Toward deeper understanding and wide-scale implementation of naturalistic developmental behavioral interventions

D’Agostino et al. (2023) wrote a position paper. They asked why NDBIs are still rare in early autism services even though the evidence is strong.

The authors mapped out steps to move NDBI from research labs to everyday clinics.

The paper does not give new data. Instead, it argues that wide-scale NDBI use is blocked by training gaps, policy misalignment, and old DTT habits.

They give a checklist for agencies: train staff, bill properly, and keep coaching parents.

Pickard et al. (2024) extends the story. Their interviews show clinicians like NDBI but slip back to DTT when caseloads rise.

Vivanti et al. (2025) build further. They use the EPIS model to show that even perfect clinician skill will fail if insurance and state rules do not pay for NDBI.

Frost et al. (2022) zooms in on one detail. They warn we may be oversimplifying our language during NDBI, so stay tuned for future data.

You can start closing the adoption gap today. Run a brief in-service on NDBI basics, then schedule follow-up coaching so staff do not drift back to table-top DTT. Ask your billing team to confirm which NDBI codes are covered so families are not surprised by denials.