Relationship Development Intervention® (RDI®) as Evidence Based Practice for Autism Spectrum Disorders
Relationship Development Intervention® (RDI®) is a research-guided intervention approach for remediating autism spectrum disorders. Following are peer-reviewed articles that document evidence of its efficacy for children with ASD.
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.
Gutstein, S., (2005)
Relationship Development Intervention®: Developing a Treatment Program to Address the Unique Social and Emotional Deficits in Autism Spectrum Disorder. Autism Spectrum Quarterly, Winter, 8-12.
Gutstein, S. E., Burgess, A. F., & Montfort, K. (2007)
This study is the second in a series evaluating the effectiveness of Relationship Development Intervention® (RDI®) to address unique deficits inherent in autism spectrum disorders. RDI® is a parent-based, cognitive-developmental approach, in which primary caregivers are trained to provide daily opportunities for successful functioning in increasingly challenging dynamic systems. This study reviewed the progress of 16 children who participated in RDI® between 2000 and 2005. Changes in the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R), flexibility, and school placement were compared prior to treatment and at a minimum 30 month follow-up period. While all children met ADOS/ADI-R criteria for autism prior to treatment, no child met criteria at follow-up. Similar positive results were found in relation to flexibility and educational placement. Generalizability of current findings is limited by the lack of a control or comparison group, constraints on age and IQ of treated children, parent self-selection, and parent education conducted through a single clinic setting.
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Gutstein, S. E. (2009)
Relationship Development Intervention® (RDI®) is a program designed to empower and guide parents of children, adolescents and young adults with autism spectrum disorders (ASD) and similar developmental disorders to function as facilitators for their children’s mental development. RDI® teaches parents to play an important role in improving critical emotional, social, and metacognitive abilities through carefully graduated, guided interaction in daily activities.
The paper reviews RDI’s® theoretical underpinnings, current methodology and preliminary research results. The clinical utilization of RDI® is discussed as an important part of the biopsychosocial management of ASD.
Although a controlled, blinded study of RDI® has yet to be done, preliminary research suggests that parents, through the RDI® curriculum and consultation process, have the potential to exert a powerful impact on their ASD children’s experience-sharing communication, social interaction, and adaptive functioning.
RDI® should be considered as part of a comprehensive treatment regimen, in which the physician plays a clinical management role, providing medical and psychiatric consultation. The RDI® clinician can function as a remediation specialist, providing accurate feedback to the physician, along with individualized training and guidance to family members.
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Hobson, J. A., Hobson, P., Gutstein, S., Ballarani, A., Bargiota, K. (2008)
Caregiver-child relatedness in autism, what changes with intervention? Poster presented at the meeting of the International Meeting for Autism Research.
Hobson, J. A., Tarver, L., Beurkens, N., & Hobson, R. P. (2015)
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.
Larkin, F., Guerin, S., Hobson, J. A., & Gutstein, S. E. (2013)
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.
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