Step 1.1 Identify a Target Behavior

First, it is important to identify specific, measurable skills for the target behaviors of a naturalistic intervention. These skills need to be more specific than a general goal or outcome and include behaviors that can be observed.

• pre-linguistic or linguistic communication and/or
• social skills

The target behavior should represent team consensus and come from outcomes on the toddler’s Individualized Family Service Plan (IFSP) or other individualized plan.

The target behaviors identified for naturalistic intervention are generated from the IFSP developed by the toddler’s IFSP team. The IFSP team, which includes early interventionists and parents, meets to determine appropriate outcomes and target behaviors for the toddler.

When focusing on toddlers with ASD, it is important to recognize and understand the value of prelinguistic communication in setting target behaviors. For example, a target behavior may be pointing to an object to establish shared attention, engaging in shared attention, or vocal turn-taking. Although none of these target behaviors demonstrates actual language use, these skills provide the foundation for language development.

For video clips demonstrating shared attention and other pre-linguistic behaviors, see the ASD Video Glossary found on the Autism Speaks website.

Step 1.2 Collect baseline data

It is important to have a clear understanding of the toddler's baseline skills before beginning a naturalistic intervention. 

Take data on the target skill or behavior a minimum of three times in more than one environment on more than one day. 

A frequency log of how often these behaviors occur in a variety of settings may be useful when collecting data. These baseline data will be critical for assessing whether or not the intervention is effective. 

Example of Baseline Data Collection in a Home-based Setting

Example of Baseline Data Collection in a Center-based Setting

With information from a log like these, you can identify how frequently toddlers currently use the target behavior. In the notes column, you might indicate prompts that were used, environmental cues, or other antecedents to the demonstration of the target behavior.

Language sampling can provide useful information about toddlers who are using words or phrases regularly. A language sample will provide information on the current length and content of utterances as well as antecedents to their production. A speech/language pathologist (SLP) on the toddler’s team should be able to take and analyze a language sample.

Step 1.3 Identify the contexts for intervention

Naturalistic intervention takes place throughout the day in the context of daily routines and activities. Being intentional about implementing interventions within the context of a toddler’s regular routines and activities is critical for successfully implementing naturalistic intervention.

a) Determine the toddler’s schedule of typical routines and activities

This includes activities in home, center, and other community settings. The schedule is often done on a weekly basis. Consider that all families have activities, but they may or may not occur in the same order or sequence each day or week. Therefore, it is important to use the schedule to guide planning for a naturalistic intervention, and to recognize that schedules may change as child and family circumstances change.

b) Identify activities that are of interest and highly reinforcing for the toddler

An important part of discovering the context for a toddler is to learn about a toddler’s interests and the activities that are highly reinforcing. There are several useful tools and strategies for obtaining this information.

The Interest-Based Everyday Activity Checklists includes the Early Preschool Interest-Based Everyday Activity Checklist for infants and toddlers functioning below 15-18 months of age and the Middle Preschool Interest-Based Everyday Activity Checklists for use with children functioning between 15 - 36 months of age. Both checklists help identify a toddler’s interests and potential learning opportunities within everyday routines and activities. (Swanson, Raab, Roper & Dunst, 2006)

Another tool is Getting to Know Your Child, from the Family-Guided Routines-Based Intervention Model (Woods, 2013). This tool provides open-ended space for writing in a toddler’s favorite and least favorite activities in a number of categories to help identify interests and opportunities for working on a target behavior. These resources are applicable to both home and center-based settings.

c) EI team members and the family identify contexts in which to embed naturalistic

intervention

Toddler-directed Activities

In these activities, toddlers select what they want to do within a specific environment. These preferred activities are then used to elicit the target behavior. Knowing these activities ahead of time by completing one of the strategies or tools described in Step 1.2 contributes to a toddler-directed intervention.

Home-based Example: Tom’s family wants him to engage in more interactions with Tom. They developed a target behavior related to turn taking. Tom’s mom, Norah is finishing up lunch dishes. Tom opens the cabinet and pulls out pots and pans. He starts to bang on one with a wooden spoon. Tom’s mom crouches down with him and extends a hand, nonverbally asking for a turn with the spoon. They trade the spoon back and forth.

Center-based Example: Betsy has a target behavior of labeling animals. Different animal toys are offered during free-choice time, and Betsy decides that she wants to work on an animal puzzle after math center time. To support Betsy’s use of the target behavior, the team member may encourage Betsy to request each piece that represents a different animal.

Routines and Activities

Routines and activities that take place on a regular basis (e.g., bath time, getting into the car seat, breakfast, snack and playtime, going to the grocery store) offer natural opportunities for learning and practicing target behaviors. Choice making should be built into these routines and activities, thus allowing toddlers to direct the interactions.

Strategies for conducting routines-based assessments with families are available from the following national resources. These sites include resources and strategies for identifying home and center-based routines and activities as well as a guidance for mapping community resources to inform opportunities for addressing target behaviors.

• Project TaCTICS, Florida State University (Juliann Woods)

• Early Intervention in Natural Environments, Siskin Institute, Chattanooga, TN (Robin McWilliam)

Many of the Siskin Institute resources are published in this book: McWilliam, R.A (2010). Routines-based Early Intervention: Supporting Young Children and Their Families. Baltimore: Paul H. Brookes Publishing Company

• The Donovan Family Case Study: Guidance and Coaching on Evidence-based Practices for Infants and Toddlers with ASD (National Professionals Development Center on ASD, 2013) includes additional resources for identifying the contexts for developing a naturalistic intervention.

Planned Activities

Planned activities are set-up in advance to provide opportunities for individual toddlers to practice target behaviors such as choice-making, labeling objects, or initiating a verbal communication.

View Examples of Learning Opportunities Within Daily Routines and Activities to Practice Targeted Behaviors

Naturalistic interventions can be embedded within learning opportunities that may occur throughout a toddler’s day at home. The examples illustrate the range and diversity of naturally occurring learning opportunities that occur within daily routines and activities for increasing achievement of target behaviors.

The learning opportunities create the learning context for arranging the environment to elicit the target behavior(s) and establishing how the adult responds to reinforce the toddler’s response or uses intentional evidence-base strategies to expand upon the toddler’s responses. See Step 2 for a description of these processes.

Step 1.4 Identify and provide training to the early intervention team

Since naturalistic interventions occur throughout the day, several adults may need to be taught how to elicit the target behavior.

a) Decide who will teach the skill

Identify the early interventionist(s), family members, and other adults who will facilitate the interactions to elicit target behaviors. These adults may include parents and other family members, teachers, caregivers, therapists, paraprofessionals, other community members and volunteers. Having multiple adults interact with the toddler encourages generalization. Adults who naturally interact with toddlers should be prepared to use naturalistic intervention strategies.

b) Provide adequate training to adult team members involved in the intervention before initiating naturalistic intervention

Adults who will be interacting with learners must understand:

• the target behavior including how it will be observed and measured,
• strategies used to elicit and reinforce that skill, and
• data collection strategies used to assess baseline and monitor progress toward achieving target behaviors.

Depending on the situation, different levels of training may be necessary. For example, in a center-based setting, the teacher may need to arrange the environment and model the strategies used to elicit the skill for assistants and volunteers. An early intervention home visitor might teach strategies to parents and older siblings.

All learning facilitators must understand the entire process to successfully use naturalistic strategies at appropriate times throughout the day. Coaching and ongoing support with a team lead and/or professional development consultant may be required to achieve consistency and success in implementing naturalistic intervention throughout the day when multiple adults and settings are involved. 

c) Develop a training plan

It is useful to develop a plan that identifies the full team of people who are involved in a naturalistic intervention and what type of training, support, and ongoing coaching each member will receive based on their needs and roles. The plan should also include the team leader and how the training will be carried out.

Although some naturalistic practices, such as milieu teaching, have traditionally been implemented by teachers and therapists, research also has demonstrated the effectiveness of training parents, caregivers, and/or other professionals to implement the teaching. Parents are often taught specific parts of the practice, such as reciprocal interaction techniques, while the toddler also participates in sessions that involve behavioral techniques such as modeling to elicit responses (within an environment adapted for the toddler’s own interests). Parents also can be taught to implement all aspects of the intervention in home and community settings. Parent involvement may be especially important for infants and toddlers, for whom multiple therapy sessions per week in a clinic or other out-of-home settings may not be appropriate. In these situations, parents are often the most appropriate and most effective intervention partners.

Refer to the AIM module on Parent Implemented Interventions for more information on this topic.

The training of team members is essential to ensure all identified interventionists understand the step-by-step directions for eliciting the target behavior.

Scripts provide a way to ensure that step-by step directions are available to all team members.

Sample scripts can be found in Step 2.2a.

Step 1.5 Arrange the environment to elicit the target behavior

Use information from Step 1.3 Identify the contexts for intervention and materials or resources within the home, center, and other community environments to capture a toddler’s attention and motivate him/her to produce target behaviors.

a) Choose motivating materials and activities to engage the toddler and

promote the use of targeted skills.

A key feature of naturalistic intervention is using materials and toys that will motivate the child to engage in the target behavior and that will promote generalization of skills. This is the place in the process to refer back to the information gathered about the toddler’s interests to help select highly motivating toys and activities. For a toddler’s safety, choose age appropriate toys that are designed to be mouthed, have smooth surfaces, can be easily grasped, and are washable. 

Toys and activities that can be particularly useful in facilitating communication and social play include those that require fine motor and eye-hand coordination, adult assistance, and turn-taking.toys that have multiple parts requiring fine motor skills and eye hand coordination.

EXAMPLES OF TOYS AND ACTIVITIES THAT CAN BE USED WITH NATURALISTIC INTERVENTION

 

Toys:

• Duplos^TM blocks
• a shape sorter
• Mr. Potato Head^TM

Items that can be added onto another activity:

• adding Little People^TM into play with blocks
• using puppets to act out a story
• hiding items under nesting cups

Activities that require adult assistance:

• opening a kitchen cabinet to obtain a snack
• having lid on bottle of bubbles so tight that learner must request help
• holding puzzle pieces until the child requests them

Activities that ecourage turn-taking:

• throwing a ball
• placing puzzle pieces
• sending toy cars down a ramp
• blowing bubbles

Social routines:

• finger plays or songs
• peek-a-boo game
• tickling games between a parent and child

For additional ideas on choosing toys for toddlers, visit the Zero to Three website: Tips for Choosing Toys for Toddlers.

b) Manage and distribute materials in a way that encourages a toddler to

communicate

Within interactions and contexts for intervention, materials are managed by the lead interventionist (e.g., parent, educator).This means that the interventionist and/or parent is “the keeper of the goods” and distributes the materials in a manner that encourages communication. For example, communication can often be elicited by giving toddlers only a few of the DuplosTM  at once, forgetting to open a food package for snack, or putting a doll’s hat on her feet as if by accident. Such “mistakes” are likely to elicit a request or comment from the toddler.

c) Arrange the intervention context and prepare the environment

Arrange the environment to encourage the use of the target behavior or skill and maintain the toddler's interests.

Practice Scenarios: Planning Naturalistic Intervention

Knowledge Check

Question:

Why is it important to provide training to all of the people who will be implementing a naturalistic intervention?

Question:

Identify and describe at least three types of assessments that will identify the contexts for a naturalistic intervention with Anna.

Step 2.1 Engage the toddler in an interaction

Engage the toddler in language-rich and child-directed interactions, making sure you are highly attuned and responsive to the communicative attempts of the toddler. You should also aim to use a toddler’s interests and provide language models that are at a slightly higher level than the toddler’s own language to elicit a target behavior.

Following are some strategies that can be used to maintain a toddler’s interests and provide language models that are at a slightly higher level than the toddler’s own language use. For some toddlers, these techniques will facilitate their use of the target behavior.

Continue to review details of each technique.

Step 2.2 Use strategies based on applied behavior analysis to elicit target behaviors

Use modeling, mand-models, time delay, and/or incidental teaching techniques to elicit the target behavior within intervention contexts and arranged environments that were identified in Step 1.3.

Sometimes, engaging the toddler in a language-rich and responsive interaction within an arranged environment will result in the learner demonstrating the target behavior. However, if the toddler does not demonstrate the target behavior, applied behavior analysis (ABA) techniques can be used to elicit the target behaviors. This should still be within the context of an arranged environment and with an interventionist who is using responsive interaction techniques.

These strategies can be used with pre-linguistic toddlers, with some modifications. Instead of expanding on a verbal response, the communication partner would map language onto the target behavior, such as pointing.

Applied Behavior Analysis Interventions

• Modeling,
• Mand-modeling,
• Modified time delay
• Incidental teaching

Review more about each ABA intervention.

Modeling

Modeling is a verbal or visual demonstration of the correct response requested of a toddler.

Team members implement modeling by:

• establishing shared attention,
• presenting a verbal or physical model,
• expanding the response and providing the requested material (if the toddler responds to the model correctly),
• providing another model (if the toddler does not respond or is inaccurate),
• expanding the response and providing the requested material (if the toddler responds to the model correctly), and
• stating the correct response and providing the material (if the toddler does not respond or does not repeat the model correctly).

Mand-Modeling

Mand-model procedures incorporate a question, choice, or direction (mand) into the activity prior to initiating a modeling procedure.

Team members implement mand-modeling by:

• establishing shared attention;
• presenting a verbal direction (mand) or question;
• expanding the response and providing the requested material (if the toddler responds correctly);
• giving another direction or model (depending on the toddler’s needs for support), if the toddler does not respond or does not respond with a target;
• expanding on the response and providing the requested material (if the toddler gives the target response); and
• saying the target response and providing the material (if toddler still does not give the target response or repeat the model exactly).

Modified Time Delay

Time delay is a practice that focuses on fading the use of prompts during activities. With this procedure, a brief delay is provided between the initial requests/questions and any additional instructions or prompts. The use of modified time delay, or waiting, before providing a verbal prompt allows toddlers to initiate the verbalization and encourages them to become aware of nonverbal cues. 

Interventionists implement modified time delay by:

• establishing shared attention;
• waiting 3-5 seconds for the toddler to make a request/comment;
• expanding on the request/comment and providing the requested material/activity (if the toddler initiates at the target level);
• providing a mand or model, depending on the toddler’s need for support (if the toddler does not initiate at the target level;
• expanding on the response and providing the material (if the toddler responds correctly);
• saying the target response and providing the material (if the toddler still does not give the target response or repeat the model exactly).

Incidental Teaching

Incidental teaching can be used to help toddlers elaborate on requests they have made. The interventionist encourages the learner to initiate interactions and manipulates the environment to elicit a request, and then uses a question to encourage an elaboration from the toddler. 

Team members implement incidental teaching by:

• setting up the environment to encourage learners to request assistance or materials,
• waiting for learners to initiate the request,
• responding with a request for elaboration (if the learner does not initiate with the target response),
• continuing to prompt for elaboration until the learner responds appropriately, and
• using model, mand-model, or modified time delay procedures, depending on the needs of the learner (if the learner does not initiate a request). 

(Adapted from Hancock & Kaiser, 2006)

The Autism Internet Module (AIM) Module on Naturalistic Intervention provides detailed descriptions and examples of these techniques, including those specific to toddlers.

 

Practice Scenario: Implementing Naturalistic Intervention

Knowledge Check

Question:

When may it be necessary to use applied behavior analysis (ABA) strategies in a naturalistic intervention?

Question:

Name the four applied behavior analysis interventions that are used to elicit target behaviors within naturalistic contexts.

Step 3.1 Gather and record data

Develop a system to monitor the effectiveness of the intervention that outlines where, when, by whom, and how data are collected.

Monitor the frequency and duration of the interfering behavior and the

replacement behavior

Collect data to monitor the toddler's progress. Data will be collected at planned time periods by taking language samples and/or other data (for example, frequency counts) on strategies that were used to elicit the targeDt behavior. Because naturalistic intervention involves having the conversational partner engaged with the toddler, it can be helpful to either:

• video record the session and collect data off the video at a later point in time or
• have an observer take the data.

However, this may not always be possible, especially in home-based settings where real-time data collection is the most feasible. Then, the interventionist or parent would want to use data collection measures and procedures that are easily accessible during intervention and efficient. This may involve making marks on a piece of masking tape applied to a hand or selecting off tallies on a tablet or smart phone.

Target Behavior:
Gus will use his words to request a snack item from a peer on three occasions during a 30 minute “Snack Pack” session two mornings a week.
Gus will respond to a peer’s request to pass a snack with a verbal response (e.g. Here you go, Joe) and a physical action (e.g., pass the bowl of snacks) on three occasions during a 30 minute “Snack Pack” session two mornings a week.

 

Step 3.2 Analyze data to determine next steps

Compare intervention data and baseline data to determine the effectiveness of the

intervention

Review and analyze the data on a periodic and agreed upon basis. This helps to determine what the data indicates about progress toward meeting a toddler’s target behavior. Use the data to assess whether the naturalistic intervention is achieving the desired results or if it may need to be modified. Through data analysis, you may discover that the target behavior has been met and that the goal needs to be ramped up to a more complex response.

Summarize the data to make decistions about future planning

For a naturalistic intervention, there are important decision-making points between engagement and use of ABA strategies when the early intervention team has to decide if the engagement strategies are sufficient for eliciting and reinforcing the target behavior. Careful consideration of the data helps the intervention team identify which ABA strategy may work the best to elicit a target behavior. Also, data will be useful in determining if other environmental arrangements are needed or if additional training may be required by members of the intervention team.

Together with the team, you may decide that additional data is needed to gain a better understanding of how to modify a naturalistic intervention.

Practice Scenario: Monitoring Naturalistic Intervention

Knowledge Check

Question:

Which of these elements provide useful data for analyzing the effectiveness of a naturalistic intervention?

A. quantitative data (frequency and duration)

B. observational notes

C. environmental arrangements

D. specific routine or activity

Question:

What are some reasons why is it important to identify the activity or routine and the environmental arrangement when collecting data on a naturalistic intervention?