Parent-mediated skills training and developmental outcomes among autistic children in a public psychosocial care center in Brazil: A non-randomized controlled pilot study

Objective To evaluate the potential effects of a parent-mediated basic skills training program on developmental milestones among autistic preschool children receiving care at a public child psychosocial care center in Brazil. Methods We conducted a non-randomized controlled pilot study including children with autism spectrum disorder aged 2–6 years and their primary caregivers (n = 18). Families were allocated to an intervention group (parent skills training; n = 9) or a comparison group receiving usual care (n = 9), seeking balance by child age, race/skin color, family income, and caregiver education. Developmental milestones were assessed using the Operant Portage Inventory at baseline (T0) and after 6 months (T1) across five domains (socialization, language, cognition, self-care, and motor). Within-group change was tested with Wilcoxon signed-rank tests and between-group differences with Mann–Whitney tests. Group × time effects were examined using two-way repeated-measures ANOVA. Effect sizes were estimated with Hedges’ g. Results In the intervention group, all developmental domains improved over follow-up (all p ≤ 0.009). At T1, the intervention group scored higher than the comparison group in all domains (all p ≤ 0.005), with large between-group effect sizes (Hedges’ g=1.62–2.42). The comparison group improved significantly only in language (T0 = 1.32 vs T1 = 1.53; p = 0.036). Group × time interactions were strongest for socialization (partial η²=0.823), cognition (η²=0.799), and language (η²=0.740). Conclusions Parent-mediated training delivered within a public child mental health service was associated with developmental gains in autistic preschoolers. These preliminary findings suggest caregiver-mediated interventions as a strategy to expand access to evidence-based care in low-resource public settings.