Aug 2026· Children· Vol 13· 0 citations· 31 references
Medicine
TL;DR
The evidence suggests delayed ASD diagnosis in Brazil reflects systemic gaps in care organization rather than isolated clinical factors, and strengthening PCP-based developmental surveillance and improving referral coordination are key strategies to reduce preventable delays and promote earlier access to intervention.
Abstract
Highlights What are the main findings? • Delayed autism diagnosis in Brazil reflects multilevel barriers spanning families, providers, referral pathways, and health system organization.• Primary care played a limited role in early identification, while specialist-centered pathways and regional inequalities contributed to prolonged diagnostic trajectories. What are the implications of the main findings? • Earlier diagnosis may be improved by strengthening developmental surveillance, referral coordination, and primary health care capacity.• Future Brazilian research should prioritize standardized reporting, implementation studies, and broader geographic and equity-focused representation. Abstract Background/Objectives: Timely identification of autism spectrum disorder (ASD) is essential for access to early intervention; however, diagnostic delay remains a persistent challenge. Methods: This scoping review synthesized evidence from eight studies (>24,000 participants), most conducted in the Southeast region, on diagnostic pathways, screening practices, and barriers to ASD identification in Brazil, following PRISMA-ScR guidelines. Results: Across studies, mean age at diagnosis frequently exceeded 48–60 months, while the interval between first caregiver concern and diagnosis ranged from 24 to 36 months, with tertiary-care samples reporting diagnostic ages approaching 79 months. Diagnosis was predominantly specialist-driven, with limited involvement of primary care providers (PCPs). Later identification was associated with reliance on the public health system in a multinational analysis that included Brazil, while geographic concentration of specialized services and socioeconomic inequalities were identified as reported barriers across the included studies. Race/ethnicity was rarely reported. Delays emerged from interacting multilevel barriers, including limited caregiver awareness, dismissal of parental concerns, inconsistent developmental surveillance, fragmented referral pathways, and shortages of specialists. Structural inequities, particularly geographic disparities and urban concentration of services, compounded these challenges. Conclusions: The evidence suggests delayed ASD diagnosis in Brazil reflects systemic gaps in care organization rather than isolated clinical factors. Strengthening PCP-based developmental surveillance and improving referral coordination are key strategies to reduce preventable delays and promote earlier access to intervention.
Aim: This review examined the barriers that delay the diagnosis of ADHD in adult populations.
Background: Although ADHD is increasingly recognized as a condition that persists beyond childhood, many adults remain undiagnosed. Adults often face challenges in obtaining a diagnosis, yet research on the barriers to timely identification remains limited. Undiagnosed ADHD is associated with adverse health outcomes, functional impairments, and economic burden. Primary care providers (e.g. family physicians and nurse practitioners) are ideally situated to identify and diagnose ADHD across the lifespan. A clearer understanding of the barriers adults encounter during the diagnostic process is essential to inform research, education, and policy to ensure equitable, high-quality care.
Methods: Five electronic databases were searched to identify peer-reviewed studies, published in English within the past five years, that explored barriers to timely adult ADHD diagnosis. The results were imported into Covidence for screening, and nineteen articles met the criteria for data extraction.
Findings: Thematic analysis revealed five overarching themes: (1) comorbid mental health disorders, (2) diagnostic criteria, (3) diagnostic processes, (4) gendered differences in presentation, and (5) provider education and training.
Conclusion: Future research is needed to better capture adult- and gender-specific ADHD symptoms and domains of impairment. This will help refine diagnostic criteria and processes, enhance provider education, and support more timely and equitable access to care.
Latieshia Newberry, Anila Virani, Lisa Creelman et al.· Canadian Nurse Practitioner...· 0 citations
This critical narrative review examines early autism identification as a pathway problem rather than as a single testing event and argues that early autism identification should be evaluated through linked quality measures: response to concern, repeated surveillance following negative or ambiguous screening, referral completion, time to diagnostic assessment, support initiation before diagnostic closure, and equity of access.
R. Kurmashev, Mavile Karaieva· Pediatric Investigation· 0 citations
It is argued that future early ASD detection systems should be developed as clinician-supervised decision-support tools rather than autonomous diagnostic instruments.
Wenhao Luo, Z. Yin, Jianbiao Dai· Diagnostics· 0 citations
AIM
To map and summarise evidence on the role, benefits and challenges of telehealth in autism spectrum disorder (ASD) management, including assessment and intervention.
METHODS
This scoping review searched PubMed and Scopus for English-language studies published from 2015 to 2025; the search was last updated on 14 April 2026. Nine studies met the eligibility criteria, comprising randomised controlled trials and observational, mixed-methods, descriptive, pilot, and qualitative studies.
RESULTS
Available findings suggest that telehealth-based assessment may achieve high diagnostic concordance with in-person evaluation, and that telehealth-delivered interventions may yield similar outcomes in selected domains. Several studies reported high caregiver and clinician satisfaction. Key challenges included technological access barriers, variability in caregiver engagement, and concerns regarding reliability and equity in under-resourced settings.
CONCLUSION
Telehealth may be a valuable complement to, rather than a replacement for, in-person care. Future primary studies should use rigorous designs and standardised outcome measures and should prioritise linguistically diverse and low-resource populations; future evidence syntheses should include formal risk-of-bias assessment.
Background: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition for which timely diagnosis is critical to early intervention, family support, and equitable access to care. However, substantial disparities in access to ASD diagnostic services persist across socioeconomic, geographic, clinical, and health-system contexts. This systematic review and meta-analysis synthesized evidence on determinants of access across the ASD diagnostic pathway, from recognition and referral to diagnostic completion and timely diagnosis. Methods: We systematically searched MEDLINE/PubMed, Embase, Scopus, Web of Science, Global Health, and grey-literature sources for studies published between January 2004 and December 2024. Eligible studies examined determinants of ASD diagnostic completion, diagnostic pathways, diagnostic timeliness, or barriers and facilitators to diagnostic access. Two reviewers independently extracted data and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT). Quantitatively comparable estimates were synthesized using random-effects models with restricted maximum likelihood estimation. Heterogeneity was assessed using Cochran's Q, I2, tau2, and 95% prediction intervals. Pre-specified subgroup analyses, meta-regression, sensitivity analyses, funnel-plot assessments, and Bayesian random-effects analyses were undertaken. Results: The search identified 4,899 records; after removal of 537 records without associated data, 4,362 records underwent title/abstract screening. 3,800 records were excluded, 562 reports were sought for retrieval, and 450 full-text reports were assessed after 112 could not be retrieved. Ultimately, 22 unique studies met the inclusion criteria. Nine unique studies contributed 23 quantitative effect estimates, while the remaining studies contributed to the narrative synthesis. The evidence covered socioeconomic, geographic, family, communication, screening, child developmental, provider, and health-system determinants. The overall random-effects meta-analysis yielded a pooled diagnostic access outcome of 74.1% (95% CI 65.8-81.1%), with substantial heterogeneity (Qe=209.95, p<0.001; I2=88.4%, 95% CI 79.1-94.4%; tau2=0.691) and a wide 95% prediction interval of 32.8-94.4%. Bayesian analysis produced a highly concordant pooled estimate of 73.3% (95% CrI 65.3-80.2%), with I2=87.5% and tau=0.833, and satisfactory MCMC convergence (R-hat=1.000). By outcome domain, pooled successful outcomes were highest for diagnostic pathways (89.3%, 95% CI 70.1-96.7%), followed by timely diagnosis (76.3%, 95% CI 62.9-86.0%), and lowest for diagnostic completion (67.1%, 95% CI 61.8-72.0%) (Qm=5.98, p=0.050). Timely diagnosis demonstrated particularly high heterogeneity (I2=91.2%), whereas diagnostic completion showed moderate heterogeneity (I2=40.6%). Across determinant domains, frequentist pooled estimates were 79.5% for child developmental/neurobehavioral factors, 74.2% for family/socioeconomic/perceptual factors, 68.0% for intervention/care-navigation factors, and 63.6% for provider/clinical recognition factors. Bayesian estimates were 76.7% (BF=53.76), 72.9% (BF=226.32), 64.3% (BF=25.60), and 53.7% (BF=0.684), respectively. Meta-regression indicated that determinant category (Qm=13.48, p=0.004) and effect measure (Qm=7.81, p=0.020) significantly explained between-study variation, whereas age group (p=0.203) and geographic region (p=0.453) did not. Family/socioeconomic factors had significantly larger effect sizes (B=2.703, 95% CI 0.661-4.744; p=0.009), as did child developmental/neurobehavioral factors (B=1.516, 95% CI 0.047-2.985; p=0.043). Potential small-study effects were detected by two of three asymmetry tests, although the Rosenthal fail-safe N was 1,723. Trim-and-fill identified seven potentially missing estimates, with an adjusted pooled effect of 68.4% (95% CI 27.7-109.1%). Importantly, exclusion of two influential outlying estimates produced a pooled outcome of 77.1% (95% CI 71.6-81.9%), indicating that the principal finding was robust. Conclusions: Approximately three-quarters of observed ASD diagnostic outcomes represented successful access, but the substantial heterogeneity indicates that diagnostic access is highly context-dependent. Families were more likely to successfully navigate diagnostic pathways than to complete diagnostic assessment, while timely diagnosis showed the greatest variability across settings. Family and socioeconomic circumstances and child developmental characteristics emerged as particularly important determinants, whereas provider-related effects were more heterogeneous and uncertain. Improving equitable ASD diagnosis requires interventions spanning the entire diagnostic pathway, including developmental surveillance, screening, referral coordination, family navigation, provider capacity, specialist availability, and mechanisms to ensure completion of diagnostic assessment. Greater longitudinal and implementation research is particularly needed in low- and middle-income countries, where diagnostic infrastructure and specialist capacity remain limited.
J. Muthuka, L. W. Nyambura, C. Onyango et al.· medRxiv· 0 citations
Waiting lists for an autism evaluation delay timely diagnosis and entry into autism-specific early intervention. To solve this crisis, our field must increase capacity by embracing efficient diagnostic processes. Traditional diagnostic pathways involve complex evaluations and rely on a highly trained but limited pool of specialists, which elongate wait times. Evidence suggests that emerging approaches, including telehealth assessments, primary care diagnosis, and tiered models, reduce barriers. We guide readers through five core issues critical to updating the standard of care for early autism assessment: (1) What are the consequences of maintaining the status quo? (2) What do families prioritize? (3) What evidence supports efficient diagnostic models? (4) What are the consequences of reducing accuracy? and (5) What level of assessment depth is needed to inform action? Our team contends that the critical advantages of adopting efficient service delivery models far outweigh the disadvantages. Collaboration across disciplines, and trust in families' insights, will help build capacity. We conclude with actionable recommendations for clinicians and policymakers in support of adopting these models.Lay AbstractThe growing demand for autism diagnostic services has outpaced available resources. This creates significant delays in first diagnosis and entry into early intervention services (early diagnosis and intervention improve outcomes). Expert diagnosticians in the field have debated - and tested - streamlined and flexible alternative diagnostic processes to speed up access to services; we believe that the advantages of such approaches outweigh the disadvantages, and that evidence supports updating our current standards.
Ashley de Marchena, A. Wieckowski, B. Freedman et al.· Autism· 0 citations
