RDI

1. RDI A Review of Relationship Development Intervention by Erica Dorsi and Stephanie Andrews-Diaz Caldwell College Graduate Program in Applied Behavior Analysis

2. Dr. Steven Gutstein Gutstein’s Timeline 1980 – Ph.D in Clinical Psychology from Case Western Reserve 1979-87 – Assistant Professor of Psychology and Pediatrics at Baylor College of Medicine and University of Texas, Director of Pediatric Psychology for Texas Children’s Hospital

3. Gutstein’s Timeline cont… • 1983 – Awarded the largest grant by Hogg Foundation for Mental Health, a family based intervention program for suicidal adolescents • 1990- Had to sell mental health care facility due to failure • 1995- August, He and his wife, Rachelle Sheely, PhD “co-founded” The Connection Center for RDI – A profit business corporation of Gutstein, Sheely and Associates P.C.

4. Gutstein’s Timeline cont… • 2001- Published book, Autism/Asperger’s: Solving the Relationship Puzzle • 2002 -Published 2 books, Relationship Developmental Intervention Activities for Young Children, and Activities for Children, Adolescents and Adults

5. Rationale for RDI Gutstein found: The “Missing Piece” of the puzzle for children with Autism, he calls it, Dynamic Intelligence. Going to the Heart of Autism

6. DynamicIntelligence • Emotional Referencing • Learn from experiences of others • Social Coordination • Participate in spontaneous relationships • Observe & Regulate own behavior • Declarative Language • Express curiosity, share perceptions and invite others to interact

7. Dynamic Intelligence cont… • Flexible Thinking • Adapt, change and alter plans • Relational Information Processing • Solve problems with no right/wrong answers • Foresight and Hindsight • Reflect on past experiences and anticipate future scenarios

8. Dynamic Intelligence is taught by RDI RDI – Relationship Development Intervention is: Parent-based clinical treatment Teaches the joy in connecting Changes Neurology Developmental and Systematic Realistic Precise (http://cureautismnow.org/site/c.bhLOK2PILuF/b.2214591/k.C45/Relationship _Development_Intervention)

9. RDI Assessment Tool Autism Diagnostic Observation Schedule • Structured activities to interact with child in order to evaluate social and communication skills • Tasks based on developmental level and language ability • Child’s response to bubble play, pretend play, ability to engage with observer (http://www.audiodigest.org/pages/htmlos/01126.1.10968088786264688776/PD5312)

10. RDI ActivitiesLevel I Novice Pre-requisites for becoming part in the world of learning about relationship and feelings. Make adults the center of their attention. Stage 1: Attend Spike the Dog- Stage 2: Reference Stage 3: Regulate Stage 4: Coordinate (Gutstein and Sheely, 2002)

11. RDI Activities Cont.Level II Apprentice- Introduction to shared regulation and communication repair. Learning to enjoy variation and transition. Begin working with partnered pairs. Stage 5: Variation Stage 6: Transformation Stage 7: Synchronization • Opposite World Stage 8: Duets

12. RDI Activities Cont.Level III Challenger- Children develop a group Ego that allows them to do things that they never thought they could. Begin working in groups to practice relationship skills. Stage 9: Collaboration Monster in the Mountain- Stage 10: Improvisation Stage 11: Co-Creation Stage 12: Running Mates (Gutstein and Sheely, 2002)

13. RDI Program Protocol Consultants “Coach” Assess the child Decide on the stage Support family with developing activities Give feedback and make recommendations Parents “Guide” Act as the “Mentor” Teach and motivate child to learn with activities Videotape activities and send to consultant

14. RDI Program Protocol cont.:Parents’ Role Parents should be the primary guides, as is found in neurotypical infant development • “To address the core deficits of autism, any remediation program …needs to empower parents–not professionals–in establishing the primary relationship through which this can be achieved.” (From RemediatingAuitsm[1].pdf)

15. RDI Program Protocol cont.:Parents’ Role Parents: Attend 2 day workshop or watch dvd—Going to the Heart of Autism ($275 per person without children, Houston): • “You will get a good background about the RDI® Program, plus learn the latest essential elements in starting an RDI® Lifestyle to benefit your entire family.” (www.rdiconnect.com/RDI/2dayIntro-Parents.asp)

16. RDI Program Protocol: Parent Requirements Attend a 4 day parent seminar ($2,150 per family): • “Become familiar with and identify characteristics of Autism Spectrum Disorders”; • “Become psychologically ready to "re-form" the relationship between you and your child”; • Gain an understanding on how your actions can influence the relationship between you and your child (www.rdiconnect.com/RDI/4daySeminar.asp)

17. RDI Program Protocol:Parent Requirements cont. • Complete RDA Planning Module (RDATM) with a certified consultant—aseries of3 observation sessions ($2600) • Parent begins working with child • Create and submit 30 min. videos every 2 weeks to consultant (clinician); feedback within one week via email.

18. RDI Program Protocol:Certified Consultants Certified Consultants: • “[Use] the RDA™ to evaluate the parent-child relationship.” • Are responsible for “developing hypotheses for treatment planning, including system readiness, strengths and obstacles.” (www.rdiconnect.com/RDI/intro.asp)

19. Certification Requirements Min. of Bachelor’s degree (“RDI® Program Certification does not require licensure or experience in the field of psychology or therapy”) Most are already in field of autism “The certification process includes completion of three, 4-day intensive training seminars, case supervision done via videotape and demonstration of proficiency in the RDA. The process generally takes 12-18 months.” Re-certification is required every 12 months.

20. Certification Requirements cont. RDATM Intervention planning instrument • RDA 1: “observation session consists of 20 structured activities designed to elicit experience sharing interaction that corresponds to stages of relationship development” • RDA 2: “Clinician tests out assumptions and answers questions raised by the first assessment” • RDA 3: Clinician meets with parents to determine best ways for parents to be most effective with their children (http://rdi-c4pm.com/_wsn/page3.html)

21. Certification Requirements cont. Why pursue certification? • Fees for certification training range from $8,800-$14,000 “We find most professionals recoup their investment in the training very quickly and many have waiting lists even before completing certification.” (www.rdiconnect.com/RDI/intro.asp, http://houston.bizjournals.com/housto/stories/2005/07/25/smallb1.htmp) • Professionals who seek certification “have a desire to offer unique services which make them stand out from the “crowd” of providers in their community.” (www.rdiconnect.com/RDI/intro.asp)

22. RDI Claims: What does it do? RDI remediates the “core deficits” of autism: • RDI “involves: systematic, long-term remediation of specific deficits that define autism spectrum disorders.” (www.rdiconnect.com/RDI/FAQ_Fam.asp)

23. RDI Claims: How are claims supported? Gutstein cites several “brain studies”, quality of life surveys, and infant development research and theory to prove a new consensus about the core deficits of autism: • “Groundbreaking advances in the field of autism-spectrum disorders (ASD) since DSM IV (Diagnostic and Statistical Manual of Mental Disorders, 1994) have profound new implications for treating autism, Asperger’s Syndrome and PDD-NOS…Prominent researchers, including Nancy Minshew (University of Pittsburgh),

24. RDI Claims:How are claims supported? cont. Quote cont… …Uta Frith (University of London), Peter Mundy (University of Miami), … Amy Klin (Yale Medical School) and Peter Hobson (Tavistock Institute, London) along with many others, have reached a consensus that autism is not a behavioral disorder, nor a social disorder, but a neurologically-based information processing disorder which impacts those on the spectrum in very specific ways, regardless of their IQ or language abilities.” (Third Generation Autism Treatment flyer, www.rdiconnect.com)

25. RDI Claims: How do we know? • “We know from neuroimaging that children on the autism spectrum do not fully develop pathways in the brain between the Pre-frontal Cortex, the brain’s “executive;” and the Limbic System, the emotional center of the brain. But we know from years…”

26. RDI Claims: How do we know? cont. quote continued… “of rehabilitation research that previously damaged and under used parts of the brain can be strengthened. What if there were exercises that created traffic to strengthen those pathways? That is what I set out to do in developing the RDI® Program.” (Intro. To RDI Brochure, p. 5, www.rdiconnect.com)

27. RDI Claims How are claims supported? Catchy phrases and slogans • “The time for RDI® is now. Spend four days with us and expand your child's potential for a satisfying life.” (www.rdiconnect.com/RDI/4daySeminar.asp) • “The foundations of Dynamic Intelligence underlie success in life. (www.rdiconnect.com/RDI/DynamicIntelligence.asp) • “The reference point for the RDI® Program success will always be quality of life.” (www.rdiconnect.com/RDI/RDIevolution.asp)

28. RDI Claims: How are claims supported? cont. Testimonials and Stories • Satisfied parents, RDI consultants and autism experts • Testimonials and Stories • My Baby Can Dance: Stories of Autism: Asperger's and Success Through the Relationship Development Intervention® (RDI®)Program, (Gutstein, 2006) (http://www.rdiconnect.com/RDI/testimonials.asp)

29. RDI Claims: More support… Gutstein offers his own “RDI Story”: • “I realized advances in Autism treatment had not kept up with research....I could not accept the consequences of waiting for others to do something about the tragedy I saw unfolding around me every day.” (www.rdiconnect.com/RDI/RDIstory.asp)

30. RDI Claims: Who is it for? RDI claims to work for almost everyone • “The program can also be used with children who are not who are not AS or autistic but who have relationship development problems, like ADHD, Bi-polar Disorder, Tourette Syndrome and Learning Disabilities….”(Gutstein & Sheely, 2002) • “We find that all people on the autism spectrum can benefit from the RDI Program. It appears to be effective regardless of IQ, language, gender or diagnosis.” (IntrotoRDI_2[1].073106.pdf, www.rdiconnect.com)

31. RDI Claims: How does it compare to other treatments? • “I wanted the children to smile when I walked into the waiting room, because they were happy to see me, not because they received an M&M as a reward.” (Gutstein, 2000) • “What research has consistently shown is that no behavior, biological or psychological interventions and treatments have been able to impact the devastating consequences of a failure to develop Dynamic Intelligence.” • From: Gutstein and Sheely, Introductory Guide for Parents, • Gutstein interview

32. RDI Claims:How is progress measured? Describes itself as a data-driven model • “Data collection is conducted on a daily basis and summarized weekly. RDI® Program sessions are videotaped and reviewed at least every two weeks. Progress and mastery of objectives is documented through clearly observable videotaped data.” (www.rdiconnect.com/RDI/RDIProtocol.asp)

33. RDI Claims: How is progress measured? • RDI is “precise: a method that measures and begins at the edge of each person's capability and then carefully but continually raises the bar.” (www.rdiconnect.com/RDI/RDIfamily.asp)

34. RDI Research 2002 “Asperger syndrome and the development of social competence”, Steven Gutstein, Focus on Autism and Other Developmental Disabilities. 2004 “RDI and the Ability to Generalize Learned Social Skills”, Sara Spencer, B.A., M.A. 2005 “Preliminary Evaluation of Relationship Development Intervention Program”, Steven Gutstein. (http://www.ctfeat.org/rdi_critique.htm)

35. RDI Preliminary Evaluation StudyDescription 17 Children ages 2-10 participating with their parents in RDI Compared to 14 children involved in other therapies Administered Autism Diagnostic Observation Scales (ADOS) Initial evaluation and 9 months later Non-RDI group averaged 26 hours per week & RDI group has less than 9 hours a week of formal intervention

36. RDI Preliminary Evaluation Study Results 70% of RDI group had improved diagnostic classification from Autism to Autism Spectrum or non-Autism Not a single child in the non-RDI group had improved their diagnostic classification on the ADOS 70% of RDI group moved from special education or home setting to regular classroom setting with any support Not a single child improved a school setting in the non-RDI group

37. RDI Preliminary Evaluation Study Methodological Problems • Manuscript accepted for publication by the Journal of Autism and Developmental Disorders BUT……Never Published • Based on a small sample of “high functioning” children • Results from a single setting – RDI clinic • RDI group received 5 more months, 30% more time in treatment than comparison group

38. RDI Methodological Problems Cont. • RDI group had an average IQ 12 points higher than the comparison group • RDI group was approximately 1 year younger than comparison group Last, but not least: • People who conducted the study had much to gain from positive results, such as money and professional success (http://www.ctfeat.org/rdi_critique.htm)

39. RDI Conclusion • Possible benefits: • Offers 300-400 RDI strategies that focus on social skills development • May be useful to include some strategies in ABA programs: operationally define objectives and measure outcomes • Emphasis on declarative language and gesturing for communication may offer a “greater variety of SD’s utilized or more subtle SD’s that may result in an increase in responsiveness.” • All above ideas are based on (www.ctfeat.org/rdi_critique.htm)

40. RDI Conclusion cont. Concerns: • Branding before establishing effectiveness • Marketing heavily to parents and professionals to be the “Third Generation” treatment which remediates “core deficits” • In reality he has a hypothesis which is loosely based on scientific and developmental research which he theorizes should also apply—with some modification—to autistic individuals.

41. RDI Conclusion • Court Case decision on May 11, 2007 in California denied reimbursement to parents for RDI workshop based on the opinions shared by Gutstein and parents that the program is effective; “it is hoped that further research will establish the efficacy of RDI. At this time, however, RDI remains unproven and experimental.” • KAJ S. vs. North Bay Regional Center, (www.documents.dgs.ca.gov/oah/DDS_Decisions/N2006100868.084.pdf)

42. RDI Conclusion • “Researchers may wish to conduct studies with strong scientific designs to evaluate Relationship Development Intervention. Professionals should present this intervention as untested and encourage families who are considering this intervention to evaluate it carefully.” (www.asatonline.org/resources/treatments_desc.htm)

43. RDI RDI • Questions?

44. References • Websites: • http://www.rdiconnect.com • http://www.ctfeat.org/rdi_critique.htm • http://www.cureautismnow.org/site/c.bhLOK2PILuF/b.2214591/k.C45/Relationship_Development_Intervention_RDI.htm • www.asatonline.org/resources/treatments_desc.htm • www.documents.dgs.ca.gov/oah/DDS_Decisions/N2006100868.084.pdf • http://www.bizjournals.com/houston/stories/2005/07/25/smallb1.html • http://rdi-c4pm.com/_wsn/page3.html • http://www.autismpodcast.org/ • www.documents.dgs.ca.gov/oah/DDS_Decisions/N2006100868.084.pdf • http://www.wesd.org/journals/Files/Research/Preliminary%20Evaluation%20of%20the%20Relationship%20Development%20Network.pdf

45. References • Books: • Gutstein, S., & Sheely, R. (2002). Relationship Development Intervention with Young Children. London, England: Jessica Kingsley Publishers. • Gutstein, S. (2000). Autism Aspergers: Solving the Relationship Puzzle. Arlington, TX: Future Horizons, Inc. • Journal Article: • Attwood (2004), Relationship Development Intervention with Young Children. Social and Emotional Development for Asperger’s Syndrome, Autism, PDD and NLD, Child and Adolescent Mental Health 9 (1), 42-43.

46. Additional Resources • Books: • Fogel, A. (1993). Developing Through Relationships. The University of Chicago Press: Chicago, Illinois. • Gutstein, S. (2003). Can My Baby Learn to Dance? Friendship Development in adolescents with Asperger’s Syndrome. In Willey, H. Asperger’s Syndrome in Adolescence. Jessica Kingsley, London • Gutstein, S. (2003) Relationship Development Assessment Administration Manual. Connections Center: Houston, Texas. • Hobson, P. (2004). The Cradle of Thought: Exploring the origins of thinking. • Hobson, P. (1993). Autism and the Development of Mind. Hove. Laurence Erlbaum & Associates, London. • Rogoff, B. (1990). Appenticeship in Learning: Cognitive Development in Social Context. Oxford University Press, Oxford. • Sroufe, A. (1996). Emotional Development: The Organization of Emotional Life in the Early Years. Cambridge University Press, Cambridge, U.K. • Stern, D. (1977). The First Relationship. Harvard University Press: Cambridge, MA. • Volkmar, F & Klin, A. (1993). Social development in autism: historical and clinical perspectives. In Baron-Cohen, S., Tager-Flusberg, H. & Cohen, D. (Eds.), Understanding Other Minds. Oxford University Press, Oxford.

47. Additional Resources cont. • Journal Articles • Attwood (2004), Relationship Development Intervention with Young Children. Social and Emotional Development for Asperger’s Syndrome, Autism, PDD and NLD, Child and Adolescent Mental Health 9 (1), 42-43. • Minshew, N. (2001). The pattern of intact and impaired memory functions in autism. Journal of Child Psychology & Psychiatry & Allied Disciplines 42, 1095-1101 • Mundy, P. (2003). The neural basis of social impairments in autism: the role of the dorsal medial-frontal cortex and anterior cingulated system. Journal of Child Psychology and Psychiatry, 44, 1-17. • Schultz, R.; Gauthier, I; Klin, A.; Fulbright, R.; Anderson, A.W.; Volkmar, F; Skudlarski, P.; Lacadie, C.; Cohen, D.J.; Gore, J.C. (2000). Abnormal ventral temporal cortical activity during face discrimination among individuals with Autism and Asperger Syndrome. Archives of General Psychiatry, 57, 331-340.