A quality appraisal of cultural adaptation of caregiver-implemented interventions for young autistic children

Many evidence-based practices in autism aim to improve outcomes for both family and child. Caregiver-implemented intervention is one example of such evidence-based practice as it aims to strengthen caregivers’ capacity in a natural environment. Although caregiver-implemented interventions in early autism intervention are supported by research and used by many practitioners and families, marginalized families of young autistic children from diverse cultural or linguistic backgrounds require additional adaptations to these interventions for increased contextual fit. Without these adaptations, interventions may not be equitably accessible among marginalized families who are underrepresented in autism research. While literature suggests that cultural adaptation of interventions may be an effective way to ensure equitable implementation, it is still difficult to claim its effectiveness among these populations without appraising the quality and rigor of cultural adaptation. Therefore, we conducted a review of 16 studies of caregiver-implemented interventions that were culturally adapted or tailored using the Cultural Adaptation Checklist, a novel tool for appraising the quality of cultural adaptation based on the ecological validity framework and implementation science. The results revealed great variation and use of a wide range of practices in cultural adaptation. Limitations of current literature and implications for future research are discussed.