Table 3.

Cultural Adaptations Made to the Training Based on Bernal et al.’s (1995) Framework

Parameter	Elements Added to Intervention
Language	The training manual was available in Tamil.
Persons	The trainer was matched in ethnicity with participants.
Metaphors	1. Actors in video models were matched in ethnicity. 2. Role-play scenarios chosen were relevant to the area (e.g., academic writing tasks for very young children, joint family contexts with grandparents as caregivers, visits to the temple). 3. All illustrations in the manual included Indian names and situations typical to the region.
Content	1. Specific training on the alternatives to positive punishment (commonly practiced in the region) was provided in the manual. 2. Specific strategies for conveying information regarding treatment to other family members (e.g., grandparents) were provided in the face-to-face training. 3. Examples of naturalistic (e.g., attention, breaks, setting up a preferred activity following a hard or nonpreferred task) reinforcers were provided in the manual and the face-to-face training due to the discomfort with edible and tangible reinforcers. 4. Easy data collection systems akin to the cards used to track milk purchases (used in every household in the region) were provided.
Concepts	1. The trainer used the phrase “developmental delay” instead of “developmental disability” to minimize stigma. 2. The trainer provided ABA strategies as a treatment, in addition to the existing practices in the region. 3. Equivalent Tamil words for ABA terminology, including reinforcement, punishment, function of behavior, automatic reinforcement, extinction, resurgence, and so on, were created (available from the first author).
Goals	1. Improvement in child behavior was stated as a means to remove unwanted negative attention on the child from the general public. 2. Training was viewed as a means of education for the participants to improve the child’s and the family’s quality of life, and ultimately for the child to be eligible to access regular schooling.
Methods	1. Proactive strategies were prescribed as a general means of improving behavior in an attempt for the trainer to adopt a directive role in both the manual and during the training. 2. The participants in the training were recruited via flyers distributed at an office of a pediatrician, a role that is often revered for experience and expertise. 3. During the ABA information sessions conducted prior to the training, the trainer set aside time for all attendees to introduce themselves in an attempt to develop a personal relationship. 4. The trainer also provided personal information (educational and family background, area of residence, hobbies, marital status) about herself when this information was requested during the training.
Context	1. Face-to-face training was conducted in a general education preschool to make it more accessible and less stigmatizing. 2. A snack and a beverage were offered during the face-to-face training consistent with social etiquette.