Extent and Rigor of Cultural Adaptations in Social Communication Interventions for Autistic Children and Adolescents: A Systematic Review

Social communication interventions to support autistic people are primarily developed and tested in Western countries with predominantly White, English-speaking participants. Although numerous frameworks have been developed to adapt these interventions for diverse ethnocultural groups, the quality of these adaptations is not well understood. This review used the Cultural Adaptation Checklist (CAC) to appraise the quality of cultural adaptations of social communication interventions for autistic children and adolescents. Searches across eight databases identified 16 studies involving 474 participants. Included studies reflected seven different culturally adapted interventions delivered across 12 countries in 11 languages. The methodological quality of the studies was assessed using QualSyst, and data were analyzed through narrative synthesis. All studies demonstrated at least adequate methodological quality, but only three reported using a specific framework to guide their cultural adaptations. The extent of adaptations varied, with fulfillment of CAC items across studies ranging from 44% to 91%. This review highlights the need for more comprehensively reported cultural adaptations to best support the global autistic community. The CAC offers a useful framework that researchers can use to facilitate this process. Future research should examine to what extent cultural adaptations are needed and which types of adaptations best support desired intervention outcomes.Lay AbstractMany programs have been designed in Western countries to support social communication skills such as understanding others, making friends, and building relationships in autistic people. Those who participate in these programs have mainly been English-speaking participants, so the suitability of these programs to other language, cultural, and ethnic backgrounds remains unknown. To make programs more culturally and linguistically relevant, researchers have adapted them in several ways. This study looked at how well programs for autistic children and adolescents have been adapted for various communities. Using the Cultural Adaptation Checklist (CAC), we examined 16 studies and found that the amount of adaptations varied widely. Only three studies mentioned using a framework that guided their adaptations. Our findings show that although all studies described some level of cultural adaptation, very few reported on ensuring stronger community involvement or making the programs more accessible for all. Using tools like the CAC can help researchers and clinicians make programs more inclusive and relevant for autistic individuals and their families worldwide.