Cultural adaptations of developmental interventions (DIs) and naturalistic developmental behavioural interventions (NDBIs) for preschoolers with autism: A Delphi study

Cross-cultural differences exist in caregiver-child engagement styles and play preferences, as well as caregivers’ expectations of early intervention programs, which may necessitate modification of existing early intervention programs to suit diverse families’ needs. Using the Framework for Reporting Adaptations and Modifications Expanded (FRAME) as a guide, our objective was to explore experts’ opinions on necessary adaptations for early intervention programs for preschoolers with autism to be used with various cultural groups (i.e., differing ethnic, linguistic, socioeconomic, and geographic groups) other than those for which the original intervention was created. One hundred and thirteen international experts in autism intervention were contacted to participate in our surveys using the Delphi technique. Twenty participants (18 %) responded in Round 1, 21 (19 %) in Round 2, and 15 (13 %) in Round 3. Experts suggested 114 unique adaptations across FRAME elements; we added a coaching-specific category. Consensus, defined as 75 % agreement among participants, was obtained for 86 of these statements, who rated the importance of adaptations using a 4-point Likert scale. Most suggestions pertained to ways in which the content of intervention should be adapted ( n = 66), followed by intervention delivery ( n = 17), staff training ( n = 10), and intervention evaluation ( n = 5). Sixteen coaching-specific adaptations were reported. Experts suggested modifications to increase families’ understanding of program goals/materials, increase their comfort in participation, and to decrease attrition. These findings add to a growing body of research supporting the need for culturally responsive autism interventions. • We used Stirman’s ‘Framework for Reporting Adaptations and Modifications-Expanded’. • Experts suggested 114 unique cultural adaptations for autism early intervention. • Common adaptations (based on FRAME) were to intervention content and delivery. • Findings reflect views on the importance of culturally responsive interventions.