title: Adapting an evidence-based intervention for autism spectrum disorder for scaling up in resource-constrained settings: the development of the PASS intervention in South Asia.
abstract: BACKGROUND
  Evidence-based interventions for autism spectrum disorders evaluated in high-income countries typically require highly specialised manpower, which is a scarce resource in most low- and middle-income settings. This resource limitation results in most children not having access to evidence-based interventions.
  
  
  OBJECTIVE
  This paper reports on the systematic adaptation of an evidence-based intervention, the Preschool Autism Communication Therapy (PACT) evaluated in a large trial in the United Kingdom for delivery in a low-resource setting through the process of task-shifting.
  
  
  METHODS
  The adaptation process used the Medical Research Council framework for the development and adaptation of complex interventions, focusing on qualitative methods and case series and was conducted simultaneously in India and Pakistan.
  
  
  RESULTS
  The original intervention delivered by speech and language therapists in a high-resource setting required adaptation in some aspects of its content and delivery to enhance contextual acceptability and to enable the intervention to be delivered by non-specialists.
  
  
  CONCLUSIONS
  The resulting intervention, the Parent-mediated intervention for Autism Spectrum Disorder in South Asia (PASS), shares the core theoretical foundations of the original PACT but is adapted in several respects to enhance its acceptability, feasibility, and scalability in low-resource settings.
authors.affiliation: Sangath, Goa, India; gauri.divan@sangath.in.
authors.forename: Gauri
authors.initials: G
authors.lastname: Divan
authors.affiliation: Human Development Research Foundation, Rawalpindi, Pakistan.
authors.forename: Syed Usman
authors.initials: SU
authors.lastname: Hamdani
authors.affiliation: Sangath, Goa, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Vajartkar
authors.affiliation: Institute of Psychiatry, Rawalpindi, Pakistan.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Minhas
authors.affiliation: Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Aldred
authors.affiliation: Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Leadbitter
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Atif
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Green
authors.affiliation: Sangath, Goa, India.|Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003906:Developing Countries; D055416:Evidence-Based Emergency Medicine; D005195:Family Relations; D005260:Female; D014943:Global Health; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D007194:India; D008297:Male; D010154:Pakistan; D010290:Parents; D010988:Play and Playthings
keywords: adaptation; autism spectrum disorder; intervention; low-resource setting; task-sharing