Caregiver transformation and relational growth in a parent-mediated intervention for autism in Hong Kong – A qualitative study

Parent-mediated interventions (PMI) have demonstrated effectiveness in supporting autistic children's emotional regulation, social engagement, and communication. However, most research has focused on quantitative child outcomes, with limited attention to caregivers' lived experiences, particularly within non-Western urban contexts such as Hong Kong. This study explored how a culturally adapted PMI shaped caregiving practices and parent-child relationships among Hong Kong caregivers of autistic children. Using a qualitative design, five focus groups were conducted with 22 caregivers of children diagnosed with or suspected to be on the autism spectrum. Reflexive thematic analysis identified two central themes: (1) Caregiver transformation, capturing shifts in caregivers' mindsets, emotional regulation, reflective parenting, and interactional practices as they moved from being supporters to co-regulators; and (2) Cultivating togetherness, encompassing enhanced parent-child synergy through deeper emotional attunement, mutual responsiveness, and relational engagement. Caregivers described a shift from technical caregiving to authentic relational engagement, marked by greater sensitivity to their children's needs and strengthened reciprocal dynamic in daily interaction. Structured guidance and individualised feedback were consistently identified as critical enablers, providing practical, context-sensitive strategies suited for small living environment. Furthermore, children were increasingly recognised as relational stakeholders rather than passive recipients of care. Some caregivers noted ripple effects, with other family members adopting supportive practices that fostered more cohesive family environments. This study provides qualitative evidence that culturally adapted PMI can encourage caregiver transformation, promote well-being, relational attunement, and developmental pathways that affirm neurodivergent identities. Findings underscore the value of inclusive, family-centred approaches that nurture mutual understanding and long-term relational well-being.