For Referring Providers

At KGH Autism Services, we value the relationships we’ve built with you, the physicians and ASD professionals in our community. Thank you for collaborating and trusting us with your patient referrals.

We are proud to be one of the few Accredited Behavioral Health Centers of Excellence in the Midwest - recognized for exceptional clinical quality, parent satisfaction and quality of staff. We provide results-driven therapy to infants through young adulthoods, supporting and empowering the entire family along the way.

We specialize in developmentally-based ABA therapy in the home or center for infants, toddlers and preschoolers with ASD.

There is science behind our success. Learn more about our NDBI approach to therapy here.

Naturalistic Developmental Behavior Intervention (NDBI) for Professionals

- What is Naturalistic Developmental Behavior Intervention (NDBI)?

NDBI is an autism intervention that merges applied behavioral and developmental sciences. (Schreibman, et., al, 2015).

-Why does applied behavior science need developmental science for early autism treatment?

The behavior field is less attuned to the rich body of information on typical child development.

-Why does developmental science need applied behavior science for early autism treatment?

The developmental field is less familiar with the science of learning and the principles and procedures necessary for fostering rapid skill-building.

-Why is the integration of developmental principles and ABA so important?

The ASD field has changed. Younger children are being diagnosed and recent research suggests that an ASD diagnosis becomes stable starting at 14 months (Pierce, et., al, 2019).  Early autism treatment must focus on and utilize both the science of learning as well as research on appropriate developmental learning stages.

Key elements of empirically validated NDBI

The core components are:

• Based on the well-established principles developed using the science of Applied Behavior Analysis (ABA) and,
• Uses developmentally based intervention strategies and sequences to guide goal development that is individualized to each child.

The Key Procedural Elements of NDBI:

• Uses an intervention manual or manuals that clearly specify the procedures of the intervention
• Includes procedures for assessing treatment fidelity
• Uses ongoing measurement of progress during treatment

THE KEY INSTRUCTIONAL STRATEGIES OF NDBI

• Specifies how the environment should be arranged to ensure that the child must initiate or interact with an adult to gain access to desired materials, favored activities, or familiar routines
• Uses natural reinforcement and other motivation-enhancing procedures
• Uses prompting and prompt fading during the teaching of new skills
• Balances turns within the teaching routines
• Utilizes modeling
• Uses adult imitation of the child’s language, play, or body movements
• Works to broaden the attentional focus of the child
• Involves child-initiated teaching episodes
  

Core Components

NDBI is based on the well-established principles developed using the science of Applied Behavior Analysis (ABA). It involves the three-part contingency of antecedent -> behavior or (response) -> consequence. This helps the child understand when to respond and ensures that the intervention provides feedback to the child.

Although more recent strategies for ASD intervention, such as NDBI, differ in various forms from earlier behavioral interventions, the basic tenets of NDBI are the same as those of their original ABA roots. It uses developmentally based intervention strategies and sequences to guide goal developmental that is individualized to each child

Based in developmental science, NDBI use developmentally based assessments and curriculums.  In most cases, goals are developed with the use of standardized assessment, observation, and developmental checklists. These serve to guide clinicians in determining individualized treatment targets across behavior domains.

KEY PROCEDURAL ELEMENTS

1. Uses an intervention manual or manuals that clearly specify the procedures of the intervention

Research has shown that accurate implementation of an intervention requires adherence to clearly stated procedures.  Furthermore, manualization helps with consistency of implementation and with training of treatment providers.

2. Includes procedures for assessing treatment fidelity

Treatment fidelity refers to the degree to which an intervention is being applied correctly, as it was designed.  This is essential because the evidence shows that the intervention is effective when implemented according to the manual, but it is unknown how effective the intervention might be if it is not accurately applied. 

Because of this, the accuracy of treatment implementation is likely a mediating factor in child outcome - with better outcomes likely associated with more accurate treatment implementation.  Additionally, NDBI provides specific assessment procedures and mastery criteria to allow trainers to assess the level of implementation accuracy by the practitioners.

3. Uses ongoing measurement of progress during treatment

Ongoing measurement of progress during treatment is an essential feature of good treatment and thus a feature of NDBI.

Effective practice must also be systematically and objectively verified through appropriate data collection. Data must be collected to track progress not only to ensure overall treatment effectiveness but also to allow for changes in treatment procedures or treatment targets, when needed. 

As with all ABA programming, data collection methods vary by goal to examine progress over time. 

KEY INSTRUCTIONAL STRATEGIES

1. Specifies how the environment should be arranged to ensure that the child must initiate or interact with an adult to gain access to desired materials, favored activities, or familiar routines

Environmental arrangement refers to how the adult structures the environment to facilitate and encourage child initiation of skills and learning of new target skills. For example, preferred materials may be visible, but placed out of reach to encourage the child to initiate a request for the material.

Other types of environmental arrangements include:

• control access to material until the child initiates
• playfully obstruct where the child initiates to continue the activity
• introduce materials that require assistance so that the child must interact with the adult
• create expectant waiting: the adult looks at the child and waits for initiative response
• alter a routine in which the adult changes a familiar sequence of events, so that the child must
• correct the sequence

2. Uses natural reinforcement and other motivation-enhancing procedures

NDBI gives the child a good deal of control over a teaching episode. The child’s choice of stimuli or activities allows for the use of natural reinforcement as a consequence.

“Reinforcement” refers to the strengthening of a behavior and making it more likely to occur again, as a result of what happens immediately following that behavior. A natural reinforcer is one that is directly related to the child’s response. 

For example, if the child wants to play with blocks, access to the block would be contingent on a related response from the child, such as saying “block” or pointing to the blocks while looking at the clinician.

3. Uses prompting and prompt fading during the teaching of new skills

Prompting involves presenting a cue (i.e., visual, verbal, auditory, physical) between an instruction (also referred to as a discriminative stimulus [Sd]) and the target behavior being taught in order to evoke the desired response and thus set the context for reinforcement. 

Prompts are used to support behaviors not yet in the child’s repertoire or not yet under the control of the SD, so they can occur and be reinforced.  Overall, prompts are used systematically to promote new skills.

4. Balanced turns within teaching routines

This strategy (also known as turn taking, shared control, or reciprocal interactions) involves back-and- forth exchanges in activities or with objects between the child and the adult.  Such interactions serve to increase and support the social reciprocity found in many typical social interactions. In addition, this strategy increases maintenance of social interactions as well as allows the adult to control access to materials.

5. Utilizes modeling

In modeling, the adult demonstrates a behavior that follows the child’s focus of interest and typically demonstrates the targets skill the child should perform. Modeling is often used as a prompt strategy, specifically by the adult to evoke and support the child’s imitation of a modeled action or language.

6. Uses adult imitation of the child’s language, play, or body movements

This strategy is used to increase the child’s responsivity to, and imitation of, an adult. It is also used to promote continuation of the interaction.  Research indicates that children with or without ASD respond with increased attentiveness when being systematically imitated by the adult.

7. Works to broaden the attentional focus of the child

Early research identified an attentional deficit in many children with ASD, wherein a child’s behavior might be affected by only a small portion of a compound stimulus.  This attention phenomenon is called stimulus over selectivity to denote that the level of selective attention is excessive. 

For example, one child whose father wore glasses could not identify his father when the father removed the glasses. The child used only an exceedingly small portion (glasses) of the compound stimulus (father, made up of many component features) to identify him.

It is easy to see how such restricted stimulus control might interfere with learning. More recent research has shown that over selectivity is highly related to developmental level and is not specific to ASD. Because NDBI emphasizes teaching in natural and varied contexts with a variety of materials, this natural occurrence of multiple examples may likely help broaden, or normalize, the child’s attentional focus.

8. Involves child-initiated teaching episodes

This strategy may be called child choice, or following the child's lead. It seeks to take advantage of increased motivation by presenting something highly desired to a child. It also provides instruction or opportunity to respond within the context of a child’s preferred activity or familiar routine.

The child indicates interest in an object or activity by:

• speaking
• pointing to

• reaching for
• spontaneously engaging

The clinician provides a teaching opportunity within the activity.  Because the child chooses the object or activity involved in the teaching interaction, the child’s successful achievement of his her or her goal is the positive consequence for the child’s use of the target skill set up by the adult.