Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.
The social validity of autism behavioral intervention has been questioned. Naturalistic Developmental Behavioral Interventions (NDBIs) attempt to address some concerns, but it is unclear whether autistic people consider NDBIs socially valid. Social validity of an NDBI, Pivotal Response Treatment (PRT), was investigated through autistic adults commenting on videos of autistic children receiving PRT. Qualitative coding of responses generated three themes: respect for individuals; assessment of intervention implementation; and socioemotional considerations. Although video brevity limits the scope of the present study’s conclusions, participants highlighted PRT components that appeared socially valid (e.g., reinforcing attempts, following the child’s lead) and aspects appearing invalid (e.g., overemphasis on spoken language). Therefore, adjustments appear necessary for PRT to be fully acceptable to the autistic community.
Naturalistic Developmental Behavioral Interventions (NDBIs) are child-centered and motivation-based interventions for autistic children. Though they hold great promise due to their naturalistic implementation and focus on children’s strengths, there have been recent calls to improve NDBIs such that they are more aligned with the neurodiversity approach. Central to this argument is the notion that autistic clients and their families should find the intervention acceptable. This chapter describes how NDBIs differ from other behavioral interventions, what their strengths are, and how they can continue to be improved. More specifically, we focus on expanding target NDBI outcomes to include more distal, family centered variables (such as family quality of life); improving the social validity of NDBIs; and how NDBIs can be implemented using a tiered support system.
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