Early Autism Intervention Components Deliverable by Non-specialists in Low- and Middle-Income Countries: A Scoping Review

Abstract

IntroductionThe past decade has seen key advances in early intervention for autistic children in high-income countries, with most evidence based on specialist delivery of interventions. The care gap seen in low- and middle-income countries (LMIC) remains close to 100%. A key challenge in addressing this care gap concerns the paucity of specialists available to deliver services. Task-sharing provides an important potential solution; there is a need to identify interventions that are suitable for scaled-up delivery through task-sharing in low-resourced settings. We aimed to conduct a scoping review to identify studies which reported autism intervention delivered by non-specialists within LMIC and, using established frameworks, specify intervention components with evidence of successful non-specialist delivery.MethodsA scoping literature search, conducted within four databases, generated 2,535 articles. Duplicates were removed, followed by screening of titles and abstracts, with 10% double-rated for reliability. 50 full text articles were then screened independently by two raters. Articles were included if studies: (a) were conducted in LMIC; (b) included samples of autistic children (age < 10); (c) evaluated psycho-social interventions delivered by non-specialists; (d) reported child outcomes; and (e) were peer-reviewed full-texts in English. Two established frameworks – @Practicewise and NDBI-Fi framework - were then used to ascertain the commonly delivered components of these interventions.ResultsTwo studies met the inclusion criteria. Both studies evaluated parent-mediated interventions delivered by non-specialists in South Asia. Through the two frameworks, we identified elements and techniques that had been delivered successfully by non-specialists.ConclusionThere is evidence from two acceptability and feasibility trials that non-specialists can be trained to deliver some intervention elements and techniques within parent-mediated interventions, with good fidelity and acceptability and evidence of effectiveness. The review points up the lack of a widespread evidence base in this area and need for further research in low resourced settings, including well-powered trials and mechanistic analyses to identify active ingredients. A focus on the pre-requisites for non-specialist delivery is critical to reduce inequity and provide universal health coverage within resource-constrained health systems.

Telehealth services for children with neuro‐developmental disabilities in the Asia‐Pacific region: A systematic review

“…Another review on current telehealth applications to deliver social communication intervention for young children with/at risk for ASD reported that telehealth increased intervention access by reducing the cost and removing geographic barriers (Simacek et al, 2021). Family‐centred home‐based interventions are recognized as the most successful interventional approach for ASD (Naithani et al, 2022). Further telehealth provided an opportunity to visit homes virtually, which was a specific advantage mentioned in research undertaken during the pandemic (Whitehouse et al, 2020).…”

“…Globally, children with NDDs have many unmet needs including the scarcity of specialist services and barriers to access services, and this is more in LMICs (Bitta et al, 2017). Therefore, providing services through non‐specialist caregivers and parent‐mediated interventions is options trialled in the HICs and is emerging in the LMIC settings (Naithani et al, 2022). Hence, telehealth was widely explored as a practical option to deliver interventions for children with NDDs in many settings, especially in HICs (Rosenbaum et al, 2021).…”