DESCRIPTION (provided by applicant): A significant global challenge is to develop scalable, feasible, early interventions for autism spectrum disorders (ASD) that can be implemented in diverse and low resource communities. There is growing excitement around innovative caregiver-mediated early intervention strategies, for example the Parent Early Start Denver Model (P-ESDM) co-developed by Dr. Geraldine Dawson, my primary advisor on this application. Caregiver-mediated interventions have been shown to improve parent-child interactions and child language comprehension, and reduce the severity of ASD. Importantly, engagement of caregivers promises new ways to address the capacity barrier globally. My planned research career trajectory is to become a leader in the development and implementation of caregiver-mediated interventions for ASD and other childhood neuropsychiatric disorders in diverse and low resource communities. The highly structured mentorship and training plan outlined in this proposal would set the foundation for achieving this goal. Importantly, this work is closely aligned with 2 of the top Grand Challenges in Global Mental Health priorities: 1) to reduce the duration of untreated illness by developing culturally-sensitive early interventions, and 2) to improve child access to evidence-based mental health care (11). In addition, this work aligns with an objective of the Federal Interagency Autism Coordinating Committee Strategic Plan: to support community-based studies that assess the effectiveness of interventions and services in broader community settings including scalable early intervention programs for implementation in underserved, low-resource, and low-literacy populations (12). I plan to: 1) train in implementation science and community participatory research, 2) train in clinical research and research ethics, and 3) obtain hands-on experience by conducting an ASD intervention trial using a culturally adapted version of the original evidence-based intervention in a low resource African setting. I have brought together an outstanding team of advisors with expertise in ASD (Dr. Dawson (Duke), Dr. de Vries (University of Cape Town), Dr. Rogers (UC Davis Mind Institute)), global health (Dr. de Vries, Dr. Sikkema (Duke)), child psychiatry (Dr. Egger (Duke), Dr. de Vries), intervention research (Dr. Dawson, Dr. Rogers, Dr. Sikkema), and community participatory research (Dr. Sikkema). Working in collaboration with the Center for Autism Research in Africa, I propose to adapt the Parent Early Start Denver Model (P-ESDM) treatment manual, and training approach, and conduct a pilot study to explore the acceptability, feasibility, and impact of this adapted intervention on child and caregiver outcomes in an African setting. In addition, I will capitalize on existing research infrastructure supported by the NIMH through the University of Cape Town AFFIRM Hub (see Lund letter of support). The foundational mentorship, training and experience gained through this award will set the stage for a career focused on enhancing the quality of life for children wih neurodevelopmental disorders and equip me with the skillset to become an independent clinical researcher.

PUBLIC HEALTH RELEVANCE: This Mentored Career Development Award will lay the foundation for a career focused on addressing 2 specific Grand Challenges in Global Mental Health priorities: 1) improving child access to evidence-based mental health care, and 2) reducing the duration of untreated illness by developing culturally-sensitive early interventions. The proposed research aims to assess the acceptability, feasibility, and impact of a brief caregiver-mediated early autism intervention adapted for use in a low resource setting. Data from this pilot study would inform scalable early autism intervention programs for implementation in underserved, low- resource, and low-literacy populations globally.