The Challenges Associated with Changing Practice: Barriers to Implementing Naturalistic Developmental Behavioral...

Naturalistic developmental behavioral intervention (NDBI) supports early social communication skills in young autistic children. Given their emphasis on child-led learning opportunities, NDBI is thought to be a socially valid approach to autism early intervention. Applied behavior analysis (ABA) practices could be an ideal setting to increase access to NDBIs for young autistic children; however, current ABA services continue to rely primarily on structured and adult-led approaches to teaching, including discrete trial training (DTT), which have been criticized for their intensity, limitations in skill generalization, and possible harms. Thus, while there is growing interest in translating NDBI into ABA settings, delivering NDBI in these settings may require de-implementing or transitioning away from using DTT approaches with young autistic children. The current study sought to understand the perspectives of ABA providers on the use of NDBI strategies within ABA clinical settings and the factors impacting the transition away from DTT approaches to effectively integrate NDBI. Semi-structured interviews were conducted with 18 ABA frontline and supervising clinicians across several ABA organizations. Rapid qualitative methods grounded in standard content analysis were used to analyze qualitative data. Results indicated that ABA clinicians generally viewed NDBI positively. However, several themes emerged related to the relative ease of using NDBI and DTT; the relative effectiveness of NDBI and DTT; client, caregiver, and staff perceptions of NDBI; and clinical decision-making around who might benefit from NDBI. Barriers to implementing NDBI included the need to unlearn existing DTT strategies, limited training and self-efficacy delivering NDBI, mixed attitudes toward NDBI, and broader systemic issues in the delivery of ABA services. Findings underscore the importance of understanding ABA frontline clinicians' perspectives regarding the implementation of NDBI and suggest the need for more targeted strategies to integrate NDBI strategies in ABA clinical settings.

The online version contains supplementary material available at 10.1007/s40617-024-01011-2.