Naturalistic developmental behavioural interventions (NDBI) are a group of evidence-based early interventions for autism spectrum disorders (ASD). Caregivers can be trained to deliver NDBI strategies during interactions with their young child with ASD. However, NDBI research predominantly comes from high-income countries, and the evidence base for NDBI in low/middle-income countries (LMICs) and across cultures is lacking. To understand the ‘fit' of an NDBI approach in LMICs, it is crucial to understand and be able to measure the nature of interactions between caregivers and their children with ASD and the context wherein caregiver-child interactions occur. This study sought a) to evaluate the utility of a specific measure of caregiver-child dyadic interactions and b) to examine daily routines in which caregiver-child interactions occurred in low-resource South African contexts. Methodology Children with ASD (between 18-72 months old) and their ≥18-year-old caregivers were recruited under a larger project. Interactions of 21 caregiver-child dyads were video-recorded using a standardised parent-child interaction (PCI) protocol with two 6-minute-long free-play sessions (Part I: child explored the room and available toys while the caregiver remained seated; Part II: caregiver interacted with their child as they would at home). Two research-reliable raters rated the videos using 16 items from the Joint Engagement Rating Inventory (JERI), a 7-point Likert scale behavioural coding system. Reliability and descriptive analyses were conducted. Structured interviews were conducted with ten caregivers using the Parent Survey of Home and Family Experiences (PSHFE) to explore the context of daily routines. Descriptive analyses were performed. Results For caregiver-child interactions, observer agreement for 12 of 16 items was reasonable, with weighted kappas (within 1 scale point) of 0.66-1, an estimated accuracy of 88-99%, and percentage agreements of 75-100% for all items. Ratings for items across Parts I and II of the JERI showed variability without any ceiling effects. Six items showed floor effects. Most caregiver item ratings were at the mid-point of the 7-point Likert scale. In Part II, children used more expressive language and paid more attention to their caregivers. On the PSHFE, most children participated daily in various child routines, play and early literacy activities with mothers as main partners. Most children never participated in spiritual and community activities, typically due to the child's age, safety and other reasons not specified in interview response categories. Conclusion Reliability, floor/ceiling, behavioural and Part I vs Part II profiles suggested that the JERI, used for the first time in a South African context, has potential utility both to describe caregiver-child interactions and be used as an intervention outcome measure in LMICs. The PSHFE results provided contextual data of common daily activities into which NDBI strategies could be embedded to support child generalisation of skills in South Africa.

Introduktion: Det finns en stor variation avseende behov av stöd och anpassning i skolan för barn med autism utan intellektuell funktionsnedsättning. Begränsningar i social kommunikation, förmåga att se sammanhang, bristande exekutiv förmåga och känslighet för sensoriska intryck kan skilja sig mycket och är utmaningar skolan behöver ta hänsyn till. Tidigare forskning har visat brister i skolsituationen för dessa barn. Syfte: Syftet med denna studie var att undersöka föräldrars upplevelse av deras barns skolsituation, utifrån trivsel, skolfrånvaro samt stöd och anpassning i skolan. Metod: Studiens design är en kvantitativ empirisk tvärsnittsundersökning i form av en webbenkätundersökning riktad till ett bekvämlighetsurval av föräldrar till barn med autism utan intellektuell funktionsnedsättning i grundskoleålder med avseende att mäta föräldrars upplevelse av barnens skolsituation. Inalles 45 föräldrar deltog i enkäten. Resultat: Undersökningen visade att hälften av barnen ur ett föräldraperspektiv trivs dåligt eller mycket dåligt i skolan. Ungdomar på högstadiet upplevs ha sämre stöd än barn i andra skolstadier. Det finns en samvariation mellan stöd och anpassning gentemot frånvaro, där upplevd brist av stöd har ett samband med hög frånvaro. Över hälften av respondenterna uppgav att deras barn haft en frånvaro på 30 dagar eller mer senaste året utifrån upplevda brister i skolan. Individuell kartläggning, autismkompentens hos skolans personal, struktur och tydlighet samt stöd i socialt samspel är genomgående önskemål från föräldrarna. Slutsats: Särskilt föräldrar till barn på högstadiet upplever en bristande skolsituation. Kartläggning av barnets behov är betydelsefullt då detta kan skilja sig från att inte ha särskilt behov alls, till att behöva särskild undervisning vilket sambandet mellan bristande stöd och frånvaro synliggjorde. / Introduction: There is a great deal of variation in the need of support and adaptation in school for children with autism without intellectual disabilities. Limitations in social communication, ability to see context, lack of executive ability and sensitivity to sensory impressions can differ greatly and are challenges the school needs to consider. Previous research has shown shortcomings in the school situation for these children. Aim: The aim of this study was to investigate parents' experience of their children's school situation, based on well-being, school absence and support and adaptation in school. Method: The design of the study is a quantitative empirical cross-sectional study web-based survey aimed at convenience sample of parents of children with autism without intellectual disability in elementary school age dealing with parents' experience of their children's school situation. Totally 45 parents participated in the survey. Results: The survey showed that half of the children from a parental perspective feel bad or very bad at school. Young people in lower secondary school are perceived to have less support than children in other school stages. There is a covariation between support and adaptation to absence, where the perceived lack of support is associated with high absenteeism. More than half of the respondents stated that their children had an absence of 30 days or more in the past year based on perceived shortcomings in school. Individual mapping, autism competence among the school staff, structure, and clarity as well as support in social interaction are continuously requested by the parents. Conclusion: Parents of children in lower secondary school in particular experience a lack of school situation. Mapping the child's needs is important as this can differ from not having a special need at all, to needing special education, which made the connection between lack of support and absence visible.