Developmental interventions

This is a brief overview of information about developmental interventions, taken from the Autism CRC report, Interventions for children on the autism spectrum: A synthesis of research evidence (Autism Interventions Evidence Report).

There are seven other category overviews available to help people learn about different interventions and their research evidence. To understand the information in its full context, we encourage you to access the full report.

Why are developmental interventions supposed to support children's development?

Developmental interventions draw primarily on cognitive^1,2 or social³ constructivist theories, which suggest that children construct knowledge and skills primarily through personal discovery.

From a constructivist perspective, children acquire layers of knowledge, skills, and experience through their interactions with people and in everyday settings, and that this gradually improves their capacity to engage in increasingly complex tasks.

Constructivist theories focus on children’s acquisition of knowledge and skills over time and as part of typical stages of development². This has led to the term ‘developmental’ being commonly used in the autism research literature to refer to interventions that have these elements at their core.

How are these interventions used in clinical practice?

Developmental interventions focus on supporting children’s learning through interactions with other people, particularly caregivers. These interventions target skills that are either delayed or not apparent in children on the autism spectrum, but that are assumed to be critical to learning. These skills include initiating interactions and sharing interest (e.g., use of gestures, joint attention), observing and then copying others’ behaviour (e.g., imitation), and taking turns in play sequences as well as early conversations⁴.

Developmental interventions are often described as being ‘child-led’, because they use children’s intrinsic motivation to communicate, and ‘naturalistic’, because of the contexts in which they are delivered. Common techniques include modelling words and actions, imitating the child’s actions to give them meaning, and using personal strategies (e.g., pausing, expectant looking) and environmental strategies (e.g., placing toys out of reach) to motivate communication.

Caregivers are taught to use these techniques as part of everyday routines to increase the frequency, duration, synchrony, and reciprocity of interactions with their children⁴.

What are the principles that underpin the use of developmental interventions?

There is no set of universal principles that has been explicitly articulated for developmental interventions. However, specific intervention practices, such as Paediatric Autism Communication Therapy⁵, provide examples of principles that are often reflected in other developmental interventions. These principles include:

• The intervention is designed with a developmental orientation, such that intervention goals are organised in relation to a hierarchy of developmental learning stages.
• Intervention is delivered with a focus on naturalistic interactions involving caregivers and children.
• The intervention is caregiver-directed, meaning that caregivers are partners in the intervention delivery, and are supported to build their own skills, independence and confidence in supporting their child(ren)’s learning.

Who delivers these interventions?

Children on the autism spectrum often have needs across multiple domains of learning, and physical and mental health. Accordingly, children and families may benefit from the expertise of a range of clinical practitioners spanning health, education and medical disciplines.

For all intervention categories, it is essential that clinical practitioners have acquired appropriate qualifications, are regulated (e.g., by a professional or government body), and deliver interventions that are within their scope of practice. A detailed explanation is provided in the full report.

What is the evidence for the effect of developmental interventions on child and family outcomes?

Below is a summary of the evidence for the effect of developmental interventions on child and family outcomes, taken from systematic reviews published since 2010. This means that a range of relevant individual studies have been considered, and thus reflects the best available evidence at this point in time.

Listed first are findings from systematic reviews that considered a mixture of developmental interventions. Following that are findings relating to specific developmental intervention practices.

Evidence table for developmental interventions

		Core autism characteristics				Related skills and development									Education and participation				Family wellbeing
Interventions	No. of systematic reviews	Overall autistic characteristics	Social-communication	Restricted and repetitive interests and behaviours	Sensory behaviours	Communication	Expressive language	Receptive language	Cognition	Motor	Social-emotional/ challenging behaviour	Play	Adaptive behaviour	General outcomes	School/ learning readiness	Academic skills	Quality of life	Community participation	Caregiver communication and interaction strategies	Caregiver social emotional wellbeing	Caregiver satisfaction	Caregiver financial wellbeing	Child satisfaction
Systematic reviews of assorted developmental interventions*	2		M			M													H
Developmental relationship-based treatment	1													L
DIR/Floortime	2		M			M				M				L
Naturalistic teaching strategies	2		L L			L L			L	L	L	L	L		L L	L

View the full evidence table for all intervention categories

Intervention category overviews

• Behavioural interventions
• Developmental interventions
• Naturalistic developmental behavioural interventions
• Sensory-based interventions
• Technology-based interventions
• Animal-assisted interventions
• Cognitive behaviour therapy
• Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH) interventions

References

1. Piaget, J. (1951). Play, dreams, and imitation in childhood. London: Routledge and Kegan Paul.
2. Piaget, J., & Inhelder, B. (1969). The psychology of the child. London: Routledge & Kegan Paul.
3. Vygotsky, L. S. (1978). Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press.
4. Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., . . . Woynaroski, T. G. (2020a). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1-29.
5. Aldred C, Green J, Adams C. A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry. 2004;45(8):1420-1430. doi:10.1111/j.1469-7610.2004.00848.x