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OBM Neurobiology

(ISSN 2573-4407)

OBM Neurobiology is an international peer-reviewed Open Access journal published quarterly online by LIDSEN Publishing Inc. By design, the scope of OBM Neurobiology is broad, so as to reflect the multidisciplinary nature of the field of Neurobiology that interfaces biology with the fundamental and clinical neurosciences. As such, OBM Neurobiology embraces rigorous multidisciplinary investigations into the form and function of neurons and glia that make up the nervous system, either individually or in ensemble, in health or disease. OBM Neurobiology welcomes original contributions that employ a combination of molecular, cellular, systems and behavioral approaches to report novel neuroanatomical, neuropharmacological, neurophysiological and neurobehavioral findings related to the following aspects of the nervous system: Signal Transduction and Neurotransmission; Neural Circuits and Systems Neurobiology; Nervous System Development and Aging; Neurobiology of Nervous System Diseases (e.g., Developmental Brain Disorders; Neurodegenerative Disorders).

OBM Neurobiology publishes a variety of article types (Original Research, Review, Communication, Opinion, Comment, Conference Report, Technical Note, Book Review, etc.). Although the OBM Neurobiology Editorial Board encourages authors to be succinct, there is no restriction on the length of the papers. Authors should present their results in as much detail as possible, as reviewers are encouraged to emphasize scientific rigor and reproducibility.

Publication Speed (median values for papers published in 2025): Submission to First Decision: 10.3 weeks; Submission to Acceptance: 17.1 weeks; Acceptance to Publication: 8.0 days (1-2 days of FREE language polishing included)
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Open Access Review

The Prevalence of Autism in the World: An Umbrella Review and Meta-Analysis

Mohammad Hossein Ekvan 1, Ali Sahebi 2,3,*, Maryam Kord 1, Zahra Soltanali 1, Amir Hossein Ahmadi 1, Somayeh Mohamadi 1

  1. Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran

  2. Department of Medical Emergencies and Health in Disasters and Emergencies, Ilam University of Medical Sciences, Ilam, Iran

  3. Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran

* Correspondence: Ali Sahebi

Academic Editors: Fabrizio Stasolla and Bart Ellenbroek

Received: December 05, 2025 | Accepted: March 01, 2026 | Published: April 13, 2026

OBM Neurobiology 2026, Volume 10, Issue 2, doi:10.21926/obm.neurobiol.2602332

Recommended citation: Ekvan MH, Sahebi A, Kord M, Soltanali Z, Ahmadi AH, Mohamadi S. The Prevalence of Autism in the World: An Umbrella Review and Meta-Analysis. OBM Neurobiology 2026; 10(2): 332; doi:10.21926/obm.neurobiol.2602332.

© 2026 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Abstract

Autism is a neurodevelopmental disorder characterized by persistent challenges in social interactions and repetitive behaviors. This study aimed to investigate the prevalence of autism and autism spectrum disorder(ASD) in normal and abnormal groups, such as premature infants or seizure patients, using an umbrella review and meta-analysis. This study was conducted in accordance with the PRISMA guidelines. Scientific sources included PubMed, Scopus, Web of Science, and Google Scholar, and searches were conducted without time limits until the end of September 2024. Meta-analysis was performed using a random-effects model and heterogeneity using an I2 index. Of the 799 articles identified, 30 were included in the meta-analysis. The prevalence of autism was 15.8 per 10,000 (CI = 10.5-21.0, P < 0.001) in normal samples and 600 per 10,000 (CI = 412-793, P = 0.77) in abnormal samples. The overall prevalence of autism was 18.1 per 10,000 (CI = 10.9-25.4, P < 0.001). The prevalence of ASD in normal samples was 48.9 per 10,000 (CI = 31.6-66.1, P < 0.001) and in abnormal samples 900 per 10,000 (CI = 680-1121, P < 0.001). The overall prevalence of ASD was estimated to be 153 per 10,000 (CI = 125-180, P < 0.001). Given the prevalence of ASD and its link to environmental and genetic factors, increased public awareness and better diagnostic tools are needed. In addition, timely and accurate screening is recommended to prevent delays in diagnosis and treatment.

Keywords

Autistic disorder; autism spectrum disorder; prevalence; review; meta-analysis

1. Introduction

Autism is a developmental disorder that begins in early childhood and results in social deficits, communication deficits, stereotyped interests, and repetitive behaviors [1]. Today, the term autism spectrum disorder (ASD) is used to describe a group of disorders that include autism, Asperger’s disorder, and pervasive developmental disorder not otherwise specified [2]. ASD is characterized by two key symptoms: persistent deficits in social communication/interaction and restricted, repetitive patterns of behavior and abnormal sensory responses [3]. Repetitive behavior patterns include movement stereotypes, repetitive use of objects, activities, and repetitive speech. Movement stereotypes are a type of hyperkinetic movement disorder. They are defined as involuntary, patterned, repetitive, continuous, coordinated, aimless, and ritualistic movements, postures, or utterances [4]. ASD is more common in men than in women [5]. Genetics, along with environmental factors, play a very important role in this disease [6,7]. However, the etiology and biology of this disorder are still unclear [8]. The prevalence and severity of ASD symptoms vary greatly from one patient to another, resulting in a wide range of clinical manifestations. This diversity of manifestations makes diagnosis difficult [2]. In addition, people with ASD often have comorbid psychiatric disorders. Attention deficit hyperactivity disorders, anxiety disorders, depressive disorders, and sleep disorders are the most common comorbidities. Co-occurrence of at least one mental disorder is seen in more than half of patients [9,10]. People with ASD are also more likely to experience physical illnesses such as epilepsy, digestive disorders, or vision and hearing impairments. These conditions exacerbate or mask symptoms, leading to misdiagnosis or delay [11].

However, the onset of ASD is usually visible and recognizable by 18 months of age. Sometimes a child experiences a period of apparently normal development for the first 1 to 2 years of life, followed by a sudden or gradual loss of previous skills, a phenomenon called regression [2]. A confirmed diagnosis requires the involvement of parents and caregivers in symptom recognition and assessment by a multidisciplinary medical/paramedical team to validate the symptoms [12]. The prevalence of ASD varies in different regions. In China, the prevalence rate of ASD is 11.8 per 10,000 [13], in Indian children 9 per 10,000 [14], and in Asia 36 per 10,000 [15]. The prevalence of this disorder is much higher in people with other diseases, For example, 8.1% of patients with seizures have autism, based on a comprehensive systematic review including 283,549 patients experiencing co-occurrence of epilepsy and autism [16], 19% of children with visual impairment [17] and 21% of people with attention deficit/hyperactivity disorder [18]. Although a clear association between ASD and attention deficit/hyperactivity disorder has been reported, prevalence estimates vary widely across studies, largely influenced by differences in sample characteristics, data collection sites, and assessment tools, highlighting the lack of consensus regarding the exact comorbidity rates [19]. Overall, the prevalence of ASD is increasing worldwide [20]. Apart from the actual increase, other factors may also contribute to it. The expansion of the definition of autism, changes in diagnostic criteria, changes in screening and diagnostic tools, and greater awareness and recognition of autism spectrum conditions have contributed to the increase in reporting of ASD [13]. This umbrella review aims to determine the prevalence of autism and ASD in the general population and specific subgroups.

2. Method

For this systematic review, articles on patients with ASD were identified in accordance with the PRISMA guideline [21]. The protocol for this study was registered in Prospero on 10/27/2024 with the number CRD42024597240.

2.1 Search Strategy

The international databases PubMed (Medline), Scopus, Web of Science, and Google Scholar were searched until the end of September 2024. The keywords "autism", "prevalence", "systematic review", and "meta-analysis" were used to search the databases. Based on these keywords, operators, and search fields, a PubMed search strategy was developed, and, based on it, a search strategy for the other databases was developed. The search strategy for PubMed was as follows: (((autism*[MeSH Terms]) OR (Autism Spectrum Disorder*[MeSH Terms])) OR (Autistic Spectrum Disorder*[MeSH Terms])) OR (((autism* [tiab]) OR (Autism Spectrum Disorder*[tiab])) OR (Autism Spectrum Disorder*[tiab])) AND (((((prevalence[MeSH Terms]) OR (Point Prevalence*[MeSH Terms])) OR (Period Prevalence*[MeSH Terms])) OR (incidence[MeSH Terms])) OR ((((prevalence[tiab]) OR (Point Prevalence*[tiab])) OR (Period Prevalence*[tiab])) OR (incidence[tiab]))) AND ( (Systematic review*[MeSH Terms]) OR (Systematic review*[tiab])) AND (((Meta-analysis[MeSH Terms]) OR (Meta-analytic[MeSH Terms])) OR ((Meta-analysis[tiab ]) OR (Meta-analytic[tiab]))).

2.2 Inclusion and Exclusion Criteria, Screening and Selection of Articles

All review articles related to the prevalence of autism and ASD were included in the study. There was no time limit for the inclusion of studies. Articles that met one of the following conditions were excluded from the study: (1) scoping review, literature review, intervention, and cross-sectional studies, (2) failure to use standardized tests to diagnose the disorder, (3) lack of clarity about the study population, and (4) studies published in a language other than English.

The articles found in the search were imported into EndNote 21. After removing duplicate articles, two independent researchers screened the articles for eligibility. The screening was conducted in three stages: title, abstract, and full text. At each stage, any disagreement was resolved by consultation between the two researchers and, if necessary, the opinion of a third researcher.

2.3 Data Extraction and Quality Assessment

The following data were extracted from the articles: first author, country of study, year of study, continent studied, total sample size, prevalence of autism and ASD, Heterogeneity I2, study instrument, study group, Publication Bias, and number of studies.

The Assessment of Multiple Systematic Reviews v2 tool was used to assess the quality of the included studies [22]. This tool has 16 items, and Evaluators were asked to assess each item as “yes,” “to some extent,” and “no.” The overall reliability of this tool’s results is classified into four levels: critically low, low, moderate, and high. This process was carried out independently by two researchers. Any disagreements were resolved by involving a third researcher.

2.4 Statistical Analysis

The included studies were analyzed using a random-effects model for a meta-analysis. Index I2 was used to assess heterogeneity across the studies. Heterogeneity levels were classified as less than 25%, 25-50%, 50-75%, and more than 75%, indicating no heterogeneity, moderate heterogeneity, high heterogeneity, and very high heterogeneity, respectively. The data were analyzed using STATA software (version 15).

3. Results

The search process yielded 799 articles, of which 377 were duplicates. Of the remaining 462 articles, 408 were excluded based on title and abstract, and 54 articles were reviewed in full text. Thirty articles were selected for quality assessment, and all were included in the meta-analysis stage. Figure 1 shows the steps for article selection.

Click to view original image

Figure 1 Search flow diagram and article screen.

Table 1 shows the characteristics of the included articles. The articles were from 2006 to 2024 and cover all continents.

Table 1 Characteristics of articles reviewed on the prevalence of autism in the world.

A total of N = 225,573,794 individuals were included. Some articles examined the prevalence of autism or ASD in samples with specific conditions, such as preterm birth infants [31] and seizure patients [29]. The data from these articles were classified as abnormal samples. Nine articles examined the prevalence of autism (Figure 2). Of these, two had abnormal samples [16,31]. The prevalence of autism in the normal sample was 15.8 per 10,000 (CI = 10.5-21.0, I2 = 82.9%, p ≤ 0.001). The prevalence of autism in the abnormal sample was 602 per 10,000 (CI = 412-793, I2 = 0.0%, p = 0.77). The overall prevalence of autism was 18.1 per 10,000 (CI = 10.9-25.4, I2 = 88.9%, p ≤ 0.001).

Click to view original image

Figure 2 Forest plot of overall and subgroup prevalence of autism of included studies with 95% confidence intervals.

Twenty-six articles reported the prevalence of ASD (Figure 3). Of these, 14 articles had normal samples, and 12 had abnormal samples—two articles examined and reported ASD in two different groups [17,34]. The prevalence of ASD in the normal sample was 48.9 per 10,000 (CI = 31.6-66.1, I2 = 93.6%, p ≤ 0.001). The prevalence of ASD in the abnormal sample was 900 per 10,000 (CI = 680-1121, I2 = 98.6%, p ≤ 0.001). The overall prevalence of ASD was 153 per 10,000 (CI = 125-180, I2 = 97.8%, p ≤ 0.001).

Click to view original image

Figure 3 Forest plot of overall and subgroup prevalence of ASD in the included studies with 95% confidence interval.

The results of the meta-regression analysis showed that the prevalence of autism is decreasing over time, while the prevalence of ASD is increasing over the last two decades (Figure 4 and Figure 5).

Click to view original image

Figure 4 Meta-regression analysis for autism prevalence.

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Figure 5 Meta-regression analysis for ASD prevalence.

4. Discussion

This umbrella review calculated the prevalence of autism and ASD across all ages. The Prevalence of autism is much higher in individuals with other conditions, such as obsessive-compulsive disorder and fragile X syndrome [32,43]. According to the report by Baird et al., 56% of children aged 9 to 10 years with ASD have an intellectual disability, as do 73% of individuals with autism [46]. Therefore, the prevalence of autism and ASD in the normal and abnormal samples was calculated independently. But again, within each normal and abnormal sample, the reported numbers for autism and ASD were different. This difference could be due to various reasons: 1- The effect of genetics in autism and genetic differences in different populations [7,47]; 2- Differences in the system of diagnosis and registration of the disease, this is more important in developing countries and can cause underreporting of the prevalence [48]; 3- The impact of environmental factors such as maternal nutrition and air pollution [49]; 4- Public awareness and social taboos, lack of recognition or fear of social stigma by the individual and family may prevent reporting of the disorder [50]. The prevalence of autism in the normal, abnormal, and total samples was 15.8, 600, and 18.1 per 10,000, respectively.

Reporting of autism prevalence has declined specifically, with only two articles reporting it since 2018. The highest prevalence in a normal sample was 76 per 10,000 reported by Baxter et al. This study was only relevant for the Australian region [25].

The prevalence of ASD in the normal, abnormal, and total samples was 48.9, 900, and 153 per 10,000, respectively. The highest prevalence in a normal sample was 140 per 10,000, reported by Sacco et al., specifically in Europe [35]. The highest prevalence in the abnormal sample was 26.7% in patients with Prader-Willi syndrome [26] and 21% in patients with attention deficit hyperactivity disorder [18].

The approximately 3-fold higher prevalence of ASD compared to autism reflects the significant prevalence of other subtypes of ASD, such as Asperger syndrome and pervasive developmental disorder-unspecified. In abnormal samples, the prevalence was much higher, as reported by Fresnel et al. [51]. Many patients with attention deficit hyperactivity disorder, Tourette syndrome, depression, and schizophrenia also have symptoms of ASD [46,52,53,54].

In our paper, the prevalence of ASD increased while the autism trended downward in the last two decades. This is consistent with other articles that also reported an increase in ASD rates. The main reasons given were the expansion of the concept, increased awareness (especially in developed countries), and changes in tools that have led to improved diagnosis and early detection [20,55]. Chiarotti et al. also reported an increase in the prevalence of ASD in 2020 [56]. Coo et al. reported that one-third of autism diagnoses in school-aged children in Canada from 1996 to 2004 were due to a change from a non-autism diagnostic category to autism [57]. In recent years, revisions to scientific definitions and classification standards for mental disorders, as well as a more precise definition of autism, have had a significant impact on the process of diagnosing this disorder. These changes have led to some individuals with communication disorders or autism-like symptoms no longer being diagnosed as "autism" and being placed in other subtypes of ASD or even in completely different categories. Another factor affecting the reduction in autism reports is increased accuracy in early diagnosis of disorders. For example, if intellectual disability or other neurodevelopmental disorders are identified and confirmed early, the patient may no longer be screened for autism symptoms.

4.1 Strengths and Limitations of the Study

One of the strengths of this study was that it was the first umbrella study to examine the prevalence of autism and ASD. This article had several limitations. Only a few articles reported autism and ASD separately. This led to a reduction in the number of articles with each analysis, especially autism-specific analyses. Studies that included data from multiple continents reported prevalence overall, without disaggregating it by continent. This limited the possibility of detailed, continent-specific analysis and identification of prevalence differences. Moreover, the number of studies focusing exclusively on individual continents was small and geographically limited (for Asia, most studies were from East Asia and India, and for Europe, all continent-specific studies were from the UK), making further stratified analyses unrepresentative for the entire continent. Furthermore, most included studies were conducted in Western, high-income countries with predominantly White populations. Given that autism and ASD prevalence may vary across socio-demographic, cultural, and ethnic groups, this limited representation may restrict the generalizability of the findings to low- and middle-income countries and more diverse populations.

5. Conclusion

This research indicates a rise in the prevalence of ASD, while the occurrence of autism appears to be diminishing. The uptick in ASD may be linked to factors such as heightened awareness, revisions in diagnostic criteria, and enhanced methods for early identification. Decrease in autism rates could be due to better identification of autism and other developmental disorders, leading to more accurate diagnosis and clearer distinctions between the conditions. Notably, autism and ASD had higher prevalence rates in abnormal samples compared to normal samples, suggesting that co-occurring disorders and environmental factors play an important role. Future studies should focus on examining the prevalence of autism and ASD specifically across different continents to better understand regional differences and identify local influencing factors.

Acknowledgments

The authors express their gratitude to the Student Research Committee at Ilam University of Medical Sciences. This current study with ethical code IR.MEDILAM.REC.1403.192 was approved.

Author Contributions

This review article was conceived by M.H.E. and A.S. The initial draft of the manuscript was prepared by M.H.E. M.K. and Z.S. performed the literature search and screening. A.H.A. and S.M. conducted data extraction. All authors read and approved the final manuscript. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed.

Competing Interests

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

AI-Assisted Technologies Statement

The authors utilized Grammarly, an AI-powered writing assistant, for grammar checking, punctuation, and style enhancement in the preparation of this manuscript. The content, research, ideas, and intellectual contributions remain solely the responsibility of the authors.

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