Study protocol for a multi-centre randomised controlled trial of the Thai early intervention for autism: Assistive Technology for Caregivers (TEI4A-ATC) across nine hospitals in health region 1, northern Thailand.

Researchers in Thailand are testing a computer-based training program to help parents and caregivers of autistic children. Many families in rural areas struggle to access autism support services due to distance. This study will compare 160 families - half will use the new computer program (TEI4A-ATC) and half will receive usual care. The program aims to improve parents' knowledge and skills in supporting their autistic children.

Researchers will measure children's development and parents' confidence before and after 3 months to see if the program helps.

This study protocol describes a randomised controlled trial evaluating TEI4A-ATC, a computer-based intervention programme for caregivers of children with autism spectrum disorder in northern Thailand. The trial will recruit 160 children and their caregivers across nine hospitals, with participants randomised to receive either TEI4A-ATC or standard care. The intervention addresses geographical barriers to autism support services in rural Thailand by providing technology-assisted caregiver training. Primary outcomes include children's autism severity scores and caregivers' knowledge, attitudes, and practices regarding autism care, measured at baseline and after 3 months.

The study employs validated Thai assessment tools and follows intention-to-treat analysis principles. Results will inform practice and policy guidelines for autism care delivery in Thailand.

If effective, TEI4A-ATC could provide a scalable solution for delivering autism support services to geographically isolated families. The technology-based approach may improve caregiver capacity and child outcomes while reducing barriers to accessing specialised autism services in resource-limited settings.

This is a protocol paper with no results reported. The study is limited to northern Thailand, potentially limiting generalisability. The 3-month follow-up period may be insufficient to assess long-term effectiveness of the intervention.

The management of autism spectrum disorder (ASD) involves a varied and comprehensive range of support services at various stages of an autistic individual's life. In Thailand, parents/legal guardians of children with ASD often encounter challenges such as difficulty travelling from rural areas to access support services. The aim of the present study is to investigate the effectiveness of a computer-based intervention programme for caregivers of children with ASD called the Thai Early Intervention for Autism-Assistive Technology for Caregivers (TEI4A-ATC), designed and implemented by a multidisciplinary team. 160 children and their caregivers are being recruited. They will be randomised 1:1 into two treatment arms: access to TEI4A-ATC for the intervention group and standard care for the control group.

Before enrolment, ASD diagnosis will be conducted using the Thai Diagnostic Autism Scale: children's ASD scores will be determined using the Thai Autism Treatment Evaluation Checklist for evaluating communication, sociability and sensory/cognitive awareness and the Thai Early Developmental Assessment for Intervention for evaluating motor skills, social interaction, language development and problem-solving. Both assessment tools will be used again after 3 months of treatment. Similarly, the caregivers' knowledge, attitude and practice (KAP) for ASD care will be assessed using a questionnaire at enrolment and again after treatment. Comparison of the children's ASD scores and caregivers' KAP responses between the treatment groups and before and after treatment will be performed based on the intention-to-treat principle.

This study was approved by the Human Research Ethics Committee for Mental Health and Psychiatry, Department of Mental Health, Ministry of Public Health (DMH.IRB.COA 037/2565). Written informed consent will be obtained from the participants prior to enrolment. The study's findings may be disseminated through scientific publications and conference presentations. The results of the study will be shared with key stakeholders, including caregivers, psychiatrists, policymakers and the general public, via appropriate dissemination channels to aid in creating appropriate practice and policy guidelines.

This study was registered with the Thai Clinical Trials Registry (TCTR20240320010) on 20 March 2024.