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Treating the early signs of autism - NDBIs and the Parent Infant Centre

Geoff Ferguson - April 14th 2015

The Journal of Autism and Developmental Disorders has recently published an overview of NDBI treatments for autism. The Naturalistic Developmental Behavioral Intervention approach combines behavioural strategies with insights gained from developmental science. This approach is particularly suitable for younger children

This post gives a brief summary of this overview and highlights some similarities between the NDBI approach and the approach used by the Parent Infant Centre. The full paper is well worth reading and is available open-access from the journal.

The nature of NDBIs

NDBIs, as described by the paper's authors, are 'implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills'. Rather than using a highly structured approach to learning isolated skills, the approach prioritises more flexible learning that is responsive to the child and that takes place within meaningful relationships.

This approach follows more closely the path of learning found to be most effective with all young children. As we are increasingly able to identify autism at an early age, so it becomes important to find interventions that are effective with very young children. By emphasising the importance of relationships for the young child, NDBIs set out to deliver a developmentally appropriate setting for learning skills.

The paper describes various NDBI models, along with evidence for their effectiveness. Three areas are found to be common to these various NDBIs:

The nature of the learning target: Rather than teaching specific skills discretely or in isolation, these approaches teach skills within the context of the child's daily life, with an emphasis upon 'social-communication learning via interactive, meaningful exchanges with others'.

The nature of the learning context: Following on from the above, these approaches emphasise the importance of learning within a socially meaningful context and in natural settings.

The nature of the development-enhancing strategies: These approaches emphasise learning strategies which build complexity from simple interventions through to joint activities that develop the child's communicative and social skills. The activities are child-centred, with scaffolding used to support the child's development of age-appropriate skills.

The context

The authors give an historical context for the development of NDBIs. Treatments for autism were developed in the '70s and '80s that were based upon operant learning. This is a behavioural approach in which skills are broken down into separate components and where the correct performance of the desired behaviour is strongly reinforced. ABA is one example of this form of treatment and this approach has proved to be very successful in helping some children.

The paper goes on to describe how research in child development during the '80s and '90s led to an increased awareness of the importance of the social and emotional context of learning. Infants learn by actively testing out predictions that they make of their environment, especially of their social environment. The emotional content of this social environment plays a crucial role in facilitating learning. However, it is this very issue, that of social and emotional awareness, that the autistic infant finds difficult.

The development of NDBIs represents an attempt to include within treatments for autism those insights regarding learning that have been gained from developmental science. Treatments began to directly address the skills involved in joint attention, imitation and social engagement. Learning schemes helped the child to build upon existing skills within a developmental sequence of gradually increasing complexity.

Crucially, within this process there is an understanding of the central role played by the emotional context:

'...young children develop their skills in the context of affectively rich social interactions involving play with both people and objects. Identical information delivered outside the context of an affectively engaged social exchange does not result in the same degree or depth of learning.'

The authors note that there are many different treatment models that incorporate an NDBI approach, each with their own specific emphasis and terminology. Their paper is an attempt to bring 'parsimony' to the field, by proposing some core components of these various NDBI approaches and with suggestions of some common features. They also indicate some areas for further research.

The work of the Parent Infant Centre

The Parent Infant Centre's ReStart programme shares several characteristics with the NDBI approach, as described in the above paper. ReStart is an intensive programme for young children up to around the age of three who show the early signs of autism. The programme includes sessions with the child, with each parent and child, with individual members of the family and with the parental couple. The techniques used include child and adult psychotherapy, parent-infant psychotherapy, music and art therapy, speech and language therapy, and physiotherapy.

The programme involves the whole family in a fulltime treatment programme for around three weeks. This is followed by regular weekly sessions with parent/s and child that may go on for several months. Some of the learning takes place within naturalistic settings, such as cooking and eating together or visits to a local shop or park. The parents are taught skills that will enable the learning to continue at home.

This programme has a strong emphasis upon supporting learning through affectively rich social interactions. For us this involves giving careful thought to the relationships that exist between all members of the family. The families that we work with generally have a high level of commitment and love for their autistic child. Our aim is to help the members of these families to gain the further skills and self-awareness that will enable them to create an even more affectively rich environment in support of their child's development.

Do contact us if you would like more information about this programme.


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Welcome to ourNews, where we keep up-to-date with research and other news related to infant mental health. These articles can be of interest to both parents and professionals.
We are keen to know your views and so please do comment on our articles.
Is there a topic that you would like us to write about? Just send us a message via 'Contact us'.

ourAdvice, our other blog, has brief posts with advice for parents.

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