Psychosocial Burden Among Parents Caring for Children With Autism Spectrum Disorder: A Qualitative Study in Hawassa City, Sidama Region, Ethiopia, 2025

Psychosocial Burden Among Parents Caring for Children With Autism Spectrum Disorder: A Qualitative Study in Hawassa City, Sidama Region, Ethiopia, 2025 | 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 Psychosocial Burden Among Parents Caring for Children With Autism Spectrum Disorder: A Qualitative Study in Hawassa City, Sidama Region, Ethiopia, 2025 ABEL MELESE NERI, WONDWOSEN T/SILASIE KIDANE This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7371337/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 Autism spectrum disorder (ASD) is severe and pervasive impairment in various aspects of development. It poses a significant psychosocial burden. There is limited data on psychosocial burden experienced by parents. This study aims to identify predictors of Autism Spectrum Disorder (ASD) and explore its psychosocial burden among parents caring for children with ASD in Hawassa city, Sidama Region. In-depth interviews (IDIs; n = 23) using purposive sampling technique, were conducted to explore the psychosocial burden among parents caring children with autism in February 2025 and March 2025. From the qualitative study findings, the psychosocial burdens among parents caring for children with Autism Spectrum Disorder were identified. Key themes included fear of judgment, cause of divorce, extra expenses and disruption of daily activities. Based on these findings, psychosocial counseling services and community based awareness programs should be provided. ACRONYMS AND ABBREVIATIONS Autism Spectrum Disorder (ASD) Psychosocial Burden Children Parents Caring for Children Qualitative Study Hawassa City Sidama Region Figures Figure 1 INTRODUCTION Background As per The Diagnostic and Statistical Manual of Mental Disorders, 5 th edition (DSM 5), Autism spectrum disorders (ASD) is severe and pervasive impairment in various aspects of development includes stereotyped interest, behavior and activities [1]. Caregivers of children with ASD often face increased psychosocial burden because of their caregiving responsibilities. Stress, as a psychological burden, exceeds other emotional burdens (such as anxiety and depression) experienced by caregivers of autistic children [2]. The mere presence of certain symptoms during their child’s early years would undoubtedly result in the family experiencing fear and frustration over the possibility of the individual being diagnosed with autism [3]. This could potentially lead to tension and stress within the family long before the individual is formally diagnosed with autism [4]. Parents of children with ASD face stressful situations. It is linked to decreased capacity to interact with others and therapeutic process for their children [5]. According to the study conducted by Lainhart [6] showed that caregivers of children with autism faced a higher likelihood of experiencing psychiatric disorders like depression; this elevated risk might be directly connected to the challenges associated with caring for a child with ASD. Kogan et al. [7] clarify that parents of a child with ASD experience feelings of isolation and depression. When a person exhibits certain unusual behaviors, their family or friends would clearly take them to a hospital. The procedures for examination and treatment will consequently incur some expenses for them. Similarly, an individual with autism and their family would face substantial expenses for the diagnosis and treatment of that person [8]. A research conducted by Rossler in 2016 revealed that, parents of a child with autism experience isolation from social interactions because of a perceived lack of comprehension regarding autism and the associated caregiving responsibilities within the community [9]. Parents bringing up a child with autism encounter significant challenges in managing difficult behavior [10], instructing their child in communication, imparting essential life skills, protecting their child from harm, and equipping their child for adulthood. There are significant risk factors that can cause acute or chronic stress and trauma for the parents of autistic children, which can subsequently result in ineffective parenting [11]. In previous most studies on ASD predictors are from high income countries, with limited evidence from low-and middle-income settings countries. In Ethiopia, limited information exist on ASD the psychosocial challenges faced by the affected families. This gaps results in inadequate care and increase the burden on the parents and or caregivers. Therefore, the aim of this study is to fill the critical gap in the literature and provide the valuable insight into the psychosocial burden on parents. The finding from this study will be crucial for guiding the local policies, reducing stigma and care for children with ASD. OBJECTIVE General objective To explore its psychosocial burden experienced by the parents caring for children with ASD, Hawassa city, Sidama region, from January 2025 to April 2025. METHODOLOGY Study area and period This study was conducted in Hawassa city administration from January 2025 to April 2025. Hawassa City is a capital city of Sidama region and situated 273 km to the south of Addis Ababa and 1125 kilometers to the north of Nairobi, Kenya. As per the Central Statistics Agency's (CSA) population projection, Hawassa city administration had a projected population of 555,480 in 2022 from which 277,032 were males. There are a total of 15 government-operated health facilities in the administrative division, which is made up of eight sub-cities and 32 kebeles. In the city, there are 9 hospitals and 1 Comprehensive Specialized Referral Hospital; 1 general hospital, 2 primary hospitals, and 5 private hospitals (1 general and 4 primary hospitals). According to Hawassa city administration education department, there are 5 Inclusive schools, 29 primary schools (grades 1 through 8), 15 secondary schools, one governmental university, and 5 colleges. In the city, Bright Autism Center is the well-known organization on providing support to children with autism spectrum disorder. Study design This study employed a phenomenological qualitative study. Population Source population All parents caring for children with Autism Spectrum Disorder (ASD) who were registered at HUCSH, inclusive schools, or the Bright Autism Center during the study period. Study population Parents caring for children with Autism Spectrum Disorder (ASD) who attend HUCSH, inclusive schools or the Bright Autism Center, Hawassa city, Sidama region, from January 2025 to April 2025. Study unit Each parent of a child aged 2 to 6 years diagnosed with Autism Spectrum Disorder (ASD). Sample size determination and sampling procedure Sample size calculation For the qualitative component, the sample size decided based on data saturation. Qualitative sampling techniques & procedure A non-probability purposive settings-based sampling technique was applied to select the parents of children with the diagnosis of ASD from HUCSH, bright autism center and inclusive schools. Criterion sampling was used to recruit participants for IDIs, from Hawassa University Comprehensive Specialized Hospital, Bright Autism Center and Inclusive schools. The inclusion criteria were (1) children aged 2 to 6 years with ASD should be diagnosed by a pediatrician and the diagnosis should be confirmed, (2) the age of the parents should be 18 years or above, and who are volunteer. Exclusion criteria are (1) being a parent for child diagnosed with other neurodevelopmental disorders different from ASD, (2) parents of children were having other comorbidities. Initial contact was supported by cooperation with relevant institutions. Recruitment was done until data saturation point was achieved, ensuring thorough consideration of the research queries. Informed consent was given to study participants, and then they was assessed individually, with each participant given a number to maintain their confidentiality; therefore, no details regarding the involvement of other family members in caregiving was asked for. Taking part in this study was optional, and no incentive was provided. The sample collection was taken place in person when participants bring their children to HUCSH for follow-up or other medical evaluations. Parents of children from Bright Autism Center and inclusive schools were contacted through each setting and invited to attend an in-person appointment at the center or the respective schools. Eligibility criteria Inclusive and exclusive criteria are shown in Fig 1. Operational definition Autism Spectrum Disorder (ASD) diagnosis: is the identification of a children as having autism based on the following specific criteria mentioned in DSM-V. (A) Enduring impairments in social communication and interaction across multiple situations, as reflected in all of the following. ( I) Difficulties in social-emotional reciprocity, which may include atypical social approaches, lack of typical back-and-forth conversations, limited sharing of interests, emotions, or feelings, and failure to initiate or respond to social interactions. ( II) Impairments in nonverbal communication used for social interaction, including difficulties integrating verbal and nonverbal cues, unusual eye contact and body language, challenges in understanding and using gestures, or a complete absence of facial expressions and nonverbal communication. ( III) Difficulties in building, sustaining, and comprehending relationships, which may involve trouble adjusting behavior to fit different social settings, challenges in engaging in imaginative play or forming friendships, or a lack of interest in interacting with peers. (B) Limited and repetitive behaviors, interests, or activities, as demonstrated by at least two of the following. (I) Repetitive or patterned motor actions or repeated use of objects and speech. (II) A strong need for consistency, strict adherence to routines, or fixed, ritual-like patterns in both speech and body language. (III) Intensely narrow and focused interests those are unusually strong or fixated. (IV) Either an exaggerated or diminished response to sensory stimuli or an unusual focus on sensory details in the environment. (C) Symptoms must emerge during early development, though they may not become fully apparent until social demands exceed the individual's limited capacities, or they may be obscured by adaptive strategies learned later in life. (D) The symptoms lead to significant challenges in social interactions, work, or other key areas of daily functioning. (E) These issues cannot be more accurately attributed to intellectual developmental disorder (intellectual disability) or global developmental delay [1]. Psychosocial burden: refers perceived emotional, psychological, and social strain experienced by parents or caregivers of children with autism spectrum disorder (ASD). This burden is assessed qualitatively through in-depth interviews, where parents share their personal experiences, challenges, emotional well-being and social support. Data collection Data collection tools & procedure Face to face in-depth interviews were conducted with parents, healthcare providers and teachers using semi-structured question guide consist of 10 questions from an interview guide. A total of 23 In-depth interviews were conducted, as the data saturation has been achieved. Time and place of interviews was chosen for the convenience of study participants. Each interview took approximately 45 to 60 minutes. With the participants' consent, it was both audiotape recorded and in handwriting. The audiotape then transcribed. In-depth interview was performed in Amharic and Sidaamu Affoo language depending on the participant’s language preference. Data quality control Credibility, reliability, and trustworthiness of the qualitative data were ensured. Dependability of data was done using a thick description of the data and member check method. Translation was done meticulously before, during and after data collection. The similarity of the translated version and the original version was checked. Confirmability was ensured by maintaining a clear audit trail that documented each step of the data collection and analysis process. Ongoing reflexive journaling was used to acknowledge and minimize researcher bias. Data processing & analysis Regarding qualitative component, thematic analysis was used to analysis the interview data. Trilingual data collectors were translated the Sidaamu Affoo records into Amharic. Then, the interviews were transcribed verbatim from Amharic language into English version by data collectors. Following translation of the transcribed data into English, the transcripts were uploaded into NVivo 14 software (QSR International Pty Ltd., Cardigan, UK) for thematic coding. Three researchers conducted the coding independently to enhance the credibility and consistency of the analysis. Guided by the NVivo 14 training manual, the analysis followed some stages of theme development. Initially, the transcripts were examined line by line to generate open codes. Words and expressions with related meanings were then organized into broader categories. This was followed by selective coding, during which the most relevant codes were grouped to develop themes. Key themes were further broken down into sub-themes to capture more specific insights. To keep the original context and meaning, participants’ direct quotes and narratives were presented verbatim without any modification [12]. Triangulation was conducted through cross-checking to assess convergence, complementarity and divergence between parents, healthcare providers and teachers. RESULTS 5.1 Qualitative section A total of four themes and eight sub-themes were identified in the analysis. The identified themes were: fear of judgment; cause of divorce, extra expenses and disruption of daily activities. 5.1.1 Socio-demographic characteristics of participants A total of 23 participants were interviewed due to saturation reached. All participants provided written consent following the Helsinki declaration. Among interviewees participated during the study, 15(65.2%) were biological parents of ASD children, 4(17.4%) were healthcare providers and 4(17.4%) were teachers at inclusive schools. 8(44.4%) of participants were interviewed at Hawassa University Comprehensive Specialized Hospital, 7(38.9%) and 3(16.7%) were interviewed at inclusive schools and Bright Autism Center respectively. About five out of 10 parents of the autistic children were graduates. Table 1: Demographic characteristics of study participants, of the total respondents, 69.6% were female, 95.6% were married or cohabiting, 73.9% were educated to at least primary level and 65.2% were 36 years old or older. The mean age of respondents was 38.49 ± 5.39 Parents Part. Code Sex Age Religious Marital Status Educational status Settings P1 01PH Female 39 Orthodox Married Grade 12 HUCSH P2 02PH Female 33 Protestant Married Grade 8 HUCSH P3 03PH Female 45 Orthodox Married Degree HUCSH P4 04PH Male 52 Orthodox Married Grade 10 HUCSH P5 05PB Female 36 Orthodox Married Grade 6 HUCSH P6 06PB Female 35 Catholic Married Diploma HUCSH P7 07PB Male 47 Muslim Married Grade 8 Bright Autism Center P8 08PS Female 40 Protestant Divorced Grade 12 Bright Autism Center P9 09PS Male 34 Orthodox Married Masters Bright Autism Center P10 010PS Male 41 Muslim Married Diploma Bright Autism Center P11 011PS Female 38 Protestant Married Grade 4 Bright Autism Center P12 012PS Female 35 Orthodox Married Grade 10 Bright Autism Center P13 013PS Female 45 Protestant Married Illiterate Inclusive Schools P14 014PS Female 38 Catholic Married Degree Inclusive Schools P15 015PS Female 42 Orthodox Married Grade 7 Inclusive Schools HP P16 016HH Male 32 Orthodox Married Position (GP) HUCSH P17 017HH Female 36 Protestant Married Position (N) P18 018HH Male 30 Orthodox Unmarried Position (P) P19 019HH Female 33 Catholic Married Position (R) SNT P20 020TS Female 36 Orthodox Married Adare Inclusive Schools P21 021TS Female 34 Protestant Married Tabor Inclusive Schools P22 022TS Male 39 Orthodox Married Haike Inclusive Schools P23 023TS Female 43 Catholic Married Nigst Fura Inclusive Schools Abbr . Part. = participants, SNT = Special Need Teachers, GP = General Practitioner, N = Nurse, P = Psychiatrist, R = Resident, HUCSH = Hawassa University Comprehensive Specialized Hospital. Emerging themes The themes were developed through systematic approach to coding and organizing patterns identified in the data, applying a thematic analysis method to emphasize key patterns or concepts that emerge from the information. This qualitative study on psychosocial burden among parents caring for children with ASD explored themes such as “fear of judgment, cause of divorce, extra expenses and disruption of daily activities”. Four main themes and eight sub-themes were identified in total. For an overview of the themes, sub-themes and codes, see Table 2. Table 2: Provides a concise summary of the main themes along with their respective sub-themes and codes that highlight the psychosocial burden experienced by the parents caring for children with Autism Spectrum Disorder, Hawassa city, Sidama Region, 2025. Theme Sub-theme Code Fear of Judgment Blame and criticism from others Blamed for neglect Criticized by family Parental held responsible Blamed for inadequate parenting Judged based on child’s behavior Criticism from community members Perceived as responsible for everything Received wrong conclusion from others Fear of disclosing the diagnosis Worry about stigma Concern about gossip Hiding the child’s diagnosis Fear of being misunderstood Feeling shame when disclosing Avoiding talks about diagnosis Avoidance of social gathering Isolation from public Anxiety over social judgment Withdrawing to avoid embarrassment Cause of divorce Lacked of shared responsibility Unequal sharing of responsibility Frustration over parenting burden Minimal involvement in caregiving No cooperation in managing child’s behavior Marital conflict due to child’s condition Pointing fault at each other Arguments about autistic child Disputes over lack of intimacy or time Communication problem between parents Extra expenses Job loss or reduced income Unable to manage extra costs Dependent on a single income Income loss due to caregiving Parent leaving work to care for child Disruption of daily activities Isolation and lack of personal time No one to share daily tasks Less contact with extended family Emotional retreat from persistent stress Missing out friendships due to lack of time Difficulty managing household responsibility Difficulty in time management Trouble planning daily routines Fatigue with day-to-day activities Struggling maintaining a regular routine Main Theme 1: Fear of judgment Parents of children with autism reported a strong sense of fear of being judged by others. This fear manifested in several ways, criticism, reluctance to disclose the diagnosis, and social withdrawal. These experiences contributed significantly to their emotional burden and sense of isolation. This theme mainly include three sub-themes; Blame and criticism from others, fear of disclosing the diagnosis and avoidance of social gathering Sub-theme 1.1: Blame and criticism from others Fear of other judgment was reported as the critical theme by the participant. A 42-years mother said that, “…Children with autism need close supervision; we have to take care of them constantly. Another issue is that people often perceive autism based on their own understanding, which can be quite limiting. We fear being judged by others, and that worries us a lot. People look at us differently, and sometimes, I even go out alone because I fear how others will react. This shows how much their lack of understanding affects our experience. I know some parents even feel ashamed to be seen with their children. Most people judge the parents, blamed for inadequate parenting and their judgment affects our emotions. We don’t really want to hear anything from them because we already know what they’re thinking. We often received wrong conclusion from others. The influence of others becomes a burden, and it forces us to lead our lives in secret.” ( Participant 15 ) Another a 38-years mother also said, “Societal perceptions and cultural beliefs about autism can greatly impact how parents experience raising a child with autism. Often, there’s a lack of awareness about autism, which can lead to stigma and misconception; eh…eh... [?]. Parents may feel judged or blamed for their child's condition, also criticized by family and that can be emotionally challenging…” ( Participant 11 ) A 34-years man participant reported that, “I worry about what people say. Some people try to judge you without knowing the truth about autism, that’s really annoying. They just speak like that it was happened due to parent’s problem and blame us. I heard what it was talked from others during some event … [???]. I think our culture, beliefs; norms would be the factors for their wrong understanding. Most of us hold some myths, which we heard from our community, like autism is a mental illness, happen due to evil…and other a lot. I usually fear their judgment, because it makes us to feel somewhat stress…They judge based on child’s behavior” ( Participant 9 ) Sub-theme 1.2: Fear of disclosing the diagnosis Parents expressed a reluctance to openly talk about their child’s diagnosis due to fear of being labeled, misunderstood, or treated differently. Mother of a 5-year old girl explained that, “I haven’t told anyone outside my family that my daughter has autism. I’m afraid they might look at her and us differently, like we are less.” ( Participant 1 ) As the participant number four said, “…I avoid talking the diagnosis with people, because they make me feel anxious. The reason is how judge us, due to the beliefs they hold within our context. I worry about what others might think of me as a parent, there is also concern of gossip…emm…that really disturbs me…It’s very stressful for me” ( Participant 4 ) “…I understand that there is fear of disclosing the diagnosis of their children, because parents think what others may talk in negative way, so don’t want to let other to know…mmm…just they might think the people misunderstood autism and try to give other meaning. So some parents prefer silence not to disclose about their child condition, fear of being misunderstood. Considering mentioning the case may other makes them as guilty, or unless they found to be shameful and embarrassing. So we worry about stigma” ( Participant 23 ) According to the participant who teach in special need education, “…Parents often don’t talk about their child’s diagnosis; because…um…Many people believe that autism is caused by evil spirits, a curse, or even sin. According to these beliefs, it's seen as something that results from the parents' actions, so we’re often blamed for it. This makes them feel really uncomfortable. These misconceptions are deeply rooted, and they affect their emotions…so they never want to disclose to others” ( Participant 20 ) Sub-theme 1.3: Avoidance of social gatherings Due to fear of judgment, many parents avoid public events, family occasions, or community gatherings. Parent labeled by number six said “In the beginning, I tried taking my son to weddings and community events, thinking that it would be good for him to socialize. But sometimes he acted out; people stared, whispered behind our back, and even say hurtful things, like that he was ‘possessed’ by evil spirits or that he was a punishment for our wrongdoings. This all makes us to withdraw to avoid embarrassment. It became too much, so now we don’t go to these events anymore” ( Participant 6 ) “…At family gatherings, people try to offer advice, but it’s usually not helpful. They tell me to pray harder or to take him to a traditional healer, thinking that something spiritual is wrong with him. It’s exhausting and creates anxiety over social judgment. Eventually, I stopped going to these events altogether. I just couldn’t bear the comments anymore.” ( Participant 7 ) Another participant also expressed his emotion as follow, “...It’s very difficult. Thinking about my child’s condition and behavior creates a lot of stress and depression. All that frustration is very challenging as a parent. Sometimes, I feel emotionally exhausted and even bored. Since there are no immediate solutions, as a parent you will be fall into depression easily and isolation from public.” (Participant 10) Main Theme 2: Cause of divorce From the in-depth interview finding, cause for divorce was one of the main among themes. Two sub-themes were reported: Lacked of shared responsibility and marital conflict due to child’s condition. Sub-theme 2.1: Lacked of shared responsibility A 40-years old mother said as follow, “It always felt like I was carrying the whole load. He would go to work and come home expecting everything to be in order. It is the results of frustration over parenting burden. Over time, that kind of imbalance just broke us” (Participant 8) “There are days when I feel completely alone. Even in our own family, people think I am supposed to know everything about how to care for our son. If he starts disturbing, everyone looks at me. My husband helps only when I ask, but I wish he could understand that I need support without always having to explain or request it.” (Participant 3) “…my husband doesn’t want to discharge his responsibility and let everything for me to do alone. He doesn’t give much attention to our child condition, rather he think it’s my business only. Even when I ask him to spend time together, but he doesn’t have any willingness. He lacked and unequal sharing parental responsibility, I am the only one who provides for my child, lacking a support from my partner makes thing difficulty to handle. Almost no cooperation in managing child’s behavior and other stuff” (Participant 5) “The whole responsibilities reside on mothers. Sometimes, fathers have minimal involvement in supporting and taking care process, this would result in a huge burden on mothers, imbalance of responsibility sharing would create stress and other psychological impacts, I have seen most of the mothers get difficulties due to lack of appropriate support from their partner, they mentioned out the biggest problem is their partners don’t have interest to share our responsibility, make the mothers to be the only and main responsible person for autistic children… ” (Participant 14) Sub-theme 2.2: Marital conflict due to child’s condition Parents say, there is a conflict between the couple after the diagnosis of the child. Some of the parents mentioned this issue emotionally; the child condition’s is believed to be the cause of conflict. The participants response were stated as follow, “We’ve argue suddenly when we talk about our child regarding autism, he don’t even want to speak about it with me,….emm…as we know, there should be open discussion between partners to tackle the challenges we face; but for us it is cause for conflict, I understand that the disputes were due to lack of intimacy and not having enough time to spend together. He shows some irritable behavior… [Paused]…I don’t know what to do” (Participant 12) “…I am always gets a conflict with my husband after we know that our son diagnosis with autism, actually the conditions is stressful, but he try to make this as my problem, pointing fault at me. I don’t think he’s right, he always said that I hadn’t take care of my son during pregnancy and also after birth, this is not right, his cause of conflict is resisting to accept the conditions, and put down all the burdens from him, that makes me angry.” (Participant 1) “We used to be close, but now the constant responsibilities and emotional stress have driven a wedge between us. There’s blame, frustration, and barely any time to talk about anything other than our child. We often argue about our autistic child…um…um…I don’t think the issue would create such conflict between us; Seem communication problem between us, but I often found that as a cause…it’s affect the relationship with my husband” (Participant 12) Main Theme 3: Extra expenses Sub-theme 3.1: Job loss and reduced income All parents indicated that having a child with autism incurs additional/extra costs in various areas, one parent identified with code number 012 fully indicated that, “…I stopped working for the sake of my autistic child. I used to have different jobs before, but I’ve lost all of them now, so I don’t have any source of income. The expenses are huge including school fees, transportation costs, foods and so on. The economic burden is quite challenging, and it makes it very difficult to manage daily life.” (Participant 12) Another a 45 year female participant said that, “…I had to quit my job to stay at home with my child, and my partner works long hours to support us financially. I can’t able to manage the extra expenses for my child. Sometimes, I feel guilty because I know my family is sacrificing so much, and I constantly worry about the long-term financial strain. We’ve even had to ask for help from family members just to make ends meet, which is hard for me because I’ve always taken pride in being independent. I depend on my husband income. The financial stress is constant, and it really affects us...” (Participant 3) “To be honest, as a teacher, my salary is over 9,000 Ethiopian Birr. Almost 65% of my salary more than 5,000 Birr each month goes toward my child’s school fees and transportation alone, not even counting food and other expenses. We are really frustrated about our financial situation. If things continue like this, it feels like everything will get out of control. I sometimes tell my wife, ‘What are we going to eat if we spend almost everything on his needs?’ We have so many expenses. This worries us a lot as parents. On top of the economic burden, we are truly suffering now. Unlike other people, we can’t manage our budget properly. We’re living in my father’s house, renting a single room that used to be rented out for 3,000 to 4,000 Birr. We decided to stay, but sometimes it’s even difficult to pay him the rent. I explained everything to him, and he told us to pay the rent whenever we get the money. To cope with this, I also work part-time to earn some additional income because of the financial challenges we’re facing these days. Overall, the economic burden on parents of autistic children is extremely challenging.” ( Participant 9 ) The other participant informed his concern regarding the extra expense as a financial burden, “…Usually, we eat Injera, but my child doesn’t. We’ve tried to feed him Injera, but he prefers rice and potatoes, and sometimes meat, like chicken. These foods are extra costs for us compared to what we typically eat, and they require a bit more spending. Also, we can use any type of cooking oil, but for him, it doesn’t work. We prefer a specific type of oil, nougat oil, but it’s expensive and often hard to find. So, to meet his special needs, we’re forced to spend extra money. This financial burden is challenging, and as a parent, it really takes a toll”. ( Participant 5 ) Main Theme 4: Disruption of daily activities Sub-theme 4.1: Isolation and lack of personal time A 35-year mother shared her experience, “I used to be active in the community. I participated in women’s groups, attended church programs, and visited my neighbors regularly. But now, I can’t do any of that. My child cannot be left alone, and I don’t trust anyone else to understand his needs. I haven’t had a single day to myself in years….” ( Participant 6 ) “…I feel alone, because nobody is there with us, I spend almost the whole time with my child, just taking care of him become a big matter for me, I manage everything, no one share this burden with me, The pressure makes to feel you loneliness….umm…you don’t have time for yourself, even I miss my friends. So it’s quite challenging. These feeling of isolation sometimes make you to give up…” ( Participant 9 ) Sub-theme 4.2: Difficulty managing household responsibility One of the themes reported by the participant is daily routine disruption. As participant 5, “…I’m unable to do other businesses; even our social life is affected. We can’t do the things we used to do before because we spend so much time caring for our child. This creates a lot of problems for me as a father. I feel sometimes exhausted in day to day activities. Every activity is restricted; it’s not something we can do freely because I always have to keep a close eye on him. I can never be completely sure about him, he might get injured or harm someone else…” ( Participant 11 ) Similarly, other participant said that, “Most parents’ daily activities are limited because they need to take care of their children. Work and other aspects of life are greatly affected. A lot of time, energy, and resources are invested in caring for them, and parents are expected to be with their children with autism at all times. As a result, their daily activities are reduced and disrupted, unable to manage their time properly, difficulty in planning and struggle to maintain regular routines, this all creating a huge burden and leading to stress.” ( Participant 18 ) DISCUSSION This study provided an in-depth exploration about the psychosocial burden among parents having children with autism spectrum disorder. Based on the findings of this study, the psychosocial burdens were organized into four themes, eight sub-themes and 37 codes (Table 2 ). Parents identified several key psychosocial challenges they face during caregiving, including fear of judgment, the cause of divorce, extra expense and disruption of daily activity. Particularly, community’s limited awareness of Autism Spectrum Disorder (ASD), which often led to harmful cultural narratives and inappropriate judgments. Many parents shared experiences of being unfairly blamed for their child’s behavior, with assumptions of inappropriate judgments. These misconceptions frequently resulted in social comparisons with typically developing children, leading to parental shame and ridicule. Existing literature confirms that such misinformed societal attitudes rooted in a lack of understanding about autism can intensify parents’ emotional strain, contributing to increased levels of stress, anxiety, and depression, subsequently it cause for fear of judgment [ 13 ]. The fear of being socially judged emerged as dominant theme among participants. Many parents described feelings of shame, blame, and feelings of exclusion due to persistent misconceptions surrounding autism. In our context, cultural beliefs often associated with autism to spiritual causes such as curses; sin, or divine punishment, parents of autistic children are frequently stigmatized. This results align with existing literature indicating that stigma can lead to social withdrawal and emotional distress in parents [ 14 ]. The social stigma faced by parents of children with Autism Spectrum Disorder shows broader societal prejudices. When parents perceive the social support available to them or their children as insufficient, they are more likely to report increased level of stress. Many studies have shown that limited support, especially when coupled with the negative perception or labeling of autistic behaviors can contribute to parental withdrawal from social engagement and community participation. Similarly, findings from other qualitative studies have shown the absence of supportive social networks can significantly affects the parent’s emotional well-being, often leading to feelings of isolation, marginalization and perceived judgment from others [ 15 ]. Another burden experienced by parents caring for a child with autism was challenge on marital relationships. Two key sub-themes emerged under this theme: lack of shared responsibility and marital conflict. In many cases, mother assumed the majority of caregiving duties, while fathers distanced themselves from the emotional and practical demands of caregiving responsibility. The unequal distribution of caring responsibilities often led to feelings of frustration and emotional separation between partners. Several participants described how constant disagreements, unmet expectations, and differing approaches to parenting ultimately led to separation or divorce. Similar patterns have been documented in India and other low-income settings, where raising a child with ASD can lead to marital dissatisfaction and even divorce [ 16 ]. Parents caring for children with Autism Spectrum Disorder (ASD) often face intense psychological and emotional stress; that may contribute to conflict within the marital relationship. Considerable time and attention required for caregiving can reduce opportunities for couples to engage with each other, this potentially affect their marriage and leads to conflict or divorce [ 17 ]. Research has indicated a significant association between the breakdown of parental marriages and the period when a child with Autism Spectrum Disorder (ASD) approaches adolescence, particularly around the age of twelve [ 17 ]. Hartley et al. (2010) found that parents of children with Autism Spectrum Disorder (ASD) experience higher divorce rates until their child reaches early adulthood. In contrast, parents caring for children with ASD tend to experience a decline in divorce rates after their child reaches the age of eight. However, for parents of children with ASD, the significant and ongoing caregiving demands may contribute to higher vulnerability of marital conflict and divorce due to the increased stress levels associated with these responsibilities. Furthermore, these parents often do not experience the empty nest phase as early as parents of neurotypical children, as the transition of children with ASD from school to community settings usually requires ongoing assistance from one or both parents [ 18 ]. Another theme revealed by the present qualitative study is extra expenses, include two sub-themes, (1) job loss and reduced income (2) difficulty of accessing financial support, providing care for children with Autism Spectrum Disorder (ASD) places a substantial financial burden on families. According to the study conducted by Saunders et al. reported that households with children diagnosed with ASD often face considerable economic challenges due to the specialized services and support their children require [ 19 ]. Jarbrink et al. estimated that the financial demands of raising a child with a disability are nearly three times higher than those for raising a child without such needs. In this study, participants associated the financial burden they faced with various essential needs, including costs related with clothing, food, medical care, transportation and so on. Parents also emphasized that the need for additional costs they pays for schools. But more concern on foods that they prepare for their child. Furthermore, providing a balanced diet posed an added burden due to the increasing cost of food [ 20 ]. Generally, the demands of both caregiving and financial responsibilities appeared to contribute to parents' emotional distress and feelings of unease regarding their child’s condition. Many Participants commonly spoke about the significant financial burden they face in caring a children diagnosed with Autism Spectrum Disorder (ASD). This result is consistent with prior study by Karst and Van Hecke[ 21 ], who reported that autism imposes a considerable economic challenges and diminishes quality of life for parents. Likewise, findings by Lai, Goh, Oei, and Sung [ 22 ] indicated that both person with autism and their parents endure emotional, social, and economic difficulties, often worsened by lack of adequate public awareness and understanding about ASD. STRENGTHS AND LIMITATIONS OF THE STUDY Strengths The triangulation of data sources enhances the credibility and trustworthiness of the qualitative result, helping to reduce the potential bias and strengthen its conclusions. Limitations The qualitative findings may not be fully representative of the broader population, as they were based on purposively selected participants, introducing selection bias that limits the transferability of the results CONCLUSION AND RECOMMENDATIONS Conclusion To conclude, this study explored the psychosocial burdens experienced by the parents caring for children with ASD. Fear of judgment, cause of divorce, extra expenses and disruption of daily activities were the key themes identified in the study. Recommendations Mental health professionals and non-governmental organizations (NGOs) to provide accessible and sustained psychosocial support services, including counseling aimed at helping parents to manage emotional distress. Community based awareness campaigns should be implemented to reduce misconception and promote public understanding of ASD. This effort reduces the social judgment and other related psychosocial challenges faced by parents caring for children with ASD. Additional large-scale research is recommended to deepen the understanding its psychosocial impact experienced by the parents and or caregivers. Declarations Consent Statement: Written informed consent was obtained from the patient (or the patient’s legal guardian) for participation in this study and for the publication of their clinical case, including all relevant details. Ethical consideration The protocol of the study was approved by the Ethical Review Committee of HUCMHS (IRB/507/17). A formal letter of cooperation was written to HUCSH, Bright Autism Center and Hawassa city administration education department from public health academic and service directorate to facilitate data collection. Then a letter was written from the educational department to inclusive schools accordingly. Written informed consent obtained from the participants before data collection. The study ensured that the participants fully understand the purpose, procedure and benefits of the research. Data were securely stored and used solely for the purpose of this research. All methods were strictly adhering to the relevant national and institutional guidelines and regulations, as well as international ethical standards. Availability of data and materials: The data used for this study cannot be shared publicly due to the inclusion of sensitive participant information. Data is available upon request from Abel Melese (MPH in Epidemiology) via email ( [email protected] ) for researchers who meet the criteria for access to confidential data. Conflict of Interest: The author declares that there is no Conflict of interest. Funding: The author received no specific funding for this study. Authors' contributions: ABN and WTK conceptualized the study. ABN conducted the research, carried out the statistical analysis, wrote manuscript and developed the tool; ABN and WTK participated in the design of the study and tool development, performed qualitative analysis, and drafted the manuscript. Both read and approved the final manuscript. Acknowledgements: We would like to acknowledge Hawassa University Comprehensive Specialized Hospital, Bright Autism Center and Inclusive Schools from which the data were collected. The data collectors are also going to share gratitude for their contribution to data collection. References American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed: Washington, DC: (2013).Access on https://doi.org/10.1176/appi.books.9780890425787. Al-Dujaili et.al; Psychosocial burden among caregivers of children with autism spectrum disorder in Najaf province. International Journal of Pediatrics, Current Pediatric Research, 2017. Pierce, K., Glatt, S. J., Liptak, G. S., & McIntyre, L. L. (2009). The power and promise of identifying autism early: insights from the search for clinical and biological markers. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 21(3), 132–147. Bravo-Benítez, J., Pérez-Marfil, M. N., Román-Alegre, B., & Cruz-Quintana, F. (2019). Grief Experiences in Family Caregivers of Children with Autism Spectrum Disorder (ASD). International Journal of Environmental Research and Public Health, 16(23), 4821. Sim A, Vaz S, Cordier R, Joosten A, Parsons D, Smith C, et al. Factors associated with stress in families of children with autism spectrum disorder. Dev Neurorehabil. 2017; . Lainhart D. Psychiatric problems in individuals with autism, their primary caregiver and siblings. Int Rev Psychiatr 1999; 11: 278-298. Kogan P, He J, Glickman GN, et al. The effects of various additives on setting properties of MTA. J Endod 2006; 32: 569-572. Weiss, J. A., Wingsiong, A., & Lunsky, Y. (2014). Defining crisis in families of individuals with autism spectrum disorders. Autism : The International Journal of Research and Practice, 18(8), 985–995. Rössler, W. (2016). The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. EMBO Reports, 17(9), 1250–. Miranda, A., Mira, A., Berenguer, C., Rosello, B., & Baixauli, I. (2019). Parenting Stress in Mothers of Children With Autism Without Intellectual Disability. Mediation of Behavioral Problems and Coping Strategies. Frontiers in Psychology, 10, 464. Emberti Gialloreti, L., Mazzone, L., Benvenuto, A., Fasano, A., Alcon, A. G., Kraneveld, A., Moavero, R., Raz, R., Riccio, M. P., Siracusano, M., Zachor, D. A., Marini, M., & Curatolo, P. (2019). Risk and Protective Environmental Factors Associated with Autism Spectrum Disorder: Evidence-Based Principles and Recommendations. Journal of Clinical Medicine, 8(2), 217. Creswell JW. Research design: qualitative and quantitative and mixed methods approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2011. Shrestha R, Dissanayake C, Barbaro J. Caregivers’ knowledge of autism in a local peri-urban community of Nepal: A cross-sectional study in Kirtipur, Kathmandu. Res Autism Spectr Disord. 2021;80:101696. doi: 10.1016/j.rasd.2020.101696. Samadi, S. A., & McConkey, R. (2020). Perspectives on inclusive education of preschool children with autism spectrum disorders and other developmental disabilities in Iran. International Journal of Inclusive Education, 24(5), 495–513. https://doi.org/10.1080/13603116.2018.1464063. Devenish BD, Sivaratnam C, Lindor E, Papadopoulos N, Wilson R, McGillivray J, et al. A Brief Report: Community Supportiveness May Facilitate Participation of Children With Autism Spectrum Disorder in Their Community and Reduce Feelings of Isolation in Their Caregivers. Front Psychol. 2020;11:583483. doi: 10.3389/fpsyg.2020.583483. [PubMed: 33240173]. [PubMed Central: PMC7683380]. 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. Bursnall, S., Kennedy, E., Senior, R., & Violet, J. (2009). Understanding the Experience of Parenting a Child with Autism. 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. Saunders, B., Tilford, J., Mick, F., Fussell, J., Schulz, E., Eldon, G., Casey, P., Patrick, H., & Dennis, Z. (2015). Financial and employment impact of intellectual disability on families of children with autism. Families, Systems, and Health, 33(1), 36-45. Jarbrink, K., Fombonne, E., & Knapp, M. (2003). Measuring the parental service and cost impacts of children with autistic spectrum disorder: A pilot study. Journal of Autism and Developmental Disorders, 33(4), 396–402. Karst, S., & Van Hecke, V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Journal of Clinical Child and Family Psychology Review, 15(3), 247-277. Lai, W., Goh, J., Oei, S., & Sung, M. (2015). Coping and well-being in parents of children with Autism Spectrum Disorders (ASD). Journal of Autism and Developmental Disorder, 45(8), 2582–2593. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7371337","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500812539,"identity":"8cfb9b7b-5d51-42b4-8b2a-1e0af3fcd157","order_by":0,"name":"ABEL MELESE NERI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACCQbGA0BKho+BseHAByCLjZ2wFgaQFh42BubGgzNAWpiJ18LefJgHJEJIC//s5gOHKyrseNgkEhsO2/zaJs/HzMD44WMOHkvuHEs4eOZMMkRLbt9twzZmBmbJmdvwWHMjx+BgYxszVEvPbUagFjZmXjxa5G/kfzjY+K8eosWy57Y9QS0GN3IYDjY2HIZoYfhxO5GgFsM7xwwONhw7zsPG87DhYG/D7eQ2ZsZmvH6Ru9388GFDTbUcP3v64w8//ty2nd/efPDDR3zehwOBBAYGxjYQi7GBGPVAwH8ASPwhUvEoGAWjYBSMKAAASuZW76GstOIAAAAASUVORK5CYII=","orcid":"","institution":"Hawassa University","correspondingAuthor":true,"prefix":"","firstName":"ABEL","middleName":"MELESE","lastName":"NERI","suffix":""},{"id":500812541,"identity":"63391792-dbfe-41aa-855c-30aa2a8ef153","order_by":1,"name":"WONDWOSEN T/SILASIE KIDANE","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"WONDWOSEN","middleName":"T/SILASIE","lastName":"KIDANE","suffix":""}],"badges":[],"createdAt":"2025-08-14 08:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7371337/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7371337/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89464396,"identity":"ee3e1872-cd79-40d4-8cba-f12c4452af68","added_by":"auto","created_at":"2025-08-20 08:22:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":86208,"visible":true,"origin":"","legend":"\u003cp\u003eIllustration diagram – Eligibility criteria for the qualitative study. Adopted from Arafat H. Al-Dujaili 2017\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7371337/v1/954fc7f2f413e4dad139832b.png"},{"id":95405287,"identity":"31278b27-2268-4b6a-89dc-0569f05f3ff7","added_by":"auto","created_at":"2025-11-07 17:08:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1428329,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7371337/v1/9e1b8a10-462c-464a-a21e-022797264b1d.pdf"},{"id":89464398,"identity":"1f1d1908-b294-4eec-ba93-588371574964","added_by":"auto","created_at":"2025-08-20 08:22:55","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":159232,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.doc","url":"https://assets-eu.researchsquare.com/files/rs-7371337/v1/ec3a690bc9016a5afccf0d22.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePsychosocial Burden Among Parents Caring for Children With Autism Spectrum Disorder: A Qualitative Study in Hawassa City, Sidama Region, Ethiopia, 2025\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eAs per The Diagnostic and Statistical Manual of Mental Disorders, 5\u003csup\u003eth\u003c/sup\u003e edition (DSM 5), Autism spectrum disorders (ASD) is severe and pervasive impairment in various aspects of development includes stereotyped interest, behavior and activities [1]. Caregivers of children with ASD often face increased psychosocial burden because of their caregiving responsibilities. Stress, as a psychological burden, exceeds other emotional burdens (such as anxiety and depression) experienced by caregivers of autistic children [2]. The mere presence of certain symptoms during their child\u0026rsquo;s early years would undoubtedly result in the family experiencing fear and frustration over the possibility of the individual being diagnosed with autism [3]. This could potentially lead to tension and stress within the family long before the individual is formally diagnosed with autism [4]. Parents of children with ASD face stressful situations. It is linked to decreased capacity to interact with others and therapeutic process for their children [5]. According to the study conducted by Lainhart [6] showed that caregivers of children with autism faced a higher likelihood of experiencing psychiatric disorders like depression; this elevated risk might be directly connected to the challenges associated with caring for a child with ASD. Kogan et al. [7] clarify that parents of a child with ASD experience feelings of isolation and depression. When a person exhibits certain unusual behaviors, their family or friends would clearly take them to a hospital. The procedures for examination and treatment will consequently incur some expenses for them. Similarly, an individual with autism and their family would face substantial expenses for the diagnosis and treatment of that person [8]. A research conducted by Rossler in 2016 revealed that, parents of a child with autism experience isolation from social interactions because of a perceived lack of comprehension regarding autism and the associated caregiving responsibilities within the community [9]. Parents bringing up a child with autism encounter significant challenges in managing difficult behavior [10], instructing their child in communication, imparting essential life skills, protecting their child from harm, and equipping their child for adulthood.\u003c/p\u003e\n\n\u003cp\u003eThere are significant risk factors that can cause acute or chronic stress and trauma for the parents of autistic children, which can subsequently result in ineffective parenting [11]. In previous most studies on ASD predictors are from high income countries, with limited evidence from low-and middle-income settings countries. In Ethiopia, limited information exist on ASD the psychosocial challenges faced by the affected families. This gaps results in inadequate care and increase the burden on the parents and or caregivers. Therefore, the aim of this study is to fill the critical gap in the literature and provide the valuable insight into the psychosocial burden on parents. The finding from this study will be crucial for guiding the local policies, reducing stigma and care for children with ASD. \u003c/p\u003e\n\u003ch2 id=\"_Toc198501328\"\u003eOBJECTIVE\u003c/h2\u003e\n\u003ch2 id=\"_Toc198501329\"\u003eGeneral objective\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003eTo explore its psychosocial burden experienced by the parents caring for children with ASD, Hawassa city, Sidama region, from January 2025 to April 2025.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"METHODOLOGY","content":"\u003ch2\u003eStudy area and period\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in Hawassa city administration from January 2025 to April 2025. Hawassa City is a capital city of Sidama region and situated 273 km to the south of Addis Ababa and 1125 kilometers to the north of Nairobi, Kenya. As per the Central Statistics Agency\u0026apos;s (CSA) population projection, Hawassa city administration had a projected population of 555,480 in 2022 from which 277,032 were males. There are a total of 15 government-operated health facilities in the administrative division, which is made up of eight sub-cities and 32 kebeles. In the city, there are 9 hospitals and 1 Comprehensive Specialized Referral Hospital; 1 general hospital, 2 primary hospitals, and 5 private hospitals (1 general and 4 primary hospitals). According to Hawassa city administration education department, there are 5 Inclusive schools, 29 primary schools (grades 1 through 8), 15 secondary schools, one governmental university, and 5 colleges. In the city, Bright Autism Center is the well-known organization on providing support to children with autism spectrum disorder.\u003c/p\u003e\n\u003ch2 id=\"_Toc198501333\"\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThis study employed a phenomenological qualitative study.\u003c/p\u003e\n\u003ch2 id=\"_Toc198501334\"\u003ePopulation\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eSource population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll parents caring for children with Autism Spectrum Disorder (ASD) who were registered at HUCSH, inclusive schools, or the Bright Autism Center during the study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParents caring for children with Autism Spectrum Disorder (ASD) who attend HUCSH, inclusive schools or the Bright Autism Center, Hawassa city, Sidama region, from January 2025 to April 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy unit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach parent of a child aged 2 to 6 years diagnosed with Autism Spectrum Disorder (ASD).\u003c/p\u003e\n\u003ch2 id=\"_Toc198501335\"\u003eSample size determination and sampling procedure\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eSample size calculation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the qualitative component, the sample size decided based on data saturation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative sampling techniques \u0026amp; procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA non-probability purposive settings-based sampling technique was applied to select the parents of children with the diagnosis of ASD from HUCSH, bright autism center and inclusive schools. Criterion sampling was used to recruit participants for IDIs, from Hawassa University Comprehensive Specialized Hospital, Bright Autism Center and Inclusive schools. The inclusion criteria were (1) children aged 2 to 6 years with ASD should be diagnosed by a pediatrician and the diagnosis should be confirmed, (2) the age of the parents should be 18 years or above, and who are volunteer. Exclusion criteria are (1) being a parent for child diagnosed with other neurodevelopmental disorders different from ASD, (2) parents of children were having other comorbidities. Initial contact was supported by cooperation with relevant institutions. Recruitment was done until data saturation point was achieved, ensuring thorough consideration of the research queries. Informed consent was given to study participants, and then they was assessed individually, with each participant given a number to maintain their confidentiality; therefore, no details regarding the involvement of other family members in caregiving was asked for. Taking part in this study was optional, and no incentive was provided. The sample collection was taken place in person when participants bring their children to HUCSH for follow-up or other medical evaluations. Parents of children from Bright Autism Center and inclusive schools were contacted through each setting and invited to attend an in-person appointment at the center or the respective schools.\u003c/p\u003e\n\u003ch2\u003eEligibility criteria\u003c/h2\u003e\n\u003cp\u003eInclusive and exclusive criteria are shown in Fig 1.\u003c/p\u003e\n\u003ch2 id=\"_Toc198501345\"\u003eOperational definition\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eAutism Spectrum Disorder (ASD) diagnosis:\u003c/strong\u003e is the identification of a children as having autism based on the following specific criteria mentioned in DSM-V.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A)\u003c/strong\u003e Enduring impairments in social communication and interaction across multiple situations, as reflected in all of the following. (\u003cstrong\u003eI)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eDifficulties in social-emotional reciprocity, which may include atypical social approaches, lack of typical back-and-forth conversations, limited sharing of interests, emotions, or feelings, and failure to initiate or respond to social interactions. (\u003cstrong\u003eII)\u003c/strong\u003e Impairments in nonverbal communication used for social interaction, including difficulties integrating verbal and nonverbal cues, unusual eye contact and body language, challenges in understanding and using gestures, or a complete absence of facial expressions and nonverbal communication. (\u003cstrong\u003eIII)\u003c/strong\u003e Difficulties in building, sustaining, and comprehending relationships, which may involve trouble adjusting behavior to fit different social settings, challenges in engaging in imaginative play or forming friendships, or a lack of interest in interacting with peers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(B)\u003c/strong\u003e Limited and repetitive behaviors, interests, or activities, as demonstrated by at least two of the following. \u003cstrong\u003e(I)\u003c/strong\u003e Repetitive or patterned motor actions or repeated use of objects and speech. \u003cstrong\u003e(II)\u003c/strong\u003e A strong need for consistency, strict adherence to routines, or fixed, ritual-like patterns in both speech and body language. \u003cstrong\u003e(III)\u003c/strong\u003e Intensely narrow and focused interests those are unusually strong or fixated. \u003cstrong\u003e(IV)\u003c/strong\u003e Either an exaggerated or diminished response to sensory stimuli or an unusual focus on sensory details in the environment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(C)\u003c/strong\u003e Symptoms must emerge during early development, though they may not become fully apparent until social demands exceed the individual\u0026apos;s limited capacities, or they may be obscured by adaptive strategies learned later in life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(D)\u003c/strong\u003e The symptoms lead to significant challenges in social interactions, work, or other key areas of daily functioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(E)\u003c/strong\u003e These issues cannot be more accurately attributed to intellectual developmental disorder (intellectual disability) or global developmental delay [1].\u003c/p\u003e\n\u003cp id=\"_Toc184912593\"\u003e\u003cstrong\u003ePsychosocial burden:\u003c/strong\u003e refers perceived emotional, psychological, and social strain experienced by parents or caregivers of children with autism spectrum disorder (ASD). This burden is assessed qualitatively through in-depth interviews, where parents share their personal experiences, challenges, emotional well-being and social support.\u003c/p\u003e\n\u003ch2\u003eData collection\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools \u0026amp; procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFace to face in-depth interviews were conducted with parents, healthcare providers and teachers using semi-structured question guide consist of 10 questions from an interview guide. A total of 23 In-depth interviews were conducted, as the data saturation has been achieved. Time and place of interviews was chosen for the convenience of study participants. Each interview took approximately 45 to 60 minutes. With the participants\u0026apos; consent, it was both audiotape recorded and in handwriting. The audiotape then transcribed. In-depth interview was performed in Amharic and Sidaamu Affoo language depending on the participant\u0026rsquo;s language preference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCredibility, reliability, and trustworthiness of the qualitative data were ensured. Dependability of data was done using a thick description of the data and member check method. Translation was done meticulously before, during and after data collection. The similarity of the translated version and the original version was checked. Confirmability was ensured by maintaining a clear audit trail that documented each step of the data collection and analysis process. Ongoing reflexive journaling was used to acknowledge and minimize researcher bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing \u0026amp; analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding qualitative component, thematic analysis was used to analysis the interview data. Trilingual data collectors were translated the Sidaamu Affoo records into Amharic. Then, the interviews were transcribed verbatim from Amharic language into English version by data collectors. Following translation of the transcribed data into English, the transcripts were uploaded into NVivo 14 software (QSR International Pty Ltd., Cardigan, UK) for thematic coding. Three researchers conducted the coding independently to enhance the credibility and consistency of the analysis. Guided by the NVivo 14 training manual, the analysis followed some stages of theme development. Initially, the transcripts were examined line by line to generate open codes. Words and expressions with related meanings were then organized into broader categories. This was followed by selective coding, during which the most relevant codes were grouped to develop themes. Key themes were further broken down into sub-themes to capture more specific insights. To keep the original context and meaning, participants\u0026rsquo; direct quotes and narratives were presented verbatim without any modification [12]. Triangulation was conducted through cross-checking to assess convergence, complementarity and divergence between parents, healthcare providers and teachers.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003e5.1 Qualitative section\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eA total of four themes and eight sub-themes were identified in the analysis. The identified themes were: fear of judgment; cause of divorce, extra expenses and disruption of daily activities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.1.1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSocio-demographic characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 23 participants were interviewed due to saturation reached. All participants provided written consent following the Helsinki declaration. Among interviewees participated during the study, 15(65.2%) were biological parents of ASD children, 4(17.4%) were healthcare providers and 4(17.4%) were teachers at inclusive schools. 8(44.4%) of participants were interviewed at Hawassa University Comprehensive Specialized Hospital, 7(38.9%) and 3(16.7%) were interviewed at inclusive schools and Bright Autism Center respectively. About five out of 10 parents of the autistic children were graduates.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"715\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 715px;\"\u003e\n \u003cp\u003eTable 1:\u0026nbsp;Demographic characteristics of study participants, of the total respondents, 69.6% were female, 95.6% were married or cohabiting, 73.9% were educated to at least primary level and 65.2% were 36 years old or older. The mean age of respondents was 38.49 \u0026plusmn; 5.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"16\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePart.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSettings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e01PH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e02PH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e03PH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDegree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e04PH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e05PB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e06PB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e07PB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBright Autism Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e08PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBright Autism Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e09PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMasters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBright Autism Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e010PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBright Autism Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e011PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBright Autism Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e012PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eBright Autism Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e013PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eIlliterate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eInclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e014PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDegree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eInclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e015PS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eInclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e016HH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePosition (GP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHUCSH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e017HH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePosition (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e018HH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePosition (P)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e019HH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePosition (R)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp; \u0026nbsp;\u003cstrong\u003eSNT\u003c/strong\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e020TS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAdare Inclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e021TS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eTabor Inclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e022TS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHaike Inclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e023TS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eNigst Fura \u0026nbsp;Inclusive Schools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbr\u003c/strong\u003e. \u003cem\u003ePart. = participants, SNT = Special Need Teachers, GP = General Practitioner, N = Nurse, P = Psychiatrist, R = Resident, HUCSH = Hawassa University Comprehensive Specialized Hospital.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmerging themes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe themes were developed through systematic approach to coding and organizing patterns identified in the data, applying a thematic analysis method to emphasize key patterns or concepts that emerge from the information. This qualitative study on psychosocial burden among parents caring for children with ASD explored themes such as \u0026ldquo;fear of judgment, cause of divorce, extra expenses and disruption of daily activities\u0026rdquo;. Four main themes and eight sub-themes were identified in total. For an overview of the themes, sub-themes and codes, see Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2: Provides a concise summary of the main themes along with their respective sub-themes and codes that highlight the psychosocial burden experienced by the parents caring for children with Autism Spectrum Disorder, Hawassa city, Sidama Region, 2025.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"679\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-theme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"17\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFear of Judgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBlame and criticism from others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eBlamed for neglect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eCriticized by family\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eParental held responsible\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eBlamed for inadequate parenting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eJudged based on child\u0026rsquo;s behavior \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eCriticism from community members\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003ePerceived as responsible for everything\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eReceived wrong conclusion from others\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFear of disclosing the diagnosis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eWorry about stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eConcern about gossip\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eHiding the child\u0026rsquo;s diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eFear of being misunderstood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eFeeling shame when disclosing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eAvoiding talks about diagnosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAvoidance of social gathering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eIsolation from public\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eAnxiety over social judgment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eWithdrawing to avoid embarrassment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCause of divorce\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLacked of shared responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eUnequal sharing of responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eFrustration over parenting burden\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eMinimal involvement in caregiving\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eNo cooperation in managing child\u0026rsquo;s behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMarital conflict due to child\u0026rsquo;s condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003ePointing fault at each other\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eArguments about autistic child\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eDisputes over lack of intimacy or time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eCommunication problem between parents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtra expenses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eJob loss or reduced income\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eUnable to manage extra costs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eDependent on a single income\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eIncome loss due to caregiving\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eParent leaving work to care for child\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDisruption of daily activities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eIsolation and lack of personal time\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eNo one to share daily tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eLess contact with extended family\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eEmotional retreat from persistent stress\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eMissing out friendships due to lack of time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDifficulty managing household responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eDifficulty in time management\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eTrouble planning daily routines\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eFatigue with day-to-day activities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 294px;\"\u003e\n \u003cp\u003eStruggling maintaining a regular routine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eMain Theme 1: Fear of judgment \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParents of children with autism reported a strong sense of fear of being judged by others. This fear manifested in several ways, criticism, reluctance to disclose the diagnosis, and social withdrawal. These experiences contributed significantly to their emotional burden and sense of isolation. This theme mainly include three sub-themes; Blame and criticism from others, fear of disclosing the diagnosis and avoidance of social gathering\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 1.1: Blame and criticism from others \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFear of other judgment was reported as the critical theme by the participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA 42-years mother said that, \u0026ldquo;\u0026hellip;Children with autism need close supervision; we have to take care of them constantly. Another issue is that people often perceive autism based on their own understanding, which can be quite limiting. We fear being judged by others, and that worries us a lot. People look at us differently, and sometimes, I even go out alone because I fear how others will react. This shows how much their lack of understanding affects our experience. I know some parents even feel ashamed to be seen with their children. Most people judge the parents, blamed for inadequate parenting and their judgment affects our emotions. We don\u0026rsquo;t really want to hear anything from them because we already know what they\u0026rsquo;re thinking. We often received wrong conclusion from others. The influence of others becomes a burden, and it forces us to lead our lives in secret.\u0026rdquo; (\u003cstrong\u003eParticipant 15\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother a 38-years mother also said, \u0026ldquo;Societal perceptions and cultural beliefs about autism can greatly impact how parents experience raising a child with autism. Often, there\u0026rsquo;s a lack of awareness about autism, which can lead to stigma and misconception; eh\u0026hellip;eh... [?]. Parents may feel judged or blamed for their child\u0026apos;s condition, also criticized by family and that can be emotionally challenging\u0026hellip;\u0026rdquo; (\u003cstrong\u003eParticipant 11\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA 34-years man participant reported that, \u0026ldquo;I worry about what people say. Some people try to judge you without knowing the truth about autism, that\u0026rsquo;s really annoying. They just speak like that it was happened due to parent\u0026rsquo;s problem and blame us. I heard what it was talked from others during some event \u0026hellip; [???]. I think our culture, beliefs; norms would be the factors for their wrong understanding. Most of us hold some myths, which we heard from our community, like autism is a mental illness, happen due to evil\u0026hellip;and other a lot. I usually fear their judgment, because it makes us to feel somewhat stress\u0026hellip;They judge based on child\u0026rsquo;s behavior\u0026rdquo; (\u003cstrong\u003eParticipant 9\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 1.2: Fear of disclosing the diagnosis \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParents expressed a reluctance to openly talk about their child\u0026rsquo;s diagnosis due to fear of being labeled, misunderstood, or treated differently.\u003c/p\u003e\n\u003cp\u003eMother of a 5-year old girl explained that, \u0026ldquo;I haven\u0026rsquo;t told anyone outside my family that my daughter has autism. I\u0026rsquo;m afraid they might look at her and us differently, like we are less.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 1\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;As the participant number four said, \u0026ldquo;\u0026hellip;I avoid talking the diagnosis with people, because they make me feel anxious. The reason is how judge us, due to the beliefs they hold within our context. I worry about what others might think of me as a parent, there is also concern of gossip\u0026hellip;emm\u0026hellip;that really disturbs me\u0026hellip;It\u0026rsquo;s very stressful for me\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 4\u003c/strong\u003e)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;I understand that there is fear of disclosing the diagnosis of their children, because parents think what others may talk in negative way, so don\u0026rsquo;t want to let other to know\u0026hellip;mmm\u0026hellip;just they might think the people misunderstood autism and try to give other meaning. So some parents prefer silence not to disclose about their child condition, fear of being misunderstood. Considering mentioning the case may other makes them as guilty, or unless they found to be shameful and embarrassing. So we worry about stigma\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 23\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003eAccording to the participant who teach in special need education,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026ldquo;\u0026hellip;Parents often don\u0026rsquo;t talk about their child\u0026rsquo;s diagnosis; because\u0026hellip;um\u0026hellip;Many people believe that autism is caused by evil spirits, a curse, or even sin. According to these beliefs, it\u0026apos;s seen as something that results from the parents\u0026apos; actions, so we\u0026rsquo;re often blamed for it. This makes them feel really uncomfortable. These misconceptions are deeply rooted, and they affect their emotions\u0026hellip;so they never want to disclose to others\u0026rdquo; (\u003cstrong\u003eParticipant 20\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 1.3: Avoidance of social gatherings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to fear of judgment, many parents avoid public events, family occasions, or community gatherings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParent labeled by number six said\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In the beginning, I tried taking my son to weddings and community events, thinking that it would be good for him to socialize. But sometimes he acted out; people stared, whispered behind our back, and even say hurtful things, like that he was \u0026lsquo;possessed\u0026rsquo; by evil spirits or that he was a punishment for our wrongdoings. This all makes us to withdraw to avoid embarrassment. It became too much, so now we don\u0026rsquo;t go to these events anymore\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 6\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;At family gatherings, people try to offer advice, but it\u0026rsquo;s usually not helpful. They tell me to pray harder or to take him to a traditional healer, thinking that something spiritual is wrong with him. It\u0026rsquo;s exhausting and creates anxiety over social judgment. Eventually, I stopped going to these events altogether. I just couldn\u0026rsquo;t bear the comments anymore.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 7\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003eAnother participant also expressed his emotion as follow,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;...It\u0026rsquo;s very difficult. Thinking about my child\u0026rsquo;s condition and behavior creates a lot of stress and depression. All that frustration is very challenging as a parent. Sometimes, I feel emotionally exhausted and even bored. Since there are no immediate solutions, as a parent you will be fall into depression easily and isolation from public.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 10)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Theme 2: Cause of divorce\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the in-depth interview finding, cause for divorce was one of the main among themes. Two sub-themes were reported: Lacked of shared responsibility and marital conflict due to child\u0026rsquo;s condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 2.1: Lacked of shared responsibility \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 40-years old mother said as follow,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;It always felt like I was carrying the whole load. He would go to work and come home expecting everything to be in order. It is the results of frustration over parenting burden. Over time, that kind of imbalance just broke us\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 8)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;There are days when I feel completely alone. Even in our own family, people think I am supposed to know everything about how to care for our son. If he starts disturbing, everyone looks at me. My husband helps only when I ask, but I wish he could understand that I need support without always having to explain or request it.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;my husband doesn\u0026rsquo;t want to discharge his responsibility and let everything for me to do alone. \u0026nbsp; He doesn\u0026rsquo;t give much attention to our child condition, rather he think it\u0026rsquo;s my business only. Even when I ask him to spend time together, but he doesn\u0026rsquo;t have any willingness. He lacked and unequal sharing parental responsibility, I am the only one who provides for my child, lacking a support from my partner makes thing difficulty to handle. Almost no cooperation in managing child\u0026rsquo;s behavior and other stuff\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The whole responsibilities reside on mothers. Sometimes, fathers have minimal involvement in supporting and taking care process, this would result in a huge burden on mothers, imbalance of responsibility sharing would create stress and other psychological impacts, I have seen most of the mothers get difficulties due to lack of appropriate support from their partner, they mentioned out the biggest problem is their partners don\u0026rsquo;t have interest to share our responsibility, make the mothers to be the only and main responsible person for autistic children\u0026hellip; \u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 14)\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 2.2: Marital conflict due to child\u0026rsquo;s condition \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParents say, there is a conflict between the couple after the diagnosis of the child. Some of the parents mentioned this issue emotionally; the child condition\u0026rsquo;s is believed to be the cause of conflict. The participants response were stated as follow,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026ldquo;We\u0026rsquo;ve argue suddenly when we talk about our child regarding autism, he don\u0026rsquo;t even want to speak about it with me,\u0026hellip;.emm\u0026hellip;as we know, there should be open discussion between partners to tackle the challenges we face; but for us it is cause for conflict, I understand that the disputes were due to lack of intimacy and not having enough time to spend together. He shows some irritable behavior\u0026hellip; [Paused]\u0026hellip;I don\u0026rsquo;t know what to do\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 12)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;I am always gets a conflict with my husband after we know that our son diagnosis with autism, actually the conditions is stressful, but he try to make this as my problem, pointing fault at me. I don\u0026rsquo;t think he\u0026rsquo;s right, he always said that I hadn\u0026rsquo;t take care of my son during pregnancy and also after birth, this is not right, his cause of conflict is resisting to accept the conditions, and put down all the burdens from him, that makes me angry.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We used to be close, but now the constant responsibilities and emotional stress have driven a wedge between us. There\u0026rsquo;s blame, frustration, and barely any time to talk about anything other than our child. We often argue about our autistic child\u0026hellip;um\u0026hellip;um\u0026hellip;I don\u0026rsquo;t think the issue would create such conflict between us; Seem communication problem between us, but I often found that as a cause\u0026hellip;it\u0026rsquo;s affect the relationship with my husband\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 12)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Theme 3: Extra expenses\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 3.1: Job loss and reduced income \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll parents indicated that having a child with autism incurs additional/extra costs in various areas, one parent identified with code number 012 fully indicated that,\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;I stopped working for the sake of my autistic child. I used to have different jobs before, but I\u0026rsquo;ve lost all of them now, so I don\u0026rsquo;t have any source of income. The expenses are huge including school fees, transportation costs, foods and so on. The economic burden is quite challenging, and it makes it very difficult to manage daily life.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 12)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother a 45 year female participant said that, \u0026ldquo;\u0026hellip;I had to quit my job to stay at home with my child, and my partner works long hours to support us financially. I can\u0026rsquo;t able to manage the extra expenses for my child. Sometimes, I feel guilty because I know my family is sacrificing so much, and I constantly worry about the long-term financial strain. We\u0026rsquo;ve even had to ask for help from family members just to make ends meet, which is hard for me because I\u0026rsquo;ve always taken pride in being independent. I depend on my husband income. The financial stress is constant, and it really affects us...\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Participant 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026ldquo;To be honest, as a teacher, my salary is over 9,000 Ethiopian Birr. Almost 65% of my salary more than 5,000 Birr each month goes toward my child\u0026rsquo;s school fees and transportation alone, not even counting food and other expenses. We are really frustrated about our financial situation. If things continue like this, it feels like everything will get out of control. I sometimes tell my wife, \u0026lsquo;What are we going to eat if we spend almost everything on his needs?\u0026rsquo; We have so many expenses. This worries us a lot as parents. On top of the economic burden, we are truly suffering now. Unlike other people, we can\u0026rsquo;t manage our budget properly. We\u0026rsquo;re living in my father\u0026rsquo;s house, renting a single room that used to be rented out for 3,000 to 4,000 Birr. We decided to stay, but sometimes it\u0026rsquo;s even difficult to pay him the rent. I explained everything to him, and he told us to pay the rent whenever we get the money. To cope with this, I also work part-time to earn some additional income because of the financial challenges we\u0026rsquo;re facing these days. Overall, the economic burden on parents of autistic children is extremely challenging.\u0026rdquo; (\u003cstrong\u003eParticipant 9\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003eThe other participant informed his concern regarding the extra expense as a financial burden,\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;Usually, we eat Injera, but my child doesn\u0026rsquo;t. We\u0026rsquo;ve tried to feed him Injera, but he prefers rice and potatoes, and sometimes meat, like chicken. These foods are extra costs for us compared to what we typically eat, and they require a bit more spending. Also, we can use any type of cooking oil, but for him, it doesn\u0026rsquo;t work. We prefer a specific type of oil, nougat oil, but it\u0026rsquo;s expensive and often hard to find. So, to meet his special needs, we\u0026rsquo;re forced to spend extra money. This financial burden is challenging, and as a parent, it really takes a toll\u0026rdquo;. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(\u003cstrong\u003eParticipant 5\u003c/strong\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Theme 4: Disruption of daily activities \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 4.1: Isolation and lack of personal time\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 35-year mother shared her experience, \u0026ldquo;I used to be active in the community. I participated in women\u0026rsquo;s groups, attended church programs, and visited my neighbors regularly. But now, I can\u0026rsquo;t do any of that. My child cannot be left alone, and I don\u0026rsquo;t trust anyone else to understand his needs. I haven\u0026rsquo;t had a single day to myself in years\u0026hellip;.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 6\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;I feel alone, because nobody is there with us, I spend almost the whole time with my child, just taking care of him become a big matter for me, I manage everything, no one share this burden with me, The pressure makes to feel you loneliness\u0026hellip;.umm\u0026hellip;you don\u0026rsquo;t have time for yourself, even I miss my friends. So it\u0026rsquo;s quite challenging. These feeling of isolation sometimes make you to give up\u0026hellip;\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 9\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme 4.2: Difficulty managing household responsibility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the themes reported by the participant is daily routine disruption. As participant 5, \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;I\u0026rsquo;m unable to do other businesses; even our social life is affected. We can\u0026rsquo;t do the things we used to do before because we spend so much time caring for our child. This creates a lot of problems for me as a father. I feel sometimes exhausted in day to day activities. Every activity is restricted; it\u0026rsquo;s not something we can do freely because I always have to keep a close eye on him. I can never be completely sure about him, he might get injured or harm someone else\u0026hellip;\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 11\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSimilarly, other participant said that,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;Most parents\u0026rsquo; daily activities are limited because they need to take care of their children. Work and other aspects of life are greatly affected. A lot of time, energy, and resources are invested in caring for them, and parents are expected to be with their children with autism at all times. As a result, their daily activities are reduced and disrupted, unable to manage their time properly, difficulty in planning and struggle to maintain regular routines, this all creating a huge burden and leading to stress.\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003eParticipant 18\u003c/strong\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study provided an in-depth exploration about the psychosocial burden among parents having children with autism spectrum disorder. Based on the findings of this study, the psychosocial burdens were organized into four themes, eight sub-themes and 37 codes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Parents identified several key psychosocial challenges they face during caregiving, including fear of judgment, the cause of divorce, extra expense and disruption of daily activity. Particularly, community\u0026rsquo;s limited awareness of Autism Spectrum Disorder (ASD), which often led to harmful cultural narratives and inappropriate judgments. Many parents shared experiences of being unfairly blamed for their child\u0026rsquo;s behavior, with assumptions of inappropriate judgments. These misconceptions frequently resulted in social comparisons with typically developing children, leading to parental shame and ridicule. Existing literature confirms that such misinformed societal attitudes rooted in a lack of understanding about autism can intensify parents\u0026rsquo; emotional strain, contributing to increased levels of stress, anxiety, and depression, subsequently it cause for fear of judgment [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The fear of being socially judged emerged as dominant theme among participants. Many parents described feelings of shame, blame, and feelings of exclusion due to persistent misconceptions surrounding autism. In our context, cultural beliefs often associated with autism to spiritual causes such as curses; sin, or divine punishment, parents of autistic children are frequently stigmatized. This results align with existing literature indicating that stigma can lead to social withdrawal and emotional distress in parents [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The social stigma faced by parents of children with Autism Spectrum Disorder shows broader societal prejudices. When parents perceive the social support available to them or their children as insufficient, they are more likely to report increased level of stress. Many studies have shown that limited support, especially when coupled with the negative perception or labeling of autistic behaviors can contribute to parental withdrawal from social engagement and community participation.\u003c/p\u003e\u003cp\u003eSimilarly, findings from other qualitative studies have shown the absence of supportive social networks can significantly affects the parent\u0026rsquo;s emotional well-being, often leading to feelings of isolation, marginalization and perceived judgment from others [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Another burden experienced by parents caring for a child with autism was challenge on marital relationships. Two key sub-themes emerged under this theme: lack of shared responsibility and marital conflict. In many cases, mother assumed the majority of caregiving duties, while fathers distanced themselves from the emotional and practical demands of caregiving responsibility. The unequal distribution of caring responsibilities often led to feelings of frustration and emotional separation between partners. Several participants described how constant disagreements, unmet expectations, and differing approaches to parenting ultimately led to separation or divorce. Similar patterns have been documented in India and other low-income settings, where raising a child with ASD can lead to marital dissatisfaction and even divorce [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Parents caring for children with Autism Spectrum Disorder (ASD) often face intense psychological and emotional stress; that may contribute to conflict within the marital relationship. Considerable time and attention required for caregiving can reduce opportunities for couples to engage with each other, this potentially affect their marriage and leads to conflict or divorce [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Research has indicated a significant association between the breakdown of parental marriages and the period when a child with Autism Spectrum Disorder (ASD) approaches adolescence, particularly around the age of twelve [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Hartley et al. (2010) found that parents of children with Autism Spectrum Disorder (ASD) experience higher divorce rates until their child reaches early adulthood. In contrast, parents caring for children with ASD tend to experience a decline in divorce rates after their child reaches the age of eight. However, for parents of children with ASD, the significant and ongoing caregiving demands may contribute to higher vulnerability of marital conflict and divorce due to the increased stress levels associated with these responsibilities. Furthermore, these parents often do not experience the empty nest phase as early as parents of neurotypical children, as the transition of children with ASD from school to community settings usually requires ongoing assistance from one or both parents [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Another theme revealed by the present qualitative study is extra expenses, include two sub-themes, (1) job loss and reduced income (2) difficulty of accessing financial support, providing care for children with Autism Spectrum Disorder (ASD) places a substantial financial burden on families.\u003c/p\u003e\u003cp\u003eAccording to the study conducted by Saunders et al. reported that households with children diagnosed with ASD often face considerable economic challenges due to the specialized services and support their children require [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Jarbrink et al. estimated that the financial demands of raising a child with a disability are nearly three times higher than those for raising a child without such needs. In this study, participants associated the financial burden they faced with various essential needs, including costs related with clothing, food, medical care, transportation and so on. Parents also emphasized that the need for additional costs they pays for schools. But more concern on foods that they prepare for their child. Furthermore, providing a balanced diet posed an added burden due to the increasing cost of food [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Generally, the demands of both caregiving and financial responsibilities appeared to contribute to parents' emotional distress and feelings of unease regarding their child\u0026rsquo;s condition. Many Participants commonly spoke about the significant financial burden they face in caring a children diagnosed with Autism Spectrum Disorder (ASD). This result is consistent with prior study by Karst and Van Hecke[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], who reported that autism imposes a considerable economic challenges and diminishes quality of life for parents. Likewise, findings by Lai, Goh, Oei, and Sung [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] indicated that both person with autism and their parents endure emotional, social, and economic difficulties, often worsened by lack of adequate public awareness and understanding about ASD.\u003c/p\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eSTRENGTHS AND LIMITATIONS OF THE STUDY\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eStrengths\u003c/strong\u003e\u003cp\u003eThe triangulation of data sources enhances the credibility and trustworthiness of the qualitative result, helping to reduce the potential bias and strengthen its conclusions.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003cp\u003eThe qualitative findings may not be fully representative of the broader population, as they were based on purposively selected participants, introducing selection bias that limits the transferability of the results\u003c/p\u003e\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATIONS","content":"\u003ch2\u003eConclusion\u003c/h2\u003e\n\u003cp\u003eTo conclude, this study explored the psychosocial burdens experienced by the parents caring for children with ASD. Fear of judgment, cause of divorce, extra expenses and disruption of daily activities were the key themes identified in the study.\u003c/p\u003e\n\u003ch2 id=\"_Toc198501358\"\u003eRecommendations\u003c/h2\u003e\n\u003cp\u003eMental health professionals and non-governmental organizations (NGOs) to provide accessible and sustained psychosocial support services, including counseling aimed at helping parents to manage emotional distress. Community based awareness campaigns should be implemented to reduce misconception and promote public understanding of ASD. This effort reduces the social judgment and other related psychosocial challenges faced by parents caring for children with ASD. Additional large-scale research is recommended to deepen the understanding its psychosocial impact experienced by the parents and or caregivers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eConsent Statement: Written informed consent was obtained from the patient (or the patient\u0026rsquo;s legal guardian) for participation in this study and for the publication of their clinical case, including all relevant details.\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eEthical consideration \u0026nbsp;\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe protocol of the study was approved by the Ethical Review Committee of HUCMHS (IRB/507/17). A formal letter of cooperation was written to HUCSH, Bright Autism Center and Hawassa city administration education department from public health academic and service directorate to facilitate data collection. Then a letter was written from the educational department to inclusive schools accordingly. Written informed consent obtained from the participants before data collection. The study ensured that the participants fully understand the purpose, procedure and benefits of the research. Data were securely stored and used solely for the purpose of this research. All methods were strictly adhering to the relevant national and institutional guidelines and regulations, as well as international ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe data used for this study cannot be shared publicly due to the inclusion of sensitive participant information. Data is available upon request from Abel Melese (MPH in Epidemiology) via email ([email protected]) for researchers who meet the criteria for access to confidential data.\u003c/p\u003e\n\u003ch2\u003eConflict of Interest:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe author declares that there is no Conflict\u0026nbsp;of interest.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc198501350\"\u003eFunding:\u0026nbsp;\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eThe author received no specific funding for this study.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eABN and WTK conceptualized the study. ABN conducted the research, carried out the statistical analysis, wrote manuscript and developed the tool; ABN and WTK participated in the design of the study and tool development, performed qualitative analysis, and drafted the manuscript. Both read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eWe would like to acknowledge Hawassa University Comprehensive Specialized Hospital, Bright Autism Center and Inclusive Schools from which the data were collected. The data collectors are also going to share gratitude for their contribution to data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed: Washington, DC: (2013).Access on https://doi.org/10.1176/appi.books.9780890425787.\u003c/li\u003e\n\u003cli\u003eAl-Dujaili et.al; Psychosocial burden among caregivers of children with autism spectrum disorder in Najaf province. International Journal of Pediatrics, Current Pediatric Research, 2017.\u003c/li\u003e\n\u003cli\u003ePierce, K., Glatt, S. J., Liptak, G. S., \u0026amp; McIntyre, L. L. (2009). The power and promise of identifying autism early: insights from the search for clinical and biological markers. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 21(3), 132\u0026ndash;147.\u003c/li\u003e\n\u003cli\u003eBravo-Ben\u0026iacute;tez, J., P\u0026eacute;rez-Marfil, M. N., Rom\u0026aacute;n-Alegre, B., \u0026amp; Cruz-Quintana, F. (2019). Grief Experiences in Family Caregivers of Children with Autism Spectrum Disorder (ASD). International Journal of Environmental Research and Public Health, 16(23), 4821.\u003c/li\u003e\n\u003cli\u003eSim A, Vaz S, Cordier R, Joosten A, Parsons D, Smith C, et al. Factors associated with stress in families of children with autism spectrum disorder. Dev Neurorehabil. 2017; .\u003c/li\u003e\n\u003cli\u003eLainhart D. Psychiatric problems in individuals with autism, their primary caregiver and siblings. Int Rev Psychiatr 1999; 11: 278-298.\u003c/li\u003e\n\u003cli\u003eKogan P, He J, Glickman GN, et al. The effects of various additives on setting properties of MTA. J Endod 2006; 32: 569-572.\u003c/li\u003e\n\u003cli\u003eWeiss, J. A., Wingsiong, A., \u0026amp; Lunsky, Y. (2014). Defining crisis in families of individuals with autism spectrum disorders. Autism : The International Journal of Research and Practice, 18(8), 985\u0026ndash;995.\u003c/li\u003e\n\u003cli\u003eR\u0026ouml;ssler, W. (2016). The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. EMBO Reports, 17(9), 1250\u0026ndash;.\u003c/li\u003e\n\u003cli\u003eMiranda, A., Mira, A., Berenguer, C., Rosello, B., \u0026amp; Baixauli, I. (2019). Parenting Stress in Mothers of Children With Autism Without Intellectual Disability. Mediation of Behavioral Problems and Coping Strategies. Frontiers in Psychology, 10, 464.\u003c/li\u003e\n\u003cli\u003eEmberti Gialloreti, L., Mazzone, L., Benvenuto, A., Fasano, A., Alcon, A. G., Kraneveld, A., Moavero, R., Raz, R., Riccio, M. P., Siracusano, M., Zachor, D. A., Marini, M., \u0026amp; Curatolo, P. (2019). Risk and Protective Environmental Factors Associated with Autism Spectrum Disorder: Evidence-Based Principles and Recommendations. Journal of Clinical Medicine, 8(2), 217.\u003c/li\u003e\n\u003cli\u003eCreswell JW. Research design: qualitative and quantitative and mixed methods approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2011.\u003c/li\u003e\n\u003cli\u003eShrestha R, Dissanayake C, Barbaro J. Caregivers\u0026rsquo; knowledge of autism in a local peri-urban community of Nepal: A cross-sectional study in Kirtipur, Kathmandu. Res Autism Spectr Disord. 2021;80:101696. doi: 10.1016/j.rasd.2020.101696.\u003c/li\u003e\n\u003cli\u003eSamadi, S. A., \u0026amp; McConkey, R. (2020). Perspectives on inclusive education of preschool children with autism spectrum disorders and other developmental disabilities in Iran. International Journal of Inclusive Education, 24(5), 495\u0026ndash;513. https://doi.org/10.1080/13603116.2018.1464063.\u003c/li\u003e\n\u003cli\u003eDevenish BD, Sivaratnam C, Lindor E, Papadopoulos N, Wilson R, McGillivray J, et al. A Brief Report: Community Supportiveness May Facilitate Participation of Children With Autism Spectrum Disorder in Their Community and Reduce Feelings of Isolation in Their Caregivers. Front Psychol. 2020;11:583483. doi: 10.3389/fpsyg.2020.583483. [PubMed: 33240173]. [PubMed Central: PMC7683380].\u003c/li\u003e\n\u003cli\u003eDivan, G., Vajaratkar, V., Desai, M. U., Strik-Lievers, L., \u0026amp; 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\u0026ndash;200. https://doi.org/10.1002/aur.1225.\u003c/li\u003e\n\u003cli\u003eBursnall, S., Kennedy, E., Senior, R., \u0026amp; Violet, J. (2009). Understanding the Experience of Parenting a Child with Autism.\u003c/li\u003e\n\u003cli\u003eHartley, S. L., Barker, E. T., Seltzer, M. M., Floyd, F., Greenberg, J., Orsmond, G., \u0026amp; 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.\u003c/li\u003e\n\u003cli\u003eSaunders, B., Tilford, J., Mick, F., Fussell, J., Schulz, E., Eldon, G., Casey, P., Patrick, H., \u0026amp; Dennis, Z. (2015). Financial and employment impact of intellectual disability on families of children with autism. Families, Systems, and Health, 33(1), 36-45.\u003c/li\u003e\n\u003cli\u003eJarbrink, K., Fombonne, E., \u0026amp; Knapp, M. (2003). Measuring the parental service and cost impacts of children with autistic spectrum disorder: A pilot study. Journal of Autism and Developmental Disorders, 33(4), 396\u0026ndash;402.\u003c/li\u003e\n\u003cli\u003eKarst, S., \u0026amp; Van Hecke, V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Journal of Clinical Child and Family Psychology Review, 15(3), 247-277.\u003c/li\u003e\n\u003cli\u003eLai, W., Goh, J., Oei, S., \u0026amp; Sung, M. (2015). Coping and well-being in parents of children with Autism Spectrum Disorders (ASD). Journal of Autism and Developmental Disorder, 45(8), 2582\u0026ndash;2593.\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":"Autism Spectrum Disorder (ASD), Psychosocial Burden, Children, Parents Caring for Children, Qualitative Study, Hawassa City, Sidama Region","lastPublishedDoi":"10.21203/rs.3.rs-7371337/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7371337/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAutism spectrum disorder (ASD) is severe and pervasive impairment in various aspects of development. It poses a significant psychosocial burden. There is limited data on psychosocial burden experienced by parents. This study aims to identify predictors of Autism Spectrum Disorder (ASD) and explore its psychosocial burden among parents caring for children with ASD in Hawassa city, Sidama Region. In-depth interviews (IDIs; n\u0026thinsp;=\u0026thinsp;23) using purposive sampling technique, were conducted to explore the psychosocial burden among parents caring children with autism in February 2025 and March 2025. From the qualitative study findings, the psychosocial burdens among parents caring for children with Autism Spectrum Disorder were identified. Key themes included fear of judgment, cause of divorce, extra expenses and disruption of daily activities. Based on these findings, psychosocial counseling services and community based awareness programs should be provided.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eACRONYMS AND ABBREVIATIONS\u003c/b\u003e\u003c/p\u003e","manuscriptTitle":"Psychosocial Burden Among Parents Caring for Children With Autism Spectrum Disorder: A Qualitative Study in Hawassa City, Sidama Region, Ethiopia, 2025","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 08:14:51","doi":"10.21203/rs.3.rs-7371337/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":"64aa89a5-d263-4244-be0b-04416d6bc070","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-07T17:08:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-20 08:14:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7371337","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7371337","identity":"rs-7371337","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}