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Examining a Brief Intervention for Parents of Children with Autism in Global Contexts with Limited Resources
Despite the global presence of Autism Spectrum Disorders (ASD), a paucity of treatment services exists in Tanzania and many other low- and middle-income countries. Two primary barriers to accessing ASD treatments in Tanzania include a lack of non-English manualized interventions and treatment providers who can deliver interventions in Swahili. Thus, developing feasible, sustainable methods to offer empirically-based interventions to Tanzanian children with ASD is a public health priority.
Objectives:
The aim of this study was to address these two primary barriers through the development of a very brief parent-based behavioral intervention protocol that can be feasibly delivered via an interpreter. This talk will (1) describe the development this intervention designed to introduce parents to general behavior modification strategies, (2) reports on the initial feasibility and acceptability of a pilot trial in Tanzania, and (3) examines the generalization of this intervention to a different cultural context.
Methods: Study development and pilot testing occurred in Tanzania in two phases. Twelve caregivers of children with ASD and other developmental disabilities (DD) participated in the initial intervention development phase. The intervention was tailored to meet collaboratively set goals. In the second phase of the study, the intervention was piloted among 29 caregivers of children with ASD and DD. Parents received a subset of nine brief behavior modification lessons in areas of general parent training and teaching self-help skills. Parents were provided verbal didactics (via an interpreter), handouts in Swahili with visuals depicting strategies, and therapist-modeling. To examine the generalizability of this approach data collection is ongoing to examine the implementation of the intervention in Mongolia.
Results:
In support of the feasibility of use among Swahili-speaking Tanzanians, all 29 caregivers approached agreed to participate in the study. Despite cultural, language, and logistical barriers, 86% of parents reported that the intervention was helpful, with the remainder of parents requesting more comprehensive training. Families received training in one to six (M=4.16, SD=1.53) of the behavioral modules depending on the treatment goals determined collaboratively between the clinician and caregiver. Those delivered most frequently included “Using Reinforcement Strategies” (86%), “Teaching Requesting” (71%), “Increasing Eye Contact” (65%), “Following Directions” (48%), “Imitating” (48%), and “Toileting” (45%). We examined differences in the number of modules administered to children with ASD as compared to children with DD and found no group difference, t(26)=.82, p=.42, thus indicating that the intervention modules were relevant for both diagnostic groups.
Conclusions: Teaching parents to implement basic behavioral principles may ameliorate functional impairments among Tanzanian children with ASD. Results from the pilot intervention support the feasibility of future use among Swahili speaking Tanzanians. Implications of this pilot extend to non-English families in the U.S. who are also in need of brief interventions to teach basic behavioral techniques. This approach will help to improve functional outcomes among children with ASD and reduce ASD disparities both locally and globally. In the discussion, we also will examine how this intervention generalizes to another global context, Mongolia, where intervention implementation and data collection is underway.