A Comparison of Naturalistic Behavioral and Developmental, Social-Pragmatic Interventions on Language Use and Social Engagement In Children with Autism

Background: Naturalistic interventions show promise for improving language in children with autism.  Specific interventions differ in direct elicitation of child language and indirect language stimulation, which may produce different language outcomes.  Naturalistic behavioral interventions use direct prompting and reinforcement within natural contexts to teach specific social-communication skills while naturalistic developmental/social pragmatic interventions focus on increasing the adult’s responsiveness to the child and establishing balanced turns between the child and the adult. 

Objectives: This study compared the effects of responsive interaction (a naturalistic developmental/social pragmatic intervention), milieu teaching (a naturalistic behavioral intervention), and a combined intervention on the type and communicative function of expressive language in five preschoolers with autism.  In addition, it examined the differential effect of the three interventions on the children’s social engagement with the therapist. 

Methods: This study used a single-subject, ABACAD design across five children with autism.  Children received three weeks of each intervention.  The order of interventions was determined for each child by a coin flip.

Results: Results suggested that the milieu teaching and combined conditions were more effective at increasing the overall rate of expressive language targets than responsive interaction.  These conditions also led to substantial increases in prompted language and requests.  Responsive interaction had a small but consistently higher rate of commenting than milieu teaching.  All children showed higher social engagement ratings with the therapist during treatment than baseline.

Conclusions: Overall, these results suggest that the direct elicitation of child language within naturalistic interactions is the most effective strategy for producing short-term gains in child use of expressive language targets and can promote social engagement.