The prevalence of Autism Spectrum Disorder (ASD) in low- and middle-income countries (LMIC) is significant, yet the availability of specialized interventions is often limited. The study titled "Adapting an evidence-based intervention for autism spectrum disorder for scaling up in resource-constrained settings: the development of the PASS intervention in South Asia" provides valuable insights into addressing this gap. Here, we discuss how practitioners can implement the outcomes of this research to improve their skills and create better outcomes for children with ASD.
The original intervention, Preschool Autism Communication Therapy (PACT), was developed in the UK and required adaptation to fit the needs of resource-constrained settings in South Asia. The resulting intervention, Parent-mediated intervention for Autism Spectrum Disorder in South Asia (PASS), retains the core theoretical foundations of PACT but has been modified to enhance acceptability, feasibility, and scalability.
Key Adaptations for Practitioners
- Parent as Agents of Change: The PASS intervention empowers parents to be the primary agents of change in their child's communication development. Practitioners should focus on training parents to recognize and adapt their communication strategies, making them active participants in the intervention process.
- Reflective Therapy Style: Unlike the directive approach commonly expected in low-resource settings, PASS uses a reflective approach where parents are encouraged to observe and understand their child's communication cues. Practitioners should guide parents through video-feedback sessions to help them internalize and apply these reflective techniques.
- Use of Video-Feedback: Video-feedback is a crucial component of PASS, allowing parents to observe their interactions with their child and identify areas for improvement. Practitioners should ensure that parents are comfortable with being recorded and understand the benefits of this method.
- Home-Practice Instead of Homework: The intervention includes daily home-practice sessions where parents apply the strategies learned during therapy. Practitioners should help parents integrate these practices into their daily routines, making them less burdensome and more effective.
- Play-Based Intervention: PASS emphasizes the importance of play in developing communication skills. Practitioners should encourage parents to engage in play activities with their child, using locally available toys and materials to make the sessions enjoyable and culturally relevant.
Training and Supervision
One of the critical adaptations of PASS is the task-shifting approach, where non-specialist health workers deliver the intervention under the supervision of specialists. Practitioners should ensure that non-specialists receive comprehensive training, including:
- Understanding typical child development and ASD.
- Developing observation and counseling skills.
- Practicing intervention techniques through role-playing and supervised sessions.
Regular supervision and clear referral guidelines are essential to maintain the quality and effectiveness of the intervention. Practitioners should establish a robust support system for non-specialists, including ongoing training and competency assessments.
Conclusion
The PASS intervention demonstrates that high-quality, evidence-based ASD interventions can be adapted for resource-constrained settings without losing their effectiveness. By implementing the adaptations discussed above, practitioners can enhance their skills and provide better support to children with ASD and their families.
To read the original research paper, please follow this link: Adapting an evidence-based intervention for autism spectrum disorder for scaling up in resource-constrained settings: the development of the PASS intervention in South Asia.
