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History and Future of Autism Treatment

Schreibman and her colleagues set out to describe the development of “Naturalistic Developmental Behavioral Interventions” (NDBIs) in a historical, theoretical and empirical manner to provide a comprehensive review of these interventions. The review starts off with the history of autism treatment: behavioral and developmental approaches remained separate until early detection during toddler years caused a paradigm shift.

When these two fields combined, NDBIs were applied which has empirically shown that children and toddlers achieve more substantial and accelerated behavior change than each alone. The main benefits of NDBI treatment are that spontaneity, initiative, and generalization (to multiple family members and friends) are enhanced. Additionally, NDBIs provide skills needed for the acquisition of language and other academic requirements of children. Schreibman provides a novel approach to understanding autism intervention by consolidating research from treatments that go by a plethora of names but have common features that often leave us confused and overwhelmed. This paper enhances choice-making for families and service providers who are searching for the most effective and compassionate autism intervention.

A strength in this paper is the clarity it provides about types of treatments. Many people (including me) think “Applied Behavior Analysis” (ABA) is equivalent to a specific method. Rather, ABA is an umbrella of empirically based practices that are built on operant learning procedures. This confusion causes health insurance companies to restrict funding to only one type of ABA: discrete trial learning (DTT), which has many limitations including flexibility of the skills learned. Thus, many families are not getting the most empirically effective treatment available which may have detrimental, irreversible effects on their child’s development. Thus, the way Schreibman clearly addresses mainstream misconceptions about autism intervention is extremely important and has powerful implications for intervention in a systematic way.

A weakness in this review is that it does not provide a timeline for development, even though it refers to phrases such as the “zone of proximal development.” It would be helpful for a reader to understand at what time in a toddlers or child's life these interventions are most useful, and are there differences based on age if any? Only terms such as “toddler” and “child” are mentioned which could be concerning to a parent who is looking for treatment for an older child. An accompanying article such as “Neonatal Transitions in Social Behavior and Their Implications for Autism (Shultz et al., 2018)” would enhance the developmental milestones Schreibman describes in this review.

Future works inspired by this paper could include how the personality of a child affects the effectiveness of NDBI. Since personalized medicine is a huge topic in the healthcare world and Schreibman prompts other researchers to explore individualized treatment, finding how different personalities are affected by variations of NDBI have an even more potent effect of autism treatment.

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