Parent-Mediated Primary Intervention (CATER-Autism) for Children with Autism aged 6-13 Years: A Non-randomized Feasibility and Pilot Trial

Background: Despite considerable heterogeneity in intervention objectives, delivery formats, outcome measures, and proposed mechanisms of action, parent support and parent-mediated interventions (PMIs) have demonstrated efficacy in improving outcomes for children with autism spectrum disorder (ASD). This study evaluated the feasibility and preliminary effectiveness of a culturally adapted PMI on behavioral problems in children with ASD and parental psychological outcomes. Methods: This quasi-experimental study evaluated a therapist-assisted, group-based PMI delivered over 8 weekly sessions (32 hours). Children aged 6-13 years with a DSM-5 diagnosis of ASD, an Indian Scale for Assessment of Autism (ISAA) score >70, and a Social Quotient (SQ) >55 were eligible. Outcomes were assessed using the Child Behavior Checklist (CBCL), Parental Knowledge Questionnaire of Autism (PKAQ), Coping Health Inventory for Parents (CHIP), Zarit Burden Interview (ZBI), and Parenting Stress Index-Short Form (PSI-SF). Results: Twenty-three parents (12 mothers and 11 fathers; mean age, 38.22 ± 4.95 years) of 17 children with ASD (12 males and 5 females; mean age, 7.59 ± 2.81 years; mean SQ, 75.82 ± 16.12) completed the intervention. The intervention demonstrated good feasibility, with 85% participant retention, 82.6% adherence to intervention tasks, and high acceptability among participating parents. Significant improvements were observed in children’s behavioral problems, reflected by reductions in internalizing, externalizing, and total CBCL scores. Parents also demonstrated significant improvements in autism-related knowledge, coping across all CHIP domains, and parenting stress, whereas caregiver burden did not significantly change. Conclusions: CATER-Autism is a feasible, culturally adapted, bilingual PMI that shows promise for improving behavioral outcomes in children with ASD and enhancing parental coping and well-being. These preliminary findings warrant confirmation in a fully powered randomized controlled trial.