Culturally Adapted RUBI-T for Spanish-Speaking Families in Texas and Mexico

Background and Rationale Challenging behaviors in young autistic children can negatively affect their quality of life and increase stress for caregivers. Behavioral Parent Training (BPT) programs, such as the Research Units in Behavioral Intervention (RUBI), have demonstrated strong evidence for reducing child behavior difficulties and improving parenting outcomes. However, most studies have been conducted with White, English-speaking families, limiting generalizability to diverse communities. Spanish-speaking families in the United States and Mexico often experience limited access to culturally responsive interventions, creating disparities in autism care.

Cultural adaptation is a systematic approach to tailoring interventions to better align with the values, language, and lived experiences of target populations. Research indicates that culturally adapted interventions can improve both child and caregiver outcomes, but adaptation practices are inconsistently reported. Adapting RUBI for Spanish-speaking caregivers has the potential to increase its accessibility and effectiveness for an underserved group.

Objectives

This study aims to evaluate the effectiveness, feasibility, and cultural acceptability of an adapted RUBI program for Spanish-speaking caregivers of autistic children. The specific objectives are to:

• Determine whether the adapted program reduces children's challenging behaviors.
• Assess changes in caregiver stress, confidence, and knowledge of behavior strategies.
• Examine caregiver perceptions of cultural relevance and satisfaction with the program.
• Identify barriers and facilitators to program implementation.

Study Design This study uses a convergent mixed-methods design combining a pilot randomized controlled trial (RCT) with qualitative data collection. A total of 100 caregivers will be randomly assigned to either (a) the immediate intervention group or (b) the waitlist control group, who will receive the intervention after the initial study period.

Participants and Recruitment Caregivers will be recruited through community organizations, autism advocacy groups, ABA clinics, and online platforms serving Spanish-speaking families. Eligible participants must (a) be a caregiver of a child aged 2-9 years diagnosed with or suspected of autism, (b) report child challenging behaviors in everyday settings, (c) be Spanish-speaking, and (d) have access to internet and a device for online participation. Exclusion criteria include prior experience with RUBI.

Recruitment, consent, and baseline data collection will occur online. Participants will be enrolled beginning September 2025, with intervention delivery from September-November 2025 (intervention group) and January-March 2026 (waitlist control).

Intervention

The intervention is an eight-session, virtually delivered version of RUBI, culturally adapted for Spanish-speaking families. Parents will:

(a) Attend weekly group sessions via Zoom led by trained behavioral therapists; (b) Use a Spanish-language RUBI handbook for guided practice at home; (c) Engage in role-play, modeling, and practice with feedback based on behavioral skills training.

Outcomes Quantitative measures will include: (a) RUBI Parent Confidence Scale (PCS), (b) Home Situations Questionnaire-ASD (HSQ-ASD), (c) Caregiver Knowledge Assessment (CKA), (d) Scale of Treatment Perceptions (STP), (e) Autism Parent Stress Index (APSI), and (f) Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM).

Qualitative data will be collected through post-intervention open-ended responses and optional focus groups in Spanish, focusing on feasibility, satisfaction, and cultural relevance.

Analysis Plan Quantitative data will be analyzed using repeated measures ANOVA with time (pre vs. post) as a within-subject factor and condition (intervention vs. control) as a between-subject factor. Post hoc tests and Cohen's d will estimate effect sizes. Qualitative data will undergo rapid analysis by bilingual coders to identify themes related to program benefits, cultural fit, and implementation barriers. Triangulation across survey, focus group, and observational data will be used to strengthen findings.

Inclusion criteria

• Caregiver of a child aged 2 to 9 years.
• Caregiver of a child diagnosed with autism or suspected of being autistic.
• Child exhibits challenging behaviors in naturalistic environments (e.g., home, school, community).
• Caregiver is willing to complete all aspects of the study, including assessments and intervention sessions.
• Caregiver has access to electronic resources (e.g., high-speed internet and a device capable of participating in Zoom sessions).
• Caregiver is fluent in Spanish (speaks and understands Spanish sufficiently to participate in the intervention and assessments).

Exclusion criteria

• Prior participation in the Research Units in Behavioral Intervention (RUBI) program.
• Caregiver does not speak Spanish.
• Caregiver unable or unwilling to provide informed consent.