Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;66(1):4-15.
doi: 10.1111/jcpp.13994. Epub 2024 May 8.

Examining variability in Naturalistic Developmental Behavioral Intervention strategy use in caregivers of children with autism spectrum disorders

Hallie Brown  1 , Deanna Swain  2 , Hye Won Kim  3 , Sally Rogers  4 , Annette Estes  5 , Connie Kasari  6 , Catherine Lord  6 , So Hyun Kim  3
Affiliations

Examining variability in Naturalistic Developmental Behavioral Intervention strategy use in caregivers of children with autism spectrum disorders

Hallie Brown et al. J Child Psychol Psychiatry. 2025 Jan.

Abstract

Background: Naturalistic Developmental Behavioral Interventions (NDBIs) for young children with autism spectrum disorder commonly involve caregiver-mediated approaches. However, to date, there is limited research on how caregivers' skills change, and, in turn, impact child outcomes.

Methods: We evaluated the NDBI strategy use of 191 caregivers prior to participation in NDBIs (or control groups) across multiple randomized controlled trials, using the Measure of NDBI Strategy Implementation, Caregiver Change (MONSI-CC). Clustering analyses were used to examine caregiver variability in NDBI strategy use at intervention entry. Generalized Linear Mixed Models were used to examine changes in caregiver strategy use over the course of intervention and its impact on changes in children's social communication.

Results: Using clustering analysis, we found that caregivers' baseline skills fit four profiles: limited, emerging, variable, and consistent/high, with few demographic factors distinguishing these groups. Caregivers starting with limited or emerging skills improved in their strategy use with intervention. Caregivers starting with more skills (consistent/high or variable) maintained higher skills over intervention. Children of caregivers in these groups who received target NDBIs improved in their social communication skills.

Conclusions: Results suggested that caregiver skills improve through participation in NDBIs and may directly contribute to their children's outcomes, although more research on mediating factors is needed. Individualized approaches for caregivers and their children starting with differing skill profiles at intervention entry may be warranted.

Keywords: Naturalistic Developmental Behavioral Interventions (NDBI); autism; caregiver Input; caregiver‐mediated intervention; child mental health.

PubMed Disclaimer

References

    1. Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomised controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45, 1420–1430.
    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn). Arlington, VA: American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596
    1. Beaudoin, A.J., Sébire, G., & Couture, M. (2019). Parent‐mediated intervention tends to improve parent‐child engagement, and behavioral outcomes of toddlers with ASD‐positive screening: A randomized crossover trial. Research in Autism Spectrum Disorders, 66, 101416.
    1. Bruinsma, Y.E., Minjarez, M.B., Schreibman, L., & Stahmer, A.C. (2020). Naturalistic developmental behavioral interventions for autism Spectrum disorder. Baltimore, MD: Brookes Publishing Company.
    1. Charrad, M., Ghazzali, N., Boiteau, V., & Niknafs, A. (2014). NbClust: An R package for determining the relevant number of clusters in a data set. Journal of Statistical Software, 61, 1–36.