Evidence-Based Research

Relationship Development Intervention (RDI®) is a cost-effective, research-guided intervention approach for remediating autism spectrum disorders. The program is a parent-training model to help children overcome deficits and learn joint attention, social referencing, theory of mind, social reciprocity, and communication for experience sharing purposes. RDI® is an evidence-based practice approach that makes use of a combination of the best available research and clinical expertise in treatment decisions (Twachtman- Cullen, 2009). The following are peer-reviewed published articles document evidence of its efficacy for children with ASD.

Relationship Development Intervention (RDI®) as Evidence-Based Practice for Autism Spectrum Disorders

Beurkens, N. M., Hobson, J. A., & Hobson, R. P. (2013)

The aim of this 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.

To access the full article, please go here. 

Derwin, M., Soreth, M. E., Gangemi, C., & Coleman, B. (2016)

Preliminary Efficacy of Relationship Development Intervention® and Parent-Implemented Applied Behavior Analysis/Verbal Behavior on Joint Attention and Communication of Preschool Children with Autism

Background:
Acquiring joint attention (JA) and functional spoken language by the time a child with autism enters school around the age of 5 years old are critical. Involving parents in treatment maximizes the child’s opportunities to learn. Relationship Development Intervention® (RDI) is a relationship-based intervention focusing on recreating developmental milestones through meaningful interactions with parents with a primary goal of increasing JA. However, little research has evaluated the efficacy of this intervention. In contrast, a model based on Skinner’s Analysis of Verbal Behavior (ABA/VB) increases spoken language directly when implemented by therapist and teachers; however, this approach has not been evaluated when implemented by parents. RDI and ABA/VB have different primary targets for intervention; however, both approaches assume that language and JA, respectively, will emerge as a corollary effect of the intervention.

Objectives:
The purpose of this pilot study is to compare the efficacy of two parent-implemented adjunctive interventions, RDI and ABA/VB, against Services As Usual (SAU) on JA and language in children 2-6 year old with ASD.

Methods:
Participants were 36 children diagnosed with autism spectrum disorder (ASD) by community providers and the Autism Diagnostic Observation Schedule-2™. Participants were randomly assigned to RDI, parent-implemented ABA/VB, or SAU conditions. All parents, regardless of assigned condition, reported weekly on the type and extent of services delivered. The intervention consisted of 16 sessions over 14 weeks delivered in the home. Assessments were conducted pre-treatment and end of treatment (3 months). The primary outcome measure was direct observation of parents and children interacting under different scenarios designed to implement conditions most likely to produce the behavior targeted by the interventions (e.g., joint attention, specific language skills) including prompts that involved having the child ask the parent for preferred items and engaging the child in a conversation about family photographs. The direct observations were coded by research assistants blind to treatment condition and trained to interobserver reliability levels of 80% or above on a coding taxonomy that included an array of parent and child behavior related to joint attention, language, and problem behavior. In addition, two standardized assessments were also administered (Mullen Scales of Early Learning and Communication and Symbolic Behavior Scales).

Results:
All participants for the study have been recruited and 29 children have completed the treatment and post-assessment. Preliminary results indicate that both RDI and ABA/VB produced gains in the child’s following of bids for joint attention, three-point gazes, and initiating verbalizations while SAU did not result in any gains for any of these behaviors.

Conclusions:
This pilot study examines the efficacy of parent-implemented RDI and ABA/VB against SAU on social and emotional communication and language via direct observation and standardized measures. Preliminary results indicate that both interventions are able of producing gains in joint attention and verbal behavior, even though the two interventions differ in primary intervention targets. Furthermore, children in SAU condition did not show evidence of change. These results support that parents can serve as effective agents of change in the implementation of empirically supported early interventions for ASD.

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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 Disorders39, 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. Autism18, 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 Orthopsychiatry75, 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.

To access the full article, please go here. 
Gutstein, S. E. (2009)

BACKGROUND:
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.

METHODS:
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.

RESULTS:
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.

CONCLUSIONS:
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.

To access the full paper, go here. 

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.

To read the full paper, go here. 

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.

To access the full article, please go here. 

A broader examination of the literature demonstrates a growing body of empirical research evidence and best practice recommendations supporting the practices embedded in RDITM. Specifically, RDITM is a family-centered, intensive, objective driven, individualized intervention targeting the components of social-emotional development in the context of the parent-child relationship. The articles listed below document the peer-reviewed published evidence supporting the core components of RDITM for treating autism spectrum disorders.

Incorporating Intervention Into Daily Routines 

Aldred, C., Green, J., and Adams, C. (2004)

A new social communication intervention for children with autism: pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology & Psychiatry, 45(8), 1420-1430.

Prizant, B. (2008)

Treatment Options and Parent Choice: An Individualized Approach to Intervention. Autism Spectrum Quarterly, Winter, 34-37.

Prizant, B. (2009)

Creating a culture of family-centered practice for the autism community. Autism Spectrum Quarterly, Summer, 30-33.

Improving Overall Functioning Related to ASD

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., Burgess, A. & Montfort, K. (2007)

Evaluation of the Relationship Development Intervention Program. Autism, 11, 397-411.

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.

Training Parents through Ongoing Consultation &
Using the Parent-Child Relationship as a Natural
Context for Child Learning & Growth

Aldred, C., Green, J., and Adams, C. (2004)

A new social communication intervention for children with autism: pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology & Psychiatry, 45(8), 1420-30.

Beurkens, N.M., Hobson, J.A., Hobson, R.P. (2013)

Autism severity and qualities of parent-child relations. J Autism Dev Disord., 43(1), 168-78. doi: 10.1007/s10803-012-1562-4.

Casenhiser, D., Shanker, S.G., & Stieben, J. (2011)

Learning Through Social Interactions in Children with Autism: Preliminary Data from a Social-Communications-Based Intervention. Autism, 26, Sept. 1- 22.

Center on the Developing Child at Harvard University. (2015)

Supportive Relationships and Active Skill- Building Strengthen the Foundations of Resilience: Working Paper 13.

www.developingchild.harvard.edu.

Dawson, G., Rogers, S., et al. (2010)

RCT of an Intervention for Toddlers with Autism: The Early Start Denver Model. Pediatrics, 125(1).

Drew, A., G. Baird, S. Baron-Cohen, A. Cox, V. Slonim, S. Wheelwright, J. Swettenham, B. Berry, and T. Charman. (2002)

A pilot randomized control trial of parent training intervention for pre-school children with autism. European Child & Adolescent Psychiatry, 11, 266-272.

Green, J., Charman, T., McConachie, H., et al. (2010)

Parent-mediated communication-focused treatment in children with autism (PACT): A randomized controlled trial. Lancet Online, May 21.

Greenspan, S.I., & Wieder, S. (1997)

Developmental Patterns and Outcomes in Infants and Children with Disorders in Relating and Communication: A Chart Review of 200 Cases of Children with Autistic Spectrum Disorders. The Journal of Developmental and Learning Disorders, 1(1), 87-141.

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. E., Burgess, A. F., & Montfort, K. (2007)

Evaluation of the relationship development intervention program. Autism, 11(5), 397-411.

Ingersoll, B., Dvortcsak, A., Whalen, C. & Sikora, D. (2005)

The Effects of a Developmental, Social- Pragmatic Language Intervention on Rate of Expressive Language Production in Young Children With Autistic Spectrum Disorders. Focus of Autism and Other Developmental Disorders, 20(4), 213-222.

Jones E. A., Carr E. G., Feeley K. M. (2006)

Multiple effects of joint attention intervention for children with autism. Behavior Modification. Nov. 30(6), 782-834.

Kasari, C., Gulsrud, A.C., Wong, C., Kwon, S. & Locke, J. (2010)

Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056.

Kasari, C., Paparella, T., Freeman, S., & Jahromi, L.B. (2008)

Language outcome in autism: randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125-137.

Landa, R.J., Holman, K.C., O’Neill, A.H., & Stuart, E.A. (2011)

Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 52(1), 13-21.

Krebs Seida, J., Ospina, M., Karkhaneh, M., Hartling, L., Smith, V. & Clark, B. (2009)

Systemic reviews of psychosocial interventions for autism: An umbrella review. Developmental Medicine & Child Neurology, 51, 95-104.

Mahoney, G. & Perales, F. (2003)

Using relationship-focused intervention to enhance the social emotional functioning of young children with autism spectrum disorders. Topics in Early Childhood Special Education, 23(2), 74–86.

Mahoney, G., & Perales, F. (2005)

Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study. Journal of Developmental & Behavioral Pediatrics, 26(2), 77-85.

McConachie H., Diggle T. (2007)

Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. Journal of Evaluation in Clinical Practice, Feb. 13(1), 120-9.

McConachie, H., Randle, V., Hammal, D., & Le Couteur, A. (2005)

A controlled trial of a training course for parents of children with suspected autism spectrum disorder. Journal of Pediatrics, 147(3), 335-340.

Ospina, M., Krebs Seida, J., Clark, B., Karkhaneh, M., Hartling, L., Tjosvold, L., Vandermeer, B. & Smith, V. (2008)

Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review. PLoS ONE, 3(11), e3755. doi:10.1371/journal.pone.0003755.

Prizant, B.M. & Wetherby, A.M. (1998)

Understanding the continuum of “discrete-trial traditional behavioral” to “social-pragmatic developmental” approaches to communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19, 329–353.

Reichow, B., Volkmar, & Cicchetti, (2008)

Development of the Evaluative Method for Evaluating and Determining Evidence-Based Practices in Autism. J. Autism Dev. Disord., 38, 1311.

Schertz, H. H., Odom, S. L. (2007)

Promoting joint attention in toddlers with autism: a parent-mediated developmental model. Journal of Autism and Developmental Disorders, Sept. 37(8), 1562-1575.

Siller, M. & Sigman M. (2002)

The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32(2), 77-89.

Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007)

Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program. Autism, 11(3), 205-224.

Remediating the Core Deficits of Autism
in a Developmental Progression

Aldred C, Green J, and Adams C. (2004)

A new social communication intervention for children with autism: pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology & Psychiatry, 45(8), 1420-1430.

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 (IMFAR), April 2008, London, UK.

Howlin, P. (2008)

Can children with autism spectrum disorders be helped to acquire a “theory of mind”? Revista de Logopediay Audiologia, Vol. 28(7), 74-89.

Jones E. A., Carr E. G., Feeley K. M. (2006)

Multiple effects of joint attention intervention for children with autism. Behavior Modification, Nov. 30(6), 782-834.

Kasari C, Freeman S, Paparella T. (2006)

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611-20.

Keen D, Rodger S, Doussin K, Braithwaite M. (2007)

Pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism. Autism, 11(1), 63-71.

Mahoney, G., and F. Perales (2005)

Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study. Journal of Developmental & Behavioral Pediatrics, 26(2), 77-85.

Schertz, H. H., Odom, S. L. (2007)

Promoting joint attention in toddlers with autism: a parent-mediated developmental model. Journal of Autism and Developmental Disorders, Sept. 37(8), 1562-1575.

Siller, M. & Sigman, M. (2008)

Modeling longitudinal change in the language abilities of children with autism: parent behaviors and child characteristics as predictors of change. Developmental Psychology, 44(6), 1691-1704.

Solomon, R., Necheles, J., Ferch, C. & Bruckman, D. (2007)

Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program. Autism, 11, no.3, 205- 224.

Tannock, R., Girolametto, L. & Siegal, L. (1992)

Language intervention with children who have developmental delays: Effects of an interactive approach. American Journal on Mental Retardation, 97, 145-160.

Whalen, C. and Schreibman, L. (2003)

Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry, 44(3), 456-468.

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