD public policy enforcement in Cyprus mandating screenings in pre-primary schools for early identification, and monitoring prevalence rates through a central database, for adequate service planning.