Sub-Saharan Africa (SSA) has a scarcity of research on autism spectrum disorder (ASD) and available early interventions, as most of what is known about the disorder is from highincome countries. Early detection and intervention methods were found to have positive effects on developmental delays and to alleviate symptom severity in children with ASD or at risk of it. There is a need for scalable interventions in low-resource settings, which are characterised by a lack of highly-trained specialists, infrastructure and funding. This study explored the barriers and facilitators to implementing and sustaining a caregiver-coaching ASD early intervention, informed by the principles of the Early Start Denver Model (ESDM), adapted for South Africa and for delivery by non-specialists. The study also identified some changes that could be made to improve intervention adoption and sustainability. Nine multilevel stakeholders involved in the implementation of the caregiver-coaching intervention were purposively sampled, individual in-depth interviews were conducted, transcribed verbatim and thematically analysed. Major implementation facilitators included: ECD worker baseline ASD knowledge and experience; skills gained from the training received and coaching; clear in-session caregiver-coaching structure; value of strong team relationships; clear video illustration of intervention concepts; and the mastery and generalisation of skills by the ECD workers, ECD supervisors and caregivers. Implementation barriers included: the complexity of the intervention and coaching concepts; misalignment of ECD teacher training with the caregiver-coaching approach; logistical challenges; and mismatch of the video content with the South African context. Facilitators to sustain the intervention included: child outcomes; caregiver ‘buy-in;’ and competence; and the need for ongoing live supervision. Barriers to sustaining the intervention included: structural issues of poverty, transportation and unemployment. Positive child and caregiver outcomes could be offset by larger contextual and system-level issues such as poverty and the need for ongoing support, supervision and local coaching materials in South African languages. The results will inform tailoring of the intervention training and supervision approach for a larger pilot study.

L’augmentation du nombre d’enfants avec un trouble du spectre de l’autisme (TSA) accroît les demandes sur le réseau de la santé et des services sociaux du Québec. Les programmes d’accompagnement parental semblent une alternative intéressante pour répondre aux besoins des familles ayant un jeune enfant avec un diagnostic ou une suspicion de TSA. Par contre, peu de chercheurs se sont intéressés à l’expérience des parents qui sont pourtant les acteurs-clés de ce type d’intervention. Cette étude mixte séquentielle explicative vise à évaluer un programme d’accompagnement parental de 12 semaines pour des enfants de 12 à 30 mois avec une suspicion de TSA en considérant autant les effets sur l’enfant que son parent. Méthodologie : Pour le volet quantitatif (essai clinique randomisé croisé), les 19 dyades parent-enfant ont été randomisées dans le groupe Intervention (immédiatement) ou le groupe Liste d’attente qui devait attendre trois mois avant de recevoir l’intervention. Les données collectées via des questionnaires et par observation directe réalisés trois à quatre fois en fonction du groupe de randomisation ont été analysées à l’aide de statistiques descriptives, de comparaisons inter- et intra-groupe. Pour le volet qualitatif (exploratoire), une analyse thématique a été complétée pour le contenu des entrevues semi-dirigées effectuées auprès d’un sous-échantillon de 6 parents. Résultats : Globalement, le programme a été fortement apprécié (score médian = 3,625/4). Plus spécifiquement, le programme met en évidence un effet positif significatif de l’intervention sur l’engagement dyadique (p = 0,012; taille d’effet = 0,51). De plus, les habiletés cognitives (p = 0,010; taille d’effet = 0,57) et motrices (p = 0,071; taille d’effet = 0,38) des enfants se normalisent suite à la participation au programme. La quasi-absence d’effet sur le bien-être parental pourrait être améliorée en offrant davantage de soutien directement aux parents pendant les interventions plutôt que de se concentrer uniquement sur le développement des habiletés nécessaires à la stimulation de leur enfant. Conclusion : L’intervention d’accompagnement parental a eu des effets bénéfiques prometteurs sur la variable proximale (interactions parent-enfant) et, dans une moindre mesure, sur les variables distales (développement de l’enfant, bien-être parental et validité sociale). L’intervention gagnerait toutefois à être bonifiée afin de mieux répondre aux besoins de soutien des parents. / Abstract: The increase in the prevalence of autism spectrum disorder (ASD) puts pressure on the healthcare system. Parent-mediated interventions are an interesting alternative to answer the needs of families having a toddler with a diagnosis or a suspicion of ASD. However, few researchers have looked at parents’ experience during parent-mediated interventions even though parents are the main actors of these interventions. This sequential explanatory mixed study aims to evaluate a 12-week parent-mediated intervention for young children with a suspicion of ASD aged between 12 and 30 months by considering both parents’ and children’s outcomes. Methods: For the quantitative part (crossover randomized controlled trial), the 19 parent-child dyads were randomized either in the Intervention group or the Waitlist group (participants in this group had to wait three months before getting access to the intervention). Data were collected through questionnaires and direct observation three to four times depending on the group allocation. Quantitative data were analyzed using descriptive statistics as well as between and within group comparisons. For the qualitative part (exploratory), semi-directed interviews conducted with a subsample of six participants were analyzed thematically. Results: The program was globally highly appreciated (median score = 3.625/4). Specifically, there was a significant positive effect of the intervention on parent-child dyadic engagement (p = .012; effect size = .51). Furthermore, there was a normalization of children’s cognitive (p = .010; effect size = .57) and motor abilities (p = .071; effect size = .38) after the 12-week program. The near absence of effect on parental well-being could be fixed by targeting specifically parental support rather than focusing on their skills development. Conclusion: The parent-mediated intervention brings promising benefits on the proximal outcome (parent-child interactions) and, to a lesser extent, on distal outcomes (children development, parental well-being and social validity). Still, the intervention should be adapted to better answer parental needs.