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<p>Background: Early detection and early intervention for autism spectrum disorder
(ASD) is critical because it can reduce the severity of core ASD symptoms, and result
in significant long-term improvements in language acquisition, social skills, cognitive
abilities, and adaptive behaviors. Involving caregivers in the delivery of early ASD
intervention is becoming increasingly important, particularly in low-resource settings,
due to limited access to specialist ASD services. Currently, there is no published
research on early ASD intervention in South Africa or sub-Saharan Africa (SSA). In
addition, there are no published descriptions of caregiver-child joint activity routines,
in which early intervention techniques can be embedded, or perceptions of the acceptability
of a caregiver coaching approach. </p><p>Study Aims: This study aimed to elicit qualitative
descriptions of caregiver-child joint activity routines in order to understand how
the Early Start Denver Model (ESDM), an evidence-based early ASD intervention, could
fit in a low resource South African setting. It also aimed to gauge the acceptability
of a caregiver coaching intervention from South African caregivers of young children
with ASD who received two taster sessions of caregiver coaching. </p><p>Methods: Participants
were recruited from the Western Cape Education Department autism waiting list through
convenience sampling. Four focus group discussions were conducted with 22 caregivers
of young children with ASD, which gathered data on caregiver-child joint activity
routines. Four additional families were recruited to participate in two caregiver
coaching sessions each. Four in-depth interviews were subsequently conducted with
the six caregivers from these families, which gathered data on joint activity routines
and acceptability of a caregiver coaching intervention. Data were analyzed through
a qualitative content analysis approach, which used a combination of inductive and
deductive methods to determine the salient themes and subthemes within the data.
</p><p>Results: Caregiver descriptions of joint activity routines aligned with ESDM
themes of object-based play, sensory social routines, and family routines. In object-based
play caregivers reported engaging in turn-taking with their children, teaching skills
across developmental domains, embracing child-directed activities, and managing challenges
related to play in resource limited settings. In sensory social routines, caregivers
described physical play, an awareness of the child’s affect and engagement, increased
child expressive communication, and willingness of the child to engage with different
play partners. In family routines, caregivers reported child participation in meals
and bath time. Caregivers reported that a caregiver coaching approach was acceptable
and that they had acquired a variety of skills, including strategies to enhance their
child’s social communication. Caregivers preferred receiving coaching in their homes
as opposed to in a clinic setting; however, limitations in physical space and financial
resources were important considerations. </p><p>Conclusion: Training caregiver coaches
and non-specialist workers narrows the treatment gap by providing access to children
in need of early ASD intervention. This is essential, because of the scarcity of
psychologists and psychiatrists working in mental health in low and middle-income
countries (LMIC). Descriptions from South African caregivers of caregiver-child joint
activity routines and acceptability of the caregiver coaching approach contextualize
the caregiver coaching intervention. These data will inform the adaptation and piloting
of an early ASD intervention within a low-resource South African setting.</p>
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