# Tailoring treatment targets for early autism intervention in Africa

> **NIH NIH R21** · DUKE UNIVERSITY · 2020 · $167,317

## Abstract

The public health impact of autism spectrum disorder (ASD) is gaining global recognition. Early 
intervention for ASD is of critical importance because it improves outcomes and lessons long-term 
costs. Naturalistic Developmental Behavioral Interventions (NDBIs), are a type of empirically-based 
early ASD intervention methods that can be taught to caregivers, via caregiver-coaching. Caregiver 
use of NDBI strategies can promote child joint attention and affective engagement, which promote 
language acquisition - a key predictor of long-term functional outcomes. However, very little 
behavioral and developmental research that examines the principles and underlying assumptions of 
NDBIs has been performed outside of Western contexts. In addition, ASD research has 
disproportionately low representation from minority groups, multilingual families, and participants 
from lower socioeconomic status. Importantly, cross-cultural variation has been reported in NDBI 
treatment targets, such as core ASD symptoms and features of caregiver-child interactions. 
Fundamental gaps in our knowledge therefore remain on the validity of NDBI treatment targets, 
especially in multi-cultural  settings. In addition, objectively assessing NDBI response is a 
significant challenge. 'Gold standard' tools are costly, require trained professionals, and may not 
be culturally valid. MHealth tools that assess ASD biomarkers may help address this challenge by 
enabling point-of-care detection by non-specialists. Efforts to implement NDBIs in multi-cultural 
community settings is increasing worldwide. Alongside these efforts, it is crucial to ensure that 
our treatment targets are valid and that we can measure treatment response. The R21 builds upon 
work conducted in an NIMH-funded K01 (PI: Franz). In the first study of its kind on the African 
continent, Dr Franz has adapted a caregiver-coaching NDBI for delivery by non-specialists, and 
'gold standard' clinical outcomes as well as implementation outcomes are being assessed. The R21 
aims to extend this work by evaluating NDBI treatment targets and a novel digital outcome measure 
of treatment response, following 12 sessions of NDBI-informed caregiver coaching, delivered by 
non-specialists in South Africa. South Africa, a multi-cultural nation marked by health 
disparities, is an innovative study location because it provides a unique opportunity to assess 
feasibility and impact of a scalable intervention, in an environment with significant contextual 
challenges. The R21 is a joint project between Duke University and the University of Cape Town 
(UCT). While all research activities will be conducted in Cape Town, South Africa, ASD clinical 
research capacity building will include both UCT and Kilimanjaro Christian Medical Center (KCMC) in 
Tanzania, via a South-to-South collaboration. Both sites are included in order to prepare our team 
to develop an R01 application for a regionally-focused randomized ASD early intervention...

## Key facts

- **NIH application ID:** 9990893
- **Project number:** 5R21MH120696-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Lauren Franz
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $167,317
- **Award type:** 5
- **Project period:** 2019-08-07 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9990893

## Citation

> US National Institutes of Health, RePORTER application 9990893, Tailoring treatment targets for early autism intervention in Africa (5R21MH120696-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9990893. Licensed CC0.

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