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September 10, 2025Open Access

Culturally Adapted Play-based Behavioral Intervention among Children with Autism Spectrum Disorder in Semi-rural Tamil Nadu: A Randomized Controlled Trial

Key Points

Both interventions led to decreased behavioral issues and enhanced prosocial behaviors among children with autism spectrum disorder.
Significant time effects were observed in behavior changes as reported by both teachers and parents on the strength and difficulties questionnaire.
A randomized controlled trial setting ensured a rigorous evaluation of culturally adapted play-based intervention versus applied behavior analysis.
The results imply that culturally tailored behavioral interventions can be effective in improving social engagement in children within resource-constrained environments.

Abstract

Abstract Background: Autism spectrum disorder (ASD) is a growing neurodevelopmental condition that affects communication, cognition, social behavior, and sensory processing. The presence of sensory, emotional, and motor challenges can significantly affect a child’s behavior. To address these difficulties, culturally adapted play-based intervention was introduced to manage emotional, conduct, peer problems, hyperactivity, and prosocial problems. Objectives: The objective is to evaluate the effectiveness, feasibility, and acceptability of culturally adapted play-based behavioral intervention (PPBI) compared to applied behavior analysis (ABA) in enhancing behavior among ASD children in semi-rural Tamil Nadu. To assess behavior using parent and teacher-reported strength and difficulties questionnaire (SDQ) for a comprehensive evaluation at home and school. Methods: This study utilized a double-blinded randomized controlled trial and employed a purposive sampling method to recruit 46 children with ASD and divided them into two groups: Culturally Adapted PPBI and ABA group. Behavior was assessed using SDQ at baseline, 4 th , 8 th , and 12 th Week. Results: The baseline characteristics of the children were examined to ensure comparability, and there was no significant difference in age ( P = 0.06), gender and SDQ parent ( P = 0.153), SDQ teacher ( P = 0.571), prosocial parent ( P = 0.463), prosocial teacher ( P = 0.829) baseline scores between the two groups, which showed children were similar at the beginning of the intervention. Both parent and teacher reported outcomes of SDQ score revealed a significant time effect ( P 0.05). Conclusion: Both PPBI and ABA improved behavior in children with ASD. However, PPBI enhances social engagement found through teacher-reported prosocial behavior. These results support the understanding that culturally tailored interventions in resource-constrained environments.

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