Background: Autism is a global disorder, but relatively little is known about its presentation and occurrence in many developing countries, including Libya. Aims: 1.) To estimate the prevalence of autistic spectrum disorders in children referred to Al-Khadra hospital (KH). 2.) To increase the awareness among pediatrician and primary health care providers of the importance of considering autism in children presenting with speech and language disorders. Methods: Prospective hospital-based study of all children referred to a neurodevelopment clinic between 2005 and 2009 with the diagnosis of either speech and language difficulties or behavioral difficulties. Results: A total of 38,508 children were seen in the pediatric outpatient clinics of KH, Tripoli, between 2005 and 2009. Of these, 180 children were referred to the neurodevelopment clinic with history of delayed speech and language and or behavioral difficulties. A diagnosis of autism was made in 128 children, which gives a prevalence of approximately 1 in 300. Conclusion: The prevalence of autism in Libya is probably similar to that seen in the USA and the UK. No data were available for comparison from either Arab or other developing countries. Autism is an important differential diagnosis of any language disorder "and behavioral difficulties". (Contains 1 figure.)