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What are Naturalistic Developmental Behavioral Interventions (NDBIs)?

Updated: Apr 26, 2023


NDBIs can be viewed as the merging of applied behavioral and developmental sciences. NDBIs draw from the field of behavior analysis and the principles are grounded in the science of ABA. But they also draw from developmental science which provides us with information about how children develop & learn.


How Did NDBIs Come About?

The field of autism early intervention has changed significantly over the past 30 years. Since the development of the highly-structured ABA interventions, ongoing research has expanded these efforts by moving towards more naturalistic interventions that integrate ABA principles and developmental science. Our increased ability to diagnose children sooner, and the evidence supporting the effectiveness of providing services for younger children with autism, have brought these two fields together. The younger the child, the more critical the need to adjust to the child’s developmental level and to carefully sequence the specific component skills to be taught. A developmental perspective integrates into the intervention method, the science of child development, which informs the choice of activities based on the sequence of skills as they unfold in a typical sequence.


In 2015, Zwaigenbaum and colleagues reviewed the literature on interventions for children with autism (ages 0-3) and identified 24 randomized-controlled, quasi-experimental, and open-label studies. Their analysis supports the effectiveness of integrated developmental and behavioral interventions for this very young population. Also, around that same time (2015), the developers of several prominent ‘named’ interventions designed for young children with autism, authored a consensus statement designating that those approaches comprised a new intervention category called Naturalistic Developmental Behavioral Interventions. In that article, they describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, and common features. If you’re not familiar with these research studies, go check them out.
















 
















What Are Some NDBI Models?

NDBI can be considered an umbrella term for a number of different models that share common features. This is not an exhaustive list of NDBI Models, but it represents a sample of the most prominent models with strong empirical support…that demonstrates 1) literature or published manuals to adequately describe and implement the model, and 2) the model itself or its core components are considered as an evidence-based practice.


What Are the Common Features of All NDBIs

While there are some procedural and technical differences between existing NDBIs, 13 features are common across them.



What Is The Controversy Around ABA and NDBIs?

Perhaps some of the controversy surrounding the efficacy of NDBIs could be attributed to BCBA’s knowledge and beliefs about them. For example, in 2022 Hampton & Sandbank conducted a survey to describe and understand the knowledge and beliefs that BACB certificants have about NDBIs. They included open-ended questions and Likert-type rating scales which were used to examine the knowledge of NDBIs, familiarity with NDBIs, use of NDBI practices, and beliefs about effective interventions. They found that 32% of supervising respondents reported that they had not received formal training in NDBIs. Only 57% believed NDBIs are important for BACB professionals. And only 44% have received consistent training in developmental sequences. Results of the survey suggest that few behavior professionals recognize or understand what NDBIs are in practice. It also showed that they had not received training in developmental scope and sequences, yet many of them were developing treatment goals and supervising programs for young children with autism.


Here are a few quotes from open-ended questions that were submitted by respondents “BCBAs can pretty effectively work on play and communication skills through discrete trials and naturalistic teaching opportunities” and another one “Nothing beats full-time EIBI. That gets better results.” I would disagree with both of those statements and here’s why….


First, with regards to “BCBAs can pretty effectively work on play and communication skills through discrete trials and naturalistic teaching opportunities”. It seems that behavior analysts appear to understand that NDBIs have a focus on teaching in the natural environment, but they might not fully grasp the developmental perspective and the developmental teaching procedures that are utilized. Please note…that doing DTT in the natural environment is not the same as implementing NDBI strategies in the natural environment…While the traditional “do this” (copy me) approach helps children learn new things by copying others, it ignores the social role of imitation. Typically developing babies and young children play copycats with their caregivers and peers for the pure joy of sharing a common focus and being together. We want to strengthen these skills…we want them to socially initiate with others.


Second, with regards to “Nothing beats full-time EIBI. That gets better results.” I would like to refer to an article published by Sally Rogers and colleagues in 2021, titled “A multisite randomized-controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. They designed a randomized, multisite, intent-to-treat study to compare EIBI and ESDM, across 15 hours or 25 hours per week of therapy. This was a large study that started in 2013 and ended in 2019 and included 87 toddlers with autism from three sites. The EIBI approach and curriculum were defined by the ‘A Work in Progress’ manual (from one of the researchers) and treatment was delivered in blocks of teaching trials with short breaks. The ESDM was carried out per the manual and the curriculum checklist, with treatment delivered in everyday childhood routines, using play-based objects and activities. They measured four outcome variables (receptive and expressive language ability, nonverbal development, and autism severity).


Their results showed some significant (and interesting) findings:

-No significant differences across groups in terms of participant characteristics

-All children made significant gains on all outcome variables

-The treatment style (EIBI or ESDM) had no effect on any of the dependent variables

-Baseline autism severity didn’t moderate the effects of treatment style on any dependent variable


The “brand name” of interventions may be less important than more general characteristics of high-quality interventions, with services for young children with ASD converging towards a unified model, adjusted to the unique learning needs of each child.


What Are Some Misconceptions?

Maybe part of the confusion is also related to a “translational issue” as NDBI manuals do not often use ABA lingo as frequently…which could make things look ‘conceptually fuzzy.’ The use of easily understood language and caregiver-friendly terminology (aka non-technical language) is meant to support collaborators, promote the dissemination of the model, and increase implementation across settings, as well as seem acceptability by parents and other providers. However, if you were to pick up the ESDM manual and look through the Index, you will see terms such as…antecedent, behavior plans, chaining, daily data sheet, engagement, eye gaze, gestures, incidental teaching, intensive teaching, motivation, prompts, requests, reinforcement, task analysis, and more. Would you not also see these terms in an ABA manual? Sometimes I don’t understand the confusion regarding the terminology…


A possible misconception of NDBIs is that they are synonymous with embedded discrete trials in the natural environment (i.e., natural environment teaching). Oftentimes I hear staff say “We do teaching in the NET” or we do natural environment training. Please note…that doing DTT in the natural environment is not the same as implementing NDBIs…While there are traditional ABA programs that are delivered in the natural environment, staff using these approaches control the learning trials (adult-directed)…and their selection of instructional targets is rarely informed by developmental sequences or natural reinforcers. So it seems that behavior analysts appear to understand that NDBIs have a focus on the natural environment, but they might not fully grasp the perspective and the developmental teaching procedures that are utilized.


I think one of the other misconceptions about NDBIs is that during teaching episodes in the natural environment, the child runs the session. And that’s simply not true. There is a difference between child-run and child-led sessions. In child-run sessions, the child gets to do whatever they want, there is no adult support or plans, and there are no boundaries, limits, or rules. Whereas in child-led sessions, (which you find in NDBIs) they value connection over compliance, they join in and expand on a child’s interests, they add support and structure to the child’s ideas (as needed), they set limits and hold boundaries, and they share curiosities and enjoyment with the child. Essentially, I think developmental and behavioral concepts are mutually informative, rather than mutually exclusive, and that they are better together…especially for infants and toddlers with autism. Further, a viewpoint that they can’t coexist together presents an obstacle to progress in our field.


If you would like to listen to a lively discussion about NDBIs, Dr. Jamie did a podcast with the ABA Inside Track crew. Check out episode #229



Developmental Principles + the Science of ABA



If you work with young children with ASD and are looking for ways to help increase their social attention, joint engagement, and communication skills...then this course is for you.


This master class provides a comprehensive introduction to the principles and practices of NDBIs. Over the course of 11 hours (yes, hours. There is a lot of amazing content to cover), you will learn about the theoretical background underlying the various NDBI models, review the empirical evidence supporting the effectiveness of those models, and will explore the foundational principles and strategies to improve social engagement and communication skills for young children with ASD. Recommendations for incorporating strategies into existing ABA programs will also be provided. Information will be provided on how to create your own resources, templates, and tools or you can access our already-designed supplemental materials included in the course resource library, to maximize your time and focus on what is important for you and your clients… amazing clinical outcomes. This master class also includes over 90 downloadable materials that you can start using as you work through the lessons. Instructional guides, data sheets, troubleshooting tips and tricks, fidelity checklists, research resources, and so much more! We’ve also included over 35 video examples highlighting the different instructional techniques, so you can see what they look like in action.

 

References

Hampton, L. H., & Sandbank, M. P. (2022). Keeping up with the evidence base: Survey of behavior professionals about Naturalistic Developmental Behavioral Interventions. Autism: the International Journal of Research and Practice, 26(4), 875–888.


Rogers, S. J., Yoder, P., Estes, A., Warren, Z., McEachin, J., Munson, J., Rocha, M., Greenson, J., Wallace, L., Gardner, E., Dawson, G., Sugar, C. A., Hellemann, G., & Whelan, F. (2021). A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism. Journal of the American Academy of Child and Adolescent Psychiatry, 60(6), 710–722


Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll, B., Kaiser, A. P., Bruinsma, Y., McNerney, E., Wetherby, A., & Halladay, A. (2015). Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428.


Schuck, R. K., Tagavi, D. M., Baiden, K. M. P., Dwyer, P., Williams, Z. J., Osuna, A., Ferguson, E. F., Jimenez Muñoz, M., Poyser, S. K., Johnson, J. F., & Vernon, T. W. (2022). Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. Journal of Autism and Developmental Disorders, 52(10), 4625–4645.


Zwaigenbaum, L., Bauman, M. L., Stone, W. L., Yirmiya, N., Estes, A., Hansen, R. L., McPartland, J. C., Natowicz, M. R., Choueiri, R., Fein, D., Kasari, C., Pierce, K., Buie, T., Carter, A., Davis, P. A., Granpeesheh, D., Mailloux, Z., Newschaffer, C., Robins, D., Roley, S. S., … Wetherby, A. (2015). Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics, 136 Suppl 1(Suppl 1), S10–S40.






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