The Autism Blog

Naturalistic Developmental Behavioral Interventions for Children with Autism

With so many different interventions being used in the treatment of ASD, it can be incredibly challenging to understand what they all mean, which ones are effective, what the research tells us about different models, and which one is best for an individual child. Terms like Applied Behavior Analysis, Pivotal Response Treatment, Early Start Denver Model, Project DATA and Incidental Teaching become a blur, especially when parents and caregivers are trying to make sense of what is best for their child. Although developing a new term may seem like it just adds to the confusion, the term Naturalistic Developmental Behavioral Intervention (NDBI) was coined by Laura Schreibman and colleagues in 2015 in an attempt to unify the field around interventions that have a shared set of characteristics. Let’s take a look at what this new term means and why it is helpful.

Many years of research has shown us that interventions based on Applied Behavior Analysis (ABA) are effective for teaching skills to individuals with ASD and reducing challenging behaviors (e.g., tantrums, aggression, rigid behavior patterns). ABA interventions can be delivered in many different ways. Many researchers and clinicians have moved toward developmentally-focused models where ABA interventions are delivered within natural activities (e.g., play) and routines (e.g., family routines). As these interventions have evolved, they have increasingly begun to blend developmental theories and interventions with ABA, and thus, the NDBI approaches were born.

Some of the hallmark features of NDBI include teaching functional skills for increasing quality of life; a focus on enhancing motivation and engagement in treatment; embedding active opportunities for teaching in the natural environment; and following the child’s lead and interests when selecting teaching materials and activities. In a nutshell, NDBI combine effective teaching methods based on the science of ABA with the developmental methods known to enhance motivation, engagement and learning. This blend is then used to embed learning into activities that are appropriate and fun for individuals and families regardless of age or developmental level. While some have referred to it as a “modern ABA”, we just refer to it as good teaching!

Many existing treatment models fall into the NDBI category, including Early Start Denver Model (ESDM); Pivotal Response Treatment (PRT); Classroom Pivotal Response Treatment (cPRT); Enhanced Milieu Teaching (EMT); Incidental Teaching (IT); Project ImPACT (Improving Parents as Communication Partners); Project DATA (Developmentally Appropriate Treatment for Autism in Toddlers); Social ABC’s; and Joint Attention, Symbolic Play, Engagement and Regulation (JASPER). While some of these models are primarily available in university-based research settings (e.g., EMT, JASPER), others are more readily available in the community depending on where you live (e.g., ESDM, PRT, Project DATA).

Since making sense of these interventions and gaining access to them can be very difficult for clinicians and families, a small group has recently collaborated to improve access to this information. A new book, titled, Naturalistic Developmental Behavioral Interventions for Autism Spectrum Disorder (Bruinsma, Minjarez, Stahmer and Schreibman) is due out this fall. Further, an NDBI conference has just been announced for October in Irvine, CA! The book and conference will focus on outlining the core components that are shared among these interventions in an attempt to increase access to the “active ingredients” of treatment regardless of which model you choose. This effort is focused on moving away from rigid adherence to any one model and promoting widespread use of a core set of intervention strategies that are known to be effective in improving the lives of individuals with ASD. The conference will feature speakers who have developed these models (e.g., Laura Schreibman, Sally Rogers), which will be an exciting opportunity to learn about ASD intervention straight from the source! Hope to see you there!

Conference information and registration.

 

Ask Dr. Emily – Hugging Alternatives

Welcome to the July edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Neuhaus, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

Read full post »

Autism 200 Series: Transition to Adulthood – Autistic Burnout

This month’s Autism 200 series class is Autism 206, the first of a 2-part series: Transition to Adulthood: “My physical body and mind started shutting down”: Autistic burnout and the costs of coping and passing.

Instructor: Dora Raymaker, PhD

Although autistic adults have identified an urgent need to address autistic burnout – a near-total exhaustion, sense of hopelessness and detachment and loss of function in daily life (sometimes called autistic regression) – research on burnout and autism has focused on caregiver and provider burnout. The Academic Autism Spectrum Partnership in Research and Education (AASPIRE), a long-standing community based participatory research partnership, has begun new research in this area. This presentation will first provide an understanding of the characteristics and experience of autistic burnout, and how it impacts people’s lives. Then we will discuss its potential causes, including prolonged masking of autistic traits. Lastly we will offer suggestions for preventing or reducing autistic burnout, and conclude with implications for healthcare and service providers.

Class Schedule: This class will be held Thursday, July 18, 2019, at Seattle Children’s Hospital in Wright Auditorium from 7:00 to 8:30 p.m. Please join us in person or watch on Facebook live. For more information see the  Autism 200 Series webpage.

Limelight’s Captive- A Mother’s Struggle and Love

This week we welcome guest blogger Lisa Wasikowski sharing a heartfelt story about some of the struggles and laughter she experiences with her daughter.

Right now, my daughter’s head is in my lap, resting between the first waves of a bad seizure episode. It’s going to be a long day. She’s medicated, as comfortable as she can be, her hand in mine, in it together until the end – as we do. Read full post »

Why Should We Care About Research?

This blog will be our first in a series regarding Research.  We welcome guest author Soo Jeong-Kim, MD Medical Director of the Seattle Children’s Autism Center.  Dr. Kim explains why we should care about research, and what to consider before participating.  In our next blog, we will detail a current research opportunity available in the area. 

Soo Jeong-Kim, MD Medical Director of the Seattle Children’s Autism Center

We know a great deal more about autism than our previous generation did. For example, we know autism is not caused by poor parenting. We know some interventions are safer and more effective than others. We know these because of research. Many important questions are being asked by families and doctors and researchers are trying to answer these questions by gathering evidence, making hypothesis, and systematically investigating to support or reject the hypotheses.
While children and families participating in research studies may not receive direct benefit from the study, research will help us to understand better about what’s going on in our children with autism and what can be done to help them, so that we do not repeat the past, such as blaming parenting for autism or trial of therapies or medications that are proven to be ineffective or even harmful.

What should we consider before participating in research?

Research cannot be done without participation of individuals with autism and their families. Researchers may not able to answer research questions when they do not have enough participants. Most research studies require dozens and sometimes several hundreds of participants to be able to answer questions.

When you decide to contribute to the research, you should be informed:
  1. You may not receive direct benefit from the participating in the study. It’s because the study is just to learn more about what is going on with our children with autism (e.g., how much physical activities your child is doing per typical day) or it’s because your child is participating in a clinical trial study that requires half of participants to be randomly assigned for the “placebo” group. While your child or family may not receive direct benefit, your participation will result in better understanding and may also potentially lead to a new treatment intervention (e.g., therapy or medication).
  2. Sometimes it takes years before researchers to be able to answer research question. It is not uncommon researchers to repeat the studies to make sure the results from the original study were not by chance. It is known that even with the best evidence, it may take years to develop new treatment intervention.
  3. Participation in research studies should be voluntary and after weighing risk and benefit ratio carefully.