Effectiveness of Parent-mediated Intervention Versus Standard Therapist-based Intervention in Indian Children With Autism Spectrum Disorder: A Randomized Controlled Trial.
Abstract
Objective
The global prevalence of autism spectrum disorder (ASD) has increased substantially in recent decades. In India, prevalence estimates range from 0.74% to 1.68% among children aged 2 to 6 years. Therapist-based interventions are resource-intensive and impractical in low- and middle-income countries. Parent-mediated interventions (PMIs) offer an alternative; however, Indian comparative data are limited. This RCT compared the effectiveness of the Value-based, Quality interaction, Unique for the child, Responsive and Adapted for family (VQURA), a PMI, with standard Therapist-Based Intervention in young children with ASD.
Methods
This prospective RCT included 24 to 36-month-old children fulfilling DSM-5 criteria for ASD. Participants were randomized to either the Parent-Mediated Intervention group, involving parent-delivered intervention with therapist guidance, or the Therapist-Based Intervention group, involving therapist-led sessions. Outcomes were assessed at baseline and 6 months using the Bayley Scales of Infant Development, Vineland Social Maturity Scale (VSMS), and Childhood Autism Rating Scale (CARS).
Results
Baseline characteristics were comparable between groups. Both interventions resulted in significant within-group improvements across developmental domains. The PMI group demonstrated significantly greater reductions in autism symptom severity (CARS score mean change -4.40 vs -2.60; p = 0.005) and larger gains in social and adaptive functioning (VSMS Social Quotient +17.22 vs +11.18; p = 0.015). Longitudinal analysis confirmed superior improvement trajectories for PMI in autism severity (p = 0.005) and social functioning (p = 0.009).
Conclusion
The VQURA Parent-Mediated Intervention was more effective than therapist-based intervention in improving autism severity and social functioning, supporting its use as a scalable early intervention model in resource limited settings.