Using qualitative content analysis to understand the active ingredients of a parent-mediated naturalistic developmental behavioral intervention.

Although naturalistic developmental behavioral interventions are supported by research for supporting the development of children on the autism spectrum, how they work is not well understood. This study reviewed parent reflection comments in a systematic way to better how one such treatment worked, when delivered by caregivers. Caregivers completed weekly written reflection responses as they learned how to use the treatment techniques. We studied these responses to understand caregiver perspectives on how their children responded to the techniques. The responses were then compared to a theory of how the treatment works. Many responses were consistent with the treatment theory; however, others were not. We found that individual techniques were associated with different child responses, suggesting that general measures of social communication may not measure these specific short-term changes. Our findings point to specific behaviors that may be useful to measure in future research, or useful as indicators of treatment response in clinical practice settings. Overall, qualitative methods may be useful for understanding complex treatment processes.