The Experience of Chinese Parents of Children with Language Development Delay(LDD) in Family Intervention under the ABC-X Model: A Qualitative Study

The Experience of Chinese Parents of Children with Language Development Delay(LDD) in Family Intervention under the ABC-X Model: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Experience of Chinese Parents of Children with Language Development Delay(LDD) in Family Intervention under the ABC-X Model: A Qualitative Study Xuxing Lin, Lijiao Cai, Wenjuan Yan, Hongjuan Zhou, Yingying Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8408915/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Childhood language development delay (LDD) has emerged as a pressing global public health challenge, and targeted family interventions are pivotal to enhancing prognostic outcomes in the context of China. Objective: Drawing on the ABC-X model, this study investigates the experiences of Chinese parents of children with LDD throughout family interventions, examining their stressors, resources, perceptions and coping strategies. Methods: A qualitative study was performed at Fujian Maternity and Child Health Hospital (June–October 2025) among parents of children with LDD undergoing parent-implemented intervention (PII). Family sociodemographic data, children’s clinical baseline information, and family intervention profiles were collected. After pre-surveying three parents to refine interview questions, in-depth semi-structured interviews were conducted with 20 parents; audio recordings were analysed via Colaizzi’s seven-step method. Results: A dynamic "Pressure-Resources-Perception-Adaptation" model was established, with four key themes identified: (1) Pressure: coexistence of multiple pressures in family intervention; (2) Resources: insufficient support systems; (3) Perception: divergent parental cognition of family intervention; (4) Adaptation: varied family intervention capabilities. Conclusion: Parents of children with LDD face multiple pressures during family intervention; inadequate coping resources, unmet social support demands and negative perceptions tend to lead to passive coping. Future parent-centred support programs based on family stress theory should reduce specific pressures, establish systematic support resources, promote positive cognitive restructuring, strengthen family resilience, and thereby enhance intervention effectiveness and improve children’s LDD prognosis. Language development delay Parent-implemented intervention ABC-X model Qualitative research Parents Introduction Language developmental delay (LDD) refers to children with age-discordant language acquisition, excluding delays caused by articulation disorders or hearing impairments.(Nudel et al., 2023 ) LDD is globally prevalent, with international studies reporting 3%-19% among preschoolers (highest in two-year-olds) and Chinese data showing ~ 17% in children under two, declining to 3%-7.5% in older preschoolers.(Reilly et al., 2018 ; Wu et al., 2023 ) LDD imposes multidimensional adverse impacts on children and families. For children, impaired communication leads to cascading sequelae: cognitively, elevated risks of reading and math difficulties by age five, and 4–6 times higher likelihood of subsequent literacy/numeracy disorders even if preschool language development normalizes; psychosocially, associations with challenging behaviours, emotional dysregulation, and increased vulnerability to anxiety/depression (persisting into adolescence/adulthood), alongside higher risks of alcohol/substance abuse in adulthood.(J. K. Heidlage et al., 2020 ) For families, children’s limited ability to express needs exacerbates parental caregiving stress and powerlessness. Mothers of children with LDD experience significantly higher stress and reduced quality of life, perpetuating a vicious cycle of elevated parental stress, impaired parent-child interaction, and worsened behavioural problems in children. Early intervention is critical for improving LDD prognosis, as it enhances language abilities, optimises academic and socioemotional functioning, reduces long-term adverse outcomes, and lowers the risk of poor language comprehension by 39%.(Roberts et al., 2019 ) In China, rehabilitation services are primarily delivered in hospital or specialised institutional settings, with core intervention strategies including language training, social skills training, and sensory integration training. These modalities are often combined with traditional Chinese medicine (TCM), physical therapy, and family-centred training programs. Clinical intervention content is individualised based on results of the S-S Language Development Assessment and the child’s functional capabilities, with comprehensive training established as the cornerstone of the overall intervention framework. As a vital adjunct to professional institutional care, parent-implemented intervention (PII) plays a pivotal role in pediatric language rehabilitation. Given that most children acquire language competencies through high-quality parent-child interactions, parents who integrate targeted intervention practices into home environments, in addition to adhering to therapist-guided rehabilitation protocols, can achieve synergistic therapeutic effects. Cumulative empirical evidence confirms that parental proficiency in language-facilitation strategies and consistent implementation of family-based interventions effectively improve children’s language performance, alleviate receptive and expressive language deficits, expand expressive vocabulary repertoires, and enhance syntactic competence. These outcomes are comparable to those of professional speech-language therapy, while PII also exerts a favourable influence on infants’ long-term neurodevelopmental trajectories. However, parental cognition and engagement in PII are markedly insufficient. Only 53.3% of parents recognise the necessity of family intervention, and most do not prioritise home-based therapy. Additionally, 64.6% of families frequently fail to complete prescribed training. Within the Chinese sociocultural context, unique barriers exist. Deep-rooted beliefs, such as the notion that “noble children speak late,” lead some families—especially grandparents—to misclassify LDD as a normal individual difference or a sign of “late blooming.”(Huiyan et al., 2023 ) This fosters wait-and-see attitudes toward early warning signs. Only 12.38% of children with LDD receive medical consultation before age two, and most families seek care when their children are non-verbal between 1.5 and 3.5 years. This undoubtedly causes them to miss the critical intervention window before age three. Furthermore, in Mandarin-speaking households in mainland China, PII efficacy is further limited by inadequate parental interaction skills, bidirectional parent-child influence, and suboptimal interaction environments.​ Existing research notes that parents of children with LDD face complex stress during PII, including role strain, skill deficits, and cultural conflict. However, current studies primarily focus on PII efficacy or analyse parent-child interaction issues from a therapist’s perspective, and they neglect the lived experiences of parents as core implementers. Notably, qualitative research on the PII experiences of Mandarin-speaking Chinese parents of children with LDD remains scarce. Globally, early childhood development is a core target of the United Nations Sustainable Development Goals (SDGs), specifically the goal to “ensure all children access quality early development services.” Understanding the real-world PII experiences of Chinese parents thus not only safeguards individual family well-being but also provides a basis for optimising grassroots early intervention systems and advancing the localization of global development agendas.​ To systematically unpack the “stress-coping-adaptation” psychological process of parents implementing PII for children with LDD, this study adopts Hill’s ABC-X family stress model, which includes four core elements: A (stressor event), B (resources), C (stress perception), and X (stress outcome). A and B interact to shape C, which further modulates X.(Frishman et al., 2017 ; Liu & Zhang, 2024) Didericksen et al. (Didericksen et al., 2019 )refined the model by expanding X from “crisis” to the more comprehensive “parental coping strategies.” Unlike traditional linear “stressor→crisis” stress theories, the ABC-X model incorporates the regulatory roles of resources and perception, aligning with the “person-in-environment” holistic perspective and thus suiting this study.(Ballard et al., 2020 ) Guided by this model as the analytical framework, this parent-centred study explores the lived PII experiences of parents of children with LDD, aiming to address the scarcity of qualitative research on Chinese parents’ PII experiences and provide empirical evidence for developing culturally appropriate home and community-based interventions. Methods This study adopted a qualitative descriptive design to comprehensively explore parents’ experiences of implementing interventions for children with LDD. This methodological approach is widely acknowledged as effective for capturing rich, detailed insights into participants’ perceptions of specific phenomena or events.(Lim, 2024) The ABC-X Model served as the analytical framework, where A denotes the stressor (specifically the implementation of family-based interventions for children with LDD), B represents resources (encompassing personal, familial, and social resources), C refers to stress perception (namely parents’ perceptions and interpretations of the family intervention process), and X signifies the stress outcome. Parental behavioural coping strategies can reflect the magnitude of stress induced by the intervention process, and parents’ intervention competence was used as the indicator of stressor-induced outcomes in this study. Notably, the three core determinants (A, B, and C) are mutually influential, and their synergistic interactions collectively shape the final stress outcome (X).(Liu & Zhang, 2024) Ethical approval for this study was granted by the Ethics Committee of Fujian Health College (IRB No.: RT2025-05). Population The study population comprised parents of children diagnosed with language development delay (LDD). To ensure parents could accurately and comprehensively recall their family intervention experiences, all interviews were scheduled at least one month after the initiation of family-based interventions. Inclusion criteria were defined as follows: (1) The child, aged 2–6 years, was diagnosed with LDD using the S-S method;(Dingxu & Yang, 2020) (2) The child received outpatient rehabilitation training 2–3 times weekly, with each session lasting ≥30 minutes for a minimum of one month; (3) The parent was the primary implementer of therapist-assigned family intervention tasks; (4) The parent had no communication barriers and could articulate their experiences clearly; (5) The parent provided written informed consent and voluntarily participated in the study. Exclusion criteria included: (1) The child had comorbid conditions such as cerebral palsy, cleft palate, genetic disorders (e.g., Down syndrome), neurodevelopmental abnormalities (e.g., epilepsy), or autism spectrum disorder; (2) The child had severe visual or hearing impairments; (3) The parent discontinued family interventions midway or failed to implement them as required; (4) The parent had a history of severe mental illness or cognitive impairment; (5) The family was concurrently enrolled in other interventional clinical trials related to child language development. Participants were purposively sampled to maximise variability (maximum variation purposive sampling) in parent age, educational level, occupation, and monthly household income, as well as child age and intervention duration, thereby enhancing sample representativeness. The final sample size was determined by data saturation. No new themes emerged after interviewing 17 participants; three additional interviews were conducted to confirm saturation, with no novel insights identified. Recruitment was thus terminated, yielding a final sample of 20 participants (19 mothers and 1 father) and a total of 22 interviews completed. Specifically, 18 participants provided complete data in a single interview. Two participants had their initial interviews interrupted—one due to the completion of the child’s rehabilitation course and the other due to urgent childcare needs. To ensure data completeness, a supplementary interview was arranged for each participant by mutual agreement within 72 hours of the initial interview, minimising recall bias. Integrated data from these two participants were included in the final analysis. Family Intervention Content The family-based interventions implemented by parents were based on standardised assessments of children with LDD, including the 0–6 Years Old Child Development and Behaviour Assessment Scale and the S-S Method.(Miller et al., 2012) Individualised education programs (IEPs) were developed according to the assessment results and adjusted dynamically as the children progressed in rehabilitation. The intervention content focused on core abilities such as basic social communication skills, language comprehension, and expressive language abilities.(Matte-Landry et al., 2020) Specifically, after each outpatient rehabilitation session, speech therapists assigned targeted home training tasks for parents to implement, such as gross motor imitation exercises (raising hands, touching the head, patting the abdomen) and functional verb application drills (“point to”, “give me”, “put it in my hand”). Meanwhile, parents participated in structured online training courses covering four modules: course overview and intervention environment setup, prelinguistic skill development, oral language induction strategies, and practical video demonstrations with interactive Q&A. These courses aimed to improve parents’ ability to carry out home interventions. Data Collection From June 2025 to October 2025, purposive sampling was employed to recruit participants who met the predefined inclusion criteria. Following the acquisition of written informed consent from the eligible participant, an appointment was scheduled for one-on-one interviews. To safeguard participants’ privacy, all subjects were assigned anonymous codes (N1–N20) throughout the study. Data collection was conducted via semi-structured interviews of approximately 1 hour in duration, which were held in the Parent Reception Room of the Department of Pediatric Rehabilitation. The venue was characterised by a quiet, private, and undisturbed setting, with adequate ventilation, sufficient lighting, and a face-to-face seating arrangement to facilitate effective communication. The interview content was designed to guide participants in retrospectively reflecting on their experiences with family-based interventions for children with LDD. Specifically, the interviews explored the participants’ comprehensive perceptions of LDD rehabilitation training, practical implementation strategies of family-based interventions, approaches to addressing encountered challenges, unmet support needs, and subjective experiences throughout the intervention process. A structured data collection form was developed to gather information regarding the participants’ demographic and clinical characteristics. This form contained three core sections: (1) parental information, including age, gender, educational background, occupation, household income, and relationship to the child; (2) child-related information, covering current age and gender; and (3) intervention-related information, such as total duration of intervention, weekly frequency of family-based training sessions, and daily duration of family-based training. Furthermore, based on the ABC-X theoretical model, the study objectives and research content, the initial draft of the interview guide was designed following an extensive literature review and in-depth team discussions. A pilot interview was conducted with three parents of children with LDD, and the preliminary interview guide was then submitted to a panel of three experts for review and revision. The expert panel consisted of one speech-language pathologist, one developmental-behavioural paediatrician, and one senior rehabilitation nurse, all of whom held senior professional titles and possessed over a decade of clinical experience in pediatric language rehabilitation. The final version of the interview guide was finalised according to the experts’ evaluations and is provided in Supplementary Material 1. The interview guide was designed with flexibility to allow progressive adjustments throughout the study. These adjustments were made by a researcher specialising in qualitative research methods, based on real-time practical circumstances, to ensure alignment with emerging research insights. All interviews were conducted by the same trained researcher (XXL) to maintain consistency in data collection. During the interview process, efforts were made to establish a trusting relationship with participants and to foster open and honest dialogue. In instances where parents exhibited severe emotional distress during interviews, the interview was immediately suspended. The research team then provided timely psychological support, and interviews were resumed only after the parent had regained emotional stability and provided voluntary consent to continue. Interview content was recorded using a secure digital voice recorder to ensure data integrity and accuracy. Within 24 hours of each interview, the audio recordings were fully transcribed verbatim using professional word processing software. Before data analysis, all transcribed texts underwent anonymisation to protect participant privacy, with identifying information (e.g., names, addresses) removed or replaced with study-specific codes. For this manuscript, any excerpts of transcribed text cited were presented in the participants’ original wording; a native English-speaking professional translator translated these excerpts to ensure accuracy and linguistic authenticity. Analysis of results Upon completion of interview transcription, Interpretative Phenomenological Analysis (IPA) was adopted for data analysis, a methodological approach uniquely suited to exploring individual participants’ subjective experiences and lived realities regarding family-based interventions for children with LDD. (Kelly, 2023)Transcribed texts were imported into NVIVO 12© software to facilitate the systematic identification of themes embedded within participants’ narrative accounts. Specifically, the analytical process entailed repeated close reading and open coding of the textual data to distil the core essence of participants’ discourses. Codes were then categorised into distinct themes, with recurrent themes further aggregated into overarching meta-themes to synthesise the collective narrative of the study cohort. Each meta-theme was explicitly linked to its constituent sub-themes, which in turn were anchored to original codes and verbatim interview excerpts, ensuring a transparent and traceable analytical trail.(Campbell et al., 2011) To enhance the methodological rigour and trustworthiness of the study findings, primary data analysis was conducted by one researcher (XXL). This was followed by triangulation verification performed by an additional four researchers (LJC, WJY, HJZ, YYZ), all of whom possessed substantial expertise in qualitative research methodologies; among them, three (LJC, WJY, YYZ) held specialised knowledge in adolescent psychiatry. After independent analyses, the study findings were further deliberated and cross-validated in a dedicated qualitative research workshop. Throughout the entire research process—from study conceptualisation to result interpretation—a reflexive journal was maintained by the research team, documenting individual team members’ prior beliefs, interpretive biases, and hypothetical assumptions related to the research topic. Additionally, regular team meetings were held to discuss researchers’ evolving perspectives on the study topic, interview data, and preliminary findings, with the explicit aim of critically examining how these subjective viewpoints might have influenced the research process and outcomes. Results Based on the ABC-X model, an in-depth thematic analysis of semi-structured interview data identified four core themes with corresponding sub-themes. These themes were explicitly mapped to the stressor (A)—specifically, the implementation of family-based interventions for children with LDD—coping resources (B) encompassing personal, familial, and social resources, stress perception (C), namely parents’ perceptions and interpretations of the family intervention process, and stress outcome (X) components of the model. This analytical framework systematically delineates the dynamic interplay underlying the “Stressor-Resource-Perception-Outcome” cascade among parents implementing family-based interventions for children with LDD. Table 1 summarises the participants’ basic characteristics. The thematic categories and their intrinsic associations are visualised in Table 2 . Stress Dimension (A): Coexistence of Multiple Stresses in Family Interventions The stress dimension (A) corresponds to the core stressor events in the ABC-X model. It delineates a multifaceted stress system associated with family-based interventions, which encompasses three distinct layers of burden: parental, child-characteristic, and economic. These three burden categories constitute the primary stressors that exert a direct impact on parents’ implementation of intervention behaviours. Parental Stress at the Individual Level Parents bear direct stress associated with the responsibilities and skills required for implementing family-based interventions. Conflicts in the Allocation of Intervention Responsibilities : Regarding conflicts in the allocation of intervention responsibilities, family intervention tasks were highly concentrated on primary caregivers (with mothers being the most representative group), who were required to simultaneously manage multiple pressures, including engagement in paid employment and caregiving for other children. “I work days. Evenings involve post-work dinner prep and bathing him, and it’s almost his bedtime after that. With little time for training, I only do a quick homework review before he sleeps daily.”P01. Bottlenecks in the Application of Intervention Skills Most parents reported significant barriers to translating the skills they had learned into practical, effective interactive practices with their children. “I don’t know if I’m giving the wrong instructions. When he plays with cars and I ask what color the car is, he just pushes the car aside and plays with other things right away.”P05. Physical and Mental Fatigue Under Intervention Pressure The challenge of juggling hospital-led rehabilitation programs and family-initiated intervention activities takes a toll on parents’ physical and mental well-being. Some participants explicitly articulated their overwhelming fatigue. “The two-hour round trip to the hospital alone is utterly draining. Emotionally, I feel completely worn out—there are nights when I lie awake, unable to fall asleep without relying on medication.” (Participant 04) Intervention Challenges Stemming from Child Characteristics The innate developmental characteristics of children with LDD act as unpredictable and persistent stressors throughout the entire course of family intervention. Difficulty Sustaining Attention and Cooperation Excessive environmental distractions in the home setting posed a major barrier to establishing a focused intervention space. “The home environment is too familiar. He touches everything in sight, runs off midway through the session, and it’s hard to get him back on track.” P08. Emotional and Behavioural Challenges as Barriers to Intervention Adherence Children’s emotional and behavioural dysregulation often disrupts the continuity of intervention implementation and may even escalate into parent–child conflicts. I feel utterly helpless. He knows exactly how to push my buttons—he simply refuses to cooperate with me and throws full-blown tantrums. Once he gets worked up like that, there’s no point in attempting any teaching or intervention activities. Economic Burden Beyond the direct financial costs of rehabilitation training, many parents face substantial economic strain stemming from two primary sources. First is the necessity of relinquishing employment to ensure uninterrupted intervention participation. “I quit my job to accompany my child to intervention sessions. Our family now depends entirely on my husband’s income, and our finances have become extremely tight.”P03. Second is the accumulation of additional expenses—such as rental fees for accommodation near intervention centres, which families incur to reduce travel-related barriers and burdens. “If we knew exactly how much longer the intervention would last, we might even borrow money to get by. But if it requires an indefinite duration, the subsequent costs would be completely unsustainable.”P12. This persistent financial pressure indirectly constrains the time and energy parents can allocate to the consistent implementation of family-based intervention activities. Resource Dimension (B): Deficiencies in Family Coping Resources Within the ABC-X model, Resource Dimension (B) corresponds to the coping resources available to families. When facing Component A (intervention-related pressures), families exhibit notable deficiencies in both internal and external support resources—specifically encompassing three key domains: inadequate family internal support, insufficient professional guidance from hospitals, and limited community/peer support. The scarcity of these critical resources directly impairs families’ capacity to regulate cumulative pressure and execute effective intervention strategies.​ Breakdown of the Family Internal Support System Deficiencies in Spousal Support Within Family Internal Resources A critical manifestation of inadequate family internal support lies in the lack of effective spousal support—specifically, spouses often fail to share intervention-related responsibilities substantially or provide emotional backing, leaving primary caregivers to cope with intervention burdens independently. This dynamic was reflected in Parent P13’s experience of being blamed rather than supported They blame me for our child’s speech delay, saying I’m the reason the child is like this. Hearing that makes me shake with anger, and now they won’t even lift a finger to help with the training. Similarly, the father of Parent P18’s child cited “inability to participate” as a reason to avoid involvement: I’m busy with work and social engagements—I really can’t manage. Everything has to be left to the mother. Deficiencies in Intergenerational Support Within Family Internal Resources Grandparents, constrained by personal limitations (e.g., dialect barriers, insufficient educational attainment) or cognitive biases, are generally only able to provide daily living care. They often show reluctance to participate in intervention-related tasks and struggle to offer meaningful support for intervention implementation. “The child’s grandparents are from rural areas and usually only speak their local dialect... They feel they can’t even speak standard Chinese themselves, so there’s no way they can help teach the child.”P07. “My parents believe that educating a child is solely the parents’ job... They’re willing to help with daily care, but ‘teaching tasks’ like reading or using flashcards—they refuse, afraid they’ll teach the child incorrectly.”P17. Weaknesses in the Hospital Professional Guidance System The professional guidance provided by hospitals exhibits notable shortcomings in three core dimensions: accessibility, depth, and continuity—factors that collectively hinder alignment with parents’ practical learning needs for intervention implementation. “The offline guidance sessions are too short—just five minutes. I often don’t fully understand the content, and sometimes communication with the teacher over WeChat isn’t clear either. In the end, I just stop asking.”p13. Insufficiency of Community Support Systems Lack of Specialised Rehabilitation Resources : ​A critical manifestation of community support inadequacy lies in the scarcity of specialised child rehabilitation resources—particularly prominent in rural and town communities. This deficiency manifests in two key ways: first, the absence of dedicated child rehabilitation facilities, which forces families to seek services at urban institutions and incurs additional intervention-related costs. “Our town has no specialized child rehabilitation institutions or hospitals. To give my child better training, I had to rent a place near the urban hospital—there’s no other choice.”​P03. Second, the over-reliance on generic theoretical guidance in community support, with a lack of practical, actionable strategies tailored to intervention needs. “The community organized a parent lecture, but it only covered general principles. When I asked specifically, ‘What should I do if the child doesn’t follow instructions?’ I didn’t get any practical guidance at all.”P15. Both issues further amplify the logistical and psychological burdens on parents, weakening the community’s role as a supplementary support hub. Unmet Needs for Social Peer Support Another notable gap in community support is the lack of effective communication channels and support networks for families with similar child intervention needs. This inadequacy leaves parents’ core needs largely unmet, including those for emotional resonance and targeted information sharing, as they lack accessible platforms to connect with peers of comparable experiences. Unmet in this way, parents become further isolated, worsening their psychological burden during ongoing interventions. “Peer support is critical—we could share useful information with each other. I wish parents whose kids have made quicker progress would share their training experiences; that would help us a lot.”P17. “The last thing I want to hear is ‘the child will be fine when they grow up.’ How could it be that simple? I really wish I could talk to other parents who have similar experiences—so we could comfort each other and feel less alone.”​P18. Cognitive Dimension (C): Variations in the Cognitive Level of Family Intervention The cognitive dimension (C) aligns with the conceptualisation and assessment of stressful events as defined in the model. Our study demonstrated that parents exhibit marked heterogeneity in their cognitive appraisals of family intervention. This cognitive evaluation is bidirectionally modulated by both stressors (A) and resource availability (B), and in turn exerts a regulatory effect on the ultimate stress response (X). Positive Cognition: Facilitating Engagement in Family Intervention Despite confronting multiple practical challenges, a subset of parents in this study expressed strong endorsement of the value of family intervention. Several participants emphasised the irreplaceable role of family-based practice. “Home practice is essential; children require consistent, repeated practice to achieve meaningful progress.” P01. Another parent (P07) corroborated the immediate, tangible benefits of intervention through direct observation, which further consolidated their confidence in sustaining the intervention process. Consistently completing family practice has yielded remarkable changes in our child— the effects are truly immediate and noticeable. Negative Cognition: Impeding Adherence to Family Intervention Cognitive Role Conflict A prominent cognitive barrier identified was the pervasive role conflict experienced by parents, who struggled to reconcile their dual identities as emotionally supportive caregivers and structured intervention implementers. “I fully understand that family-based intervention must be sustained, yet I lack the professional know-how to guide my child effectively, and he often refuses to cooperate. Such specialized work truly feels beyond the capacity of non-professionals— it should be left to trained therapists.”P04. Participant P08 offered a more vivid illustration of this dilemma. Trying to act as an interventionist at home is incredibly challenging. The moment I pull out the intervention flashcards, he immediately yells, ‘Class is over! Class is over!’ Internalisation and Intergenerational Conflicts of Traditional Beliefs The internalisation of traditional beliefs, such as the folk adage “Noble infants speak late,” has evolved into a salient source of negative cognition within families in China. It particularly sparks intergenerational discord that directly undermines the acceptance of evidence-based intervention strategies. “Aligning the whole family on the value of intervention is incredibly challenging. Elders cling to the ‘noble infants speak late’ notion, asserting that children will naturally develop language skills as they grow, and that formal intervention is a waste of time and money. They immediately remove the child whenever I try to start a home training session.”P13. “My child’s grandmother argues that my husband did not speak in full sentences until age three, yet turned out fine, dismissing my intervention efforts as pointless fussing. This forces me to conduct family training secretly behind closed doors.”P20. Adaptive Dimension (X): Disparities in Family Intervention Capacities The adaptive dimension (X) represents the ultimate outcome of the ABC-X model, emerging from the intricate interplay of stressors (A), coping resources (B), and cognitive appraisals (C). The present study identifies two distinct developmental pathways of family intervention adaptation. Positive Outcomes: Significant Effectiveness of Family Intervention When facing family intervention, the effective use of resources and a good cognitive level helped caregivers cope with stress, ultimately achieving positive results. Deepened Parent-Child Bonding Sustained engagement in intervention-related interactions allowed parents to accurately discern their children’s nuanced needs, fostering a progressive deepening of mutual understanding and trust between caregivers and children. “I used to constantly worry that my limited educational background would hold my child back. Yet through consistent accompaniment and repeated practice sessions, I have become the person he trusts most. This feeling of being genuinely needed brings immense joy.”P06. Parents’ Self-Growth and Enhanced Self-Efficacy Through hands-on engagement in intervention practices, parents gradually mastered core intervention techniques and accrued practical experience, which in turn translated into a marked boost in their confidence and problem-solving competence. “When the therapist first advised me to continue intervention with my child at home, I was utterly at a loss. Now, no matter what new training tasks arise, I feel fully confident in addressing them, and my mind is clear and focused.”P12. “Every time my child utters a new word, a surge of immense pride washes over me.”P19. Empowerment of Support Systems Access to effective support serves to convert available resources into robust adaptive motivation for parents engaged in family intervention. “Since my husband took the initiative to join our child’s practice sessions, I have finally been able to get some much-needed rest. This support has been incredibly important and has significantly alleviated my feelings of anxiety.”P16. Negative Outcomes: Impeded Implementation of Family Intervention Disruption of Intervention Practices Uneven allocation of intervention responsibilities and divergent cognitive appraisals triggered both marital discord and intergenerational conflicts, which in turn disrupted the continuity of family-based intervention. “For a while, every time I took out the flashcards, my child would burst into tears and throw tantrums. In the end, I just gave up and decided we should just enjoy our time playing together.” P10. Tense Family Dynamics Uneven allocation of intervention responsibilities and divergent cognitive appraisals were found to precipitate both marital friction and intergenerational rifts. Participant P05 recounted the spousal disagreements that ensued. We’ve argued countless times over how to guide our child. He accuses me of being overly strict, while I criticise him for being a hands-off parent. The atmosphere at home hit rock bottom during that period. Participant P09, in turn, described facing reproach from her partner. My child is cared for by my mother and me. His father argues that we do too much for him, depriving him of sufficient opportunities to communicate verbally. Now he even sneers that I’m reaping what I’ve sown. Persistent slow progress in children and suboptimal intervention outcomes left some parents mired in profound distress over their children’s long-term prospects. Participant P04’s account laid bare an overwhelming sense of despair I am consumed by the fear that my child has autism. If that were the case, he would never be able to attend school or secure employment like neurotypical children. My own outlook on the future feels shrouded in utter darkness, and all my relentless efforts seem utterly futile. Participant P20 further articulated her profound distress, remarking: “The mere thought that she might be isolated or bullied at school because of her limited verbal communication is enough to shatter my heart. Table 1 Baseline Characteristics of Parents of Children with Language Developmental Delay (LDD). Number of participants Age (years) Relationship to Child Educational Attainment Occupation Monthly household income (¥) Gender of Children with LDD Age of Child with LDD Rehabilitation Intervention Content Rehabilitation Duration (months) Family Training Duration(hour/day) Family Training Frequency (sessions/week) P01 38 Mother Bachelor’s Degree Teacher 20,000–50,000 Boy 4 Cognitive Function, Sensory Integration 4 0.5-1 7 P02 28 Mother Bachelor’s Degree Teacher 10,000–20,000 Girl 2 Cognitive Function, Articulation Training, Oral Motor Therapy 18 0.5-1 7 P03 25 Mother Bachelor’s Degree Housewife 5,000–10,000 Boy 3 Cognitive Function, Sensory Integration 0.5 < 0.5 5–6 P04 30 Mother Primary School Diploma Housewife 10,000–20,000 Boy 4 Cognitive Function, Phonetic Initiation Training 3 1–2 3–4 P05 27 Mother Associate Degree Housewife 5,000–10,000 Boy 3 Cognitive Function, Social Skills Training, Sensory Integration 2 0.5-1 3–4 P06 40 Mother Senior High School Diploma Individual 20,000–50,000 Girl 1 Cognitive Function, Sensory Integration 1 1–2 5–6 P07 35 Mother Bachelor’s Degree Government Employee 20,000–50,000 Boy 1 Social Skills Training, Sensory Integration 22 1–2 5–6 P08 29 Mother Senior High School Diploma Housewife 10,000–20,000 Boy 3 Cognitive Function, Sensory Integration, Phonetic Initiation Training 6 1–2 3–4 P09 42 Mother Associate Degree Housewife 5,000–10,000 Boy 2 Cognitive Function Training 7 0.5-1 7 P10 41 Mother Senior High School Diploma Company employee 10,000–20,000 Boy 2 Social Skills Training, Cognitive Function 3 < 0.5 7 P11 27 Mother Senior High School Diploma Housewife 10,000–20,000 Boy 2 Social Skills Training, Cognitive Function 9 < 0.5 5–6 P12 26 Mother Associate Degree Company employee 5,000–10,000 Girl 3 Cognitive Function, Phonetic Initiation Training, Sensory Integration 4 < 0.5 7 P13 43 Mother Bachelor’s Degree Housewife 20,000–50,000 Girl 4 Cognitive Function, Social Skills Training 5 0.5-1 3–4 P14 28 Mother Associate Degree Housewife < 5000 Boy 3 Cognitive Function, Sensory Integration, Social Skills Training 1 0.5-1 3–4 P15 34 Mother Associate Degree Housewife 10,000–20,000 Boy 5 Cognitive Function, Social Skills Training, Sensory Integration 5 0.5-1 3–4 P16 38 Mother Associate Degree Housewife 5,000–10,000 Boy 3 Cognitive Function, Sensory Integration 2 0.5-1 7 P17 42 Mother Master’s Degree Construction Worker 10,000–20,000 Girl 4 Cognitive Function, Phonetic Initiation Training, Social Skills Training 3 1–2 7 P18 37 Father Bachelor’s Degree Individual 10,000–20,000 Girl 4 Cognitive Function, Sensory Integration 5 < 0.5 1–2 P19 33 Mother Associate Degree Housewife 10,000–20,000 Girl 5 Motor Skills, Social Skills, Language Integration Training 1 1–2 4–5 P20 28 Mother Associate Degree Housewife < 5000 Boy 5 Integrated Intervention 12 1–2 7 Table 2 Meta-themes and themes regarding Parental Experience Meta-themes Themes A: Coexistence of Multiple Stresses in Family Interventions -Parental Stress at the Individual Level Conflicts in the Allocation of Intervention Responsibilities Bottlenecks in the Application of Intervention Skills Physical and Mental Fatigue Under Intervention Pressure -Intervention Challenges Stemming from Child Characteristics Difficulty Sustaining Attention and Cooperation Emotional and Behavioural Challenges as Barriers to Intervention Adherence -Economic Burden B: Deficiencies in Family Coping Resources -Breakdown of the Family Internal Support System Deficiencies in Spousal Support Within Family Internal Resources Deficiencies in Intergenerational Support Within Family Internal Resources -Weaknesses in the Hospital Professional Guidance System -Insufficiency of Community Support Systems Lack of Specialised Rehabilitation Resources Unmet Needs for Social Peer Support C: Variations in the Cognitive Level of Family Intervention -Positive Cognition: Facilitating Engagement in Family Intervention -Negative Cognition: Impeding Adherence to Family Intervention Cognitive Role Conflict Internalisation and Intergenerational Conflicts of Traditional Beliefs X: Disparities in Family Intervention Capacities -Positive Outcomes: Significant Effectiveness of Family Intervention Deepened Parent-Child Bonding Parents’ Self-Growth and Enhanced Self-Efficacy Empowerment of Support Systems -Negative Outcomes: Impeded Implementation of Family Intervention Disruption of Intervention Practices Tense Family Dynamics Anxiety and Uncertainty About the Future Discussion Coexisting Pressures in Family Intervention and Parents’ Physical-Mental Burdens This study identifies three interrelated pressures for parents of children with LDD during family intervention, namely limited intervention skills, children’s intrinsic traits and economic constraints. These cumulative stressors significantly amplify caregiving burden, and this observation aligns with the ABC-X model’s key proposition that stressor synergies exacerbate coping difficulties. Family intervention responsibilities fall disproportionately on mothers, a pattern that reflects China’s mother-centric caregiving culture and corroborates Osarfo et al.’s work.(Osarfo et al., 2025 ) Burdened by the need to balance core intervention duties, career demands, multi-child care and household chores, mothers struggle to maintain consistent, high-quality intervention time—a result that aligns with Poduval ’s study(Poduval & Poduval, 2009 ) .A more formidable barrier is the intervention’s protracted nature. J. Heidlage et al.’s(J. Heidlage et al., 2020 ) meta-analysis reports parent-implemented language interventions last a mean of 34 weeks with a maximum of 124 weeks. This prolonged cycle combines with persistent anxiety over children’s developmental outcomes and often triggers maternal burnout and emotional distress. Existing evidence(Kruythoff-Broekman et al., 2019 ) shows depression and anxiety affect 11% and 28% of mothers of children with language disorders, respectively, confirming parents of children with special needs endure far greater psychological strain than caregivers of typically developing children. Difficulties translating learned intervention skills into daily interactions represent another critical stressor. High-quality adult language input is pivotal to children’s language acquisition, so parental mastery of evidence-based language-promotion strategies becomes a cornerstone of early intervention. However, most parents struggled to apply trained skills flexibly in routine interactions. This deficit may stem from limited access to professional training. Insufficient skills further impede the generalisation of children’s language abilities across contexts and ultimately compromise intervention efficacy. Children’s intrinsic characteristics also contribute significantly to parental stress. Poor attention regulation and emotional lability among children with LDD directly disrupted intervention implementation, and this aligns with prior studies. (Hutchins et al., 2025 )Communication impairments often precipitate social and behavioural difficulties, which reduce children’s intervention compliance. Non-compliance in turn amplifies parental feelings of powerlessness and stress and forms a vicious cycle linking behavioural problems to heightened parental stress. (Neece et al., 2012 ) Finally, economic constraints impede the sustainability of family intervention. Many parents cited the high cost of rehabilitation services and long-term financial burden as key barriers. Economic pressure not only limits parents’ capacity to participate in professional training but also restricts investment in high-quality intervention resources. LDD has been included in medical insurance reimbursement schemes across many regions in China. However, low policy awareness and stigma-related concerns prevent numerous families from accessing these supportive measures. Enhancing Parents’ Self-Efficacy and Multidimensional Social Support Construction Analysis of the resource dimension (B) in the ABC-X model showed that families of children with LDD experience marked deficits in internal family support, professional guidance, and community-peer support. This resource scarcity directly impairs parental self-efficacy and the efficacy of family interventions, highlighting the urgent need to establish an integrated, multi-level support system. Imbalanced familial roles, skewed caregiving responsibilities, and weakened intergenerational synergy undermine the effectiveness of family-based interventions. This study found intervention duties to be disproportionately borne by mothers; crucially, it confirms that active paternal participation plays a dual empowering role by alleviating mothers’ practical and emotional burdens. Existing research further links paternal engagement to better child language outcomes, underscoring the necessity of integrating fathers into intervention frameworks. Additionally, although over 70% of Chinese families adopt a grandparent-parent co-parenting model, traditional role delineations often lead grandparents to perceive language intervention as an exclusive parental responsibility, with many avoiding participation for fear of improper implementation. Rural grandparents may face additional barriers, such as dialect limitations and inadequate Mandarin proficiency, which hinder their capacity to provide standardised language input. (Liang & Van Leeuwen, 2025 )These findings align with those from one study, which identified insufficient intergenerational language stimulation as a risk factor for child language delay, as well as with the conclusions from Zhong J.,(Zhong & Luo, n.d.), reflecting the failure to convert intergenerational support into effective intervention assistance. For hospital-based professional guidance, systemic inadequacies constrain parents’ acquisition of core intervention skills. Despite its theoretical advantages, the hybrid online–offline training model employed in this study yielded suboptimal outcomes. Specifically, online modules were hindered by poor participation rates; furthermore, their one-size-fits-all structure failed to incorporate personalised instruction, instant feedback, and hands-on practice—key elements for skill acquisition in family intervention settings. Offline training is similarly hampered by a severe specialist shortage: against the international benchmark of 20 speech therapists per 100,000 population, mainland China faces a talent gap of approximately 250,000 practitioners. Burdened by heavy clinical workloads, rehabilitation therapists can only deliver brief, superficial guidance; in practice, therapist-supervised training accounts for a mere 17.4% of parents’ total intervention efforts, falling far short of meeting demands for systematic, in-depth learning.(Dandan & Kaixi, 2024 ) As for community and social-peer support, resource scarcity at these levels amplifies parental feelings of isolation and powerlessness. Specialised child rehabilitation facilities remain scarce across most communities; geographic disparities force families to travel long distances for urban-based services, with some even incurring extra accommodation costs to reside near intervention institutions, thereby substantially increasing their financial and logistical burdens. Current community guidance is largely theoretical, offering generic advice (e.g., “increase child communication”) without actionable strategies to address specific intervention challenges. Social-peer support is equally deficient, as no stable, accessible platforms exist for families with similar needs to share experiences. Parents thus struggle to obtain practical, personalised intervention insights and lack peer emotional empathy—a gap that may directly reduce their motivation and confidence to sustain long-term intervention efforts. Parental Perceptual Divergences on Family-Based Intervention for LDD Children Based on an analysis of the cognitive-perceptual dimension (C) in the ABC-X model, we identified significant perceptual divergences among parents of children with LDD regarding family-based intervention. A small subset of parents held positive perceptions to facilitate intervention implementation, whereas the majority exhibited cognitive biases and even encountered intergenerational cognitive conflicts, highlighting the urgent need for targeted guidance. From the parental cognitive perspective, adaptability to and cognitive positioning of the “family intervenor” role directly correlate with intervention efficacy. We found that only a minority of parents successfully adapted to this role, and their active practice enhanced intervention effectiveness, parent-child bonding and self-efficacy. Most parents, by contrast, struggled with role maladjustment, which aligns with the conclusions of Sugden et al.(Sugden et al., 2018 ) Cognitive biases stem from two core sources. First, parents commonly hold a one-sided view that hospital-based intervention is primary and family-based intervention supplementary, believing that professional hospital training diminishes the urgency of family-based practice. Second, shaped by traditional perceptions of medical services in China, parents rarely prioritise family-based intervention for speech therapy and instead prefer full reliance on professional institutions, an observation consistent with the findings of Wen et al.(Wen & Lin, 2012 ) A prominent issue lies in the prevalent cognitive conflict between parents’ dual identities as emotional caregivers and structured therapists. They often assess their own performance against the standardised requirements of professional rehabilitation, yet the inherently natural and intimate home environment fundamentally contradicts structured rehabilitation models. When children display non-cooperation or slow progress, parents are highly prone to frustration, which may prompt them to abandon family-based intervention and turn to complete reliance on professional institutions. Intergenerational cognitive conflict constitutes another key barrier to early intervention, primarily stemming from the deep-seated traditional belief that noble persons speak late. Empirically, this belief erroneously extrapolates isolated cases of successful late talkers into a universal rule. Normatively, it misconstrues LDD as a marker of a calm temperament. Emotionally, it temporarily mitigates parenting anxiety through romanticised framing of developmental differences, fostering cultural inertia. From a modern medical standpoint, this belief obscures the boundary between normal developmental variation and pathological delay, prompting families to adopt a wait-and-see stance at the onset of warning signs and thus causing them to miss the critical pre-three intervention window. Research confirms that without timely intervention, approximately 50% of children with LDD develop persistent language disorders, which impose long-term adverse impacts on their cognitive and social development.(Matte-Landry et al., 2020 ) In practice, shaped by this belief, grandparents often insist that children naturally acquire language as they mature and resist or doubt scientific intervention, whereas younger parents tend to seek professional support. This intergenerational cognitive misalignment not only delays intervention but also risks exacerbating family conflicts and undermining a supportive parenting environment, thereby amplifying children’s language rehabilitation challenges. Constructing a “Hospital-Community-Family” Trinity System to Improve Parents’ Family-Based Intervention Efficacy Based on our findings, to comprehensively improve family-based intervention efficacy, a collaborative support system integrating hospital, family, and community resources is essential. Specifically, a localised “teaching-demonstration-coaching-assessment” closed-loop training model should be established, incorporating lectures, videos, role-playing, and home guidance manuals to help parents integrate intervention strategies into daily environments (e.g., reading corners, interactive toy areas) and enhance child engagement.(Senent-Capuz et al., 2021 ) Digital tools should also be leveraged to expand service accessibility, including building online platforms integrating self-directed learning and remote coaching, and exploring AI interactive robots to boost intervention fun and children’s participation motivation.(Sawyer et al., 2025 ) At the cognitive level, early guidance and education should be strengthened by integrating language development screening into routine child healthcare. Parents should be provided with materials on specific intervention methods and developmental warning signs to dispel misconceptions such as “noble persons speak late” and foster awareness of “early screening and early intervention.” Additionally, whole-family participation should be promoted via gamified interactive courses for fathers and cognitive correction sessions for grandparents, establishing a “whole-family participation and collaborative division of labour” model to address the over-concentration of responsibility on mothers. In terms of external support, the community rehabilitation network and peer support system need improvement. This can be achieved by setting up grassroots rehabilitation stations, establishing a “medical institution-community-family” linkage mechanism, and creating parent experience-sharing and emotional support platforms to reduce home intervention costs and ensure continuity. Finally, from a macro-policy perspective, the government should expand special education support, systematically develop early screening and intervention systems, and increase investment in speech therapy professionals and rehabilitation resources. This holistic approach aims to elevate children’s overall language health and alleviate family burdens. Limitations of this study This study has several inherent limitations that should be acknowledged. First, all participants were recruited from a single tertiary maternal and child health hospital, with the sample predominantly consisting of mothers (19/20). This sampling bias constrains the generalizability of the findings in terms of geographical diversity and gender representation. Consequently, the results may not fully capture the intervention experiences across different healthcare settings, regional cultural contexts, or from paternal perspectives. Second, as a cross-sectional qualitative study, the research primarily relied on self-reported data obtained through interviews. This design precluded the capture of the dynamic evolution of family experiences with the intervention, which would require long-term follow-up assessments and on-site observational data. Furthermore, although thematic analysis was performed based on the Pressure-Resources-Perception-Adaptation model, the exploration of certain underlying interactive mechanisms within the family pressure and adaptation process remains insufficient. For instance, the temporal dynamics of how resources and perceptions mutually influence each other warrant further in-depth investigation. Declarations Statement on Participant Consent Written informed consent was obtained from all participants or their legal guardians prior to study participation. Author Contribution Xuxing Lin, Lijiao Cai, Wenjuan Yan, and Yingying Zhang were responsible for conducting the interviews. 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06:22:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14541,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8408915/v1/c0e9ddbae1154a0a2291173c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Experience of Chinese Parents of Children with Language Development Delay(LDD) in Family Intervention under the ABC-X Model: A Qualitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLanguage developmental delay (LDD) refers to children with age-discordant language acquisition, excluding delays caused by articulation disorders or hearing impairments.(Nudel et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) LDD is globally prevalent, with international studies reporting 3%-19% among preschoolers (highest in two-year-olds) and Chinese data showing\u0026thinsp;~\u0026thinsp;17% in children under two, declining to 3%-7.5% in older preschoolers.(Reilly et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Wu et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) LDD imposes multidimensional adverse impacts on children and families. For children, impaired communication leads to cascading sequelae: cognitively, elevated risks of reading and math difficulties by age five, and 4\u0026ndash;6 times higher likelihood of subsequent literacy/numeracy disorders even if preschool language development normalizes; psychosocially, associations with challenging behaviours, emotional dysregulation, and increased vulnerability to anxiety/depression (persisting into adolescence/adulthood), alongside higher risks of alcohol/substance abuse in adulthood.(J. K. Heidlage et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) For families, children\u0026rsquo;s limited ability to express needs exacerbates parental caregiving stress and powerlessness. Mothers of children with LDD experience significantly higher stress and reduced quality of life, perpetuating a vicious cycle of elevated parental stress, impaired parent-child interaction, and worsened behavioural problems in children.\u003c/p\u003e \u003cp\u003eEarly intervention is critical for improving LDD prognosis, as it enhances language abilities, optimises academic and socioemotional functioning, reduces long-term adverse outcomes, and lowers the risk of poor language comprehension by 39%.(Roberts et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) In China, rehabilitation services are primarily delivered in hospital or specialised institutional settings, with core intervention strategies including language training, social skills training, and sensory integration training. These modalities are often combined with traditional Chinese medicine (TCM), physical therapy, and family-centred training programs. Clinical intervention content is individualised based on results of the S-S Language Development Assessment and the child\u0026rsquo;s functional capabilities, with comprehensive training established as the cornerstone of the overall intervention framework.\u003c/p\u003e \u003cp\u003eAs a vital adjunct to professional institutional care, parent-implemented intervention (PII) plays a pivotal role in pediatric language rehabilitation. Given that most children acquire language competencies through high-quality parent-child interactions, parents who integrate targeted intervention practices into home environments, in addition to adhering to therapist-guided rehabilitation protocols, can achieve synergistic therapeutic effects. Cumulative empirical evidence confirms that parental proficiency in language-facilitation strategies and consistent implementation of family-based interventions effectively improve children\u0026rsquo;s language performance, alleviate receptive and expressive language deficits, expand expressive vocabulary repertoires, and enhance syntactic competence. These outcomes are comparable to those of professional speech-language therapy, while PII also exerts a favourable influence on infants\u0026rsquo; long-term neurodevelopmental trajectories.\u003c/p\u003e \u003cp\u003eHowever, parental cognition and engagement in PII are markedly insufficient. Only 53.3% of parents recognise the necessity of family intervention, and most do not prioritise home-based therapy. Additionally, 64.6% of families frequently fail to complete prescribed training. Within the Chinese sociocultural context, unique barriers exist. Deep-rooted beliefs, such as the notion that \u0026ldquo;noble children speak late,\u0026rdquo; lead some families\u0026mdash;especially grandparents\u0026mdash;to misclassify LDD as a normal individual difference or a sign of \u0026ldquo;late blooming.\u0026rdquo;(Huiyan et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) This fosters wait-and-see attitudes toward early warning signs. Only 12.38% of children with LDD receive medical consultation before age two, and most families seek care when their children are non-verbal between 1.5 and 3.5 years. This undoubtedly causes them to miss the critical intervention window before age three. Furthermore, in Mandarin-speaking households in mainland China, PII efficacy is further limited by inadequate parental interaction skills, bidirectional parent-child influence, and suboptimal interaction environments.​\u003c/p\u003e \u003cp\u003eExisting research notes that parents of children with LDD face complex stress during PII, including role strain, skill deficits, and cultural conflict. However, current studies primarily focus on PII efficacy or analyse parent-child interaction issues from a therapist\u0026rsquo;s perspective, and they neglect the lived experiences of parents as core implementers. Notably, qualitative research on the PII experiences of Mandarin-speaking Chinese parents of children with LDD remains scarce. Globally, early childhood development is a core target of the United Nations Sustainable Development Goals (SDGs), specifically the goal to \u0026ldquo;ensure all children access quality early development services.\u0026rdquo; Understanding the real-world PII experiences of Chinese parents thus not only safeguards individual family well-being but also provides a basis for optimising grassroots early intervention systems and advancing the localization of global development agendas.​\u003c/p\u003e \u003cp\u003eTo systematically unpack the \u0026ldquo;stress-coping-adaptation\u0026rdquo; psychological process of parents implementing PII for children with LDD, this study adopts Hill\u0026rsquo;s ABC-X family stress model, which includes four core elements: A (stressor event), B (resources), C (stress perception), and X (stress outcome). A and B interact to shape C, which further modulates X.(Frishman et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Liu \u0026amp; Zhang, 2024) Didericksen et al. (Didericksen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)refined the model by expanding X from \u0026ldquo;crisis\u0026rdquo; to the more comprehensive \u0026ldquo;parental coping strategies.\u0026rdquo; Unlike traditional linear \u0026ldquo;stressor\u0026rarr;crisis\u0026rdquo; stress theories, the ABC-X model incorporates the regulatory roles of resources and perception, aligning with the \u0026ldquo;person-in-environment\u0026rdquo; holistic perspective and thus suiting this study.(Ballard et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) Guided by this model as the analytical framework, this parent-centred study explores the lived PII experiences of parents of children with LDD, aiming to address the scarcity of qualitative research on Chinese parents\u0026rsquo; PII experiences and provide empirical evidence for developing culturally appropriate home and community-based interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study adopted a qualitative descriptive design to comprehensively explore parents’ experiences of implementing interventions for children with LDD. This methodological approach is widely acknowledged as effective for capturing rich, detailed insights into participants’ perceptions of specific phenomena or events.(Lim, 2024) The ABC-X Model served as the analytical framework, where A denotes the stressor (specifically the implementation of family-based interventions for children with LDD), B represents resources (encompassing personal, familial, and social resources), C refers to stress perception (namely parents’ perceptions and interpretations of the family intervention process), and X signifies the stress outcome. Parental behavioural coping strategies can reflect the magnitude of stress induced by the intervention process, and parents’ intervention competence was used as the indicator of stressor-induced outcomes in this study. Notably, the three core determinants (A, B, and C) are mutually influential, and their synergistic interactions collectively shape the final stress outcome (X).(Liu \u0026amp; Zhang, 2024) Ethical approval for this study was granted by the Ethics Committee of Fujian Health College (IRB No.: RT2025-05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population comprised parents of children diagnosed with language development delay (LDD). To ensure parents could accurately and comprehensively recall their family intervention experiences, all interviews were scheduled at least one month after the initiation of family-based interventions. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria were defined as follows: \u003c/em\u003e(1) The child, aged 2–6 years, was diagnosed with LDD using the S-S method;(Dingxu \u0026amp; Yang, 2020) (2) The child received outpatient rehabilitation training 2–3 times weekly, with each session lasting ≥30 minutes for a minimum of one month; (3) The parent was the primary implementer of therapist-assigned family intervention tasks; (4) The parent had no communication barriers and could articulate their experiences clearly; (5) The parent provided written informed consent and voluntarily participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExclusion criteria included:\u003c/em\u003e (1) The child had comorbid conditions such as cerebral palsy, cleft palate, genetic disorders (e.g., Down syndrome), neurodevelopmental abnormalities (e.g., epilepsy), or autism spectrum disorder; (2) The child had severe visual or hearing impairments; (3) The parent discontinued family interventions midway or failed to implement them as required; (4) The parent had a history of severe mental illness or cognitive impairment; (5) The family was concurrently enrolled in other interventional clinical trials related to child language development.\u003c/p\u003e\n\u003cp\u003eParticipants were purposively sampled to maximise variability (maximum variation purposive sampling) in parent age, educational level, occupation, and monthly household income, as well as child age and intervention duration, thereby enhancing sample representativeness. The final sample size was determined by data saturation. No new themes emerged after interviewing 17 participants; three additional interviews were conducted to confirm saturation, with no novel insights identified. \u003c/p\u003e\n\u003cp\u003eRecruitment was thus terminated, yielding a final sample of 20 participants (19 mothers and 1 father) and a total of 22 interviews completed. Specifically, 18 participants provided complete data in a single interview. Two participants had their initial interviews interrupted—one due to the completion of the child’s rehabilitation course and the other due to urgent childcare needs. To ensure data completeness, a supplementary interview was arranged for each participant by mutual agreement within 72 hours of the initial interview, minimising recall bias. Integrated data from these two participants were included in the final analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFamily Intervention Content \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe family-based interventions implemented by parents were based on standardised assessments of children with LDD, including the 0–6 Years Old Child Development and Behaviour Assessment Scale and the S-S Method.(Miller et al., 2012) Individualised education programs (IEPs) were developed according to the assessment results and adjusted dynamically as the children progressed in rehabilitation. The intervention content focused on core abilities such as basic social communication skills, language comprehension, and expressive language abilities.(Matte-Landry et al., 2020) Specifically, after each outpatient rehabilitation session, speech therapists assigned targeted home training tasks for parents to implement, such as gross motor imitation exercises (raising hands, touching the head, patting the abdomen) and functional verb application drills (“point to”, “give me”, “put it in my hand”). Meanwhile, parents participated in structured online training courses covering four modules: course overview and intervention environment setup, prelinguistic skill development, oral language induction strategies, and practical video demonstrations with interactive Q\u0026amp;A. These courses aimed to improve parents’ ability to carry out home interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom June 2025 to October 2025, purposive sampling was employed to recruit participants who met the predefined inclusion criteria. Following the acquisition of written informed consent from the eligible participant, an appointment was scheduled for one-on-one interviews. To safeguard participants’ privacy, all subjects were assigned anonymous codes (N1–N20) throughout the study. Data collection was conducted via semi-structured interviews of approximately 1 hour in duration, which were held in the Parent Reception Room of the Department of Pediatric Rehabilitation. The venue was characterised by a quiet, private, and undisturbed setting, with adequate ventilation, sufficient lighting, and a face-to-face seating arrangement to facilitate effective communication. The interview content was designed to guide participants in retrospectively reflecting on their experiences with family-based interventions for children with LDD. Specifically, the interviews explored the participants’ comprehensive perceptions of LDD rehabilitation training, practical implementation strategies of family-based interventions, approaches to addressing encountered challenges, unmet support needs, and subjective experiences throughout the intervention process.\u003c/p\u003e\n\u003cp\u003eA structured data collection form was developed to gather information regarding the participants’ demographic and clinical characteristics. This form contained three core sections: (1) parental information, including age, gender, educational background, occupation, household income, and relationship to the child; (2) child-related information, covering current age and gender; and (3) intervention-related information, such as total duration of intervention, weekly frequency of family-based training sessions, and daily duration of family-based training. \u003c/p\u003e\n\u003cp\u003eFurthermore, based on the ABC-X theoretical model, the study objectives and research content, the initial draft of the interview guide was designed following an extensive literature review and in-depth team discussions. A pilot interview was conducted with three parents of children with LDD, and the preliminary interview guide was then submitted to a panel of three experts for review and revision. The expert panel consisted of one speech-language pathologist, one developmental-behavioural paediatrician, and one senior rehabilitation nurse, all of whom held senior professional titles and possessed over a decade of clinical experience in pediatric language rehabilitation. The final version of the interview guide was finalised according to the experts’ evaluations and is provided in \u003cstrong\u003eSupplementary Material 1. \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interview guide was designed with flexibility to allow progressive adjustments throughout the study. These adjustments were made by a researcher specialising in qualitative research methods, based on real-time practical circumstances, to ensure alignment with emerging research insights. All interviews were conducted by the same trained researcher (XXL) to maintain consistency in data collection.\u003c/p\u003e\n\u003cp\u003eDuring the interview process, efforts were made to establish a trusting relationship with participants and to foster open and honest dialogue. In instances where parents exhibited severe emotional distress during interviews, the interview was immediately suspended. The research team then provided timely psychological support, and interviews were resumed only after the parent had regained emotional stability and provided voluntary consent to continue.\u003c/p\u003e\n\u003cp\u003eInterview content was recorded using a secure digital voice recorder to ensure data integrity and accuracy. Within 24 hours of each interview, the audio recordings were fully transcribed verbatim using professional word processing software. Before data analysis, all transcribed texts underwent anonymisation to protect participant privacy, with identifying information (e.g., names, addresses) removed or replaced with study-specific codes. For this manuscript, any excerpts of transcribed text cited were presented in the participants’ original wording; a native English-speaking professional translator translated these excerpts to ensure accuracy and linguistic authenticity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUpon completion of interview transcription, Interpretative Phenomenological Analysis (IPA) was adopted for data analysis, a methodological approach uniquely suited to exploring individual participants’ subjective experiences and lived realities regarding family-based interventions for children with LDD. (Kelly, 2023)Transcribed texts were imported into NVIVO 12© software to facilitate the systematic identification of themes embedded within participants’ narrative accounts. Specifically, the analytical process entailed repeated close reading and open coding of the textual data to distil the core essence of participants’ discourses. Codes were then categorised into distinct themes, with recurrent themes further aggregated into overarching meta-themes to synthesise the collective narrative of the study cohort. Each meta-theme was explicitly linked to its constituent sub-themes, which in turn were anchored to original codes and verbatim interview excerpts, ensuring a transparent and traceable analytical trail.(Campbell et al., 2011)\u003c/p\u003e\n\u003cp\u003eTo enhance the methodological rigour and trustworthiness of the study findings, primary data analysis was conducted by one researcher (XXL). This was followed by triangulation verification performed by an additional four researchers (LJC, WJY, HJZ, YYZ), all of whom possessed substantial expertise in qualitative research methodologies; among them, three (LJC, WJY, YYZ) held specialised knowledge in adolescent psychiatry. After independent analyses, the study findings were further deliberated and cross-validated in a dedicated qualitative research workshop. Throughout the entire research process—from study conceptualisation to result interpretation—a reflexive journal was maintained by the research team, documenting individual team members’ prior beliefs, interpretive biases, and hypothetical assumptions related to the research topic. Additionally, regular team meetings were held to discuss researchers’ evolving perspectives on the study topic, interview data, and preliminary findings, with the explicit aim of critically examining how these subjective viewpoints might have influenced the research process and outcomes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBased on the ABC-X model, an in-depth thematic analysis of semi-structured interview data identified four core themes with corresponding sub-themes. These themes were explicitly mapped to the stressor (A)—specifically, the implementation of family-based interventions for children with LDD—coping resources (B) encompassing personal, familial, and social resources, stress perception (C), namely parents’ perceptions and interpretations of the family intervention process, and stress outcome (X) components of the model. This analytical framework systematically delineates the dynamic interplay underlying the “Stressor-Resource-Perception-Outcome” cascade among parents implementing family-based interventions for children with LDD. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarises the participants’ basic characteristics. The thematic categories and their intrinsic associations are visualised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003ch3\u003eStress Dimension (A): Coexistence of Multiple Stresses in Family Interventions\u003c/h3\u003e\u003cp\u003eThe stress dimension (A) corresponds to the core stressor events in the ABC-X model. It delineates a multifaceted stress system associated with family-based interventions, which encompasses three distinct layers of burden: parental, child-characteristic, and economic. These three burden categories constitute the primary stressors that exert a direct impact on parents’ implementation of intervention behaviours.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParental Stress at the Individual Level\u003c/b\u003e Parents bear direct stress associated with the responsibilities and skills required for implementing family-based interventions.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eConflicts\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003ein the Allocation of Intervention Responsibilities\u003c/em\u003e: Regarding conflicts in the allocation of intervention responsibilities, family intervention tasks were highly concentrated on primary caregivers (with mothers being the most representative group), who were required to simultaneously manage multiple pressures, including engagement in paid employment and caregiving for other children.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I work days. Evenings involve post-work dinner prep and bathing him, and it’s almost his bedtime after that. With little time for training, I only do a quick homework review before he sleeps daily.”P01.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eBottlenecks in the Application of Intervention Skills\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eMost parents reported significant barriers to translating the skills they had learned into practical, effective interactive practices with their children.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I don’t know if I’m giving the wrong instructions. When he plays with cars and I ask what color the car is, he just pushes the car aside and plays with other things right away.”P05.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003ePhysical and Mental Fatigue Under Intervention Pressure\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe challenge of juggling hospital-led rehabilitation programs and family-initiated intervention activities takes a toll on parents’ physical and mental well-being. Some participants explicitly articulated their overwhelming fatigue.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The two-hour round trip to the hospital alone is utterly draining. Emotionally, I feel completely worn out—there are nights when I lie awake, unable to fall asleep without relying on medication.” (Participant 04)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cb\u003eIntervention Challenges Stemming from Child Characteristics\u003c/b\u003e The innate developmental characteristics of children with LDD act as unpredictable and persistent stressors throughout the entire course of family intervention.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eDifficulty Sustaining Attention and Cooperation\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eExcessive environmental distractions in the home setting posed a major barrier to establishing a focused intervention space.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“The home environment is too familiar. He touches everything in sight, runs off midway through the session, and it’s hard to get him back on track.” P08.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEmotional and Behavioural Challenges as Barriers to Intervention Adherence\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eChildren’s emotional and behavioural dysregulation often disrupts the continuity of intervention implementation and may even escalate into parent–child conflicts.\u003c/p\u003e\u003cp\u003eI feel utterly helpless. He knows exactly how to push my buttons—he simply refuses to cooperate with me and throws full-blown tantrums. Once he gets worked up like that, there’s no point in attempting any teaching or intervention activities.\u003c/p\u003e\u003cp\u003e \u003cb\u003eEconomic Burden\u003c/b\u003e Beyond the direct financial costs of rehabilitation training, many parents face substantial economic strain stemming from two primary sources. First is the necessity of relinquishing employment to ensure uninterrupted intervention participation.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I quit my job to accompany my child to intervention sessions. Our family now depends entirely on my husband’s income, and our finances have become extremely tight.”P03.\u003c/em\u003e \u003c/p\u003e\u003cp\u003eSecond is the accumulation of additional expenses—such as rental fees for accommodation near intervention centres, which families incur to reduce travel-related barriers and burdens.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“If we knew exactly how much longer the intervention would last, we might even borrow money to get by. But if it requires an indefinite duration, the subsequent costs would be completely unsustainable.”P12.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e This persistent financial pressure indirectly constrains the time and energy parents can allocate to the consistent implementation of family-based intervention activities.\u003c/p\u003e\u003ch2\u003eResource Dimension (B): Deficiencies in Family Coping Resources\u003c/h2\u003e\u003cp\u003eWithin the ABC-X model, Resource Dimension (B) corresponds to the coping resources available to families. When facing Component A (intervention-related pressures), families exhibit notable deficiencies in both internal and external support resources—specifically encompassing three key domains: inadequate family internal support, insufficient professional guidance from hospitals, and limited community/peer support. The scarcity of these critical resources directly impairs families’ capacity to regulate cumulative pressure and execute effective intervention strategies.​\u003c/p\u003e\u003ch3\u003eBreakdown of the Family Internal Support System\u003c/h3\u003e\u003cp\u003e \u003cstrong\u003eDeficiencies in Spousal Support Within Family Internal Resources\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eA critical manifestation of inadequate family internal support lies in the lack of effective spousal support—specifically, spouses often fail to share intervention-related responsibilities substantially or provide emotional backing, leaving primary caregivers to cope with intervention burdens independently. This dynamic was reflected in Parent P13’s experience of being blamed rather than supported\u003c/p\u003e\u003cp\u003eThey blame me for our child’s speech delay, saying I’m the reason the child is like this. Hearing that makes me shake with anger, and now they won’t even lift a finger to help with the training.\u003c/p\u003e\u003cp\u003eSimilarly, the father of Parent P18’s child cited “inability to participate” as a reason to avoid involvement:\u003c/p\u003e\u003cp\u003eI’m busy with work and social engagements—I really can’t manage. Everything has to be left to the mother.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eDeficiencies in Intergenerational Support Within Family Internal Resources\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eGrandparents, constrained by personal limitations (e.g., dialect barriers, insufficient educational attainment) or cognitive biases, are generally only able to provide daily living care. They often show reluctance to participate in intervention-related tasks and struggle to offer meaningful support for intervention implementation.\u003c/p\u003e\u003cp\u003e\u003cem\u003e“The child’s grandparents are from rural areas and usually only speak their local dialect... They feel they can’t even speak standard Chinese themselves, so there’s no way they can help teach the child.”P07.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e “My parents believe that educating a child is solely the parents’ job... They’re willing to help with daily care, but ‘teaching tasks’ like reading or using flashcards—they refuse, afraid they’ll teach the child incorrectly.”P17.\u003c/em\u003e\u003c/p\u003e\u003ch3\u003eWeaknesses in the Hospital Professional Guidance System\u003c/h3\u003e\u003cp\u003eThe professional guidance provided by hospitals exhibits notable shortcomings in three core dimensions: accessibility, depth, and continuity—factors that collectively hinder alignment with parents’ practical learning needs for intervention implementation.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The offline guidance sessions are too short—just five minutes. I often don’t fully understand the content, and sometimes communication with the teacher over WeChat isn’t clear either. In the end, I just stop asking.”p13.\u003c/em\u003e \u003c/p\u003e\u003ch2\u003eInsufficiency of Community Support Systems\u003c/h2\u003e\u003cp\u003e \u003cem\u003eLack of Specialised Rehabilitation Resources\u003c/em\u003e: ​A critical manifestation of community support inadequacy lies in the scarcity of specialised child rehabilitation resources—particularly prominent in rural and town communities. This deficiency manifests in two key ways: first, the absence of dedicated child rehabilitation facilities, which forces families to seek services at urban institutions and incurs additional intervention-related costs.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“Our town has no specialized child rehabilitation institutions or hospitals. To give my child better training, I had to rent a place near the urban hospital—there’s no other choice.”​P03.\u003c/em\u003e \u003c/p\u003e\u003cp\u003eSecond, the over-reliance on generic theoretical guidance in community support, with a lack of practical, actionable strategies tailored to intervention needs.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The community organized a parent lecture, but it only covered general principles. When I asked specifically, ‘What should I do if the child doesn’t follow instructions?’ I didn’t get any practical guidance at all.”P15.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e Both issues further amplify the logistical and psychological burdens on parents, weakening the community’s role as a supplementary support hub.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eUnmet Needs for Social Peer Support\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAnother notable gap in community support is the lack of effective communication channels and support networks for families with similar child intervention needs. This inadequacy leaves parents’ core needs largely unmet, including those for emotional resonance and targeted information sharing, as they lack accessible platforms to connect with peers of comparable experiences. Unmet in this way, parents become further isolated, worsening their psychological burden during ongoing interventions.\u003c/p\u003e\u003cp\u003e\u003cem\u003e“Peer support is critical—we could share useful information with each other. I wish parents whose kids have made quicker progress would share their training experiences; that would help us a lot.”P17.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e“The last thing I want to hear is ‘the child will be fine when they grow up.’ How could it be that simple? I really wish I could talk to other parents who have similar experiences—so we could comfort each other and feel less alone.”​P18.\u003c/em\u003e\u003c/p\u003e\u003ch2\u003eCognitive Dimension (C): Variations in the Cognitive Level of Family Intervention\u003c/h2\u003e\u003cp\u003eThe cognitive dimension (C) aligns with the conceptualisation and assessment of stressful events as defined in the model. Our study demonstrated that parents exhibit marked heterogeneity in their cognitive appraisals of family intervention. This cognitive evaluation is bidirectionally modulated by both stressors (A) and resource availability (B), and in turn exerts a regulatory effect on the ultimate stress response (X).\u003c/p\u003e\u003ch2\u003ePositive Cognition: Facilitating Engagement in Family Intervention\u003c/h2\u003e\u003cp\u003e Despite confronting multiple practical challenges, a subset of parents in this study expressed strong endorsement of the value of family intervention. Several participants emphasised the irreplaceable role of family-based practice.\u003c/p\u003e\u003cp\u003e\u003cem\u003e“Home practice is essential; children require consistent, repeated practice to achieve meaningful progress.” P01.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAnother parent (P07) corroborated the immediate, tangible benefits of intervention through direct observation, which further consolidated their confidence in sustaining the intervention process.\u003c/p\u003e\u003cp\u003eConsistently completing family practice has yielded remarkable changes in our child— the effects are truly immediate and noticeable.\u003c/p\u003e\u003ch2\u003eNegative Cognition: Impeding Adherence to Family Intervention\u003c/h2\u003e\u003cp\u003e \u003cstrong\u003eCognitive Role Conflict\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e A prominent cognitive barrier identified was the pervasive role conflict experienced by parents, who struggled to reconcile their dual identities as emotionally supportive caregivers and structured intervention implementers.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I fully understand that family-based intervention must be sustained, yet I lack the professional know-how to guide my child effectively, and he often refuses to cooperate. Such specialized work truly feels beyond the capacity of non-professionals— it should be left to trained therapists.”P04.\u003c/em\u003e \u003c/p\u003e\u003cp\u003eParticipant P08 offered a more vivid illustration of this dilemma.\u003c/p\u003e\u003cp\u003eTrying to act as an interventionist at home is incredibly challenging. The moment I pull out the intervention flashcards, he immediately yells, ‘Class is over! Class is over!’\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInternalisation and Intergenerational Conflicts of Traditional Beliefs\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe internalisation of traditional beliefs, such as the folk adage “Noble infants speak late,” has evolved into a salient source of negative cognition within families in China. It particularly sparks intergenerational discord that directly undermines the acceptance of evidence-based intervention strategies.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“Aligning the whole family on the value of intervention is incredibly challenging. Elders cling to the ‘noble infants speak late’ notion, asserting that children will naturally develop language skills as they grow, and that formal intervention is a waste of time and money. They immediately remove the child whenever I try to start a home training session.”P13.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“My child’s grandmother argues that my husband did not speak in full sentences until age three, yet turned out fine, dismissing my intervention efforts as pointless fussing. This forces me to conduct family training secretly behind closed doors.”P20.\u003c/em\u003e \u003c/p\u003e\u003ch2\u003eAdaptive Dimension (X): Disparities in Family Intervention Capacities\u003c/h2\u003e\u003cp\u003eThe adaptive dimension (X) represents the ultimate outcome of the ABC-X model, emerging from the intricate interplay of stressors (A), coping resources (B), and cognitive appraisals (C). The present study identifies two distinct developmental pathways of family intervention adaptation.\u003c/p\u003e\u003ch2\u003ePositive Outcomes: Significant Effectiveness of Family Intervention\u003c/h2\u003e\u003cp\u003eWhen facing family intervention, the effective use of resources and a good cognitive level helped caregivers cope with stress, ultimately achieving positive results.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eDeepened Parent-Child Bonding\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e Sustained engagement in intervention-related interactions allowed parents to accurately discern their children’s nuanced needs, fostering a progressive deepening of mutual understanding and trust between caregivers and children.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I used to constantly worry that my limited educational background would hold my child back. Yet through consistent accompaniment and repeated practice sessions, I have become the person he trusts most. This feeling of being genuinely needed brings immense joy.”P06.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eParents’ Self-Growth and Enhanced Self-Efficacy\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThrough hands-on engagement in intervention practices, parents gradually mastered core intervention techniques and accrued practical experience, which in turn translated into a marked boost in their confidence and problem-solving competence.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“When the therapist first advised me to continue intervention with my child at home, I was utterly at a loss. Now, no matter what new training tasks arise, I feel fully confident in addressing them, and my mind is clear and focused.”P12.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“Every time my child utters a new word, a surge of immense pride washes over me.”P19.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEmpowerment of Support Systems\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e Access to effective support serves to convert available resources into robust adaptive motivation for parents engaged in family intervention.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“Since my husband took the initiative to join our child’s practice sessions, I have finally been able to get some much-needed rest. This support has been incredibly important and has significantly alleviated my feelings of anxiety.”P16.\u003c/em\u003e \u003c/p\u003e\u003ch2\u003eNegative Outcomes: Impeded Implementation of Family Intervention\u003c/h2\u003e\u003cp\u003e \u003cstrong\u003eDisruption of Intervention Practices\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eUneven allocation of intervention responsibilities and divergent cognitive appraisals triggered both marital discord and intergenerational conflicts, which in turn disrupted the continuity of family-based intervention.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e“For a while, every time I took out the flashcards, my child would burst into tears and throw tantrums. In the end, I just gave up and decided we should just enjoy our time playing together.” P10.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cstrong\u003eTense Family Dynamics\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eUneven allocation of intervention responsibilities and divergent cognitive appraisals were found to precipitate both marital friction and intergenerational rifts. Participant P05 recounted the spousal disagreements that ensued.\u003c/p\u003e\u003cp\u003eWe’ve argued countless times over how to guide our child. He accuses me of being overly strict, while I criticise him for being a hands-off parent. The atmosphere at home hit rock bottom during that period.\u003c/p\u003e\u003cp\u003eParticipant P09, in turn, described facing reproach from her partner.\u003c/p\u003e\u003cp\u003eMy child is cared for by my mother and me. His father argues that we do too much for him, depriving him of sufficient opportunities to communicate verbally. Now he even sneers that I’m reaping what I’ve sown.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e Persistent slow progress in children and suboptimal intervention outcomes left some parents mired in profound distress over their children’s long-term prospects. Participant P04’s account laid bare an overwhelming sense of despair\u003c/p\u003e\u003cp\u003eI am consumed by the fear that my child has autism. If that were the case, he would never be able to attend school or secure employment like neurotypical children. My own outlook on the future feels shrouded in utter darkness, and all my relentless efforts seem utterly futile.\u003c/p\u003e\u003cp\u003eParticipant P20 further articulated her profound distress, remarking:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The mere thought that she might be isolated or bullied at school because of her limited verbal communication is enough to shatter my heart.\u003c/em\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Parents of Children with Language Developmental Delay (LDD).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of participants\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelationship to Child\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducational Attainment\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMonthly household income (¥)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGender of Children with LDD\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAge of Child with LDD\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRehabilitation Intervention Content\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRehabilitation Duration (months)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFamily Training Duration(hour/day)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eFamily Training Frequency (sessions/week)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20,000–50,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP02\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Articulation Training, Oral Motor Therapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,000–10,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt; 0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5–6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP04\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary School Diploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Phonetic Initiation Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3–4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,000–10,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Social Skills Training, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3–4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior High School Diploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20,000–50,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5–6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGovernment Employee\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20,000–50,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSocial Skills Training, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5–6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior High School Diploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration, Phonetic Initiation Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3–4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,000–10,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior High School Diploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCompany employee\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSocial Skills Training, Cognitive Function\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt; 0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenior High School Diploma\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSocial Skills Training, Cognitive Function\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt; 0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5–6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCompany employee\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,000–10,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Phonetic Initiation Training, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt; 0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20,000–50,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Social Skills Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3–4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt; 5000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration, Social Skills Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3–4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Social Skills Training, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3–4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,000–10,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5-1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaster’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eConstruction Worker\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Phonetic Initiation Training, Social Skills Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBachelor’s Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCognitive Function, Sensory Integration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt; 0.5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10,000–20,000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMotor Skills, Social Skills, Language Integration Training\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4–5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt; 5000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIntegrated Intervention\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1–2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeta-themes and themes regarding Parental Experience\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeta-themes\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA: Coexistence of Multiple Stresses in Family Interventions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Parental Stress at the Individual Level\u003c/p\u003e \u003cp\u003eConflicts in the Allocation of Intervention Responsibilities\u003c/p\u003e \u003cp\u003eBottlenecks in the Application of Intervention Skills\u003c/p\u003e \u003cp\u003ePhysical and Mental Fatigue Under Intervention Pressure\u003c/p\u003e \u003cp\u003e-Intervention Challenges Stemming from Child Characteristics\u003c/p\u003e \u003cp\u003eDifficulty Sustaining Attention and Cooperation\u003c/p\u003e \u003cp\u003eEmotional and Behavioural Challenges as Barriers to Intervention Adherence\u003c/p\u003e \u003cp\u003e-Economic Burden\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB: Deficiencies in Family Coping Resources\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Breakdown of the Family Internal Support System\u003c/p\u003e \u003cp\u003eDeficiencies in Spousal Support Within Family Internal Resources\u003c/p\u003e \u003cp\u003eDeficiencies in Intergenerational Support Within Family Internal Resources\u003c/p\u003e \u003cp\u003e-Weaknesses in the Hospital Professional Guidance System\u003c/p\u003e \u003cp\u003e-Insufficiency of Community Support Systems\u003c/p\u003e \u003cp\u003eLack of Specialised Rehabilitation Resources\u003c/p\u003e \u003cp\u003eUnmet Needs for Social Peer Support\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC: Variations in the Cognitive Level of Family Intervention\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Positive Cognition: Facilitating Engagement in Family Intervention\u003c/p\u003e \u003cp\u003e-Negative Cognition: Impeding Adherence to Family Intervention\u003c/p\u003e \u003cp\u003eCognitive Role Conflict\u003c/p\u003e \u003cp\u003eInternalisation and Intergenerational Conflicts of Traditional Beliefs\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eX: Disparities in Family Intervention Capacities\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Positive Outcomes: Significant Effectiveness of Family Intervention\u003c/p\u003e \u003cp\u003eDeepened Parent-Child Bonding\u003c/p\u003e \u003cp\u003eParents’ Self-Growth and Enhanced Self-Efficacy\u003c/p\u003e \u003cp\u003eEmpowerment of Support Systems\u003c/p\u003e \u003cp\u003e-Negative Outcomes: Impeded Implementation of Family Intervention\u003c/p\u003e \u003cp\u003eDisruption of Intervention Practices\u003c/p\u003e \u003cp\u003eTense Family Dynamics\u003c/p\u003e \u003cp\u003eAnxiety and Uncertainty About the Future\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCoexisting Pressures in Family Intervention and Parents\u0026rsquo; Physical-Mental Burdens\u003c/h2\u003e \u003cp\u003e This study identifies three interrelated pressures for parents of children with LDD during family intervention, namely limited intervention skills, children\u0026rsquo;s intrinsic traits and economic constraints. These cumulative stressors significantly amplify caregiving burden, and this observation aligns with the ABC-X model\u0026rsquo;s key proposition that stressor synergies exacerbate coping difficulties.\u003c/p\u003e \u003cp\u003eFamily intervention responsibilities fall disproportionately on mothers, a pattern that reflects China\u0026rsquo;s mother-centric caregiving culture and corroborates Osarfo et al.\u0026rsquo;s work.(Osarfo et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) Burdened by the need to balance core intervention duties, career demands, multi-child care and household chores, mothers struggle to maintain consistent, high-quality intervention time\u0026mdash;a result that aligns with Poduval \u0026rsquo;s study(Poduval \u0026amp; Poduval, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) .A more formidable barrier is the intervention\u0026rsquo;s protracted nature. J. Heidlage et al.\u0026rsquo;s(J. Heidlage et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) meta-analysis reports parent-implemented language interventions last a mean of 34 weeks with a maximum of 124 weeks. This prolonged cycle combines with persistent anxiety over children\u0026rsquo;s developmental outcomes and often triggers maternal burnout and emotional distress. Existing evidence(Kruythoff-Broekman et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) shows depression and anxiety affect 11% and 28% of mothers of children with language disorders, respectively, confirming parents of children with special needs endure far greater psychological strain than caregivers of typically developing children.\u003c/p\u003e \u003cp\u003eDifficulties translating learned intervention skills into daily interactions represent another critical stressor. High-quality adult language input is pivotal to children\u0026rsquo;s language acquisition, so parental mastery of evidence-based language-promotion strategies becomes a cornerstone of early intervention. However, most parents struggled to apply trained skills flexibly in routine interactions. This deficit may stem from limited access to professional training. Insufficient skills further impede the generalisation of children\u0026rsquo;s language abilities across contexts and ultimately compromise intervention efficacy. Children\u0026rsquo;s intrinsic characteristics also contribute significantly to parental stress. Poor attention regulation and emotional lability among children with LDD directly disrupted intervention implementation, and this aligns with prior studies. (Hutchins et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)Communication impairments often precipitate social and behavioural difficulties, which reduce children\u0026rsquo;s intervention compliance. Non-compliance in turn amplifies parental feelings of powerlessness and stress and forms a vicious cycle linking behavioural problems to heightened parental stress. (Neece et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFinally, economic constraints impede the sustainability of family intervention. Many parents cited the high cost of rehabilitation services and long-term financial burden as key barriers. Economic pressure not only limits parents\u0026rsquo; capacity to participate in professional training but also restricts investment in high-quality intervention resources. LDD has been included in medical insurance reimbursement schemes across many regions in China. However, low policy awareness and stigma-related concerns prevent numerous families from accessing these supportive measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eEnhancing Parents\u0026rsquo; Self-Efficacy and Multidimensional Social Support Construction\u003c/h2\u003e \u003cp\u003eAnalysis of the resource dimension (B) in the ABC-X model showed that families of children with LDD experience marked deficits in internal family support, professional guidance, and community-peer support. This resource scarcity directly impairs parental self-efficacy and the efficacy of family interventions, highlighting the urgent need to establish an integrated, multi-level support system.\u003c/p\u003e \u003cp\u003eImbalanced familial roles, skewed caregiving responsibilities, and weakened intergenerational synergy undermine the effectiveness of family-based interventions. This study found intervention duties to be disproportionately borne by mothers; crucially, it confirms that active paternal participation plays a dual empowering role by alleviating mothers\u0026rsquo; practical and emotional burdens. Existing research further links paternal engagement to better child language outcomes, underscoring the necessity of integrating fathers into intervention frameworks. Additionally, although over 70% of Chinese families adopt a grandparent-parent co-parenting model, traditional role delineations often lead grandparents to perceive language intervention as an exclusive parental responsibility, with many avoiding participation for fear of improper implementation. Rural grandparents may face additional barriers, such as dialect limitations and inadequate Mandarin proficiency, which hinder their capacity to provide standardised language input. (Liang \u0026amp; Van Leeuwen, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)These findings align with those from one study, which identified insufficient intergenerational language stimulation as a risk factor for child language delay, as well as with the conclusions from Zhong J.,(Zhong \u0026amp; Luo, n.d.), reflecting the failure to convert intergenerational support into effective intervention assistance.\u003c/p\u003e \u003cp\u003eFor hospital-based professional guidance, systemic inadequacies constrain parents\u0026rsquo; acquisition of core intervention skills. Despite its theoretical advantages, the hybrid online\u0026ndash;offline training model employed in this study yielded suboptimal outcomes. Specifically, online modules were hindered by poor participation rates; furthermore, their one-size-fits-all structure failed to incorporate personalised instruction, instant feedback, and hands-on practice\u0026mdash;key elements for skill acquisition in family intervention settings. Offline training is similarly hampered by a severe specialist shortage: against the international benchmark of 20 speech therapists per 100,000 population, mainland China faces a talent gap of approximately 250,000 practitioners. Burdened by heavy clinical workloads, rehabilitation therapists can only deliver brief, superficial guidance; in practice, therapist-supervised training accounts for a mere 17.4% of parents\u0026rsquo; total intervention efforts, falling far short of meeting demands for systematic, in-depth learning.(Dandan \u0026amp; Kaixi, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAs for community and social-peer support, resource scarcity at these levels amplifies parental feelings of isolation and powerlessness. Specialised child rehabilitation facilities remain scarce across most communities; geographic disparities force families to travel long distances for urban-based services, with some even incurring extra accommodation costs to reside near intervention institutions, thereby substantially increasing their financial and logistical burdens. Current community guidance is largely theoretical, offering generic advice (e.g., \u0026ldquo;increase child communication\u0026rdquo;) without actionable strategies to address specific intervention challenges. Social-peer support is equally deficient, as no stable, accessible platforms exist for families with similar needs to share experiences. Parents thus struggle to obtain practical, personalised intervention insights and lack peer emotional empathy\u0026mdash;a gap that may directly reduce their motivation and confidence to sustain long-term intervention efforts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eParental Perceptual Divergences on Family-Based Intervention for LDD Children\u003c/h2\u003e \u003cp\u003eBased on an analysis of the cognitive-perceptual dimension (C) in the ABC-X model, we identified significant perceptual divergences among parents of children with LDD regarding family-based intervention.\u003c/p\u003e \u003cp\u003e A small subset of parents held positive perceptions to facilitate intervention implementation, whereas the majority exhibited cognitive biases and even encountered intergenerational cognitive conflicts, highlighting the urgent need for targeted guidance. From the parental cognitive perspective, adaptability to and cognitive positioning of the \u0026ldquo;family intervenor\u0026rdquo; role directly correlate with intervention efficacy. We found that only a minority of parents successfully adapted to this role, and their active practice enhanced intervention effectiveness, parent-child bonding and self-efficacy. Most parents, by contrast, struggled with role maladjustment, which aligns with the conclusions of Sugden et al.(Sugden et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCognitive biases stem from two core sources. First, parents commonly hold a one-sided view that hospital-based intervention is primary and family-based intervention supplementary, believing that professional hospital training diminishes the urgency of family-based practice. Second, shaped by traditional perceptions of medical services in China, parents rarely prioritise family-based intervention for speech therapy and instead prefer full reliance on professional institutions, an observation consistent with the findings of Wen et al.(Wen \u0026amp; Lin, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) A prominent issue lies in the prevalent cognitive conflict between parents\u0026rsquo; dual identities as emotional caregivers and structured therapists. They often assess their own performance against the standardised requirements of professional rehabilitation, yet the inherently natural and intimate home environment fundamentally contradicts structured rehabilitation models. When children display non-cooperation or slow progress, parents are highly prone to frustration, which may prompt them to abandon family-based intervention and turn to complete reliance on professional institutions.\u003c/p\u003e \u003cp\u003eIntergenerational cognitive conflict constitutes another key barrier to early intervention, primarily stemming from the deep-seated traditional belief that noble persons speak late. Empirically, this belief erroneously extrapolates isolated cases of successful late talkers into a universal rule. Normatively, it misconstrues LDD as a marker of a calm temperament. Emotionally, it temporarily mitigates parenting anxiety through romanticised framing of developmental differences, fostering cultural inertia. From a modern medical standpoint, this belief obscures the boundary between normal developmental variation and pathological delay, prompting families to adopt a wait-and-see stance at the onset of warning signs and thus causing them to miss the critical pre-three intervention window. Research confirms that without timely intervention, approximately 50% of children with LDD develop persistent language disorders, which impose long-term adverse impacts on their cognitive and social development.(Matte-Landry et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) In practice, shaped by this belief, grandparents often insist that children naturally acquire language as they mature and resist or doubt scientific intervention, whereas younger parents tend to seek professional support. This intergenerational cognitive misalignment not only delays intervention but also risks exacerbating family conflicts and undermining a supportive parenting environment, thereby amplifying children\u0026rsquo;s language rehabilitation challenges.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eConstructing a \u0026ldquo;Hospital-Community-Family\u0026rdquo; Trinity System to Improve Parents\u0026rsquo; Family-Based Intervention Efficacy\u003c/h2\u003e \u003cp\u003eBased on our findings, to comprehensively improve family-based intervention efficacy, a collaborative support system integrating hospital, family, and community resources is essential. Specifically, a localised \u0026ldquo;teaching-demonstration-coaching-assessment\u0026rdquo; closed-loop training model should be established, incorporating lectures, videos, role-playing, and home guidance manuals to help parents integrate intervention strategies into daily environments (e.g., reading corners, interactive toy areas) and enhance child engagement.(Senent-Capuz et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) Digital tools should also be leveraged to expand service accessibility, including building online platforms integrating self-directed learning and remote coaching, and exploring AI interactive robots to boost intervention fun and children\u0026rsquo;s participation motivation.(Sawyer et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAt the cognitive level, early guidance and education should be strengthened by integrating language development screening into routine child healthcare. Parents should be provided with materials on specific intervention methods and developmental warning signs to dispel misconceptions such as \u0026ldquo;noble persons speak late\u0026rdquo; and foster awareness of \u0026ldquo;early screening and early intervention.\u0026rdquo; Additionally, whole-family participation should be promoted via gamified interactive courses for fathers and cognitive correction sessions for grandparents, establishing a \u0026ldquo;whole-family participation and collaborative division of labour\u0026rdquo; model to address the over-concentration of responsibility on mothers.\u003c/p\u003e \u003cp\u003eIn terms of external support, the community rehabilitation network and peer support system need improvement. This can be achieved by setting up grassroots rehabilitation stations, establishing a \u0026ldquo;medical institution-community-family\u0026rdquo; linkage mechanism, and creating parent experience-sharing and emotional support platforms to reduce home intervention costs and ensure continuity. Finally, from a macro-policy perspective, the government should expand special education support, systematically develop early screening and intervention systems, and increase investment in speech therapy professionals and rehabilitation resources. This holistic approach aims to elevate children\u0026rsquo;s overall language health and alleviate family burdens.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eLimitations of this study\u003c/h2\u003e \u003cp\u003eThis study has several inherent limitations that should be acknowledged. First, all participants were recruited from a single tertiary maternal and child health hospital, with the sample predominantly consisting of mothers (19/20). This sampling bias constrains the generalizability of the findings in terms of geographical diversity and gender representation. Consequently, the results may not fully capture the intervention experiences across different healthcare settings, regional cultural contexts, or from paternal perspectives.\u003c/p\u003e \u003cp\u003eSecond, as a cross-sectional qualitative study, the research primarily relied on self-reported data obtained through interviews. This design precluded the capture of the dynamic evolution of family experiences with the intervention, which would require long-term follow-up assessments and on-site observational data.\u003c/p\u003e \u003cp\u003eFurthermore, although thematic analysis was performed based on the Pressure-Resources-Perception-Adaptation model, the exploration of certain underlying interactive mechanisms within the family pressure and adaptation process remains insufficient. For instance, the temporal dynamics of how resources and perceptions mutually influence each other warrant further in-depth investigation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eStatement on Participant Consent Written informed consent was obtained from all participants or their legal guardians prior to study participation.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXuxing Lin, Lijiao Cai, Wenjuan Yan, and Yingying Zhang were responsible for conducting the interviews. Xuxing Lin, Wenjuan Yan, and Hongjuan Zhou undertook the data analysis. Xuxing Lin drafted the initial manuscript, while Hongjuan Zhou and Yingying Zhang revised it. All authors have made substantial contributions to the study and approved the final version of the manuscript for submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBallard, J., Wieling, E., Solheim, C. A., \u0026amp; Lang, D. 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Parenting stress and child behavior problems: a transactional relationship across time. \u003cem\u003eAmerican Journal on Intellectual and Developmental Disabilities\u003c/em\u003e, \u003cem\u003e117\u003c/em\u003e(1), 48\u0026ndash;66. https://doi.org/10.1352/1944-7558-117.1.48\u003c/li\u003e\n\u003cli\u003eNudel, R., Christensen, R. V., Kalnak, N., Schwinn, M., Banasik, K., Dinh, K. M., DBDS Genomic Consortium, Erikstrup, C., Pedersen, O. B., Burgdorf, K. S., Ullum, H., Ostrowski, S. R., Hansen, T. F., \u0026amp; Werge, T. (2023). Developmental language disorder - a comprehensive study of more than 46,000 individuals. \u003cem\u003ePsychiatry Research\u003c/em\u003e, \u003cem\u003e323\u003c/em\u003e(115171), 115171. https://doi.org/10.1016/j.psychres.2023.115171\u003c/li\u003e\n\u003cli\u003eOsarfo, J., Ampofo, G. D., \u0026amp; Tagbor, H. K. (2025). 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Prevalence, co-occurring difficulties, and risk factors of developmental language disorder: first evidence for Mandarin-speaking children in a population-based study. \u003cem\u003eThe Lancet Regional Health. Western Pacific\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(100713), 100713. https://doi.org/10.1016/j.lanwpc.2023.100713\u003c/li\u003e\n\u003cli\u003eZhong, J., \u0026amp; Luo, R. (n.d.). Child Development in Rural China:A Cross-Sectional Study. \u003cem\u003eInt.J.Environ.Res.Public Health\u003c/em\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Language development delay, Parent-implemented intervention, ABC-X model, Qualitative research, Parents","lastPublishedDoi":"10.21203/rs.3.rs-8408915/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8408915/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eChildhood language development delay (LDD) has emerged as a pressing global public health challenge, and targeted family interventions are pivotal to enhancing prognostic outcomes in the context of China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Drawing on the ABC-X model, this study investigates the experiences of Chinese parents of children with LDD throughout family interventions, examining their stressors, resources, perceptions and coping strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA qualitative study was performed at Fujian Maternity and Child Health Hospital (June–October 2025) among parents of children with LDD undergoing parent-implemented intervention (PII). Family sociodemographic data, children’s clinical baseline information, and family intervention profiles were collected. After pre-surveying three parents to refine interview questions, in-depth semi-structured interviews were conducted with 20 parents; audio recordings were analysed via Colaizzi’s seven-step method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA dynamic \"Pressure-Resources-Perception-Adaptation\" model was established, with four key themes identified: (1) Pressure: coexistence of multiple pressures in family intervention; (2) Resources: insufficient support systems; (3) Perception: divergent parental cognition of family intervention; (4) Adaptation: varied family intervention capabilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Parents of children with LDD face multiple pressures during family intervention; inadequate coping resources, unmet social support demands and negative perceptions tend to lead to passive coping. Future parent-centred support programs based on family stress theory should reduce specific pressures, establish systematic support resources, promote positive cognitive restructuring, strengthen family resilience, and thereby enhance intervention effectiveness and improve children’s LDD prognosis.\u003c/p\u003e","manuscriptTitle":"The Experience of Chinese Parents of Children with Language Development Delay(LDD) in Family Intervention under the ABC-X Model: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-24 06:22:20","doi":"10.21203/rs.3.rs-8408915/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e572647-b59e-425f-a4bc-ce1e8e7f80a7","owner":[],"postedDate":"December 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-28T19:38:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-24 06:22:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8408915","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8408915","identity":"rs-8408915","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}