Volume 22, Issue 2 (6-2025)
J Res Dev Nurs Midw 2025, 22(2): 39-43 |
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Lestari L, Ramadhaniyati R, Saito R, Tsuda A. Parental perspectives on the maltreatment of children with autism spectrum disorder and associated factors: A cross-sectional study in Indonesia. J Res Dev Nurs Midw 2025; 22 (2) :39-43
URL: http://nmj.goums.ac.ir/article-1-1996-en.html
URL: http://nmj.goums.ac.ir/article-1-1996-en.html
1- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan; Maternity and Child Health Nursing Department, School of Nursing, ITEKES Muhammadiyah Kalbar, Pontianak, Indonesia , lilis@stikmuhptk.ac.id
2- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan; Maternity and Child Health Nursing Department, School of Nursing, ITEKES Muhammadiyah Kalbar, Pontianak, Indonesia
3- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
2- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan; Maternity and Child Health Nursing Department, School of Nursing, ITEKES Muhammadiyah Kalbar, Pontianak, Indonesia
3- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
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Discussion
In this study, most participants considered physical and psychological maltreatment necessary to make it easier for parents to interact with children with ASD. This finding is supported by previous reports that in Indonesian culture, parental maltreatment is often interpreted as normal and is considered important to instill obedience in children including those with ASD (13). Similar findings were reported in a study conducted in Bangladesh, also a developing country, where parental maltreatment was considered necessary to help control the behavior of children with ASD (4). These findings reflect similar parental perspectives on maltreatment often seen in ASD childcare practices in developing countries.
Our findings showed that the participants aged >35 years and those whose first child had ASD were more likely to have inappropriate perspectives that tolerate maltreatment. Older parents are likely caring for older children with ASD compared to younger parents. Similar to parents of older typically developing children, parents caring for older children with ASD share similar hopes for their children’s future, including access to education and job opportunities (29). However, when hopes for their children’s future do not align with their dreams, these parents may experience hopelessness (21). Such conditions could lead to inappropriate perspectives that tolerate maltreatment.
Parenting children with ASD is often reported to trigger stress (30). This stress may be more intense for parents whose first child is diagnosed with ASD, as they typically face challenges including increased role differentiation during the transition to parenthood compared to parents with prior parenting experience (31). These challenges may hinder parents from developing appropriate perspectives in responding to their child’s behaviors. The active involvement of healthcare professionals in providing ongoing parental support, especially during transitional periods, is essential. This support can help prevent parenting stress that could lead to inappropriate perspectives on maltreatment of children with ASD.
This study found that knowledge about typical development and ASD and the need for pre-diagnosis support also influenced the perspectives on maltreatment of children with ASD. The participants who had poor knowledge about typical development and ASD and those who stated not needing pre-diagnosis support were more likely to have inappropriate perspectives. However, this may be linked to limitations within Indonesia’s ASD treatment system, including inadequate human resources, uneven distribution of facilities, and high therapy costs (32). These limitations often make it difficult for parents to determine the best support and may lead them to switch between treatment centers without clear referral systems, resulting in suboptimal care for children with ASD and further hindering parents’ understanding of the condition. Comprehensive improvements to the ASD treatment system in Indonesia are needed, including enhancing parental knowledge about child development and pre-diagnosis support, beginning with efforts to increase the competence of healthcare professionals, ensure equitable distribution of facilities, and make support services for children with ASD more affordable. This study used a cross-sectional design, which provided only an overview and allowed the interpretation of the relationship between the variables without establishing causality. Another limitation is that this study examined only parental perspectives regarding maltreatment of children with ASD, without investigating whether the parents actually engage in abusive behaviors when interacting with their children. Therefore, it remains unclear whether parents with appropriate or inappropriate perspectives are more likely to maltreat children with ASD. Further research into how parental perspectives may influence acts of maltreatment toward children with ASD is needed to provide a comprehensive understanding of parenting to prevent maltreatment, especially in developing countries. Additionally, the study data were obtained from parents living in West Kalimantan Province, which is not a metropolitan province in Indonesia. Thus, the data collected may not fully represent all regions in Indonesia. In conclusion, this study found that most parents have an inappropriate perspective that tolerates maltreatment of children with ASD. Parental perspectives that tolerate maltreatment can lead to harsh parental responses to the behavior of children with ASD, which potentially contributes to the increased risk of maltreatment in this population in developing countries such as Indonesia.
Conclusion
Most parents caring for children with ASD in Indonesia have inappropriate perspectives that tolerate maltreatment. Parental age of >35 years, first child with ASD, poor knowledge about typical child development and ASD, and lack of need for pre-diagnosis support can influence parental perspectives on maltreatment of children with ASD. Ongoing support, opportunities for socialization, and training aimed at improving knowledge of compassionate parenting and pre-diagnosis support, beginning with increasing the competence of healthcare professionals, ensuring equitable distribution of facilities, and reducing the cost of support services for children with ASD, are needed to address inappropriate parental perspectives on maltreatment of these children. Parental perspectives may influence acts of maltreatment toward children with ASD is needed to provide a comprehensive understanding of parenting to prevent maltreatment, especially in developing countries.
Acknowledgement
The authors sincere thanks to all participants and parties who have participated in this study.
Funding sources
Maternity and Child Health Nursing Department, School of Nursing, ITEKES Muhammadiyah Kalbar, Pontianak, Indonesia as research funding.
Ethical statement
This study has been reviewed and approved by the Research Ethics Committee in Indonesia (Number: 80/II.I.AU/KET.ETIK/III/2022) and also obtained administrative approval from the Ministry of Health, Ministry of Education, and the Department of Research and Development of West Kalimantan Province. All participants involved in this study have given informed consent. In addition, anonymity, the right to withdraw from the research, and data confidentiality were also ensured.
Conflicts of interest
The authors state that no conflicts of interest are present.
Author contributions
LL, design the project, data collection and formal analysis. RR, design the project, and formal analysis. RS, design the project, and formal analysis. AT, design the project, and formal analysis. All authors; Writing-review, editing, and final approval of published version.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Introduction
According to the 1989 Convention on the Rights of the Child, every child has the right to receive comprehensive protection from all forms of maltreatment (1). However, maltreatment remains a serious global issue and continues to be reported in various countries (2). Children with autism spectrum disorder (ASD) are at a high risk of parental maltreatment (3), particularly physical and psychological forms (4). Maltreatment can cause negative effects on children with ASD including increased attention deficits, and attachment problems, potentially leading to hyperactivity, aggression, and anger (5). In severe cases, maltreatment can even result in death (3). However, some parents in developing countries still use physical (Hitting) and psychological maltreatment (Shouting or threatening to harm or kill) when interacting with children with ASD (4). A similar situation has been reported in Indonesia, where acts of maltreatment (e.g., pinching) are used as part of parenting strategies for these children (6).
Parents have been reported to experience more difficult challenges in raising children with ASD compared to raising children with other developmental disorders (7), due to limitation in social interaction, communication, behavioral patterns, and unusual activities in children with ASD (8), are what may underlie parents having inappropriate perspectives that tolerate the maltreatment of children with ASD. Parental perspectives can affect the parenting patterns for children with ASD (9). Inappropriate perspectives that tolerate maltreatment can lead to violent parental responses to the behaviors of children with ASD, potentially contributing to the increased risk of maltreatment in this population. Exploring parental perspectives on maltreatment and their associated factors can provide deeper insights into maltreatment of children with ASD.
Limited studies have specifically examined parental maltreatment of children with ASD in developing countries, including Indonesia. Most research has focused on developmental disorders associated with a high risk of maltreatment (10), the types of maltreatment commonly experienced by children with ASD (4,10-12), and contributing factors such as parenting stress (11) and cultural influences (13) that increase the risk of parental maltreatment of children with ASD. This study aimed to explore parental perspectives on maltreatment of children with ASD and their associated factors in Indonesia.
Methods
Study design and setting
A cross-sectional study was conducted from January to March 2023 in two major cities, namely Pontianak and Singkawang in West Kalimantan Province, Indonesia, evaluating 345 parents caring for children with ASD. These cities were selected because they are representative of different regions in Indonesia. We sent research permission letters to all 70 schools for children with special needs and child development facilities in the two cities. Of these, 53 schools and facilities granted approval for us to collect data at their institutions. Participants were selected by consecutive sampling by these institutions. We held meetings with principals of schools for children with special needs and heads of child development facilities to discuss this study. Principals and heads then gathered parents of children with ASD for scheduled information sessions, and we explained the purpose and confidentiality of the study verbally and in writing. Parents who agreed to participate in the study signed a consent form. Parents caring for children with ASD aged ≥2 years were included in this study. They were recruited through schools and facilities for children with special needs, and they provided informed consent after receiving information about the study’s purpose, benefits, and risks. Parents whose children had chronic illnesses or multiple disabilities, as documented in medical records at each study site, were excluded. For parents who were unable to attend on the scheduled days, follow-up opportunities were provided within the same data collection period. Data were collected using a self-administered printed questionnaire in Indonesian.
Measurement tools
The questionnaire was developed by a multidisciplinary team of experts in the development of children with ASD. It collected information on participant demographics and characteristics of children with ASD across 12 categories: perspectives on parental maltreatment of children with ASD, using 3 questions based on original research (14), scored using the Guttman Scale (1 for a correct answer and 0 for an incorrect answer); knowledge of typical development and ASD, using 7 questions, each based on child developmental milestones (15), maternal and child monitoring books used in Indonesia (16), published surveys (17,18), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria for children with ASD (8), evaluated using the Guttman Scale (1 for a correct answer and 0 for an incorrect answer); awareness of the attachment behaviors of children with ASD, using 5 questions based on original research (14,19,20), scored using a 2-point Likert scale (1 for disagree; 2 for agree); and support needs in caring for children with ASD, using 10 questions based on original research (21-27), assessed using a 2-point Likert scale (1 for no need; 2 for need). Two parents of children with ASD and three experts on ASD in Indonesia tested the content validity of the questionnaire. Parents rated the clarity of the questionnaire on a scale of 1 (Very unclear) to 5 (Very clear). The average clarity score was 4.9, with a standard cut-off point of 3.0, indicating that the questions can be understood clearly. The relevance of the questionnaire yielded an average score of 0.98 (S-CVI/Ave=0.90) (28), demonstrating that the questions are substantially relevant to the research topic. Conversely, the clarity assessment by experts showed an average score of 0.98 (S-CVI/Ave=0.90) (28), which indicated that the questions can be clearly understood.
Statistical analysis
Descriptive statistics including percentages and frequencies were used to describe the data. We categorized perspectives on maltreatment into two categories (Appropriate and inappropriate) adjusted to the Indonesian context. A total score of ≥2 was considered to indicate an appropriate perspective on maltreatment of children with ASD. For univariate analysis of categorical data, we used the chi-square test. Multivariate logistic regression analysis with a stepwise method was utilized to determine the factors influencing parental perspectives on maltreatment. We conducted a multicollinearity test and found that all variables had a variance inflation factor (VIF) score below 5, which indicates that there are no serious multicollinearity concerns. Model fit was determined using the Hosmer-Lemeshow test. P-values less than 0.05 were considered statistically significant. All data analyses were performed using IBM SPSS Statistics 29.
Results
This study included 251 participants, with a response rate of 72.8%. The majority were mothers (84.9%), with a mean age of 38.1 ± 7.1. The majority were aged >35 years (60.6%). Most children with ASD were boys (72.5%) and were aged ≥6 years (73.7%). Only 32.7% of participants had the appropriate perspectives that children with ASD should not be maltreated. However, when responding to statements that children with ASD only understand commands if their parents shout at them, threaten them, or pinch them, 53.8%, 66.1%, and 62.6% of participants, respectively, had appropriate perspectives.
The majority of the participants aged >35 years (60.6%) and more participants with children with ASD aged ≥6 years (78.7%) held inappropriate perspectives (Table 1). Approximately 46.2%, 49.0%, and 52.6% of the participants correctly identified crucial signs for recognizing early ASD symptoms such as limited eye contact, communication, and social interaction, respectively. These proportions were smaller than those for the other four items. Regarding knowledge about ASD, 73.3% and 74.5% correctly answered that children with ASD have hypersensitivity and that ASD can be cured with medication, respectively. The remaining five items had higher correct response rates (Table 2). More than 50% of the participants reported difficulties in interpreting the wishes expressed by their children with ASD (Table 3).
Over 80% of the participants indicated needing pre-diagnosis support through education on typical development and ASD. Approximately 88.8% reported needing post-diagnosis support through programs that guide appropriate responses to children with ASD and emotional support from healthcare professionals to encourage their child’s development (Table 4).
Table 5 shows the results of the logistic regression analysis. The participants whose first child did not have ASD (Odds ratio [OR]=2.240, confidence interval [CI]=1.227–4.090, p-value [p]=0.009), who had knowledge of typical development (OR=1.254, CI=1.048–1.499, p=0.013) and ASD (OR=1.743, CI=1.316–2.309, p=<0.001), and who stated needing pre-diagnosis support (OR=1.225, CI=1.042–1.439, p=0.014) showed greater odds of having appropriate perspectives. Conversely, the participants aged >35 years were more likely to have inappropriate perspectives (OR=0.532, CI=0.290–0.976, p=0.042).
According to the 1989 Convention on the Rights of the Child, every child has the right to receive comprehensive protection from all forms of maltreatment (1). However, maltreatment remains a serious global issue and continues to be reported in various countries (2). Children with autism spectrum disorder (ASD) are at a high risk of parental maltreatment (3), particularly physical and psychological forms (4). Maltreatment can cause negative effects on children with ASD including increased attention deficits, and attachment problems, potentially leading to hyperactivity, aggression, and anger (5). In severe cases, maltreatment can even result in death (3). However, some parents in developing countries still use physical (Hitting) and psychological maltreatment (Shouting or threatening to harm or kill) when interacting with children with ASD (4). A similar situation has been reported in Indonesia, where acts of maltreatment (e.g., pinching) are used as part of parenting strategies for these children (6).
Parents have been reported to experience more difficult challenges in raising children with ASD compared to raising children with other developmental disorders (7), due to limitation in social interaction, communication, behavioral patterns, and unusual activities in children with ASD (8), are what may underlie parents having inappropriate perspectives that tolerate the maltreatment of children with ASD. Parental perspectives can affect the parenting patterns for children with ASD (9). Inappropriate perspectives that tolerate maltreatment can lead to violent parental responses to the behaviors of children with ASD, potentially contributing to the increased risk of maltreatment in this population. Exploring parental perspectives on maltreatment and their associated factors can provide deeper insights into maltreatment of children with ASD.
Limited studies have specifically examined parental maltreatment of children with ASD in developing countries, including Indonesia. Most research has focused on developmental disorders associated with a high risk of maltreatment (10), the types of maltreatment commonly experienced by children with ASD (4,10-12), and contributing factors such as parenting stress (11) and cultural influences (13) that increase the risk of parental maltreatment of children with ASD. This study aimed to explore parental perspectives on maltreatment of children with ASD and their associated factors in Indonesia.
Methods
Study design and setting
A cross-sectional study was conducted from January to March 2023 in two major cities, namely Pontianak and Singkawang in West Kalimantan Province, Indonesia, evaluating 345 parents caring for children with ASD. These cities were selected because they are representative of different regions in Indonesia. We sent research permission letters to all 70 schools for children with special needs and child development facilities in the two cities. Of these, 53 schools and facilities granted approval for us to collect data at their institutions. Participants were selected by consecutive sampling by these institutions. We held meetings with principals of schools for children with special needs and heads of child development facilities to discuss this study. Principals and heads then gathered parents of children with ASD for scheduled information sessions, and we explained the purpose and confidentiality of the study verbally and in writing. Parents who agreed to participate in the study signed a consent form. Parents caring for children with ASD aged ≥2 years were included in this study. They were recruited through schools and facilities for children with special needs, and they provided informed consent after receiving information about the study’s purpose, benefits, and risks. Parents whose children had chronic illnesses or multiple disabilities, as documented in medical records at each study site, were excluded. For parents who were unable to attend on the scheduled days, follow-up opportunities were provided within the same data collection period. Data were collected using a self-administered printed questionnaire in Indonesian.
Measurement tools
The questionnaire was developed by a multidisciplinary team of experts in the development of children with ASD. It collected information on participant demographics and characteristics of children with ASD across 12 categories: perspectives on parental maltreatment of children with ASD, using 3 questions based on original research (14), scored using the Guttman Scale (1 for a correct answer and 0 for an incorrect answer); knowledge of typical development and ASD, using 7 questions, each based on child developmental milestones (15), maternal and child monitoring books used in Indonesia (16), published surveys (17,18), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria for children with ASD (8), evaluated using the Guttman Scale (1 for a correct answer and 0 for an incorrect answer); awareness of the attachment behaviors of children with ASD, using 5 questions based on original research (14,19,20), scored using a 2-point Likert scale (1 for disagree; 2 for agree); and support needs in caring for children with ASD, using 10 questions based on original research (21-27), assessed using a 2-point Likert scale (1 for no need; 2 for need). Two parents of children with ASD and three experts on ASD in Indonesia tested the content validity of the questionnaire. Parents rated the clarity of the questionnaire on a scale of 1 (Very unclear) to 5 (Very clear). The average clarity score was 4.9, with a standard cut-off point of 3.0, indicating that the questions can be understood clearly. The relevance of the questionnaire yielded an average score of 0.98 (S-CVI/Ave=0.90) (28), demonstrating that the questions are substantially relevant to the research topic. Conversely, the clarity assessment by experts showed an average score of 0.98 (S-CVI/Ave=0.90) (28), which indicated that the questions can be clearly understood.
Statistical analysis
Descriptive statistics including percentages and frequencies were used to describe the data. We categorized perspectives on maltreatment into two categories (Appropriate and inappropriate) adjusted to the Indonesian context. A total score of ≥2 was considered to indicate an appropriate perspective on maltreatment of children with ASD. For univariate analysis of categorical data, we used the chi-square test. Multivariate logistic regression analysis with a stepwise method was utilized to determine the factors influencing parental perspectives on maltreatment. We conducted a multicollinearity test and found that all variables had a variance inflation factor (VIF) score below 5, which indicates that there are no serious multicollinearity concerns. Model fit was determined using the Hosmer-Lemeshow test. P-values less than 0.05 were considered statistically significant. All data analyses were performed using IBM SPSS Statistics 29.
Results
This study included 251 participants, with a response rate of 72.8%. The majority were mothers (84.9%), with a mean age of 38.1 ± 7.1. The majority were aged >35 years (60.6%). Most children with ASD were boys (72.5%) and were aged ≥6 years (73.7%). Only 32.7% of participants had the appropriate perspectives that children with ASD should not be maltreated. However, when responding to statements that children with ASD only understand commands if their parents shout at them, threaten them, or pinch them, 53.8%, 66.1%, and 62.6% of participants, respectively, had appropriate perspectives.
The majority of the participants aged >35 years (60.6%) and more participants with children with ASD aged ≥6 years (78.7%) held inappropriate perspectives (Table 1). Approximately 46.2%, 49.0%, and 52.6% of the participants correctly identified crucial signs for recognizing early ASD symptoms such as limited eye contact, communication, and social interaction, respectively. These proportions were smaller than those for the other four items. Regarding knowledge about ASD, 73.3% and 74.5% correctly answered that children with ASD have hypersensitivity and that ASD can be cured with medication, respectively. The remaining five items had higher correct response rates (Table 2). More than 50% of the participants reported difficulties in interpreting the wishes expressed by their children with ASD (Table 3).
Over 80% of the participants indicated needing pre-diagnosis support through education on typical development and ASD. Approximately 88.8% reported needing post-diagnosis support through programs that guide appropriate responses to children with ASD and emotional support from healthcare professionals to encourage their child’s development (Table 4).
Table 5 shows the results of the logistic regression analysis. The participants whose first child did not have ASD (Odds ratio [OR]=2.240, confidence interval [CI]=1.227–4.090, p-value [p]=0.009), who had knowledge of typical development (OR=1.254, CI=1.048–1.499, p=0.013) and ASD (OR=1.743, CI=1.316–2.309, p=<0.001), and who stated needing pre-diagnosis support (OR=1.225, CI=1.042–1.439, p=0.014) showed greater odds of having appropriate perspectives. Conversely, the participants aged >35 years were more likely to have inappropriate perspectives (OR=0.532, CI=0.290–0.976, p=0.042).
|
Table 1. Association between the participants’ demographics and perspectives on maltreatment of children with ASD
 ASD, Autism Spectrum Disorder; p-value was determined using the chi-square test. |
|
Table 2. Association between the participants’ knowledge on typical development and ASD and perspectives on maltreatment of children with ASD
 ASD, Autism Spectrum Disorder; Total (n [%]) is the total number of correct answers; a negative statement; p-value was determined using the chi-square test. Table 3. Association between the participants’ awareness of the attachment behaviors of children with ASD and perspectives on maltreatment of children with ASD  ASD, Autism Spectrum Disorder; Total (n [%]) is the total number of agreeing answers; p-value was determined using the chi-square test. Table 4. Association between the participants’ support needs in caring for children with ASD and perspectives on maltreatment of children with ASD  ASD, Autism Spectrum Disorder; Total (n [%]) is the total number of agreeing answers; p-value was determined using the chi-square test. |
|
Table 5. Logistic regression analysis of the factors associated with parental perspectives on maltreatment of children with ASD
 ASD, Autism Spectrum Disorder; CI, Confidence Interval; AOR, Adjusted Odds Ratio; CI and AOR were determined using the stepwise method; Hosmer-Lemeshow test: 0.870; Cox & Snell R2: 0.178; Nagelkerke R2: 0.248. |
Discussion
In this study, most participants considered physical and psychological maltreatment necessary to make it easier for parents to interact with children with ASD. This finding is supported by previous reports that in Indonesian culture, parental maltreatment is often interpreted as normal and is considered important to instill obedience in children including those with ASD (13). Similar findings were reported in a study conducted in Bangladesh, also a developing country, where parental maltreatment was considered necessary to help control the behavior of children with ASD (4). These findings reflect similar parental perspectives on maltreatment often seen in ASD childcare practices in developing countries.
Our findings showed that the participants aged >35 years and those whose first child had ASD were more likely to have inappropriate perspectives that tolerate maltreatment. Older parents are likely caring for older children with ASD compared to younger parents. Similar to parents of older typically developing children, parents caring for older children with ASD share similar hopes for their children’s future, including access to education and job opportunities (29). However, when hopes for their children’s future do not align with their dreams, these parents may experience hopelessness (21). Such conditions could lead to inappropriate perspectives that tolerate maltreatment.
Parenting children with ASD is often reported to trigger stress (30). This stress may be more intense for parents whose first child is diagnosed with ASD, as they typically face challenges including increased role differentiation during the transition to parenthood compared to parents with prior parenting experience (31). These challenges may hinder parents from developing appropriate perspectives in responding to their child’s behaviors. The active involvement of healthcare professionals in providing ongoing parental support, especially during transitional periods, is essential. This support can help prevent parenting stress that could lead to inappropriate perspectives on maltreatment of children with ASD.
This study found that knowledge about typical development and ASD and the need for pre-diagnosis support also influenced the perspectives on maltreatment of children with ASD. The participants who had poor knowledge about typical development and ASD and those who stated not needing pre-diagnosis support were more likely to have inappropriate perspectives. However, this may be linked to limitations within Indonesia’s ASD treatment system, including inadequate human resources, uneven distribution of facilities, and high therapy costs (32). These limitations often make it difficult for parents to determine the best support and may lead them to switch between treatment centers without clear referral systems, resulting in suboptimal care for children with ASD and further hindering parents’ understanding of the condition. Comprehensive improvements to the ASD treatment system in Indonesia are needed, including enhancing parental knowledge about child development and pre-diagnosis support, beginning with efforts to increase the competence of healthcare professionals, ensure equitable distribution of facilities, and make support services for children with ASD more affordable. This study used a cross-sectional design, which provided only an overview and allowed the interpretation of the relationship between the variables without establishing causality. Another limitation is that this study examined only parental perspectives regarding maltreatment of children with ASD, without investigating whether the parents actually engage in abusive behaviors when interacting with their children. Therefore, it remains unclear whether parents with appropriate or inappropriate perspectives are more likely to maltreat children with ASD. Further research into how parental perspectives may influence acts of maltreatment toward children with ASD is needed to provide a comprehensive understanding of parenting to prevent maltreatment, especially in developing countries. Additionally, the study data were obtained from parents living in West Kalimantan Province, which is not a metropolitan province in Indonesia. Thus, the data collected may not fully represent all regions in Indonesia. In conclusion, this study found that most parents have an inappropriate perspective that tolerates maltreatment of children with ASD. Parental perspectives that tolerate maltreatment can lead to harsh parental responses to the behavior of children with ASD, which potentially contributes to the increased risk of maltreatment in this population in developing countries such as Indonesia.
Conclusion
Most parents caring for children with ASD in Indonesia have inappropriate perspectives that tolerate maltreatment. Parental age of >35 years, first child with ASD, poor knowledge about typical child development and ASD, and lack of need for pre-diagnosis support can influence parental perspectives on maltreatment of children with ASD. Ongoing support, opportunities for socialization, and training aimed at improving knowledge of compassionate parenting and pre-diagnosis support, beginning with increasing the competence of healthcare professionals, ensuring equitable distribution of facilities, and reducing the cost of support services for children with ASD, are needed to address inappropriate parental perspectives on maltreatment of these children. Parental perspectives may influence acts of maltreatment toward children with ASD is needed to provide a comprehensive understanding of parenting to prevent maltreatment, especially in developing countries.
Acknowledgement
The authors sincere thanks to all participants and parties who have participated in this study.
Funding sources
Maternity and Child Health Nursing Department, School of Nursing, ITEKES Muhammadiyah Kalbar, Pontianak, Indonesia as research funding.
Ethical statement
This study has been reviewed and approved by the Research Ethics Committee in Indonesia (Number: 80/II.I.AU/KET.ETIK/III/2022) and also obtained administrative approval from the Ministry of Health, Ministry of Education, and the Department of Research and Development of West Kalimantan Province. All participants involved in this study have given informed consent. In addition, anonymity, the right to withdraw from the research, and data confidentiality were also ensured.
Conflicts of interest
The authors state that no conflicts of interest are present.
Author contributions
LL, design the project, data collection and formal analysis. RR, design the project, and formal analysis. RS, design the project, and formal analysis. AT, design the project, and formal analysis. All authors; Writing-review, editing, and final approval of published version.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Type of study: Original Article |
Subject:
Nursing
References
1. United Nations. The Convention on the Rights of the Child. 1989. [View at Publisher] [Google Scholar]
2. Abbasi MA, Saeidi M, Khademi G, Hoseini BL, Emami Moghadam Z. Child Maltreatment in the Worldwide: A Review Article. Int J Pediatr. 2015;3:353-65. [View at Publisher] [Google Scholar]
3. Samuel D, O'Malley F, Brink FW, Crichton KG, Duffy B, Letson MM, et al. Characterizing child maltreatment fatalities among child victims with disabilities in the United States, 2010-2019. Child Abus Negl. 2023;144:106354. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Haque MA, Islam S, Tasnim A, Salwa M, Sultana S, Akhter S, et al. Maltreatment In Autism Spectrum Disorder Children From Parent's Perspective: A Single-Cantered Cross-Sectional Studyat Dhaka, Bangladesh. Malaysian J Public Heal Med. 2021;21(2):190-8. [View at Publisher] [DOI] [Google Scholar]
5. Dion J, Paquette G, De La Sablonnière-Griffin M, Argumedes M, Martin-Storey A, Bolduc M-L, et al. Forms and correlates of child maltreatment among autistic children involved in child protection services. Front Child Adolesc Psychiatry. 2024;3:1386781. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Lestari L, Herini E, Gamayanti I. Caregivers' experience in meeting self-care needs of adolescents with autism spectrum disorder: A qualitative study. Belitung Nurs J. 2017;3(4):316-28. [View at Publisher] [DOI] [Google Scholar]
7. Yesilkaya M, Magallón-Neri E. Parental Stress Related to Caring for a Child With Autism Spectrum Disorder and the Benefit of Mindfulness-Based Interventions for Parental Stress: A Systematic Review. Sage Open. 2024;14(2):1-22. [View at Publisher] [DOI] [Google Scholar]
8. American Psychiatric Association. Understanding mental disorders: Your guide to DSM-5-TR®. American Psychiatric Pub;2023. [View at Publisher] [Google Scholar]
9. Battanta NK, Jenni OG, Schaefer C, von Rhein M. Autism spectrum: parents' perspectives reflecting the different needs of different families. BMC Pediatr. 2024;24(1):1-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Winters N, Langer L, Geniets A. Physical, psychological, sexual, and systemic abuse of children with disabilities in East Africa: Mapping the evidence. PLoS One. 2017;12(9):e0184541. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Aini RN, Susanto T, Rasni H. Parenting Stress and Physical Abuse against Children with Disabilities. Inklusi. 2020;7(1):151-66. [View at Publisher] [DOI] [Google Scholar]
12. Mohammadi F, Rakhshan M, Molazem Z, Zareh N, Gillespie M. Parents' perspectives on Family Violence against children with Autism. Arch Iran Med. 2019;22(9):505-10. [View at Publisher] [PMID] [Google Scholar]
13. Kosmah Dewi RF, Kusnandi Rusmil V, Rahayuningsih SE, Mutyara K, Arisanti N, Sekarwana N, et al. Cultural perceptions of child abuse in terms of parents' perspective: a qualitative study in Bandung-Indonesia. J Community Empower Heal. 2023;5(3):191-201. [View at Publisher] [DOI] [Google Scholar]
14. Keenan BM, Newman LK, Gray KM, Rinehart NJ. Parents of Children with ASD Experience More Psychological Distress, Parenting Stress, and Attachment-Related Anxiety. J Autism Dev Disord. 2016;46(9):2979-91. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Center for Disease Control and Prevention. CDC's developmental milestones. 2022. [View at Publisher] [Google Scholar]
16. Ministry of Health of the Republic of Indonesia. Public health program indicators in the RPJMN and the Ministry of Health's strategic plan for 2020-2024. Jakarta: Ministry of Health of the Republic of Indonesia; 2020. [View at Publisher] [Google Scholar]
17. Tipton LA, Blacher J. Brief report: Autism awareness: Views from a campus community. J Autism Dev Disord. 2014;44(2):477-83. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Shrestha R, Dissanayake C, Barbaro J. Caregivers' knowledge of autism in a local peri-urban community of Nepal: A cross-sectional study in Kirtipur, Kathmandu. Res Autism Spectr Disord. 2021;80(November 2020):101696. [View at Publisher] [DOI] [Google Scholar]
19. Teague SJ, Newman LK, Tonge BJ, Gray KM, team M. Caregiver Mental Health, Parenting Practices, and Perceptions of Child Attachment in Children with Autism Spectrum Disorder. J Autism Dev Disord. 2018;48(8):2642-52. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Oppenheim D, Koren-Karie N, Joels T, Hamburger L, Maccabi Y, Slonim M, et al. Attachment to fathers and mothers in preschoolers with an Autism Spectrum Disorder diagnosis. Attach Hum Dev. 2022;24(5):645-58. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Gentles S, Nicholas DB, Jack SM, Mckibbon KA, Szatmari P. Coming to understand the child has autism :A process illustrating parents ' evolving readiness for engaging in care. Autism. 2020;24(2):470-83. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Goh JX, Aishworiya R, Ho RCM, Wang W, He HG. A qualitative study exploring experiences and support needs of parents of children with autism spectrum disorder in Singapore. J Clin Nurs. 2021;30(21-22):3268-80. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Viana CR, Caldeira S, Lourenço M, Figueiredo AS. Parenting of children with Autism spectrum Disorder:A Grounded Theory Study. Healthcare (Basel). 2021;9(7):872. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Abela JRZ, Hankin BL, Haigh EAP, Adams P, Trayhern L, Vinokuroff T, Trayhern L . Interpersonal vulnerability to depression in high-Risk children: the role of insecure attachment and reassurance seeking. J Clin Child Adolesc Psychol. 2005;34(1):182-92. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Smith-Young J, Chafe R, Audas R. "Managing the Wait": Parents' Experiences in Accessing Diagnostic and Treatment Services for Children and Adolescents Diagnosed With Autism Spectrum Disorder. Health Serv Insights. 2020;13:1178632920902141. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. Frolli A, Bosco A, Carmine F Di, Cavallaro A, Lombardi A, Sergi L, et al. Parent Training and Therapy in Children with Autism. Pediatr Rep. 2021;13(2):216-26. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Wright B, Edginton E. Evidence-Based Parenting Interventions to Promote Secure Attachment: Findings From a Systematic Review and Meta-Analysis. Glob Pediatr Heal. 2016;3:2333794X1666188. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? critique and recommendations. Res Nurs Health. 2006;29(5):489-97. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Chun J, Curtiss SL, Richard C, Zhou K, Rios YC, Park S, et al. Where Does Hope Lie? The Dialectical Tensions Between Hopes and Expectations of Vocational Transition Planning from the Perspectives of Autistic Young Adults, Parents, and Practitioners. J Autism Dev Disord. 2025;55(5):1857-75. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Warreman EB, Lloyd SE, Nooteboom LA, Leenen PJM, Terry MB, Hoek HW, et al. Psychological, behavioural, and physical aspects of caregiver strain in autism-caregivers: a cohort study. EClinicalMedicine. 2023;64:102211. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Dijkstra-de Neijs L, Boeke DB, van Berckelaer-Onnes IAV, Swaab H, Ester WA. Parental Stress and Quality of Life in Parents of Young Children with Autism. Child Psychiatry Hum Dev. 2024;(0123456789). [View at Publisher] [DOI] [PMID] [Google Scholar]
32. Yanti NH, Habibah M, Rafiek M. Proses Dan Tantangan Terapi Applied Behaviour Analysis Pada Anak Autis. J Psikol dan Bimbing Konseling. 2024;7(2):1-6. [View at Publisher] [DOI] [Google Scholar]
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