Discussion

Equitable access to sustainable healthcare services for children with autism is vital, requiring collaborative efforts from policymakers, healthcare providers and community organisations to address systemic, service-related and psychosocial barriers. Strategies encompass policy reforms, capacity-building initiatives and community empowerment.

Tiered care systems, which stratify healthcare into levels of increasing specialisation, offer a promising model for addressing the diverse needs of children with autism across different regions. In LMICs, resource constraints often make it difficult for all patients to access specialist care. However, task-sharing approaches, where paraprofessionals and community health workers manage less complex cases under the supervision of specialists, have proven to be effective.^{Reference Divan, Bhavnani, Leadbitter, Ellis, Dasgupta and Abubakar2} This approach helps extend services to underserved populations by utilising trained non-specialists to deliver basic interventions. It ensures that specialists can focus on managing more severe and complex cases, optimising the use of scarce resources in LMICs.

In contrast, high-income countries (HICs) often have better infrastructure, enabling the integration of primary healthcare providers, social care services and autism-specific interventions across various levels of care. In HICs, tiered care systems allow for a more coordinated and comprehensive approach to managing autism. For instance, primary care physicians may identify early signs of autism and refer patients to specialised services, while social care providers work with families to address behavioural and social challenges. This integration ensures that children receive the right level of care at each stage of development, facilitating early interventions, timely referrals and continued support throughout childhood and adolescence.

Tiered care models are scalable and adaptable to different socioeconomic contexts, making them a cornerstone of sustainable autism care. In LMICs, the scalability of task-shifting approaches – where community health workers deliver care at a basic level – enables broader access to services despite limited resources. These systems are also adaptable, allowing for the gradual inclusion of more specialised services as resources become available. In HICs, the adaptability of tiered care allows for a flexible approach to healthcare, integrating various levels of support depending on the severity of the condition and ensuring that children can access specialised autism interventions when necessary.

Addressing the variation in needs across regions requires context-specific solutions. In LMICs, the primary challenge is the shortage of specialists, which makes task-sharing and tiered care essential. In HICs, where specialists are more readily available, the focus is often on integrating services to ensure comprehensive and ongoing support. By tailoring tiered care models to these differing regional needs, we can work towards achieving equitable access to autism care on a global scale.

Changes in diagnostic thresholds, particularly the broadening of criteria for autism in recent years, have led to a significant increase in the number of children eligible for services. This shift reflects a more inclusive understanding of autism, encompassing a wider range of behaviours and developmental patterns. However, this broadening poses unique challenges for resource-limited LMICs, where healthcare systems may not have the capacity to adapt quickly to these evolving global standards. In these regions, limited access to diagnostic tools and specialised training, together with poor awareness, can result in delayed or missed diagnoses, further exacerbating existing disparities in access to care.

Efforts to harmonise diagnostic thresholds across regions are crucial for ensuring that children with autism, regardless of where they live, receive appropriate and timely care. By standardising diagnostic criteria and improving the availability of resources globally, we can create a more equitable system where all children have the opportunity to be accurately diagnosed and provided with the necessary interventions. Harmonisation efforts involve not only aligning diagnostic practices but also ensuring that regions have the infrastructure, training and support needed to implement these changes effectively. This will help close the gap in care between high-income and resource-limited settings, promoting more consistent and fair access to autism services worldwide.