Naturalistic developmental behavioural interventions

This is a brief overview of information about naturalistic developmental behavioural interventions (NDBIs), 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 NDBIs supposed to support children's development?

The intervention category of NDBIs was proposed in 2015 to describe several intervention practices that had recently emerged from the practical integration of behavioural and developmental theories ¹.

NDBI techniques are based on behavioural principles, but applied in a way that emphasises their delivery in the context of developmentally appropriate adult-child interactions, with a focus on learning in the context of play and routine activities¹. Skills are taught in a developmental sequence, with early skills (e.g., eye contact) considered pre-requisites for the development of more complex behaviours (e.g., joint attention).

How are these interventions used in clinical practice?

NDBIs share similarities in terms of the nature of the learning targets, contexts, and strategies¹. First, in relation to the nature of the learning targets, skills in these interventions are taught across developmental domains (e.g., social, communication, motor, play), and with a focus on integration and generalisation across contexts and as part of daily activities, interactions, and routines with a variety of communication partners.

There is a focus on helping children develop precursor knowledge and skills that lay the foundation for later development. For instance, intervention may focus on supporting a child who is not speaking to initiate joint attention with others, use gestures, and imitate sounds, as a step towards the development of spoken language.

Second, in terms of the nature of the learning contexts, interventions are delivered in contexts that promote social engagement, in particular, dyadic caregiver-child interactions.

Finally, with respect to the nature of the development-enhancing strategies, interventions bring together a range of behavioural strategies (e.g., modelling, shaping, differential reinforcement) as part of intrinsically motivating routines that build in complexity over time and as part of daily routines and play.

What are the principles that underpin the use of NDBIs?

Schreibman et al.¹ described 13 features that are common to the intervention approaches classified as NDBIs:

• Teaching incorporates the three-part contingency of antecedent, behaviour, consequence.
• The use of a manual to guide implementation.
• Fidelity checks to ensure the intervention is implemented accurately.
• Individualised intervention goals.
• Ongoing measurement of progress.
• Child-initiated teaching episodes.
• Arranging the environment to promote children’s interaction and learning.
• A focus on intrinsic reinforcement and natural contingencies, over external reinforcement.
• Use of prompting and prompt fading to teach skills, leading to children’s independent use.
• Helping children to learn to take turns in social and play routines.
• Adults modelling the skills children are being supported to learn.
• Adults imitating children’s actions and attempts to communicate to motivate further communication attempts.
• Systematic attempts to broaden children’s repertoires of skills and interests.

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 NDBIs on child and family outcomes?

Below is a summary of the evidence for the effect of NDBIs 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 NDBIs. Following that are findings relating to specific NDBI practices.

Evidence table for naturalistic developmental behaviourial 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 NDBIs*	2	M	M	M		M	M	M	M		M	M	M
Early Start Denver Model	2	M	M	M		M			M				M	M					M	M	M
Pivotal Response Treatment	3		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. Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., Halladay, A. (2015). Naturalistic developmental behavioral interventions: empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411-2428. doi:10.1007/s10803-015-2407-8