Naturalistic Developmental Behavioral Interventions Research Articles

Supporting caregivers within caregiver-mediated interventions: a commentary on Brown etal. (2024).

A substantial portion of interventions designed to support autistic children are also designed to be delivered by caregivers (i.e. are 'caregiver-mediated'). Brown etal. (Journal of Child Psychology and Psychiatry, 2024) are one of the first groups to critically examine the baseline skills that caregivers bring as they prepare to learn a class of interventions called Naturalistic Developmental Behavioral Interventions (NDBIs), which are designed to support social communication growth in young autistic children. This commentary commends Brown and colleagues for their focus on caregivers, a linchpin within the increasingly prominent caregiver-mediated process of intervention delivery. However, it is imperative that future research understand the potential adverse effects and supports that are needed to bolster caregivers in this crucial role. We present six recommendations for research on caregiver-mediated interventions that build on Brown and colleagues' work and address these needs, which involve: caregiver supports, equitable samples, community settings, adaptive designs, general principles, and implications for NDBI dissemination.

The Challenges Associated with Changing Practice: Barriers to Implementing Naturalistic Developmental Behavioral Interventions in ABA Settings

The Challenges Associated with Changing Practice: Barriers to Implementing Naturalistic Developmental Behavioral Interventions in ABA Settings

Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system.

Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention-based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.

Implementing a Uniform Outcome Measurement Approach for Early Interventions of Autism Spectrum Disorders

Naturalistic developmental behavioral interventions for children with autism spectrum disorder show evidence for effectiveness for specific social communication targets such as joint attention or engagement. However, combining evidence from different studies and comparing intervention effects across those studies have not been feasible due to lack of a standardized outcome measure of broader social communication skills that can be applied uniformly across trials. This investigation examined the usefulness of the Brief Observation of Social Communication Change (BOSCC) as a common outcome measure of general social communication skills based on secondary analyses of data obtained from previously conducted randomized controlled trials of 3 intervention models, Early Social Intervention (ESI), Early Start Denver Model (ESDM) and Joint Attention Symbolic Play Engagement and Regulation (JASPER). The subset of datasets from the 3 randomized controlled trials was created to examine differences in the BOSCC scores between intervention and control groups over the course of the interventions. Based on 582 videos from 207 caregiver-child dyads, the BOSCC noted significant differences between intervention vs control groups in broad social communication skills within 2 of the 3 intervention models, which were longer in duration and focused on a broad range of developmental skills. The BOSCC offers the potential to take a uniform measurement approach across different intervention models to capture the effect of intervention on general social communication skills but may not pick up the effects of some brief interventions targeting proximal outcomes. Comparing Parent-Implemented Interventions for Toddlers With Autism Spectrum Disorders; https://www. gov/; NCT00760812. Intensive Intervention for Toddlers With Autism (EARLY STEPS); https://www. gov/; NCT00698997. Social and Communication Outcomes for Young Children With Autism; https://www. gov/; NCT00953095.

The Role of Pathways Early Autism Intervention in Improving Social Skills and Respeto for Young Hispanic Autistic Children.

We know very little about Hispanic autistic children's response to intervention as, historically, Hispanic children are underrepresented in intervention studies. Pathways parent-mediated early autism intervention is one of the few naturalistic developmental behavioral interventions (NDBIs) that is contextually and linguistically responsive to Hispanic families. However, some child-centered NDBI strategies do not align with the Hispanic caregiving value of respeto. A child exhibiting respeto demonstrates affiliative obedience by displaying deference and respect toward adults. Furthermore, theories of the ontogeny of cultural learning suggest that certain levels of social development may be necessary to learn cultural values. The current study investigates (1) the relationship between Hispanic autistic children's social skills and affiliative obedience and (2) the efficacy of Pathways in improving affiliative obedience in Hispanic children. This quasi-experimental design study used preexisting standardized test data and video recordings from 26 Hispanic participants who took part in a previous Pathways efficacy study. Recordings were coded for affiliative obedience and social connectedness. Residual change variables were used to measure progress from baseline to post-intervention, and correlation and hierarchical regression analyses were conducted to analyze the data. We found significant positive correlations between social skills and children's affiliative obedience for baseline and change variables. In addition, we found Pathways had a significant medium-large magnitude effect on change in affiliative obedience skills. This study highlights the benefits of NDBI interventions that advance social development in autistic children and support Hispanic parents in enculturating their children in the value of respeto.

Using an evaluative lens to characterize the implementation outcomes of an NDBI within an early intervention system

A growing number of research studies are attempting to increase access to naturalistic developmental behavioral interventions (NDBIs) for autistic toddlers and their families by translating these approaches into Part C Early Intervention systems. As efforts to increase the use of NDBIs across EI systems grow, it is important to expand the scope of research to evaluate the implementation impact of this work. In order to address this gap, the current study was grounded in the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) to evaluate a broader range of implementation outcomes when a parent-mediated NDBI, Project ImPACT, was implemented within an Early Intervention system. Specific aims included examining: 1) the reach of Project ImPACT to children across the system; 2) the perceived effectiveness of Project ImPACT; 3) rates of provider participation in Project ImPACT training and consultation; 4) the delivery and adaptation of Project ImPACT by Early Intervention providers; and 5) providers’ intent to sustain their use of Project ImPACT. Forty-eight Early Intervention providers enrolled in Project ImPACT training, with a subsample participating in ongoing group consultation followed by an exit interview and a 6-month follow-up survey. Although there was a high level of interest in Project ImPACT training and good retention once enrolled, only half of EI providers who expressed interest in Project ImPACT training ultimately enrolled. Participating providers delivered Project ImPACT to families and children who were representative of state-level demographic information and perceived that Project ImPACT was effective for families and children on their caseload irrespective of whether children were autistic. Consistent with other research studies, providers’ fidelity to Project ImPACT was inconsistent, and providers reported a moderate level of adaptation to the program. At 6-month follow-up, providers reported high maintenance of Project ImPACT. The findings from this study have implications for how the RE-AIM framework could be used to more concisely characterize the impact of implementation efforts within public systems serving autistic toddlers and their families.

Unraveling the Spectrum: A Comprehensive Review of Autism Spectrum Disorder in India.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in social interaction, communication difficulties, and repetitive behaviors that profoundly impact the lives of affected individuals and their families. This article provides a comprehensive overview of ASD, focusing on screening, diagnosis, and intervention strategies. Early signs of ASD can manifest in infancy, but parents may not recognize them until their child falls behind in meeting social milestones. This delay in recognition is often due to a lack of awareness, societal stigma, and limited knowledge about developmental and behavioral disorders. Globally, ASD prevalence is increasingpotentially due to broader diagnostic criteria, increased awareness, and improved screening practices. Screening for ASD is crucial for early identification and intervention. Various tools are available such as the Modified Checklist for Autism in Toddlers (M-CHATs), Trivandrum Autism Behavioral Checklist (TABC), and the Social Communication Questionnaire (SCQ). Diagnosing ASD involves using established criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and specific diagnostic tools like the Autism Diagnostic Observation Schedule (ADOS) and the Indian Scale for the Assessment of Autism (ISAA). Interventions for ASD should be multidisciplinary, involving professionals such as developmental pediatricians, psychologists, psychiatrists, special educators, occupational therapists, physiotherapists, speech therapists, and social workers. Applied behavior analysis (ABA), naturalistic developmental behavioral interventions (NDBIs), and parent-mediated treatment are among the evidence-based approaches. Additionally, speech-language therapy, motor therapy, and sensory integration therapy play vital roles in addressing the diverse needs of individuals with ASD. Medical interventions should be used alongside behavioral and environmental strategies. Early screening, accurate diagnosis, and tailored interventions are essential for improving the lives of individuals with ASD. A multidisciplinary approach and increased awareness are crucial in addressing the growing prevalence of ASD worldwide.

Introduction to the Special Issue on Naturalistic Developmental Behavioral Interventions

Introduction to the Special Issue on Naturalistic Developmental Behavioral Interventions

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

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.

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.

Naturalistic Developmental Behavioral Interventions for Developmental Language Disorder.

Naturalistic-developmental-behavioral interventions (NDBIs) are a widely accepted and validated approach for treating language-related symptoms in autism spectrum disorder, including deficits in vocabulary, social skills, and grammar. The purpose of this article is to define the elements naturalistic, developmental, and behavioral as applied to children with developmental language disorder (DLD) and to provide an example of how this type of intervention can be implemented to teach vocabulary and test cross-modal generalization between expressive and receptive modalities. A vocabulary intervention using hybrid NDBI methods (storybook reading and conversational recast interaction) was provided to three participants with DLD using a single-case design. The results indicated that all participants successfully learned receptive and expressive vocabulary targets with extensive cross-modal generalization. However, generalization was limited in some of the participants. This article provided definitions of key elements of NDBI (naturalistic, developmental, and behavioral) including a rationale for extending NDBI procedures to language intervention for children with DLD. In addition, a single-case design demonstrated that NDBI can be implemented in DLD and that broadly defined naturalistic-developmental applied behavior analysis techniques are applicable to language interventions for children with language disorders. Moreover, diverse naturalistic and developmental procedures meet the highest standards for evidence-based practice to treat DLD.

Cognitive, behavioral and socio-communication skills as predictors of response to Early Start Denver Model: a prospective study in 32 young children with Autism Spectrum Disorder.

The effectiveness of early interventions in young autistic children is well established, but there is great interindividual variability in treatment response. Predictors of response to naturalistic developmental behavioral interventions (NDBI), like the Early Start Denver Model (ESDM), are needed. We conducted an exploratory study to prospectively seek predictors of response in 32 young children treated with ESDM after receiving an ASD diagnosis. All children were less than 39 months old (mean age: 29.7 mo), and received individualized ESDM for nine months. Tests were administered at the beginning, after 4 months, and at the end of treatment. Four children (12.5%) were "strong responders", 8 children (25.0%) were "moderate responders", and 20 children (62.5%) were "poor responders". A more favorable response to ESDM was significantly predicted by higher PEP-3 Expressive Language, Receptive Language, Cognitive Verbal/Preverbal, Visuo-Motor Imitation scores, higher GMDS-ER Personal/Social, and VABS-II Communication scores, by lower ADI-R C restricted/stereotypic behaviors, and by joint attention level. Most predictors showed a linear association with increasing response to ESDM, but GMDS-ER Personal-Social and joint attention level predicted strong response, while PEP-3 receptive language equally predicted moderate or strong response. Although larger samples will be necessary to reach definitive conclusions, in conjunction with prior reports our findings begin providing information able to assist clinicians in choosing the most appropriate treatment program for young autistic children.

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.

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 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.