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.

  • Each cell represents evidence for the intervention category or practice (horizontal rows) on various child and family outcomes (vertical columns).
  • The effect of these interventions on a range of child and family outcomes is summarised as positive, null, or mixed.
    • Positive means that all available evidence indicated a positive effect of the intervention on a given child or family outcome.
    • Inconsistent means that there was a mixture of positive and null effects reported for the intervention on a given child or family outcome.
    • Null means that all available evidence indicated a null effect of the intervention on a given child or family outcome.
  • H / M / L indicates the methodological quality of the evidence that contributed to the overall intervention effect for a given child or family outcome. The quality of evidence on which these findings are based is summarised as high, moderate, or low. These quality ratings are relative to those that met the minimum standards to be included in the report. Where there is more than one quality rating, it means more than one systematic review is represented.
    • H indicates evidence from a high quality review
    • M indicates evidence from a moderate quality review
    • L indicates evidence from a low quality review
  • Where a cell is empty, it means there was no evidence available from the systematic reviews included in the report.

Please refer to the full report for a detailed explanation of the process used to collect, summarise, and synthesise the evidence presented here. 

Summary of evidence table

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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

Null
M
Positive
M
Null
M
Positive
M
Positive
M
Positive
M
Positive
M
Null
M
Positive
M
Null
M

Early Start Denver Model

2

Null
M
Null
M
Null
M
Positive
M
Positive
M
Null
M
Positive
M
Positive
M
Positive
M
Positive
M

Pivotal Response Treatment

3

Inconsistent
L
Positive
L
Null
L
Positive
L
Positive
L
Inconsistent
L
Positive
L
Inconsistent
L

Systematic reviews of assorted NDBIs*

No. of systematic reviews: 2

Core autism characteristics

Overall autistic characteristics: Null effect (Evidence from 1 moderate quality review)

Social-communication: Positive effect (Evidence from 1 moderate quality review)

Restricted and repetitive interests and behaviours: Null effect (Evidence from 1 moderate quality review)

Sensory behaviours: No evidence available

Related skills and development

Communication: Positive effect (Evidence from 1 moderate quality review)

Expressive language: Positive effect (Evidence from 1 moderate quality review)

Receptive language: Positive effect (Evidence from 1 moderate quality review)

Cognition: Positive effect (Evidence from 1 moderate quality review)

Motor: No evidence available

Social-emotional/ challenging behaviour: Null effect (Evidence from 1 moderate quality review)

Play: Positive effect (Evidence from 1 moderate quality review)

Adaptive behaviour: Null effect (Evidence from 1 moderate quality review)

General outcomes: No evidence available

Education and participation

School/ learning readiness: No evidence available

Academic skills: No evidence available

Quality of life: No evidence available

Community participation: No evidence available

Family wellbeing

Caregiver communication and interaction strategies: No evidence available

Caregiver social emotional wellbeing: No evidence available

Caregiver satisfaction: No evidence available

Caregiver financial wellbeing: No evidence available

Child satisfaction: No evidence available

Early Start Denver Model

No. of systematic reviews: 2

Core autism characteristics

Overall autistic characteristics: Null effect (Evidence from 1 moderate quality review)

Social-communication: Null effect (Evidence from 1 moderate quality review)

Restricted and repetitive interests and behaviours: Null effect (Evidence from 1 moderate quality review)

Sensory behaviours: No evidence available

Related skills and development

Communication: Positive effect (Evidence from 1 moderate quality review)

Expressive language: No evidence available

Receptive language: No evidence available

Cognition: Positive effect (Evidence from 1 moderate quality review)

Motor: No evidence available

Social-emotional/ challenging behaviour: No evidence available

Play: No evidence available

Adaptive behaviour: Null effect (Evidence from 1 moderate quality review)

General outcomes: Positive effect (Evidence from 1 moderate quality review)

Education and participation

School/ learning readiness: No evidence available

Academic skills: No evidence available

Quality of life: No evidence available

Community participation: No evidence available

Family wellbeing

Caregiver communication and interaction strategies: Positive effect (Evidence from 1 moderate quality review)

Caregiver social emotional wellbeing: Positive effect (Evidence from 1 moderate quality review)

Caregiver satisfaction: Positive effect (Evidence from 1 moderate quality review)

Caregiver financial wellbeing: No evidence available

Child satisfaction: No evidence available

Pivotal Response Treatment

No. of systematic reviews: 3

Core autism characteristics

Overall autistic characteristics: No evidence available

Social-communication: Inconsistent effect (Evidence from 1 low quality review)

Restricted and repetitive interests and behaviours: Positive effect (Evidence from 1 low quality review)

Sensory behaviours: No evidence available

Related skills and development

Communication: Null effect (Evidence from 1 low quality review)

Expressive language: Positive effect (Evidence from 1 low quality review)

Receptive language: No evidence available

Cognition: No evidence available

Motor: No evidence available

Social-emotional/ challenging behaviour: No evidence available

Play: Positive effect (Evidence from 1 low quality review)

Adaptive behaviour: No evidence available

General outcomes: Inconsistent effect (Evidence from 1 low quality review)

Education and participation

School/ learning readiness: Positive effect (Evidence from 1 low quality review)

Academic skills: No evidence available

Quality of life: No evidence available

Community participation: No evidence available

Family wellbeing

Caregiver communication and interaction strategies: No evidence available

Caregiver social emotional wellbeing: Inconsistent effect (Evidence from 1 low quality review)

Caregiver satisfaction: No evidence available

Caregiver financial wellbeing: No evidence available

Child satisfaction: No evidence available

*Practices included in systematic reviews of assorted naturalistic developmental behaviourial interventions

Advancing Social-Communication and Play (ASAP); Caregiver-based intervention program in community day-care centers; Denver Model; Early Social Interaction Project (ESI); Early Social Interaction Project (SCERTS); Early Start Denver Model (ESDM); Focus parent training program; Home-based Building Blocks Program; ImPACT Online; Interpersonal Synchrony; Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER); Joint Engagement Intervention with Creative Movement Therapy; Joint Engagement Intervention; Learning Experiences Alternative Program (LEAP); Parent-Early Start Denver Model (P-ESDM); Pivotal Response Treatment (PRT); Reciprocal Imitation Training (RIT); Social ABCs.

View the full evidence table for all intervention categories

Full reference of report

Whitehouse, A., Varcin, K., Waddington, H., Sulek, R., Bent, C., Ashburner, J., Eapen, V., Goodall, E., Hudry, K., Roberts, J., Silove, N., Trembath, D. Interventions for children on the autism spectrum: A synthesis of research evidence. Autism CRC, Brisbane, 2020

Intervention category overviews

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