Adapting NDBIs for Autistic Children Who Use Echolalia: A Cascading Coaching Approach to Supporting Communication and Language Development.

This pilot study examined a cascading coaching model to train graduate student clinicians and caregivers to use adapted Naturalistic Developmental Behavioral Intervention (NDBI) techniques with autistic preschoolers who use echolalia. Adaptations were designed to incorporate children's echolalic speech within intervention activities and support changes in spoken language. Strategies emphasized responding to, expanding upon, and creating opportunities around children's verbal productions during play. Two clinician-caregiver-child triads participated. Effects were evaluated using multiple-probe designs across adult participants and intervention contexts. Across four weeks, adults increased their use of targeted NDBI skills, including elicitation techniques (e.g., creating opportunities, wait time, prompting) and response techniques (responsive actions and language models), with moderate to very large effects. Child participants also demonstrated increases in targeted spoken-language communication responses across intervention contexts, with the strongest effects observed during student clinician-led interactions and more variable outcomes during caregiver-led interactions. Visual analysis indicated functional relations for most adult and child outcomes, although individual differences and variability were observed across participants. Findings provide preliminary evidence regarding the feasibility of incorporating echolalia-responsive adaptations within NDBI-based coaching programs for autistic children who use echolalia and their caregivers.