The childhood prevalence and characteristics of Autism Spectrum Disorder (ASD) in Cyprus and the predictors of minimally verbal children, using a new parent report tool

Introduction: Autism spectrum disorder (ASD) prevalence was not consistently monitored in Europe nor reported for Cyprus in the literature. Limited research was found concerning children with ASD presenting with persistent language delay, considered nonverbal/minimally-verbal (NV/MV). The factors associated with linguistic differences within ASD are indefinite.
Purpose: This research aimed to examine which prelinguistic factors predicted linguistic outcome in ASD, and to determine the childhood prevalence, gender ratio, and characteristics for ASD in Cyprus, the factors associated with prevalence, and the risk/prognostic factors associated with ASD-NV/MV linguistic status, using a new parent report tool in Greek, developed and validated by the research team.
Methodology: First, a cross-sectional study with convenience cluster school-sample of 117 schools and weighted child-sample (five-to-12 years) of 9,990 students, calculated the prevalence through school report. Second, the newly developed Developmental/Verbal Language Phase (DeVLP) questionnaire (collecting familial, perinatal, developmental, and current linguistic information) was validated in a sample of 22 children with ASD and 28 without, based on the gold-standard method, language sample analysis. Third, the risk and prognostic factors for ASD-NV/MV status in a convenience sample of 56 children (three-to-12 years) already diagnosed with ASD, were examined via an age-and-gender-matched case-control study, utilizing the DeVLP tool to determine linguistic status.
Results: ASD prevalence in Cyprus (2022-2023) was 1.8% with 4.1 males for every female. Males, children enrolled in preschool, and special schools, had a higher probability of report of an ASD diagnosis compared to females, elementary level, and mainstream schools (p<0.05). Of the familial, perinatal, and developmental factors examined, only a low early development score (EDS), corresponding to a high developmental risk score was significantly associated with reduced linguistic outcome (p<0.05). Children with lower EDS, reflecting delays in developmental milestones (gestures, motor skills, etc.), had higher probability of ASD-NV/MV classification using the valid and reliable DeVLP instrument.
Conclusions: This research provided the first published data for ASD prevalence in Cyprus, a novel parent report tool (DeVLP) assessing linguistic skill and for the first time the interlinguistic skills of children with ASD, including those classified as NV/MV in Cyprus were examined. Results emphasized the need for monitoring prevalence, classifying ASD-NV/MV status utilizing the new and valid DeVLP tool, and monitoring early development for toddlers at-risk-for-ASD, in Cyprus, to enhance their linguistic skills as early as possible, for an optimum outcome. The impact of this research in public policy for ASD was substantial in the new National Strategy for Autism, by providing information on the prevalence, characteristics, and needs of children with ASD in Cyprus, which was missing.