We hear from parents a continuing interest in naturalistic forms of behavior therapy and questions around 1) what is actually meant by “naturalistic” and 2) how to find a provider who focuses on naturalistic therapy.
As we’ve highlighted on our website and in our New Parent Kit, there are multiple types of programs rooted in the principles of applied behavior analysis (ABA). Indeed, ABA is a family or umbrella of overlapping therapies rather than one specific thing. Several different models may be used with your child that, while based on the same principles, in practice look quite different.
Parents may feel intimidated at first trying to understand the different sub-types of ABA when choosing their child’s care program. To bridge this gap, we’ve created this chart to differentiate 2 key forms of ABA programs in general terms, between discrete trial training (DTT) and the Early Start Denver Model (ESDM):
|Dimension||Discrete trial training (DTT)||Early Start Denver Model (ESDM)|
|Evidence-base||Clinically effective in research studies||Clinically effective in research studies|
|Primary focus||Behavior shaping||Behavior shaping blended with developmental science|
|Structure||Highly structured (e.g., child and therapist work at a table together)||Less structured (e.g., child and therapist play together, skill-building happens through play)
Becomes gradually more structured if needed for the child
|Response to challenging behaviors||Heavy-handed responses potentially used by some providers (e.g., forcing of child action)||No heavy-handed responses (prioritizes relationship over any specific behavior or skill acquisition)|
|Reinforcers used||Artificial (e.g., candy) or natural||Natural (e.g., play)|
|Developmental framing||Used across all ages regardless of developmental stage||Incorporates knowledge of developmental milestones (e.g., typical toddler behavior)|
If you are the type of parent who likes to see the differences in practice, here are a couple videos you can watch to see the differences between DTT and ESDM in practice:
Discrete trial training (DTT): watch the first minute of this video:
Early Start Denver Model (ESDM): watch the first 2 minutes of this video:
We have prioritized naturalistic forms of ABA, specifically the Early Start Denver Model (ESDM), at Soar Autism Center because we’ve found them to be the most effective and compassionate for young learners. But both forms are evidence-based, and it’s wise to ask potential providers you’re evaluating if you can view a session to understand what it looks like in practice. And if you read or hear something that causes you to question whether a certain type of therapy is right for your child, talk to a few providers and make sure your questions are answered. There are a lot of opinions out there based on various experiences, and it’s important to find the right fit for you and your child.
If you’re interested in receiving naturalistic forms of behavior therapy, you should ask your provider about their background and training in Naturalistic Developmental Behavioral Interventions (NDBIs). Broadly speaking, there are two types of providers you may find:
– Certified or trained providers in an NDBI: These providers have received advanced training and/or certification in a discipline, such as the ESDM or Pivotal Response Treatment (PRT). These trainings require additional time, supervision, and cost and may be harder to find from providers depending on your location. If finding a naturalistic provider is important to you, ask if they are trained or certified in an NDBI discipline such as ESDM or PRT. We have providers trained in ESDM at Soar Autism Center.
– Providers who incorporate Natural Environment Teaching (NET) or advertise as “naturalistic”: These providers may not have received additional training in an NDBI and instead try to apply principles of ABA in a more naturalistic way. It is possible these providers may be effective as certified/trained providers, but they may not have received additional training or have the necessary expertise to implement an NDBI with fidelity to how it was designed.
If you’re interested in learning more about naturalistic approaches for your child in the greater Denver area, reach out to us today!
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