Parent-mediated intervention training for caregivers of children with developmental differences in Zambia.
Project ImPACT parent coaching lifted language and pretend play for Zambian children with developmental delays without added clinicians.
01Research in Context
What this study did
Zambian caregivers of children with autism, Down syndrome, or general delays took part in Project ImPACT coaching. The team ran one group, measured kids before and after, and had no control group.
Coaches taught parents to use naturalistic strategies during daily play and routines. They checked if children's language and pretend play grew and if parents kept using the new skills.
What they found
After the course, children talked more and showed richer pretend play. Parents also used the ImPACT strategies more often than at the start.
The study calls the results positive, but it does not give scores or counts.
How this fits with other research
Yoder et al. (2020) tested the same Project ImPACT in the United States and saw no clear child gains. The difference is age: the US babies were under two years, while Zambia worked with a wider age range who already showed delays. Younger brains may need more time or different cues.
Swain et al. (2025) pooled three trials and found that parent skill, not the program label, drives social communication gains. Vassos et al. (2023) lines up with this idea: when caregiver strategy use rose, child language and play improved.
Franz et al. (2024) are now running a larger South-African RCT that builds on this Zambian pilot. If their results hold, low-resource public school staff could roll out ImPACT across southern Africa with confidence.
Why it matters
You do not need extra clinicians or fancy rooms. Train the adults who already feed and play with the child each day. In low-resource areas, one coach can reach many families by teaching parents the same simple routines shown in Zambia. Start by modeling one strategy, watch the parent try it, and give brief feedback. Track parent use first; child gains are likely to follow.
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Pick one ImPACT strategy, model it during play, and tally how many times the parent uses it before you leave.
02At a glance
03Original abstract
BACKGROUND: Lower- and middle-income countries (LAMICs) are under-resourced and have limited intervention services for children with developmental differences and their families. A logical method to address service gaps within resource-scarce contexts is to train caregivers as interventionists, specifically using empirically-supported parent-mediated Naturalistic Developmental Behavioral Interventions (P-M NDBIs; Kasari et al., 2010; Ingersoll & Wainer, 2013). AIMS: The study implemented the first P-M NDBI in Zambia and aimed to train caregivers and improve children's social-communication skills. METHODS/PROCEDURES: The current study utilized a mixed-methods, pre-post design and implemented Project ImPACT (Ingersoll & Dvortcsak, 2010, 2019). Participants included 19 Zambian caregivers of children (n = 20) with developmental differences including autism spectrum condition, Down syndrome, and cerebral palsy. OUTCOMES/RESULTS: Findings indicated that children's language skills and pretend play skills significantly improved from pre- to post-assessment, and caregivers most frequently used intervention strategies for modeling communication and prompting communication. CONCLUSIONS/IMPLICATIONS: The success and feasibility of implementing Project ImPACT in Zambia, and recommendations for culturally adapting and implementing P-M NDBIs in LAMICs, were discussed.
Research in developmental disabilities, 2023 · doi:10.1016/j.ridd.2022.104373