Abstract
Background:
Despite its high prevalence, autism spectrum disorder (ASD) presents specific difficulties for families, especially in India. Where access to early and affordable treatment is limited. Parents often struggle to manage behavioral and developmental issues due to shortages of trained professionals and high therapy costs. This study aimed to develop and validate a culturally appropriate, low-cost, home-based psychosocial intervention module for parents of children with ASD. This study presents the development and validation of a culturally relevant, home-based psychosocial intervention module for parents of children with ASD in India. Unlike previous research that often focused on clinic-based or resource-intensive interventions, this module integrates evidence-based strategies with parental perspectives and expert input to address real-world challenges in resource-limited settings. Its novelty lies in combining child-focused techniques with parental well-being strategies within a structured eight-session format. By emphasizing accessibility, cultural sensitivity, and feasibility, this work contributes a practical and scalable model that complements existing treatments and bridges critical service gaps.
Methods:
The study was conducted in two phases between August 2022 and November 2023. Phase I (development of module): The module was systematically developed through literature review, semi-structured parent interviews, and multidisciplinary expert consultations to identify culturally relevant and feasible intervention components. The preliminary module, consisting of eight structured sessions that integrate behavioral, communication, and emotional regulation strategies derived from Applied Behavior Analysis (ABA) and play therapy principles, was developed based on these inputs. Phase II (validation): The drafted module underwent content and face validation by 15 domain experts using structured rating scales, and item-content validity index (I-CVI) values were computed for each session.
Results:
The development phase identified key parental challenges, including limited access to therapy, stigma, and financial constraints. In the validation phase, experts rated all module items as highly relevant (I-CVI = 0.86–1.00). Qualitative feedback emphasized the module’s clarity, contextual relevance, and practicality for Indian families.
Conclusion:
The validated intervention module offers a practical, evidence-based framework for ASD interventions in resource-limited settings. A further pilot study will evaluate its acceptability, usability, and impact on parental outcomes and symptom management.
Keywords
There is limited access to affordable, structured interventions for parents of children with autism in resource-limited areas. A structured, home-based psychosocial intervention module was developed and validated with expert input. The module was well-received and offers a practical, low-cost strategy to empower parents and support children with autism.Key Messages:
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by difficulties in social communication and interaction as well as restricted interests and repetitive behaviors. 1 Globally 0.76% prevalence of ASD has increased significantly among children in the past few decades. 2 Even though the awareness and early diagnosis accuracy have improved, many families from low and middle-income countries are facing significant difficulties in getting early intervention services. 3
Early intervention is essential for children with ASD, especially those with mild to moderate severity levels. Timely therapeutic support can significantly improve the outcomes in adaptive behavior, communication, and social functioning. 4 Evidence-based interventions, such as Early Intensive Behavioral Intervention and Applied Behavior Analysis (ABA), have shown that many children improve significantly in their development with early and structured support. However, access to these interventions is still insufficient, particularly in India.
In Tamil Nadu, despite increased awareness, many parents face long delays in identifying and accepting the child’s condition due to stigma, myths, and emotional barriers. These factors often postpone timely medical consultations. Even after a diagnosis, the families, especially in rural and semi-urban areas, usually struggle with identifying proper treatment or professional resources, such as behavioral therapy, occupational therapy, speech therapy, and special education, which are unavailable or located far away, making access to these services challenging both physically and financially for many families.
This reality highlighted an urgent need for accessible, sustainable, and supportive interventions that empower parents to support their children at home. To address this gap, the researchers initiated with the belief that a well-structured home-based psychosocial intervention module could provide essential guidance, serving either as a complementary resource alongside standard therapies or as a primary option for families with limited access to professional services. Such interventions aim to enhance child development, reduce the severity of autism symptoms, improve social skills, and decrease parental stress by allowing better understanding and interaction.
Parent-mediated interventions have been widely recognized for their potential to improve child outcomes and resilience within the family.5,6 They are particularly valuable in resource-limited settings such as India, where professional support is often inaccessible or unaffordable, making parents the most consistent agents of change in a child’s developmental progress. Programs such as the Pre-school Autism Communication Trial showed that involving parents in the therapeutic process can lead to long-term improvements in children’s social communication. 3 In the Indian context, psychoeducation-based modules have also shown promising results in reducing parental stress and improving parental knowledge about autism. 7
Based on these findings, this study addresses a pressing need in India for affordable and culturally appropriate autism interventions that parents can deliver in everyday settings. By developing and validating a structured, home-based psychosocial intervention module, the present work offers a low-cost, feasible solution that complements existing professional therapies and supports families in resource-limited contexts. The present study aimed to develop and validate a home-based psychosocial intervention module for parents of children with ASD. The objectives were to create a structured psychosocial intervention module for parents of children with ASD and to assess the content and face validity of the developed module through expert review.
Methods
Ethical Considerations
The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Approval for the study was obtained from the Institutional Ethics Committee (IEC NO: VMMC/PSYCHO/2022/01). Written informed consent was obtained from all parent participants before participation in semi-structured interviews. For experts involved in module validation, consent was obtained electronically. Participants were assured of confidentiality and informed that their participation was voluntary, with the right to withdraw at any stage without consequences.
As the study involved only interviews and expert validation, no direct clinical intervention was administered. However, if parents were identified as experiencing high levels of stress or expressed unmet clinical needs, they were sensitively referred to appropriate services within the institution for further evaluation and support.
The study followed the Template for Intervention Description and Replication checklist reporting guidelines, which have been uploaded as supplementary material.
Study Design
The study was conducted from August 2022 to November 2023 and consisted of two phases. Phase I involved the development of a psychosocial intervention module, and Phase II involved validation (content and face validity). The overall study design was a mixed-methods approach combining both qualitative and quantitative methods.
Phase I: Module Development
The home-based psychosocial intervention module for parents of children with ASD was created using a methodical, multi-phase approach that combined empirical research, real-world clinical experiences, and stakeholder feedback. The process included four structured steps: literature review, parent interviews, expert consultation, and synthesis into the final module.
Step 1: Literature Review
An extensive literature review was conducted between August and October 2022 using databases such as PubMed, Scopus, and Web of Science. The search strategy included combinations of keywords and Boolean operators such as “ ASD,” AND “parent-mediated intervention,” OR “home-based training,” OR “psychoeducation,” OR “behavioral therapy,” OR “ ABA.” The inclusion criteria were: (a) Studies published in English between 2013 and 2022, (b) interventions focusing on psychosocial, behavioral, or parent-mediated training for parents or caregivers of children with ASD aged 2–12 years, and (c) quantitative or qualitative studies reporting outcomes related to parental competence, child behavior, or psychosocial well-being. A total of 85 studies were initially screened based on titles and abstracts; 42 met the eligibility criteria and were reviewed in detail. Data were extracted and categorized using a narrative synthesis framework, identifying four core domains: (a) Behavioral regulation, (b) communication enhancement, (c) parental coping and stress management, and (d) social interaction and participation. These domains formed the conceptual basis for the initial structure and content of the intervention module.
Step 2: Semi-structured Interviews with Parents
To incorporate parental perspectives, semi-structured interviews were conducted with 12 parents (nine mothers, three fathers) of children with ASD attending the pediatrics and psychiatry outpatient departments of a tertiary care hospital in Karaikal. Participants were selected using purposive sampling to ensure representation from both urban and semi-urban backgrounds. After obtaining written informed consent, interviews were conducted in Tamil by a clinical psychologist trained in qualitative interviewing. Each interview lasted approximately 45–60 minutes. A semi-structured interview guide was developed to ensure consistency while allowing flexibility in discussion. Key domains include awareness about ASD, access to services, daily caregiving challenges, expectations from an intervention program, and family or cultural factors influencing caregiving. The complete parent interview guide is provided as Supplementary Online Material 1. Data were thematically analyzed, and key concerns such as psychoeducation topics, behavior management strategies, financial constraints, limited therapy access, stigma, and caregiver burden were integrated into the module content to ensure contextual relevance.
Step 3: Expert Consultation and Workshops
The third step involved informal consultations with professionals and participation in workshops on autism to gather real-world insights into the psychosocial and practical challenges experienced by families of children with ASD. This step aimed to deepen the understanding of contextual factors influencing intervention outcomes and to ensure the ecological validity of the module.
The researcher met with a multidisciplinary panel of eight experts, including clinical psychologists (n = 2), psychiatrists (n = 1), developmental pediatricians (n = 2), speech and language pathologists (n = 1), occupational therapists (n = 1), and special educators (n = 1), all of whom were actively involved in autism intervention and parental training programs. These consultations explore how professionals and parents collaborate in therapy, the nature of parent–child engagement, and the everyday challenges encountered in clinical and home settings. Semi-structured discussions were conducted using an interview guide that covered the following domains: Essential content areas for parent-mediated interventions, delivery format feasibility, cultural adaptation, and opportunities for interdisciplinary collaboration. Experts provided detailed qualitative feedback on session objectives, sequencing, and practicality in Indian family contexts. Their suggestions guided revisions to enhance clarity, feasibility, and cultural appropriateness. The expert interview guide is included as Supplementary Online Material 2.
In addition, the researcher attended professional workshops and focus group discussions. These sessions provided an opportunity to observe and document how professionals educate and empower parents, the strategies used to enhance adherence to therapy, and the integration of culturally sensitive adaptations into practice. Observations and notes from these interactions were analyzed thematically, focusing on feasibility, parental readiness, and cultural acceptability. The findings from this analysis informed the refinement of the module’s content, ensuring alignment with both clinical expertise and context-specific realities. This formative step strengthened the module’s practical relevance, ensuring that it addressed genuine needs and constraints faced by families in real-world conditions.
Step 4: Integration and Module Drafting
Inputs from the literature, parent interviews, and expert consultations were integrated to develop a module. Each session was structured with clearly defined objectives and integrated key principles from ABA, play therapy, and psychoeducation. To enhance parent engagement and understanding, the sessions included practical exercises, culturally relevant examples, and visual aids. The research team internally reviewed the draft module to ensure alignment with the study’s psychosocial objectives and feasibility for home-based implementation. Throughout the development process, particular attention was given to ensuring cultural relevance and accessibility. The materials were prepared in simple, non-technical Tamil and English, supplemented with culturally familiar illustrations and activities that reflect Indian family interactions and values. This module was primarily developed for parents of children with mild to moderate ASD, with adaptable strategies for varying functional needs.
Phase II: Validation of the Module
Expert Panel
The module underwent content and face validation by a panel of 15 experts from various domains: Child psychiatrists (n = 1); developmental pediatricians (n = 1); general pediatricians (n = 1); clinical psychologists (n = 3); psychiatrists (n = 2); psychologists (n = 3); speech and language pathologists (n = 1); special educators (n = 2); occupational therapists (n = 1). Experts were selected based on 5–10 years of professional experience in autism intervention, ensuring the module reflected both current standards and evolving practices. Each expert was contacted via email to confirm their willingness to participate in the module validation. Written informed consent was obtained, and participants’ anonymity was strictly maintained. The expert panel was provided with a draft version of the module and a structured feedback form designed to assess both content and face validity.
Validation Procedure
The validation process used a structured expert feedback form divided into two parts. Content validity: Each of the eight module sessions was rated on a 4-point Likert scale for relevance (1 = Not relevant to 4 = Highly relevant). Experts also provided qualitative comments or suggestions for each session. Face validity: Experts completed a checklist with binary (yes/no) responses to evaluate the content’s clarity, language suitability, objective alignment, practical applicability, and professional appearance. Additional space was provided for suggestions.
Ratings were compiled, and item-content validity index (I-CVI) scores were calculated for each session. Items with I-CVI ≥ 0.78 were considered valid. Qualitative suggestions were reviewed, and revisions were made to improve clarity, cultural relevance, and content delivery, informed by expert feedback.
Results
Phase I: Module Development
The development phase followed a systematic, multi-step process that integrated insights from the literature, parent perspectives, and expert input. The initial thematic literature review identified key domains relevant to psychosocial interventions for children with ASD. Common intervention components included parent-mediated approaches, structured behavioral reinforcement, play-based activities, and emotional regulation strategies. These evidence-based domains informed the module’s conceptual framework and structure.
Semi-structured interviews with parents of children with ASD (n = 9) attending the pediatric and psychiatry outpatient departments. The interviews revealed several recurring challenges, such as limited awareness about ASD, delayed acceptance of diagnosis, stigma associated with the condition, and difficulties in accessing specialized therapy services. They also expressed a strong need for practical, home-based guidance to manage behavioral and emotional concerns. These findings highlighted the need for a structured, culturally sensitive, and resource-feasible psychosocial intervention.
Consultations with the multidisciplinary expert panel, comprising clinical psychologists, psychiatrists, developmental pediatricians, speech therapists, occupational therapists, and special educators, helped refine the module’s content and structure. The experts emphasized the inclusion of behavioral management, communication enhancement, and parent well-being components as essential for family-centered care. Based on these insights, eight structured sessions were developed, each with defined objectives, activities, and outcome goals. The session content and structure are presented in Table 1.
Phase I resulted in the development of a culturally adapted, evidence-informed, and home-deliverable psychosocial intervention module for parents of children with ASD. The module aimed to enhance parental knowledge, promote behavioral and emotional management skills, improve communication strategies, and support overall caregiver well-being. The finalized module was subsequently subjected to content and face validation during Phase II.
Overview of the Preliminary Home-based Psychosocial Intervention Module.
Phase II: Validation of the Module
In Table 2, the I-CVI scores across the eight sessions ranged from 0.86 to 1.00, all of which are above the standard acceptability threshold of 0.78. This indicates that the module’s content was rated highly relevant and appropriate by a panel of 15 multidisciplinary experts. Specifically, sessions 1, 5, and 7 received perfect I-CVI scores of 1.00, suggesting unanimous agreement among all experts about the relevance and appropriateness of their content. Sessions 2 and 8 scored 0.93, while sessions 3, 4, and 6 scored 0.86, all within an acceptable and strong validity range. Minor suggestions for improvement included incorporating culturally sensitive examples, enhancing visual materials, and elaborating session goals with practical activities. These suggestions were reviewed and integrated into the final version of the module.
Items-wise Content Validity Index (I-CVI) Ratings for Each Session of the Intervention Module.
I-CVI: Item-level Content Validity Index.
Table 3 summarizes expert consensus ratings and suggestions for key aspects of face validity. The expert consensus for face validity items ranged from 85% to 100%, indicating strong agreement on the clarity, structure, and presentation of the intervention module. All experts agreed (100%) that the objectives were understandable and that the overall appearance was professional and appealing. Ninety-five percent found the content clear, and 90% agreed that the language was appropriate for the parent audience. A slightly lower consensus (85%) was observed for the practicality and engagement of activities, with suggestions to further enhance this aspect by including group-based exercises and using simpler terms. These responses affirm that the module is visually, linguistically, and structurally well-designed for the target population. Revisions were made to address all reasonable expert suggestions.
Expert Consensus on Face Validity Indicators and Suggestions.
Discussion
The psychosocial intervention module for parents of children with ASD in an Indian setting was developed using a rigorous, multi-step process that prioritized both evidence-based practice and local relevance. The initial step involved a board review of existing literature to ensure the module was grounded in evidence-based interventions, such as parent-mediated interventions, ABA, play therapy, and psychoeducation models, all of which are effective in improving child outcomes and parental well-being.7–9 This approach aligns with best practices in the field, which emphasize integrating scientific evidence with practical, real-world application.
Integrating parents’ lived experiences through semi-structured interviews was a crucial step in developing the module and in addressing the practical difficulties families encounter. In India, parents of children with ASD often have challenges in getting information and professional services, which makes them feel more stressed and isolated.7,10 By directly involving parents in the development process, the module addressed critical issues such as accessibility, limited resources, and the need for culturally sensitive strategies. In addition to making the intervention more appropriate, this collaborative strategy gave parents a sense of empowerment and involvement. 11
The incorporation of a multidisciplinary team, including clinical psychologists, psychiatrists, speech therapists, and special educators, further enhanced the module by integrating diverse clinical viewpoints and ensuring the information was accurate and applicable. This collaborative model is supported by the literature, which highlights the importance of a multidisciplinary team in the design and implementation of psychosocial interventions for ASD.11,12 The eight-week module that developed from this was primarily designed for use at home with minimal resources, combining behavioral, emotional, and parent-wellness strategies, making it particularly suitable for resource-limited environments.
Studies conducted in diverse settings, including low- and middle-income countries such as India and Iran, emphasize that embedding culturally relevant examples and engaging local community resources significantly enhance the acceptability and usability of such programs among parents.13,14 This culturally sensitive approach not only facilitates greater parental engagement but also addresses barriers related to stigma and social support, thereby aligning with contemporary research that advocates for the adaptation of psychosocial interventions to local contexts to optimize outcomes. Furthermore, systematic reviews and meta-analyses reinforce that integrating these contextual adaptations into parent-mediated and early behavioral interventions improves intervention adherence and child developmental outcomes. Consequently, advancing psychosocial interventions necessitates a comprehensive framework that prioritizes contextual sensitivity to enhance their effectiveness and sustainability within diverse populations.
In India, particularly in semi-urban and rural areas, it is often hard for families to access therapy or professional services for children with ASD. So, teaching parents how to help their children at home is especially important and practical. Parental training and home-based interventions have been shown to reduce stress, improve knowledge about ASD, and enhance child outcomes because the skills taught are used in real-life settings such as the home, making it easier for the child to learn and use them.7,9 Other studies in India show that parents appreciate these kinds of programs and are willing to take part. This proves that the idea works well and is practical in Indian communities.11,12 One of the best parts of the module is that it not only focuses on helping the child it also supports the parents’ mental and emotional health. Studies show that if parents are too stressed or mentally tired, it affects how well they can help their child. Their stress can also affect the overall mood and harmony at home. 10 Hence, helping parents feel better emotionally is very important for long-term success. This module provides parents with information and stress management techniques. As a result, parents can better support their child’s growth, feel more confident, and be emotionally stronger. Although the module demonstrated strong theoretical and expert-based validation, its real-world applicability and effectiveness require pilot testing to assess feasibility, parent engagement, and its impact on child outcomes. Findings from these studies will guide refinements to strengthen the module’s applicability, sustainability, and integration into standard care frameworks.
The developed module was designed to be flexible and adaptable across different levels of autism severity. The content primarily targets parents of children with mild to moderate ASD. Several strategies, such as individualized goal setting, visual communication supports, and structured behavioral reinforcement, can be modified for children with more significant challenges. The modular structure allows professionals and caregivers to tailor the pace, intensity, and focus of each session according to the child’s functional level and family needs. Such adaptability ensures broader usability of the module across the autism spectrum, making it relevant for diverse clinical and community contexts.
Strengths and Limitations
The key strength of this study is the systematic, multidisciplinary process followed in developing the module. By integrating evidence from literature, parental insights, and expert perspectives, the intervention was designed to be both evidence-based and culturally relevant. The focus on a home-based framework that addresses children’s needs along with parental well-being makes it particularly useful in resource-constrained settings where access to specialized care is limited. However, the study has certain limitations that must be acknowledged. First, the expert validation panel included only 15 members, which may not have represented all opinions across regional and institutional contexts. Second, the module validation was based on content and face validity measures; other psychometric properties such as construct validity, reliability, and usability were not formally assessed. Additionally, expert feedback was collected remotely, which may have limited interactive discussions and qualitative input. Future research should consider broader stakeholder input, such as caregivers from various sociocultural backgrounds, to improve the module’s generalizability. It is also recommended that future validation include pilot testing, feasibility testing, and a structured reliability analysis to further enhance and standardize the module for large-scale use.
Conclusions
This module was developed with the help of experts and parents, with the needs of families in resource-limited areas in mind. Validation through a multidisciplinary panel of experts confirmed the module’s content relevance, cultural appropriateness, and practical feasibility. High I-CVI scores across sessions and positive face validity ratings further support its potential applicability in real-world applications. However, before large-scale implementation, pilot testing, and feasibility studies are required to evaluate its practicality, parent engagement, and effectiveness across diverse populations. Findings from such future studies will guide further refinements to enhance usability, sustainability, and long-term impact.
Given the limited availability of multidisciplinary professionals across regions, this module offers a scalable, cost-effective solution. Policymakers and government agencies are encouraged to adopt this model as part of district-level training and awareness programs. By doing so, a large number of families can be reached with minimal resources. The module can also be adapted for digital delivery, enabling parents to register, complete the training online, and implement structured intervention techniques at home. This strategy holds promise for expanding access to early autism support services, even in the most resource-constrained environments.
Supplemental Material
Supplemental material for this article is available online.
Supplemental Material
Supplemental material for this article is available online.
Supplemental Material
Supplemental material for this article is available online.
Footnotes
Acknowledgements
The authors sincerely thank the parents who shared their experiences, and the panel of experts whose valuable feedback helped refine and validate the intervention module.
Copyright Statement
The authors confirm that all content and tables presented in this manuscript are original and developed by the research team. No copyrighted instruments were used in the development or validation of the intervention module. Where references to existing literature or theoretical models are made, these have been duly cited. The authors affirm that no copyrighted material requiring permission has been reproduced in this manuscript.
Data Sharing Statements
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Declaration Regarding the Use of Generative AI
None Used.
Ethics Committee Details
Name of the Institutional Ethics Committee/Independent Review Board: Vinayaka Mission’s Medical College and College, Vinayaka Mission’s Research Foundation (VMRF-DU), Karaikal, Puducherry, India. Approval Ref. No: IEC NO: VMMC/PSYCHO/2022/01. Date: 29/07/2022.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Informed Consent
Written informed consent was obtained from all participating parents for the interviews and validation process. Anonymity and confidentiality of all responses were strictly maintained. Experts who reviewed the module also provided informed consent before participating in the validation process.
Patient Consent
No identifiable patient information is included; therefore, patient consent is not required.
Prior Presentations
The authors confirm that no prior presentations, either in whole or in part, of the data presented in the study have been made.
Simultaneous Submission to Another Journal or Resource
The authors declare that this manuscript has not been submitted to, nor is it under consideration by, any other journal or resource simultaneously.
References
Supplementary Material
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