Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa
Non-specialist coaches can deliver a 12-session parent-NDBI package that lifts both caregiver fidelity and child skills in a low-resource setting.
01Research in Context
What this study did
Rieder and her team tested a 12-session parent program in South Africa. Non-specialist coaches taught caregivers how to use naturalistic ABA with their preschoolers who have autism.
Each coach had learned the steps from a trainer, then taught the parents. The researchers checked if parents could run the steps correctly and if the children gained new skills.
What they found
Nine out of ten children showed gains in language and daily living skills. Parents also hit high fidelity scores after the short training.
The program worked even though the coaches were not BCBAs. A low-cost, task-sharing model still moved child scores in the right direction.
How this fits with other research
Wanniachchi et al. (2024) ran a near-copy study in Sri Lanka and saw the same caregiver gains. Both proofs show brief parent-NDBI works across low-resource countries.
Van der Donck et al. (2023) hit 95% fidelity with telehealth coaching, while Rieder reached similar levels face-to-face. The high scores are not tied to one delivery style.
Ousley et al. (2026) looks like a clash—their brief telehealth NDBI did not improve triadic play. The difference is dose and modality: Ousley used fewer sessions online, so social changes may need more in-person practice.
Why it matters
You can train community workers to run a short NDBI sequence and still lift child skills. Use their model when waitlists are long or BCBAs are scarce. Start with a 12-session script, check fidelity each week, and track language plus adaptive goals.
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02At a glance
03Original abstract
Despite 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. We 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. Caregiver 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. This 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.
Child and Adolescent Psychiatry and Mental Health, 2023 · doi:10.1186/s13034-023-00611-0