Research Paper
saedeh khojasteh; farangis demehri; alireza afshani
Abstract
AbstractThe present study aimed to investigate the psychometric properties of the Autism Family Experience Questionnaire in families with autistic children in Yazd province. The study used a descriptive, correlational-normative method. The statistical population consisted of all families with autistic ...
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AbstractThe present study aimed to investigate the psychometric properties of the Autism Family Experience Questionnaire in families with autistic children in Yazd province. The study used a descriptive, correlational-normative method. The statistical population consisted of all families with autistic children in 1403, from which a sample of 385 individuals was selected by convenience sampling. The measures used in this study were the Autism Family Experience Questionnaire, an Autism Symptom Severity scale, and a Social Support scale. The validity of the Autism Family Experience Questionnaire was confirmed through content validity (using CVI and CVR) and confirmatory factor analysis using AMOS software. An analysis of internal consistency revealed a positive and significant relationship between scores on the Autism Family Experience Questionnaire, Autism Symptom Severity, and Social Support. To examine the internal consistency reliability of the questionnaire, Cronbach's alpha was calculated. The findings showed a Cronbach's alpha of 0.929 for the autism parent experience subscale, 0.916 for the family life subscale, 0.94 for the child development, understanding, and social relations subscale, 0.897 for the child symptoms, feelings, and behavior subscale, and 0.952 for the total autism family experience scale. The results indicate that the Autism Family Experience Questionnaire has appropriate reliability and validity. Therefore, this scale can be used to assess the family experience of autism.Keywords: Psychometric Properties, Autism Family Experience Questionnaire, Autism Spectrum Disorder, Family Extended AbstractIntroductionFrom a systemic perspective, the functioning of each family member affects the overall system, and the challenges faced by one member can disrupt the functioning of others. Autism Spectrum Disorder (ASD) is one of the most prevalent neurodevelopmental disorders, characterized by impairments in social interaction, communication difficulties, and restricted, repetitive patterns of behavior (American Psychiatric Association, 2024). These challenges not only affect the lives of individuals with ASD but also impose significant psychological, social, and economic burdens on their families (Hodges et al., 2020). Prior research has consistently documented high levels of stress among families of children with ASD, which arises from factors such as stigma, intensive caregiving demands, social isolation, financial strain, and long-term concerns about the child’s future (Hoogsteen & Woodgate, 2013; Lutz et al., 2012; Gomes et al., 2015). Parents often report feelings of shame when unable to manage their child’s behaviors in public (Pisula-Barancko et al., 2021), while frequent "meltdown" episodes demand constant attention and reduce opportunities for rest (Ten Hoopen et al., 2010). Moreover, many families experience isolation from relatives and friends who fail to understand or accept their child’s condition, which further intensifies their stress (Pinto et al., 2016).Research also highlights differences in the lived experiences of mothers and fathers. Fathers often struggle with accepting developmental changes, employing effective coping strategies, navigating shifting paternal roles, and managing recurring feelings of shame and guilt following the diagnosis (Brown et al., 2021). Mothers frequently report experiencing ambivalent emotions, low psychological capital, and limited social networks (Ramezanloo et al., 2020). These findings underscore the importance of considering the entire family unit in intervention planning, as parental involvement is a key factor in improving treatment outcomes (Miner et al., 2023).Existing instruments measuring autism-related outcomes primarily focus on parental stress or general quality of life, paying limited attention to family-specific lived experiences (Leadbitter et al., 2018). Common tools—such as the Social Responsiveness Scale, Autism Spectrum Rating Scales, Aberrant Behavior Checklist, and child anxiety questionnaires—largely assess individual child symptoms (Ghadiri et al., 2022). This gap underscores the need for a comprehensive tool that evaluates both family experiences and child-related behaviors.The Autism Family Experience Questionnaire (AFEQ), developed by Leadbitter et al. (2018), was designed to capture the personal and family experiences of parents, as well as the developmental, behavioral, and emotional features of their children with ASD. The AFEQ assesses four domains: parenting experience, family life, child development, and social understanding/relationships, in addition to child symptomatology. It has demonstrated good internal consistency and convergent validity in studies conducted in the UK and Turkey (Leadbitter et al., 2018; Ebugla, 2024). Given the rising prevalence of ASD in Iran and the current lack of integrated tools assessing both family experiences and child symptoms, this study aims to examine the psychometric properties of the AFEQ within the Iranian context. Validating this instrument could provide researchers and clinicians with a comprehensive, reliable measure to assess the lived experiences of families raising children with ASD.Research QuestionDoes the Autism Family Experience Questionnaire (AFEQ) demonstrate valid and reliable psychometric properties for assessing the lived experiences of Iranian families of children with Autism Spectrum Disorder (ASD)? MethodologyThis study aimed to examine the psychometric properties of the Autism Family Experience Questionnaire (AFEQ) within an Iranian context. The research was applied in its purpose, quantitative in design, and descriptive-correlational in method, utilizing a survey approach. The statistical population consisted of all parents of children with Autism Spectrum Disorder (ASD) in Yazd Province, Iran, in 2024 (approximately 730 individuals, according to the Welfare Organization). A total of 391 parents were initially recruited via convenience sampling. After the removal of incomplete questionnaires, data from 385 participants were included in the final analysis.The inclusion criteria consisted of having at least one child with ASD and without comorbid ADHD, based on parent reports. The exclusion criterion was incomplete submission of the questionnaire. The study employed three instruments: (1) the Autism Family Experience Questionnaire (AFEQ; Leadbitter et al., 2018), a 48-item tool comprising four subscales that assess parenting experience, family life, child development and social relationships, and child symptoms; (2) the Gilliam Autism Rating Scale (GARS; Gilliam, 2014), a 56-item scale measuring restricted/repetitive behaviors, communication, social interaction, and emotional responses; and (3) the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1986), a 23-item measure assessing support from family, friends, and significant others. ResultsA total of 385 parents participated in the study, comprising 90 males (mean age = 43) and 295 females (mean age = 37). Among the participants, 202 had a high school diploma or lower, and 183 held a bachelor’s or master’s degree. The psychometric evaluation of the Autism Family Experience Questionnaire (AFEQ) included assessments of content validity, construct validity, and internal consistency reliability. Content validity, assessed by 10 experts using CVR and CVI indices, was satisfactory, with all items exceeding the recommended thresholds (CVR > 0.62, CVI > 0.79). Construct validity was examined using confirmatory factor analysis (CFA) in AMOS. The results showed that all factor loadings were above 0.4 and statistically significant (p <.001), and model fit indices confirmed the adequacy of the factor structure.Internal consistency analysis revealed a positive and significant correlation between autism symptom severity and family experience (p <.001), and a negative correlation between social support and family experience (p <.001). Reliability, assessed using Cronbach’s alpha, indicated high internal consistency for all subscales: Parenting Experience (α = 0.929), Family Life (α = 0.916), Child Development and Social Relationships (α = 0.940), Child Symptoms (α = 0.897), and the overall scale (α = 0.952). These results collectively demonstrate that the AFEQ is a valid and reliable instrument for assessing the experiences of Iranian families with children on the autism spectrum. Discussion and ConclusionThis study aimed to examine the psychometric properties of the Persian version of the Autism Family Experience Questionnaire (AFEQ), an instrument designed to assess parents' personal and family experiences alongside the developmental, emotional, and behavioral characteristics of their children with Autism Spectrum Disorder (ASD). The results demonstrated strong content validity, with all items meeting satisfactory indices. Reliability analysis revealed high internal consistency for all subscales, with Cronbach’s alpha coefficients ranging from 0.897 (Child Symptoms) to 0.940 (Child Development and Social Relationships), and 0.952 for the overall scale, a finding consistent with previous studies (Ibogla et al., 2024). Furthermore, confirmatory factor analysis supported the questionnaire's construct validity, demonstrating a good model fit (CMIN/df = 2.81, RMSEA = 0.06, PNFI = 0.606) and confirming that the four subscales—Parenting Experience, Family Life, Child Development, and Child Symptoms—measure distinct underlying dimensions.Correlation analyses revealed a significant positive relationship between autism symptom severity and family experience, indicating that families of children with more severe symptoms reported greater challenges. Conversely, a significant negative correlation was found between social support and family experience, suggesting that higher levels of perceived challenges were associated with lower levels of social support. This finding is consistent with Leadbitter et al. (2018).In summary, the findings indicate that the Persian version of the AFEQ is a valid, reliable, and practical instrument for assessing the experiences of families with children on the autism spectrum. Study limitations include the inability to control for cultural and socioeconomic variables, as well as differences in the treatment levels received by the children, which may affect the generalizability of the results. Future studies are recommended to include an assessment of test-retest reliability to further validate the instrument's consistency over time.
Research Paper
seyede fateme pakzadian; saeed rezayi; fateme nikkhoo
Abstract
Abstract
The present study aimed to determine the Effectiveness of attention-based cognitive rehabilitation program on auditory discrimination and information processing speed of children with dyslexic learning disorder (dyslexia) in Semnan, Iran. This research employed a quasi-experimental design with ...
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Abstract
The present study aimed to determine the Effectiveness of attention-based cognitive rehabilitation program on auditory discrimination and information processing speed of children with dyslexic learning disorder (dyslexia) in Semnan, Iran. This research employed a quasi-experimental design with a pre-test and post-test control group structure. The statistical population included all dyslexic students in Semnan during the 2023-2024 academic year, from which 24 participants were selected using convenience sampling and were then randomly assigned to two groups: an experimental group (n=12) and a control group (n=12). Both groups completed the Auditory Discrimination Test (Wepman, 1958) and the Processing Speed Test (Zahlen-Verbindungs, 1978; Neubauer & Noort, 1998) as a pre-test. The experimental group received ten training sessions designed to enhance attention and concentration, while the control group continued their regular daily activities without intervention. After the training, a post-test was administered to both groups. The collected data were analyzed using descriptive statistics (central tendency and dispersion measures) and inferential statistics (ANCOVA analysis). The findings revealed that attention-based cognitive rehabilitation training had a significant and positive impact on improving auditory discrimination and processing speed in dyslexic students (p<0.005). Implementing such a rehabilitation program as an effective educational intervention can contribute to enhancing reading skills, visual and auditory processing speed, spelling, writing, and mathematical calculations, ultimately supporting academic success and progress.
Keywords: Attention, Auditory Discrimination, Dyslexia, Learning Disorder, Information Processing Speed.
Extended Abstract
Introduction
Learning disabilities, particularly dyslexia, significantly impact children’s academic performance, especially in reading. Dyslexia is characterized by difficulties in accurate and fluent word recognition, spelling, and decoding abilities, despite normal intelligence. Research indicates that nearly 80% of children with learning disabilities struggle primarily with reading (Margolis & Liu, 2023; Quinn et al., 2020). Over the past decade, the diagnosis of learning disabilities has increased by more than 300%, highlighting a growing demand for effective educational interventions (Perhon et al., 2021; Del Bianco & Mason, 2021). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dyslexia is no longer classified as an independent disorder but rather as part of a broader category of specific learning disorders (American Psychiatric Association, 2022). One of the major cognitive deficits associated with dyslexia is auditory discrimination, which refers to the ability to distinguish between phonemes in spoken language. This skill is essential for phonological awareness, an important component of reading development. In addition, processing speed, which reflects the efficiency of cognitive and perceptual processes, is often impaired in dyslexic children, leading to slower reading fluency and reduced comprehension (Aro et al., 2019; Rahimipour et al., 2017). While several intervention strategies exist, recent research has highlighted the potential benefits of cognitive rehabilitation programs that focus on improving attention, auditory discrimination, and processing speed. These programs are designed to enhance executive functions, which play a crucial role in academic success. Given the importance of early intervention, this study aims to evaluate the effectiveness of an attention-based cognitive rehabilitation program in improving auditory discrimination and processing speed in children with dyslexia.
Research Question(s)
The primary goal of this study is to determine whether attention-based cognitive rehabilitation can effectively enhance auditory discrimination and processing speed in children with dyslexia. While previous studies have examined different intervention methods, there is still a need for more empirical evidence regarding the impact of attention-training programs on these specific cognitive functions. This research seeks to fill this gap by investigating the effects of a structured intervention designed to improve foundational cognitive skills in dyslexic children.
Literature Review
Dyslexia is a common neurodevelopmental disorder affecting 10-15% of school-aged children worldwide (Norton et al., 2014; Zavadenco, 2021). One of the primary characteristics of dyslexia is difficulty in phonological processing, which is directly linked to deficits in auditory discrimination and processing speed (Papanastasiou, 2017; Watson et al., 2016). Auditory discrimination deficits impair a child’s ability to recognize and differentiate speech sounds, making it difficult to develop strong phonemic awareness and reading fluency. Studies suggest that children with dyslexia struggle to process subtle differences in phonemes, which negatively affects their ability to decode and understand written text (Brooks et al., 2011; Khalili Kermani et al., 2012). Additionally, processing speed deficits have been widely observed in children with dyslexia. This cognitive function affects how quickly individuals can process and integrate visual and auditory information, which is crucial for fluent reading. Children with dyslexia often require significantly more time than their peers to recognize letters and words, impacting their overall reading comprehension and academic performance (Lais et al., 2017; Araujo & Faisca, 2019). Recent research has highlighted the potential of attention-based cognitive rehabilitation programs in addressing these deficits. Several studies have shown that structured cognitive training interventions, including computerized attention-training programs, can improve auditory processing, executive functions, and reading-related cognitive abilities in children with dyslexia (Dehghani et al., 2015; Birami et al., 2017). This study builds upon these findings by evaluating the effectiveness of a structured intervention designed to target auditory discrimination and processing speed.
Methodology
This study employed a quasi-experimental design with a pre-test and post-test control group structure. The research was conducted in learning disability centers in Semnan, Iran, where 24 children diagnosed with dyslexia were selected using convenience sampling. These participants were randomly assigned to either:
Experimental Group (n=12): Received a 10-session attention-based cognitive rehabilitation program
Control Group (n=12): Did not receive any intervention
To assess cognitive improvements, three standardized instruments were used:
Wepman Auditory Discrimination Test (Wepman, 1958) to measure auditory discrimination skills
Processing Speed Test (Oswald & Roth, 1978) to evaluate reaction time and cognitive efficiency
Dyslexia Diagnosis Test (Karami Nouri & Moradi, 2005) to confirm the presence of reading disabilities
The Attention Gym Program, which consists of ten 45-minute sessions, was implemented to enhance selective attention, divided attention, auditory processing, and visual processing speed. The collected data were analyzed using ANCOVA (Analysis of Covariance) in SPSS (Version 22) to compare pre-test and post-test scores between the experimental and control groups.
Results
The statistical analysis confirmed that the cognitive rehabilitation intervention significantly improved both auditory discrimination and processing speed in the experimental group.
Auditory Discrimination Scores (Error Reduction):
Pre-test: 30.10 errors
Post-test: 13.90 errors (p < 0.001(
Processing Speed Scores (Response Time Reduction):
Pre-test: 124.01 sec
Post-test: 58.50 sec (p < 0.001)
These findings indicate that after participating in the attention-based rehabilitation program, children demonstrated faster auditory processing and greater accuracy in distinguishing phonemes.
Discussion
The results of this study align with previous findings suggesting that attention-based cognitive training can significantly improve phonological awareness, reading fluency, and executive functioning in children with dyslexia (Bonavita et al., 2015; Giora et al., 2024). The improvement in auditory discrimination indicates that phonological training can enhance the brain’s ability to process and differentiate speech sounds more effectively. Similarly, the increase in processing speed supports the hypothesis that cognitive training strengthens neural pathways involved in rapid information retrieval and reading automaticity (Feizi Pour et al., 2019).
Conclusion
The findings of this study suggest that attention-based cognitive rehabilitation is an effective intervention for improving auditory discrimination and processing speed in children with dyslexia. The results underscore the importance of early intervention programs that focus on enhancing executive functions and phonological processing to support reading development. Given the positive outcomes observed, further research should explore the long-term impact of these interventions, compare them with alternative methods, and assess their applicability to different types of learning disabilities. Additionally, developing Persian-language cognitive training software could enhance accessibility and effectiveness for children in non-English-speaking populations.
Acknowledgments
Special thanks and sincere appreciation are extended to all the esteemed mothers and students who participated in this study.