Jump to content

Relationship Development Intervention

Edit links
From Wikipedia, the free encyclopedia
This is an old revision of this page, as edited by 2001:569:7415:6400:f139:d9cc:fcaf:294 (talk) at 21:22, 1 March 2018 (→References). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Relationship Development Intervention (RDI) is a trademarked proprietary treatment program for autism spectrum disorders (ASD), based on the belief that the development of dynamic intelligence is the key to improving the quality of life for autistic people. The program's core philosophy is that autistic people can participate in authentic emotional relationships if they are exposed to them in a gradual, systematic way. The goal of treatment is to systematically build up the motivation and tools for successfully interacting in social relationships, to correct deficits in this area that are thought to be common to all autistic people.

RDI focuses on cultivating the building blocks of social connection—such as referencing, emotion sharing, coregulation, and experience sharing—that normally develop in infancy and early childhood. RDI is a family-based program, where trained consultants support families to alter their interaction and communication styles. There is a period of parent education, followed by an assessment of both the child and the child-parent relationship. After that consultants support the family through a set of specific objectives to build a "guided participation" relationship between parents and child that will allow the child to once again become a "cognitive apprentice" to the parents. Once the cognitive apprenticeship is in place, the family can move on to specific cognitive remediation objectives for the child. These are developmentally staged objectives designed to restore optimal neural connectivity through a series of "discoveries" and "elaborations".

After four years, the RDI Program has evolved into RDIconnect, a company with a series of programs not only for autistics, but for other populations as well. Along with a Consultant Training program, RDIConnect now offers the Family Guided Participation Program, Dynamic Education Program and the RDI Program for ASD, each accompanied by tools that help organize, expedite and create a continuous dialogue between professional and parent. RDIConnect now applies the quality assurance, level of treatment and training that has been central to their internationally known program and to a new audience.

History

The RDI program was developed by the psychologist Steven Gutstein in the 1990s.[1] Gutstein studied the means by which typical children become competent in the world of emotional relationships. He looked at the research in developmental psychology and found that early parent-infant interaction predicted later abilities in language, thinking and social development. Two books of RDI-based activities as well as a book explaining the background ideas were published in 2002, but RDI has changed significantly since then and is now only available through the RDI_LS, or learning system, accessed by trained consultants.

There are now trained consultants in the US, UK, Australia, Canada, China, Japan, Singapore, India, Italy, Malaysia, Mexico, New Zealand, and Switzerland.

Latest publications by Dr. Steven Gutstein are: My Baby Can Dance - Stories of Autism, Asperger's and Success through the Relationship Development Intervention (RDI) Program (2005), The Relationship Development Intervention (RDI) Program and Education (2007), and The RDI Book - Forging New Pathways for Autism, Asperger's and PDD with the Relationship Development Intervention Program (2009).

Major ideas

RDI is based on the idea that "dynamic intelligence" must be enhanced for autistic children to develop typical behaviors. Dynamic Intelligence means being able to think flexibly, take different perspectives, cope with change, and process information simultaneously (e.g. listen and look at the same time).[1] These abilities are essential in the real world.

Neural underconnectivity in autistic people leads to a rigid and static view of the world[citation needed]. Because of this dislike of change and inability to cope with new information, autistic people do not develop dynamic intelligence[citation needed] which is essential for relationships, independence and quality of life.

Typical children develop dynamic intelligence through guided participation, that is being guided and given challenges by their caregivers. Due to their social difficulties, this relationship breaks down in autistic children and so families must be supported to re-build it, in a slow and more deliberate manner. Children need to learn to reference their parents, share emotions and use experience-sharing language to build a close and trusting relationship where they can learn and cope with the uncertainty of life.

The six objectives of RDI are to improve the following:[2][3]

  • Emotional referencing: learning from the subjective and emotional experiences of others
  • Social coordination: controlling behavior and observing others to enable participation in social relationships
  • Declarative language: using language and non-verbal communication to interact with others
  • Flexible thinking: adapting and altering plans when circumstances change
  • Relational information processing: placing things in context and solving problems lacking clear solutions
  • Foresight and hindsight: anticipating future possibilities based on past experiences

Effectiveness

While the Connections Center has conducted two studies into RDI, there have been as yet no independent studies, although there is currently one study being conducted at the University of Sydney, Australia.

In a 2007 study, children whose families had participated in RDI and who had relatively high IQ at start of treatment showed dramatic changes in diagnosic category on the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R), though the study represented a non-experimental study without a control group and whose evaluators were not blinded to time in treatment.[4]

In a 2011 study Jessica Hobson and Peter Hobson (2011) reported the present study reports objectively evaluated improvements in parent-child interaction within families receiving RDI, and now comparison with control groups is indicated. The relation between changes in dyadic interaction and changes in children’s social-communication will be reported. Treatment approaches which focus on interaction between children with autism and their caregivers have the potential to affect the children’s emotion regulation abilities which, in turn, are likely to influence other areas of emotional, cognitive, and social development.

In a 2013 study, Beurkins, Hobson et al used RDI treatment as the basis for their study. The aim of this RDI-based study was to examine how severity of autism affects children's interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children's autism was assessed using the calibrated severity metric of the Autism Diagnostic Observation Schedule (Gotham et al. in J Autism Dev Disord 39:693-705, 2009). Parent-child dyads were videotaped in 10-min semi-structured play interactions, and qualities of interpersonal relatedness were rated with the Dyadic Coding Scales (Humber and Moss in Am J Orthopsychiatr 75(1):128-141, 2005). Quality of relationships between parents and children were evaluated with a parent self-report measure, the Parent Child Relationship Inventory (Gerard in Parent-Child Relationship Inventory (PCRI) manual. WPS, Los Angeles, 1994). Multivariate regression analysis revealed that severity of autism was inversely related to patterns of parent-child interaction but not to reported quality of parent-child relationship. We consider the implications for thinking about relatedness and relationships among children with autism, and opportunities for intervention.

In a 2014 study Larkin et al reported on the use of The Relationship Development Assessment - Research Version: Preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism. Clinical Child Psychology and Psychiatry: 2015 Apr: 20(2):239-60. The aim of this project was to replicate and extend findings from two recent studies on parent-child relatedness in autism (Beurkens, Hobson, & Hobson, 2013; Hobson, Tarver, Beurkens, & Hobson, 2013, under review) by adapting an observational assessment and coding schemes of parent-child relatedness for the clinical context and examining their validity and reliability. The coding schemes focussed on three aspects of relatedness: joint attentional focus (Adamson, Bakeman, & Deckner, 2004), the capacity to co-regulate an interaction and the capacity to share emotional experiences. The participants were 40 children (20 with autism, 20 without autism) aged 6-14, and their parents. Parent-child dyads took part in the observational assessment and were coded on these schemes. Comparisons were made with standardised measures of autism severity (Autism Diagnostic Observation Schedule, ADOS: Lord, Rutter, DiLavore, & Risi, 2001; Social Responsiveness Scale, SRS: Constantino & Gruber, 2005), relationship quality (Parent Child Relationship Inventory, PCRI: Gerard, 1994) and quality of parent-child interaction (Dyadic Coding Scales, DCS: Humber & Moss, 2005). Inter-rater reliability was very good and, as predicted, codes both diverged from the measure of parent-child relationship and converged with a separate measure of parent-child interaction quality. A detailed profile review revealed nuanced areas of group and individual differences which may be specific to verbally-able school-age children. The results support the utility of the Relationship Development Assessment - Research Version for clinical practice.

In a 2015 study, J, Hobson, L Tarver, N Beurkens, R.P, Hobson (2015/16). The aim of this study was to examine the relations between severity of children's autism and qualities of parent-child interaction. We studied these variables at two points of time in children receiving a treatment that has a focus on social engagement, Relationship Development Intervention (RDI; Gutstein 2009). Participants were 18 parent-child dyads where the child (16 boys, 2 girls) had a diagnosis of autism and was between the ages of 2 and 12 years. The severity of the children's autism was assessed at baseline and later in treatment using the autism severity metric of the Autism Diagnostic Observation Schedule (ADOS; Gotham et al. Journal of Autism and Developmental Disorders, 39, 693-705 2009). Although the ADOS was designed as a diagnostic measure, ADOS calibrated severity scores (CSS) are increasingly used as one index of change (e.g., Locke et al. Autism, 18, 370-375 2014). Videotapes of parent-child interaction at baseline and later in treatment were rated by independent coders, for a) overall qualities of interpersonal relatedness using the Dyadic Coding Scales (DCS; Humber and Moss The American Journal of Orthopsychiatry, 75, 128-141 2005), and b) second-by-second parent-child Co-Regulation and Intersubjective Engagement (processes targeted by the treatment approach of RDI). Severity of autism was correlated with lower quality of parent-child interaction. Ratings on each of these variables changed over the course of treatment, and there was evidence that improvement was specifically related to the quality of parent-child interaction at baseline.

In this dissertation study Palmiotto, Jennifer, Psy.D. (2015). This study aimed to improve understanding of interactions between parent-child with autism within two domains central to autism; intersubjectivity and social regulation. In this qualitative study, the researcher examined the Relationship Development Assessment-Adapted (RDA-RV) Coding Scales, a novel observational measure used to assess the quality of interactions between parent and child with autism, within the context of Relationship Development Intervention (RDI) treatment and pretreatment. The researcher used qualitative content analysis to describe each of the subcategories of the RDA-RV Coding Scales within the two main categories—Intersubjective Engagement States and Interactive Regulation States. Eleven parent-child dyads participated by providing short video recordings of parent-child interactions in RDI guiding engagements and a pretreatment video. With review of textual transcriptions and video, the researcher's findings included three themes that were tracked in each of the four predetermined subcategories of the Intersubjective Engagement States. The themes found were: (a) quality of affective connection/relatedness, (b) quality of communication, and (c) quality of gaze. In addition, within the four predetermined subcategories of Interactive Regulation States, three unique themes emerged: (a) quality of monitoring and aligning (b) dynamic-ness (c) complexity of the shared endeavor. The researcher deconstructed each theme into subthemes distinguishing each subcategory as a different and distinct levels of interaction that also related to the respective main category. The researcher formulated the findings into a codebook to increase clinical and research utility of the RDA-RV Coding Scales. The results may directly influence the assessment and ongoing treatment of developmental-relational approaches, namely RDI, by increasing the usability of the RDA-RV Coding Scales.

References

  1. ^ a b Eikeseth, Svein; Klintwall, Lars (2014). "Educational Interventions for Young Children with Autism Spectrum Disorders". In Patel, Vinwood B.; Preedy, Victor R.; Martin, Colin R. (eds.). Comprehensive Guide to Autism. New York, NY: Springer. p. 2101-2103. ISBN 978-1-4614-4787-0.
  2. ^ Wagner, Amy Lee; Wallace, Katherine S.; Rogers, Sally J. (2014). "Developmental Approaches to Treatment of Young Children with Autism Spectrum Disorder". In Tarbox, Jonathan; Dixon, Dennis R.; Sturmey, Peter; Matson, Johnny L. (eds.). Handbook of Early Intervention for Autism Spectrum Disorders : research, policy, and practice. New York, NY: Springer. p. 393-427. ISBN 978-1-4939-0400-6.
  3. ^ "Relationship Development Intervention". Autism Speaks. 25 July 2012. Retrieved 10 May 2017.
  4. ^ Gutstein SE; Burgess, AF; Montfort, K (2007). "Evaluation of the Relationship Development Intervention Program". Autism. 11 (5): 397–411. doi:10.1177/1362361307079603. PMID 17942454.

5. Gutstein, S. (2004). The effectiveness of Relationship Development Intervention in remediating core deficits of autism-spectrum children. Journal of Developmental and Behavioral Pediatrics, 25(5), 375.

6. J. A. Hobson1 and P. Hobson2 (2011). Emotional Regulation In Autism: A Relational, Therapeutic Perspective. (1) Institute of Child Health, London, United Kingdom, Institute of Child Health, (2) University College London and Tavistock Clinic, London, London, United Kingdom . International Meeting for Autism Research: Emotional Regulation in Autism: A Relational Therapeutic Perspective. International Society for Autism Research.

7. Beurkens NM, Hobson JA, Hobson RP (2013). Autism severity and qualities of parent-child relations. Journal of Autism and Developmental Disorders. Jan;43(1):168-78.

8. Larkin F, Guerin S, Hobson JA, Gutstein SE. (2014). The Relationship Development Assessment - Research Version: Preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism. Clinical Child Psychology and Psychiatry: 2015 Apr: 20(2):239-60.

9. J, Hobson, L Tarver, N Beurkens, R.P, Hobson (2015/16) The Relation between Severity of Autism and Caregiver-Child Interaction: a Study in the Context of Relationship Development Intervention. Journal of Abnormal Psychology, (online) August 2015. pp 1-11. (print) May 2016, Volume 44, Issue 4, pp 745-755.

10. Palmiotto, Jennifer, Psy.D. (2015). A qualitative content analysis of parent-child interactions in autism within RDI. Doctoral dissertation ALLIANT INTERNATIONAL UNIVERSITY, 2015, 288 pages; 3702866




Retrieved from "https://en.wikipedia.org/w/index.php?title=Relationship_Development_Intervention&oldid=828318155"