The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting.
Lay coaches in rural India boost parent-child play and cut parent stress, though child autism signs stay steady.
01Research in Context
What this study did
Divan et al. (2019) tested PASS Plus in rural India. Lay health workers visited homes and coached parents of preschoolers with autism.
The program lasted several weeks. It taught parents to play, talk, and manage behavior. Workers also helped parents cope with stress.
What they found
Parents and children played together better. Parents felt less stress and sadness.
Children's core autism signs stayed the same. The program did not shrink repetitive moves or fix language delays.
How this fits with other research
Agiovlasitis et al. (2025) tried online coaching for babies in India. Like PASS Plus, parent sensitivity rose fast, but gains faded without boosters.
Magaña et al. (2020) ran a Latino parent class in Colombia. Moms gained confidence and used more ABA tricks, matching PASS Plus parent wins.
Proctor et al. (2024) ran parent groups for mixed delays in South India. Peer support grew, echoing PASS Plus stress relief, but used groups not home visits.
Harrison et al. (2016) gave one short workshop in Tanzania. It was feasible, yet PASS Plus shows longer coaching yields stronger parent gains.
Why it matters
You can train local helpers to coach parents in places with no BCBA. Expect happier, more skilled parents even if autism scores stay flat. Use PASS Plus lessons when you design rural services or supervise community aides.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a brief parent stress check before your next session and teach one play prompt to the caregiver.
02At a glance
03Original abstract
The treatment gap for autism globally is high. Our previous PASS intervention, delivered by community based lay health workers, showed effectiveness. This article reports the development and evaluation of a new "PASS 'Plus'" intervention in a rural population in India. Using formative research methods, we supplemented the PASS intervention with additional (Plus) modules to address autism comorbidities. This is the first time that a rigorous methodology has been used to evaluate autism symptom outcomes in a low and middle-income country setting. 40 parent-child dyads were recruited in a pilot randomized controlled trial against usual care (mean age 65 months (34 boys); n = 19 PASS Plus, n = 21 UC). 89% of intervention families partially or entirely completed the 12-session intervention. Intention to treat analysis showed a reduction in mean scores of autism symptom severity, though the confidence interval contains zero, (adjusted mean difference AMD -2.42 95% CI -7.75, 2.92; ES 0.22); large treatment effects on proximal outcomes of proportion of parent synchronous responses (AMD 0.35; 95% CI 0.18, 0.52; effect size ES 3.97) and proportion of child communication initiations with parent (AMD 0·17; 95% CI 0.03, 0.32; ES 1.02). Confidence intervals for effects on mutual shared attention (AMD 0.10; 95% CI -0.07, 0.27; ES 0.5) and co-morbid symptoms (AMD -9.0; 95% CI -24.26, 6.26; ES 0.32) contained zero. There were significant effects to improve parental mental health. PASS Plus shows good feasibility and adds to the evidence of the effectiveness of task sharing complex autism interventions to lay health workers in India. Autism Res 2019, 12: 328-339 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This article describes the development of a comprehensive, community-delivered, intervention for young children with autism, which combines a previously developed parent-mediated communication intervention with support for co-morbid problems like challenging behaviors and sensory sensitivities. The unique aspect of this intervention is that it can be delivered by community health workers, addressing the lack of specialists in low resource settings. Our study reports the encouraging findings of a pilot trial evaluating its feasibility and effectiveness.
Autism research : official journal of the International Society for Autism Research, 2019 · doi:10.1002/aur.1978