Relationship development intervention (RDI) is a newer approach to treating symptoms of autism. It does not bill itself as a medical treatment, but as a form of training for parents, guardians, and caregivers of children with autism.
An RDI consultant will train the parent on implementing specific goals and supporting the child’s social and communication development. Since it is new, there are very few studies supporting RDI’s success, especially when compared with an evidence-based program like applied behavior analysis (ABA) therapy.
The Spectrum of Autism
Autism spectrum disorder (ASD) is a developmental disability affecting about 1 in 54 children in the United States. Boys are roughly four times more likely to receive a diagnosis of autism than girls.
Autism is called a developmental disability because the condition becomes noticeable as babies become toddlers, between 6 months and 2 years old. Brain development changes, and this materializes in changes to the child’s learning, speech, nonverbal communication, and play, among other areas. A diagnosis is not usually considered steady until 2 years old since some of the early signs may stabilize over time.
Thanks to changes in medical science, people with autism can be diagnosed earlier than ever before. Despite this, most children are typically not diagnosed until after they are 3 years old. There are some adolescents or adults who are not diagnosed until later in life.
Since the developmental condition occurs on a spectrum, many people with autism do not need help in their daily lives, while others need more substantial support to take care of themselves. There is no cure for autism, but with regular therapy starting as early as possible, many people on the autism spectrum improve their motor skills, cognitive function, communication skills, and social abilities.
What Is Relationship Development Intervention?
One newer form of therapy for autism is relationship development intervention (RDI). This approach to treatment has few medical studies to back it up, unlike more established therapies like applied behavior analysis (ABA).
RDI empowers parents and caregivers by making them the leaders of this therapy. RDI consultants train family members to use RDI therapy techniques at home. This helps to solidify relationships with the most important people in the autistic child’s life.
Goals of RDI
The relationship development intervention (RDI) therapy approach was developed by Dr. Steven Gutstein. This approach to therapy uses the child’s dynamic intelligence to increase social awareness, especially through more natural interactions between family members.
Dynamic intelligence is defined as:
- Understanding different perspectives or that other people have a different experience or opinion.
- Coping with change, from big to small changes.
- Integrating information from multiple sources or senses, like understanding sights and sounds together.
Parents tend to be the lead therapists during RDI treatment, after receiving training from an RDI consultant or specialist. The RDI consultant will work with the parent or caregiver to create a treatment plan based on the child’s age, developmental level, and current abilities. This plan will be divided into steps to achieve goals, which the parent or caregiver will implement.
Teachers and school administrators also benefit from working with RDI consultants to understand the process and how this therapy might improve their relationships with students with autism. The goal is to inform all important people in the child’s life of this approach.
The Key Principles of Relationship Development Intervention
RDI attempts to change inflexibility in thinking, one of the most common signs of autism spectrum disorder, and influence experience sharing, which improves the child’s ability to socialize with others. This occurs through six RDI objectives.
- Emotional referencing: This is the ability to learn from the subjective experiences of other people, especially family and friends.
- Social coordination: This involves observing and controlling behavior to participate in social relationships.
- Declarative language: This is using both verbal and nonverbal communication to invite others in, share perceptions, talk about feelings, coordinate actions, and express curiosity.
- Flexible thinking: This allows for altering plans and adapting to new circumstances as change occurs.
- Relational information processing: This is putting things into a context to solve problems without obvious black-and-white or right-or-wrong solutions.
- Foresight and hindsight: This is the ability to think about past experiences and learn to use these experiences to extrapolate what might happen in the future.
At the start of therapy, parents will build guided participation relationships between themselves and their children, treating the child as a cognitive apprentice. Once the parent and child have a more established relationship, the family will begin to take steps based on the child’s treatment plan to advance the six RDI objectives.
Ultimately, the process should improve neural connectivity in areas like cognition and communication that the child would otherwise struggle with. Like ABA therapy, RDI uses positive reinforcement to support the child’s improved self-awareness, adaptability, and changed behaviors.
How Does Relationship Development Intervention Compare to Applied Behavior Analysis?
RDI is a relatively new approach to helping people with autism, especially children on the autism spectrum. ABA therapy has been used to treat developmental disorders, especially autism, since the 1950s.
There is a long history of clinical approaches to ABA, research studies on ABA published in peer-reviewed journals, and adjustments to ABA approaches that have been objectively proven to help more people with autism. For example, ABA has mostly removed negative reinforcement from the practice and focused on positive reinforcement. This was after a public outcry about cruelty associated with using this type of treatment due to the negative reinforcement principle.
Gutstein, the leading founder of RDI, originally created this treatment in response to older models of ABA, which were criticized by some for their ineffectiveness. In decades past, ABA therapists attempted to be objective by becoming impersonal in their approach, which did not help the socializing issues associated with autism. This was especially true of experience sharing, which is a vital method of communicating during conversations with others. ABA therapy has evolved substantially since the time when these approaches were used.
Both RDI and ABA break down their treatment plans into individual steps to follow. This helps both the therapist and the client, as each individual step relates to a clear goal. This also allows for the therapist or parent to adjust their approach if something does not work.
Both approaches list specific symptoms of autism, mostly communication and socialization, that require an intensive amount of therapy and interaction to manage.
There are many differences between RDI and ABA therapies. The primary one is the person who is considered the leader or therapist.
In RDI, parents are trained through working with RDI consultants, reading books, taking classes, and attending seminars on how to support their children who have autism. In contrast, ABA therapists have specific educational requirements and must pass a certification exam that is managed through the Behavior Analyst Certification Board (BACB).
RDI providers also do not discuss RDI as a therapy. Instead, they describe it as a developmental intervention. This is, in part, because the direct providers for RDI treatment are parents, teachers, guardians, and other close caregivers who do not necessarily have extensive training in psychology, education, or a related field. In contrast, ABA therapists are therapy providers, which means they must be licensed to practice medicine or psychology in their state of residence.
Although ABA had been criticized for being too impersonal in the past, the therapy practice is continually adjusting to new, objective information from clinical trials and individual therapist experiences. In contrast, RDI has few research studies associated with it, and the first one has been criticized as biased.
The 2007 study was originally conducted by Gutstein and colleagues, and only 16 children participated in it. While the study measured specific outcomes in the group of babies and toddlers, there was little control for where each child was on the autism spectrum. While data was collected before and after children participated in RDI therapy over 18 months, there was no control group to use for comparison. This means that children participating in the study could have improved for reasons other than RDI therapy, but there was no objective measurement of this.
While ABA therapy should be received regularly in at least one, if not more, sessions per week, RDI is a treatment that works in daily life. This is because parents and other family members constantly interact with the autistic child.
Using Both Approaches
As long as there is no conflict in the overall treatment plan, it is possible for a parent or teacher to learn RDI and coordinate their efforts with the child’s ABA therapist.
In this case, it generally works better for a parent to learn the principles of ABA therapy as well. This way, there are fewer messaging conflicts. The treatment approaches are more uniform, which helps the child feel more secure.
Finding Relationship Development Intervention Consultants
While ABA therapy is likely to be covered by your health insurance, other approaches to treatment are less likely to be covered like this. This is because insurance coverage generally only covers evidence-based treatments, and the data is still lacking on RDI. Confirm the specifics of coverage with your provider.
Regardless of insurance coverage, RDI may be more affordable because the parent is the leading treatment provider. While you may need to keep up with changes in RDI treatment by occasionally working with a consultant or going to a seminar, you will have more direct control over the process since you are the one implementing it.
To find an RDI consultant and start your training process, you can use these links:
- RDI Certified Program Consultants, through the RDI Connect website
- Directory of Autism Services through Autism Speaks
- Autism and Developmental Disabilities Monitoring (ADDM) Network. (March 2020). Centers for Disease Control and Prevention (CDC).
- When Do Children Usually Show Signs of Autism? (January 2017). Eunice Kennedy Shriver National Institute of Child Health and Human Development.
- Can Your Child’s Autism Go Away? (November 2015). Cleveland Clinic.
- What Is Relationship Development Intervention (RDI)? Autism Speaks.
- An Introduction to RDI. RDIConnect.com.
- Is There Science Behind That? Relationship Development Intervention: A Review of Its Effectiveness. (2010). Association for Science in Autism Treatment (ASAT).
- Autism Therapy and Insurance – A Situation That Has to Change. (July 2012). Psychology Today.