Implementing a parent-mediated intervention for toddlers with ASD within the Chinese child healthcare system: a...

Behavioural interventions remain the cornerstone of evidence-based practice for addressing the core symptoms of autism spectrum disorder (ASD). The Skill Training Program for Parents with ASD Children (STPAC) is a group intervention programme for parents and the first parent-mediated intervention programme developed by Chinese clinical practitioners. This study was conducted to evaluate the feasibility and effectiveness of STPAC within the context of routine child healthcare services in China.

This is a real-world, multi-site implementation study employed a single-arm, pre-post design. Between July 2023 and June 2025, 128 families of toddlers (aged 18-54 months) with suspected or diagnosed ASD were enrolled from two child healthcare settings. Participants received the 8-week, group-based parent training programme, which integrated didactic lessons, video modelling and individualised coaching. Outcomes were assessed at baseline and post-intervention using parent-reported measures: the Knowledge of Autism Intervention Questionnaire (KAIQ), the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) and the Parenting Stress Index-Short Form (PSI-SF). Statistical analysis included paired-samples t-tests to evaluate within-group changes, with effect sizes (Cohen's d) calculated to quantify the magnitude of improvement.

Parental knowledge of autism intervention strategies increased substantially (mean improvement=6.26 points, p<0.001; d=1.17). Child communication and symbolic skills also improved, with the CSBS DP total score rising from 35.30 to 40.88 (p<0.001; d=0.99), representing an overall improvement rate of 85.7%. Furthermore, parenting stress decreased from clinically significant to normal levels (mean reduction=3.70 points, p=0.005). The intervention was equally effective across diverse family demographics, and baseline child communication ability was the strongest predictor of post-intervention gains.

Despite an attrition rate of approximately 30%, STPAC demonstrated feasibility as a parent-mediated intervention delivered by trained local clinicians within routine child healthcare settings. Participation in the programme was associated with improvements in parental knowledge, child social communication and parenting stress. These findings provide preliminary evidence supporting the potential of STPAC to expand access to early ASD intervention, though confirmation in a randomised controlled trial is warranted.