Although early diagnosis and treatment of autism spectrum disorder in toddlers is vital for improving their developmental functioning, haredi (ultra-Orthodox) Jewish and Arab-Israeli families suffer from “extreme inequality” in the availability of help.
This was determined by a new, 30-page, Hebrew-language study by Jerusalem’s Taub Center for Social Policy Studies, conducted in collaboration with the KI Institute, a new, non-profit academic center for applied computational health research in the central Israeli moshav of Kfar Malal.
The Taub Center is an independent and non-partisan research institution that deals with economic and social issues, providing policymakers and the public with research on some of the most important issues facing Israel in the areas of education, health, welfare, the labor market, and economic policy, in order to influence decision-making processes and improve the well-being of all Israelis.
The in-depth research revealed that children in haredi neighborhoods receive eligibility for autism benefits at an average age of 4.7, two years later than children in non-haredi neighborhoods, thus missing the critical window of time for effective treatment.
A significant gap in self-identification was also found in Arab society and in Jewish neighborhoods of low socioeconomic status. Fewer children come for diagnosis despite high exposure to risk factors, the researchers wrote.
New system based on risk-prediction proposed
They proposed an immediate solution in the form of leveraging the existing infrastructure of the tipat halav (well-baby clinic) system for universal coverage based on a risk-prediction model that would make early identification possible without the need for additional budgeting.
Researchers Dr. Sarit Silverman, Dr. Guy Amit, and Dr. Yair Sadaka examined the age of diagnosis and identification of autism in Israel. The most critical stage for effective intervention to advance the child, known as the “golden hour” – depends largely on the area of residence and sector affiliation.
“Similar to the global trend, in the last two decades, there has been a dramatic increase in the incidence of autism diagnoses in Israel. During this period, diagnosis rates increased 20-fold – from about one per 1,000 children in 2005 to about 20 per 1,000 children in 2025, with most of the increase occurring in recent years,” Silverman told The Jerusalem Post in an interview.
She suggested that the significant increase in autism diagnoses around the world in the last decade was largely due to the broader definition of the condition of a “broad spectrum” rather than individual disabilities, as well as earlier diagnosis and greater awareness. “The increase here stems from a combination of raising awareness, state incentives, and social acceptance – but, according to our findings, this growth is not equitable.”
“A paradoxical situation has arisen in which, despite the extensive support set that the state provides – both in terms of budget and treatment – there are gaps in accessibility between population groups,” said Silverman, who is a senior early-children education researcher in learning disabilities. Her doctorate explored the unique relationship between spatial working memory and mathematics performance among primary school-aged children and university students.
Double inequality: ASD diagnoses appear later and at lower rates
Conventional practice recommends diagnosis at ages two to three for optimal intervention results; late diagnosis reduces the effectiveness of the intervention. A two-year delay means that the child begins receiving treatment and assistance only in kindergarten, when the critical time window for early intervention has largely passed. Beyond this delay in the timing, the study also shows that overall identification rates are lower in this community relative to its share in the population.
“In the study, we saw two types of inequality: the first in the haredi community, where we witness a double gap: both in the lower rate of children who have received a diagnosis and official confirmation of being on the autism spectrum compared to the general population, as indicated by the eligibility and confirmation data, and in a critical delay in the age at which children are diagnosed, Silverman said.
“The second is in Arab society and other groups of low socioeconomic status, where the problem focuses on profound under-recognition, which reflects resource gaps in navigating the diagnostic and treatment systems, making it difficult for families from disadvantaged populations,” she said. “In both cases, the sad result is children who do not receive an equal opportunity to integrate into society and reach their potential simply because of their background.”
To bridge the gaps, the researchers recommend a transition to universal coverage for autism at tipat halav clinics. The study proposes using the predictive model developed at the KI Institute, which allows for an accurate assessment of autism risk based on developmental milestones routinely assessed at the well-baby facilities.
Tipat halav is a “treasured system,” but some have an inadequate number of nurses and doctors to take over the task of early diagnosis and referral. They have to be improved, Silverman said. “I didn’t study the ‘why’ – the reasons that haredi and Arab families suffer from extreme inequality. I can’t imagine that it’s intentional; every child should get early intervention. As for the Arab sector, it may also be due to an inadequate number of Arabic-speaking professionals in the field.”
Since well-baby clinics are public institutions and their services are provided to all sectors, “this step will maximize accessibility to autism diagnoses,” the team suggested. “Moreover, because the infrastructure for developmental assessments already exists, the diagnoses can be integrated into existing clinical work processes at no additional cost. This solution will provide a universal approach to developmental monitoring that can identify children at risk for autism before differences in family resources create barriers to identification and intervention,” the researchers wrote.
The universal identification process needs to be complemented by one of targeted interventions for disadvantaged populations that would address the complex barriers faced by families from low socioeconomic status, the report continued.
“This process should include proactive support for families from disadvantaged communities,” it concluded, “from initial screening and access to services through community outreach programs, customized educational material, and cultural-sensitivity training for service providers, to mediation programs that reduce barriers in the existing community framework.”