Characteristic features and risk factors of autism spectrum disorders among children and adolescents in Western Saudi Arabia: a case-control study

Objectives The rising prevalence of autism spectrum disorder (ASD) globally and in Saudi Arabia poses substantial challenges for patients and caregivers. This study investigated the initial presentation, associated comorbidities, and risk factors of ASD in Makkah Province, Saudi Arabia.Methods This questionnaire-based case-control study included 100 children/adolescents with ASD and 112 age-matched controls from Makkah and Jeddah. Sociodemographic, clinical, and environmental factors potentially associated with ASD were collected and analyzed by bivariate and multivariate logistic regression.Results The mean age (±SD) was 8.85 ± 3.13 years in the ASD group and 7.89 ± 3.16 years in controls, with no significant difference (p = 0.35). Males were significantly more frequent among ASD patients (p = 0.000). The median age at ASD diagnosis was 3 years, while the median age at joining ASD care center was 5 years. The most common initial presentation was a combination of delayed speech, poor eye contact, and stereotypic behavior, reported in 49% of ASD patients. Attention deficit hyperactivity disorder was the most frequent comorbidity, affecting 22% of cases. Multivariate logistic regression identified male gender, family history of ASD, lack of maternal folic acid intake during pregnancy, traumatic events during pregnancy, maternal chronic illness before or during pregnancy, and advanced paternal age at conception as the most significant independent risk factors. Other factors significant in bivariate analysis lost significance after adjustment.Conclusions This study is one of few comprehensive investigations evaluating a wide-range of potential ASD risk factors. The findings highlight potentially modifiable environmental and clinical factors that can guide local awareness programs and preventive strategies. Larger national and international cohort studies are needed to elucidate underlying risk factors of ASD and support appropriate prevention for disorders with no currently existent definitive/effective treatment.