CULTURAL ADAPTATIONS OF DEVELOPMENTAL INTERVENTIONS AND NATURALISTIC DEVELOPMENTAL BEHAVIOURAL INTERVENTIONS FOR PRESCHOOLERS WITH AUTISM

Abstract

Developmental Interventions (DIs) and Naturalistic Developmental Behavioural Interventions (NDBIs) for preschoolers with autism are typically delivered by caregivers in the context of play or daily routines to amplify children’s social communication gains. Cross-cultural differences exist in caregivers’ expectations of these programs, parent-child engagement styles, and play preferences, which may necessitate modification of existing DIs/NDBIs to suit diverse families’ needs. Stirman et al. (2013, 2019) developed the Framework for Reporting Adaptations and Modifications- Enhanced (FRAME), which captures content, contextual, and training and evaluation modifications to evidence-based interventions. In this three-part study, we examined the ways in which DIs/NDBIs have been or can be modified to suit the needs of cultural groups using the FRAME. Manuscript 1 details the findings of our scoping review. Forty-one studies detailed culturally adapting a DI/NDBI spanning 17 countries. Findings provide examples of the various ways in which researchers/clinicians have modified these interventions, most frequently describing modifications to intervention content, context, and staff training. We also coded the goals and rationales for implementing these adaptations. To further enhance our understanding of cultural adaptations, we disseminated a series of questionnaires to experts globally to discern ways in which DIs/NDBIs have been, or should be, adapted for cultural groups. We used the Delphi technique to establish consensus among experts regarding the importance of these adaptations. Many themes overlapped with our scoping review findings, including the importance of adapting intervention materials and packaging. Building on these findings, Study 3, described in Chapter 5, showcases the development and evaluation of an NDBI knowledge translation tool for Arabic-speaking families. Clinicians and caregivers made positive reflections regarding the infographic during its development. Overall, this dissertation sought to offer ways that researchers and clinicians may modify DIs/NDBIs to better suit the cultural needs of families they serve. Numerous examples obtained in this dissertation research showcased the breadth of modifications to consider. More empirical assessments of adapted interventions would further enhance our understanding of, and need for, cultural adaptations.