Efeitos da Intervenção Mediada pews Pais no Ensino de Competências de Comunicação Sociai a Crianças com Perturbações do Espetro do A utismo (PEA): uma Revisão Sistemática

ALKINJ, Issa; SANCHES-FERREIRA, Manuela; ALVES, Sílvia

doi:10.1590/1980-54702025v31e0191

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Literature Review • Rev. bras. educ. espec. 31 • 2025 • https://doi.org/10.1590/1980-54702025v31e0191 linkcopiar

Efeitos da Intervenção Mediada pews Pais no Ensino de Competências de Comunicação Sociai a Crianças com Perturbações do Espetro do A utismo (PEA): uma Revisão Sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO:

As intervenções mediadas pelos pais (Parent-mediatedinterventions – PMIs) são a maneira mais eficaz de atingir problemas de comunicação social e comportamentais em indivíduos com Transtorno do Espectro Autista (TEA). Esta síntese de pesquisa visa (a) identificar os tipos de programas PMI que foram usados para melhorar as habilidades de comunicação social de crianças com TEA e (b) registrar os resultados desses programas que foram relatados em pesquisas anteriores sobre crianças com TEA e seus pais. Foram utilizadas as diretrizes PRISMA para identificar os estudos sobre PMI publicados entre 2004 e 2022. Os bancos de dados digitais Scopus, ERIC, Web of Science e B-on foram rastreados para publicações relevantes, utilizando as palavras-chave “autism spectrum disorder” AND “home-based intervention” OR “parent-mediated intervention” OR “family-mediated intervention” AND “educational program” OR “training program” AND “social skills” OR “communication skills” nos títulos e/ou resumos dos estudos. Os critérios de inclusão foram os seguintes: estudos com programas de intervenção mediados pelos pais, que visassem principalmente as competências de comunicação social de crianças com TEA, publicados em inglês e que relatassem resultados em crianças com TEA. A pesquisa identificou 462 estudos, dos quais 37 foram elegíveis para inclusão na análise final. No geral, esses estudos mostraram que os PMIs foram eficazes na melhoria da comunicação social e de outras competências das crianças com TEA. Além disso, os pais demonstraram elevada fidelidade na implementação das intervenções, bem como uma perceção positiva, autoeficácia, satisfação e uma diminuição do stress. Foram discutidas as limitações dos estudos e as implicações futuras.

PALAVRAS-CHAVE:
Intervenção mediada pelos pais; Transtorno do Espectro Autista; Habilidades de comunicação social; Intervenção familiar

Study	Country	Research design	Participants with ASD			Dependent variables		Measures
Study	Country	Research design	Total N (control group)	Age months (Mean)	Male %	Child	Parent	Child	Parent
Ingersoll et al. (2016)	USA	A pilot RCT: pre-posttest-follow-up design.	27	19–73 (M = 12.71)	70	Social skills and language.	Fidelity, stress, perception, and self-efficacy.	MacArthur-Bates Communicative Development Inventory (MCDI), Vineland Adaptive Behavior Scales (VABS-II).	Project ImPACT fidelity checklist, Parent Sense of Competence Scale (PSOC), Family Impact Questionnaire (FIQ).
Stadnick et al. (2015)	USA	A pilot study: pre-posttest design.	30 (control = 14)	18–96 (M= 55.41)	81	Communication skills	Parental Stress	Vineland Adaptive Behavior Scales, (Vineland-II).	Center for Epidemiological Studies-Depression Scale (CES-D), Parenting Stress Index-Short Form (PSI-SF).
Roberts et al. (2011)	Australia	RCT: pre-post intervention, follow-up design.	84 (control = 28)	41.5–43.7 (M = 42.76)	90.5	Social interaction and language	Perception, stress, and quality of life	Vineland Adaptive Behaviour Scales (VABS-II), Reynell Developmental Language Scales (RDLS-III), The Pragmatics Profile, The Developmental Behaviour Checklist (DBC).	Parenting Stress Index (PSI), The Beach Family Quality of Life Questionnaire, The Parent Perception Questionnaire.
Brian et al. (2022)	Canada	RCT: pre-posttest-follow-up design.	179	14 – 34(M = 25.18)	72.6	Functional communication, Language, and ASD symptoms.	Fidelity	The Infant- Toddler Checklist (ITC), Autism Diagnostic Observation Schedule (ADOS-2), The Mullen Scales of Early Learning (MSEL), The Vineland Adaptive Behavior Scales (VABS-II), Survey Interview Form.	Video coding for checking parents’ fidelity.
Tripathi et al. (2022)	USA	A pilot study: Pre-posttest-follow-up design.	45	48 – 72 (M = 59.88)	79	Social, play, and behavioral skills.	Parental stress	Social Responsiveness Scale, 2^nd: School Age (SRS-2), Quality of Play Questionnaire (QPQ), Social Skills Improvement System Rating Scales (SSiS).	Parenting Stress Inventory, 4^th ed., Short-Form (PSI-4-SF).
Shire et al. (2022)	Canada	A Pilot – Randomized: Pre-posttest-follow-up design.	56	33–33.12 (M = 33.06)	NR	Joint engagement, play, and joint attention.	Fidelity	Mullen Scales of Early Learning (MSEL), Early Social Communication Scales (ESCS), Structured play assessment (SPA).	Caregiver-child interaction (CCX), Caregivers’ JASPER strategy use.
Li, Wu et al. (2022)	China	A pilot study: pre-posttest design.	68 (control = 33)	24 – 72 (M = 48)	82.4	Social communication, and language skills.	Stress, self-efficacy, and satisfaction.	The Social Responsiveness Scale (SRS), The Autism Treatment Evaluation Checklist (ATEC).	The Parenting Stress Index-Short Form (PSI-SF), Parental Self-Efficacy of Competence Scale.
Wainer et al. (2021)	USA	RCT: pre-posttest design.	20 (control = 10)	18-60 (M = 37.75)	80	Social communication skills	Fidelity, perception, self-efficacy, and quality of life.	Social communication checklist (SCC), Unstructured imitation assessment (UIA).	RIT parent fidelity form (RIT-PFF), Beach Center Family Quality of Life Scale (FQOL), Early Intervention Parenting Self-Efficacy Scale (EIPSES).
Stahmer et al. (2020)	USA	Quasi-experimental: Pre-posttest-follow-up design.	25 (control = 9)	22.46-23. 08 (M = 22.76)	68%	Social communication, and adaptive behavior	Fidelity, parent child interaction, and social support.	The Communication and Symbolic Behavior Scales-Infant Toddler Checklist (CSBS–ITC), MacArthur–Bates Communicative Development Inventory, Vineland Adaptive Behavior Scales (VABS- II).	Parent Participatory Engagement Measure, Social Support Index, Parent Interactions with Children: Checklist of Observations Linked to Outcomes, Project ImPACT for Toddlers-Parent Intervention Fidelity.
Ingersoll and Wainer (2013b)	USA	A pilot study: pre-post intervention design.	24	26 – 70 (M = 44.9)	77.7	Social engagement, language, imitation, and play.	Fidelity, and stress.	The Social-Communication Checklist (SCC), the Social Responsiveness Scale (SRS), Observation parent- child interaction.	The ImPACT Fidelity Rating Scale, the Parenting Stress Index 3rd. ed (PSI), the Behavioral Intervention Rating Scale (BIRS) to assess project impact acceptability.
Prelock et al. (2011)	USA	A Pilot study: pre-posttest design.	4	37 – 69 (M = 56)	75	Social interaction, and language.	Satisfaction, and perception.	The Communication Symbolic Behavior Scale, Developmental Profile (CSBS-DP), the MacArthur-Bates Communicative Development Inventories (MCDI), Caregiver questionnaire, and the examiners’ CSBS-DP observations.	Satisfaction survey, interview.
Yoder et al. (2021)	USA	RCT: pre-posttest-follow-up.	97 (control = 48)	12-18 (M = 14)	55	Intentional communication, expressive language, play, and motor skills.	Fidelity.	The Semi-Structured Imitation Scale (SSIS), Adapted Legerstee Imitation Task (ALIT), the Communication and Symbolic Behavior Scales-behavior sample (CSBS), Brief Observation of Social Communication Change (BOSCC), Developmental Play Assessment (DPA), MacArthur-Bates Communicative Development Inventory (MCDI), the Mullen Scales of Early Learning (MSEL), the Autism Diagnostic Observation Scale (version 2, ADOS-2).	Three observers using Procoder for Digital Video, Frost’s Naturalistic Developmental Behavioral Intervention code (adapted).
Turner-Brown etal. (2019)	USA	RCT: Pre-posttest design.	49 (control = 17)	29.6-29.7 (M = 29.65)	81	Social communication skills, and ASD severity.	Stress, quality of life, and fidelity	The Autism Diagnostic Observation Schedule (ADOS2), The Services/Intervention Questionnaire, The Mullen Scales of Early Learning (MSEL), the Parent Interview for Autism-Clinical Version (PIA- CV).	The Parenting Stress Index: Short Form (PSI–SF), The RAND-36 = healh-related quality of life (HRQoL) survey instrument, The Parent Implementation Rating Form (PIRF), FITT Fidelity Forms, Parent Feedback Form.
Penney and Schwartz (2019)	USA	A multiple baseline design: pre-post intervention.	3	48 – 65 (M = 57.66)	66.6	Social imitation	Fidelity, and satisfaction.	Videos coding – observation.	RIT fidelity form = video coding + Inter observer agreement, satisfaction survey.
Sengupta et al. (2020)	India	Quasi-experimental pre-posttest design.	57	12-72 (M = 43.2)	84	Social engagement, expressive language, and social imitation.	Stress, fidelity, and satisfaction.	The Social Communication Checklist.	Video coding for parents’ Fidelity of Implementation, A Family Satisfaction Survey, The Parenting Stress Index-Short Form (PSI-SF)-3rd ed.
Liao et al. (2022)	USA	A multiple baseline design: pre-posttest-follow-up.	3	60–180 (M = 104)	100	Social communication skills	Fidelity.	Video coding – Observation.	Video coding – Observation.
Meadan et al. (2016)	USA	A multiple-baseline design: pre-post intervention.	3	24 – 48 (M = 36)	66.6	Social initiation and responsive communication skills.	Fidelity, and satisfaction.	Video coding – Observation.	A fidelity checklist, interviews.
Shire et al. (2017)	USA	RCT: pre-posttest-follow-up.	85 (PEI = 42)	> 36 (M = 31	82	Joint engagement and language.	Fidelity.	Video coding, The Mullen Scales of Early Learning (MSEL).	The Maternal Behavior Rating Scale (MBRS), JASPER strategy use -Video coding.
Hernandez-Ruiz (2018)	UK	A pilot study: pre-posttest design.	3	30 – 36 (M = 33)	66.6	Social interaction skills.	Stress, fidelity, self- efficacy, and perception.	The Social Responsiveness Scale-2 (SRS-2).	Parental Sense of Competence, K-6 Scale/ For parents’ mental health, Survey.
Rollins et al. (2016)	USA	A Multiple-baseline design: pre-post intervention.	4	28 -33 (M = 30.25)	100	Eye contact, social engagement, turn taking, and verbal reciprocity.	Fidelity, and perception.	Video coding – Observation – Interobserver agreement.	Parents fidelity checklist, questionnaire.
Sengupta et al. (2021)	India	Mixed methods: pre-posttest design.	22	24 – 108 (M = 61.95)	86.3	Communication, social interaction, and adaptive behavior.	Stress, fidelity, and perception.	Vineland Adaptive Scales (VABSII), Social Communication Checklist (SCC), Video coding.	The Adult–Child Interaction Fidelity Scale (video coding), The Caregivers Skills, and Knowledge Measure (WHO-CST Team), The Parenting Stress Index-Short Form (PS1-SF)—3^rd ed.
Glumbic et al. (2022)	Serbia	A pilot: pre-posttest design.	36	48-102 (M= 71.52)	69.4	Speech, Language and Communication skills.	Perception.	The Autism Treatment Evaluation Checklist (ATEC).	Caregivers Feedback Form.
Green et al. (2017)	UK	RCT: pre-posttest-follow-up design.	54 (control = 26)	9 – 36 (M = 22.5)	NR	Communication, language, and ASD symptoms.	Not Reported	The Autism Diagnostic Observation Schedule 2^nd. ed., Manchester Assessment of Caregiver–Infant Child interaction (MACI), The Dyadic Communication Measure for Autism (DCMA), The Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales (VABSII).	-
Manohar et al. (2019)	India	RCT: pre-posttest-follow-up design.	50 (control = 24)	24 – 72 (M = 42.6)	84	Imitation skills, visual response, communication, and ASD severity symptoms.	Stress, fidelity, and perception.	The Childhood Autism Rating Scale (CARS), Vineland Social Maturity Scale.	Family Interview for Stress and Coping (FISC), 10 Point Visual Analog Scale for Parental and Child-Related Outcome Measures, Fidelity survey.
Brian et al. (2016)	Canada	A multi-site pilot study: pre-post-follow-up design.	20	12 – 32 (M = 22.05)	70	Communication skill (responsivity, initiations), and language skills.	Fidelity, and satisfaction.	The Autism Observation Scale for Infants (AOSI), The Mullen Scales of Early Learning (MESL), video coding.	Fidelity = video coding, satisfaction questionnaire.
Youn Kang and Kim (2020)	USA	A multiple baseline design: pre-post intervention – follow-up.	3	36 – 84 (M = 56)	100	Verbal and non-verbal initiations, and responses skills.	Satisfaction.	Video coding – Observation, The Developmental Play Assessment (DPA).	Social validity questionnaire.
Schertz et al. (2013)	USA	RCT: Pre-posttest-follow-up design.	23 (control = 12)	> 30 (M = 24.6)	NR	Joint intention, receptive language, and social skills.	Fidelity.	The Precursors of Joint Attention Measure (PJAM), Video coding for parent-child interaction, the Mullen Scales of Early Learning (MSEL), the Vineland Adaptive Behavior Scales (VABS).	The Fidelity Checklist.
Schertz et al. (2018)	USA	RCT: Pre-posttest-follow-up design.	144 (control = 71)	16-30 (M = 24.55)	79.4	Preverbal social communication	Fidelity.	Video coding, the Communication and Symbolic Behavior Scales (CSBS).	Parent Implementation Fidelity Checklist, the Maternal Behavior Rating Scale Revised (MBRS-R).
Rogers et al. (2019)	USA	RCT: pre-posttest-follow-up.	45	12 – 30 (M = 25.2)	68.8	Social, adaptive behavior, and ASD severity.	Fidelity, and Satisfaction.	Video coding Interobserver agreement, Early Screening of Autistic Traits Questionnaire (ESAT), Infant Toddler Checklist (ITC), The Modified Checklist for Autism in Toddlers (M-CHAT), The Autism Diagnostic Observation Scale for Toddlers (ADOS-T), Mullen Scales of Early Learning, Vineland Adaptive Behavior Scales (VABS II), Child Behavior Checklist for 1–5 Years (CBCL), Child Intervention History (Version 6-10-13).	The ESDM Fidelity Rating System, Parent Satisfaction Survey.
Killmeyer et al. (2019)	USA	A multiple-baseline: pre-posttest-follow-up design.	3	27 – 34 (M = 31)	100	Eye contact	Fidelity, and satisfaction.	The Communication and Symbolic Behavior Scales Developmental Profile-ITC (CSBS DP-ITC), the Mullen Scales of Early Learning (MSEL), the Early Learning Composite (ELC), Videos coding – observation.	Implementation fidelity form, parent satisfaction form.
Wainer and Ingersoll (2013)	USA	A multiple-baseline design: pre-posttest intervention.	8 (therapist = 5, parents = 3)	26 – 88 (M = 58)	100	Social imitation skills.	Fidelity, and satisfaction.	Video coding – observation, Inter-Observer agreement, the Behavioral Intervention Rating Scale (BIRS).	RIT fidelity form, treatment acceptability questionnaire.
Carter et al. (2011)	USA	RCT: pre-posttest-follow-up.	62 (control = 30)	15-25 (M =20.25)	82.2	Communication skills and object interest.	Fidelity, and satisfaction.	The Screening Tool for Autism in Two-Year-Olds (STAT), The Mullen Scales of Early Learning (MSEL), The Vineland Adaptive Behavior Scales 2^nd, The Autism Diagnostic Observational Schedule (ADOS), The Early Social Communication Scales (ESCS), The Developmental Play Assessment (DPA).	Parent Interview for Autism-Clinical Version (PIA-CV), The Parent-Child Free Play Procedure (PCFP) Video coding. Fidelity of Treatment Implementation (FOT), A Consumer Satisfaction Survey, A Non-Project Treatment Questionnaire.
Bagaiolo et al. (2017)	Brazil	Quasi- experimental: pre-posttest design.	67 (control = 33)	36 – 72 (M = 57.72)	82.1	Eye contact, join attention, and disruptive behavior.	Fidelity.	The Brazilian version of the ADI-R SON-R 21/2-7-IQ, the Autism Behavior Checklist (ABC), the Vineland Adaptive Behavior Scales, the Child Behavior Checklist (CBCL), SNAP-IV Rating Scale to evaluate attention-deficit hyperactivity disorder (ADHD), The Adult Self-Report Scale (ASRS-18).	Questionnaire.
Laugeson et al. (2009)	USA	RCT: pre-posttest design.	33 (control = 16)	156-204 (M =175.2)	84.8	Social skills	-	Vineland Adaptive Behavior Scales (VABSII), Social Skills Rating Scale (SSRS), The Quality of Play Questionnaire (QPQ), Test of Adolescent Social Skills Knowledge (TASSK), Friendship Qualities Scale (FQS).	-
Solomon et al. (2007)	USA	A Polit study: pre-posttest design.	68	24 – 84 (M = 44.4)	75	Social- emotional functional skills.	Satisfaction.	The Functional Emotional Assessment Scale (FEAS), Video coding-observation.	Client satisfaction survey.
Nefdt et al. (2010)	USA	RCT: pre-posttest design.	27 (control = 14)	60 < (M=38.92)	92.6	Functional verbal utterances.	Fidelity, and satisfaction.	Video coding – observation.	Video coding – observation, questionnaire.
Klein et al. (2021)	USA	RCT: pre-posttest design.	15	24 – 28 (M = 26.84)	66.6	Social communication, adaptive skills, and severity of ASD.	Fidelity, and satisfaction.	The Brief Observation of Social Communication Change (BOSCC), The Mullen Scales of Early Learning (MSEL), The Vineland Adaptive Behavior Scales (VABSII + III).	Caregiver VF survey, Video coding – observation.

Study	Intervention approach	Intervention			Intervention outcomes
Study	Intervention approach	Intervention format	Duration	Setting	Child	Parent
Ingersoll et al. (2016)	Improving Parents as Communication Teachers (ImPACT).	Online ImPACT: Self-Directed (SD) vs Therapist-Assisted group (TAG)	lhl5mins (SD) vs 3h 45mins (TAG) weekly 12/24 weeks.	Online	Both groups showed significant improvement on language skills, and only children in TAG showed significant improvement on social skills and maintained at follow-up. No effect on motor and daily living skills.	TAG group showed higher fidelity and positive perceptions than SDG. Also, parents in both groups showed self-efficacy and less stress on the post-test (no differences).
Stadnick et al. (2015)	ImPACT	ImPACT group received individual didactic instruction vs Community based-services group.	1 h weekly session/ 12 weeks.	Center	Significant improvement in communication skills over TAU.	Decrease in Parental stress due to changes in child’s social skills
Roberts et al. (2011)	Building Blocks	Centre-based program (CB) = six play training groups vs Home-based program (HB) = Individual visits vs non-treatment group (WL).	2h–20 weekly sessions (HB)/40 weeks (CB).	Home + Center.	Both groups showed significant increase in social interaction, and language skills, however, Children in the CB group improved significantly more than HB and WL groups on some social and communication measures.	Parent in CB group making the most gains in perception of competence and quality of life and decrease in stress over HB and WL groups.
Brian et al. (2022)	The Social ABCs.	Individual in-home training on The Social ABCs program.	1.5h - 12 weeks training/ 24 weeks.	Home	Significant improvements in language and functional communication skills and decrease in ASD symptoms.	High fidelity which was associated with their toddlers’ outcomes.
Tripathi et al. (2022)	The Program for the Education and Enrichment of Relational Skills (PEERS®)	Parents and children received group training (8-10) using PEERS curricula (adapted version).	1.5h weekly session/ 16 weeks.	Clinic	Significant improvements and maintained the social and play skills after 1 -5 years of intervention, and post-treatment improvements on behavioral problem, bur did nor maintain ar follow up.	Decrease in parental stress but was not maintained at follow-up.
Shire et al. (2022)	Joint Attention, Symbolic Play, Engagement and Regulation intervention (JASPER)	Individual and group training for both JASPER with coaching only vs JASPER with observation and coaching.	2h weekly sessions/ 12 weeks.	Home + Center	No difference between both groups, all participants showed significant growth in joint engagement, play diversity, and joint attention.	Both groups showed significant gains in strategy use. Practitioners showed high fidelity in both groups.
Li, Xu et al. (2022)	ImPACT	Group training on online ImPACT program vs waitlist group.	1.5h weekly session/ 8 weeks.	Online	Significant improvements on social communication, and sociability skills in favor ImPACT group, and no significant effects on language.	Decrease in parental stress and high self-efficacy over WLG, no significant effect on parent satisfaction.
Wainer et al. (2021)	Reciprocal Imitation Training (RIT).	Individual RIT online training vs treatment as usual (TAU).	6-10 weeks training/ 15 weeks (Time NR).	Online	Significant improvements on social skills over TAU group, no difference in imitation skills.	High acceptability and feasibility of the Online RIT digital intervention, no difference between groups in imitation ability and family quality of life, parents in IG showed higher fidelity and self-efficacy
Stahmer et al. (2020)	ImPACT	Individual training on ImPACT program vs Usual Care group (UCG).	2.5h weekly sessions/ 12 weeks.	Home + center	Significant improvement in social communication skills over UCG, no significant difference in adaptive skills. Also, significant improvements in positive parent—child interactions in favor of ImPACT group.	ImPACT group shows higher fidelity, supportive parenting behavior, and engagement in the intervention. No difference in social support.
Ingersoll and Wainer (2013b)	ImPACT	Group and individual training on ImPACT strategies.	2h. 45mins weekly/ 16 weeks.	Special school	Significant improvement in language and social engagement skills, decrease of social impairment, and no effect on imitation and play skills.	High fidelity and decrease in parental stress.
Prelock et al. (2011)	More Than Words (MTW)	Group training MTW strategies + home visit to assess child’s skills vs Joint Attention Training (JAT) to assess professionals’ impressions about collaborating with families.	2.5h/ 8 sessions/16 weeks.	School + Home	All participants increased their social interaction and vocabulary development.	High satisfaction and positive perspective about the intervention (MTW). Interventionist impressions were positive about collaborating with families to select intervention approach (JAT).
Yoder et al. (2021)	ImPACT	Individual in-home training on ImPACT program vs control group.	5h weekly sessions/ 12 weeks/	Home	Improvements on children intentional communication, expressive language, and play. No effects on motor skills.	Increased the use and generalization of ImPACT strategies.
Turner-Brown etal. (2019)	Family Implemented TEACCH for Toddlers (FITT).	20 individually in-home training sessions + 4 clinic group sessions on TEACCH strategies (adapted) vs Treatment as Usual group (TAU).	1.5h-24 sessions/ 24 weeks.	Home + clinic	Significant effects on social communication skills particularly higher score on imitation skills of ASD over CG. No effects on general child measures.	Significant decrease in stress, improved well-being over time and high fidelity.
Penney and Schwartz (2019)	Reciprocal Imitation Training (RIT)	Individual training on Reciprocal imitation training (RIT) + group training = 90 minutes for once.	1.5h + lh40 mins weekly/6 weeks.	Home	All three children increased in social imitation.	Parents met the fidelity after training and were satisfied with program implementation.
Sengupta et al. (2020)	ImPACT	Group training on adapted ImPACT (2h – 6 weeks) + individual coaching in-home sessions (1h a week).	2h- weekly session/ 6 weeks.	Home + center	Significant Increased in social communication (social engagement, expressive language form and function, understanding and following directions, and social imitation), particularly, social engagement.	High fidelity and satisfaction and decrease in the stress.
Liao et al. (2022)	Multimodal communication intervention.	2h webinar group training + individual training sessions on behavioral strategies e.g., prompting, reinforcement, modeling.	2h ₊ (6.5-19.6 mins a session) 12-13 sessions /6 weeks.	Online + home.	Improvements in social communication skills (requesting, asking questions, and spontaneous comments).	Parents learned intervention strategies – positive moderate correlation between parents’ implementation and children’s outcomes.
Meadan et al. (2016)	Internet-Based Parent-Implemented Communication Strategies [i-PiCS]).	Online training (Skype)- iPiCS, with provision feedback to implement 3 naturalistic teaching strategies: (1) modeling, (2) mand-model, and (3) time delay.	45 mins + lh weekly sessions ∕ 14 weeks.	Online	Increased social initiation and responsive communication skills for all participants with ASD.	Parents learned the strategies of intervention with fidelity after receiving skype training, and high satisfaction with intervention.
Shire et al. (2017)	Joint attention, symbolic play, engagement, and regulation (JASPER)	Individual training on JASPER strategies vs psychoeducation program (PEI).	lh weekly session/ 10 weeks.	Center	All participants in JASPER group achieved significant improvement on joint engagement over PEI group. No differences on development level (MSEL).	JASPER group showed high responsivity and fidelity and maintained after 6 months over PEI group. Parent responsivity was associated with child joint engagement.
Hernandez-Ruiz (2018)	Early Start Denver Model (ESDM)	Group music therapy training based on the P-ESDM to coach parents in the use behavioral strategies.	2h weekly sessions ∕ 6 weeks.	Clinic	Improvements in social interaction skills for all children.	High efficacy -learned the principles of ESDM, showed high competence, 2 mothers showed decrease in stress, one mother no change (no stress in pre-posttest). Also, mothers rated the intervention as acceptable and enjoyable.
Rollins et al. (2016)	Early Identification and Intensive Behavioral and Developmental Intervention (EIBDI).	In-home individual visits by therapist to coach parents on EIBDI strategies (6 units).	1.5h weekly - 16 sessions/ 8 weeks.	Home	3 out of 4 participants showed moderate to high increase in eye contact, social engagement, and verbal reciprocity but only 2 children improved in nonverbal turn taking.	High fidelity and positive perception about intervention.
Sengupta et al. (2021)	World Health Organization (WHO) program.	The WHO-CST program consists of 2h- 9 group sessions, and 3h- 3 home visits to promote child learning and development through parent-child home activities and play routines.	2-3h- 12 sessions/ 12 weeks.	Home + special school	Participants showed significant improvements in communication, social interaction, and adaptive behavior (daily living skills).	High attendance, and fidelity, and rated the program as feasible, increased in their knowledge and skills, and decrease in level of stress.
Glumbic et al. (2022)	World Health Organization (WHO) program.	The WHO-CST program consists of 2h-9 group sessions, and 3h- 3 home visits to promote child learning and development through parent-child home activities and play routines.	2-3h- 12 sessions/ 12 weeks.	Home + special school	Significant improvement in Speech, Language and Communication skills.	Parents rated the program positively and useful and increased their knowledge.
Green et al. (2017)	iBASIS-Video Interaction for Promoting Positive Parenting (iBASIS-VIPP)	iBASIS-Video Interaction for Promoting Positive Parenting (iBASIS-VIPP) is in-home training, uses video-aided feedback therapy to help parents of ASD to understand and adapt to their infant’s communication style.	12 sessions/20 weeks (time NR).	Home	Significant improvement in attention and communication initiation skills, and maintained at follow up, decrease in ASD symptoms, and no effect on language.	NR
Manohar et al. (2019)	Naturalistic Developmental Behavioral Interventions (NDBI)	Individual five home visits by therapist to coach parents on the use of NDBI strategies.	5 sessions/ 12 weeks (time-NR).	Home	Significant improvements on imitation skills, visual response, communication, and decrease in ASD severity symptoms over control group – and maintained in follow-up.	High fidelity, significant decrease in parental stress, and rated the intervention as acceptable and feasible.
Brian et al. (2016)	The Social ABCs	Individual in-home training consists of 8 weeks vivo coaching + 4 weeks consultation through email or phone, and 12 weeks implementation without assistance.	1-1.5h- 12 weeks training/ 24 weeks.	Home	Significant improvements on functional communication skill and language skills but did not maintain the skills at follow-up.	High fidelity and satisfaction.
Youn Kang and Kim (2020)	Social stories and Self-modeling	Individual in-home training on using social stories and self-modeling through play activities.	3-4 weekly sessions/ 8 weeks.	Home	Significant improvements in verbal and non-verbal initiations, responses skills and maintained the gains at the follow-up.	High satisfaction.
Schertz et al. (2013)	Joint Attention Mediated Learning (JAML)	Individual in-home training on JAML strategies including focusing, planning, encouraging, giving meaning, and expanding.	30 mins daily + 15 home visits/ 12 weeks.	Home	Participant in JAML group showed significant improvement in joint intention, receptive language, and social skills and maintained the skills at follow-up.	High fidelity.
Schertz et al. (2018)	Joint Attention Mediated Learning (JAML)	Individual in-home training on JAML strategies.	1h – weekly sessions /32 weeks.	Home	Significant improvement on preverbal social communication and maintained the outcomes after 6- months.	High fidelity.
Rogers et al. (2019)	Early Start Denver Model (ESDM).	P-ESDM – received 1. 5h – 12 weekly clinic visits vs P-ESDM++ – received additional procedures motivational interviewing, multimodal learning tools, and extra 1.5-h home visits weekly for 12 weeks.	1.5h-(12-24) sessions/12 weeks.	Clinic + home	Both groups showed significant decrease in ASD severity, and significant improvement in social, and adaptive behavior.	P-ESDM ++ group showed more significant interaction skills than basic group. Also, both groups showed high satisfaction, and fidelity (no difference). Positive correlation between parental fidelity and children’s improvements.
Killmeyer et al. (2019)	Reciprocal Imitation Training (RIT)	Individual training on contingent imitation (CI) strategies including didactic teaching, responding to their questions, modeling the technique with parents’ observation, and feedback.	45 mins – 3 weekly sessions/ not specific.	Home	Two children showed high increase and one with moderate in their social eye gaze and maintained at follow-up.	High fidelity and satisfaction.
Wainer and Ingersoll (2013)	Reciprocal Imitation Training (RIT)	2 weeks RIT online training through university software (self- directed). Post training: parents receive live coaching at home by experts if they are unable to reach the fidelity.	2 weeks training + 40 mins – 12 sessions ∕ 4 weeks.	Online	High increase in social imitation skills.	Parents and therapists met the fidelity, learn the techniques, and were satisfied with the intervention, and rated the program as useful and acceptable.
Carter et al. (2011)	More than Words’ (MTW)	HMTW training consists of 8 group sessions with parents only + 3 in-home individualized parent-child sessions to increase playful parent- child interactions.	11 sessions/14 weeks – time not specific.	Center + home.	Moderate increase in communication skills and object interest at post-intervention and moderate decrease at the follow-up.	High fidelity and satisfaction.
Bagaiolo et al. (2017)	Video modeling based on applied behavior analysis (ABA).	Group training including 14 videos created by clinicians covering management of disruptive behaviors, eye contact and joint attention to be implemented at home – one video a week (14 sessions) + 8 sessions to discuss parents doubts about the videos.	1.5h – 22 sessions/ 12 weeks.	Clinic	Improvement in eye contact and join attention and decrease in disruptive behavior.	Parents learned to use a teaching strategy, and the technique was feasible.
Laugeson et al. (2009)	PEERS	Parents and teens received group training on adapted social skills program (PEERS) for teens.	1.5h - 12 weekly sessions/ 12 weeks.	Clinic	Significant improvements in their knowledge of social skills, increased frequency of hosted get-togethers, and improved overall social skills over the control group.	NR
Solomon et al. (2007)	The PLAY Project Home Consultation (PPHC)	One day workshop about play-based on DIR/Floortime model + 15h weekly one to one interaction with their child through daily routines. Also, 3-4h monthly home visits.	3-4h monthly visit + 15h weekly ∕ 48 weeks.	Home	Significant increase in social- emotional functional skills, no effects on ASD severity.	High satisfaction.
Nefdt et al. (2010)	Pivotal Response Treatment (PRT)	Self-directed learning program (SDLP) based on pivotal response treatment (PRT) through DVD, which was sent by mail.	66 mins each video/ NR.	Home	Significant increase functional verbal utterances over control group.	High fidelity and satisfaction.
Klein et al. (2021)	Naturalistic developmental behavioral interventions (NDBI)-Video Feedback (VF).	NDBI – No VF = 3h weekly coaching (lh at center, and 2h at home) + 6 group classroom intervention by clinicians vs. NDBI+VF = parents received the same with extra 10–15 mins weekly video feedback.	3h - weekly sessions/ 24 weeks.	Clinic + home	Both groups showed significant improvements in social communication skills, adaptive skills, and a decrease of severity of ASD. However, NDBI+VF achieved additional gains on adaptive behavior and behavioral problems.	Parents in VF showed high satisfaction, and parents in both groups showed high fidelity.

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