Relationship Development Intervention RDI

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Relationship Development Intervention (RDI)

• Andrea Hamlin, Bethany Taylor, Paige Hays

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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

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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

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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.

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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

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• Level I- Novice
• parent is center of childs attention, as highly
  directive but fun guide to basic elements of a
  relationship
• Example activity- Peek-a-boo
• Level II- Apprentice
• parent is childs 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 anothers shoes
• Level VI- Partner
• developing coherent sense of personal identity
  and seeking of mature friendships

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RDI treatment process

• Evaluation- childs 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

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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

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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

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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

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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
  Aspergers 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, childrens
  abilities may not have been comparable

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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 childs 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

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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

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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/