Short Report: Pragmatic Adaptations of Telehealth-Delivered Caregiver Coaching for Children with Autism in the Context of COVID-19, Perspectives from the United States and South Africa

When COVID-19 disrupted autism spectrum disorder (ASD) research globally many clinical trials of behavioral interventions pivoted to telehealth. Telehealth has the potential to increase geographic reach and improve racial/ethnic diversity in research. This matters because most ASD intervention studies have primarily included White, upper-middle income families from North America and Europe. Participant homogeneity limits our ability to identify what types of intervention works in which context for which populations. Importantly, telehealth needs to ‘fit’ the local context, and in particular, include strategies that factor in the ‘digital divide’. This Short Report details contextual considerations and pre-implementation pragmatic adaptations in two ASD clinical trials that include Early Start Denver Model (ESDM)-informed caregiver coaching in the United States and South Africa. By comparing and contrasting how implementation context informed the telehealth pivot in these two clinical trials in different hemispheres we highlight equity considerations for adaption. The pandemic is an opportunity to understand how remote intervention can ‘fit’ diverse contexts, while providing valid scientific results. It is however important that adaptations be documented and feasibility of the adapted approach be tracked. COVID-19 related telehealth adaptations of behavioral interventions could facilitate the development of new strategies with wider global impact.