Family Support Domains and Quality of Social Interaction in School-Aged Children with Autism Spectrum Disorder: A Cross-Sectional Study in Palembang, Indonesia

Abstract

Introduction: Autism spectrum disorder (ASD) affects approximately one in 100 children worldwide, and family support is a modifiable determinant of pediatric social functioning, yet the contribution of distinct family-support domains to social-interaction quality remains poorly characterized in Indonesian children. We quantified the association between five Friedman-framework family-support domains (emotional, informational, reward, instrumental, social/network) and social-interaction quality.

Methods: In a cross-sectional analytical study at Sekolah Luar Biasa Negeri Pembina Palembang during November–December 2024, 36 of 40 eligible caregivers of children with ASD aged 7–12 years (mean 9.9 years, 91.7% male) completed Friedman's family-support inventory and the Indonesian Autism Social Skills Profile (ASSP). Spearman correlations with Fisher-z-derived confidence intervals, multivariable logistic regression, receiver-operating-characteristic (ROC) discriminative-performance analysis, and pre-specified subgroup analyses were performed.

Results: Social interaction was moderate in 58.3%, low in 25.0%, and high in 16.7%. Network/social support showed the strongest correlation with ASSP score (ρ = 0.654, 95% CI 0.413–0.808, p < 0.001), and in multivariable regression remained the only independent predictor of non-low quality (adjusted OR 6.42, 95% CI 1.48–27.83, p = 0.013; Nagelkerke R² = 0.547). The composite family-support score discriminated low from non-low quality with AUC = 0.832 (95% CI 0.701–0.963; Youden cut-off ≈ 85, sensitivity 0.78, specificity 0.81).

Conclusion: Network/social support is the predominant family-support component shaping social-interaction quality in Indonesian children with ASD, supporting pediatric primary-care screening focused on caregiver social connectedness.