You asked for background information on relationship development intervention (RDI), a therapy for children with autism spectrum disorder (ASD). You specifically asked about its general acceptance and whether any states provide funding for its use with children age three and above.

SUMMARY

RDI is a parent-based therapy based on the premise that the core deficits of ASD—rigid thinking, aversion to change, inability to understand other people's perspective, and failure to empathize—result in a lack of ability to successfully manage changing real life environments. The program starts with an RDI consultant evaluating the child's functioning. Then parents attend a two- or four-day workshop. Training focuses on building motivation, modifying communication style, enhancing memory formation, developing “friendly” practice environments, and generalizing motivation and skills into everyday life. Parents receive comments and ongoing training using videotapes of home sessions and in-person consultations.

RDI does not appear to have been the subject of independent, peer-reviewed evaluation. California agencies have rejected parents' requests for government agencies to fund RDI services for their preschool and school age children, mainly because there was too little evidence to show that RDI was effective.

The State Education Department does not track the types of programs school districts use to educate children with autism, consequently its staff do not know if any districts currently use and pay for RDI. Massachusetts and Colorado both provide funding for RDI under their Medicaid home- and community-based services waivers for children with autism. Vermont, though, refused at least one parental request to fund RDI under a developmental services program.

RELATIONSHIP DEVELOPMENT INTERVENTION (RDI)

Description

RDI is a parent-based therapy based on the premise that the core deficits of ASD—rigid thinking, aversion to change, inability to understand other people's perspective, and failure to empathize—must be addressed to improve the quality of the individual's life. Consequently, RDI focuses on building relationships, gaining friendships, feeling empathy, expressing love, and sharing experiences with others.

RDI is based on the work of Dr. Steven Gottstein, a clinical psychologist whose research in the development of typical children led to his findings that people on the autism spectrum lacked what he termed “dynamic intelligence,” the ability to successfully manage changing real life environments. He describes six aspects of dynamic intelligence:

1. emotional referencing: using an emotional feedback system to learn from the subjective experiences of others;

2. social coordination: observing and continually regulating one's behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions;

3. declarative language: using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate actions with others;

4. flexible thinking: rapidly adapting, changing strategies and altering plans based upon changing circumstances;

5. relational information processing: obtaining meaning based on the larger context and solving problems that have no "right-and-wrong" solutions; and

6. foresight and hindsight: reflecting on past experiences and anticipating potential future scenarios in a productive manner.

RDI emphasizes six approaches according to the Connecticut State Education Department's Guidelines for Identification and Education of Children and Youth with Autism. (The department lists RDI among many approaches and strategies that districts could use with students with ASD. It specifies that listing is not an endorsement.) These are:

1. teaching skills in a developmental, stepwise progression;

2. initially providing instruction from adults who act as both guides and participants;

3. developing simple, ritualized frameworks that allow for a degree of predictability without limiting the potential introduction of novelty and variation;

4. initially working in a simple, nondistractive environment;

5. spotlighting and amplifying the important actions and communication of adult coaches so that the novice learner can read them more easily; and

6. moving gradually from adult guides to peers and from simple to more complex settings.

As noted above, RDI is parent-based. The program starts with an RDI consultant evaluating the child's functioning. One Connecticut firm, Communication Clinic of Connecticut, LLC in Ridgefield, charges $2,400 for the evaluation, which involves a parent education session, a review of a home video and the child's records, formal activities and “activity probes,” and parent surveys and training.

After the evaluation, parents attend a four-day workshop with an RDI consultant (or they can first attend a two-day workshop to decide whether they want to continue with the full training). Training focuses on building motivation, modifying communication style, enhancing memory formation, developing “friendly” practice environments, and generalizing motivation and skills into everyday life. Parents receive comments and ongoing training through the use of videotapes of home sessions and in-person consultations. Later, these strategies are used with the child in sessions with other children, singly or in groups.

Evaluation and Acceptance

RDI does not appear to have been the subject of independent, peer-reviewed evaluation. The only evaluations we could find were conducted by Dr. Guttstein and his colleagues at the Connections Center he founded. The first study, released in April 2005, studied 31, two- to –nine year olds with ASD. Seventeen participated in RDI programs, 14 with similar diagnoses and functional levels, did not. After 16 months, Guttstein found 70% of those in the RDI program improved in at least one category on an autism diagnostic test; 13 of them were enrolled in a regular education classroom with no significant support. In contrast, none of the 14 children in the control group improved in any diagnostic category, and none had moved from special to regular education.

A follow-up study in 2007 reported that none of the 16 remaining RDI children met the diagnostic test criteria for autism 30 months after the study had begun. But the study noted that its findings could not be generalized widely because of the lack of a control group, constraints imposed by the children's age and IQ, parental self-selection, and parent education conducted in a single clinic setting.

Hearing officers in California have rejected parents' requests for government agencies to fund RDI services for their preschool and school age children, mainly because they found too little evidence to show that RDI was effective. In two separate 2006 cases, parents asked regional centers to fund their participation in an RDI workshop. In rejecting their appeals, one hearing officer found that while RDI might be “an interesting new therapy,” it “is currently without independent scientific support.” Another hearing officer cited the limitations on Dr. Guttstein's research and held that RDI “has not been tested sufficiently to draw any conclusions about its effectiveness.”

State Funding

Only five certified RDI consultants work in Connecticut according to the RDI website. The State Education Department does not track the types of programs school districts use to educate children with autism, consequently its staff do not know if any districts currently sanction and pay for RDI.

Other states' funding for RDI varies. Massachusetts and Colorado both provide funding for RDI under their Medicaid home- and community-based services waivers for children with autism. But Vermont declined to use developmental services funds for RDI because it was not needed to prevent institutionalization.

Massachusetts will fund an RDI provider if the child's personalized behavior plan identifies this as the treatment the parents want. Colorado permits a certified RDI consultant to assess a child's needs; develop his or her treatment plan; prescribe the amount, scope, and duration of therapy; adjust treatment as needed; and make semiannual progress reports.

In Vermont, a state hearing board denied parents' request to use Department of Disabilities, Aging, and Independent Living funds for RDI. It did so because the developmental services program the parents sought to tap was intended to prevent institutionalization. The board held that RDI is primarily an educational program and was not needed to keep the child from being institutionalized.

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