Naturalistic Developmental Behavioral Interventions (NDBI)

What Are Developmental Approaches?

Developmental approaches for young children with autism use knowledge of developmental science in the framework of the intervention. A therapist using a developmental approach will focus on assessing the child’s current skill and choosing targets that are appropriate for their development. Appropriate targets are usually skills that are just beyond the child’s current knowledge because these skills are the easiest for children to learn. 

Developmental research has found that children learn best when they actively participate in learning and when they have engaged and responsive caretakers. To accommodate this, developmental approaches are generally child-led, play-based, and reliant on relationship-building with the child. 

Developmental approaches include:

• Follow developmental sequence
• Natural environment teaching
• Follow child’s lead
• Joint engagement
• Relationship building 

What Are Behavioral Approaches?

The science of behavior and learning provide the basis of ABA therapy. ABA therapy uses knowledge of how behavior works to develop a unique program to fit the needs of the individual learner. 

These approaches use the strategies of positive reinforcement and the “A-B-Cs” of behavior to encourage desired behaviors.  

Positive reinforcement involves using a reward to encourage a positive behavior change. The rewards should be child-centered. Appropriate rewards will be different for each child based on what is important to them. Some examples of rewards are praise, toys, books, watching a movie or show, access to a playground, and many more. 

The “A-B-Cs” of behavior help to understand why a behavior is happening and which factors might affect how likely it is to happen again. 

• A stands for antecedent. This is what happens right before a behavior.
• B stands for behavior. The behavior is a reaction to the antecedent. It can be an action, verbal response, or a lack of response. 
• C stands for consequence. This is what happens after the behavior. This includes how the environment and the people in it respond to the behavior. 

Behavioral approaches include different techniques, such as:

• Task analysis
• Chaining
• Prompt hierarchy
• Differential reinforcement
• Shaping of behavior
• Direct teaching
• Environmental arrangement 

What Is NDBI?

NDBI methods combine elements of developmental and behavioral approaches. Although there are several treatment models, they all share several things in common. 

There are eight core elements of NDBI: 

1. Interactions should take place face-to-face and at the child’s level. 
2. The therapist should follow the child’s lead and actively participate in the activity chosen by the child.
3. The therapist should use a positive affect and animation to meet the child’s sensory needs. 
4. The therapist should model appropriate language and behavior to match the child’s developmental level.
5. The therapist should respond to all of the child’s attempts to communicate by repeating, clarifying, or expanding on them.  
6. The therapist should use temptations (rewards) to encourage communication.
7. The therapist should provide frequent episodes of direct teaching for new and emerging skills.
8. The therapist should provide high-quality direct teaching such as using clear instructions and teaching when the child is motivated.

In addition to the above features, NDBI methods also share several procedural elements. They should include a manual that specifies the procedure for the intervention. This manual is followed the same way for each intervention to make sure the treatment is conducted consistently each time. This is known as treatment fidelity. NDBI methods will also include ongoing measurement of progress. 

What Does NDBI Look Like?

To an outside observer, NDBI may look just like play. These methods are typically provided in natural settings. A natural setting is anywhere that the child is familiar with. Because of this, NDBI often takes place in the child’s home. 

The therapist will share control of the session with the child and may imitate the child’s language, play, or movements. You may also see the therapist modeling behaviors and interactions for the child and using prompting and prompt fading to teach new skills. 

Therapists use natural reinforcement and motivation in NDBI. For example, the therapist may arrange the environment so that the child must interact with adults to gain access to a particular object or activity. 

Therapists practicing NDBI will perform an intervention in the same way for each child. Although therapists must remain somewhat flexible, it is important to follow the intervention procedure to maintain treatment fidelity.