The site of the proposed study is the Center for Autism Research in Africa at the University of Cape Town (Director, de Vries). South Africa offers a unique opportunity to study interactions among treatment, child, family, community and context, thus providing preliminary information that could help match the right treatment to the right child/family. In a recent multisite P-ESDM RCT Estes and colleagues (33) reported that that this parent-mediated intervention helped to maintain parental adjustment directly after a child was diagnosed with ASD. However, the numbers of negative life events were a significant predictor of parenting stress and sense of competence. Child and caregiver factors, particularly prevalent in South Africa (eg. poverty, malnutrition, HIV/AIDS), are known to affect child cognitive and social-emotional development (35), as well as parenting stress. Gathering data on the feasibility and impact of a scalable early ASD intervention in an environment where other significant child and caregiver contextual challenges exist, offers a unique opportunity to examine broader contextual factors involved in the cultural adaptation of an ASD early intervention. The investigator will therefore document the effects of broader contextual factors (for e.g. caregiver mental health, negative life events, HIV/AIDS, and poverty, see Table 3: Measures) on treatment impact. In addition, this study will further the understanding of how to implement mental health early interventions in a low and middle-income country (LMIC) context, by examining processes used to train, supervise, and support counseling providers in this context.