Diagnosis Disclosure Support for Caregivers of Children With Autism

The Parental Autism Disclosure Scale (PADS) is a self-report instrument developed in this study to measure the extent to which caregivers of autistic children have considered and prepared for disclosing the diagnosis to their child. The scale consists of 26 items rated on a 5-point Likert scale ranging from "strongly disagree" (0) to "strongly agree" (4), with reverse-scored items included. Higher total scores indicate greater consideration of and preparedness for disclosing the diagnosis to the child, with total scores ranging from 0 to 104.

The Decisional Conflict Scale (DCS) will be used to assess decision-making conflict regarding diagnosis disclosure among caregivers of children with autism. Items are rated on a 5-point Likert scale ranging from "strongly agree" (0) to "strongly disagree" (4). Total scores and subscale scores are converted to a 0-100 scale, with higher scores indicating greater decisional conflict.

This will be used to assess whether the intervention program was satisfying and comprehensible to caregivers. Caregivers will respond to approximately 10 items using a Likert-type scale. The survey will include items such as "The program fits the goals of the intervention" and "The skills taught in the program are relevant to my needs."

This will be used to assess whether the intervention program was feasible for the caregivers. Caregivers will respond to approximately 10 items using a Likert-type scale. The survey will include items related to the practicality of the program such as 'Using Zoom for the sessions was easy for me.' and 'The length of each session was manageable.'

A form will be used to record the attendance of the caregivers as a measure of their participation in the intervention program.

This will be used to assess whether core elements in each session were delivered to caregivers. Interventionists will record the checklist for each session.

The Korean Version of the Internalized Stigma of Mental Illness Scale (K-ISMI) will be used to measure the level of internalized stigma experienced by caregivers and to assess the impact of stigma on family stress and adaptation. Items are rated on a 4-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (4), with reverse-scored items included. Total scores range from 29 to 116, with higher scores indicating a higher level of internalized stigma related to having a child with autism.

The Life Transition Scale for Parents of Children with Autism (LTS) will be used to assess the emotional responses and psychological adaptation of caregivers of autistic children during the process of recognizing and accepting their child's diagnosis. Items are rated on a 4-point Likert scale ranging from "never" (1) to "often" (4), with reverse-scored items included. Evaluation of the transition process is conducted by calculating the mean score for each stage, obtained by dividing the sum of item scores within each stage by the number of items; higher or lower mean scores are then compared across stages.

The Emotion Regulation Questionnaire (ERQ) will be used to assess how caregivers experience and regulate their emotions in their daily lives. Items are rated on a 7-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (7). Higher scores indicate greater use of the corresponding emotion regulation strategy.

The Autism Stigma and Knowledge Questionnaire (ASK-Q-2) will be used to assess caregivers' knowledge of and stigma toward autism. Items are scored dichotomously (agree = 1, disagree = 0).

The Parenting Sense of Competence (PSOC) scale is a parent self-report measure used to assess parenting satisfaction and efficacy. Items are rated on a 6-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (6), with reverse-scored items included. Higher total scores indicate greater parental efficacy. Scores of 58 or below are interpreted as low, scores between 58 and 74 as average, and scores of 75 or above as high.

The Parent Satisfaction Scale (PSS) is an instrument that assesses caregivers' subjective evaluation of their performance in the parenting role, as well as the positive and negative emotions arising from their parenting experiences. Items are rated on a 4-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (4), with reverse-scored items included. Higher total scores indicate greater satisfaction with the parenting role.

The Korean Parenting Stress Index-Fourth Edition Short Form (K-PSI-4-SF) is a parent self-report measure used to assess parenting stressors and overall levels of parenting stress. Items are rated on a 5-point Likert scale with varying anchor statements (e.g., from "strongly disagree" (1) to "strongly agree" (5); from "definitely not adequate as a parent" (1) to "a very good parent" (5); and from "much easier than expected" (1) to "much more difficult than expected" (5)). Total scores range from 36 to 180, with higher total scores indicating greater levels of stress experienced in parenting.

The UCLA Loneliness Scale-8 (ULS-8) is a self-report measure that assesses the degree and frequency of perceived loneliness and will be used to measure loneliness as a state of extreme distress resulting from relational deficiency. Items are rated on a 4-point Likert scale ranging from "strongly disagree" (1) to "always" (4), with reverse-scored items included. Total scores range from 8 to 32, with higher total scores indicating higher levels of perceived loneliness.

The Loneliness and Social Isolation Scale (LSIS) is an instrument designed to estimate the complex construct of social isolation by incorporating both objectively measurable aspects of social networks and individuals' subjective perceptions of social support and loneliness. Items 1 and 2 are rated on a scale ranging from "rarely true" (0) to "very true" (3). Items 3 and 4 are reverse-scored, ranging from "rarely true" (3) to "very true" (0). Item 5 assesses the number of social contacts, scored from "0 persons" (3) to "7 or more persons" (0), and Item 6 assesses time spent in social interaction, scored from "not at all" (3) to "1 hour or more" (0). A total score of 3 or higher on Items 1 and 2 indicates a high risk of loneliness. A total score of 4 or higher on Items 3 and 4, together with a total score of 4 or higher on Items 5 and 6, indicates a high risk of social isolation.