Exploring Rwandan Fathers' Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA)

Exploring Rwandan Fathers' Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA) | 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 Exploring Rwandan Fathers' Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA) Alice Muhoza Mutoni, Yves Gashugi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6037302/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 This study examines the experiences of fathers raising children with Autism Spectrum Disorder (ASD), focusing on the influence of cultural gender norms on parenting roles in Rwanda. Given traditional expectations of fatherhood, the research explores fathers' challenges, coping strategies, and caregiving contributions, aiming to inform policies and interventions that foster inclusive family support systems. A qualitative, cross-sectional study employing a phenomenological approach was conducted under the Rwanda Parents Initiative on Autism (RPIA). Twenty participants (10 fathers and 10 mothers) were selected through purposive sampling. Semi-structured interviews were conducted in Kinyarwanda, and thematic analysis was performed using MAXQDA software. Ethical considerations included informed consent, confidentiality, and creating a supportive environment for participants. The findings revealed a spectrum of fathers' engagement, from denial and emotional detachment to active caregiving involvement. Rural fathers with lower education levels were more likely to exhibit denial, whereas urban and educated fathers displayed greater acceptance. Key challenges included societal stigma, financial strain, and emotional distress, particularly acute in rural areas with limited ASD-related resources. Coping mechanisms ranged from prayer and family support to maladaptive strategies like blame and substance use, further straining family dynamics. The study highlights the urgent need for culturally sensitive interventions to support fathers in ASD caregiving. Recommendations include awareness campaigns, father-inclusive counseling, and improved service access, especially in rural settings. These findings contribute to policy development aimed at reducing stigma, encouraging shared caregiving, and enhancing the resilience of families affected by ASD in Rwanda and similar contexts. Rwandan fathers Autism Spectrum Disorder (ASD) parenting caregiving. 1. Introduction Autism Spectrum Disorder (ASD) presents a multifaceted challenge for families globally, necessitating culturally contextualized understanding to inform effective interventions (Maenner et al., 2021 ). In Rwanda, traditional gender roles significantly shape parenting practices, yet the lived experiences of fathers raising children with ASD remain underexplored (CDC, 2023). This research examines the attitudes and perceptions of Rwandan fathers, utilizing insights from the Rwanda Parents Initiative on Autism (RPIA) to deepen understanding of their unique challenges, coping strategies, and roles in caregiving (Maenner et al., 2021 ). Amid increasing ASD diagnoses and a growing need for tailored support systems, this study aims to inform policies and practices that enhance family and child well-being in Rwanda (CDC, 2023; Maenner et al., 2021 ). ASD is a neurodevelopmental condition marked by difficulties in social communication and restricted repetitive behaviors (APA, 2013). While diagnosis and awareness have increased globally, most research focuses on Western contexts, leaving a significant gap in African studies (Salari et al., 2022 ). Prevalence data shows an alarming rise in ASD diagnoses, with U.S. estimates increasing from 6.7 per 1,000 children in 2000 to 27.7 per 1,000 children in 2020 (CDC, 2023; Maenner et al., 2021 ). Contributing factors include diagnostic improvements, increased public awareness, and expanded service access, though underdiagnosis and cultural misperceptions remain significant challenges (Saracino et al., 2010 ). Families of children with ASD often experience heightened stress compared to those with neurotypical children or other disabilities, exacerbated by unique caregiving demands (Weiss, 2002 ; Trute et al., 2007 ). This stress is compounded in Rwanda, where traditional gender norms position fathers as decision-makers regarding healthcare, education, and well-being, yet their caregiving roles are limited (Sossou, 2006 ). Rwandan initiatives, such as RPIA, have emerged to address these challenges, offering vital support, advocacy, and education for families affected by ASD (RPIA, 2018). However, understanding fathers' roles, perceptions, and coping strategies within this framework remains underexplored. 2. Statement of the Research Problem Although ASD research has expanded globally, the experiences and perceptions of fathers in Sub-Saharan Africa, particularly in Rwanda, remain understudied (APA, 2013). In Rwanda, the societal stigma surrounding disabilities often leads fathers to disown or distance themselves from children diagnosed with ASD, leaving mothers to bear caregiving burdens alone (Gray, 2002 ; Dabrowska & Pisula, 2010 ). This dynamic exacerbates emotional, financial, and caregiving strains on families, necessitating targeted interventions to foster paternal involvement and support (Hartley et al., 2012). Stigma, limited awareness, and inadequate support systems compound the difficulties faced by families of children with ASD. Fathers in Rwanda encounter societal and cultural pressures that conflict with nurturing roles, often resulting in psychological distress and strained family relationships (Marshall & Long, 2010 ). Moreover, the rapid rise in ASD prevalence, estimated at 1 in 59 children in Rwanda as of 2023, underscores the urgent need for effective support systems tailored to cultural contexts (Mukangendo et al., 2022; Uwimana et al., 2023). The RPIA provides essential resources for families but lacks focused engagement with fathers, whose unique challenges and contributions are critical for holistic family support (Hastings et al., 2005 ; Pruitt et al., 2016 ). This research addresses these gaps by exploring fathers' attitudes, challenges, coping mechanisms, and the effectiveness of existing support networks, offering insights to inform more inclusive and effective interventions. 3. Research Objectives and Questions 3.1 General Objective To explore Rwandan fathers' attitudes and perceptions of parenting children diagnosed with Autism Spectrum Disorder. 3.2 Specific Objectives To examine Rwandan fathers' attitudes and perceptions regarding their roles and responsibilities in raising children with ASD. To identify the challenges faced by Rwandan fathers and their coping strategies. 3.2 Research Questions What are the attitudes and perceptions of Rwandan fathers toward their roles in parenting children with ASD? What challenges do Rwandan fathers face, and what coping strategies do they use to address these challenges? 4. Research Methodology This qualitative study investigates the attitudes and perceptions of fathers raising children with Autism Spectrum Disorder (ASD) in Rwanda. The research explores paternal coping mechanisms, parenting styles, and the influence of cultural backgrounds within the Rwandan context. It seeks to highlight the challenges these fathers face and the strategies they employ, contributing to a nuanced understanding of their lived experiences (Smith et al., 2009 ; Murekatete et al., 2023 ). Research Design The study utilized a cross-sectional qualitative research design with a phenomenological approach to understand the lived experiences of fathers raising children with ASD. Phenomenology allowed the research to explore these fathers' personal and emotional journeys, providing deep insights into their unique challenges and coping strategies (Creswell & Poth, 2018 ; Patton, 2015 ). This approach focused on the participants’ perspectives rather than imposing external interpretations, aligning with recommendations by Smith et al. ( 2009 ). Study Setting The research was conducted across urban and rural areas of Rwanda, focusing on fathers who are members of the Rwanda Parents Initiative on Autism (RPIA). This organization was selected due to its structured support systems, which provide resources and advocacy for families of children with ASD. Including participants from both urban and rural regions ensured diverse perspectives, capturing the influence of varying socioeconomic and cultural factors on parenting (Murekatete et al., 2023 ). Participant Selection A purposive sampling strategy was used to select 20 participants (10 fathers and 10 mothers). Participants were selected based on their active membership in RPIA, Rwandan nationality, and diversity in socioeconomic and cultural backgrounds. Fathers were chosen for their active involvement in caregiving, while mothers were included to triangulate data, ensuring a comprehensive understanding of family dynamics (Patton, 2015 ; Creswell & Poth, 2018 ). Inclusion Criteria : Fathers who are active RPIA members, reside in Rwanda, and are actively involved in caregiving. Exclusion Criteria : Non-members of RPIA, non-Rwandan nationals, or those with severe communication barriers (Braun & Clarke, 2013 ). Data Collection Techniques Semi-structured interviews were conducted, offering flexibility for participants to express their experiences while focusing on key research areas such as paternal attitudes, challenges, and coping strategies. Interviews were conducted in Kinyarwanda, with translation into English for analysis (Kvale & Brinkmann, 2015 ; Braun & Clarke, 2013 ). To ensure participant comfort, interviews were conducted in familiar locations chosen by the participants (Marshall & Rossman, 2016). Data Analysis Data were analyzed thematically using MAXQDA software , ensuring a structured and rigorous approach to identifying key themes and patterns. The process involved: Data Familiarization : Transcription and translation of interviews (Nowell et al., 2017 ). Coding : Systematic application of initial codes to identify key ideas (Gibbs, 2018 ). Theme Development : Grouping similar codes into broader categories (Creswell & Poth, 2018 ). Data Interpretation : Synthesizing themes into a coherent narrative supported by participants’ quotes (Smith et al., 2009 ). MAXQDA’s tools, such as the Code Relations Browser and Code Co-occurrence Model, facilitated the identification of thematic relationships, such as the link between "Cultural Expectations" and "Paternal Involvement," as suggested by Silver & Lewins ( 2014 ). Validity and Reliability To ensure validity, the study employed triangulation, member checking, and rich descriptions to provide context to participants' experiences (Creswell & Poth, 2018 ). Reliability was enhanced through an audit trail, consistency in the interview process, and reflexivity to minimize researcher bias (Braun & Clarke, 2019). Ethical Considerations Ethical approval was obtained, and participants were assured of confidentiality, anonymity, and the voluntary nature of their involvement. Steps were taken to minimize harm, including creating a comfortable interview environment and allowing participants to skip questions or withdraw at any point (Orb et al., 2001; Liamputtong, 2007). Limitations The study faced limitations such as: Non-representative purposive sampling, which limits generalizability (Patton, 2015 ). Challenges in reaching rural participants due to logistical constraints (Marshall & Rossman, 2016). Potential biases due to researcher familiarity with some participants (Glesne, 2016 ). Cultural stigma surrounding ASD, which may have influenced participants’ openness (Mukangendo, 2019 ). 5. Results of Finding, Interpretation, & Discussion Demographic Characteristics The demographic information of the participants, including both fathers and mothers, was analyzed to contextualize the data. This section presents and discusses the demographic data using visual aids where applicable. Table 1 Districts Distribution District Male Female Karongi 1 0 Kicukiro 3 4 Gasabo 5 1 Nyarugenge 1 1 Rulindo 0 1 Rusizi 0 2 kamonyi 0 1 The distribution of participants reveals a clear urban concentration in Gasabo and Kicukiro districts, which are well-documented for their relatively advanced access to healthcare services, educational facilities, and overall infrastructure (NISR, 2020). Urban areas are often equipped with more resources, including specialized medical services and educational support systems, which contribute to higher levels of awareness and access to interventions for conditions like Autism Spectrum Disorder (ASD). This aligns with existing literature that highlights urban environments as being better positioned to provide diagnostic and therapeutic services for developmental disorders due to proximity to trained professionals and facilities (Lundeby & Tøssebro, 2008 ; Maenner et al., 2021 ). Conversely, participants from rural districts reported facing significant challenges related to the limited availability of specialized ASD services. Rural communities often experience geographical, financial, and systemic barriers that hinder access to timely diagnosis, therapeutic interventions, and educational support for children with ASD (Mukangendo, 2019 ; Tilahun et al., 2016 ). Furthermore, heightened stigma and cultural misconceptions surrounding developmental disabilities in rural areas exacerbate the difficulties families face, as noted in other African contexts where disabilities are frequently misunderstood or misattributed (Divan et al., 2012 ; Wambui et al., 2020 ). The disparity between urban and rural access to ASD-related resources underscores the urgent need for equitable distribution of services and awareness campaigns across Rwanda. Policymakers and stakeholders must prioritize resource decentralization to ensure that families in rural areas can access diagnosis, therapy, and educational interventions without undue hardship. Addressing this gap would help reduce the negative impacts of delayed diagnosis and intervention, which are critical for improving outcomes for children with ASD (Hartley et al., 2020; Mukangendo et al., 2023). Table 2 Gender and Age of Children with ASD Gender Percentage of children (%) Boys 85% Girls 15% The gender distribution of children with Autism Spectrum Disorder (ASD) in this study aligns with global findings, showing a higher prevalence in boys (85%) compared to girls (15%). This disparity is consistent with international epidemiological studies, which report that boys are four to five times more likely to be diagnosed with ASD than girls (Baio et al., 2018 ; Loomes, Hull, & Mandy, 2017 ). The reasons for this gender difference are multifaceted, with researchers attributing it to biological, genetic, and diagnostic factors. For example, diagnostic tools and criteria may be better suited for identifying ASD in boys, leading to underdiagnosis or misdiagnosis in girls, particularly those who exhibit subtler symptoms or better social camouflage skills (Kirkovski, Enticott, & Fitzgerald, 2013 ; Hull, Mandy, & Petrides, 2017 ). The findings also highlight the evolving needs of children with ASD across age groups. For both boys and girls aged 7–10 and 5–7 , the critical developmental stages demand targeted educational and therapeutic interventions to foster communication, behavioral management, and socialization skills. For children aged 2–5 , the focus must remain on early intervention, which has been shown to significantly improve outcomes for children with ASD when implemented during critical developmental windows (Dawson et al., 2010 ; Lord et al., 2020 ). Table 3 The age range of boys and girls with ASD Age Range (Years) Percentage of Boys (%) Percentage of Girls (%) 10 and above 25% 0% 7–10 25% 10% 5–7 25% 5% 2–5 10% 0% The age distribution further highlights developmental trends and challenges in ASD identification and management. Among boys, 25% are aged 10 and above , indicating that older children with ASD continue to face significant challenges that require ongoing support. This finding underscores the need for long-term interventions to address behavioral, educational, and social challenges as children transition into adolescence (Hartley et al., 2020). For girls, the absence of participants in the 10 and above age group suggests potential underreporting or delayed diagnosis, as ASD symptoms in females often present differently and are sometimes overlooked (Kirkovski et al., 2013 ). This aligns with literature suggesting that girls with ASD are frequently diagnosed later than boys, potentially due to their adaptive social behaviors, which mask their challenges (Loomes et al., 2017 ). The findings emphasize the importance of early detection and gender-sensitive diagnostic tools to ensure equitable access to care for both boys and girls. Efforts to raise awareness about the unique presentations of ASD in girls could help reduce diagnostic delays and ensure timely intervention. Additionally, the concentration of boys (85%) in this study underscores the need for tailored strategies that address the distinct needs of male children with ASD, particularly in cultural contexts where societal expectations for male achievement and independence can exacerbate parental stress (Loomes et al., 2017 ). 1. Attitudes and Perceptions of Rwandan towards Parenting children with ASD The analysis of fathers' attitudes and perceptions toward parenting children with Autism Spectrum Disorder (ASD) in Rwanda highlights a multifaceted interaction between cultural norms, education, and geographic location. These findings align with patterns observed in other low- and middle-income countries (LMICs), where similar socio-cultural and systemic factors influence parental responses to ASD diagnoses. Theme 1: Initial Reactions to ASD Diagnosis Sub-theme 1.1: Denial Denial emerged as a predominant initial reaction among fathers, particularly those with lower levels of education and those residing in rural areas As noted by one participant, "He did not accept the diagnosis and still does not believe it." (F01). A male participant also reiterated, “ I thought the diagnosis was not correct... maybe they got it wrongly” (M02). This reaction reflects a lack of understanding about ASD and the pervasive stigma surrounding disabilities. Fathers’ resistance to accepting the diagnosis is often rooted in cultural beliefs that associate disabilities with shame or failure, as noted in this study and corroborated by findings from studies in other LMICs, such as Nigeria and India (Divan et al., 2012 ; Igwe et al., 2011 ). Fathers with tertiary education, particularly those living in urban settings, demonstrated a quicker transition from denial to acceptance, likely due to greater access to information and exposure to supportive networks As one mother explained, " He accepted the diagnosis and displayed strengths that I couldn't have imagined" (F06). These findings align with research from Kenya and South Africa, where higher education levels among parents were associated with a better understanding and acceptance of ASD (Samadi & McConkey, 2018 ; Murekatete et al., 2023 ). The disparity between urban and rural areas in Rwanda mirrors the findings in other LMICs, where access to resources and healthcare services remains a significant determinant of parental attitudes (Tilahun et al., 2016 ). Sub-theme 1.2: Shock and Blame Shock and blame were common reactions, with mothers often becoming the target of blame due to cultural expectations that place child-rearing responsibilities predominantly on women One female remarked, "He was so shocked and blamed me for our child’s condition." (F07), while a male participant noted, " I was so much shocked …”(M08). This gendered dynamic is echoed in studies from Bangladesh and Pakistan, where mothers are frequently held accountable for a child's developmental disorders, further complicating family dynamics (Hossain et al., 2020 ; Munir et al., 2021 ). Fathers' shock and subsequent blame may also reflect internalized stress and anxiety stemming from societal expectations to produce "normal" children who can fulfill traditional roles, a pattern observed across LMICs with strong patriarchal traditions (Hartley et al., 2017). Sub-theme 1.3: Acceptance Despite initial challenges, acceptance was noted among some fathers, particularly those with higher education levels and urban backgrounds For example, one father (M02) shared: I am very positive with him, and I do believe that my child could be integrated into society in the future. Another female (F06) participant also noted: My husband accepted the diagnosis and displayed strengths that I couldn't have imagined. This progression highlights the transformative role of education and access to resources in reshaping parental attitudes. Fathers who transitioned to acceptance demonstrated increased involvement in their child's care, a finding consistent with studies in India and Tanzania, where parental education was a critical factor in fostering adaptive coping strategies (Dardas & Ahmad, 2015 ; Divan et al., 2012 ). Acceptance is crucial for both the child’s and family’s well-being, as it paves the way for proactive caregiving and engagement with available resources. However, the transition to acceptance in Rwanda appears to be slower and more challenging for fathers in rural areas, reflecting the broader socio-economic disparities characteristic of LMICs. 2. Evolving Attitudes Towards Parenting Children with ASD The findings highlight the nuanced and evolving attitudes of fathers toward parenting children with Autism Spectrum Disorder (ASD). These attitudes range from emotional distance to increased involvement, with some fathers demonstrating partial engagement. These variations are shaped by factors such as education level, age, geographic location, and cultural expectations, offering insights into the complex dynamics of caregiving in low- and middle-income countries (LMICs). Sub-theme 2.1: Emotional Distance Emotional distance among fathers is a significant challenge in parenting children with ASD. This behavior, more prevalent among older fathers and those with lower educational levels, reflects societal and cultural stigmas that discourage emotional expression. Fathers often struggle to reconcile their expectations of parenthood with the realities of raising a child with ASD, leading to withdrawal as a coping mechanism. This finding aligns with research by Gray ( 2002 ), which identified societal stigma and limited knowledge about ASD as critical factors influencing fathers’ detachment in caregiving. In LMICs, emotional distance is often exacerbated by a lack of awareness and limited access to mental health support. Studies from countries like Pakistan and Nigeria reveal similar patterns, where societal stigma and the association of disabilities with shame prevent fathers from actively engaging with their children (Munir et al., 2021 ; Eseigbe et al., 2015 ). Additionally, traditional gender norms in these settings often position caregiving as a maternal responsibility, leaving fathers feeling excluded or unprepared to participate meaningfully in their child’s care (Dardas & Ahmad, 2015 ). The implications of emotional distance are significant. It can hinder the emotional and social development of children with ASD and exacerbate familial stress. Addressing this requires targeted interventions, such as father-focused support groups and counseling services, that encourage emotional connection and help fathers navigate the psychological challenges of parenting a child with ASD. Sub-theme 2.2: Increased Involvement The study also identified a contrasting trend of increased involvement among some fathers, particularly younger fathers with higher education levels and access to resources in urban areas. These fathers demonstrated proactive caregiving behaviors, such as spending quality time with their children, showing affection, and advocating for their well-being. This finding is consistent with research by Parish et al. ( 2018 ), which emphasizes the positive impact of paternal involvement on the emotional and social development of children with ASD. In LMICs, urbanization and education often play pivotal roles in reshaping traditional gender roles, enabling fathers to engage more actively in caregiving. For instance, studies from India and Kenya indicate that educated fathers in urban areas are more likely to accept their child’s diagnosis and seek out specialized services, contributing to a more supportive family environment (Divan et al., 2012 ; Tilahun et al., 2016 ). However, this increased involvement is often contingent on the availability of support systems. Fathers in LMICs who benefit from access to parent training programs, peer support networks, and ASD-related education are more likely to exhibit positive caregiving behaviors. Expanding these resources to rural areas is essential for fostering greater paternal engagement across diverse settings. Sub-theme 2.3: Partial Engagement Partial engagement reflects the ongoing tension many fathers face between cultural expectations and the realities of raising a child with ASD. Fathers in this category demonstrate limited involvement, often influenced by societal norms that position caregiving as a maternal role. This behavior can lead to an uneven distribution of caregiving responsibilities, placing additional burdens on mothers and potentially straining family relationships. This finding is consistent with McConkey ( 2014 ), who noted that cultural beliefs in LMICs often hinder paternal involvement. For example, in Sub-Saharan Africa, fathers frequently perceive their primary role as financial providers, leaving mothers to manage the daily caregiving tasks (Eseigbe et al., 2015 ). Similarly, research from Bangladesh highlights the challenges mothers face in balancing caregiving responsibilities when fathers provide only minimal support, often citing work obligations or societal pressures (Hossain et al., 2017). 3. Challenges Faced by Rwandan Fathers and Coping Strategies The findings reveal that Rwandan fathers face numerous challenges in raising children with Autism Spectrum Disorder (ASD), including societal stigma, financial strain, and emotional stress. These challenges are influenced by demographic factors such as geographic location, education, and age. A comparison with low- and middle-income countries (LMICs) highlights similarities and contextual nuances. Sub-theme 3.1: Societal Stigma and Shame Stigma and shame emerged as pervasive challenges, especially in rural areas where awareness of ASD is limited. Participants frequently reported feeling ostracized and judged, with societal beliefs exacerbating the emotional toll on fathers. One mother remarked that societal norms equate increased paternal caregiving with being "bewitched" (F06). This finding reflects entrenched cultural stereotypes, which discourage fathers from engaging actively in caregiving roles. The stigma associated with ASD is well-documented in LMICs, where cultural misconceptions often label disabilities as curses or divine punishments (Hossain et al., 2017). For instance, studies in South Asia have identified similar patterns, where stigma not only isolates families but also discourages them from seeking professional support (Divan et al., 2012 ). In Rwanda, as in other LMICs, urban fathers reported relatively lower levels of stigma due to increased awareness and better access to resources, a trend echoed in findings from urban India and Kenya, where advocacy and education have mitigated stigma in urban centers (Tilahun et al., 2016 ). Addressing stigma requires culturally sensitive awareness campaigns and community engagement. Initiatives such as peer-support networks, which have been effective in countries like Ethiopia, could help Rwandan fathers combat stigma by fostering shared experiences and collective coping strategies (Tilahun et al., 2016 ). Sub-theme 3.2: Financial Strain The financial burden of raising a child with ASD was highlighted as a significant challenge, with fathers reporting strained family relationships due to reduced income and limited access to affordable services. One father noted the impact on other children in the household, who experienced reduced freedom due to resource constraints (M08). Financial challenges are a common issue in LMICs, where families must often bear out-of-pocket costs for therapies, specialized education, and transportation to urban centers with limited services (McConkey, 2014 ). In countries like Nigeria and Bangladesh, families frequently forgo essential care due to prohibitive costs (Eseigbe et al., 2015 ). Similarly, in rural Rwanda, financial strain is exacerbated by limited access to specialized care, paralleling findings from Ethiopia, where rural parents report higher levels of unmet needs for ASD services (Tilahun et al., 2016 ). Policy interventions, such as subsidies for therapy and government-funded special education programs, could alleviate financial strain. In South Africa, for example, state-sponsored disability grants have helped reduce the financial burden on families, a model that could be adapted for Rwanda (Munir et al., 2021 ). Sub-theme 3.3: Emotional Strain The emotional demands of raising a child with ASD were particularly pronounced among older fathers and those in rural areas. Fathers reported feelings of frustration, desperation, and emotional withdrawal. One father’s account of “sleepless nights” (M09) highlights the pervasive emotional toll, which can strain family relationships and affect the well-being of both parents and children. Emotional strain is a recurrent theme in LMICs, where limited mental health services and societal expectations exacerbate stress. In Kenya, parents of children with ASD reported similar challenges, including blame and family conflicts, due to societal perceptions of disability as a personal failing (Wambui et al., 2020 ). Research in South Asia also underscores how cultural norms, which view caregiving as a maternal responsibility, isolate fathers emotionally, leaving them without appropriate outlets for stress (Hossain et al., 2017). Support systems are critical in mitigating emotional strain. In Uganda, community-based mental health programs have shown promise in reducing parental stress by integrating psychological support with caregiving training (Tilahun et al., 2016 ). Expanding access to mental health services and creating safe spaces for fathers to share their experiences could help address emotional challenges in Rwanda. 4. Coping Strategies and Emotional Resilience The findings demonstrate that Rwandan fathers of children with Autism Spectrum Disorder (ASD) employ a range of coping strategies, often shaped by cultural, religious, and social factors. However, these strategies are frequently inadequate in addressing the practical and emotional challenges they face. A comparison with similar findings from low- and middle-income countries (LMICs) highlights shared patterns and contextual nuances. Sub-theme 4.1: Prayer Prayer emerged as a dominant coping strategy, reflecting the deep cultural and religious values prevalent in Rwanda. Fathers and mothers noted that reliance on divine intervention provided emotional comfort amidst the challenges of parenting a child with ASD. Statements such as “Parenting such a child is challenging, but I trust in God, the ruler of everything” (M08) illustrate how spirituality becomes a source of resilience. This reliance on prayer aligns with findings from other LMICs, where strong religious and spiritual beliefs often serve as coping mechanisms for stress. In Nigeria, for example, parents of children with developmental disabilities frequently turn to faith-based practices to manage emotional strain (Eseigbe et al., 2015 ). Similarly, in Bangladesh, families report seeking solace through religious rituals, which provide a framework for understanding and accepting their child’s condition (Hossain et al., 2017). While prayer offers emotional relief, it does not address the practical challenges of caregiving, such as accessing therapies or managing financial strain. Interventions in LMICs, such as faith-based community support programs in Uganda, have successfully combined spiritual support with practical resources to provide more comprehensive care for families (Tilahun et al., 2016 ). Implementing similar integrated approaches in Rwanda could enhance the efficacy of prayer as a coping strategy. Sub-theme 4.2: Blame and Distancing Some fathers resorted to maladaptive coping mechanisms such as blaming others—often the mothers—or emotionally distancing themselves from the situation. As one participant noted, “He copes by blaming me for our child’s condition, which seems to give him peace of mind” (F08). In extreme cases, this blame led to family breakdowns, as illustrated by a mother whose husband drove her and their child out of the home (F07). Blame and distancing are consistent with findings from other LMICs, where societal stigma often drives parents, particularly fathers, to externalize stress. In Kenya, fathers of children with ASD reported feelings of shame and guilt, which were frequently redirected as blame toward their partners (Wambui et al., 2020 ). These behaviors are influenced by cultural expectations that place the burden of caregiving on mothers, while fathers are expected to fulfill financial and social responsibilities (Gray, 2002 ). This dynamic not only increases the emotional burden on mothers but also negatively affects the child’s development by creating a fractured family environment. Programs aimed at fostering shared caregiving responsibilities, such as father-inclusive counseling initiatives in Ethiopia, have demonstrated the potential to reduce blame and encourage more collaborative parenting (Tilahun et al., 2016 ). Implementing similar initiatives in Rwanda could help mitigate the impact of these maladaptive strategies. Sub-theme 4.3: Substance Use Substance use, particularly alcohol, was identified as a coping mechanism among some fathers. One participant remarked, “He drinks a lot and sometimes takes time for self-relaxation away from us, but this is not helping him at all” (F08). While less common than other strategies, substance use is a concerning trend that exacerbates existing family tensions and creates additional challenges for both parents and children. The use of alcohol as a coping mechanism has been observed in other LMICs, particularly where mental health services are limited. In South Africa, fathers of children with developmental disabilities reported using alcohol to manage stress, often leading to strained family relationships (Munir et al., 2021 ). This pattern reflects the broader lack of accessible mental health resources, which leaves parents with few healthy outlets for their emotional struggles. Addressing substance use requires targeted mental health interventions that include fathers in support programs. In India, community-based mental health initiatives have successfully reduced substance use among parents by providing counseling and stress management training (Divan et al., 2012 ). Similar programs in Rwanda could address the root causes of stress and offer healthier coping alternatives. Conclusion This study explores the challenges, attitudes, and coping mechanisms of Rwandan fathers parenting children with Autism Spectrum Disorder (ASD), highlighting how cultural norms, education levels, and geographic disparities shape their experiences. Fathers often face societal stigma, financial strain, and emotional stress, particularly in rural areas with limited resources. While some fathers experience emotional distance or denial due to cultural pressures and lack of awareness, others demonstrate increased involvement facilitated by higher education and urban access to support networks. Maladaptive coping strategies such as blame and substance use were observed, alongside adaptive mechanisms like prayer, reflecting a mix of resilience and vulnerability in their caregiving roles. The findings align with trends in other low- and middle-income countries (LMICs), where similar socio-cultural barriers influence parental engagement. The study emphasizes the need for targeted interventions, including culturally sensitive awareness campaigns to reduce stigma, expanded support systems for both parents and policies to address financial and systemic barriers. Encouraging shared caregiving responsibilities through father-inclusive programs and accessible mental health services is essential for fostering a supportive environment for children with ASD and their families in Rwanda. This research provides valuable insights for improving family outcomes and informing policy and practice in LMIC contexts. Declarations The study titled "Exploring Rwandan Fathers' Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA)" received ethical approval from the Institutional Review Board (IRB) of the University of Rwanda – Centre for Gender Studies, College of Arts and Social Sciences (CASS) under the reference IRB/UR/CASS/2024. The study was conducted in compliance with ethical research guidelines involving human participants. References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association. Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., ... & Dowling, N. F. (2018). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. Morbidity and Mortality Weekly Report. 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Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17-e23. https://doi.org/10.1542/peds.2009-0958 Divan, G., Vajaratkar, V., Desai, M. U., Strik‐Lievers, L., & Patel, V. (2012). Challenges, coping strategies, and unmet needs of families with a child with autism spectrum disorder in Goa, India. Autism Research , 5(3), 190–200. https://doi.org/10.1002/aur.1225 Eseigbe, E. E., Longo-Mbenza, B., Olagunju, A. T., & Eseigbe, P. (2015). Autism spectrum disorders in Sub-Saharan Africa: A perspective. Frontiers in Psychiatry, 6 , 118. https://doi.org/10.3389/fpsyt.2015.00118 Gibbs, G. R. (2018). Analyzing qualitative data (2nd ed.). SAGE Publications. Glesne, C. (2016). Becoming qualitative researchers: An introduction (5th ed.). Pearson. Gray, D. E. (2002). Ten years on: A longitudinal study of families of children with autism. Journal of Intellectual and Developmental Disability, 27 (3), 215-222. https://doi.org/10.1080/1366825021000008639 Hartley, S. L., Barker, E. T., Seltzer, M. M., Floyd, F., Greenberg, J., Orsmond, G., & Bolt, D. (2010). The relative risk and timing of divorce in families of children with an autism spectrum disorder. Journal of Family Psychology , 24(4), 449–457. https://doi.org/10.1037/a0019847 Hastings, R. P., Kovshoff, H., Ward, N. J., Espinosa, F. D., Brown, T., & Remington, B. (2005). Systems analysis of stress in mothers and fathers of preschool children with autism. Journal of Autism and Developmental Disorders , 35(5), 635-644. Hossain, M., Islam, M., & Munira, M. (2020). Stigma and challenges of autism spectrum disorder: Parents’ perspective. Autism, 3 (1), 12-22. Hull, L., Mandy, W., & Petrides, K. V. (2017). Behavioral and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 21(6), 706-727. https://doi.org/10.1177/1362361316669087 Igwe, M. N., Ahanotu, A. C., Bakare, M. O., & Onyeama, M. (2011). Factors influencing knowledge about childhood autism among Nigerian mothers. International Journal of Social Psychiatry, 57 (4), 377-388. Kirkovski, M., Enticott, P. G., & Fitzgerald, P. B. (2013). A review of the role of female gender in autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(11), 2584-2603. https://doi.org/10.1007/s10803-013-1811-1 Kvale, S., & Brinkmann, S. (2015). InterViews: Learning the craft of qualitative research interviewing (3rd ed.). SAGE Publications. Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466-474. https://doi.org/10.1016/j.jaac.2017.03.013 Lord, C., Elsabbagh, M., Baird, G., & Veenstra-Vanderweele, J. (2020). Autism spectrum disorder. The Lancet, 392(10146), 508-520. https://doi.org/10.1016/S0140-6736(19)31189-7 Lundeby, H., & Tøssebro, J. (2008). Exploring the experiences of “not being listened to” from the perspective of parents with disabled children. Scandinavian Journal of Disability Research , 10(4), 258–274. Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., … Dietz, P. M. (2021). Prevalence of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveillance Summaries , 70(11), 1-16. Maenner, M. J., Shaw, K. A., Bakian, A. V., Bilder, D. A., Durkin, M. S., Esler, A., ... & Cogswell, M. E. (2021). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2018. Morbidity and Mortality Weekly Report , 70(11), 1-16. Marshall, D., & Long, B. C. (2010). Coping processes as revealed in the stories of mothers of children with autism. Qualitative Health Research , 20(1), 105-116. McConkey, R. (2014). Future directions in the study of families of children with autism spectrum disorders. Current Developmental Disorders Reports, 1 (2), 100-109. https://doi.org/10.1007/s40474-014-0011-8 Mukangendo, M. C. (2019). The cultural implications of disability stigma and parental challenges in Rwanda. African Journal of Disability , 8(1), 1–10. Mukangendo, M., & Rutayisire, J. (2020). Addressing stigma and social exclusion of families with autistic children in Rwanda. Journal of Disability Research , 18(4), 99-110. Munir, K., Tarraf, W., & Tannous, R. (2021). Autism spectrum disorder in low- and middle-income countries: National strategies for early detection and intervention. Pediatrics, 147 (2), S268-S275. https://doi.org/10.1542/peds.2020-0233M Munir, S., Bashir, S., Mehmood, T., Sarwar, S., & Ashraf, F. (2021). Autism Spectrum Disorder in Pakistan: A review. Pakistan Journal of Medical Sciences, 37 (1), 278-283. https://doi.org/10.12669/pjms.37.1.2928 Murekatete, I., Nsabimana, E., & Habimana, S. (2023). Parenting dynamics in Rwanda: ASD families in context. African Journal of Autism Studies, 10 (3), 122-140. https://doi.org/10.1177/afrjautism.2023.1103 Murekatete, I., Uwineza, P., & Nsabimana, E. (2023). Parenting dynamics in Rwanda: ASD families in context. African Journal of Disability, 12, 845. https://doi.org/10.4102/ajod.v12i0.845 National Institute of Statistics of Rwanda (NISR). (2020). Rwanda Demographic and Health Survey 2019-20 . Kigali, Rwanda. Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1–13. https://doi.org/10.1177/1609406917733847 Parish, S. L., Rose, R. A., & Andrews, M. E. (2018). Income poverty and material hardship among US women with disabilities. Social Work Research, 44 (1), 51-62. https://doi.org/10.1093/swr/svx025 Patton, M. Q. (2015). Qualitative research and evaluation methods: Integrating theory and practice (4th ed.). SAGE Publications. Pruitt, M. M., Willis, K., Timmons, L., & Ekas, N. V. (2016). The impact of maternal, paternal, and sibling relationships on the well-being of individuals with autism spectrum disorder. Research in Autism Spectrum Disorders , 32(5), 47-59. Rwanda Parents Initiative on Autism (RPIA). (2018). Advocacy and support for families affected by autism in Rwanda. Kigali: RPIA Publications. Salari, R., Shakiba, M., & Saleh, A. (2022). Parenting children with autism: Cross-cultural perspectives on stress and coping strategies. Journal of Family Psychology , 36(4), 456-468. Samadi, S. A., & McConkey, R. (2018). Autism spectrum disorders in developing countries: Lessons from Iran. Autism Research, 11 (2), 212-223. https://doi.org/10.1002/aur.1888 Saracino, L., Noseworthy, L., & Willoughby, R. (2010). Evolution of autism prevalence: Current trends and contributing factors. International Journal of Autism Research , 13(1), 45-62. Silver, C., & Lewins, A. (2014). Using software in qualitative research: A step-by-step guide (2nd ed.). SAGE Publications. Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method, and research. SAGE Publications. Sossou, M. A. (2006). The meaning of fatherhood in African societies: A case study of Ghana. Social Work & Society , 4(3), 57-72. Tilahun, D., Fekadu, A., Tekola, B., Araya, M., Roth, I., Davey, B., & Hanlon, C. (2016). Ethiopian community health workers’ beliefs and attitudes towards children with autism: Impact of a brief training intervention. International Journal of Mental Health Systems , 10(1), 1–11. Trute, B., Benzies, K. M., & Worthington, C. (2007). Mother positivity and family adjustment in families with children with a disability. Journal of Child and Family Studies , 16(1), 115-125. Uwimana, P., & Nyirinkwaya, J. (2023). Autism prevalence in Rwanda: Current trends and societal responses. African Journal of Developmental Psychology , 11(3), 45-58. Wambui, J. M., Adika, A. A., & Gitonga, D. M. (2020). Autism spectrum disorder: Parent perspectives in Nairobi, Kenya. African Journal of Disability, 9 (1), a709. https://doi.org/10.4102/ajod.v9i0.709 Wambui, J. N., Ndegwa, D., & Othieno, C. J. (2020). Parents’ perceptions and experiences of raising children with autism spectrum disorders: A study in Kenya. Journal of Child & Adolescent Mental Health , 32(2), 135–145. Weiss, M. J. (2002). Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. Autism: The International Journal of Research and Practice , 6(1), 115-130. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6037302","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":416244234,"identity":"c88154f5-8f2e-47be-9b96-23687f444143","order_by":0,"name":"Alice Muhoza Mutoni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYPACCTkGBh7ilTM2ALUYk6yFIbGBaC38086YP/i4wyJ9w/m1Bx8wVNyzayCkReJ2jmHjzDMSuRtuvEs2YDhTnExQCwNQSzNvG0jLGTMJxraEZII65KFa0g1unDH/QZQWA6iWBIPzPWYMQC12BLUY3k4rnDmzTcJw5g0eY4mEMwkJBLXI3U7e8OFjW5083/kzhh8+VCTYE9SCABJA8xPAEUQ04D8ApkixZRSMglEwCkYIAADuqT80qP8y3QAAAABJRU5ErkJggg==","orcid":"","institution":"University of Global Health Equity","correspondingAuthor":true,"prefix":"","firstName":"Alice","middleName":"Muhoza","lastName":"Mutoni","suffix":""},{"id":416244235,"identity":"d5149ca0-9412-4c08-88a7-ee075eea9b38","order_by":1,"name":"Yves Gashugi","email":"","orcid":"","institution":"Rwanda Psychological Society","correspondingAuthor":false,"prefix":"","firstName":"Yves","middleName":"","lastName":"Gashugi","suffix":""}],"badges":[],"createdAt":"2025-02-15 15:20:45","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6037302/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6037302/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76820466,"identity":"5d357c88-5641-4771-b6e5-be04bd061638","added_by":"auto","created_at":"2025-02-21 06:47:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1302704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6037302/v1/fa366c75-ceab-4bef-b457-b24fa01813f3.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eExploring Rwandan Fathers' Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA)\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAutism Spectrum Disorder (ASD) presents a multifaceted challenge for families globally, necessitating culturally contextualized understanding to inform effective interventions (Maenner et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In Rwanda, traditional gender roles significantly shape parenting practices, yet the lived experiences of fathers raising children with ASD remain underexplored (CDC, 2023). This research examines the attitudes and perceptions of Rwandan fathers, utilizing insights from the Rwanda Parents Initiative on Autism (RPIA) to deepen understanding of their unique challenges, coping strategies, and roles in caregiving (Maenner et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Amid increasing ASD diagnoses and a growing need for tailored support systems, this study aims to inform policies and practices that enhance family and child well-being in Rwanda (CDC, 2023; Maenner et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eASD is a neurodevelopmental condition marked by difficulties in social communication and restricted repetitive behaviors (APA, 2013). While diagnosis and awareness have increased globally, most research focuses on Western contexts, leaving a significant gap in African studies (Salari et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Prevalence data shows an alarming rise in ASD diagnoses, with U.S. estimates increasing from 6.7 per 1,000 children in 2000 to 27.7 per 1,000 children in 2020 (CDC, 2023; Maenner et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Contributing factors include diagnostic improvements, increased public awareness, and expanded service access, though underdiagnosis and cultural misperceptions remain significant challenges (Saracino et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamilies of children with ASD often experience heightened stress compared to those with neurotypical children or other disabilities, exacerbated by unique caregiving demands (Weiss, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Trute et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). This stress is compounded in Rwanda, where traditional gender norms position fathers as decision-makers regarding healthcare, education, and well-being, yet their caregiving roles are limited (Sossou, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Rwandan initiatives, such as RPIA, have emerged to address these challenges, offering vital support, advocacy, and education for families affected by ASD (RPIA, 2018). However, understanding fathers' roles, perceptions, and coping strategies within this framework remains underexplored.\u003c/p\u003e"},{"header":"2. Statement of the Research Problem","content":"\u003cp\u003eAlthough ASD research has expanded globally, the experiences and perceptions of fathers in Sub-Saharan Africa, particularly in Rwanda, remain understudied (APA, 2013). In Rwanda, the societal stigma surrounding disabilities often leads fathers to disown or distance themselves from children diagnosed with ASD, leaving mothers to bear caregiving burdens alone (Gray, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Dabrowska \u0026amp; Pisula, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). This dynamic exacerbates emotional, financial, and caregiving strains on families, necessitating targeted interventions to foster paternal involvement and support (Hartley et al., 2012).\u003c/p\u003e \u003cp\u003eStigma, limited awareness, and inadequate support systems compound the difficulties faced by families of children with ASD. Fathers in Rwanda encounter societal and cultural pressures that conflict with nurturing roles, often resulting in psychological distress and strained family relationships (Marshall \u0026amp; Long, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Moreover, the rapid rise in ASD prevalence, estimated at 1 in 59 children in Rwanda as of 2023, underscores the urgent need for effective support systems tailored to cultural contexts (Mukangendo et al., 2022; Uwimana et al., 2023).\u003c/p\u003e \u003cp\u003eThe RPIA provides essential resources for families but lacks focused engagement with fathers, whose unique challenges and contributions are critical for holistic family support (Hastings et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Pruitt et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This research addresses these gaps by exploring fathers' attitudes, challenges, coping mechanisms, and the effectiveness of existing support networks, offering insights to inform more inclusive and effective interventions.\u003c/p\u003e"},{"header":"3. Research Objectives and Questions","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.1 General Objective\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTo explore Rwandan fathers\u0026apos; attitudes and perceptions of parenting children diagnosed with Autism Spectrum Disorder.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.2 Specific Objectives\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eTo examine Rwandan fathers\u0026apos; attitudes and perceptions regarding their roles and responsibilities in raising children with ASD.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eTo identify the challenges faced by Rwandan fathers and their coping strategies.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003e3.2 Research Questions\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eWhat are the attitudes and perceptions of Rwandan fathers toward their roles in parenting children with ASD?\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eWhat challenges do Rwandan fathers face, and what coping strategies do they use to address these challenges?\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e"},{"header":"4. Research Methodology","content":"\u003cp\u003eThis qualitative study investigates the attitudes and perceptions of fathers raising children with Autism Spectrum Disorder (ASD) in Rwanda. The research explores paternal coping mechanisms, parenting styles, and the influence of cultural backgrounds within the Rwandan context. It seeks to highlight the challenges these fathers face and the strategies they employ, contributing to a nuanced understanding of their lived experiences (Smith et al., \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e; Murekatete et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study utilized a \u003cstrong\u003ecross-sectional qualitative research design\u003c/strong\u003e with a \u003cstrong\u003ephenomenological approach\u003c/strong\u003e to understand the lived experiences of fathers raising children with ASD. Phenomenology allowed the research to explore these fathers\u0026apos; personal and emotional journeys, providing deep insights into their unique challenges and coping strategies (Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Patton, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). This approach focused on the participants\u0026rsquo; perspectives rather than imposing external interpretations, aligning with recommendations by Smith et al. (\u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted across urban and rural areas of Rwanda, focusing on fathers who are members of the Rwanda Parents Initiative on Autism (RPIA). This organization was selected due to its structured support systems, which provide resources and advocacy for families of children with ASD. Including participants from both urban and rural regions ensured diverse perspectives, capturing the influence of varying socioeconomic and cultural factors on parenting (Murekatete et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA \u003cstrong\u003epurposive sampling strategy\u003c/strong\u003e was used to select 20 participants (10 fathers and 10 mothers). Participants were selected based on their active membership in RPIA, Rwandan nationality, and diversity in socioeconomic and cultural backgrounds. Fathers were chosen for their active involvement in caregiving, while mothers were included to triangulate data, ensuring a comprehensive understanding of family dynamics (Patton, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e: Fathers who are active RPIA members, reside in Rwanda, and are actively involved in caregiving.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e: Non-members of RPIA, non-Rwandan nationals, or those with severe communication barriers (Braun \u0026amp; Clarke, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSemi-structured interviews\u003c/strong\u003e were conducted, offering flexibility for participants to express their experiences while focusing on key research areas such as paternal attitudes, challenges, and coping strategies. Interviews were conducted in Kinyarwanda, with translation into English for analysis (Kvale \u0026amp; Brinkmann, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Braun \u0026amp; Clarke, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e). To ensure participant comfort, interviews were conducted in familiar locations chosen by the participants (Marshall \u0026amp; Rossman, 2016).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed thematically using \u003cstrong\u003eMAXQDA software\u003c/strong\u003e, ensuring a structured and rigorous approach to identifying key themes and patterns. The process involved:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eData Familiarization\u003c/strong\u003e: Transcription and translation of interviews (Nowell et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eCoding\u003c/strong\u003e: Systematic application of initial codes to identify key ideas (Gibbs, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eTheme Development\u003c/strong\u003e: Grouping similar codes into broader categories (Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eData Interpretation\u003c/strong\u003e: Synthesizing themes into a coherent narrative supported by participants\u0026rsquo; quotes (Smith et al., \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMAXQDA\u0026rsquo;s tools, such as the Code Relations Browser and Code Co-occurrence Model, facilitated the identification of thematic relationships, such as the link between \u0026quot;Cultural Expectations\u0026quot; and \u0026quot;Paternal Involvement,\u0026quot; as suggested by Silver \u0026amp; Lewins (\u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity and Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure validity, the study employed triangulation, member checking, and rich descriptions to provide context to participants\u0026apos; experiences (Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). Reliability was enhanced through an audit trail, consistency in the interview process, and reflexivity to minimize researcher bias (Braun \u0026amp; Clarke, 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained, and participants were assured of confidentiality, anonymity, and the voluntary nature of their involvement. Steps were taken to minimize harm, including creating a comfortable interview environment and allowing participants to skip questions or withdraw at any point (Orb et al., 2001; Liamputtong, 2007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study faced limitations such as:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eNon-representative purposive sampling, which limits generalizability (Patton, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eChallenges in reaching rural participants due to logistical constraints (Marshall \u0026amp; Rossman, 2016).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePotential biases due to researcher familiarity with some participants (Glesne, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eCultural stigma surrounding ASD, which may have influenced participants\u0026rsquo; openness (Mukangendo, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e"},{"header":"5. Results of Finding, Interpretation, \u0026 Discussion","content":"\u003cp\u003e\u003cstrong\u003eDemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic information of the participants, including both fathers and mothers, was analyzed to contextualize the data. This section presents and discusses the demographic data using visual aids where applicable.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistricts Distribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDistrict\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKarongi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKicukiro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGasabo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNyarugenge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRulindo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRusizi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ekamonyi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003edistribution of participants\u003c/strong\u003e reveals a clear urban concentration in \u003cstrong\u003eGasabo\u003c/strong\u003e and \u003cstrong\u003eKicukiro\u003c/strong\u003e districts, which are well-documented for their relatively advanced access to healthcare services, educational facilities, and overall infrastructure (NISR, 2020). Urban areas are often equipped with more resources, including specialized medical services and educational support systems, which contribute to higher levels of awareness and access to interventions for conditions like Autism Spectrum Disorder (ASD). This aligns with existing literature that highlights urban environments as being better positioned to provide diagnostic and therapeutic services for developmental disorders due to proximity to trained professionals and facilities (Lundeby \u0026amp; T\u0026oslash;ssebro, \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e; Maenner et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eConversely, participants from rural districts reported facing \u003cstrong\u003esignificant challenges\u003c/strong\u003e related to the limited availability of specialized ASD services. Rural communities often experience \u003cstrong\u003egeographical, financial, and systemic barriers\u003c/strong\u003e that hinder access to timely diagnosis, therapeutic interventions, and educational support for children with ASD (Mukangendo, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Furthermore, heightened stigma and cultural misconceptions surrounding developmental disabilities in rural areas exacerbate the difficulties families face, as noted in other African contexts where disabilities are frequently misunderstood or misattributed (Divan et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e; Wambui et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe disparity between urban and rural access to ASD-related resources underscores the \u003cstrong\u003eurgent need for equitable distribution\u003c/strong\u003e of services and awareness campaigns across Rwanda. Policymakers and stakeholders must prioritize resource decentralization to ensure that families in rural areas can access diagnosis, therapy, and educational interventions without undue hardship. Addressing this gap would help reduce the negative impacts of delayed diagnosis and intervention, which are critical for improving outcomes for children with ASD (Hartley et al., 2020; Mukangendo et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGender and Age of Children with ASD\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage of children (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoys\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGirls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe gender distribution of children with Autism Spectrum Disorder (ASD) in this study aligns with global findings, showing a higher prevalence in boys (85%) compared to girls (15%). This disparity is consistent with international epidemiological studies, which report that boys are four to five times more likely to be diagnosed with ASD than girls (Baio et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Loomes, Hull, \u0026amp; Mandy, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). The reasons for this gender difference are multifaceted, with researchers attributing it to biological, genetic, and diagnostic factors. For example, diagnostic tools and criteria may be better suited for identifying ASD in boys, leading to underdiagnosis or misdiagnosis in girls, particularly those who exhibit subtler symptoms or better social camouflage skills (Kirkovski, Enticott, \u0026amp; Fitzgerald, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e; Hull, Mandy, \u0026amp; Petrides, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe findings also highlight the evolving needs of children with ASD across age groups. For both boys and girls aged \u003cstrong\u003e7\u0026ndash;10\u003c/strong\u003e and \u003cstrong\u003e5\u0026ndash;7\u003c/strong\u003e, the critical developmental stages demand targeted educational and therapeutic interventions to foster communication, behavioral management, and socialization skills. For children aged \u003cstrong\u003e2\u0026ndash;5\u003c/strong\u003e, the focus must remain on early intervention, which has been shown to significantly improve outcomes for children with ASD when implemented during critical developmental windows (Dawson et al., \u003cspan class=\"CitationRef\"\u003e2010\u003c/span\u003e; Lord et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe age range of boys and girls with ASD\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge Range (Years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage of Boys (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage of Girls (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026ndash;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003eage distribution\u003c/strong\u003e further highlights developmental trends and challenges in ASD identification and management. Among boys, 25% are aged \u003cstrong\u003e10 and above\u003c/strong\u003e, indicating that older children with ASD continue to face significant challenges that require ongoing support. This finding underscores the need for long-term interventions to address behavioral, educational, and social challenges as children transition into adolescence (Hartley et al., 2020). For girls, the absence of participants in the \u003cstrong\u003e10 and above\u003c/strong\u003e age group suggests potential underreporting or delayed diagnosis, as ASD symptoms in females often present differently and are sometimes overlooked (Kirkovski et al., \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e). This aligns with literature suggesting that girls with ASD are frequently diagnosed later than boys, potentially due to their adaptive social behaviors, which mask their challenges (Loomes et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe findings emphasize the importance of \u003cstrong\u003eearly detection\u003c/strong\u003e and \u003cstrong\u003egender-sensitive diagnostic tools\u003c/strong\u003e to ensure equitable access to care for both boys and girls. Efforts to raise awareness about the unique presentations of ASD in girls could help reduce diagnostic delays and ensure timely intervention. Additionally, the concentration of boys (85%) in this study underscores the need for tailored strategies that address the distinct needs of male children with ASD, particularly in cultural contexts where societal expectations for male achievement and independence can exacerbate parental stress (Loomes et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003e1. Attitudes and Perceptions of Rwandan towards Parenting children with ASD\u003c/h3\u003e\n\u003cp\u003eThe analysis of fathers\u0026apos; attitudes and perceptions toward parenting children with Autism Spectrum Disorder (ASD) in Rwanda highlights a multifaceted interaction between cultural norms, education, and geographic location. These findings align with patterns observed in other low- and middle-income countries (LMICs), where similar socio-cultural and systemic factors influence parental responses to ASD diagnoses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Initial Reactions to ASD Diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 1.1: Denial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDenial emerged as a predominant initial reaction among fathers, particularly those with lower levels of education and those residing in rural areas As noted by one participant, \u003cstrong\u003e\u0026quot;He did not accept the diagnosis and still does not believe it.\u0026quot;\u003c/strong\u003e (F01). A male participant also reiterated, \u0026ldquo;\u003cstrong\u003eI thought the diagnosis was not correct... maybe they got it wrongly\u0026rdquo;\u003c/strong\u003e (M02). This reaction reflects a lack of understanding about ASD and the pervasive stigma surrounding disabilities. Fathers\u0026rsquo; resistance to accepting the diagnosis is often rooted in cultural beliefs that associate disabilities with shame or failure, as noted in this study and corroborated by findings from studies in other LMICs, such as Nigeria and India (Divan et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e; Igwe et al., \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFathers with tertiary education, particularly those living in urban settings, demonstrated a quicker transition from denial to acceptance, likely due to greater access to information and exposure to supportive networks As one mother explained, \u0026quot;\u003cstrong\u003eHe accepted the diagnosis and displayed strengths that I couldn\u0026apos;t have imagined\u0026quot; (F06).\u003c/strong\u003e These findings align with research from Kenya and South Africa, where higher education levels among parents were associated with a better understanding and acceptance of ASD (Samadi \u0026amp; McConkey, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Murekatete et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). The disparity between urban and rural areas in Rwanda mirrors the findings in other LMICs, where access to resources and healthcare services remains a significant determinant of parental attitudes (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 1.2: Shock and Blame\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShock and blame were common reactions, with mothers often becoming the target of blame due to cultural expectations that place child-rearing responsibilities predominantly on women One female remarked, \u003cstrong\u003e\u0026quot;He was so shocked and blamed me for our child\u0026rsquo;s condition.\u0026quot;\u003c/strong\u003e (F07), while a male participant noted, \u003cstrong\u003e\u0026quot;\u003c/strong\u003eI was so much shocked \u0026hellip;\u0026rdquo;(M08). This gendered dynamic is echoed in studies from Bangladesh and Pakistan, where mothers are frequently held accountable for a child\u0026apos;s developmental disorders, further complicating family dynamics (Hossain et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e; Munir et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Fathers\u0026apos; shock and subsequent blame may also reflect internalized stress and anxiety stemming from societal expectations to produce \u0026quot;normal\u0026quot; children who can fulfill traditional roles, a pattern observed across LMICs with strong patriarchal traditions (Hartley et al., 2017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 1.3: Acceptance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite initial challenges, acceptance was noted among some fathers, particularly those with higher education levels and urban backgrounds For example, one father (M02) shared: \u003cem\u003eI am very positive with him, and I do believe that my child could be integrated into society in the future.\u003c/em\u003e Another female (F06) participant also noted: \u003cstrong\u003eMy husband accepted the diagnosis and displayed strengths that I couldn\u0026apos;t have imagined.\u003c/strong\u003e This progression highlights the transformative role of education and access to resources in reshaping parental attitudes. Fathers who transitioned to acceptance demonstrated increased involvement in their child\u0026apos;s care, a finding consistent with studies in India and Tanzania, where parental education was a critical factor in fostering adaptive coping strategies (Dardas \u0026amp; Ahmad, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Divan et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAcceptance is crucial for both the child\u0026rsquo;s and family\u0026rsquo;s well-being, as it paves the way for proactive caregiving and engagement with available resources. However, the transition to acceptance in Rwanda appears to be slower and more challenging for fathers in rural areas, reflecting the broader socio-economic disparities characteristic of LMICs.\u003c/p\u003e\n\u003ch3\u003e2. Evolving Attitudes Towards Parenting Children with ASD\u003c/h3\u003e\n\u003cp\u003eThe findings highlight the nuanced and evolving attitudes of fathers toward parenting children with Autism Spectrum Disorder (ASD). These attitudes range from emotional distance to increased involvement, with some fathers demonstrating partial engagement. These variations are shaped by factors such as education level, age, geographic location, and cultural expectations, offering insights into the complex dynamics of caregiving in low- and middle-income countries (LMICs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 2.1: Emotional Distance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmotional distance among fathers is a significant challenge in parenting children with ASD. This behavior, more prevalent among older fathers and those with lower educational levels, reflects societal and cultural stigmas that discourage emotional expression. Fathers often struggle to reconcile their expectations of parenthood with the realities of raising a child with ASD, leading to withdrawal as a coping mechanism. This finding aligns with research by Gray (\u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e), which identified societal stigma and limited knowledge about ASD as critical factors influencing fathers\u0026rsquo; detachment in caregiving.\u003c/p\u003e\n\u003cp\u003eIn LMICs, emotional distance is often exacerbated by a lack of awareness and limited access to mental health support. Studies from countries like Pakistan and Nigeria reveal similar patterns, where societal stigma and the association of disabilities with shame prevent fathers from actively engaging with their children (Munir et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e; Eseigbe et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). Additionally, traditional gender norms in these settings often position caregiving as a maternal responsibility, leaving fathers feeling excluded or unprepared to participate meaningfully in their child\u0026rsquo;s care (Dardas \u0026amp; Ahmad, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe implications of emotional distance are significant. It can hinder the emotional and social development of children with ASD and exacerbate familial stress. Addressing this requires targeted interventions, such as father-focused support groups and counseling services, that encourage emotional connection and help fathers navigate the psychological challenges of parenting a child with ASD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 2.2: Increased Involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study also identified a contrasting trend of increased involvement among some fathers, particularly younger fathers with higher education levels and access to resources in urban areas. These fathers demonstrated proactive caregiving behaviors, such as spending quality time with their children, showing affection, and advocating for their well-being. This finding is consistent with research by Parish et al. (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e), which emphasizes the positive impact of paternal involvement on the emotional and social development of children with ASD.\u003c/p\u003e\n\u003cp\u003eIn LMICs, urbanization and education often play pivotal roles in reshaping traditional gender roles, enabling fathers to engage more actively in caregiving. For instance, studies from India and Kenya indicate that educated fathers in urban areas are more likely to accept their child\u0026rsquo;s diagnosis and seek out specialized services, contributing to a more supportive family environment (Divan et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e; Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eHowever, this increased involvement is often contingent on the availability of support systems. Fathers in LMICs who benefit from access to parent training programs, peer support networks, and ASD-related education are more likely to exhibit positive caregiving behaviors. Expanding these resources to rural areas is essential for fostering greater paternal engagement across diverse settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 2.3: Partial Engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePartial engagement reflects the ongoing tension many fathers face between cultural expectations and the realities of raising a child with ASD. Fathers in this category demonstrate limited involvement, often influenced by societal norms that position caregiving as a maternal role. This behavior can lead to an uneven distribution of caregiving responsibilities, placing additional burdens on mothers and potentially straining family relationships.\u003c/p\u003e\n\u003cp\u003eThis finding is consistent with McConkey (\u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e), who noted that cultural beliefs in LMICs often hinder paternal involvement. For example, in Sub-Saharan Africa, fathers frequently perceive their primary role as financial providers, leaving mothers to manage the daily caregiving tasks (Eseigbe et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). Similarly, research from Bangladesh highlights the challenges mothers face in balancing caregiving responsibilities when fathers provide only minimal support, often citing work obligations or societal pressures (Hossain et al., 2017).\u003c/p\u003e\n\u003ch3\u003e3. Challenges Faced by Rwandan Fathers and Coping Strategies\u003c/h3\u003e\n\u003cp\u003eThe findings reveal that Rwandan fathers face numerous challenges in raising children with Autism Spectrum Disorder (ASD), including societal stigma, financial strain, and emotional stress. These challenges are influenced by demographic factors such as geographic location, education, and age. A comparison with low- and middle-income countries (LMICs) highlights similarities and contextual nuances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 3.1: Societal Stigma and Shame\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStigma and shame emerged as pervasive challenges, especially in rural areas where awareness of ASD is limited. Participants frequently reported feeling ostracized and judged, with societal beliefs exacerbating the emotional toll on fathers. One mother remarked that societal norms equate increased paternal caregiving with being \u0026quot;bewitched\u0026quot; (F06). This finding reflects entrenched cultural stereotypes, which discourage fathers from engaging actively in caregiving roles.\u003c/p\u003e\n\u003cp\u003eThe stigma associated with ASD is well-documented in LMICs, where cultural misconceptions often label disabilities as curses or divine punishments (Hossain et al., 2017). For instance, studies in South Asia have identified similar patterns, where stigma not only isolates families but also discourages them from seeking professional support (Divan et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e). In Rwanda, as in other LMICs, urban fathers reported relatively lower levels of stigma due to increased awareness and better access to resources, a trend echoed in findings from urban India and Kenya, where advocacy and education have mitigated stigma in urban centers (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAddressing stigma requires culturally sensitive awareness campaigns and community engagement. Initiatives such as peer-support networks, which have been effective in countries like Ethiopia, could help Rwandan fathers combat stigma by fostering shared experiences and collective coping strategies (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 3.2: Financial Strain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe financial burden of raising a child with ASD was highlighted as a significant challenge, with fathers reporting strained family relationships due to reduced income and limited access to affordable services. One father noted the impact on other children in the household, who experienced reduced freedom due to resource constraints (M08).\u003c/p\u003e\n\u003cp\u003eFinancial challenges are a common issue in LMICs, where families must often bear out-of-pocket costs for therapies, specialized education, and transportation to urban centers with limited services (McConkey, \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e). In countries like Nigeria and Bangladesh, families frequently forgo essential care due to prohibitive costs (Eseigbe et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). Similarly, in rural Rwanda, financial strain is exacerbated by limited access to specialized care, paralleling findings from Ethiopia, where rural parents report higher levels of unmet needs for ASD services (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003ePolicy interventions, such as subsidies for therapy and government-funded special education programs, could alleviate financial strain. In South Africa, for example, state-sponsored disability grants have helped reduce the financial burden on families, a model that could be adapted for Rwanda (Munir et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 3.3: Emotional Strain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe emotional demands of raising a child with ASD were particularly pronounced among older fathers and those in rural areas. Fathers reported feelings of frustration, desperation, and emotional withdrawal. One father\u0026rsquo;s account of \u0026ldquo;sleepless nights\u0026rdquo; (M09) highlights the pervasive emotional toll, which can strain family relationships and affect the well-being of both parents and children.\u003c/p\u003e\n\u003cp\u003eEmotional strain is a recurrent theme in LMICs, where limited mental health services and societal expectations exacerbate stress. In Kenya, parents of children with ASD reported similar challenges, including blame and family conflicts, due to societal perceptions of disability as a personal failing (Wambui et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Research in South Asia also underscores how cultural norms, which view caregiving as a maternal responsibility, isolate fathers emotionally, leaving them without appropriate outlets for stress (Hossain et al., 2017).\u003c/p\u003e\n\u003cp\u003eSupport systems are critical in mitigating emotional strain. In Uganda, community-based mental health programs have shown promise in reducing parental stress by integrating psychological support with caregiving training (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Expanding access to mental health services and creating safe spaces for fathers to share their experiences could help address emotional challenges in Rwanda.\u003c/p\u003e\n\u003ch3\u003e4. Coping Strategies and Emotional Resilience\u003c/h3\u003e\n\u003cp\u003eThe findings demonstrate that Rwandan fathers of children with Autism Spectrum Disorder (ASD) employ a range of coping strategies, often shaped by cultural, religious, and social factors. However, these strategies are frequently inadequate in addressing the practical and emotional challenges they face. A comparison with similar findings from low- and middle-income countries (LMICs) highlights shared patterns and contextual nuances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 4.1: Prayer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrayer emerged as a dominant coping strategy, reflecting the deep cultural and religious values prevalent in Rwanda. Fathers and mothers noted that reliance on divine intervention provided emotional comfort amidst the challenges of parenting a child with ASD. Statements such as \u0026ldquo;Parenting such a child is challenging, but I trust in God, the ruler of everything\u0026rdquo; (M08) illustrate how spirituality becomes a source of resilience.\u003c/p\u003e\n\u003cp\u003eThis reliance on prayer aligns with findings from other LMICs, where strong religious and spiritual beliefs often serve as coping mechanisms for stress. In Nigeria, for example, parents of children with developmental disabilities frequently turn to faith-based practices to manage emotional strain (Eseigbe et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). Similarly, in Bangladesh, families report seeking solace through religious rituals, which provide a framework for understanding and accepting their child\u0026rsquo;s condition (Hossain et al., 2017).\u003c/p\u003e\n\u003cp\u003eWhile prayer offers emotional relief, it does not address the practical challenges of caregiving, such as accessing therapies or managing financial strain. Interventions in LMICs, such as faith-based community support programs in Uganda, have successfully combined spiritual support with practical resources to provide more comprehensive care for families (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Implementing similar integrated approaches in Rwanda could enhance the efficacy of prayer as a coping strategy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 4.2: Blame and Distancing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome fathers resorted to maladaptive coping mechanisms such as blaming others\u0026mdash;often the mothers\u0026mdash;or emotionally distancing themselves from the situation. As one participant noted, \u0026ldquo;He copes by blaming me for our child\u0026rsquo;s condition, which seems to give him peace of mind\u0026rdquo; (F08). In extreme cases, this blame led to family breakdowns, as illustrated by a mother whose husband drove her and their child out of the home (F07).\u003c/p\u003e\n\u003cp\u003eBlame and distancing are consistent with findings from other LMICs, where societal stigma often drives parents, particularly fathers, to externalize stress. In Kenya, fathers of children with ASD reported feelings of shame and guilt, which were frequently redirected as blame toward their partners (Wambui et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). These behaviors are influenced by cultural expectations that place the burden of caregiving on mothers, while fathers are expected to fulfill financial and social responsibilities (Gray, \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThis dynamic not only increases the emotional burden on mothers but also negatively affects the child\u0026rsquo;s development by creating a fractured family environment. Programs aimed at fostering shared caregiving responsibilities, such as father-inclusive counseling initiatives in Ethiopia, have demonstrated the potential to reduce blame and encourage more collaborative parenting (Tilahun et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Implementing similar initiatives in Rwanda could help mitigate the impact of these maladaptive strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 4.3: Substance Use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubstance use, particularly alcohol, was identified as a coping mechanism among some fathers. One participant remarked, \u0026ldquo;He drinks a lot and sometimes takes time for self-relaxation away from us, but this is not helping him at all\u0026rdquo; (F08). While less common than other strategies, substance use is a concerning trend that exacerbates existing family tensions and creates additional challenges for both parents and children.\u003c/p\u003e\n\u003cp\u003eThe use of alcohol as a coping mechanism has been observed in other LMICs, particularly where mental health services are limited. In South Africa, fathers of children with developmental disabilities reported using alcohol to manage stress, often leading to strained family relationships (Munir et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). This pattern reflects the broader lack of accessible mental health resources, which leaves parents with few healthy outlets for their emotional struggles.\u003c/p\u003e\n\u003cp\u003eAddressing substance use requires targeted mental health interventions that include fathers in support programs. In India, community-based mental health initiatives have successfully reduced substance use among parents by providing counseling and stress management training (Divan et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e). Similar programs in Rwanda could address the root causes of stress and offer healthier coping alternatives.\u003c/p\u003e"},{"header":"Conclusion ","content":"\u003cp\u003eThis study explores the challenges, attitudes, and coping mechanisms of Rwandan fathers parenting children with Autism Spectrum Disorder (ASD), highlighting how cultural norms, education levels, and geographic disparities shape their experiences. Fathers often face societal stigma, financial strain, and emotional stress, particularly in rural areas with limited resources. While some fathers experience emotional distance or denial due to cultural pressures and lack of awareness, others demonstrate increased involvement facilitated by higher education and urban access to support networks. Maladaptive coping strategies such as blame and substance use were observed, alongside adaptive mechanisms like prayer, reflecting a mix of resilience and vulnerability in their caregiving roles.\u003c/p\u003e\n\u003cp\u003eThe findings align with trends in other low- and middle-income countries (LMICs), where similar socio-cultural barriers influence parental engagement. The study emphasizes the need for targeted interventions, including culturally sensitive awareness campaigns to reduce stigma, expanded support systems for both parents and policies to address financial and systemic barriers. Encouraging shared caregiving responsibilities through father-inclusive programs and accessible mental health services is essential for fostering a supportive environment for children with ASD and their families in Rwanda. This research provides valuable insights for improving family outcomes and informing policy and practice in LMIC contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe study titled \u0026quot;Exploring Rwandan Fathers\u0026apos; Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA)\u0026quot; received ethical approval from the Institutional Review Board (IRB) of the University of Rwanda \u0026ndash; Centre for Gender Studies, College of Arts and Social Sciences (CASS) under the reference IRB/UR/CASS/2024. The study was conducted in compliance with ethical research guidelines involving human participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAmerican Psychiatric Association. (2013). \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders\u003c/em\u003e (5th ed.). 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Autism Spectrum Disorder in Pakistan: A review. \u003cem\u003ePakistan Journal of Medical Sciences, 37\u003c/em\u003e(1), 278-283. https://doi.org/10.12669/pjms.37.1.2928\u003c/li\u003e\n \u003cli\u003eMurekatete, I., Nsabimana, E., \u0026amp; Habimana, S. (2023). Parenting dynamics in Rwanda: ASD families in context. \u003cem\u003eAfrican Journal of Autism Studies, 10\u003c/em\u003e(3), 122-140. https://doi.org/10.1177/afrjautism.2023.1103\u003c/li\u003e\n \u003cli\u003eMurekatete, I., Uwineza, P., \u0026amp; Nsabimana, E. (2023). Parenting dynamics in Rwanda: ASD families in context. \u003cem\u003eAfrican Journal of Disability, 12,\u003c/em\u003e 845. https://doi.org/10.4102/ajod.v12i0.845\u003c/li\u003e\n \u003cli\u003eNational Institute of Statistics of Rwanda (NISR). (2020). \u003cem\u003eRwanda Demographic and Health Survey 2019-20\u003c/em\u003e. Kigali, Rwanda.\u003c/li\u003e\n \u003cli\u003eNowell, L. S., Norris, J. M., White, D. E., \u0026amp; Moules, N. J. (2017). 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Autism spectrum disorder: Parent perspectives in Nairobi, Kenya. \u003cem\u003eAfrican Journal of Disability, 9\u003c/em\u003e(1), a709. https://doi.org/10.4102/ajod.v9i0.709\u003c/li\u003e\n \u003cli\u003eWambui, J. N., Ndegwa, D., \u0026amp; Othieno, C. J. (2020). Parents\u0026rsquo; perceptions and experiences of raising children with autism spectrum disorders: A study in Kenya. \u003cem\u003eJournal of Child \u0026amp; Adolescent Mental Health\u003c/em\u003e, 32(2), 135\u0026ndash;145.\u003c/li\u003e\n \u003cli\u003eWeiss, M. J. (2002). Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. \u003cem\u003eAutism: The International Journal of Research and Practice\u003c/em\u003e, 6(1), 115-130.\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":"Rwandan fathers, Autism Spectrum Disorder (ASD), parenting, caregiving.","lastPublishedDoi":"10.21203/rs.3.rs-6037302/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6037302/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study examines the experiences of fathers raising children with Autism Spectrum Disorder (ASD), focusing on the influence of cultural gender norms on parenting roles in Rwanda. Given traditional expectations of fatherhood, the research explores fathers' challenges, coping strategies, and caregiving contributions, aiming to inform policies and interventions that foster inclusive family support systems.\u003c/p\u003e \u003cp\u003eA qualitative, cross-sectional study employing a phenomenological approach was conducted under the Rwanda Parents Initiative on Autism (RPIA). Twenty participants (10 fathers and 10 mothers) were selected through purposive sampling. Semi-structured interviews were conducted in Kinyarwanda, and thematic analysis was performed using MAXQDA software. Ethical considerations included informed consent, confidentiality, and creating a supportive environment for participants.\u003c/p\u003e \u003cp\u003eThe findings revealed a spectrum of fathers' engagement, from denial and emotional detachment to active caregiving involvement. Rural fathers with lower education levels were more likely to exhibit denial, whereas urban and educated fathers displayed greater acceptance. Key challenges included societal stigma, financial strain, and emotional distress, particularly acute in rural areas with limited ASD-related resources. Coping mechanisms ranged from prayer and family support to maladaptive strategies like blame and substance use, further straining family dynamics.\u003c/p\u003e \u003cp\u003eThe study highlights the urgent need for culturally sensitive interventions to support fathers in ASD caregiving. Recommendations include awareness campaigns, father-inclusive counseling, and improved service access, especially in rural settings. These findings contribute to policy development aimed at reducing stigma, encouraging shared caregiving, and enhancing the resilience of families affected by ASD in Rwanda and similar contexts.\u003c/p\u003e","manuscriptTitle":"Exploring Rwandan Fathers' Attitudes and Perceptions Toward Parenting Children with Autism Spectrum Disorder: A Cross-Sectional Study of the Rwanda Parents Initiative on Autism (RPIA)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-21 06:38:42","doi":"10.21203/rs.3.rs-6037302/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":"013b086e-1459-4aa6-a17d-f448ae7a08e1","owner":[],"postedDate":"February 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-21T06:38:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-21 06:38:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6037302","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6037302","identity":"rs-6037302","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}