Do Cultural Adaptations Matter in Caregiver Training?

Introduction

When it comes to training caregivers in behavioral interventions, one size does not fit all. Cultural and linguistic differences can play a significant role in how well caregivers understand and apply behavioral strategies for children with Autism Spectrum Disorder (ASD). A recent study by Vargas Londono et al. (2024) examines the impact of culturally adapted caregiver training and whether making these adaptations improves caregiver performance and social acceptability.

This research is particularly relevant for behavior analysts working with culturally and linguistically diverse (CLD) families. Understanding the barriers these families face and how to tailor interventions accordingly can lead to better outcomes for both caregivers and their children with ASD.

Background

1. Autism Spectrum Disorder (ASD) and CLD Families

ASD is a neurodevelopmental disorder characterized by challenges in social communication and repetitive behaviors. It affects individuals across racial, ethnic, and socioeconomic backgrounds. However, research shows that CLD families often experience disparities in diagnosis and treatment.

Challenges that CLD families face include:

• Delayed ASD diagnoses
• Reduced access to behavior analytic services
• Lower service utilization compared to non-Hispanic White families

These disparities arise from numerous factors, such as financial constraints, insurance difficulties, and language barriers. CLD families may also struggle with a cultural mismatch between their expectations and the interventions provided by clinicians.

2. Why Caregiver Training Matters

Applied Behavior Analysis (ABA) interventions are most effective when caregivers are actively involved in implementing strategies at home. Caregiver training can result in:

• Higher treatment fidelity
• Greater caregiver confidence in applying ABA techniques
• Reduced parental stress and improved overall quality of life

Behavior Skills Training (BST) is a widely used ABA training method that includes instruction, modeling, rehearsal, and feedback. However, BST may not be as effective if language and cultural differences are not considered.

The Study: What Were Researchers Trying to Find?

The study by Vargas Londono et al. (2024) aimed to determine whether cultural adaptations in caregiver training improve treatment fidelity and social acceptability. Specifically, the researchers asked the following questions:

1. Does caregiver performance (treatment fidelity) improve when training includes cultural adaptations?
2. Do Latino caregivers find culturally adapted training more socially acceptable in terms of personal connection, engagement, and satisfaction?
3. How does the language of training impact the skill acquisition of children with ASD?
4. Are there differences in efficiency (session duration and number of sessions) between culturally adapted and non-adapted training?

Methodology

To answer these questions, the researchers conducted a well-structured study using telehealth-based caregiver training.

Participants

The study involved Latino caregivers and their children with ASD. The researchers screened participants to assess their language proficiency in both Spanish and English.

Training Intervention

Caregivers received training using BST techniques:

• Instruction: Trainers explained the ABA techniques.
• Modeling: Trainers demonstrated the techniques.
• Rehearsal: Caregivers practiced implementing the techniques.
• Feedback: Trainers provided corrective feedback.

The caregivers learned two ABA-based interventions:

1. Receptive Skills Intervention (RSI): Teaching children to match pictures using a receptive language task.
2. Motor Imitation Skills during Play (MISP): Teaching reciprocal play and imitation during interactive activities.

Study Design

The researchers compared training delivered in Spanish (culturally adapted) versus English (non-adapted) using an alternating treatments design. Caregiver performance and child progress were measured across conditions.

Key Findings

1. Cultural Adaptations Improved Caregiver Performance

Caregivers who received training in Spanish showed higher treatment fidelity. This means they implemented ABA strategies more accurately than those trained in English. This finding suggests that delivering training in a caregiver’s preferred language enhances understanding and application.

2. Caregivers Found Culturally Adapted Training More Acceptable

Social acceptability measures showed that caregivers preferred training in Spanish. They reported:

• A stronger personal connection with trainers
• Higher engagement
• Greater satisfaction with the training

These findings highlight the importance of considering cultural and linguistic factors in caregiver education.

3. Children Showed Faster Skill Acquisition in Culturally Adapted Training

Children whose caregivers were trained in Spanish demonstrated quicker learning of skills compared to those whose caregivers were trained in English. The results suggest that when caregivers feel more comfortable with training, they are more effective in teaching their children.

4. Culturally Adapted Training Was More Efficient

Training conducted in Spanish required fewer sessions and shorter durations to reach competence. This suggests that incorporating cultural adaptations can improve training efficiency and reduce the time needed to see progress.

Implications for Behavior Analysts

The findings of this study emphasize the importance of cultural responsiveness in ABA. Behavior analysts working with CLD families should consider the following takeaways:

• Deliver training in caregivers' preferred languages whenever possible.
• Adapt training materials and examples to align with the family's cultural background.
• Increase focus on building personal connections and trust with CLD caregivers.
• Utilize telehealth as a viable option to reach caregivers in their preferred language.

By implementing these changes, ABA practitioners can improve caregiver engagement and treatment outcomes.

Conclusion

Cultural adaptations in caregiver training matter. As this study demonstrates, providing ABA training in a caregiver’s native language enhances treatment fidelity, social acceptability, and child skill acquisition while also improving the efficiency of training.

Behavior analysts should consider these findings when working with diverse populations to ensure equitable access to effective interventions.

For further reading, check out the full research article by Vargas Londono et al. (2024) at 10.1007/s40617-024-00930-4.