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

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.