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.