ASHA journals
3 files

The role of NDBIs in early intervention (Lee et al., 2023)

online resource
posted on 2023-01-11, 23:10 authored by Jordan Lee, Bailey Sone, Tara Rooney, Megan Y. Roberts

Purpose: 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.

Method: 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.

Results: 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.

Conclusions: 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.

Supplemental Material S1. Codebook for qualitative content analyses for Research Question 3 (strategies/activities SLPs advise caregivers to use) and Research Question 4 (child skills, behaviors, and developmental domains discussed by SLPs and caregivers).

Supplemental Material S2. Summary of each SLPs’ observed fidelity in implementing developmental and behavioral NDBI strategies, their self-reported use of developmental and behavioral NDBI strategies, and the frequency with which they were observed to recommend developmental and behavioral strategies.

Supplemental Material S3. Full NDBI-Fi measure used to rate SLP strategy use in the current study.

Lee, J., Sone, B., Rooney, T., & Roberts, M. Y. (2023). The role of naturalistic developmental behavioral interventions in early intervention for autistic toddlers: An observational study. American Journal of Speech-Language Pathology, 32(2), 439–451.


This study was supported by a grant awarded to Megan Roberts by the National Institutes of Health (R01DC014709).