Developmental, naturalistic options for preschoolers with autism

There are many, many options for teaching pragmatic skills to children with autism, varying from structured discrete trial training (DTT) to more naturalistic, child-led interventions. Often we think of behavioral and naturalistic approaches to therapy as an either/or. In reality, though, the majority of the interventions available for young children with autism use a naturalistic approach, based on developmental principles, while also pulling in elements of behavioral theory (recently, autism researchers coined the term “naturalistic developmental behavioral intervention,” or NBDI, to reflect these nuances).

This systematic review focuses on developmental social pragmatic (DSP) interventions (similar to NBDIs, but not including any explicit prompting, which is a more behavioral strategy). The researchers carefully defined DSP interventions using a core set of criteria to make sure they pulled just the right group of studies. DSP interventions:

  • Are based on developmental principles (hence the name!)

  • Use natural/play-based settings in therapy

  • Follow the child’s lead

  • Emphasize environmental arrangement and natural communication opportunities, and

  • Avoid explicit prompting (“Say ‘More Blocks’!”)

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Although DSP interventions (like NDBIs) incorporate some behavioral principles, they are not DTT—we’re talking about less structured learning opportunities here. Need examples? Think SCERTS (social communication, emotional regulation, transactional support intervention), DIR (developmental, individual difference, relationship-based intervention), PACT (parent-mediated communication-focused treatment), and More Than Words.

There are a few ways you might use a review like this. Have an intervention in mind and want to see if it made the list? Want to learn more about the evidence base for the intervention your school or clinic is already using? Or maybe you want to look into a new and different intervention for preschoolers with ASD? Whatever your purposes, keep in mind that (as with many systematic reviews and meta analyses) it’s a bit apple-and-oranges to compare the kids’ language outcomes across studies— we need more research to be able to say which DSP interventions lead to the biggest language gains. The results show us, though, that these interventions in general had positive effects on attention, engagement in social interactions, and initiations for preschoolers with ASD. Parent interaction styles improved, too, becoming less directive and more responsive. We love seeing outcomes like that! Overall, this article is a nice place to start organizing your thoughts on the many developmental social pragmatic options available for treating preschoolers with autism. 

Binns, A. V., & Oram Cardy, J. (2019). Developmental social pragmatic interventions for preschoolers with autism spectrum disorder: A systematic review. Autism and Developmental Language Impairments. doi:10.1177/2396941518824497