Telecoaching Intervention for Children With Autism and Their Parents in Palestine

This study used an explanatory sequential mixed-methods design. The quantitative component was a two-arm, parallel-group external pilot randomized controlled trial evaluating an eight-week telehealth-delivered Occupational Performance Coaching (OPC) intervention for parents of children with autism in Palestine. The study primarily evaluated the feasibility of trial procedures and intervention delivery and the acceptability of telecoaching. Child and parent outcomes were examined exploratorily to characterize patterns and variability of change and to inform the design of a future definitive trial.

Parents and their children were recruited from West Bank districts through community-based and online recruitment approaches. Eligible parents or primary caregivers were aged 18 years or older, spent the majority of the intervention period with the child, and had access to an internet-enabled device and reliable internet connection. Eligible children were aged 3-7 years and had a confirmed diagnosis of autism spectrum disorder from a neurologist or psychiatrist. Children receiving other early-intervention or rehabilitation services remained eligible.

Following informed consent and completion of baseline assessments, 26 parent-child dyads were randomized, with 14 allocated to OPC telecoaching and 12 to the waitlist control condition. Allocation was conducted using covariate-adaptive minimization based on the Pocock-Simon approach, with a random component, to reduce imbalance between groups with respect to child sex and baseline CARS-2 autism severity. Randomization was centrally controlled by an independent coordinator who was not involved in recruitment, baseline assessment, intervention delivery, or outcome analysis. Participants and the intervention provider could not be masked because of the nature of the coaching intervention.

Participants allocated to the intervention received eight weekly individualized OPC sessions delivered synchronously through Zoom, with sessions lasting approximately 40-60 minutes. Coaching focused on parent-selected occupational performance goals and supported parents to analyze performance challenges, generate possible solutions, implement strategies within everyday routines, and review progress. The Sanad Alhayaa digital platform supported intervention-related procedures, including appointment booking, questionnaires, individualized resources, and intervention documentation. During the randomized comparison period, participants allocated to the waitlist condition had access to general Arabic-language autism-related resources through Sanad Alhayaa but did not receive individualized OPC. They were offered OPC telecoaching after completing the post-intervention assessment.

Feasibility was evaluated using prespecified progression criteria addressing recruitment, digital platform procedures, randomization, retention, questionnaire completion, intervention attendance, intervention fidelity, and safety. Telecoaching acceptability was assessed using the Saudi Telehealth Acceptance Scale. Exploratory child outcomes included individualized occupational performance and satisfaction measured using the Canadian Occupational Performance Measure, autism-related characteristics measured using the Autism Treatment Evaluation Checklist and Childhood Autism Rating Scale, Second Edition, and parent outcomes assessing parental competence and quality of life.

Quantitative analyses emphasized descriptive feasibility estimates and exploratory estimation of change rather than confirmatory hypothesis testing. Continuous outcomes were summarized descriptively, and exploratory within-group and between-group changes were accompanied by confidence intervals and standardized effect-size estimates where appropriate. The small pilot sample and exploratory nature of these analyses were considered when interpreting the findings.

Following the intervention, semi-structured interviews were conducted with intervention participants to explore their experiences and perceptions of telecoaching, including acceptability, perceived benefits, facilitators, barriers, and implementation experiences. The qualitative component was intended to provide contextual understanding of the quantitative findings and the implementation of the intervention.

Inclusion criteria

• Parent or primary caregiver aged ≥18 years and able to provide informed consent.
• Parent or caregiver spends the majority of the intervention period with the child.
• Access to an internet-enabled device capable of videoconferencing and a reliable internet connection.
• Child aged 3-7 years with a confirmed diagnosis of autism spectrum disorder by a neurologist or psychiatrist.
• Children receiving other early-intervention or rehabilitation services remained eligible to participate.

Exclusion criteria

• Parent or caregiver unable to meet the above participation requirements.
• Child with a co-occurring medical, neurological, or genetic condition requiring intensive medical or pharmacological management beyond the scope of the intervention, such as uncontrolled epilepsy or a complex genetic syndrome.