Preliminary Studies/Data: Critical to the success and sustainability of this project is the establishment of collaborative relationships with local researchers and clinicians in South Africa, and a shared goal of enhancing ASD services in the broader South African and African community (see de Vries letter of support). In 2012 the Center for Autism Research in Africa at the University of Cape Town was founded by Dr. de Vries, my primary in-country mentor. The Center aims to promote collaboration and develop capacity across the African continent (37). Dr. de Vries is the only certified trainer in ASD 'gold standard' diagnostic assessments on the African continent. He has undertaken the translation of the ADOS-2 and the ADI-R into: (1) isiXhosa and Afrikaans, the two most common languages in the Western Cape Province; and (2) Kiswahili for use in East Africa. Work to improve access to services is also beginning. Three clinicians at the Center for Autism Research in Africa have trained in ESDM. They have conducted some preliminary work with 34 ethnically diverse preschool-age children with ASD. Using an unadapted version of ESDM, but following the 12 week, 1 hour per week P-ESDM format, they reported high retention rates that suggests P-ESDM may be a feasible approach in this low resource setting (37). Children who participated in this pre-pilot ESDM work were recruited the Western Cape Education Department autism waiting list. This work helps to establish the feasibility of recruiting young children for the proposed study.