Relationship Development Intervention RDI

1. Relationship Development Intervention (RDI) Andrea Hamlin, Bethany Taylor, & Paige Hays

2. Overview of RDI Parent-based intervention Goal is to remediate deficits in �experience sharing� (also called inter-subjective engagement) Population: children and teenagers (2+), all levels of functioning, focuses the autism spectrum (also for other relationship development problems due to ADHD, Bi-polar disorder, Tourette syndrome, and learning disabilities) Developed by SE Gutstein in response to the lack of effective interventions

3. Universal Deficit Gutstein (prepublication manuscript) claims, �Deficits in Experience-sharing are universally present throughout the autism spectrum, equally impacting individuals, regardless of cognitive and language proficiency� (p. 3). Hinders development because it prevents children from learning from the reactions and perspective of others

4. Instrumental vs. Experience-Sharing Two types of social interaction Instrumental interaction- interaction that is engaged in to obtain some information or stimulation. Ex. Child comes to a parent and says �I want a cookie.� Experience-sharing, also called Inter-subjective Engagement- an emotion based encounter that is engaged in solely to share an experience with another person Child goes to parent to show a picture, �Look mommy.�

5. RDI Program Model of Experience-sharing development Modeled on typical development for competency in emotional relationships. 6 level and 28 stage model Rationale: Traditional Interventions: Teach basic social rules in order to gain some degree of independence mainly to get their needs met. RDI: Systematically teaching the motivation for and skills needed in Experience-sharing interactions

6. Level I- Novice parent is center of child�s attention, as highly directive but fun guide to basic elements of a relationship Example activity- Peek-a-boo Level II- Apprentice parent is child�s activity partner Example activity- Game playing with rule changes Level III- Challenger parent moves into role of facilitator, fading into the background during a peer interaction Example activity- Relay race on teams Stages below are aimed at older children and adolescents: Level IV- Voyager child introduced to different perspectives and the use of imagination to enhance his voyage through the world Level V- Explorer child explores others� pasts and futures and can put himself in another�s shoes Level VI- Partner developing coherent sense of personal identity and seeking of mature friendships

7. RDI treatment process Evaluation- child�s experience-sharing competencies and obstacles to progress Parent training phase Program is set with goals based on levels and stages Parent implements RDI activities series of activities that are designed to create opportunities for Experience-sharing to occur. Family works with certified RDI consultant- sends in videotapes of activities, receives consultation, and re-evaluation based on systematic observation and scoring on these sequenced objectives Children matched with dyads in weekly pairs and small groups

8. RDI Consultants Required RDI Consultant certification training- Bachelors degree is minimum requirement Most consultants have background in occupational therapy, speech-language pathology, psychology or ABA All seminars held at RDI center in Houston, TX Professionals must attend three 4-day training seminars in Houston, case supervision via videotape, and demonstrated proficiency in administering RDA. Certification fees are $8,800 Process takes 8-16 months

9. How is this measured? Experience-sharing is measured by the capability and the extent to which the child actively seeks to share and coordinate experience with others Each level has goals Ex. �the child is comforted by a glance or soothing words from a adults� Ex. �the child orients to people entering his proximity and makes sure they are familiar or safe prior to shifting attention away.� Evaluation tools- Autism Diagnostic Observation Scales (ADOS), Autism Diagnostic Interview Revised (ADIR), and the Relational Development Assessment (RDA) developed specifically for the RDI program

10. Expected Outcomes Anticipated results for occupational performance- Short-term- child more fun to be with, laugh and smile more, increase time spent looking at others in a meaningful way, appear more alive and natural, and others will approach the child more frequently Long-term- child will make friends, receive more invitations from peers, be more flexible and accepting of change, seek out others� opinions, be more aware of his/her unique identity, and his/her communication and humor will be less scripted and more creative Overall, increase social participation, school functioning, and family relationships

11. Efficacy One study accepted for publication to The Journal of Autism and Developmental Disorders, by Gutstein Outcome measures- changes in the Autism Diagnostic Observation Scales (ADOS) and independent functioning in classrooms 70% children in RDI group improved at least one diagnostic category on ADOS 82% of children in RDI group in regular education classroom in comparison with 12% at baseline. No change in control group Study limitations Participants self-selected whether to participate in RDI Study conducted with small group of high functioning children Groups not equal at baseline- more children with Asperger�s in RDI group, more with PDD-NOS in control group. Non-RDI group average of 10 months older than RDI group, RDI group had higher cognitive functioning Variety of measures were used to test cognitive measures and language functioning, children�s abilities may not have been comparable

12. Case Study: Peter RDI consultant has been working with Peter, his mother, and father for 1 year. He started at level 1, novice, and now is at level 2, apprentice (parent is child�s activity partner) Specifically, stage 6, Transformation Function: Prefers shared activities where he/she acts as a partner to add variations, while both partners equally maintain coordination through ongoing referencing and regulations Intervention activity: �Rule Changes� during any game

13. Rationale for Intervention Expected outcomes Increase tolerance and enjoyment of play with peers Increase ability to transition and adjust to changes in routines Decrease problematic behaviors Increase engagement in social activities

14. Resources/ References Books: Gutstein, S. E. (2000). Autism Aspergers: Solving the Relationship Puzzle. Arlington, TX: Future Horizons Inc. Gustein, S. E. & Sheely, R. K. (2002) Relationship Development Intervention with Young Children. Philadelphia: Jessica Kingsley Publishers. Research: Gustein, S. E. (Pre-publication manuscript). Preliminary evaluation of the relationship development intervention program. Website: http://www.connectionscenter.com/