Metadata

Podcast:: Carlat Psychiatry Report Podcast
Episode:: CRPR_17Nov2021 – The Three Approaches to Autism Intervention
Link:: thecarlatreport.com
Embed: Carlat Report Link PublishDate:: 2021-11-17

✅ Pre-Lesson Quiz (Before You Listen)

1. What are the three primary evidence-based approaches to autism intervention?
2. How does NDBI attempt to integrate aspects of ABA and DRBI?
3. Why might families struggle to select the best autism intervention program?
4. What does current research suggest about the effectiveness of 40-hour ABA programs?
5. Can multiple autism interventions be used together in a coordinated fashion?

🧠 Summary

In this episode, Dr. Josh Fader and Mara Goverman LCSW explore the three primary approaches to autism intervention: Applied Behavior Analysis (ABA), Developmental Relationship-Based Intervention (DRBI), and Naturalistic Developmental Behavioral Intervention (NDBI). They discuss the history, structure, and evidence for each, noting that each has unique benefits, time demands, and philosophical underpinnings. The episode highlights new research questioning assumptions about treatment intensity and emphasizes matching interventions to family needs and values.

⏱️ Timestamps & Highlights

• 00:00 | Introduction to the three core autism intervention models
• 02:10 | Overview of ABA: operant learning and structure
• 05:00 | DRBI: relationship-focused and emotionally meaningful interactions
• 07:30 | NDBI: blending developmental play with behavioral strategies
• 10:00 | Sandbank’s 2019 meta-analysis findings
• 13:30 | Dr. Rogers’ RCT: 15 vs. 25 hours ABA/NDBI shows no difference
• 16:00 | Factors to consider: family time, developmental fit, coordination
• 18:00 | Challenges with insurance, funding, and access to interventions

🔍 Quiz Answer Key & Explanations

1. ABA, DRBI, and NDBI are the three main types discussed.
2. NDBI uses naturalistic settings and child-preferred rewards from ABA with the relational elements of DRBI.
3. Conflicting opinions, high time demands, and insurance limitations complicate choices.
4. Recent studies (e.g., Sandbank, Rogers) question the added benefit of very high-intensity programs like 40-hour ABA.
5. Yes, families often combine interventions successfully when goals are clearly divided and providers collaborate.

📝 Key Takeaways

• ABA focuses on behavioral shaping through antecedent-reward learning.
• DRBI centers on parent-child interaction and emotional reciprocity.
• NDBI blends naturalistic play-based settings with behavioral reinforcement.
• Evidence suggests moderate-intensity programs may be as effective as intensive ones.
• Matching interventions to family style, resources, and child needs is key.
• Coordination between modalities can work if goals don’t overlap confusingly.

❓Review Questions

1. What are the core philosophical differences between ABA and DRBI?
2. Why might high-intensity ABA not outperform moderate-intensity interventions?
3. How can clinicians guide families overwhelmed by autism treatment options?
4. What limitations exist in the current evidence for ABA’s effectiveness?
5. How do family values and time availability influence treatment choice?

📚 Further Reading & Resources

• Sandbank, M., et al. (2019). Project AIM: Meta-analysis of early intervention for autism.
• Rogers, S. J., et al. (2020). Randomized trial of ABA vs. NDBI in toddlers.
• https://www.bacb.com
• https://www.icdl.com
• https://www.profectum.org

🙏 Credits

Hosts: Dr. Josh Fader, Mara Goverman, LCSW
Transcript processed using aTrain:
Haberl, A., Fleiß, J., Kowald, D., & Thalmann, S. (2024). Take the aTrain. Journal of Behavioral and Experimental Finance, 41, 100891. https://doi.org/10.1016/j.jbef.2024.100891