CT FEAT: Families Helping Children Achieve Their Full Potential
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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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