Developmental Behavioral Intervention Research Articles

Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match): A Virtual Parent-Mediated Intervention Package for Young Children with Developmental Disabilities.

This study aimed to evaluate Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match), a parent-mediated naturalistic developmental behavioral intervention package. An expansion from an earlier pilot study (see Kunze et al., 2021), PRRFCT Match incorporates virtual coaching between a novice coach and parent to implement evidence-based, applied behavior analytic (ABA) techniques during play to increase engagement and decrease unengaged behavior exhibited by their young child with developmental delays(26-50 months old). Ten parent-child dyads were matched with a coach in this concurrent multiple baseline design across participants. Simulating the clinical training level of a novice early interventionist, nine graduate student clinicians received training as coaches on PRRFCT Match implementation and weekly supervision by a research team member. All aspects of training and intervention were delivered virtually. A visual analysis of the data combined with Tau-U revealed a strong basic effect between clinician coaching and parent strategy use. For child participants, a visual analysis and Tau-U results suggest that most increased engagement and decreased their unengaged behavior during the intervention. High variability, overlap, and high engagement at baseline are discussed. This study shows promise for the PRRFCT Match intervention package. The ABA technologies mediated by parents during play increased child engagement and decreased unengagement for most participants.

Examining variability in Naturalistic Developmental Behavioral Intervention strategy use in caregivers of children with autism spectrum disorders.

Naturalistic Developmental Behavioral Interventions (NDBIs) for young children with autism spectrum disorder commonly involve caregiver-mediated approaches. However, to date, there is limited research on how caregivers' skills change, and, in turn, impact child outcomes. We evaluated the NDBI strategy use of 191 caregivers prior to participation in NDBIs (or control groups) across multiple randomized controlled trials, using the Measure of NDBI Strategy Implementation, Caregiver Change (MONSI-CC). Clustering analyses were used to examine caregiver variability in NDBI strategy use at intervention entry. Generalized Linear Mixed Models were used to examine changes in caregiver strategy use over the course of intervention and its impact on changes in children's social communication. Using clustering analysis, we found that caregivers' baseline skills fit four profiles: limited, emerging, variable, and consistent/high, with few demographic factors distinguishing these groups. Caregivers starting with limited or emerging skills improved in their strategy use with intervention. Caregivers starting with more skills (consistent/high or variable) maintained higher skills over intervention. Children of caregivers in these groups who received target NDBIs improved in their social communication skills. Results suggested that caregiver skills improve through participation in NDBIs and may directly contribute to their children's outcomes, although more research on mediating factors is needed. Individualized approaches for caregivers and their children starting with differing skill profiles at intervention entry may be warranted.

EMT en Español Para Autismo: A Collaborative Communication Intervention Approach and Single Case Design Pilot Study.

The primary purpose of the current pilot study was to test the effects of an adapted and collaborative intervention model with a systematic teaching approach on Latina Spanish-speaking caregivers' use of EMT en Español Para Autismo strategies with their young children on the autism spectrum. A multiple baseline across behaviors single case design was replicated across two dyads. A series of family interviews and a direct therapist-child intervention phase supported individualization of the intervention. Families were provided speech generating devices as part of their children's intervention protocol. Caregivers were taught to use EMT en Español Para Autismo strategies with aided language input. Strategies included contingent target-level and proximal target-level language modeling, linguistic expansions, and communication elicitations. Secondary variables measured included generalization of strategy use to unsupported interactions and at a 2-month follow-up, child communication outcomes, and social validity. There was a strong functional relation for one dyad between the adapted and collaborative intervention and caregiver use of EMT strategies. The functional relation was weakened by behavioral covariation for the other dyad. Children increased the quantity and diversity of their communication during the study. Caregivers generalized their use of most EMT strategies and reported most aspects of the approach to be socially valid. The current study provides an initial demonstration of an effective model for adaptation and individualization of naturalistic developmental behavioral interventions for Latino Spanish-speaking families with children on the autism spectrum.

Parent-Mediated Naturalistic Developmental Behavioral Interventions for Young Autistic Children: A Systematic Literature Review of Single-Case Research

AbstractNaturalistic developmental behavioral interventions (NDBIs) are a class of supports that may lend themselves to a parent-mediated approach. This systematic literature review synthesizes single-case research evaluations of parent-mediated NDBIs for young autistic children. Of the 353 articles screened, 17 were eligible for inclusion. Child outcome measures included engagement, joint attention, language/communication, imitation, and ‘compliance’/avoidance. Most studies found positive effects for at least some children on at least one measure. However, there were no consistently positive effects across studies. Most parents increased their NDBI fidelity, but many did not reach specified fidelity criteria. Only three studies met all Council of Exceptional Children quality indicators. These results suggest that parent-mediated NDBIs are a promising approach to supporting young autistic children, but more high-quality research is needed.

Preschool Teachers’ Perceptions and Use of Naturalistic Developmental Behavioral Intervention Strategies: An Explanatory Sequential Mixed Methods Investigation

Preschool classrooms serve children of varying abilities, including those who may benefit from social communication intervention. Research supports the use of naturalistic developmental behavioral interventions (NDBI) to effectively increase the social communication skills of young children. Yet, little is known about preschool teachers’ perspectives on and use of NDBI strategies. The purpose of this explanatory sequential mixed methods study was to integrate data from classroom observation, teacher self-report, and qualitative interviews to understand training and support needs for increasing implementation of NDBIs in a preschool classroom context. Eight preschool teachers provided a recording of an intervention session, self-reported their use of NDBI strategies, and participated in an interview to discuss their experiences. Results indicate preschool teacher participants perceive NDBI strategies favorably although they may need targeted support understanding and using NDBI strategies. We discuss implications for practice that may support increased use of NDBIs by preschool teachers.

Cultural Considerations in Caregiver-Implemented Naturalistic Developmental Behavioral Interventions: A Scoping Review

Cultural Considerations in Caregiver-Implemented Naturalistic Developmental Behavioral Interventions: A Scoping Review

Parent Fidelity Mediates the Effect of Project ImPACT on Vocal Complexity

Younger siblings of autistic children are at a high likelihood (HL) of autism, language, and/or cognitive delays. Vocal complexity, a continuous measure of the developmental maturity of vocal communication, is facilitated by parent-child interaction and predicts language outcomes. This study examined whether parents’ intervention fidelity to Project ImPACT, a 12-week, parent-mediated, naturalistic developmental behavioral intervention (NDBI), mediated the effect of Project ImPACT on parents’ verbal responsiveness (post-intervention) and children’s vocal complexity (3 months post-intervention). Participants were 54 12- to 24-month-old HL child-parent dyads who received 12 weeks of Project ImPACT ( n = 28) or business-as-usual ( n = 26) . Project ImPACT indirectly improved both parents’ verbal responsiveness and children’s vocal complexity by improving parents’ use of the intervention techniques. The efficacy of Project ImPACT in supporting early social communication might be attributed to how Project ImPACT helps parents improve the quality and frequency of their use of the intervention strategies across children’s everyday settings.

Do Naturalistic Developmental Behavioral Interventions improve family quality of life? A systematic review and meta-analysis.

Naturalistic Developmental Behavioral Interventions have been described as culturally responsive and family-friendly interventions, with research demonstrating improvements in children's development following the receipt of these interventions. Given the child-directed nature of Naturalistic Developmental Behavioral Interventions and the intervention's integration within families' daily routines, many studies have examined the impact of Naturalistic Developmental Behavioral Interventions on family and family member quality of life. We conducted a systematic review and meta-analysis to explore the relationship between Naturalistic Developmental Behavioral Interventions and family quality of life. Results suggest that the provision of a Naturalistic Developmental Behavioral Intervention neither improved nor worsened family or family member quality of life. For those involved in delivering Naturalistic Developmental Behavioral Intervention services, there is an immediate need to convey to families that children's improvements will likely not translate into improvements in family quality of life.

Community implementation of a brief parent mediated intervention for toddlers with probable or confirmed autism spectrum disorder: feasibility, acceptability, and drivers of success (IE Drmic et al.).

Social ABCs is a caregiver-mediated Naturalistic Developmental Behavioral Intervention for toddlers with confirmed/suspected Autism Spectrum Disorder (ASD), with evidence in controlled research settings. Information is lacking on implementation in community settings. We reported on the treatment effectiveness of this program within a community setting, and the current paper describes the implementation phase of this work. Distinguishing between treatment and implementation effectiveness is critical for transporting interventions from laboratory to community. Describe the implementation of Social ABCs through a large public autism service, supported by a research-community partnership. We describe this project through the Exploration, Preparation, Implementation, Sustainment (EPIS) framework as it focuses on implementation of evidence-based practices in publicly funded services. We apply this framework to the reporting stage. This project took place in the context of a 3-year government-funded pilot at a hospital-based publicly funded autism service. Participants: Program developers; Autism Service team; toddlers with suspected/confirmed ASD aged 14-34 months (M = 25.18 months) and their caregivers. Training/supervision: Provided by program developers at tapering intensity. Evaluation: Caregivers completed the Caregiver Diary and satisfaction surveys. We explored training processes, intervention uptake, acceptability, adaptations to fit community context, appropriateness, perceived impact, and facilitators/barriers. Six coaches were trained to fidelity, and three of these were further trained as Site Trainers. 183 clinically referred families enrolled and 89.4% completed the 12-week program. Caregivers reported increases in adherence and competence, high satisfaction and perceived benefits for their children. Coaches reported high satisfaction. Toddlers were appropriately identified to receive the intervention. Referral processes improved, including decreased referral age, and increased family readiness for diagnostic assessment and subsequent services. Social ABCs was successfully implemented in a community service through a research-community partnership. The program was feasible, acceptable, and appropriate within a community context. Drivers of success included funding, institutional support, shared decision-making, adaptations to fit context, leadership support, perceived positive impact, and commitment to evaluation.

Overview of Meta-Analyses on Naturalistic Developmental Behavioral Interventions for Children with Autism Spectrum Disorder.

We conducted an overview of reviews to determine the effects of naturalistic developmental behavioral interventions (NDBIs; Schreibman et al. (2015) J Autism Dev Disorders 45:2411-2428) on children with autism spectrum disorder under 8years old. We conducted an electronic database search of Academic Search Premier, CINHAL, ERIC, Medline, and APA PsycINFO in October 2022 and August 2023 and utilized snowball methods to locate relevant reviews of NDBI. We included reviews meeting the following inclusion criteria: (1) review included a meta-analytic synthesis for at least one child outcome; (2) primary studies examined a NDBI; (3) primary studies included children with ASD with a mean pre-treatment age under eight years; (4) primary studies were conducted using a two-group comparison design; and (5) review was published in English. We extracted data on characteristics of the review, participant characteristics from the primary studies, intervention characteristics, and assessed the risk of bias of the included reviews. We conducted a narrative synthesis across outcomes reported in the included reviews. We included five reviews from six reports in this overview. Two reviews included studies that examined the Early Start Denver Model, two reviews included studies that examined the Pivotal Response Treatment, and one review included studies examining NDBIs collectively. We found positive effects of NDBIs on child's communication/language, cognition, and adaptive behavior. We found mixed effects for NDBIs on autism symptomatology and restricted and repetitive behaviors. Examination of moderator analyses reported in the included reviews suggested variables influencing the effects of NDBIs included proximity of outcome to intervention, boundedness of outcome to intervention, and study location. As shown in this overview, positive effects of NDBI for young children with ASD are supported by meta-analytic evidence. While the overall findings for NDBI across reviews are positive, the findings on specific outcomes and influential variables moderating the effects of NDBI are inconsistent. Additional evidence from randomized controlled trials and future meta-analyses are needed to strengthen our knowledge of the effects of NDBI for young children with ASD.Protocol Registration: PROSPERO CRD42022353045.

Interdisciplinary Competencies for Implementing NDBIs With Young Children With Autism and Other Social Communication Challenges

Over the past decade, a newer class of interventions has emerged specifically designed for young children with or at high likelihood of autism, which are called Naturalistic Developmental Behavioral Interventions (NDBIs). NDBIs are particularly well-suited as a discipline agnostic, primary intervention for young children with autism and other social communication challenges; however, community providers from multiple disciplinary backgrounds who serve these children typically do not develop competencies in areas crucial for effectively implementing NDBI. The goal of this commentary is to: (a) describe the interdisciplinary competencies needed to deliver NDBIs effectively and (b) provide recommendations for moving the field of early intervention for autism and social communication delays forward. Resources for building these competencies for providers at the pre- and in-service level are also provided.

Professional Development Increases Child Care Providers’ NDBI Implementation and Children’s Language Outcomes

A majority of children’s language learning experiences occur in inclusive early child care and education settings. Few evidence-based professional development (PD) programs exist to empower early childhood education providers to use language instruction practices with children in inclusive classrooms. There is little research on providers’ implementation of naturalistic developmental behavioral intervention (NDBI) strategies to improve children’s language outcomes in whole-group inclusive instruction. We conducted a pilot cluster randomized controlled trial to test the hypothesis that providers in the Early Achievements for Child Care Providers (EA-CP) PD program would show greater gains in NDBI implementation fidelity during shared book reading relative to business-as-usual (BAU) providers. This hypothesis was confirmed. Compared to BAU providers, EA-CP providers exhibited significantly greater fidelity gains from pre-training to mid-training, post-training, and 12-week maintenance assessments. A secondary hypothesis was that toddlers with and without developmental delays in the EA-CP condition would exhibit greater vocabulary and communication gains than toddlers in the BAU condition. Analyses of children with and without delays showed significantly greater expressive vocabulary and story-related engagement and communication in the EA-CP group. For children with delays, positive effects favoring the EA-CP group but not statistically significant were found. Implications for research, practice, and policy are discussed.

Mapping the Active Ingredients and Mechanisms of Change of a Naturalistic Developmental Behavioral Intervention Using Mixed Methods

Limited research has examined the active ingredients and mechanisms of change of naturalistic developmental behavioral interventions (NDBIs). The present study used an exploratory sequential mixed-methods design to develop a comprehensive Theory of Change of Project ImPACT, an empirically supported NDBI. We used qualitative data from interviews with intervention experts ( n = 10), community providers ( n = 22), and caregivers ( n = 12) to develop a comprehensive causal model of the intervention process. We then tested select paths of the causal model using path analyses with an archival dataset ( n = 92). The causal model described how developmental techniques aimed at supporting children’s attention and engagement lay the foundation for more adult-directed learning opportunities and subsequent child skill growth. However, hypothesized causal relationships were not supported by our quantitative analyses. In the future, this research can be used to develop and prioritize nuanced research questions related to the timing, optimization, and mechanistic process underlying NDBIs.

Pilot Randomized Trial of a Caregiver-Mediated Naturalistic Developmental Behavioral Intervention in Part C Early Intervention

Few studies examine the effectiveness of community-based early interventions in unselected samples of autistic children, especially those from minoritized backgrounds. These types of studies require attention to strategies for recruitment, retention, data collection, and support for community providers beyond those used in university-based trials. We conducted a pilot trial of Project ImPACT, a promising caregiver-mediated naturalistic developmental behavioral intervention, in partnership with the early intervention system in a poor, large city. We assessed recruitment and retention strategies, training protocol, and measurement battery. We recruited representative provider and family samples, and had good measure completion among retained participants. Retention varied by study arm, providers had relatively poor fidelity to the intervention despite substantial support, and our measures did not appear sensitive to change. Lessons learned include the need for (a) a ramp-up training period prior to starting the study, (b) intensive implementation supports, and (c) additional strategies for family retention.

Pilot Feasibility of a Community Inclusion Preschool Program for Children With Autism

Few studies have reported outcomes from the delivery of naturalistic developmental behavioral interventions (NDBI) in group-based community care. Further, while the importance of inclusion for autistic individuals is well established, there is little research on the feasibility of community-based inclusion programs for preschool-aged autistic children. Positive outcomes have been reported from a few model inclusion programs. However, most involved extensive training from researchers, with limited available data on self-sustaining community-based programs. This quasi-experimental study tracked outcomes for 31 autistic preschool-aged children with verbal and play skills close to age level, who were enrolled in a community inclusion preschool program utilizing NDBI. Children, aged 2.5 to 5 years of age at entry, attended the program for 8 to 36 months. Paired sample t-tests indicated statistically significant improvements from time 1 to time 2 on standardized measures of adaptive behavior, social skills, and autism characteristics. Implications for the feasibility of using NDBI for autistic children in inclusive preschool settings and directions for future research are discussed.

Implementation of Naturalistic Developmental Behavioral Intervention Strategies: An Examination of Preschool Teachers’ Perceptions

Naturalistic developmental behavioral intervention (NDBI) strategies appear to be well-suited for implementation by preschool teachers of young children ages 3 through 5, yet research exploring NDBI implementation within this specific context is extremely limited. We applied an implementation science framework to examine reported knowledge, frequency of use, and social validity perceptions of NDBI to support implementation within preschool classrooms. We surveyed 152 preschool teachers and compared ratings of general and special educators to understand their knowledge and use of NDBI strategies. We also compared ratings of preschool teachers with and without higher education training in applied behavior analysis. Findings indicate that NDBI strategies are a usable innovation for preschool teachers, yet targeted preservice and inservice training is warranted along with improved organizational factors to support NDBI uptake. Furthermore, open-ended survey responses provided a deeper understanding of social validity ratings and suggestions for NDBI-focused professional development.

Bridging Priorities Between Naturalistic Developmental Behavioral Interventions for Autism and Educational Practice in Inclusive Early Childhood Education

Practice guidelines for early childhood education (ECE) and clinical autism interventions (Naturalistic Developmental Behavioral Intervention, NDBI) have emerged separately in history, represent different disciplines, and operate within different service systems. This manuscript identifies priorities, principles, and practices that are shared across the NDBI and ECE frameworks, unique to each framework but compatible with the other, or in conflict. Both frameworks support converging inclusive ECE models focused on autism in that they are both grounded in responsive relationships, natural learning environments, and strategies to promote children’s motivation and active engagement. While compatible in general, each framework extends the other in important ways. For example, NDBI goes beyond the ECE frameworks by focusing on a more fine-grained examination of learning strategies and targets. Opportunities for bridging gaps are identified, including the use of implementation science frameworks to integrate perspectives from different stakeholder groups, supporting the scale-up of inclusion preschools in community settings.

Characterizing mechanisms of caregiver-mediated naturalistic developmental behavioral interventions for autistic toddlers: A randomized clinical trial.

Caregiver-mediated early interventions support caregivers' use of strategies to improve their young autistic child's communication. In the current clinical trial, we sought to isolate the most effective strategies to improve short-term and long-term child communication outcomes. Results demonstrated how children may benefit from caregiver prompts to facilitate long-term language outcomes. In conclusion, the current study improves our understanding of how early intervention facilitates child communication outcomes.

Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis

ObjectiveTo summarize the breadth and quality of evidence supporting commonly recommended early childhood autism interventions and their estimated effects on developmental outcomes.DesignUpdated systematic review and meta-analysis (autism intervention meta-analysis; Project...

The devil is in the details: Advancing our collective understanding of naturalistic developmental behavioral interventions.

Given the growing body of randomized trials examining various Naturalistic Developmental Behavioral Intervention (NDBI) approaches, a dialog has emerged exploring the overlap in strategies across NDBIs to create single measures that propose to capture core strategies across the interventions. This commentary will ask readers to consider the current state of the science, the potential value of looking not only for similarities but also for differences across approaches, and present five scientific next steps to advance our collective understanding of the NDBIs including: (a) operationalizing intervention strategies and outcomes, (b) expansion of the effectiveness evidence base and begin testing implementation strategies for individual NDBIs, (c) rigorous testing of core intervention components and the mechanism of each intervention, (d) personalization, and (e) supporting transparency with a priori trial registration.