Pathways Treatment Center, Inc. Helping Children and Families Affected by Autism Spectrum Disorders

Relationship Development Intervention (RDI)

RDI is a systematic, developmental intervention intended to help people on the Autism Spectrum develop and maintain rewarding relationships with other people. RDI is designed to help people with Autism drastically improve their quality of life by becoming attached and maintaining relationships with other people. Rather than emphasizing only specific skills, RDI emphasizes the motivations and reasons why behind the use of individual skills. RDI teaches these functions and skills in a cumulative, integrated and motivating ways that encourage and require competence on behalf of the child with Autism. It was developed by Dr. Steven Gutstein and his wife Dr. Rachelle Sheely of the Connections Center in Houston, Texas. Dr. Gutstein's book, Solving the Relationship Puzzle, outlines in detail the Principles behind RDI and outlines the various stages of relationship development. Additionally, the Connections Center has a very active website filled with information and resources.

By definition, all people on the Autism Spectrum have impairments in the area of social interaction. Diagnostic Criteria in the DSM-IV requires at least 2 of the following in order to be considered on the Autism Spectrum:

• marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
• failure to develop peer relationships appropriate to developmental level
• a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
• lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )

Long term outcome studies reveal the devastating impact of social impairment. One study in Great Britain indicated the following statistics:

• 50% of Adults with Asperger Syndrome were able to enroll in higher education, BUT
• Only 12% had full-time jobs
• Over 1/3 had no outside social contact
• Over 50% had only 1-2 contacts per month
• Only 3% were living independently

Another study provided the following profile of Adults with Autism Spectrum in the USA.

• 4% live independently
• 10% have some type of competitive job
• 80% reported as withdrawn, inattentive and difficulty being around others
• 67% report socially offensive behavior
• 14% socialize with people other than relatives
• 95% unable to make friendships

Clearly, impairments in social ability need to be addressed in order to improve the quality of life for people with Autism. Interventions that teach specific "social skills" are not adequate in dynamic, constantly changing and novel real world. RDI approaches social impairment in a uniquely systematic and cumulative way that allows the person with Autism to understand not only HOW people interact socially, but also WHY they do. RDI is based on typical development of social ability.

Differences in the Autistic Brain

In order to address social deficits in people with Autism, you must understand some critical differences in the way the Autistic brain functions. Patterns of differences are clearly evident, but not absolute. Obviously each person with Autism is an individual with a unique personality as well as personal strengths and weaknesses. A person with Autism may have some of the specific abilities, in certain circumstances, but the core of deficit lies in the frequency and flexibility of use. It is not that Autistic individuals cannot perform specific abilities, it is their ability to understand WHY to do so, to have the internal motivation to relate, interact and enjoy other people.

Again, it is not a matter of ability to perform, it is a matter of frequency and internal motivation.

Differences in social ability emerge within the first two years of life. Studies have shown that there are three critical factors that clearly make toddlers on the spectrum different from non-autistic toddlers:

• initiating joint attention
• emotion sharing
• concern for others

These same three factors seen in pre-school children with Autism clearly distinguish middle school children with Autism. These same three factors do not change from pre-school to middle school, regardless of the interventions attempted during that time. These three factors are essential for social ability.

Typical Development

Typically developing people follow a pattern of learning that allows for a sophisticated ability to relate to others. Typical children learn to process information in two different ways: Absolute and Relative.

Absolute Processing

1. Solutions are either right or wrong. Correct solutions never change. Example: 2+2=4 2+2 never = 5
2. Events take place in the same manner, day after day. Example: The sun always rises in the east and sets in the west.
3. Information always has the same meaning. Example: A red light means stop. A green light means go.

Relative Processing

1. The meaningfulness of information depends on the context in which it is imbedded (ex. Person, place, time). Example: It is ok to tickle a baby if it is your brother, but not if it is a stranger.
2. Many problems require a "good enough" solution. We arrive at the solution based on whether or not it feels right, not because of objective criteria. Example: Determining how close to stand to a person when talking with them.
3. Problems may not have a single right or wrong solution. Example: Which shirt should I wear? Which airline should I fly? Which road should I drive to work? How should I play with my blocks?

Relative processing is required in order to relate socially. It is required for flexibility in problem solving, understanding meaning based upon context, adapting actions based upon feedback, and conversation, as well as many other functions to survive on a daily basis. Relative processing skills are weak in those with Autism, creating constant dilemmas in their daily lives. Many "social skills" programs emphasize capitalizing on Absolute processing in order to help improve social ability. These skills may be helpful in certain situations at certain times, but are not fluid enough to fit into the real world. (Ex. Eye contact, scripted greetings, etc.)

Typical Memory

Typically developing memory involves different mechanisms served by separate brain circuits. Two types of memory are: Procedural memory and Episodic memory. These two types of memory activate two different neural pathways.

Procedural Memory

• encodes details leading to specific goals
• procedures, scripts, and formulas
• emotional information is not stored

Examples of procedural memory

• memorizing facts for a test
• scripts for specific scenarios (ordering at McDonald's)
• saying "please" and "thank you"

Episodic Memory

• encodes information as a whole
• remembers the big picture, only certain details that are meaningful to us
• information stored as "episodes" with specific emotions attached to organize different categories

Examples of episodic memory

• recalling a trip
• remembering a visit to Grandma's house
• remembering a holiday

Instrumental Interaction and Experience Sharing

People with Autism tend to rely much more strongly upon procedural memory. The reason may lie in the way their brains are organized. We are born with many more brain connections than we can use. In childhood our brains selectively "prune" connections that are not stimulated. Specific neural pathways are stimulated based on different ways that we interact with our environment. Two different ways we interact with our environment are: Instrumental Interaction and Experience Sharing. These two different types of interaction activate two different neural pathways.

Instrumental Interaction

• social contact is a means to an end
• we expect scripted actions will lead to specific outcomes
• emotional reactions are not important
• novelty and creativity are disruptive

Examples of Instrumental Interactions

• pointing to a toy that is out of reach
• standing in line at a supermarket to pay for your stuff
• going to visit a "friend" so you can play with his new playstation game

Experience Sharing

• the interaction is an end in itself
• we prefer to interact not knowing the outcome
• emotions are the critical information
• we interact to share novel and creative ideas

Examples of Experience Sharing:

• going fishing with a friend not caring whether or not you actually catch any fish
• riding bikes side by side with a friend going no place in particular
• while out shopping noticing something you daughter would like and buying it for her

People on the Autism spectrum tend to be really good at instrumental interactions, but not with experience sharing.

Two Different Pathways

1. Absolute Thinking => Procedural Memory => Instrumental Interaction
2. Relative Thinking => Episodic Memory => Experience Sharing

People with Autism tend to be very good at pathway #1 and tend to have extreme deficits with pathway #2. RDI specifically addresses pathway #2 beginning with experience sharing, and then creating episodic memories to improve relative thinking.

Principles of RDI

1. Carefully and systematically build motivations. Motivations are the same as functions, the "why". Experience sharing can become addictive for people with Autism. RDI emphasizes the teaching of functions before skills.
   • functions are the "why bother" of doing experience sharing
   • functions must be mastered before skills
   • functions are developed through Episodic Memories
   Skills:
   • skills are the "how to" of experience sharing
   • skills never determine the starting place for intervention
   • skills are attached to episodic memories developed through functions
2. Carefully evaluate developmental readiness before teaching skills. The foundation must be solid before you add skills.
3. Learn to be an Experience Sharing Coach by balancing guiding and pacing. Follow the child's lead not in what to do, but in how fast to do it.
4. Invite and amplify using prompts and spotlighting. Use you face, voice and body to insure that critical information stands out clearly.
5. Make sure to build Episodic Memories of enjoyable shared experiences.
   • celebrations (instead of praise)
   • stop the action
   • videotape review
   • photographs
   • memory books
   • emotional comparisons
   • journaling
6. Use expandable, evolving Frameworks, not rigid activities, to develop Experience Sharing. FRAMEWORKS are activity structures designed to be gradually modified and expanded. The framework is never the central focus, it is only scaffolding for interaction.
7. Expect to make many mistakes leading to new discoveries. RDI is a continuous process of hypothesis testing.
8. Make sure to develop Experience Sharing language. (ex. We can do it! Did you see that? Is that better? Do you like it?)
9. Incorporate RDI communication and referencing and regulation into your daily life.
10. Start with Adults, to dyads, then groups. Typical children learn to be competent with adult partners before desiring time with peers. Children's first peer encounters are with one peer at a time. Groups are much more difficult that dyads.

The Developmental Sequence of RDI

Level 1: Novice (3-9 month skills)

The main goal of this level is to develop Emotion Sharing. EMOTION SHARING is a reciprocal system of face-to-face sharing of excitement and joy. Critical to emotion sharing is SOCIAL REFERENCING. Social Referencing is seeking information from another person in order to use that information to evaluate objects or events and to help know how to change your actions based on what you have learned.

Level 2: Apprentice (6-18 months)

The main goals of this level are as follows:

Synchronization requires the "3 R's". Referencing, Regulating, and Repair.

Level 3: Challenger (12 months-6years)

The main goals of this level are Collaboration, Co-Creation, and Improvisation.

Level 4: Voyager (20 months-10 years)

The main goals for this level are the sharing of inner worlds. Sharing of perceptions, points of view and imagination with others.

Level 5: Explorer (30 months - 14 years)

The main goal of this level is the creative interchange of diverse ideas.

Parent Training and Support Recommendations

• intensive training should be provided to all parents participating in RDI. Parents should receive at least 12 hours of initial preparation and education before starting their programs.
• Monthly parent support groups should be held, at convenient evening times. Groups should be facilitated by a Certified RDI Clinician. They should be mandatory for all parents participating in the RDI program.

Parent Coaching

• Parents of Level 1 children should participate in weekly one-hour coaching meetings with an RDI Certified clinician.
• Parents of level 2 children should participate in twice monthly coaching meetings with an RDI Certified clinician.
• Parents of level 3 and above children should participate in monthly coaching meetings with an RDI Certified clinician.

It is interesting to note that Dr. Gutstein said that if he were the parent of an Autistic child, he would need an RDI coach.

| | © 2006-2008 Pathways Treatment Center, Inc., All Rights Reserved.