Caregiver-Mediated Early Support Program Delivered Online Versus Care-as-Usual for Infants at Elevated Familial Likelihood for Autism: A Parallel, Assessor Masked, Feasibility Randomized Controlled Trial in India.
A short online course quickly makes Indian parents more sensitive to their autism-risk babies, but the benefit fades without ongoing touch-points.
01Research in Context
What this study did
Researchers in India tested an online program called LiL' STEPS. It teaches parents how to read and respond to their baby's early social cues.
Families had babies with a higher chance of autism because an older sibling already had the diagnosis. Half got the web coaching. Half got the usual clinic advice.
What they found
Right after the course, parents in the web group showed big jumps in warm, timely responses to their babies. Mom and baby also played together more smoothly.
Three months later, those gains had shrunk. The early boost did not stick without more help.
How this fits with other research
The short-lived win looks like Fátimas et al. (2026). Their online parent groups helped Spanish toddlers only on one tiny measure, not overall. Both studies warn: one short web cycle is rarely enough.
Yet Corona et al. (2021) saw steady parent-reported child gains after telehealth coaching. The difference? Corona kept weekly calls for months, while LiL' STEPS ended after weeks. Longer contact may lock in skills.
Divan et al. (2019) ran an earlier Indian trial with lay workers visiting homes. They also lifted parent-child play and cut parent stress, but core autism signs stayed flat. LiL' STEPS repeats the parent-benefit pattern and adds proof that the same lift can happen through a screen.
Why it matters
You can now tell funders that online caregiver coaching works even in low-resource India, but only if you build in booster sessions. Schedule brief monthly refreshers after the main course. Track parent responsiveness each time; when scores slip, add a quick video review or live call to keep the spark alive.
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02At a glance
03Original abstract
LiL' STEPS (Language development & Intervention Lab's SupporTing Early social-communication and language by Promoting caregiver Sensitive responsiveness) is a novel, manualized, caregiver-mediated early support program developed in India and delivered online for infants at elevated familial likelihood for autism. The program has been found to be feasible and acceptable. The preliminary efficacy of the LiL' STEPS program, which remains to be evaluated, was assessed in this study using a feasibility randomized controlled trial design. The study was conducted at a tertiary care academic hospital in south India. Families with infants aged 9-15 months, each with an older sibling diagnosed with autism, were recruited. Thirty-six families were randomized in a 2:1 ratio to either the LiL' STEPS group (n = 24) or the care-as-usual group (CAU; n = 12) using fixed block randomization. While families in the former group received the LiL' STEPS early support program, those in the latter did not avail themselves of any early supports. Assessors were masked to group status. The primary outcome was caregiver sensitive responsiveness, assessed using the Manchester Assessment for Caregiver-Infant Interaction (MACI). Secondary outcomes included caregiver-reported measures of social communication and language. Outcomes were measured at three time points: baseline (T1), 12 weeks post-baseline (T2), and 12 weeks after program completion (T3). Intention-to-treat analyses were performed using linear mixed models. No significant treatment effects were found between baseline (T1) and endpoint (T3) on the primary or secondary outcomes. However, significant, large, positive treatment effects were observed for caregiver sensitive responsiveness (β = 1.48; 95% CI = 0.51-2.34; d = 1.15) and dyadic mutuality (β = 1.22; 95% CI = 0.03-2.15; d = 1.01) between baseline (T1) and T2, highlighting the need for ongoing support between T2 and T3-a key direction for future large scale efficacy trials.
Autism research : official journal of the International Society for Autism Research, 2025 · doi:10.1002/aur.70116