Intergenerational Transmission of Autism Spectrum Disorder in GCC and Arab Populations: A Scoping Review

Project Description (for OSF Registration) Intergenerational Transmission of Autism Spectrum Disorder in GCC and Arab Populations: A Scoping Review of Genetic, Phenotypic, and Psychosocial Pathways Purpose This scoping review systematically maps the available evidence on intergenerational transmission of autism spectrum disorder (ASD) in Gulf Cooperation Council (GCC) countries and the broader Arab world. While ASD demonstrates high heritability globally (64–91%), intergenerational transmission extends beyond genetics to encompass broader phenotypic expressions in family members, impacts on parental mental health, culturally-mediated beliefs and practices, and family system adaptations. The Arab world presents a unique context for examining these pathways due to elevated consanguinity rates (20–50% in many communities), distinctive extended family structures, specific cultural and religious frameworks for understanding disability, and rapidly evolving but historically limited mental health infrastructure. Despite growing research activity in the region, no existing synthesis has comprehensively mapped evidence across these multiple intergenerational domains specific to Arab populations. Previous reviews have focused on narrow aspects such as genetics alone or parental stress in isolation, without integrating findings across the full spectrum of intergenerational factors. This review addresses this gap by providing the first comprehensive synthesis examining genetic, phenotypic, psychological, cultural, and family systems dimensions of intergenerational autism transmission in Arab populations. Research Questions Primary question: What is the extent, range, and nature of evidence on intergenerational transmission of ASD in GCC countries and the broader Arab world? Secondary questions: What genetic factors (familial recurrence, consanguinity effects, heritability) have been examined in Arab populations with ASD? What evidence exists regarding the broader autism phenotype (BAP) or subclinical autistic traits in family members of individuals with ASD? How does raising a child with ASD affect parental mental health outcomes in Arab families? What cultural factors, beliefs, and practices influence family experiences of ASD in Arab contexts? How do family dynamics, coping strategies, and adaptation processes manifest in Arab families affected by ASD? Methods This scoping review follows Joanna Briggs Institute (JBI) methodology and adheres to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. Eligibility Criteria: Population: Individuals with ASD (diagnosed per DSM-IV, DSM-5, DSM-5-TR, or ICD-10) and/or their family members Concept: Intergenerational transmission across five a priori domains: (1) genetic transmission, (2) broader autism phenotype, (3) parental mental health, (4) cultural factors, (5) family dynamics Context: Studies conducted in any of the 22 Arab League member states or involving Arab diaspora populations where Arab cultural context was explicitly examined Sources: Primary quantitative, qualitative, and mixed methods studies; grey literature including conference abstracts and dissertations Exclusions: Case reports, case series, editorials, and reviews without primary data Information Sources: Three electronic databases were searched from inception to 15 January 2026: PubMed/MEDLINE, Scopus, and Google Scholar. Supplementary search methods included hand-searching key regional and specialty journals (2020–2026), forward and backward citation searching of included studies, and grey literature searching of INSAR conference proceedings (2015–2025) and GCC university institutional repositories. Study Selection: Two independent reviewers conducted screening at title/abstract and full-text levels. Disagreements were resolved through discussion or third reviewer consultation. Data Extraction: A standardised charting form captured citation details, country, study design, sample characteristics, domain(s) addressed, key findings, instruments used, and methodological features. Domain-specific extraction sheets captured detailed variables for each intergenerational domain. Synthesis: Descriptive synthesis was conducted with results presented through summary tables, narrative synthesis organised by domain, and visual mapping of evidence distribution across Arab League member states. Expected Outcomes This review is expected to produce the following outcomes: Comprehensive evidence map: A systematic mapping of all available evidence on intergenerational autism transmission in Arab populations, organised by the five a priori domains and by geographic distribution across the 22 Arab League member states. Identification of research gaps: Clear delineation of under-researched areas requiring future investigation, including specific domains, populations, and geographic regions with limited or no evidence. Synthesis of genetic findings: Integration of evidence on consanguinity effects, familial recurrence patterns, diagnostic yields from genomic studies, and novel gene discoveries specific to Arab populations. Characterisation of parental mental health impacts: Summary of prevalence rates and predictors of depression, anxiety, and stress among parents of children with ASD in Arab contexts, including identification of validated assessment instruments. Documentation of cultural factors: Synthesis of evidence on culturally-specific beliefs, stigma experiences, help-seeking behaviours, religious coping strategies, and their influence on family adaptation. Evidence-based recommendations: Formulation of priorities for future research, clinical practice implications, and policy recommendations tailored to Arab healthcare contexts. Significance This scoping review will provide the first comprehensive synthesis of intergenerational autism transmission evidence specific to Arab populations. The findings will inform: Researchers: By identifying critical gaps and priority areas for future investigation Clinicians: By summarising culturally-relevant factors affecting family assessment and intervention Policymakers: By highlighting service needs and evidence-based recommendations for Arab healthcare systems Families: By contributing to improved understanding and support for Arab families affected by autism The review will also establish a foundation for future systematic reviews and meta-analyses in specific domains where sufficient evidence exists. Framework and Reporting Methodology: Joanna Briggs Institute (JBI) guidance for scoping reviews Reporting: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) Key References: Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. Study Status Registration date: [Enter date] Current status: Completed Results summary: The systematic search identified 741 records across three databases (PubMed/MEDLINE, n = 513; Scopus, n = 78; Google Scholar, n = 150). Following removal of 125 duplicates, 616 records were screened, with 64 primary studies (2008–2026) included in the final synthesis representing 15 Arab countries. Contact Corresponding Author: Syed Ali Bokhari Institution: Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, United Arab Emirates Email: sab_191@live.com ORCID: 0009-0009-1190-7613