Naturalistic 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.

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.

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.

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.

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 in the United States. This article 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.

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.

Addressing disruptive behaviors within naturalistic developmental behavioral interventions: Clinical decision-making, intervention outcomes, and implications for practice.

Naturalistic developmental behavioral interventions are a common and well-researched type of intervention for young autistic children that focus on supporting social communication. These interventions often do not include formal guidelines on how to address disruptive behaviors, even though they are common among autistic children. This study measured how often clinicians delivering a specific naturalistic developmental behavioral intervention, Project ImPACT, adapted how they delivered the program to address disruptive behavior, and how these adaptations related to children's social communication outcomes at the end of their participation in the intervention. We also spoke with clinicians about how they address disruptive behavior and emotion regulation during their sessions. In this study, clinicians adapted Project ImPACT to address disruptive behaviors in about one-third of all sessions. These adaptations did not affect children's social communication outcomes. Clinicians discussed how they felt social communication, disruptive behavior, and emotion regulation are linked to one another and that they often try to integrate intervention strategies to address each of these areas. However, they note that a clinicians' approach to addressing disruptive behavior might vary depending on their level of training and experience. These results indicate several future directions for supporting clinicians in addressing behavior and regulation effectively within these types of interventions.

Brief Report: Telehealth Music-Enhanced Reciprocal Imitation Training in Autism: A Single-Subject Feasibility Study of a Virtual Parent Coaching Intervention.

Telehealth delivery increases accessibility of parent-mediated interventions that teach parents skills and support autistic children's social communication. Reciprocal Imitation Training (RIT), an evidence-based Naturalistic Developmental Behavioral Intervention (NDBI) focused on imitation skills, a common difficulty in autism, holds promise for telehealth-based parent training. Imitation is also a core component of musical play during childhood and the affordances of musical play/song naturally shape parent-child interactions. We evaluate the feasibility of a music-based, telehealth adaptation of RIT-music-enhanced RIT (tele-meRIT)-as a novel format for coaching parents in NDBI strategies. This single-subject, multiple baseline design study included 4 autistic children (32-53months old) and their mothers. Parent-child dyads were recorded during 10-min free play probes at baseline, weekly tele-meRIT sessions, and one-week and one-month follow-up. Probes were coded for parents' RIT implementation fidelity, parent vocal musicality, and children's rate of spontaneous imitation. No parent demonstrated implementation fidelity during baseline. All parents increased their use of RIT strategies, met fidelity by the end of treatment, and maintained fidelity at follow-up. Parent vocal musicality also increased from baseline. Intervention did not consistently increase children's imitation skills. A post-intervention evaluation survey indicated high parent satisfaction with tele-meRIT and perceived benefits to their children's social and play skills more broadly. Implementing tele-meRIT is feasible. Although tele-meRIT additionally involved coaching in incorporating rhythmicity and song into play interactions, parents achieved fidelity in the RIT principles, suggesting one avenue by which music can be integrated within evidence-based parent-mediated NDBIs.

Beyond the Task List: A Proposed Integration of Naturalistic Developmental Behavioral Interventions to BCBA Training.

Naturalistic developmental behavioral intervention (NDBI) is firmly rooted in both the science of ABA as well as developmental science. Research indicates that many practicing board certified behavior analysts (BCBAs) are unfamiliar with NDBI models and do not implement these approaches when working with young autistic children (Hampton and SandbankAutism, 26(4), 875-888,2022). In this article we align NDBI to the seven dimensions of ABA, describe their compatibility with the ABA service system, and urge community agencies andinsurance funders to support NDBI use. Finally, we provide a roadmap for BCBAs who provide behavior analytic intervention to young autisticchildren and for Verified Course Sequence faculty to effectively align the 6th edition BCBA Test Content Outline with the principles and application of NDBI.

Child-therapist interaction features impact Autism treatment response trajectories

BackgroundIdentifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated. AimsThe longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling. Methods and ProceduresN = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features. Outcomes and ResultsBaseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist’s efficacy in child engagement, respecting children’s timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment. Conclusions and ImplicationsClinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.

A Waitlist Randomized Implementation Trial of Classroom Pivotal Response Teaching for Students With Autism.

Classroom Pivotal Response Teaching (CPRT) is a community-partnered adaptation of a naturalistic developmental behavioral intervention identified as an evidence-based practice for autistic children. The current study evaluated student outcomes in a randomized, wait-list controlled implementation trial across classrooms. Participants included teachers (n = 126) and students with autism (n = 308). Teachers participated in 12 hours of didactic, interactive training and additional in-classroom coaching. Generalized Estimating Equations accounted for clustering. Adjusted models evaluated the relative effects of training group, CPRT fidelity, and classroom quality on student outcomes. Results indicate higher CPRT fidelity was associated with greater increases in student learning. Having received CPRT training predicted increased student engagement and greater decreases in reported approach/withdrawal problems. These differences may be linked to the theoretical foundations of CPRT of increasing student motivation and engagement and collaborative adaptation to increase feasibility in schools. Overall, results suggest CPRT may be a beneficial approach for supporting autistic students.

Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan.

The Early Start Denver Model is an evidence-based early intervention program for young and very young children with autism. This interdisciplinary model is used by many types of professionals, such as psychologists, occupational therapists, speech pathologists, early child special educators, and paraprofessionals, as well as by parents. Most previous studies on the Early Start Denver Model were conducted in the West, and there are scarce studies on the topics of generalization in culture and countries outside the Western world. In this study, we evaluated the effect of the Early Start Denver Model with some adaptations, including a lower intensity, shorter duration, and delivery in regional general hospitals in Northern Taiwan. In total, 45 young children with autism, aged 2-4 years, were divided into the Early Start Denver Model and community-based control groups. The children in the Early Start Denver Model group received one-on-one intervention for approximately 8-9 h per week for 6 months. The results revealed that compared with the control group, the Early Start Denver Model group showed greater gains in overall development ability and nonverbal development ability from pre- to post-intervention. However, these differences did not sustain at the 6-month follow-up after the completion of the intervention. Being mindful of some caveats in trial designs, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in the regional general hospital settings in the context of Han-Chinese-mainly culture. Our findings can provide helpful information to stakeholders and policymakers of early intervention service systems for children with autism in Taiwan, as well as in Asian countries.

Teaching Therapeutic Support Staff to Implement NDBI Strategies for Children With ASD Using Behavior Skills Training

We examined adult behavioral skills training (BST) for home-based therapeutic support staff (TSS) using a naturalistic developmental behavioral intervention (NDBI) with young children with Autism Spectrum Disorder (ASD) derived from Project ImPACT. We taught three TSS to use interactive strategies with online modules, in-vivo training, and ongoing feedback to a predetermined frequency criterion with young children with ASD in the home setting. The TSS increased strategy use to criterion and generalized the strategies to other settings. Child spontaneous communication increased in frequency and complexity from mostly eye gaze and gestures to eye gaze, vocalizations, and words. Our results extend what we know about training direct service providers and measuring social communication components.