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The Relationship Development Intervention
Program: DVD Review and Other Resources
(By Laura DeAngelo)
Relationship Development Intervention (RDI) is an intervention method
that targets what some see as the core deficit of autism: the inability
to form true social and emotional relationships with others.
Dr. Steven Gutstein, a psychologist whose practice is based in Houston ,
Texas , developed the program after he felt that the “traditional”
intervention methods he had been using with his patients with autism
were not resulting in an improvement in their quality of life. These
methods had been focused around the development of skills but did
nothing to motivate the patients to seek out and successfully
participate in social relationships.
The DVD
For families interested in learning more about RDI, many resources are
available on the RDI website, www.rdiconnect.com. One of these resources
is the DVD “Going to the Heart of Autism: The Relationship Development
Intervention Program,” available through the website for $150. The
5-hour DVD is an efficient way for families to obtain comprehensive
information on the program, including its research basis, conceptual
framework, and practical applications.
The DVD first outlines the research supporting the need for an
intervention focusing on the development of relationship skills in
autistic people. Although very little research has been done on the
quality of life for autistic adults, three separate studies have shown
that, despite their level of speech, IQ, or education, the great
majority of autistic adults are not able to live independently, hold
jobs, have close friendships, or achieve other “quality of life” goals.
The DVD then presents the research supporting Gutstein’s assertion of a
“core deficit” in autism. He describes this deficit as the lack of
ability to process information in a dynamic way. According to Gutstein,
autistic people see the world only through a “static” system and
therefore are unable to form social relationships, which are based on
fluid, dynamic thoughts and interactions. The deficient dynamic system
also is responsible for many of the speech- and behavior-related
challenges in persons with autism. In fact, Gutstein asserts that this
deficit in dynamic thinking skills is directly responsible for the
inability of many autistic people to achieve a successful quality of
life.
The lack of a dynamic system of information processing in autistic
people has a neurological basis. Research on the brains of autistic
people has identified deficiencies in the relationship between two
interconnected areas, the pre-frontal cortex and the limbic system. The
autistic brain typically has difficulty integrating concept formation
(pre-frontal cortex) and emotional meaning/relevance of information
(limbic system).
The critical notion behind RDI is that the core deficit can be
remediated, or eliminated. RDI’s ultimate goal is to remediate the core
deficit of autism through techniques that strengthen the weakened
pathways and develop the dynamic system. The RDI program systematically
develops dynamic intelligence so that autistic people can achieve the
flexible thinking critical to regulate social interactions. With
improved ability to form social connections comes a greater quality of
life for the autistic person and those around him or her.
Gutstein outlines the research conducted on neurotypical children
detailing the steps in the development of their relationship skills from
infancy on. Typical children develop social skills in discrete,
predictable stages, starting from the ability to share emotion through
the face and progressing through social referencing (using eye contact
and gaze to give and receive social information), coordination of
action, and twenty-five higher-level skills.
The RDI program identifies the level of relationship skills the autistic
person possesses already, and the program for that individual begins
with approaches targeting the next higher level. In Gutstein’s terms,
the program allows these people a “do-over” for the relationship skills
they missed out on in their course of development.
For example, if the autistic person is already able to share emotion
through the face, the program for that person would begin with goals
related to social referencing, the next stage. When that stage is
mastered, the person would move on to the next stage, coordination of
action, and so on. Because the stages build on each other, only one
stage can be worked on at a time. Most people starting the program begin
at the very first stage, Emotion Sharing.
On the DVD , Gutstein discusses in
detail each of the first eight stages in relationship development. He
provides examples of people (mostly children) working on each stage in
the program. Through compelling video footage, the viewer is able to
see the progress in relationship skills of these people as they move
through the stages of the program.
The RDI program is designed to be parent-centered and home-based. A
certified RDI consultant first evaluates the child’s relationship skills
at the start of the program (the “Relationship Development Assessment”
or RDA ), and develops written objectives appropriate for the child,
based on the RDI program’s hierarchy of relationship skills. The
consultant trains the parent(s) in techniques to facilitate mastery of
the relationship development objectives, and provides ongoing support
through videotape reviews and written feedback. The cost of an RDA
varies by consultant but the two Connecticut consultants currently
charge between $1,500 and $1,800.
Since the RDI program targets a core deficit common to all autistic
individuals, it is appropriate for every person on the spectrum,
regardless of level of speech and/or functioning. In fact, high levels
of speech often present an additional challenge to the RDI program,
because inappropriate and/or nonfunctional speech patterns must be
unlearned. Also, although it is preferable to begin the program at a
young age, the intervention has been shown to have significant benefits
even when started as late as adolescence or early adulthood.
RDI is not intended to replace all other interventions. Interventions
targeting specific co-occurring disorders (occupational therapy,
physical therapy, etc.), as well as development of academic abilities
would still be appropriate. While speech therapy may still be necessary,
many families find a significant and continual improvement in speech
just through implementing an RDI program.
Compensatory strategies such as visual aids, behavioral interventions
for interfering behaviors, and the teaching of social “rules” may
continue to be necessary temporarily as coping mechanisms in the initial
stages of the program. Compensatory strategies should be less necessary
as the child progresses in the program and develops a greater motivation
and capacity to engage.
Common Misconceptions and Questions
Some people mistakenly believe that RDI defines autism as just a social
disorder. In fact, RDI defines autism as a disorder in the brain’s
ability to process change. This deficiency manifests itself in the
social, communication, and behavioral abnormalities common in autism.
Also, Dr. Gutstein clearly states that he did not come up with the
theories that provide the basis for RDI. He did, however, use the
findings from current and respected research in the fields of typical
and atypical developmental psychology and neurology to fashion a clear,
step-by-step, parent-friendly approach to treating autism. The RDI
website lists the background research from which the RDI model was
drawn.
There is some confusion as to the purpose of the consultant
certification process. Consultants are certified as a quality control
measure. In order for the RDI program to be successful, the person must
be assessed properly to determine baseline level of relationship skills,
obstacles that must be addressed, and appropriate program objectives,
strategies and techniques. The process often is not intuitive. Usually
the family requires ongoing coaching and feedback after the initial
assessment is conducted. All consultants must meet initial and ongoing
quality standards to ensure that they have the skills and training to
properly assess clients, develop an appropriate customized program, and
provide ongoing coaching to the family.
There is a belief among some that “good ABA programs” already
incorporate the elements of RDI. Some people familiar with behavioral
techniques also note that RDI incorporates behavioral elements but does
not identify them as such.
It may be true that some ABA programs have a strong emphasis on social
development. However, in my experience, ABA programs do not have the
development of dynamic thinking as their primary goal. Their goals
generally are the development of specific skills, even in the social
realm. In his two years in a school ABA program (pre-RDI) my son
Matthias was taught skills like imitation, rote counting, pattern
matching, various speech/grammar skills (plurals, prepositions,
rhyming), community helpers, eye contact, greeting skills. Certainly,
these skills are useful to have. However, here was no element in the
program to motivate and build competency in mentally engaging with
others, which I felt was a huge gap. Additionally, the rote teaching
style served to perpetuate Matthias’ rote way of relating to the world.
It is true the RDI incorporates behavioral techniques. However, there
are some major differences. One difference is in the use of “reinforcers.”
ABA programs make ample use of “external” reinforcers to develop
socially significant behaviors. RDI uses mainly or exclusively social
reinforcement right from the beginning. Also, the behaviors that RDI
aims to develop are not discrete skills, but rather the motivation and
competency to operate in dynamic systems, as measured through observable
behaviors like experience sharing, social referencing, and flexibility
in situations of change.
Some have raised concerns about the validity of the research study
“Preliminary Evaluation of the Relationship Development Intervention
Program” by Gutstein, to be published in the Journal of Autism and
Developmental Disorders. (The article can be downloaded from the
website.) The concerns involve claims that the RDI group and the
“control” group were not properly matched, service time varied between
groups, and too little information is provided regarding the nature of
the groups.
I cannot comment on these claims, except to say that more comprehensive
research is currently underway.
RDI In Schools
Although not discussed on the tape, relationship development objectives
can and should be integrated into school programs, to facilitate quicker
mastery and further reinforce the skills. The objectives can be included
in the IEP and school staff can be trained in techniques to facilitate
relationship skills. Certified consultants typically include recommended
IEP objectives in the written RDA .
For example, an IEP objective could be “The child will reference the
teacher’s eye gaze and eye movements to locate a hidden object.” The
same objective would be worked on with the parents in the home setting.
Multiple objectives targeting the same skill area could and should be
included in the IEP, for example, (facial) referencing for information,
referencing for comfort, referencing for approval, referencing for task
functioning, and referencing to resolve uncertainty.
Mastery of relationship objectives is easily measurable both in school
and at home. Data could be kept on number of attempts versus successful
attempts. Mastery criteria could be set at 90% to ensure very strong but
not “perfect” mastery of the skill, commensurate with neurotypical
people of the same age.
Other RDI Resources
The website contains a wealth of information on RDI, including books,
information on parent seminars, a list of certified consultants, chat
rooms, and a research study supporting RDI’s success versus alternative
treatment methods.
Seminars
The seminars include 2-day introductory seminars and 4-day intensive
seminars. The two-day seminar reportedly has the same content as the DVD
; the 4-day seminar contains this content plus two days of consultation
and ”hands-on” time with a certified consultant in individual and small
group settings.
The seminars range in price from $250-$300 (two day seminar) to about
$2,000 (four day seminar). All the seminars are conducted by Dr.
Gutstein at various locations throughout the U.S. , Canada , Australia ,
and Europe . The RDI website contains information and registration
instructions for all the upcoming seminars.
The most effective way to understand and implement the RDI program is to
attend a seminar and then work through a certified consultant. The
seminars will provide the very latest advances in the RDI program (it
has changed somewhat since its inception and aspects continue to change
in an effort to have the very best possible program). Certified
consultants accurately evaluate your child and develop a customized
intervention plan. They provide initial training to parents and are
available as needed for ongoing training and feedback.
Gutstein will be offering a special 2-day seminar in the Hartford , CT
area on April 27-28, 2006 , sponsored by the Special Education Resource
Center (SERC). The seminar is geared to school personnel and
professionals in the field of autism, but parents are invited as well.
Professionals can receive continuing education credits for the seminar.
The cost is $100. Interested parents may obtain a copy of the seminar
registration form by accessing the SERC website, www.CTSERC.com,
clicking on Professional Development Conferences, clicking on Early
Childhood Education, clicking on Year at a Glance Calendar, scrolling to
April and clicking on “Going to the Heart of Autism.”
Books
Gutstein also has written three books on the RDI program: Autism/
Asperger: Solving the Relationship Puzzle, Relationship Development
Intervention With Young Children, and Relationship Development
Intervention With Children, Adolescents and Adults. All the books are
available through the website.
Solving the Relationship Puzzle was written in 2000 and discusses the
theory of RDI. The other two books were written several years later and
focus on activities appropriate for teaching skills at the different RDI
levels. The books are a bit dated because the program has evolved so
much since its inception (especially the shift in emphasis from a lab-
and activities- based approach to a lifestyle approach). But the books
are still helpful in understanding the RDI program.
DVD vs. Seminars
The DVD is a relatively inexpensive way to learn about the RDI program
and decide if it is right for your child. For those not able to attend a
seminar, it can serve as a substitute. Keep in mind, however, that many
certified consultants recommend that their clients attend a seminar
before coming for their child’s evaluation.
I
n my opinion, the two-day introductory seminar is a better value than
the 4-day intensive seminar. At $250-$300 per person, it is considerably
less expensive per person per day than the $2,000 per-couple 4-day
intensive seminar. In my experience, the two additional days included in
the 4-day seminar are not worth the considerable additional money. The
hands on time can be accomplished with a local certified consultant
during the RDA . The RDI Progress Tracking Form, distributed at the
4-day seminar, can be purchased instead through the website for $25.
If parents do not have the financial means to attend the seminars and/or
use a certified consultant, it is still possible to obtain successful
results from the program. However, since many aspects of RDI are not
easy or intuitive and are much better learned through coaching from
experienced professionals, this approach is not recommended. The RDI
website gives advice and options to parents who are not ready or are not
able to start a full, intensive RDI program.
Support Networks
There are also several support networks for parents doing RDI programs
with their children. These networks include parents with a wide range of
involvement levels in RDI, from parents doing “intensive” programs with
seminars and consultants, to parents who have “just” read the books,
used the website’s resources, and/or viewed the DVD .
For families interested in integrating RDI with an existing ABA program,
the Yahoo group abaplusrdi is available. This group is moderated by
Juliet Burke, a mother who has implemented an RDI program for her child
without having attended a seminar and without having seen a certified
consultant. Another Yahoo group, RDI-List, is a general information RDI
list serve moderated by Sue Holler, SLP, a certified RDI consultant from
California .
One Family’s Experience
Our son, now five-and-a-half, has been enrolled in our public school’s
ABA program since age three. I understand that many families seek out
this kind of program for their children. However, in the fall of 2004,
after about a year and a half, we became very concerned about Matthias’s
lack of progress.
While his language had developed somewhat and he had developed many
“skills” since entering school, we noticed that he still was unwilling
and unable to relate appropriately to people. His eye contact was still
poor, despite the school working on an “eye contact” program with him
regularly. He still did not seek us out to share things. He still
preferred rote, solitary activities. He was very rigid and routine
bound, and would tantrum if his routine were altered. He did not know
how to play with peers, preferring to recite videotapes to them. There
was no “give and take” aspect involved with his interactions. He wanted
total control of the situation. He also could not speak conversationally
or ask questions.
Last November I attended an RDI workshop that I had heard about through
the CTFEAT list serve. The presenter was Nancy Schwartz, a certified RDI
consultant. She related to us the “core deficit” theory of RDI: that
autistic people have a deficit in brain function connectivity that
prevents them from being able to process information in a dynamic
manner. The compensating over-reliance on static systems explains the
rote, rigid actions and behaviors common in many autistic people. The
inability to process dynamic information is also responsible for the
deficits in forming relationships, since relationships by their very
nature are based on dynamic exchanges.
I felt that Dr. Schwartz, in her presentation, had pinpointed exactly
the deficit areas that I had observed in Matthias and that I continued
to observe after almost two years in an ABA program.
Dr. Schwartz explained that the core deficit needed to be worked on
directly and systematically if the child’s autism is to be reduced or
possibly even remediated. The RDI program defines for the parents, step
by step, what skills need to be worked on in the child. The program show
parents how to modify their interaction style with the child to develop
the dynamic system, thus improving the capacity for flexible thinking
and the motivation and competence for relationships.
I called Dr. Schwartz the next morning and made an appointment. We
started an RDI program with Matthias last February. Since that time we
have seen a significant decrease in his rigidity and reliance on
routine. He is able to tolerate changes that used to send him over the
edge, like a change in his bedtime routine or people changing seats at
the dinner table.
We have seen him develop empathy for others. When I told him to stop
singing in the car one day because his sister did not feel good, he
looked at her and said “I hope you feel better, Julianne.” Recently, his
teacher told him she was sad about something. A while later he went to
her, looked at her face and said “Are you happy now?”
We have seen him develop the ability to understand and respond to
nonverbal information. He is able to find a hidden object just by my
communicating through eye or head movements. He seeks out my face for
approval when he wants something. He knows that a head nod or smile
means yes, a head shake or frown means no, and he responds
appropriately. He walks together with me now, only crossing the street
when I give him a nod.
Matthias now seeks out family and friends to play. Just tonight he saw
me come into his room and he said “Are you going to play with me?” A few
weeks ago, we saw a typical kindergarten classmate at the playground. I
had never met the child or the mom. Matthias said “There’s Anthony!” and
ran up to him and said, “Hi, Anthony!” (No scripting videos!) The two of
them ran off and were soon playing tag, riding the seesaw, and pushing
each other on the swings. I did not need to prompt him.
We have seen him develop more varied and creative speech patterns and
have observed the emergence of more “conversational” speech. Just a few
weeks into the RDI program, our family was riding in the car and I
noticed that my 8 year old (typically developing) daughter and my son
were having an ongoing back and forth conversation about the different
kinds of trees we were passing. We also have seen him start to use slang
terms like “Deal with it!” and “You’re kidding!” appropriately.
Clearly, Matthias’s social and language gains accelerated after the RDI
program was begun. School staff have also agreed to use a more flexible,
creative teaching approach (no more rote drills) and have agreed to
incorporate RDI objectives into the IEP.
We realize we still have much work to do in helping our son to grow up
to be a happy, productive and independent adult, and we believe that RDI
has brought us closer to that goal.
If you would like more information about our family’s experience with
the RDI program, please contact Laura DeAngelo at
lbdeang@yahoo.com.
For some ideas on how RDI techniques can be implemented in a
kindergarten classroom, click here.
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