Naturalistic Developmental Behavioral Interventions (NDBI)

According to current research Naturalistic Developmental Behavioral Interventions (NDBI)  are considered highly effective intervention programs for very young children with autism. NDBIs are described as the merging of Applied Behavioral Analysis (ABA) and developmental sciences.

What is NDBI?

In 2020 the American Academy of Pediatrics (AAP) published a clinical report: Identification, Evaluation, and Management of Children With Autism Spectrum Disorder.

According to the AAP, “Naturalistic developmental behavioral interventions (NDBIs) incorporate elements of behavioral and developmental principles, such as emphasis on developmentally based learning targets and foundational social learning skills, with delivery of interventions in the context of naturally occurring social activities within natural environments. They use child-initiated teaching episodes, naturally occurring opportunities for learning, and turn-taking interactions within play routines and implement ABA-based approaches to address measurable goals. NDBIs may be an excellent match for public intervention systems due to their focus on early child development and the naturalistic strategies that are required by early intervention legislation.”

An NDBI can be delivered in the home, coaching parents to implement the strategies. Parent training models have been shown to be effective and are considered evidence-based. Further these are ‘‘family friendly’’ approaches that tend to increase both the quantity and quality of early learning experiences. Parents can readily implement these strategies in their natural environments and during ongoing activities such as meals, bath time, and visiting a park.

NDBI Requisite Criteria...

NDBI IS NOT One specific program—but a group of effective evidence-based comprehensive programs with common characteristics and requisite features. Here are the features an intervention must have to be considered an NDBI:

• Three Part Contingency
• Manualized Practice
• Fidelity of Implementation Criteria
• Individual Treatment Goals
• Ongoing Measurement of Progress
• Child-Initiated Teaching Episodes

• Environmental Arrangement
• Natural Reinforcement and Related Methods for Enhancing Motivation of the Child
• Use of Prompting and Prompt Fading
• Modeling
•Adult Imitation of the Child’s Language, Play, or Body Movement

Pathways Meets the Criteria of a NDBI

The Pathways Parent Training Program meets all criteria of a Naturalistic Developmental Behavioral Intervention. Applied Behavioral Analysis or ABA is the behavioral part of the NDBI. The teaching strategies parents learn in the Pathways Parent Training Program are based on the researched principles of ABA. What parents teach is based on the researched principles of early child and social communication development. By training parents in specific behavioral strategies that target developmentally appropriate social communication behaviors within the child’s every day routines, parents extend the intervention throughout the child’s day. This is how to achieve the intensive intervention or active engagement the child needs. Increasing active engagement within in the child’s naturally occurring routines increases learning while developing important relationships for both child and family. The child’s natural environment, most often the home, is a setting that is appropriate and meaningful to the child.

NDBI the Research

A recent meta-analysis, Project AIM: Autism Intervention Meta-Analysis for Studies of Young Children, found the following: Naturalistic developmental behavioral interventions and developmental interventions approaches have amassed enough quality evidence to be considered promising for supporting children with ASD in achieving a range of developmental outcomes. By far, NDBIs have emerged as the intervention type most supported by evidence from Randomized Controlled Trials. These studies suggest NDBIs may be particularly useful for supporting the development of social communication, language, and play skills.

According to the American Academy of Pediatrics, “More Randomized Controlled Trials have been published on parent-mediated therapies than on other non-pharmacologic interventions. Parent-mediated interventions, which are technique-focused and provide direct benefit to the child, may target core symptoms of ASD or other behaviors or skills and may be built on ABA approaches in natural settings. Parent training approaches may be used to promote compliance with instruction, social communication, and other identified goals of the caregiver, such as reducing maladaptive behaviors. Including parents in the intervention process is critically important.

A randomized controlled trial is a type of research design that measures the effectiveness of a new intervention or treatment. Although no study is likely on its own to prove causality, randomization reduces bias and provides a rigorous tool to examine cause-effect relationships between an intervention and outcome. Randomized controlled trials are considered the gold standard for studying causal relationships.

What about Applied Behavioral Analysis (ABA)?

What ABA is… ABA or Applied Behavioral Analysis is the science of how organisms learn. It is NOT a specific program or approach but rather a set of scientifically proven principles and procedures that address in a step-wise manner, how we learn.

What ABA is not… ABA is not a comprehensive program or curriculum (each behavior analyst decides what skills are targeted and the scope and sequence for intervention)

While ABA has a large body of evidence showing the effectiveness of the principles and procedures, there are few if any randomized controlled studies on a comprehensive program. When discussing ABA programming, The American Academy of Pediatrics stated: “When only randomized controlled trials are considered, few (ABA) interventions have sufficient evidence to be endorsed either for children younger than 12 years or for adolescents.”

Historically behavioral and developmental sciences reflected very different perspectives, theories and methodologies. They are now coming together integrating the strengths of each in NDBI approaches.

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