E:\IBUK\NERS DESEMBER 2021\15-- 315Suprajitno, Sri Mugianti, Questionnaire for Children with Autism Syndrome Disorder Questionnaire for Children with Autism Syndrome Disorder Suprajitno1, Sri Mugianti2 1,2Nursing Department, Poltekkes Kemenkes Malang, Indonesia JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 21/09/2021 Accepted, 20/11/2021 Published, 15/12/2021 Keywords: Autism Syndrome Disorder (ASD), Questionnaire, Family Support, Stimulation, Ability Article Information Abstract Children with autism syndrome disorder (ASD) have a developed mental condition like normal children in general. However, in Indonesia there is no instrument to measure the achievement of the development of children with autism syndrome disorder. The purpose of this research resulted in a ques- tionnaire used to measure institutional and family support, parental stimula- tion abilities, and the ability of children with autism syndrome disorder. The design used exploratory for developing of instruments. Experts involved in the development of the instruments were psychologists, occupational thera- pists, speech therapists, pediatricians, autistic child behavioral therapy prac- titioners, and the institution of Autism Center of Blitar City. The instrument development began with focus group discussion, instrument preparation, instrument trials, and analysis. The questionnaire trial was conducted on 40 parents and children with ASD at the Autism Center of Blitar City. The analy- sis was conducted sthrugh several steps namely the validity of the content and construct by experts, while the test of validity and reliability of the questionnaire used Lisrel 8.50. Valid and reliable questionnaires items on the institutional and family support were 21 questions, parents’ ability to stimu- late as many as 17 questions, and the ability of children with autism syn- drome disorder as many as 17 questions. The resulting questionnaire has a minimum GFI score of 0.88 and a CR of 0.78, so that the questionnaire can be used as a instrument on autism services. © 2021 Journal of Ners and Midwifery 315 Correspondence Address: Poltekkes Kemenkes Malang – East Java, Indonesia P-ISSN : 2355-052X Email: suprajitno_skp@poltekkes-malang.ac.id E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i3.ART.p315–320 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://doi.org/10.26699/jnk.v8i3.ART.p315-320 https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i3.ART.p315-320&domain=pdf&date_stamp=2021-12-26 316 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 315–320 INTRODUCTION The number of children with autism syndrome disorder (ASD) in Indonesia has not been well re- corded. Children with ASD in the world in 2014 were 1 in 68 children and increased by 15% to 1 in 59 children in 2018. Meanwhile, WHO predicts 1 in 160 children (Dirjen P2 Penyakit Kemkes RI, 2020). Family as the first and the main place for chil- dren with autism syndrome disorder (Suprajitno, 2017) has a role in knowing health problems and meeting the developmental needs of children. The developmental needs of children with autism syn- drome disorder are less able to be met by parents because they do not know the support that needs to be provided, the stimulation skills that need to be had, and the development that the child has been through. The cause of parents does not do devel- opmental stimulation because there was never a measurement tools of the development level of chil- dren with autism syndrome disorder. METHODS The design used exploratory for developing of the questionnaires. The development of question 1 Institutional and family support 1 to 4 Autism Centre support 0.98 0.83 0.74 0.98 5 to 9 The family emotional support 0.92 0.78 0.65 0.92 10 to 15 The family informational support 0.96 0.88 0.83 0.96 16 to 21 The family instrumental support 0.88 0.93 0.91 0.88 2 Parental stimulation 1 to 5 The parent stimulation of fine ability motoric ability for children with ASD 0.96 0.79 0.67 0.96 6 to 9 The parent stimulation of socialization ability for children with ASD 0.94 0.81 0.68 0.94 10 to 17 The parent stimulation of language ability for children with ASD 0.75 0.91 0.89 0.75 3 Ability of children 1 to 5 The fine motoric ability of children with ASD with ASD 0.96 0.81 0.72 0.95 6 to 11 The socialization ability of children with ASD 0.86 0.85 0.78 0.86 12 to 17 The language ability of children with ASD 0.85 0.87 0.81 0.85 GFI = Goodness of Fit Index; ASD = Autism Syndrome Disorder Table 1 The validity and Composite Reliability of Sub-Variable No. Questioner Number of item Sub-variable Validity Compo- site reliability Alpha Cronbach GFI items involved experts, namely psychologists, oc- cupational therapists, speech therapists, pediatri- cians, autistic child behavioral therapy practitioners, and the institution of Autism Center of Blitar City. The development of the instruments was based on the book of Bina Anak Autis di Rumah (Foster Autistic Children at Home) (Suprajitno & Aida, 2017). The instrument development began with fo- cus group discussion, instrument preparation, instru- ment trials, and analysis. The questionnaire trial was conducted on 40 parents and children with autism syndrome disorder at the Autism Center in Blitar City. The questionnaire trials were conducted three times in June – September 2017. The questionnaire improvement was conducted twice based on the results of the trials that have been analyzed. The analysis was conducted namely the validity of the content and construct by experts, while the test of validity and reliability of the questionnaire using Lisrel 8.50. RESULT The confirmatory factor analysis results of questioner are listed in Table 1 and questioner for measured (see Appendix 1). 317Suprajitno, Sri Mugianti, Questionnaire for Children with Autism Syndrome Disorder DISCUSSION Validity and reliability are the two most impor- tant and fundamental in the evaluation of measure- ment instrument or tools (Forthofer et al., 2007; Frost, 2019; Mohaffyza Mohamad et al., 2015). Analysis of validity used Pearson correlation and reliability used Cronbach’s alpha (Forthofer et al., 2007; Frost, 2019). The purpose of testing the validity and reli- ability is to ensure that the questionnaire used is good for measuring the expected data. Confirma- tory factor analysis aims to confirm the indicators as a statement of the data collected (Brown, 2015; Long, 1992; Thompson, 2004). The Pearson coefficients between 0 and ± 0.30 show low, the coefficients between ± 0.31 and ± 0.70 indicate medium and the coefficients between ± 0.71 and ± 1 point out high relationships (Shevlyakov & Oja, 2016). Meanwhile, the Pearson coefficient and reliability if <0.67 show Poor, 0.67 to 0.80 indicate Fair, 0.81 – 0.90 indicate Good, 0.91 – 0.94 indicate Very Good, and >0.94 indicate Ex- cellent (Mohaffyza Mohamad et al., 2015). The minimum value of validity 0.75 and reliability 0.65 (Table 1). So statistically, the validity and reliability of indicators of the questionnaire are in the Good – Excellent category. The assessment of the question indicators in the questionnaire used confirmatory factor analy- sis together using Lisrel. The aim is to confirm the suitability of the indicators with the theory used. The results of indicator confirmation with theory are seen from GFI results. Goodness of fit index (GFI) is an index that describes the level of suit- ability of the overall model which is calculated from the squared residual of the predicted model com- pared to the actual data. The GFI value > 0.90 indi- cates that the tested model has a good fit (Brown, 2015; Long, 1992; Thompson, 2004). Even though the lowest GFI value (Table 1) is 0.75, theoretically this indicator is needed, so it can still be used as a measurement indicator. The limitations of this in- strument are not yet classifying the ability of par- ents and children with ASD in a criterion. CONCLUSION The minimum value of validity and reliability of the questionnaire is 0.75 and 0.65 in both catego- ries so that it can be used to measure institutional and family support, parental stimulation ability, and the ability of children with ASD. SUGGESTION Questionnaires can be used to assess the sup- port of educational institutions for autistic children, the ability of parents to stimulate, and the ability of children with ASD. It is hoped that the question- naire can be developed as a predictive tool for the ability of children with ASD. REFFERENCE Brown, T. A. (2015). Confirmatory Factor Analysis for Applied Research. In The American Statistician (Second, Vol. 62, Issue 1). The Guilford Press. https:/ /doi.org/10.1198/tas.2008.s98 Dirjen P2 Penyakit Kemkes RI. (2020). Hari Peduli Autisme Sedunia/ : Pentingnya Pendampingan dan Edukasi bagi Anak Gangguan Spektrum Autisme ditengah Pandemi Covid-19. http:// p2p.kemkes.go.id/hari-peduli-autisme-sedunia- pentingnya-pendampingan-dan-edukasi-bagi-anak- gangguan-spektrum-autisme-ditengah-pandemi- covid-19/ Forthofer, R. N., Lee, E. S., & Hernandez, M. (2007). Bio- statistics: Analysis, and to Design, A Guide Dis- c ov e ry . El sevi er. h t t p: / / li br a ry. l ol / m ai n / 5EB8824580E860997136DA1C7C215AFC Frost, J. (2019). Introduction to Statistics. Statistics By Jim Publishing. https://statisticsbyjim.com/basics/ correlations/ Long, J. S. (1992). Confirmatory Factor Analysis: A Pref- ace to Lisrel. Quantitative Applications in the So- cial Sciences. Sage Publications. Mohaffyza Mohamad, M., Lisa Sulaiman, N., Chee Sern, L., & Mohd Salleh, K. (2015). Measuring the Valid- ity and Reliability of Research Instruments. 4th World Congress on Technical and Vocational Edu- cation and Training (WoCTVET), 5th–6th Novem- ber 2014, Malaysia, 204, 164–171. https://doi.org/ 10.1016/j.sbspro.2015.08.129 Shevlyakov, G. L., & Oja, H. (2016). Robust Correlation Theory and Applications. John Wiley & Sons, Ltd. h t t p : / / l i b r a r y . l o l / m a i n / 0DA2CF00E440F37F50CD9D831ED70F53 Suprajitno. (2017). Effect of Family Empowerment in En- hancing the Capabilities of Children with Autism. Belitung Nursing Journal, 3(5), 533–540. https:// doi.org/10.33546/bnj.113 Suprajitno, & Aida, R. (2017). Bina Aktivitas Anak Autis di Rumah/ : Panduan bagi Orang Tua. Media Nusa Crea t ive. h t t p: / / mn cpubl i sh i n g. com/ book- detail.php?id=000095 Thompson, B. (2004). Exploratory And Confirmatory Fac- tor Analysis: Understanding Concepts and Appli- cations. In Acta Geophysica (First, Vol. 58, Issue 4). American Psychological Association. 318 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 315–320 Appendix 1: Questionnaire 1. Questionnaire to measure of family perception about the Institutional and Family Support 1 I got an explanation about my child’s education program plan at the Autism Center 2 I got information from the Autism Center about my child’s education activities next week 3 I got an explanation of my child’s last ability after being given therapy at Autism Center 4 I got a chance to ask about my child’s development 5 My family feels responsible for education 6 My family protects the child while at home and playing 7 My family explains to other families that my child’s condition is not a disease 8 My family is encouraging during the upbringing if anyone is sad about the state of the child 9 My family remembers the education program needs to be done according to plan 10 My family provides corrections about the actions that have been done to the child 11 My family is looking for information on how to educate a child 12 My family gives examples of ways to improve the ability of a child 13 My family creates a comfortable environment for a child 14 My family provides a book that matches the child’s condition 15 My family provides information on places of education for a child other than the Autism Centre 16 My family asked about the educational needs of children 17 My family provided about the educational needs of children 18 My family maintains the educational tools of children 19 My family uses well the educational tools needed by the child 20 My family maintains the educational tools that children need 21 My family is repairing the educational tools of children No. How to fill in: Put a check () on the column that you feel best represents your answer. Statements That is felt Never Ever Often Very often 319Suprajitno, Sri Mugianti, Questionnaire for Children with Autism Syndrome Disorder 2. Questionnaire to measure of the Parental Stimulation Ability How to fill in: Put a check () on the column that you feel best represents your answer. 1 Crawling under a cloth tunnel 2 Manipulating face in front of the mirror 3 Touching and holding objects round or box 4 Colouring the image using a dye 5 Singing a song that his/her favourite 6 Lending a favourite toy to the child’s friends 7 Following orders given by the child or others 8 Engaging other children to play the same 9 Imitates or modifies the movements of other children 10 Giving simple reading material 11 Giving simple calculating materials 12 Asking the child to write the name of their parents and sister/brother 13 Asking the child to write the name of a playmate or someone familiar 14 Asking children to write good free sentences 15 Asking the child to sing the child’s song 16 Asking the child to imitate the song being heard 17 Asking the child to concentrate on watching television No. Statements That is felt Cannot Needs help Can Skillful 320 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 315–320 1 Hand in hand with children or adults for at least 5 minutes 2 Imitating the highlighted halos on the wall 3 Following the direction of the highlighted light on the wall 4 Blowing balloon bubbles made of soapy water 5 Concentrates when getting orders until the command is finished 6 Sharing toys that are desired by a child’s friend 7 Sharing food with children nearby 8 Invites other children to follow the game 9 Does activities by following the orders of other children who are considered leaders 10 Helping other children who carry out activities 11 Reports the ability of yourself or another child 12 Mentions the names of father, mother, and siblings 13 Mentions a friend’s name, of at least 5 people 14 Mentions a minimum of 10 consecutive letters 15 Mentions a minimum of 8 consecutive numbers 16 Writes sentences according to the example 17 Reads sentences according to examples 3. Questionnaire to measure ability of the children with ASD How to fill in: Put a check () on the column that you feel best represents your answer. No. Statements That is felt Cannot Needs help Skillful