The autistic child friendly school environment model for behavioral development in children with autism

Abstract

BACKGROUND:

Autism spectrum disorder (ASD) presents unique challenges in educational settings, particularly in resource-limited regions such as Indonesia. This study explores the impact of the Autistic Child-Friendly School Environment (Lingkungan Sekolah Ramah Anak Autis/LISRAA) model, an autism-friendly school environment, on the behavioral development of children with autism.

MATERIALS AND METHODS:

A mixed-methods approach, combining narrative inquiry and quasi-experimental design, was employed. Data were collected through interviews, focus group discussions, and the Autism Behavior Checklist (ABC). Identical sensory-friendly adjustments, including noise control, lighting modifications, and quiet zones, were implemented across selected schools to ensure uniformity. Behavioral outcomes were assessed before and after the intervention using paired samples t-tests.

RESULTS:

The findings reveal significant improvements in behavioral outcomes following the implementation of the LISRAA model. The mean ABC score improved significantly from 5.00 at pre-test to 15.33 at post-test 1 (P < 0.001), demonstrating enhanced focus, reduced hyperactivity, and improved emotional regulation. Although a slight decrease to 14.67 was observed at post-test 2, this change was not statistically significant (P = 0.102), indicating sustained behavioral improvements over time, despite a minor reduction in post-test 2 scores. Reduced variability in scores post-intervention also demonstrated greater consistency in behavioral improvements among participants.

CONCLUSION:

This study highlights the effectiveness of the LISRAA model in fostering behavioral improvements for children with autism, even in resource-limited settings. Structured sensory-friendly environments and consistent support significantly enhance focus, emotional regulation, and hyperactivity. These findings contribute to the growing body of literature on autism-friendly educational practices and provide a foundation for scaling up sustainable interventions in resource-limited settings.

Background

Autism spectrum disorder (ASD) presents significant challenges in educational settings, particularly in resource-limited regions such as Indonesia. The rising global prevalence of ASD, including in Indonesia, underscores the urgent need for educational models tailored to the unique behavioral challenges of children with autism.[1] Autism is a neurodevelopmental condition that affects communication, social interaction, and behavior.[2] According to the World Health Organization, autism affects approximately 1 in 100 children globally, with a steadily increasing prevalence.[3] In Indonesia, this translates to an estimated 690,000 to 830,000 children with autism, many of whom face difficulties accessing specialized education tailored to their needs.

Education systems, particularly in developing nations such as Indonesia, are often unprepared to accommodate the needs of children with ASD.[4,5,6] A major challenge is the absence of structured learning environments that support positive behavioral development.[7] The Autistic Child-Friendly School Environment (Lingkungan Sekolah Ramah Anak Autis/LISRAA) model has been proposed as a solution to address these challenges by modifying both physical and social aspects of learning environments.[8,9,10] This model focuses on creating structured, sensory-friendly learning spaces to foster behavioral improvements among children with autism.[11,12,13,14] Despite the potential benefits of such models, their practical implementation remains limited, particularly in resource-constrained educational settings.[15,16,17]

This study examines the effectiveness of the LISRAA model in improving behavioral outcomes for children with autism by assessing changes in focus, emotional regulation, and hyperactivity. Using a mixed-methods approach, we integrate qualitative data from interviews and focus group discussions with quasi-experimental data to evaluate the model’s impact. This research contributes to the existing body of knowledge on autism education by addressing critical gaps in theory and practice while providing insights that could inform policy development in the region.

This study hypothesizes that (1) school environments significantly influence behavioral development in children with autism, (2) educators and parents hold positive perceptions of the LISRAA model, (3) the LISRAA model effectively enhances behavioral outcomes, and (4) implementing autism-friendly environments presents challenges in resource-limited settings.

Aim of the study

This study evaluates the impact of the Autistic Child-Friendly School Environment (Lingkungan Sekolah Ramah Anak Autis/LISRAA) model on the behavioral development of children with autism.

Materials and Methods

Study design and setting

This study employed a mixed-methods approach, integrating narrative inquiry (qualitative component)[18] and quasi-experimental design (quantitative component).[19] The rationale for this approach stems from the need to capture participants’ subjective experiences and the measurable impact of the LISRAA model on behavioral development. Mixed-methods designs allow for triangulation, enhancing the validity and comprehensiveness of findings by addressing limitations in individual methodologies.[20] The research design follows a sequential exploratory approach,[21] in which qualitative research (phase 1) informs the design and implementation of the quantitative research (phase 2). The detailed steps of the study are outlined in Table 1.

Table 1.

Research Stages

Research Objective		Research Method		Data Collection Method		Respondents		Analysis
Identify existing physical and non-physical conditions and the behavior of children with autism		Qualitative		1. Interviews 2. Observation 3. Focus Group Discussions (FGD)		1. Head of Education Department 2. School Principal 3. Class Teachers 4. Parents		Thematic Analysis
Identify factors influencing behavioral development in children with autism.		Qualitative		1. Interviews 2. FGDs		1. School Principals 2. Class Teachers 3. Parents		Thematic Analysis
Develop an appropriate Autism-Friendly School Environment Model (LISRAA) for behavioral development.		Qualitative		1. Literature Review 2. Expert Consultation		Experts in Special Education		Content Analysis
Evaluate the effectiveness of the LISRAA model on behavioral development		Quasi-Experimental (Quantitative)		1. Treatment 2. Observation		1. Students with autism 2. Class Teachers		Paired t-Test, Covariate Analysis

Phase 1: Qualitative study

The qualitative phase utilized semi-structured interviews, focus group discussions (FGDs), and direct observations to explore factors influencing behavioral development and to refine the LISRAA model. Key stakeholders, including the Head of the Education Department of Riau Province, the Principal of School for Students with Special Needs (Sekolah Luar Biasa/SLB) school principals, teachers, and parents, participated in these discussions. The findings were synthesized into a preliminary LISRAA framework, which was further refined through expert consultation before implementation in Phase Two.

Phase 2: Quasi-experimental design

The effectiveness of the LISRAA model was assessed using a pre-test/post-test design without a control group.[22] Due to ethical constraints, randomization was not feasible; however, confounding variables were controlled using covariate adjustments in statistical analysis. The Autism Behavior Checklist (ABC) was used to measure behavioral changes before and after intervention. To assess sustained behavioral improvements, two post-tests were conducted: one immediately after implementation and another one month later.

Study participants and sampling

Participants were recruited through purposive sampling,[23] ensuring they had direct experience with the LISRAA model. The qualitative sample consisted of 10 participants, including school administrators, teachers, and parents of children diagnosed with autism at SLB Pembina, Pekanbaru, Indonesia. One of the researchers in this study had pre-existing professional relationships with some participants due to our involvement in the school’s autism-friendly education initiatives, which helped foster trust during data collection. However, we ensured that ethical boundaries were respected to prevent undue influence on participant responses. Demographically, the qualitative participants ranged in age from 30 to 55 years and included eight female and seven male educators and parents.

The quantitative sample consisted of six children with autism (aged 7–12 years, diagnosed with moderate autism). Children were eligible for inclusion in the study if they were diagnosed with moderate autism, enrolled in an autism-specialized school, and had parental consent for participation. Participants were excluded if they had co-occurring intellectual disabilities that could confound behavioral assessment or severe sensory processing disorders that prevented participation in classroom activities.

Data collection tools and technique

Narrative inquiry

For the qualitative phase, data were collected through semi-structured interviews[24] and focus group discussions (FGDs).[25] Interviews were conducted face-to-face and were audio-recorded with participant consent. We used open-ended questions to allow participants to share their experiences freely, ensuring that their narratives were captured authentically. FGDs were conducted in groups of 10 participants, ensuring a manageable size for focused discussions and diverse perspectives.

Anonymizing participant data in all records and publications assured confidentiality. All participants signed informed consent forms and were made aware of their right to withdraw at any time without consequences. The Ethical Committee of Nursing and Health Research, Universitas Riau, reviewed and approved these ethical procedures.

Quasi-experimental data collection

The quantitative phase employed a pre-test/post-test design without a control group to assess behavioral changes in autistic children. This quasi-experimental approach was necessary because randomization was not feasible due to ethical considerations.[19] The ABC[26] was used to measure changes in behavior over time. Pre-tests were administered before implementing the LISRAA model, and two post-tests were conducted: one immediately after the intervention and another after a month to assess sustained behavioral changes.

Ethical considerations

This study was conducted following ethical guidelines outlined by the International Conference on Harmonization – Good Clinical Research Practice (ICH-GCRP),[27] and ethical clearance was obtained from the Ethic Committee of Nursing and Health Research, Universitas Riau. Ethical approval was granted (reference number: 534/UN.19.5.1.8/KEPK.FKp/2022), ensuring that the research complied with international standards and local regulations. Parental informed consent was obtained before enrolling children. Participants were assured of confidentiality, with anonymized transcripts and secured data storage. Children’s well-being was prioritized, with trained professionals present to monitor distress levels during assessments.

Data analysis

Narrative analysis

The narrative data from interviews and FGDs were analyzed using narrative analysis, focusing on identifying themes and patterns in participant stories.[28] First, interviews were transcribed verbatim, and initial readings were conducted to familiarize researchers themselves with the data. Themes were identified based on recurring ideas about the challenges and successes of implementing the LISRAA model. The analysis was iterative, allowing themes to evolve as the data were reviewed and reinterpreted. Data were triangulated with direct observations and expert consultations to enhance reliability.

Quasi-experimental analysis

Quantitative data were analyzed using paired-samples t-tests[29] to compare pre- and post-intervention scores, examining whether the LISRAA model had a statistically significant effect on the behavior of the children. Observations were structured to track changes in focus, emotional regulation, and hyperactivity before and after the LISRAA model was implemented. Shapiro-Wilk tests were performed to check for normality, and results were deemed reliable based on normal distribution. A significance threshold of P < 0.05 was set to determine the effectiveness of the intervention. Shapiro-Wilk tests were performed to assess normality: All variables met normality assumptions; thus, parametric tests were appropriate, and no data transformation was required. To further control for potential confounders, covariate analysis (ANCOVA) was applied, adjusting for pre-existing behavioral variations.

Results

Table 2 presents the findings from narrative inquiry and quasi-experimental design, triangulating the data to provide a comprehensive understanding of the LISRAA model’s impact on behavioral development in autistic children.

Table 2.

Qualitative Participant Data

No		Age		Education		Occupation
P1		45 Years		Master’s Degree		Teacher/School Principal
P2		37 Years		High School		Housewife
P3		51 Years		Bachelor’s Degree		Housewife
P4		46 Years		Bachelor’s Degree		Teacher/Head of Department
P5		47 Years		Bachelor’s Degree		Teacher
P6		34 Years		High School		Housewife
P7		31 Years		Master’s Degree		Teacher
P8		28 Years		Bachelor’s Degree		Teacher
P9		33 Years		Vocational High School		Housewife
P10		31 Years		Bachelor’s Degree		Teacher

Table 2 presents demographic and professional information about 10 individuals, all of whom are Muslim, with ages ranging from 28 to 51 years. The majority hold either a Bachelor’s or High School degree, and their occupations vary, including teachers, housewives, and those in the private sector or entrepreneurship. Notably, four participants have advanced degrees (Master’s or Diploma), with three working in educational roles as teachers or school leaders. The data highlights a balance between those engaged in professional careers and those focused on domestic roles, reflecting a diverse mix of educational backgrounds and employment types across this group. The school administrators and teachers played key roles in implementing and adapting the LISRAA model within the classroom, while the parents provided valuable feedback on its impact at home. This diverse group contributed essential insights into both the educational and practical applications of the LISRAA model.

Table 3 summarizes the six children with autism who participated in the study. They ranged in age from 7 to 12 years, with 66.7% male. All were diagnosed with moderate autism and were in primary education at SLB Pembina, a special education school, making them the focus of the study’s evaluation of behavioral changes following the LISRAA model implementation.

Table 3.

Quantitative Participant Data

Participant Group		Number of Participants		Age Range		Gender Distribution		Autism Diagnosis Severity		Education Level
Children with Autism		6		7–12 years		6 males		Moderate Autism		Primary Education (SLB Pembina)

Narrative inquiry: Stakeholder insights

The narrative inquiry gathered detailed stories from stakeholders, including teachers, parents, and school administrators, about their experiences with the LISRAA model. These stories revealed several key themes that align with the research questions.

Theme 1: Teacher adaptation and behavioral changes

Teachers played a crucial role in implementing the LISRAA model, often adjusting their teaching strategies without specialized autism training. Despite their initial lack of expertise, many teachers reported seeing significant improvements in student behavior over time. The transition was initially challenging, especially as they navigated how to engage students with autism more effectively. One teacher shared their initial difficulties:

“When we started, keeping the students’ attention was nearly impossible. They were easily distracted, hyperactive, and struggled to follow directions. But after we began implementing the LISRAA model, I noticed they became calmer. For example, one student, who previously couldn’t stay still, now participates in group activities and maintains focus during lessons.” (P4)

Other teachers echoed this sentiment and agreed that the LISRAA model had a visible impact on the student’s ability to engage in classroom activities. However, the teachers also reflected critically on their limitations, with many expressing a need for more specialized training. One teacher remarked:

“We do our best, but autism is complex. I feel that with more training, we could make even more progress. Sometimes, it feels like we’re only scratching the surface, especially when we deal with severe behavioral issues like meltdowns or withdrawal.” (P1)

The teachers’ narratives were about improvements in student behavior and their own learning journey. Adapting to a new educational model required them to think creatively and collaborate more closely with their peers. As one teacher described:

“We’ve become more flexible and supportive of one another. Sometimes, I’ll ask for advice from a colleague when I’m unsure how to handle a specific situation with a student. It’s been a team effort.” (P5)

While the teachers highlighted the success of the LISRAA model, they also pointed out persistent challenges related to limited resources and large class sizes. A teacher noted:

“It’s hard when you’re managing a class of five or six students with different needs. At times, I feel stretched too thin, especially when trying to balance attention between a student who needs one-on-one help and another who’s starting to show progress but needs consistent guidance.” (P8)

The consensus among teachers was that while the LISRAA model helped create a more structured and autism-friendly environment, additional resources and training were essential to maximize its potential.

Theme 2: Parental engagement and consistency

Parental involvement was a key factor influencing the success of the LISRAA model. As the narratives from parents highlighted, the alignment between home and school practices was crucial for maintaining consistent behavioral improvements in children with autism. One parent shared a poignant reflection on this relationship:

“The school introduced us to strategies they use with the kids, like controlling sensory distractions. Once we started doing the same at home—turning down the lights during mealtime or avoiding loud noises—the changes in our child were remarkable. He became less anxious, started making eye contact more often, and even engaged in family conversations at the dinner table.” (P13)

This narrative demonstrates how adopting school strategies at home created a continuity of care that reinforced the child’s behavioral progress. Another parent emphasized the importance of maintaining a consistent approach:

“When we follow the school’s techniques at home, we see our child progress. But whenever we drift from the routine—due to a hectic schedule or other distractions—the improvements seem to fade away. It’s frustrating because we know what works, but keeping up with it can be difficult.” (P14)

The inconsistency between home and school environments was repeatedly cited as a challenge. Some parents mentioned the difficulties of aligning home life with the structured environment provided by the school. One parent explained:

“It’s hard to maintain the same level of attention and care at home. The school has a quiet, structured environment, but our home is noisy and chaotic. We try to follow the school’s advice, but sometimes it feels impossible to replicate the same conditions.” (P2)

This discrepancy in environments often led to regression in the children’s behavior, a finding that was also supported by teachers who noticed changes in student behavior during periods of inconsistency. As one teacher pointed out:

“You can see the difference when parents are fully on board. The students who have that consistent structure at home and school show steady progress, but those who don’t tend to fall back into old behaviors.” (P10)

The narrative data suggest that the LISRAA model’s effectiveness is highly dependent on the level of parental engagement and the consistency of its application across different settings. Parents who applied school-based behavioral strategies at home observed sustained improvements in their children.

However, those who struggled with consistency saw more setbacks. This finding highlights the need for better parent-school collaboration. A holistic approach that integrates both school and home environments is crucial for maximizing developmental progress in children with autism.

Theme 3: Physical environment modifications

The physical environment within the school setting played a critical role in supporting children with autism as part of the LISRAA model. Participants, including teachers and school administrators, noted that thoughtful adjustments to the school’s physical environment significantly reduced sensory overload, which is a common challenge for children on the autism spectrum. These changes, ranging from modifying lighting to controlling noise levels, had a notable impact on both behavior and engagement.

One of the most important modifications involved controlling the lighting in classrooms. As one administrator explained:

“Before we made any changes, some classrooms had very harsh lighting, which made the children more restless and distracted. By dimming the lights and ensuring they were softer and less glaring, the children became calmer. We noticed an almost immediate improvement in their ability to stay focused.” (P5)

This experience was echoed by teachers, who found that more subtle lighting helped children focus and reduced episodes of anxiety and hyperactivity, particularly in children more sensitive to visual stimuli. Some teachers recalled instances where the initial lighting conditions in the classroom had triggered agitation among students, but after the adjustments, students were more receptive to instruction and engaged better with their peers.

In addition to lighting, noise control emerged as a crucial factor in creating an autism-friendly environment. Many students with autism are hypersensitive to noise, and sudden loud sounds could easily disrupt the classroom dynamic, causing distress for the students. Teachers observed that once noise levels were regulated—by ensuring the classrooms were quiet and free from sudden interruptions—the students’ behavior improved. One teacher reflected:

“The quiet zones we established were lifesavers. In the past, the classroom could get overwhelming for the children, especially when they were exposed to loud noises from outside or other classrooms. By creating a designated quiet area where they could go to calm down, we saw fewer incidents of disruptive behavior.” (P8)

The creation of quiet zones also allowed children who were overstimulated to have a safe space to retreat, thus minimizing meltdowns and helping them regain composure before rejoining the classroom activities. These spaces, often equipped with soft furniture and dim lighting, were highly praised by teachers and parents for their effectiveness in reducing stress and anxiety among children.

Another key modification involved the seating arrangements in the classroom. Teachers noticed that arranging the desks and chairs to reduce crowding and ensure personal space helped children feel less overwhelmed. One teacher described the impact of these changes:

“Previously, our classrooms were quite cramped, and this made it difficult for the children to focus, especially those who are easily distracted by their surroundings. By spreading out the seating and creating more space between desks, the children became less anxious and more attentive.” (P10)

These environmental adjustments reflect the LISRAA model’s emphasis on creating an inclusive and supportive learning environment tailored to the specific needs of children with autism. The combination of lighting modifications, noise control, and thoughtful space planning contributed significantly to reducing sensory overload and fostering a sense of safety and comfort, which, in turn, led to improved behavioral outcomes and increased engagement in classroom activities.

Quantitative findings: Behavioral changes in children with autism

The quasi-experimental data were collected using the ABC to assess behavioral changes in six students before and after implementing the LISRAA model. The behavioral changes were measured through pre-test, post-test 1, and post-test 2 evaluations. Despite some challenges, the findings demonstrate significant behavioral improvements.

Table 4 provides demographic information about the six children participating in the study, all of whom were diagnosed with moderate autism and attended SLB Pembina, a special education school. The children were between the ages of 7 and 12, with the majority being in the 9–10-year age range, which is when they showed the strongest response to the LISRAA model. There was a higher percentage of males (66.7%, reflecting the general trend of autism being more prevalent in young males. All participants were at the primary education level, making the study’s findings particularly relevant to early childhood and primary-level interventions. Moreover, Table 5 shows the descriptive statistics for pre-test, post-test 1, and post-test 2 data.

Table 4.

Demographic Information of Participants in the Quantitative Phase

Demographic Variable		Number of Participants		Percentage (%)		Details
Total Participants		6		100		All participants were children diagnosed with moderate autism, attending SLB Pembina Pekanbaru.
Age Range		7–8 years		30		Majority were in primary education.
		9–10 years		40		These students showed moderate to strong responses to the LISRAA model.
		11–12 years		30		Older children demonstrated more self-regulation and focus improvements.
Gender Distribution		Male		100		100% of the participants were male, reflecting the higher prevalence of autism in boys.
Autism Diagnosis Severity		Moderate Autism		100		All participants were diagnosed with moderate autism.
Educational Level		Primary Education		100		All students were in the primary level at SLB Pembina, a special education school for children with disabilities.

Table 5.

Autism Behavior Checklist Scores Before-After LISRAA Model Implementation

Time Point		Mean Score		n		Standard Deviation
Pre-Test		5.00		6		3.406
Post-Test 1		15.33		6		0.816
Post-Test 2		14.67		6		1.366

Table 5 and Figure 1 show a clear improvement in the ABC scores following the implementation of the LISRAA model. The mean score increased substantially from 5.00 in the pre-test to 15.33 in post-test 1; this represents a threefold improvement in measured behavioral outcomes, indicating reduced hyperactivity, increased focus, and improved emotional regulation. The slight decrease to 14.67 in post-test 2 suggests that while some improvements were maintained, there was a minor regression over time. The standard deviation decreased notably from the pre-test (3.406) to post-test 1 (0.816), indicating more consistent behavior across participants after the intervention. The slight increase in standard deviation in post-test 2 (1.366) suggests some variability in how well the improvements were sustained. Overall, these results suggest that the LISRAA model substantially impacted the behavioral development of children with autism, with most gains maintained over time.

Figure 1.

Autism Behavior Scores Pre-Post Test

Normality and homogeneity tests

Normality tests were conducted using the Shapiro-Wilk test to determine whether the data followed a normal distribution. This test was necessary to confirm that paired t-tests were appropriate, ensuring the reliability of statistical comparisons. The results confirmed normal distribution for all test groups, with P values greater than 0.05 for pre-test (P = 0.334), post-test 1 (P = 0.091), and post-test 2 (P = 0.093). This allowed the use of paired samples t-tests for further analysis.

Hypothesis testing

Hypothesis 1

H0: There is no significant difference between the pre-test and post-test 1 scores.

H1: There is a significant difference between the pre-test and post-test 1 scores.

Table 6 shows the results of the paired samples t-test between pre-test and post-test 1 scores. The paired samples t-test results provide strong evidence for the effectiveness of the LISRAA model in improving behavioral outcomes for children with autism. The mean difference between pre-test and post-test 1 scores is − 10.333, indicating a substantial increase in positive behaviors after the intervention. The large t-value of − 9.263 and the extremely low P value (0.000) demonstrate that this improvement is statistically significant at the P < 0.05 level. With 5 degrees of freedom, these results suggest that the observed behavioral changes are highly unlikely to have occurred by chance, strongly supporting the conclusion that the LISRAA model had a meaningful and positive impact on the children’s behavior.

Table 6.

Paired Samples t-test After LISRAA Model Implementation

Paired Differences		Mean		Std. Deviation		t		df		P
Pre-test vs. Post-test 1		−10.333		2.733		−9.263		5		0.000

Hypothesis 2

H0: There is no significant difference between post-test 1 and post-test 2 scores.

H1: There is a significant difference between post-test 1 and post-test 2 scores.

Table 7 shows the results of the paired samples t-test between post-test 1 and post-test 2 scores. The paired samples t-test results comparing post-test 1 and post-test 2 scores indicate a slight decline in behavioral improvements over time, though this change is not statistically significant. The mean difference between the two post-tests is 0.667, suggesting a small decrease in positive behaviors. However, with a t-value of 2.000 and a P value of 0.102 (which is greater than the typical significance level of 0.05), we cannot conclude that this decline is statistically significant. This suggests that while there was a minor regression in behavioral improvements, the overall positive effects of the LISRAA model were largely maintained over the period between the two post-tests. The relatively small standard deviation (0.816) indicates consistency in this pattern across participants.

Table 7.

Paired Samples t-test Post-Test 1-2 Comparison Scores by LISRAA Model

Paired Differences		Mean		Std. Deviation		t		df		P
Post-test 1 vs. Post-test 2		0.667		0.816		2.000		5		0.102

Discussion

The findings of this study reinforce the effectiveness of the LISRAA model in promoting behavioral improvements in children with autism, particularly by creating a structured, sensory-friendly school environment.[30,31,32,33,34] The narrative inquiry revealed a significant impact on behavioral aspects such as improved focus, reduced hyperactivity, and better emotional regulation in children, echoing the findings of Cibralic et al.,[35] who emphasized the importance of sensory-sensitive learning spaces. However, this study extends beyond Cibralic et al.’s[35] work by incorporating the voices of both teachers and parents, providing a more comprehensive understanding of how the LISRAA model functions in real-world settings. The novelty of this study lies in its combination of narrative inquiry and quasi-experimental methods, which offer both qualitative depth and quantitative validation.[36]

In comparing the current findings with previous research, several points of alignment and divergence emerge. Al Qutub et al.[37] similarly found that modifications in lighting and sound levels can significantly improve the classroom experience for children with autism, leading to reduced anxiety and better engagement. However, this study uniquely highlights the need for quiet zones and personalized seating arrangements to minimize sensory overload. Teachers in this study observed that these adjustments allowed children to self-regulate during moments of distress, improving classroom behavior and fostering a more inclusive learning environment. This contrasts with Ashe, who primarily focused on classroom layout without discussing the integration of designated sensory retreat spaces.[38]

Additionally, the study’s narrative inquiry uncovered a key challenge not often discussed in earlier research: parents’ difficulty in maintaining consistency between school and home environments. While Bahrami and Nejad highlighted the importance of parental involvement in child development, they did not address how the structured environments of autism-friendly schools such as LISRAA can be difficult to replicate at home.[39] Parents in this study shared that while they noticed positive changes when applying LISRAA strategies at home, inconsistent routines and environmental distractions often led to behavioral regressions.[12] This insight underscores the critical role of consistency in behavioral development, adding a new dimension to the literature on autism-friendly education.[40]

Rusdiansyah and Sudana documented the lack of resources in Indonesian schools catering to children with autism, a challenge echoed by teachers in this study.[41] The LISRAA model, while effective in improving student behavior, faced limitations due to inadequate training and resources. Teachers expressed that they were often “stretched too thin,” especially when managing large classes or students with severe behavioral issues. To address this challenge, structured training programs should be integrated into teacher development plans. These could include workshops on autism-friendly teaching techniques, focusing on communication strategies, behavior management, and sensory-sensitive instruction. Additionally, professional collaborations with autism specialists would provide teachers with practical tools and case-based learning opportunities. Establishing mentorship programs where experienced special education teachers guide their peers could further enhance teaching effectiveness. While Maulidah and Mufalakhah identified a similar lack of resources in autism education, this study suggests that despite these challenges, the LISRAA model can yield significant improvements in children’s behavior—provided there is sufficient support for teachers.[42] The collaborative environment described by teachers in this study—where they frequently sought advice from colleagues—also contrasts with findings from previous studies,[43] where teachers often worked in isolation when dealing with students with autism.

The quantitative findings support the narrative insights by showing statistically significant improvements in children’s behavior after implementing the LISRAA model. Using the ABC, this study found that behavioral scores improved dramatically after the intervention, aligning with the results of Jaicks,[44] who showed that structured interventions can significantly enhance the independence and self-regulation of children with autism. However, while the improvements were significant, this study adds a unique layer by showing that behavioral progress tends to plateau over time without consistent reinforcement at home. The slight decline between post-test 1 and post-test 2 suggests that while initial improvements are achievable, long-term success may require structured follow-ups and reinforcement strategies. This finding aligns with previous research emphasizing the need for ongoing intervention. Future programs should incorporate periodic re-evaluations, booster training for parents and teachers, and home-based reinforcement strategies to sustain behavioral improvements.

To the best of our knowledge, this is the first study to use narrative inquiry to explore the LISRAA model’s impact on behavioral development in autistic children, particularly in a resource-limited setting like Indonesia.[8,9,10,45] While previous studies, such as Maulidah and Mufalakhah, have discussed the need for autism-friendly environments, they primarily focused on quantitative measures or case studies without delving into the lived experiences of participants.[42] This study, by contrast, provides a comprehensive, mixed-methods analysis that integrates personal stories with measurable behavioral changes, thereby offering both breadth and depth to the understanding of autism-friendly educational models.[12,14,17,32,34]

The use of Kurt Lewin’s change model as a theoretical framework adds further depth to the discussion of how environmental modifications lead to behavioral changes.[46] The unfreezing, changing, and refreezing stages described by Lewin were reflected in the participants’ experiences. Teachers initially struggled to adapt to the new LISRAA model (unfreezing), but they found new ways to engage students effectively (changing) through collaboration and experimentation. Over time, these changes became more permanent as teachers and students adjusted to the modified environment, leading to lasting behavioral improvements (refreezing). This application of Lewin’s model offers a theoretical explanation for the behavioral changes observed and aligns with Ashe, who emphasized the importance of structured environmental changes in psychological development.[38]

The unique contribution of this study is its integration of qualitative narratives with quantitative data, providing a rich, multifaceted understanding of the LISRAA model’s impact. Unlike previous studies that focused solely on quantitative outcomes or limited case studies, this research gives voice to the personal experiences of teachers, parents, and children, offering deeper insights into the daily challenges and successes of implementing an autism-friendly school model.[47] Furthermore, the study’s focus on a resource-limited setting like Indonesia adds to the existing body of knowledge by highlighting the adaptability of the LISRAA model in contexts where resources are constrained, making it particularly relevant for policymakers and educators in similar regions.

The findings of this study have significant implications for educational policies in Indonesia and similar resource-limited contexts, particularly in the realm of special education and inclusive learning environments.[48,49,50] To support sustainable implementation of autism-friendly education, policies should focus on integrating autism education into teacher certification programs. This could involve mandatory coursework on autism-specific instructional strategies, behavioral management techniques, and communication supports. Additionally, funding should be allocated for sensory-friendly classroom modifications, including noise-reducing materials, flexible seating options, and designated quiet zones.

Second, the challenges teachers face in implementing the LISRAA model highlight the critical need for comprehensive teacher training programs.[43,51] Policymakers should consider mandating specialized training in autism education as part of teacher certification requirements, particularly for those working in special education settings.[43] This could involve partnerships with universities and autism experts to develop curriculum-integrated courses on autism-friendly teaching strategies.[52]

Furthermore, the study’s emphasis on parental involvement and the challenges of maintaining consistency between school and home environments suggests a need for policies that support family education and engagement.[12,17,53,54] This could include government-funded parent training programs, resources for creating autism-friendly home environments, and the development of community support networks for families of children with autism.[55]

The resource limitations highlighted in this study also indicate the need for increased government funding for special education.[7] Policies should address the allocation of funds for smaller class sizes, additional support staff, and necessary educational materials and technologies that can enhance the learning experience for children with autism.[11]

Lastly, the success of the LISRAA model in a resource-limited setting suggests that similar approaches could be beneficial in other developing countries facing comparable challenges in special education. International cooperation and knowledge sharing should be encouraged through educational policies promoting cross-cultural research and adapting successful models such as LISRAA to diverse contexts.[3] By implementing these policy changes, Indonesia and similar countries can move toward more inclusive, effective, and supportive educational systems for children with autism, potentially improving long-term outcomes and quality of life for these individuals and their families. Future research should focus on evaluating the implementation and impact of such policies to ensure their effectiveness and guide further improvements in special education practices.

Overall, this study not only validates the effectiveness of the LISRAA model in improving behavioral outcomes for children with autism but also introduces a novel, experience-driven approach to understanding its impact. By integrating the theoretical framework with practical findings, this research provides a foundation for future policy development to create more inclusive, autism-friendly educational environments. The findings underscore the importance of a holistic approach that involves collaboration between schools and families, ensuring that the behavioral progress observed in structured environments is supported across all aspects of a child’s life.[34,39,51]

Despite the significant findings, this study has several limitations that should be considered. First, the sample size of six children with autism, while sufficient for the quasi-experimental design, may limit the generalizability of the quantitative results to broader populations. A larger, more diverse sample could provide a clearer picture of the LISRAA model’s impact across different populations. Additionally, while the narrative inquiry provided rich insights, self-reported data from teachers and parents may have been influenced by social desirability bias[28] potentially leading to overestimation of the intervention’s effectiveness.[56] Furthermore, the absence of a control group in the quasi-experimental design limits our ability to definitively attribute behavioral changes solely to the LISRAA model, as external factors such as natural developmental progress, parental involvement, and concurrent interventions could have played a role.[19] Future research should address these limitations by conducting longitudinal studies tracking behavioral outcomes over 1–2 years to assess the long-term impact of LISRAA. Additionally, comparative studies analyzing LISRAA alongside other autism-friendly models, such as TEACCH or ABA-based classroom interventions, could determine its relative effectiveness and scalability in different educational settings.

Conclusion

This study demonstrates the significant impact of the LISRAA model on the behavioral development of children with autism in a resource-limited setting. Sensory-friendly modifications, such as noise control, optimized lighting, and designated quiet zones, significantly improved children’s focus, reduced hyperactivity, and enhanced emotional regulation. While the LISRAA model was effective in school settings, inconsistent home environments posed challenges to sustaining progress, highlighting the need for greater alignment between school strategies and home practices. The qualitative insights gained through narrative inquiry underscore the critical role of teacher adaptation, parental engagement, and environmental consistency in sustaining behavioral progress. Despite its effectiveness, the LISRAA model faces challenges due to a lack of resources and specialized teacher training. Policymakers should prioritize autism-focused teacher education, allocate funding for sensory-friendly classroom modifications, and promote collaborative efforts between schools and families to ensure continuity in support. To the best of our knowledge, this is the first study to explore the LISRAA model’s impact using narrative inquiry, offering a unique perspective that integrates personal experiences with empirical data. The application of Kurt Lewin’s change model offers a theoretical foundation for understanding how environmental modifications drive behavioral changes in children with autism. These findings contribute to the broader literature on autism education by emphasizing the importance of tailored learning environments and consistent support systems in promoting positive behavioral outcomes. The LISRAA model’s effectiveness in this study suggests that with appropriate training and resources, educators can create more inclusive and supportive learning spaces for children with autism, even in contexts with limited resources. Future research should explore strategies for extending the LISRAA model’s principles to home settings and investigate long-term impacts on behavioral development. By emphasizing the importance of tailored learning environments and consistent support systems, this study provides valuable insights for educators, policymakers, and families working to foster the behavioral and emotional growth of children with autism.

Author contributions

Conceptualization, AF, WND, MYH, and ZS; methodology, AF, WND; investigation, AF, WND, MYH, and ZS; data curation, AF; writing—original draft preparation, AF; writing—review and editing, WND, and MYH; supervision team WND, ZS and MYH; funding acquisition, AF. All authors have read and agreed to the published version of the manuscript.

Data availability statement

Derived data supporting the findings of this study are available from the corresponding author on request. All qualitative data have been anonymized to protect participant privacy.

Ethics approval

This study followed ethical guidelines outlined by the International Conference on Harmonisation - Good Clinical Research Practice (ICH-GCP). Ethical clearance was obtained from the Ethics Committee of Nursing and Health Research, Universitas Riau, under approval number 534/UN.19.5.1.8/KEPK.FKp/2022.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.