Scoping review maps multi-level barriers and fixes in healthcare access for autistic children

A scoping review published in BMC Health Services Research has synthesised evidence on the challenges and opportunities in accessing healthcare for children with autism spectrum disorder, mapping the barriers across individual, interpersonal, organisational, community and policy levels. The review, conducted by Sohani Afroja, Md. Mizanur Rahman and Chen Yoke Yong, applied a socio-ecological framework to organise findings from the perspectives of children with ASD, parents and caregivers, and healthcare professionals.

The researchers systematically searched PubMed, Web of Science, Google Scholar, Scopus, CINAHL and MEDLINE for empirical studies published between January 1, 2020 and December 31, 2025. Following the PRISMA extension for scoping reviews (PRISMA-ScR) 2018 guidelines, they identified 1,084 records, of which 22 studies met all inclusion criteria and entered the final synthesis. The evidence base comprised 11 quantitative, 9 qualitative and 2 mixed-methods studies drawn from 14 countries worldwide, and the team assessed study quality using the Joanna Briggs Institute checklists.

The synthesis identified five dominant barriers to healthcare access. Shortages of healthcare professionals trained in ASD appeared in 12 studies, while communication difficulties between patients and providers, sensory and environmental barriers in clinical settings, limited specialised services, and financial constraints each featured in 11 studies. These recurring themes indicate that access problems arise simultaneously in workforce capacity, clinical interactions, the physical environment, service availability and cost.

Beyond these leading obstacles, the review catalogued additional barriers reported in the included literature: long waiting times, stigma, geographic distance, poor navigation of the health system, child behavioural issues, and limited awareness among caregivers. Applying the socio-ecological framework revealed that challenges and opportunities operate across the five levels with substantial interconnections between them.

The review also identified a parallel set of opportunities for improving access. ASD-specific training for healthcare providers was highlighted in 12 studies, sensory-friendly healthcare environments in 11, family-centred care approaches in 10, and specialised ASD clinics and telehealth services in 8 studies each. Financial support or insurance coverage, flexible appointment systems, alternative communication methods, social support networks and policy reforms were also reported as avenues for improvement.

The framework located both challenges and opportunities at every level of the model. Child characteristics such as communication needs and behavioural issues sit at the individual level, while caregiver resources and awareness operate at the interpersonal level. Organisational factors include provider training, clinic design and appointment systems, and the community and policy levels encompass stigma, social support networks and the financing and organisation of services.

The review’s conclusions emphasise that families of children with ASD encounter complex, multi-level challenges and opportunities in healthcare access that span individual characteristics, caregiver resources, healthcare system organisation, community attitudes and policy frameworks. Because the included studies span 14 countries, the synthesis captures a broad geographic range of health system contexts, although the findings represent a synthesis of existing empirical literature rather than a measure of how access has changed over time.

As a scoping review, the study maps the breadth of reported barriers and facilitators rather than testing the effectiveness of any specific intervention. The reported frequencies, such as the number of studies citing workforce shortages or telehealth, indicate how often each theme appeared in the 2020 to 2025 literature, not the magnitude of the underlying effects. The review was pre-registered, with the protocol available under DOI 10.17605/OSF.IO/ZN3UM, and the published version is an open-access article in BMC Health Services Research, shared early as a citable accepted manuscript ahead of the final Version of Record.

For clinicians, service planners and policymakers, the review offers an organised inventory of where access frictions arise and what the recent literature identifies as promising responses, from provider training and sensory-friendly environments to family-centred care models, dedicated ASD clinics, telehealth and financing reform, all viewed through a framework that keeps individual, interpersonal, organisational, community and policy influences in view simultaneously.

Subject of Research: Barriers and facilitators of healthcare access for children with autism spectrum disorder

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

Article References: Afroja, S., Rahman, M. M., & Yong, C. Y. (2026). Challenges and opportunities in healthcare access for children with autism spectrum disorder: a scoping review using the socio-ecological model. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15486-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15486-y

Keywords: autism spectrum disorder, healthcare access, scoping review, socio-ecological model, health services research, caregivers, telehealth, sensory-friendly environments, provider training, health policy, Challenges, opportunities