Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa

Child and Adolescent Psychiatry and Mental Health

Research

Noleen Seris¹  Petrus J. de Vries¹  Nokuthula Shabalala¹  Marisa Viljoen¹  Minkateko Ndlovu²  Lauren Franz³  Amber D. Rieder⁴  Elizabeth L. Turner⁵  Ryan Simmons⁵ 

[1]Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, South Africa

[2]Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, South Africa

[3]Department of Psychology, University of Cape Town, Cape Town, South Africa

[4]Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, 7700, Rondebosch, South Africa

[5]Duke Global Health Institute, Duke University, Durham, North Carolina, USA

[6]Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA

[7]Division of Child and Family Mental Health & Community Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA

[8]Duke Global Health Institute, Duke University, Durham, North Carolina, USA

[9]Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA

[10]Duke Global Health Institute, Duke University, Durham, North Carolina, USA

[11]Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA

关键词: Autism;    Early intervention;    Task-sharing;    Naturalistic developmental behavioural intervention;    Proof-of-principle study;   

DOI  :  10.1186/s13034-023-00611-0

 received in 2023-02-24, accepted in 2023-05-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDespite the high number of children living with neurodevelopmental disabilities in sub–Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI—whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes.MethodsWe utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2.ResultsCaregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication—9/10 improved, Foundations of Learning—10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication—9/10 improved, Socialization—6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers.ConclusionsThis proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.

【 授权许可】

CC BY   
© The Author(s) 2023

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