Tehran University Medical Journal

Background: The prevalence of autism spectrum disorder (ASD) as a child neurodevelopmental disorder has increased significantly during the past 3 decades worldwide and in Iran. This chronic disease does not cause premature death and there is no definitive treatment. Thus, the cost of ASD is extremely heavy and overwhelming. The purpose of this study is to calculate the economic burden of ASD in Iran.
Methods: A cross-sectional descriptive-analytic study was conducted to calculate all-important ASD costs. Two hundred and ninety autism patients in Tehran participated in this study in 2017 with the support of Tehran University of Medical Sciences (TUMS). A valid and reliable questionnaire was used to estimate direct medical costs, direct non-medical costs and indirect costs.
Results: The annual economic burden of ASD is estimated to be 223,561,841 Rials ($6,883 2014 USD) per patient in Tehran, Iran in 2017. Approximately 32%, 52% and 16% of the total cost were direct medical costs, direct non-medical costs, and indirect costs. The average ASD direct cost was $5,765 of which 38% was direct medical costs and 62% was direct non-medical costs. The average annual ASD direct medical cost was $2,215 per patient of which 70%, 16% and 7% were related to rehabilitation, medicine and doctor visit costs. The average annual ASD direct non-medical cost was $3,550 per patient of which 35% was the cost of parents’ immigration to Tehran to receive health care services. The average annual ASD indirect cost for productivity loss from unemployment or reduced work productivity was estimated at $1,118. The largest cost component was parents’ productivity loss due to caregiving (70%).
Conclusion: Autism imposes substantial direct and indirect economic effects on patients and their families. Hence, health policy makers must take the most effective measures to make best use of scarce societal resources, to reduce the cost of the disease for patients and their families and subsequently, reduce its psychosocial burden.

Background: Autism spectrum disorder (ASD) represents one of the most significant neurodevelopmental disorders in early childhood, where early diagnosis, particularly in children under five years of age, is crucial for effective interventions. Although global autism incidence has risen due to improved awareness, enhanced screening programs, and broader diagnostic criteria, epidemiological data from middle-income countries like Iran remain limited, especially for children under five. This study aimed to examine autism incidence trends among Iranian children under five from 1990 to 2021, stratified by sex and province. 
Methods: This ecological study was conducted from October 2024 to March 2025, analyzing data extracted from the Global burden of disease (GBD) database (1990-2021). Age-specific incidence data for children under five were obtained by sex and province. Incidence rates per 100,000 population were calculated for gender and provincial comparisons. Joinpoint regression analysis assessed annual trends and identified significant inflection points. Heat maps illustrated geographical distributions, while trend graphs stratified by sex and province were generated using GraphPad Prism. 
Results: The incidence rate of autism in children under five gradually increased from 1990 to 2005, followed by a sharp rise between 2005 and 2009, reaching its peak during this period. A subsequent decline was observed from 2009 to 2021. The male-to-female ratio remained consistently stable at approximately 3:1 throughout the study period and across all provinces. Notable provincial disparities were observed, with border provinces exhibiting greater fluctuations compared to central regions.
Conclusion: In contrast to the continuous global increase, autism incidence among Iranian children under five demonstrated an initial rise followed by a sustained decline after 2009. This trend may be attributed to declining birth rates, demographic shifts, evolving diagnostic criteria, improved prenatal care, and persistent challenges in early screening and case registration, alongside regional disparities in access to diagnostic services. These findings emphasize the need for enhanced early-screening programs, equitable resource distribution, and evidence-based child mental health policies in Iran.