CARER program for autism spectrum disorder: a formative qualitative study on developing an early play-based, parent-mediated intervention in the Indian context
CARER gives you a parent-vetted, 12-session Indian NDBI playbook that is primed for pilot testing.
01Research in Context
What this study did
Yadav et al. (2026) asked Indian parents what they need from a play-based coaching program.
They ran focus groups and interviews to shape 12 outpatient sessions.
The team blended NDBI strategies with everyday Indian play routines.
What they found
Parents liked short, low-cost sessions that fit local games and festivals.
They wanted coaches who speak their language and respect family roles.
The final plan is ready for pilot testing; outcome data are not yet in.
How this fits with other research
JMcQuaid et al. (2024) already showed Social ABCs works in Goa clinics. Their 55 toddlers gained social and communication skills after parents were coached. CARER uses the same parent-coach idea but starts from scratch with Indian voices instead of importing a Canadian manual.
Gevarter et al. (2025) got very-large communication gains in Hispanic preschoolers after student clinicians coached parents in NDBI. CARER extends this coached-NDBI model to Indian families, swapping bilingual students for Indian outpatient staff.
Rouhandeh et al. (2022) ran only four caregiver meetings and still saw social gains. CARER keeps the brief format but stretches to 12 sessions so families can practice more games at home.
Why it matters
You now have a ready-made 12-session script that Indian parents helped write. Use it as a template when you need a short, culturally tuned parent program. Start with local play materials and Hindi or Tamil examples. Track pilot data to see if gains match those seen in Social ABCs.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Map your current toy shelf to the CARER play list and swap in one local game this week.
02At a glance
03Original abstract
Families of children with Autism Spectrum Disorder (ASD) often face unmet needs in psychoeducation, skill-building, and coping with behavioral challenges, particularly in low-resource or task-sharing settings. Existing parent-mediated interventions are either intensive, specialist-led, or focus primarily on psychoeducation, leaving gaps in structured caregiver training and support for parental well-being. Therefore, we aimed to develop an early, play-based, parent-mediated intervention program integrating Naturalistic Developmental Behavioral Interventions (NDBI) and structured play-based strategies to enhance caregiver competence and child developmental outcomes, tailored for use in resource-scarce, brief outpatient settings. The current study reports the qualitative phase of a broader mixed-methods, proof-of-concept investigation conducted at a premier medical college and its affiliated tertiary hospital within the Armed Forces Medical Services (AFMS), India. Focus group discussions were conducted with purposively selected primary stakeholders (five professionals and five parents of children ASD) supplemented by expert validation to develop a play-based, parent-mediated intervention. Only qualitative findings from the program development phase are presented; quantitative feasibility and outcome data will be reported separately. Thematic analysis of detailed field notes informed program adaptation. The CARER (Communication & social skills, Autism, Restricted and repetitive behaviors management, Empowerment of caregivers, and Responsive play) intervention program was structured into 12 outpatient sessions (45–60 min each), incorporating psychoeducation, modeling, guided parent–child practice, barrier-solving, home tasks, and strategies addressing parental stress. Credibility was ensured through investigator triangulation and member checking, with reporting aligned to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Thematic analysis to understand stakeholders’ perspectives revealed four core domains: (i) psychoeducation, (ii) caregiver training needs, (iii) educational needs of the child, and (iv) parental stress. The CARER program operationalizes these themes into structured, play-based sessions targeting communication, social interaction, restricted and repetitive behaviors, sensory issues, and caregiver empowerment. The program emphasizes parent-mediated delivery and home generalization of skills, balancing feasibility in outpatient settings with developmental relevance for children with ASD. The CARER program represents an early, brief, and pragmatically designed outpatient parent-mediated intervention framework to support families of young children with ASD. Further piloting and systematic evaluation in larger samples across similar low-resource settings are needed to assess feasibility, acceptability, fidelity of delivery, and potential clinical impact, and to inform ongoing adaptation. Trial registration: AFMRC PROJECT NO :5337 /2020 The online version contains supplementary material available at 10.1186/s13034-026-01027-2.
Child and Adolescent Psychiatry and Mental Health, 2026 · doi:10.1186/s13034-026-01027-2