Challenges and opportunities in healthcare access for children with autism spectrum disorder: a scoping review using the socio-ecological model

Children with autism spectrum disorder (ASD) need significant healthcare and face substantial disparities in accessing appropriate healthcare services. This review aims to synthesise evidence on the challenges and opportunities in accessing healthcare for children with ASD, examining the perspectives of children with ASD, parents/caregivers, and healthcare professionals. Using a socio-ecological framework, we seek to understand multi-level factors influencing access to healthcare services. A systematic search of PubMed, Web of Science, Google Scholar, Scopus, CINAHL, and MEDLINE identified empirical studies published between January 1, 2020 to December 31, 2025. Following the PRISMA extension for scoping reviews (PRISMA-ScR) 2018 guidelines, a total of 1,084 records were identified, of which 22 studies met all inclusion criteria and were included in the final synthesis. The review included 11 quantitative, 9 qualitative, and 2 mixed-methods studies from 14 countries worldwide. Quality assessment was conducted using the Joanna Briggs Institute checklists. The review found that major healthcare access challenges included shortages of ASD-trained healthcare professionals (12 studies), communication difficulties between patients and providers (11 studies), sensory and environmental barriers in clinical settings (11 studies), limited specialised services (11 studies), and financial constraints (11 studies). Additional barriers identified include long waiting times, stigma, geographic distance, poor system navigation, child behavioural issues, and limited caregiver awareness. Key opportunities for improving access included ASD-specific training for healthcare providers (12 studies), sensory-friendly healthcare environments (11 studies), family-centred care approaches (10 studies), specialised ASD clinics (8 studies), and telehealth services (8 studies). Financial support or insurance coverage, flexible appointment systems, alternative communication methods, social support networks, and policy reforms were also identified. Applying the socio-ecological framework revealed that challenges and opportunities operate across individual, interpersonal, organisational, community, and policy levels, with substantial interconnections between levels. Families of children with ASD encounter complex, multi-level challenges and opportunities to healthcare access that span individual characteristics, caregiver resources, healthcare system organisation, community attitudes, and policy frameworks. https://doi.org/10.17605/OSF.IO/ZN3UM .