A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka
Authors: Wanniachchi Pamoda Madhubhashini , Sumanasena Samanmali P 
Published: November 2023

Caregivers are increasingly recognised as significant in providing naturalistic interventions for children with autism spectrum disorder in high-income countries and low- and middle-income countries including Sri Lanka. It is imperative to assess the impact of programmes targeting desired parenting skills within cultural boundaries. A preliminary study evaluated the effectiveness of a play-based parent coaching programme by assessing caregiver interaction skills. A mixed-method approach included a prospective pre–post interventional study. A caregiver skills assessment checklist was designed by adapting a freely available tool to assess caregiver–child interactions following a 3-h parent coaching programme. Pre-/post-training 10-min video recordings were obtained for each child–caregiver dyad 2 weeks apart. Thirty mothers (25–55 years) participated. Mean scores improved significantly in all caregivers ( p < 0.005) for special emotional (8.80–22.83), cognitive (4.63–14.13) and language (5.53–12.97) domains. Higher education level and older age of caregivers positively associated with the skill acquisition. Qualitative data revealed caregiver satisfaction of detailed workshops. Promising short-term outcomes demonstrated the potential role of parents as partners in autism spectrum disorder management in low- and middle-income countries. Longer-term outcomes on larger groups of children and caregivers need exploration. Lay abstract Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2–4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent–child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children’s overall development need to be looked into using larger and more generalised studies.