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Relationship Development Intervention (RDI)
What is Relationship Development Intervention (RDI)?
Developed by Dr. Steven Gutstein Ph. D., Relationship Development Intervention (RDI) shares features with other treatment approaches like structured teaching, behavior modification, and other effective social and communication interventions, but places an emphasis on “experience sharing.”1 According to Dr. Gutstein, “[e]xperience sharing competence is measured by the extent to which individuals are able to coordinate and integrate elements of their subjective experience with that of others.”2 Some examples of experience sharing activities include reciprocal conversations, expressing curiosity about others’ thoughts and feelings, sharing memories, and maintaining friendships.2 The goal of experience sharing interactions “is to sense the joy and stimulation intrinsic in our social encounters.”1 RDI is a family-based program that helps “individuals with autism form personal relationships by gradually strengthening the building blocks of social connections.”3
Dynamic intelligence is another important concept of Relationship Development Intervention. Individuals on the autism spectrum often experience difficulties with dynamic situations, when new things occur, aren’t “black and white”, events occur simultaneously, there is “no correct answer”, etc. and RDI attempts to remediate the information processing problems that are present in individuals with ASD.4 Dynamic intelligence is defined as “how you respond to change, how you respond to new information, how you respond to environments where there isn’t a clear-cut right or wrong answer, which is really what most of real life is about.”4 In addition to promoting dynamic intelligence and experience-sharing, the RDI program aims to achieve remediation of the core deficits of autism. Remediation is a systematic process “of correcting a deficit, to the point where it no longer constitutes an obstacle to reaching ones potential.”5 According to Dr. Gutstein’s book Autism/Aspergers: Solving the Relationship Puzzle,1 the following are goals for individuals using the Relationship Development Intervention treatment method:
- Understand and appreciate the many levels of Experience Sharing
- Become an equal partner in co-regulating Experience Sharing interactions
- Understand and value the uniqueness of other people—their perspectives, ideas and feelings
- Value and work to maintain enduring relationships
- Become adaptable and flexible in both social and non-social problem solving
- Recognize their own unique identity that can continue to grow and develop
How does Relationship Development Intervention make a Difference for Individuals on the Autism Spectrum?
Dr. Gutstein refers to RDI not as an intervention, but more as a lifestyle that parents can learn to implement that won’t only help the child, but them as well.4 There is no set number of hours of RDI therapy that an individual should receive because the family-based concept of RDI promotes addressing the areas of greatest weakness throughout the child’s day. RDI works to improve the core deficits of autism and assess the child’s weaknesses through the Rational Development Assessment, which evaluates the child’s social development and the child-parent relationship.6 The parent-child relationship is the basis for the educational development of the child undergoing RDI. According to Dr. Gutstein’s article in Autism Quarterly,2 RDI provides the following techniques to foster a child’s developmental growth:
- Developing an Emotional Feedback System: Children on the autism spectrum tend to have difficulty interpreting their parents’ emotional expressions. To address this issue, RDI teaches parents to employ simple activities and exercises that promote emotional attunement between themselves and their child. More complex experience sharing occurs only when the child is regularly engaging in both unprompted facial gazing for emotional sharing and consistently responding to parental joint-attention behaviors.
- Apprenticeship in Co-Regulation: In typically developing children, parents increase demands for their children to take greater responsibility for coordinating and regulating the actions necessary to have mutual interpersonal encounters. Many children on the autism spectrum fail to master co-regulation. Parents implementing RDI carefully pace their demands for co-regulation, so that their children develop a sense of self-efficacy and are motivated to take part reciprocal interactions.
- Participating in Dynamic Systems: Parents are taught to guide the child by co-participating in simple, regulated activities. Simple challenges are added to allow the child the opportunity to grasp the added complexity and/or incongruity. For example, a parent teaching a child to sweep with a broom might, at first, simply have the child match their actions of sweeping back and forth. Later, parents could insert “complementary” roles by having one individual act as “sweeper” while the other preforms the “dustpan” role in a coordinate fashion.
- Developing Declarative Communication: Declarative communication involves the intent to share or invite others to share some aspect of one’s experience. Parents practicing RDI learn to emphasize and maintain a primarily declarative communication style by slowing down the communication to allow the child time to process information and to consider his/her reply. Additionally, parents limit and modify communication elements to avoid over-talking, frequent questioning, and prompting.
- Constructing Optimal Learning Environments: Parents are taught to implement optimal learning environments by slowing down the pace of daily activities, simplify physical environments, and provide opportunities throughout the day for their children to hone their newly developed experience sharing skills. RDI consultants assist parents to monitor their child’s progress and gradually increase environmental noise to mirror real-world conditions.
What do RDI Treatment Providers do?
Certified RDI treatment providers help train parents in the techniques of RDI, but also work with the child to develop relationships with his/her parents and family members.7 The first job of the consultant is to meet with the parents to ensure that they understand the core deficits of autism, and that they are committed to implementing the program, even if it means making some lifestyles changes.8 Parents who are not ready to implement the RDI program can enroll in training workshops, engage in weekly online chats at RDIconnect, or visit our Forums/Discussion Groups dedicated to the Relationship Development Intervention.8
Once parents are prepared to implement the RDI program, an RDI consultant will conduct the Relationship Development Assessment (RDA), which gauges the child’s core deficits, or weaknesses, in order to create an individualized program for the child. The RDI program is set at a marathon pace, as the child will start with early stages of training which, for example, may involve limiting spoken communication and instead encouraging eye-contact and other instances of non-verbal communication, until the child’s abilities gradually increase and he/she is able to move on to the next goal.3 Some of the RDI techniques that a consultant may introduce to a parent include spotlighting, using not only your communication, but also your facial expression, how you speak, smiling, etc. to help the child remember a rewarding experience. A parent may also present their child with a challenge, which is a slight variation of a routine the child has already mastered. A good example these two working in concert would be spilling a little milk (challenge), waiting for the child to express the need for a paper towel (this helps the child to think on his/her own), and then reward the child will praise and positive facial expressions (spotlight) in a way that the child remembers the experience.8 Parents can attend multiple education sessions with their RDI consultant to learn these techniques and more.
What Can One Expect from an RDI Treatment Provider?
According to Dr. Gutstein’s book, Autism/Aspergers: Solving the Relationship Puzzle,1 the stages of RDI are as follows:
- Conduct a careful assessment
- Outline developmentally appropriate objective
- Educate parents are other adults
- Prepare the treatment setting
- Allocate sufficient time
- Minimize obstacles to experience sharing
- Construct simple, appropriate activities
- Gradually shift the guidance function from therapist to parents
- Gradually shift responsibility for regulation from adults to equal partnership with the child
- Introduce carefully matched peers
- Gradually add more level of complexity to approximate “real world” setting and demands
Who is Qualified as a Relationship Development Intervention Provider?
The RDIconnect Certification Program is broken down into beginner, intermediate, professional, and advanced seminars. Prior to entering the Consultant Training Program, one must already have credentials in a broad range of professional backgrounds and specialty areas. Consultants receive training in a variety of programs. Although parents provide the most intervention, only professionals who have at the very least obtained a degree in psychology, speech pathology, or another field related to ASD can attempt to receive certification.6
Where do Relationship Development Intervention Providers work?
Although the treatment method is designed for the home, RDI can be implemented in classroom settings and by behavioral therapists.3
Is there Research to Support Relationship Development Intervention?
The National Standards Project has qualified developmental relationship-based treatments, such as RDI, as “emerging treatments.”10 An emerging treatment is one that has been shown to be beneficial in one or more studies, but additional, high-quality studies are necessary to consistently demonstrate that the treatment is indeed effective.10 The National Standards Project reviewed 7 studies that were classified as developmental relationship-based treatments to come to the conclusion that RDI should be labeled as an emerging treatment.10
A small study, published in the journal Autism in 2007, was conducted on 16 children on the autism spectrum who participated in RDI between 2000 and 2005. No child met criteria for autism diagnosis according to the ADOS/ADI-R during the posttest evaluation, despite every child meeting the diagnostic criteria prior to undergoing RDI.11 Small sample size, a lack of control group, constraints on age and IQ of treated children, parent self-selection, and parent education was conducted through a single clinic setting were design flaws of this study.12
A longitudinal study published in 2005 compared 31 children who participated in either RDI or a non-RDI based therapy and found that after sixteen months 70% of the children who underwent RDI “had improved in at least diagnostic category on the ADOS.”2 This study’s limitations include the variety of measures used to evaluate cognitive functioning make a valid comparison impossible, the study failed to evaluate older and teenage children, results were obtained from a single setting—the clinic where RDI was initially developed, and the small sample size of children included many individuals who were deemed to be “high functioning”, and few had significant cognitive difficulties.12
Although both of these studies demonstrated positive preliminary results, they also contained several weaknesses. Both of the aforementioned studies were conducted by Dr. Gutstein and his colleagues. Future studies should be conducted by independent researchers, employ larger sample sizes, different age groups, longer-term follow ups, and more extensive measurements of progress.2 More information about research concerning Relationship Development Intervention can be found on their site.
How can I Find a Relationship Development Intervention Treatment Provider?
RDIConnect has an extensive directory of certified RDI consultants from all over the globe, including 163 in the United States alone.13