Autism interventions in ‘natural settings’ may work best

Interventions that parents and caregivers can offer in natural settings—such as during dinner, while playing in the park, or in the classroom—show the greatest promise for children with autism, a new study shows.

The interventions are particularly effective for supporting language, social communication, and play development.

“Naturalistic developmental behavior interventions (NDBIs) have garnered more high-quality evidence supporting their use than some traditional approaches for aiding young children with autism,” says Micheal Sandbank, assistant professor in the College of Education Special Education at the University of Texas at Austin and principal investigator of the study in Psychological Bulletin.

Natural settings

Researchers say the analysis marks the first meta-analysis of 130 reviewed studies of non-pharmacological interventions designed for young children with autism.

“Meta-analysis allows us to see whether interventions are more or less effective depending on different characteristics of the participants and the intervention—it helps us determine what works and for whom,” Sandbank says.

NDBIs are early intervention techniques that clinicians, educators, and other caregivers implement in natural settings, as opposed to more highly structured and formalized interventions.

The interventions use a variety of behavioral strategies to teach developmentally appropriate skills to young children with autism. For example, an NDBI strategy for teaching a child to say the word “ball” might include playing naturally with a ball in the park and modeling the word many times. Developers created them in such a way they can easily integrate into routine activities throughout the day to have maximum impact for the children.

Although NBDIs are not new, categorizing them as a specific type of intervention is, Sandbank says. In 2015, the developers wrote a consensus statement declaring that they were similar approaches guided by a shared philosophy.

“This statement allowed us to consider their evidence together, rather than separately,” Sandbank says. “We also found similarly strong evidence that developmental interventions are effective for supporting social communication development in children with autism.”

Language and communication

The meta-analysis showed that although traditional intervention methods such as early intensive behavioral intervention have promising evidence supporting their use, more high-quality research is needed.

The research also concludes that there is little evidence to support the effectiveness of several other interventions, including TEACCH (which focuses on learning strengths and preferences of the individual with autism), sensory-based interventions, animal-assisted interventions, and interventions mediated solely through technology (though approaches that integrate technology, such as high-tech augmentative and alternative communication devices, into more established interventions appear promising).

Additional research found that interventions are often more effective for kids with more language skills and are more effective for improving spoken language compared with understood language. The team is continuing to explore other findings related to how intervention effects vary based on different characteristics of the intervention, participants, or outcomes being tracked.

“The evidence regarding intervention for children on the autism spectrum has been rapidly transforming,” Sandbank says. “The last decade has seen the publication of over 100 group design studies of intervention, including at least 50 randomized controlled trials. These studies attest to the fact that access to intervention in early childhood can yield a range of positive outcomes for the children receiving it, but we have further to go to improve the quality of our evidence.”

Source: UT Austin

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