INTRODUCTION

Autism Spectrum Disorder (ASD) is a childhood developmental condition marked by various social, behavioral, and communication challenges (Hodges, Fealko, & Soares, 2020). Anatomical and functional alterations in the brain accompany ASD, exhibiting a spectrum of severity from moderate to severe. Individuals with severe cases often require extensive assistance and ongoing support, displaying a proclivity for repetitive behaviors and resistance to changes in their daily routines. Affecting one in every 44 children, ASD transcends racial and ethnic boundaries, making it one of the most prevalent developmental impairments among children (Maenner et al., 2018). The incidence of ASD has risen over the past two decades, possibly attributed to increased awareness, leading caregivers to seek screening and diagnosis from specialists (Maenner et al., 2018). Diagnosing ASD remains challenging, as there are no direct tests or specific biomarkers available. Instead, diagnosis relies on observing the child's behavior. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 consolidated the ASD spectrum, incorporating pervasive developmental disorder and Asperger’s disorder. ASD is associated with various mental disorders, including attention deficit hyperactivity disorder (ADHD), social anxiety disorder, depression, and intellectual disability (Posar, Resca, & Visconti, 2015). The age of diagnosis varies, with some children identified as early as 18 months, while others require an additional 18 months for confirmation, causing delays in treatment initiation. Early intervention significantly enhances verbal and cognitive abilities, especially for those with more acute symptoms. Factors contributing to diagnosis delays in Saudi Arabia include limited information and awareness among both the community and healthcare staff. Various screening instruments, such as the Modified Checklist for Autism in Toddlers (M-CHAT) and the Communication and Symbolic Behavior Scales (CSBS), are employed, with the Autism Diagnostic Observation Schedule-2 (ADOS-2) considered the "gold standard (Alyami, Naser, Alyami, Alharethi, & Alyami, 2022). Risk factors for ASD encompass genetic and environmental variables, including maternal use of certain medications during pregnancy, advanced parental age, and maternal health conditions like hypertension or infections. Genetic and chromosomal disorders, such as the Fragile X chromosome, may contribute to ASD (Modabbernia, Velthorst, & Reichenberg, 2017). Additionally, exposure to neurotoxic chemicals has been linked to changes in the GABAergic, glutamatergic, serotonergic, and dopaminergic systems in ASD (Quaak, Brouns, & Bor, 2013). Numerous myths and misconceptions surround autism spectrum disorder including the unfounded belief that vaccines contribute to its development. Contrary to such notions, the World Health Organization (WHO) asserts that there is no documented link between vaccines and ASD, including the MMR vaccine (Gabis et al., 2022). It is crucial to dispel these misconceptions to ensure accurate public understanding. ASD lacks a definitive medical cure, emphasizing the importance of initiating specialized behavioral therapies upon confirmation of the diagnosis (Okoye et al., 2023). Caregivers play a pivotal role in helping ASD patients acquire essential skills, such as communication, eye contact, social interaction, and physical activities. The management of ASD incurs substantial costs, encompassing both direct expenses, such as healthcare, and indirect costs, like additional educational support, especially for children with intellectual disabilities (Tathgur & Kang, 2021). This financial burden can strain families and, in many instances, lead to maternal job loss. Recognizing the economic impact underscores the urgency of fostering community and healthcare worker awareness about the ASD spectrum. Improved understanding is pivotal for early diagnosis and intervention, contributing to a more favorable prognosis. Consequently, assessing the general public's awareness of typical infant development and ASD in Saudi Arabia becomes imperative. Identifying knowledge gaps and implementing appropriate interventions will contribute significantly to enhancing overall awareness and facilitating better outcomes for individuals with ASD.

MATERIALS AND METHODS

Questionnaire Tool

The present investigation employed a meticulously validated survey methodology, as detailed by Liu (Liu et al., 2016) serving as the fundamental instrument for data collection. This survey, consisting of a comprehensive set of 32 inquiries, underwent a rigorous process of systematic categorization to ensure precision in addressing the overarching research objectives. The inaugural segment, comprising eight inquiries, was meticulously designed to elicit demographic information from the study subjects. Subsequently, a discerning focus was directed towards a segment encompassing 15 binary format items, strategically positioned to meticulously scrutinize the participants' familiarity with ASD. Each correct response within this domain was attributed a numerical value of one, ultimately contributing to the computation of a cumulative knowledge score, with a maximum attainable score of 15. The topics under consideration spanned a spectrum, ranging from a nuanced understanding of ASD symptoms and behaviors, appreciation of standard child development, recognition of the pivotal role of early diagnosis in treatment efficacy, exploration of causative factors and associated risk elements, discernment of appropriate treatment methodologies, comprehensive understanding of the disorder's etiology, and a nuanced grasp of its prevalence. The third segment of the survey comprised four items, each presented on a 5-point Likert scale, ranging from 1 ("strongly disagree") to 5 ("strongly agree"). This segment served as a nuanced exploration of participants' perspectives concerning caregiving and advocacy for children affected by ASD. Delving into attitudes regarding the distinctive needs of autistic children, prerequisites for their educational and instructional needs, opinions on governmental financial support, considerations for resource allocation dedicated to autistic children, and the inclusivity of insurance policies for this demographic, this section aimed to capture the multifaceted nature of participant viewpoints. Moving forward, the fourth section featured three items, also presented on a 5-point Likert scale, with the intent of assessing participants' interest levels and perceived effectiveness regarding ASD. This segment aimed to unravel participant attitudes towards ASD-related matters, offering insights into the nuanced interplay of interest and perceived efficacy. The final segment of the survey was crafted to gauge participants' awareness levels concerning interventions and strategies dedicated to the holistic well-being of individuals grappling with ASD. This segment comprised six binary format items, intricately designed to probe participants' familiarity with a spectrum of interventions and strategies devised to enhance the quality of life for individuals navigating the challenges posed by ASD.

Figure 1

Overview of the Methodology in Flowchart Form

Table 1

Exploring and Analyzing the Demographic Characteristics of Participants in the Study

Parameters	N	%	Mean
Age Group
15-25	1080	61.7
26-36	247	14.2
37-47	397	22.7
48-58	28	1.7	26.64± 9.73
Gender
Male	162	9.2
Female	1590	90.8
Total Knowledge
Low knowledge	1329	75.9
Average knowledge	387	22.1
High knowledge	36	2.1	8.41 ± 2.91
Marital Status
Single	620	35.4
Married	609	34.8
Divorced	303	17.3
Widow	220	12.6
Highest Qualification
Postgraduate	63	3.6
Graduate	1211	69.1
High School	307	17.5
Intermediate	108	6.2
Promary Level	54	3.1
Illitrate	9	0.5
Employnment Status
Healthcare Sector	1047	59.8
Non-health Sector	422	24.1
Unemployed	142	8.1
Retired	4.7	4.7
Housewife	58	3.3
Region
AL-Baha	1342	76.6
Alaqiq	36	2.1
Algara	40	2.3
Alhojra	36	2.1
Almandaq	46	2.6
Bany Alhassan	45	2.6
Bhaljureshi	99	5.7
Gamid Alznad	36	2.1
Qilwa	72	4.1
Monthly Income (SAR)
≥5000	504	43.7
5 - 7 000	99	5.6
7-10000	216	12.3
10,000 – 15,000	243	13.8
>15000	99	5.6
≥16000	1	0.1
17000-30000	13	1.3
No-income	577	32.9
Is there a presence of autism spectrum disorder in any first relatives’ degree
Yes	116	6.2
No	1400	79.8

RESULTS

DISCUSSION

This research endeavor sought to investigate the cognitive acumen of the populace in Al-Baha, Saudi Arabia, concerning ASD. Furthermore, the study aimed to evaluate variables linked to a precise comprehension of ASD. Additionally, an exploration of the participants' attitudes towards autism and their cognizance of methodologies dedicated to the caregiving of individuals with autism was undertaken. The pivotal outcomes derived from our investigation reveal a notable deficiency in the level of autism-related knowledge among study participants. In assessing participants' attitudes towards the care and advocacy of children with autism, several consensus points emerged. Participants widely concurred on the necessity for government funding to facilitate staff employment in preschools, particularly to cater to the specific needs of children with autism. There was a strong endorsement for increased governmental allocation of resources to enhance services for children with special needs. Additionally, there was a prevalent opinion favoring amendments to insurance policies to encompass coverage for developmental disorders as chronic disabilities. Of particular note was the unanimous agreement among participants regarding the imperative for all preschools to integrate special education teachers and therapists to cater to the requirements of children with special needs attending these institutions. The study participants also demonstrated a high degree of consensus on the need for alterations in public facilities to accommodate the needs of autistic patients. Noteworthy is their expressed eagerness to actively contribute to the treatment and enhancement of conditions for autistic patients, exemplified by their endorsement of interventions such as the utilization of visual aids and medications. Moreover, participants exhibited heightened awareness of behavioral management therapy that includes development programs and auditory integration therapy as approaches specifically devoted to the care of individuals with autism. These findings collectively illuminate the nuanced landscape of knowledge, attitudes, and awareness among the study participants concerning autism-related matters. A precedent study conducted in the United States revealed that approximately 90% of participants exhibited proficient knowledge of ASD across domains such as diagnosis, symptoms, etiology, and therapy (Rouphael et al., 2023). Contrarily, only 75% of participants demonstrated substantial knowledge of ASD, aligning with the findings of a prior study conducted in Saudi Arabia. Despite participants' prior exposure to information about ASD, the current study identified a pervasive lack of understanding and numerous misconceptions about the disorder among participants. Similar patterns of insufficient knowledge have been documented in previous research within the Middle East region, including Lebanon and Oman, where students and professionals exhibited inadequate knowledge about ASD (Mustafa, Grifa, Shebani, Alharabi, & Alnajjar, 2024). An Australian survey indicated that, while the majority of participants were familiar with the term ASD, there existed a notable knowledge gap regarding the condition's etiology and impact. Notably, a considerable proportion of Australians incorrectly associated ASD with a purported reaction to the MMR vaccine, despite the World Health Organization's explicit statement that no evidence links any vaccine to autism (Thorsteinsson, Draper, & Lykins, 2020). Furthermore, misconceptions about the treatment of ASD were identified in another study, with participants erroneously believing that children with ASD are incapable of attending public school (Robledo & Donnellan, 2016). As highlighted earlier, the multifaceted origins of ASD involve a combination of genetic and environmental factors (Genovese & Butler, 2020). In an additional African study, a deficiency in comprehension of ASD was observed not only among communities but also among healthcare providers and educators (Aderinto, Olatunji, & Idowu, 2023). These collective findings underscore the imperative for comprehensive educational initiatives to rectify misconceptions, dispel inaccurate beliefs, and enhance awareness surrounding ASD across diverse populations and geographic regions (Aderinto et al., 2023).

A predominant representation of females, comprising approximately 94% of the study participants, was observed. Noteworthy similar with previous research suggesting that females tend to exhibit a higher awareness of autism disorder when knowledge is compared by gender. The rationale behind this gender difference might be attributed to the reported inclination of females toward the study of diseases (Estrin, Milner, Spain, Happé, & Colvert, 2021). Several studies have demonstrated a substantial knowledge disparity between males and females, with the latter exhibiting a heightened awareness of specific psychiatric illnesses (Sagar-Ouriaghli, Godfrey, Bridge, Meade, & Brown, 2019). Additionally, a significant proportion of the current study's participants were below the age of 15-25 years old underscoring a potential lack of awareness of autism spectrum disorder within younger age cohorts. A parallel observation in a prior study indicated that older participants tended to possess more experience than their younger counterparts. Contrarily, one study posited that, while there may be gender-related differences in knowledge, neither age nor educational attainment exerted a discernible impact on the level of knowledge about ASD (Kim & Chung, 2022). An examination of ASD knowledge in China reported that gender and socioeconomic status were pivotal demographic variables influencing awareness. The multifaceted nature of public knowledge about ASD is underscored by the interplay of numerous variables, including cultural differences and diverse information sources, encompassing the internet, social media, and television (Yu, Stronach, & Harrison, 2020). These factors collectively contribute to the discernible disparities in public knowledge regarding ASD. A preceding investigation focusing on the comprehension of autism spectrum disorder among healthcare professionals in Saudi Arabia discerned that approximately fifty percent of them exhibited a moderate to poor level of knowledge concerning ASD (Abualhommos et al., 2022). Notably, the study identified pronounced gaps in their understanding, particularly with respect to the origins and comorbidities associated with the disorder. Another pertinent study emphasized the imperative for increased knowledge acquisition among healthcare providers and educators in the realm of ASD. Furthermore, this body of research underscored that, within the spectrum of healthcare professionals, pediatricians and psychiatrists demonstrated the highest levels of expertise in ASD (Grzadzinski et al., 2021). This highlights a critical need for targeted educational interventions, particularly among healthcare personnel who may play pivotal roles in the identification, diagnosis, and management of individuals with ASD. Enhancing the knowledge base of healthcare providers and educators is instrumental in fostering an environment that is conducive to the optimal care and support of individuals affected by ASD. In our investigation, we observed that the highest percentages of accurate responses were associated with items related to knowledge about the symptoms and behavior of children with autism spectrum disorder. Conversely, the lowest percentages of correct answers were found in items concerning knowledge about the treatment and etiology of ASD. This aligns with the outcomes of a prior study conducted in China and the USA, highlighting the prevalent misunderstanding of pharmaceutical treatments for ASD within the general public. Recognizing the risk factors for ASD assumes paramount importance in mitigating the likelihood of having children with the disorder (Zhou et al., 2020). Early detection emerges as a pivotal factor in improving outcomes, with potential positive impacts on a child's linguistic, cognitive, and adaptive behaviors. Timely intervention, ideally before the age of four, contributes to enhancing a child's social behavior and daily skills. It is crucial to note that early detection is not always a straightforward process, as it hinges significantly on the healthcare provider's level of education and adherence to ASD guidelines. Furthermore, as indicated by a previous study, the interval between the initial observation of a child's behavior and the confirmed diagnosis could extend up to two years. This underscores the intricate nature of the diagnostic process, highlighting the reliance on healthcare providers' education levels and the diligent execution of established ASD guidelines (Alrehaili, Elkady, Alrehaili, & Alreefi, 2023). It emphasizes the need for streamlined processes and heightened awareness to facilitate early detection and intervention, thereby positively influencing the developmental trajectory of individuals with ASD. Our study uncovered a noteworthy discrepancy in knowledge between individuals with a first-degree relative diagnosed with autism and those without such familial connections, consistent with earlier research findings. Research has previously indicated that individuals with direct interactions with autism spectrum disorder patients tend to possess enhanced knowledge due to their accrued experiences. A significant majority of participants in our study advocated for government initiatives, expressing agreement that funding should be made available to preschools to bolster staffing for meeting the specific needs of children with ASD (Crompton, Hallett, Ropar, Flynn, & Fletcher-Watson, 2020). Participants also called for increased government allocation of resources to provide services for children with special needs, emphasizing the necessity for all preschools to have special education teachers and therapists. The consensus among participants aligns with the broader body of research, wherein numerous studies underscore the pivotal role of government involvement in augmenting awareness of ASD and providing support to families with autistic individuals. Recommendations from prior studies include the initiation of nationwide awareness campaigns to elevate understanding. Drawing attention to international perspectives, a 2015 Australian study highlighted disparities in government support, particularly for older adolescents with ASD, leading to adverse consequences such as decreased opportunities for secondary school education and future employment (Rasheed, 2023). This deficiency in support translated into significantly lower employment rates for individuals with ASD compared to those with other disabilities or without disabilities. Moreover, the impact of inadequate support from school professionals in the education system was observed in contributing to the social isolation and withdrawal of ASD students from their schools (Rasheed, 2023). Government funding, as evidenced in studies, played a crucial role in educating parents and teachers about ASD, emphasizing the importance of comprehensive support systems in enhancing the overall well-being and educational experiences of individuals with ASD (Jaffal & M, 2022). Given the perceived substantial cost associated with the treatment of developmental disorders, a consensus among the majority of participants in our study emphasized the importance of insurance policies incorporating coverage for developmental disorders. This viewpoint aligns with findings from a previous study, which quantified the lifetime costs of treating autism spectrum disorder patients in the United Kingdom and the United States. The study revealed that costs were significantly higher for individuals with intellectual disabilities, emphasizing the economic impact of ASD on both direct and indirect treatment expenses (Buescher, Cidav, Knapp, & Mandell, 2014). Moreover, another study highlighted the financial implications of special education services for ASD children, indicating a 76% higher cost compared to non-ASD students. The additional financial burden on educational institutions was illustrated by ASD students requiring approximately $8610 more in school-related costs than their non-ASD counterparts (Lavelle et al., 2014). These economic considerations underscore the importance of inclusive insurance policies to alleviate financial burdens on families affected by ASD. It is noteworthy that early diagnosis and intervention for autism have demonstrated a profound impact on treatment outcomes, contributing to improved efficacy and a reduction in the severity of the disorder, particularly in cognitive and behavioral aspects.

Understanding and appreciating the array of interventions available for children diagnosed with autism spectrum disorder (ASD) is not merely a matter of knowledge; it's a gateway to unlocking the full potential and improving the quality of life for these individuals. Delving into recent data, we find a rich tapestry of interventions, each offering a unique set of tools and strategies tailored to address the multifaceted needs of children on the autism spectrum. At the forefront of awareness stands behavioral management therapy, a cornerstone in the treatment landscape, recognized by approximately 35.9% of respondents. This form of therapy embodies a nuanced approach, encompassing an amalgamation of techniques aimed at reshaping behaviors, nurturing social skills, and honing communication abilities. Through structured interventions and positive reinforcement, children with autism learn not just to navigate social interactions, but to thrive within them, forging meaningful connections and fostering a sense of belonging. Closely intertwined with behavioral management therapy is cognitive behavior therapy, acknowledged by 6.9% of participants. This therapeutic modality provides a scaffold for individuals with autism to navigate the labyrinth of their emotions, offering strategies to mitigate anxiety, manage stress, and cultivate resilience. By delving into the inner workings of thought patterns and behavioral responses, cognitive behavior therapy equips children with autism with the tools to navigate the complexities of their internal landscape, fostering emotional well-being and empowering self-advocacy. Education and school-based therapies emerge as pivotal pillars in the intervention framework, capturing the attention of 9.8% of respondents. These interventions operate at the nexus of academia and holistic development, weaving together specialized instruction, individualized education plans (IEPs), and tailored accommodations to create a conducive learning environment for children with autism. By recognizing and honoring the unique learning styles and needs of each child, educational interventions strive not only to impart knowledge but to nurture a love for learning, fostering intellectual curiosity and paving the path for academic achievement. In tandem with these psychosocial interventions, medication treatment emerges as a vital component, identified by 9.4% of participants. While not a panacea, medications play a pivotal role in managing co-occurring conditions such as attention deficit hyperactivity disorder (ADHD), anxiety, or depression, thereby alleviating barriers to optimal functioning and enhancing overall well-being. When used judiciously and in conjunction with other therapeutic modalities, medication treatment can serve as a catalyst for positive change, empowering children with autism to thrive in diverse domains of their lives.

Nutritional therapy takes center stage as a holistic approach to wellness, capturing the attention of 18.4% of respondents. Grounded in the belief that food is medicine, nutritional interventions focus on optimizing dietary habits, addressing nutritional deficiencies, and promoting gut health to support cognitive function and overall well-being. By harnessing the power of nutrition to nourish both body and mind, these interventions lay the groundwork for sustained vitality and resilience, fostering a robust foundation for growth and development. Occupational therapy emerges as a linchpin in the intervention continuum, recognized by 19.6% of participants. This holistic approach encompasses a spectrum of interventions aimed at enhancing daily living skills, refining sensory processing abilities, and fostering independence in children with autism. Through a repertoire of activities spanning from fine motor exercises to sensory integration techniques, occupational therapists empower children to engage meaningfully in their daily routines, navigate sensory stimuli, and participate fully in the world around them. The tapestry of interventions available for children with autism spectrum disorder is as diverse as the spectrum itself, spanning from behavioral and cognitive therapies to educational, medical, nutritional, and occupational interventions. By deepening our understanding and appreciation of these interventions, we not only enrich the lives of children with autism but create a more inclusive and compassionate society where every individual is valued and empowered to thrive. While there is currently no definitive treatment for ASD, studies have suggested that certain behaviors, when adopted by pregnant women, may contribute to the prevention of autism (Lu, Wang, Liang, & Yao, 2022). This underscores the broader significance of awareness campaigns not only in fostering early diagnosis but also in disseminating information that may aid in preventative measures.

Research published in the New England Journal of Medicine reveals that abnormalities in the brain development of autistic children can emerge as early as the second trimester of pregnancy. To potentially prevent autism in the developing fetus from conception, pregnant women are advised to reduce toxin exposure, maintain a healthy diet, and attend regular visits to both their family physician and obstetrician (Shen & Piven, 2017). Our study reveals a knowledge gap in the community regarding ASD, particularly evident among males and younger participants. It underscores the need for increased attention from public health professionals towards non-communicable disorders, including psychiatric and developmental disabilities, due to their significant impact on community productivity. This places a collective responsibility on national policymakers and healthcare practitioners to enhance overall knowledge and dispel misconceptions. To address these gaps, we propose the implementation of awareness campaigns, distribution of informative materials such as leaflets and booklets, and utilization of multimedia platforms like Facebook, Twitter, and local television channels. These strategies aim to augment community knowledge about ASD and foster positive attitudes towards individuals affected by the disorder. However, certain limitations must be acknowledged. The cross-sectional study design hinders the establishment of causal relationships between study variables. Additionally, the study's skewed gender distribution, with 90.8% of participants being females, may impact the generalizability of our findings.

CONCLUSION

Our study indicates a restricted level of knowledge among participants regarding autism. Advocating for the improvement of educational services for autism spectrum disorder children, we recommend that government funds be allocated for this purpose. A heightened commitment to providing financial resources from the government is essential to support children with special needs. Moreover, adjustments in public facilities are imperative to meet the specific requirements of individuals with ASD. To foster a better understanding of ASD within the community and cultivate a more positive attitude towards individuals with ASD, we propose a comprehensive and informed educational effort across various media platforms. These educational campaigns should prioritize enhancing public knowledge about the treatment options and the etiology of ASD. By disseminating accurate information through these channels, we aim to bridge the existing knowledge gap and contribute to a more inclusive and supportive societal environment for individuals with ASD.

Author contributions

S beigh and MAAlshehri- Conceptualization, Investigation, Formal Analysis, Writing - Original Draft. S Alzahrani and L Abdallah:: Formal Analysis, Writing - Original Draft. N Fahad: Writing - Review & Editing, Z Alghamd: Conceptualization, Investigation, Formal Analysis, supervision, Writing - Review & Editing. Y Alghamd: Investigation, Writing - Original Draft, A Jabbar and W Babiker: Investigation, Writing - Original Draft, R Ahmad and BAbdalla: Review & Editing.  All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript. 

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not for- profit sectors

Ethical approval

The research adhered to the principles outlined in the Declaration of Health Affairs and obtained approval from the Institutional Review Board of Al-Baha University (IRB number: KFH/IRB20112022/6).

Conflicts of interest

The authors report no conflicts of interest.