Relationship Development Intervention (RDI) for Autism
Impaired development in social interaction, communication, and behavior characterizes all individuals on the autism spectrum. However, due to the individualized nature of autism and the variety of possible sensory issues and dysfunctions, no single autism treatment will work for every individual. Relationship Development Intervention (RDI), created and founded by Dr. Steven E. Gutstein, has been successful at removing the obstacles affecting the quality of life for autistic children by paralleling typical child development and teaching emotional sharing.
What is Emotional Sharing?
While social skills training and behavior modification teach daily life skills and simple social courtesies, the rules and formulas for social interaction form only a small part of a child’s total development. The joy and wonder of living, the excitement of being involved in another person’s life, the experience of making friends, of emotionally connecting and sharing with others gets lost in the core deficits of autism. These internal experiences form the other side of child development that most treatment programs ignore or overlook.
In a typical child, emotional sharing and feedback begins at birth, but in an autistic child, something goes wrong. The bond between parent and child, the silliness and playfulness that lays the foundation for future relationship interaction, intimacy, and mutual joy doesn’t happen. As the months turn into years, the problems compound. Each stage of development depends on, and builds upon, the level that came before. While autistic children do have the potential to grow, gaping holes result within each level of development. These deficits interfere with their ability to understand, relate to, and connect with others.
Behavior techniques work well to teach social skill fundamentals, but most autistic children can’t have a real, caring relationship. There’s no curiosity about what others feel, no ability to stay on topic, and they can’t share about themselves. Scripted interactions help meet basic needs, but most autistic children are incapable of relating on an emotional level. After 20 years of clinical experience, Dr. Gutstein realized that most behavior therapies work in the same way an actor memorizes and rehearses lines for a play. Great for teaching an autistic child to:
- stand in line
- take turns
- brush his teeth
- take a bath
- get dressed
But not so good for situations where others may not respond in the predicted manner. Autistic individuals armed with memorized programs can easily find themselves in real-life situations where their treasured scripts won’t work. Sharing experience requires a different type of processing than memorization. It requires:
- flexibility and evaluation
- decisions based on current happenings
- the ability to read another person’s interest
- making instant adjustments, depending on the answers
For another 10 years, Gutstein studied the stages of development in typical children and designed an intervention program for children with autism that parallels those steps.
The Relationship Development Intervention Program
Relationship Development Intervention is a comprehensive, step-by-step, parent-centered treatment for autism that attempts to reverse social deficits by giving autistic children the framework to participate in authentic relationships. It goes beyond teaching social skills by rote to emphasize social awareness and experience sharing. This developmental model begins with basic relationship exercises, and then moves both parent and child through the six levels of typical child development:
Level 1 – Tuning In (at birth): Lays the foundation for relational development. It consists of face-to-face sharing, and places adults at the center of the child’s attention. He learns emotional attunement, social referencing, excitement sharing, and simple games.
Level 2 – Learning to Dance (6 months): Teaches the child to become an apprentice. He learns the rules, roles, and structure of experience sharing. In addition, he learns to accept and find value in variety, begins participating as a partner in synchronized actions, and observes and regulates his actions with others.
Level 3 – Improvising and Co-creating (12 months): Begins working with a play partner carefully matched to his developmental level. Introduced to novelty, chaining activities into a fluid sequence, improvisation (modifying rules and roles), and co-creation.
Level 4 – Sharing Outside Worlds (18 months): Sharing begins. Learns to enjoy perception sharing, compare and contrast perceptions, share personal reactions, and add imaginative elements to events.
Level 5 – Discovery Inside Worlds (30 months): Learns to share thoughts. Shares ideas, enjoys differences in others, discovers the difference between inner and outer reactions, and recognizes that thoughts, feelings, and ideas are critical to sharing.
Level 6 – Binding Selves to Others (48 months): Introduced to true friendship. Discovers the sameness and differences in others, participates in groups (a critical part of identity), appreciates playmates, shares interests, activities, and history, and finds value in close friendships built on mutual trust and caring.
RDI seeks to give autistic children the tools they need to overcome autism’s major issues by returning to the stage where the child stopped developing appropriately, correcting the deficits, and then moving forward in a gradual, systematic manner. For many autistic children, that means returning to level 1 where they can master essential relationship fundamentals.
What Makes Relationship Development Intervention Different?
Most autistic children have sensory issues that interfere with development and make it difficult for them to interact. Intervention begins with a carefully staged setting parents are required to duplicate at home. This ideal environment consists of a treatment room with all possible distractions removed (including toys and objects), covered windows, and bare walls. In addition, RDI also limits spoken language to the language patterns of the child. If he speaks in two or three-word phrases, parents are encouraged to do the same.
Unlike other play therapies that encourage parents to follow the child’s lead, RDI consultants (along with training seminars, books, and other materials) teach parents to take control of the child’s physical environment. In some cases, that requires parents to change the way they currently interact with their child. Parents make the rules, choose materials, lead activities, and decide when the child is ready to learn a new skill. Distractions, when re-introduced, are added one at a time.
By placing the focus on emotional sharing, and gradually moving through developmental levels, autistic children become capable of:
- being more fun to teach
- making true friends who appreciate them
- using scripted communication, actions, and rules less often
- bringing actions more in line with the feelings and needs of others
- using humor and other creative communication devices
- receiving and accepting more invitations from peers
- becoming a good collaborator and valued team member
- making meaningful contributions to others’ lives
- changing their thinking and acting in a more flexible manner
- being more accepting of change and transitions
- valuing the perspectives of others
- becoming more aware of their unique identity
- thinking in terms of gray, rather than black and white
- considering alternative solutions to their problems
Behavior modification teaches one of the two ways of social interaction with prompts, and sometimes, external rewards. For autistic children, behavior techniques offer a chance to learn how to act, but not a way to enjoy life itself. Behavior therapy offers no way to ignite the emotional spark that will allow an autistic child to laugh, run, and do things a typical child would do.
RDI teaches relationship skills with no prompts or external rewards – no M&Ms, jelly beans, or treats attached to any of the activities. The joy that comes from relating intimately with others is the reward. Both types of social interaction are necessary, but each has a different purpose. While instrumental scripts teach autistic children how to get what they need, Relationship Development Intervention teaches a child the attributes necessary to make permanent, real-life friendships.