Utilization, Accessibility and Outcomes of Parent-Mediated Therapies for Neurodivergent Children in India: A Systematic Review.

The Neurodevelopmental Disorders (NDDs) data on evidence-based interventions is significantly underrepresented in India, which is mainly due to the lack of specialists and a significant geographic barrier to care. This systematic review is a critique of the effectiveness, accessibility and outcomes of parent-mediated interventions (PMIs) that function within the Indian healthcare environment. The protocol used in the review was registered in PROSPERO (reference: CRD420261299971) and followed PRISMA 2020 requirements. Twenty-six articles published in the past five years (2020-2025) were synthesised. The findings reveal that 95% of the studies reported statistically significant changes in paediatric functioning and parental self-efficacy (effect size = 1.61). Notably, non-inferiority studies revealed similar social-adaptive outcomes of PMIs overseen by frontline community health workers as compared to clinic-based intensive behavioural interventions. There were better retention levels (92-100%) in the case of synchronous versus asynchronous telehealth modalities, and the improvements were also maintained at an 18-month follow-up. Although the financial load and geographic centralization remain the key obstacles, the task-shifting and digital infrastructure are placed as the key facilitators. This review creates a strong evidence base of PMIs as a flexible, culturally adaptable paradigm in order to fill the treatment gap. The results support a policy change towards de-medicalised and community-based care models to achieve universal health coverage in the low-resource contexts.