The Role of Naturalistic Developmental Behavioral Interventions in Early Intervention for Autistic Toddlers: An Observational Study.

Researchers watched 25 speech therapists working with autistic toddlers and their families at home to see how well they used specific teaching strategies called NDBIs. They found the therapists weren't using these strategies very well, though they did better with some types than others. The therapists covered many different skills during their visits. The study suggests therapists need more training in these methods, and researchers should study how these approaches help children in more areas of development.

This observational study examined how 25 early intervention speech-language pathologists (SLPs) use Naturalistic Developmental Behavioral Interventions (NDBIs) during home-based sessions with autistic toddlers and their families. Researchers recorded one session per family and assessed NDBI strategy implementation quality. Results showed SLPs did not implement NDBI strategies with high quality overall, though they performed better with developmental strategies compared to behavioral strategies. SLPs addressed diverse skills and strategies across multiple disciplines during sessions.

The study suggests SLPs may need additional training in NDBI implementation, while researchers should investigate NDBI impacts across broader developmental domains to better align with family-centered early intervention principles.

Results suggest early intervention SLPs require enhanced training in NDBI implementation, particularly behavioral strategies. The multidisciplinary nature of sessions supports investigating NDBI effects across broader developmental domains. Findings highlight the gap between research protocols and real-world implementation in family-centered early intervention settings.

Small sample size of 25 families limits generalizability. Single session observation may not capture typical practice patterns. Observational design cannot establish causal relationships. Study focused on implementation quality rather than child outcomes, limiting clinical applicability.

Naturalistic developmental behavioral interventions (NDBIs) have demonstrated initial promise in facilitating social communication development for autistic toddlers, but their highly structured protocols may be a barrier toward their use by early intervention (EI) providers who must individualize intervention according to family-centered principles. This study aimed to characterize the extent to which EI speech-language pathologists (SLPs) use NDBI strategies, and the range of skills and behaviors addressed during their EI sessions, to contextualize the role of NDBIs within the scope of needs of families with autistic children in EI. This observational study included 25 families with an autistic toddler and their EI SLP. One home-based session was recorded for each family, and an observational measure was used to describe SLPs' NDBI strategy use.

Qualitative content analyses were also used to characterize the strategies SLPs recommended to families, and the child skills and behaviors they discussed. SLPs did not implement NDBI strategies with high quality, but they implemented developmental NDBI strategies with significantly higher quality than behavioral NDBI strategies. SLPs discussed many strategies and skills across disciplines within the session. SLPs may require further training to implement NDBI strategies, but given the breadth and depth of skills addressed during sessions, researchers should investigate and report on the impact of NDBIs on a wider range of communication skills and developmental domains.

This will facilitate clinical decision making and make these interventions better aligned with family-centered EI principles. https://doi.org/10.23641/asha.21834480.