Extent and Rigor of Cultural Adaptations in Social Communication Interventions for Autistic Children and Adolescents: A Systematic Review.
Vipula Rajesh Kumar, Aditi Iyer, Theresa Pham and 3 others
Only 16 studies adapting social communication interventions for autistic young people were found, and on average researchers documented 66% of the quality steps for cultural adaptation.
The same programme (PEERS) was adapted to very different degrees depending on the country.
Key findings
1Across the included studies, researchers documented full or partial fulfillment of 21 out of 32 cultural adaptation checklist items on average (66%), with individual studies ranging from 44% to 91%.
2Only 16 studies met the inclusion criteria, identifying seven social communication interventions culturally adapted in 11 languages across 12 countries.
384.3% of studies reported involving community stakeholders during the planning phase, but only 43.7% did so during delivery, highlighting a gap in sustained community engagement.
Still to come
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 16 studies were found, so the evidence base for culturally adapted social communication interventions is very small. Only English-language, peer-reviewed journals were included; adaptations published in other languages or in grey literature are missing. The Cultural Adaptation Checklist is newly developed and has not been validated; it has no cutoff scores, so a 66% average cannot be interpreted as 'adequate' or 'inadequate' adaptation. Adaptations may be underreported in the original papers due to journal word limits, making the true extent of adaptation unclear. Caregiver-mediated interventions were excluded to avoid duplication with a prior review, so the findings apply only to professionally delivered programmes. Ethnicity was reported in only five of the 16 studies and race in two, limiting the ability to judge whether adaptations matched the target population.
Declared interests
The authors of this review declared no financial support and no conflicts of interest. However, within the included studies, several authors of PEERS-related trials reported receiving royalties from the PEERS publisher, and one author of the KONTAKT trial received royalties from the KONTAKT publisher.
The easy way to misread this
Do not read the 66% average CAC score as evidence that cultural adaptations in these studies were adequate or sufficient. The authors explicitly state that the checklist has no cutoff scores and that they cannot determine what proportion constitutes poor versus adequate adaptation. A 66% score tells you how many quality steps were documented, not whether the intervention was well adapted for the client in front of you.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →