CT FEAT: Families Helping Children Achieve Their Full Potential

RDI®: Effective Intervention or Effective Marketing?
Suzanne Letso, M.A., BCBA, Chief Executive Officer and Co-founder of the Connecticut Center for Child Development, Inc., and parent of a son with autism

Introduction

There is now a substantive and growing body of research that clearly demonstrates that the application of educational strategies based on applied behavior analytic learning principles can result in significant learning outcomes for children diagnosed with autism spectrum disorders (Sallows & Graupner, 2005; Howard, Sparkman, Cohen, Green & Stanislaw, 2005; Eikeseth, Smith, Jahr & Eldevick, 2002; Green, Brennan & Fein, 2002; Smith, Groen & Wynne, 2000; Weiss, 1999; Smith, 1999; Matson, Benavidez, Compton, Paclawskyj & Baglio, 1996, Perry, Cohen & De Carlo, 1995; Birnbrauer & Leach, 1993; McEachin, Smith & Lovaas, 1993; Harris, Handleman, Gordon, Kristoff & Fuentes, 1991; Lovaas, 1987; Anderson, Avery, DiPietro, Edwards & Christian, 1987; Fenske, Zalenski, Krantz & McClannahan, 1985; Wolf, Risley & Mees, 1964; Ferster & DeMyer, 1961).

There are now over 600 articles published in peer reviewed journals that demonstrate the efficacy of applied behavior analytic teaching strategies for children with autism spectrum disorders. A recent literature search located 102 articles alone published in the Journal of Applied Behavior Analysis as of September 2005. However, in spite of the large and expanding body of research, there continues to be consumer interest in other intervention strategies that have questionable empirical evidence demonstrating enhanced learner outcomes (Jacobson, Foxx & Mulick, 2005).

The Relationship Development Intervention® (RDI®) is one such intervention strategy that has become increasingly popular with parents across the nation. This growing popularity may be due to a number of factors, including the paucity of well trained and qualified behavior analysts and educators, the variability of provider effectiveness, the inherent difficulties associated with designing effective educational strategies for students with either high functioning autism (HFA) or Asperger’s Syndrome (AS), the difficulties often associated with grafting outside consultants into school programs, the scarcity of formalized behaviorally based curricula designed specifically to address the complex needs of students with HFA or AS, and both the financial and emotional costs of operating an intensive behavioral program. In addition, the aggressive marketing strategies employed by the for-profit domestic business corporation, The Connections Center™, which is the sole provider of RDI® products and services, has likely contributed to the widespread interest in this intervention package, despite of the lack of substantial evidence of its effectiveness to date.

It is doubtful that this intervention would be so popular if there were not at least aspects of the program that were perceived to be helpful to parents and children. However, the underlying assumptions that have resulted in the conceptualization of this program are based largely on hypotheses, not facts (Gutstein, 2002).

Steven Gutstein, Ph.D., and his wife Rachelle Sheely, Ph.D. are the two directors and incorporators of The Connections Center™, established in August 1995, and are the “co-founders” of RDI®. This business is registered as a for-profit domestic business corporation under the name of Gutstein, Sheely, and Associates, P.C., (assumed name certificates filed with the Texas Secretary of State are identified as “Relationship Development Innovations” and “RDI Connect”) D/B/A The Connections Center™. Additionally, Rachelle Sheely, Steven Gutstein, and Connections Center™ employee Carlotta Baird established the Relationship Development Research Institute™, a non-profit Texas corporation in December 2003. Both Dr. Sheely and Gutstein are licensed clinical psychologists.


Defining Autism Spectrum Disorders
In the video, “Going to the Heart of Autism: The Relationship Development Program,” (2005), Dr. Gutstein states that there is “a research consensus” that autism spectrum disorders are “a change disorder” and are characterized as follows:

Failure to develop flexible collaboration of neural sub-systems needed for the brain to process information related to change
Failure to develop competence in dynamic systems
Failure to develop the motivation to master increasingly complex dynamic systems
Desire to remain in static systems and amplify the static elements of dynamic systems
Self-concept based on static competence
All other characteristics such as language deficits, sensory deficits or excesses, and behavioral deficits or excesses are considered “co-occurring conditions,” not signs or symptoms of autism spectrum disorders.

Although Dr. Gutstein asserts that there is now widespread agreement amongst researchers that these represent the “core deficits” of autism, these statements are not supported by the evidence. The diagnostic criteria for Autistic Disorder are defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition as follows:

“A. A total of six (0r more items from (1), (2), and (3), with at least two from (1), and one each from (2), and (3):
(1) qualitative impairment in social interaction (abridged)
(2) qualitative impairments in communication (abridged)
(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities (abridged)

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.” (DSM-IV TR, (2000), American Psychiatric Association, see pages 74 – 84 for complete description Autism Disorder, Asperger’s Disorder, and PDD NOS)

Other recent resources that identify autism spectrum disorders as inclusive of symptoms other than social deficits include:

“Research on Screening and Diagnosis in Autism: A Work in progress.” Journal of Autism And Developmental Disorders, (1999), Volume 29, Number 6, 435-438, Marie M. Bristol-Power, National Institute of Child Health & Human Development, and Giovanna Spinella, National Institute of Neurological Disorders and Stroke, National Institutes of Health.

“Autism and pervasive developmental disorders.” Journal of Child Psychology and Psychaitry 45:1 (2004), pp 135-170, Fred R. Volkmar, Catherine Lord, Anthony Bailey, Robert T. Schultz, and Ami Klin.

Diagnostic Criteria Impacts Educational Efforts
The evidence suggests that there is not a research consensus that supports Dr. Gutstein’s hypothesis that autism has been, or should be, redefined to include only signs and symptoms of social deficits, or that other signs and symptoms should be considered separately from the diagnosis of autism. While this may seem like a small point, it has become the catalyst for the design of curricula and educational programming that focus only on remediation of these social deficits rather than on all of the unique behavioral deficits and excesses often demonstrated by individuals diagnosed with autism spectrum disorders.

Comprehensive programming for children with autism spectrum disorders should be determined on an individual basis (Wright & Wright, 2004) but should typically include programming in the areas of language and communication, self-help skills, problem solving skills, social skills, development of interpersonal relationships, pre-academics, academics, health and safety skills, play, leisure, and recreational skills, pre-vocational and vocational skills, and remediation of behaviors that interfere with learning and impact quality of life for children and their families. The ultimate goal is for “life in the least restrictive environment” with as many choices of living, working, recreating, and socializing as possible (Bannerman, Sheldon, Sherman & Harchik, 1990). Therefore, what we teach may be best measured by the social significance of the goals we select, the social appropriateness of the procedures we utilize to teach those goals, and the social importance of the effects of our efforts (Baer, Wolf & Risley, 1968). This includes, but should not be limited to remediation of social deficits (Taylor, Hughes& Richard, Hoch & Coello, 2004; Volkmar & Wiesner, 2004; Lord & McGee, 2001).

Possible Benefits
While the RDI® approach does include some innovative instructional strategies for social skills training and enhancing social engagement, improvement in this area will not necessarily remediate other behavioral excesses or deficits associated with this disorder. Unfortunately, some of the marketing materials and chat statements (see www.rdiconnect.com) may lead the reader to believe that it is not necessary to teach these children to talk because 85% of children with autism will learn to talk without intervention (Going to the Heart of Autism DVD), and that stereotypic behaviors will eventually just dissipate, (Dr. Gutstein’s Live Chat Transcripts 12/29/04 as follows: Allan: “does the hand flapping go away in all cases?” Gutstein: “yes it goes away in every case.” Bevc: “What do you mean it goes away in every case??” Gutstein: “We don’t have any kids who’ve been doing RDI for 2yrs+ that are regular flappers.”). There is no evidence to support these statements, and left untreated, these behavior deficits and excesses may actually become increasingly problematic.

Although there is not yet any research that actually demonstrates the efficacy of the RDI® program design in its entirety, or of specific educational strategies, it is important to note that there are some good ideas encompassed by this approach, and some creative suggestions for programming. For example, many “Discrete Trial Instruction” programs rely very heavily on using questions or overt physical or visual cues as the discriminative stimulus (S) to evoke a response from a student. RDI® strategies incorporate the use of nonverbal gestures and facial expressions as well as verbal (declarative) statements that are not questions to evoke language. Although these are still actually SD’s that may result in a social or verbal response (Cooper, Heron & Heward, 1987), greater variety of SD’s utilized or more subtle SD’s may result in an increase in responsiveness.

While the use of more declarative statements may be beneficial, at least for some students, it is as yet not known if this modification will result in improved language acquisition or enhanced comprehension. It may turn out to be a very effective strategy for some learners and is certainly worth exploring as a teaching strategy. However, one of the RDI® rules of thumb is to use a ratio of 80% declarative language to 20% imperative language (Dr. Gutstien’s Live Chat 11/03/03). There does not appear to be any actual evidence that supports this claim. This arbitrary “one-size-fits-all” rule could actually prove to be detrimental, particularly for those students who do not yet demonstrate substantive receptive and expressive language skills.

Other possible benefits of the RDI® approach include a parent training program that (in behavioral terms) may teach parents contingency management, shaping, delivery of social reinforcement, and some instructional strategies. The program does not require intensive commitment of time or money compared to traditional ABA home programs. Because the program allows parents to identify how much time and when they incorporate interactions with their child into their lives, there may be an increase in parent participation in the education process, and an increase in parents feeling both competent and successful. Additionally, parents spend their time on social skill development that is important to them, which may increase their motivation to interact with, and teach their child.

There are approximately 300-400 RDI™ instructional strategies that focus on social skill development (Gutstein & Sheely, 2002a; Gutstein & Sheely, 2002b: Gutstein & Sheely, 2003). Many of these instructional strategies are derived from various sources including behavioral curricula (Fovel, 2002; Leaf & McEachin, 1999; Maurice, Green & Luce, 1996), and Dr. Sidney Greenspan’s work (Greenspan, Wieder & Simons, 1998); some of the ideas are novel, or at least creative interpretations of existing strategies. While not all of these programs are unique to RDI®, it does represent a good compendium of social skills programs, which may be useful to both parents and educators.

Clinical Concerns
The problem is not any particular program per se, but with some aspects of implementation, and the marketing and branding strategies that overstate what the research has actually demonstrated to be effective for children and their families. For example, while the following treatment setting may result in the desired goal, it may not represent the least restrictive environment in which learning can be reasonably expected to occur. And, for many students with HFA or AS, such a restricted setting may not only be not necessary, it may be completely inappropriate.

“People who conduct Social Skills training generally do so in natural settings, such as a classroom or shopping mall, believing that the skills will more likely be used if they are learned in the setting in which they are needed. If the goal is to teach instrumental behaviors and social scripts, such as waiting in line at a booth in a mall food court, or sitting quietly during circle time in the classroom, natural settings are clearly preferable.

However, natural social systems are far too complex and noisy to learn Social Referencing for people with Autism. We begin treatment in a highly controlled setting with minimal competition and distraction for a child’s attention. Windows are well covered. There are no wall decorations. Objects are behind locked cabinets when not specifically needed for an activity. There is no permanent furniture, except for strongly reinforced beanbags. We ask parents to configure similar settings in their homes.”

Excerpted from “Solving the Relationship Puzzle: A New Developmental Program that Opens the Door to Lifelong Social & Emotional Growth,” Steven Gutstien, 2000, Chapter 5, Principles of Treatment, pg. 71.

It can be relatively easy to include some RDI® programs into an ABA program, although it may be necessary to re-write these programs so that objectives are clearly defined and measurable. One example of an RDI® program that can be incorporated is as follows:

Emotion Sharing
Definition: “Seeks out face-to-face gazing to intensify joy and excitement, soothe distress and attend to Coach’s communication,” (Gutstein., S. & Sheely, R., (2003). The RDI® Program Progress Tracking System, pg. 5).

Revised behavioral definition: Child will initiate eye contact with adult within 10 seconds of adult’s verbal or non-verbal communication and/or if a child engages in a fear response and will imitate adult’s facial expression.

However, not all RDI® programs can be re-written so that objectives are clearly defined and measurable. One example of a RDI® program that may be difficult or impossible to measure is as follows:

Co-Creation
Definition: “Communicates memories indicating that the highlight of interaction is co-creating new activity frameworks as an equal partner” (Gutstein., S. & Sheely, R., (2003). The RDI® Program Progress Tracking System, pg. 5).

The problem here is that we can possibly assess verbal behavior as a measure, but verbal behavior is not necessarily an indicator of what someone thinks or believes. Furthermore, there actually is no evidence that “co-creating new activity frameworks as an equal partner” is a necessary component of instruction, nor one likely to enhance learner outcomes.

RDI® Research
The ‘research’ posted on the RDI® website in support of this educational approach is as follows:

“RDI and the Ability to Generalize Learned Social Skills,” Sara Spencer, B.A., M.A. completed this study in 2004 as a thesis for her Master of Arts Degree in Education Admin. & Policy Study at CA State University , Sacramento . This study has not been published and is not part of the ‘public domain.’

“Improving Social Referencing Skills in Preschool Children with Autism,” Donna Morrison, OTR, Certified RDI™ Consultant, completed this research as a thesis for her Post Professional Master of Science degree in Occupational Therapy at Columbia University . Like the above-mentioned study, this study has not been published and is not part of the ‘public domain.’

“Asperger syndrome and the development of social competence,” Steven Gutstein, Focus on Autism and Other Developmental Disabilities, September 22, 2002 . This article is actually a discussion paper of Dr. Gutstein’s theories and philosophy and does not provide any evidence of learner outcomes.

“Preliminary Evaluation of the Relationship Development Intervention Program,” Steven Gutstein, manuscript accepted for publication by The Journal of Autism and Developmental Disorders. This is the only ‘research’ study that has been widely publicized as evidence of program efficacy. However, the results of this research have been significantly overstated, and the methodological problems with this research have been minimally reported, and in some contexts not identified at all (Gutstein, 2005).

The abstract (summary) written by Dr. Gutstein of this preliminary evaluation of the RDI® program is as follows. “The Relationship Development Intervention program (RDI) was designed to remediate deficits in Inter-subjective Engagement, a critical impairment in autism. In a preliminary evaluation, 17 children in the autism spectrum participating in RDI were compared to 14 children receiving other interventions. Changes in the ADOS and school placement were primary outcome measures. The RDI group demonstrated significantly greater improvement in ADOS scores, diagnostic classification and independent functioning in classrooms. Results, while tempered by methodological limitations, provide early support for RDI as an effective intervention addressing important deficits of children with autism.”

In the “Discussion” section of this evaluation, Dr. Gutstein identifies a number of flaws that significantly limit interpretation of the results of this evaluation process.

“Results are based on examination of a small sample of relatively “high functioning” children. Few children in either group had significant cognitive deficits.”

“The variety of measures used to evaluate cognitive functioning make a valid comparison impossible.”

“Future studies should make sure that RDI and non-RDI groups are comparable and that standard cognitive measures are employed.”

“Similarly, the assortment of measures of language functioning made it difficult to evaluate its potential influence.”

“Additionally, older children and Teenagers were not studied. Thus, the effects of age, cognitive and language functioning on treatment effectiveness are as yet untested.”

“The current results were obtained using consultants from a single setting – the clinic where RDI was initially developed.”

“The efficacy of training other clinicians to provide effective RDI consultation has not been determined.”

“Finally, the retrospective nature of the study, precluding random assignment or matching procedures, opens up the possibility of a self-selection bias where important variable led to parents choosing RDI vs. another intervention method.”

There are also a number of significant concerns not cited by Dr. Gutstein, including the following:

The RDI® group received 5 more months of treatment than the comparison group, or roughly 30% more time in treatment.

The description of both RDI® group and comparison group treatment protocols is inadequate to allow an interpretation of what the treatments were comprised of, making a replication of this study impossible.

The RDI® group had an average IQ 12 points higher than the comparison group. This represents a significant difference in cognitive ability.

The RDI® group was approximately 1 year younger than comparison group (on average, 6 years of age vs. 7 years of age). This is not only a significant difference that can clearly impact outcomes, it also means that the second measure of treatment effectives, i.e., a change in student placements is invalid due to the fact that the RDI® group, simply by virtue of their age, would probably have been transitioning to a school placement anyway. In addition, given their level of functioning and cognitive ability prior to treatment, the RDI® group may have been reasonably expected to have been placed in a regular education classroom as well.

This study was conducted by the person/agency that is in a position to derive significant financial benefit and professional acclaim from positive outcome results. That is, the researcher is potentially biased because he has a financial stake in the outcome.

And finally, “the retrospective nature of the study, precluding random assignment,” also means that not only might there be parental “selection bias,” but Dr. Gutstein may also have been biased in his selection of student records that he reviewed as part of this evaluation. We do not know how many student records were considered, or how many students were treated, versus how many students where included or excluded for the discussion of results.


RDI® Marketing Strategies
One very troubling aspect of the marketing of the RDI® program is that the description of results of this preliminary evaluation have been stated on the website to be far more significant than actually indicated in this study. For example, the following statements regarding this research can be found on the website, rdiconnect.com:

Remediating Autism Through Relationships:
“The initial study on the RDI® Program is the first study to ever demonstrate that a clinical intervention method can change a child’s diagnostic classification on the Autism Diagnostic Observation Schedule (ADOS).” While not technically an inaccurate statement, it is highly likely that readers not familiar with autism research will interpret this statement to mean that this is the first study ever to demonstrate that any clinical intervention can improve a child’s autism, rather than that this is the first study ever to utilize the ADOS to evaluate results, which is what it really means.

What to expect from the RDI® program:
“This is an initial study and the research paper points out a number of reasons to limit conclusions. However, there is no doubt that the RDI® Program has been proven to be an extremely powerful method of addressing the core deficits of autism spectrum conditions.” This is not what the research demonstrated, and is a significant overstatement of the research results.

“We found children improved dramatically within months of starting the RDI program.” As a “stand alone” comment, this is not substantiated by the research and is quite misleading.

Introductory Guide for Parents:
Page 19, “We found children improved dramatically within 18 months of starting the RDI® Program,”
Page 21, “However, our research demonstrates that the RDI® program dramatically increases children’s motivation to communicate and to use meaningful reciprocal language.” This is not only an overstatement of treatment effects, the evaluation itself did not even discuss “children’s motivation to communicate and to use meaningful reciprocal language.”

In addition to statements on the web, and in articles that appear to significantly overstate the research findings and understate the limitations of the evaluation process itself, these additional statements were cited in presentation made by Drs. Gutstein and Sheely sponsored by the Elija Foundation entitled, “Getting to the Heart of Autism: The Relationship Development Intervention Program,” regarding the above research:

“Preliminary demonstration of potential to impact core deficits of ASD’s, high parent satisfaction and empowerment, high involvement of fathers, cost effective”

There may indeed be high parent satisfaction, increased involvement of fathers, and reduced direct costs associated with implementation of an RDI® program. However, the research did not discuss these potential outcomes, nor provide evidence of such outcomes.

Overstatements of research results are just one of the marketing strategies of concern. In addition, the certification of “RDI™ Consultants,” the extensive use of parent and provider testimonials, and the “Relationship Development Assessment™” (RDA™) are some of the other marketing strategies that appear to be utilized to create exclusive product and service branding, and a revenue stream for The Connections Center™. (Please note that when purchasing products or services, payments are made to “Gutstein, Sheely, and Associates, P.C.” directly.) There is nothing wrong with an individual or an agency marketing their products or services, or deriving a significant income from the sale of those services. However, thus far there is little or no proof that the RDI™ process will generate results.

The RDI™ Consultant Certification Process
Certification and licensing processes are supposed to demonstrate that any particular individual meets some minimum standard criteria of education, experience and/or performance in order to become certified or licensed in a particular area of expertise. Either state agencies or independent associations or organizations will conduct certification processes completely independent of any particular training agent or provider of services. The purpose of this is to provide consumers and employers with an independent determination of an individual’s ability to meet certain minimum standards, without prejudice or financial pressures to pass or not pass any particular applicant. When one agency, such as The Connections Center™, is both the sole training agent and the sole certifying agent, the value of the entire process is suspect, and may be compromised by the potential for this to be a self-perpetuating system of creating an exclusive branding of an intervention package rather than a litmus test of any particular individual providers’ knowledge, experience, education, or abilities.

The application for admittance into the RDI™ Consultant training program states applicants must have at least a bachelor’s degree, although a bachelor’s degree in any particular discipline or profession is not specified. Of the 53 certified consultants on the web as of 9/28/05 , 20 of the RDI™ consultants listed either indicate no advanced degree, or indicate a bachelor’s degree as their highest level of education. Of those with advanced degrees, not all are in professional disciplines typically associated with the field of autism education, such as individuals trained to be marriage and family therapists and social workers.

It is interesting to note that The Connections Center™ is listed as a certified consultant, and they have 4 stars indicating that they have successfully completed the certification or re-certification process for the last 4 years. This raises the question of who tests and evaluates Drs. Gutstein and Sheely, as they appear to be the only individuals capable of training and assessing participants.

The certification process consists of 3 segments of 4 days of training, 6 hours per day, with supervision “done completely through videotaping and Internet feedback.” No specific testing mechanism is identified, therefore an email inquiry was sent to Dr. Sheely which stated, “If there is a “certification test,” what percentage of the people who take it actually receive their certification?” Dr. Sheely’s complete response in an email dated September 26, 2005 is as follows:

“Assessments are built into each step. For example, beginning and intermediate trainings include a written exam. Professional supervision is all feedback for implementing RDI. The advanced training is a case presentation and also includes a written exam on structuring dyads. Additionally, we require attendance on the chats and also have an annual recertification which demonstrates that you’ve kept up to speed with chances as they’ve occurred – usually a case presentation.” This response did not actually answer the question. It remains unclear if all participants who complete the process are certified, or if some percentage do not meet minimum standards, or if there even are any established minimum standards for successful completion.

The Relationship Development Assessment™
A significant component of the RDI® Certification Process is training on utilization of the RDA™. (Note: There is no evidence that this evaluation tool as been validated as a testing protocol either as a stand alone testing protocol, or as a component of a diagnostic or evaluative process.) The RDA™ consists of three components; RDA1, RDA2, RDA3 addressing administration, scoring and intervention planning. Although the instruction book states that the evaluator should tell parents the RDA™ will not yield a diagnosis (Gutstein & Sheely, 2002c), the net result of the evaluation is the identification of “co-occurring conditions,” determination of the priorities for treatment of these conditions, and includes a determination of a treatment plan for the following: “Attention Deficit Disorder, Anxiety, Phobias, Panic states, allergies/food intolerance, specific speech/language disorder (e.g. apraxia, word retrieval), depression, attachment disorder, eating disorder, hearing, learning disability (e.g. Dyslexia, Dysgraphia) memory deficits, mood swings, obsessive-compulsive disorder, oppositional-defiant or conduct disorder, proprioceptive, visual-motor, siezures, Tics or other neurological conditions, sleep disorder, visual-perception, vision, toileting, and other,” Page 57, Relationship Development Assessment Treatment Planning Forms (Gutstein & Sheely, 2002c).

So, in spite of the caveat that the RDA™ will not yield a diagnosis (“Make sure the Coach leaves the interview understanding the gist of the following: “The RDA is not used for diagnosis but for intervention and treatment planning.” Pg. 9, Gutstein & Sheely, 2002d), for all intents and purposes, it appears to do just that. It is important to note that many of the above conditions are generally determined by someone with an advanced degree and training, such as a SLP, clinical psychologist, medical doctor, or other professional trained well above the bachelor’s degree or master’s degree level of education.

The above stated email that was sent to Dr. Sheely included a second inquiry about the RDA™ process. The inquiry was, “I also had a chance to review the RDA and had a question about how to determine co-occurring conditions. Is this done through a document review, direct observation, a combination of the two or some other means?” The entire email response from Dr. Sheely was as follows, “We use a good case history, obstacles and strengths check lists and observation.”

Generally speaking, diagnosticians utilize a variety of formal and informal testing protocols prior to making a diagnostic determination, with at least some of these diagnostic tools that have been formally norm referenced. The RDA™ process is of concern not only due to the lack of norm referencing and empirical validation of the process, but also because it appears that a determination of the presence or absence of significant medical conditions, as well as treatment plans for those conditions, is being conducted by individuals who do not possess sufficient qualifications, other than their designation as a RDI™ Consultant.

It is also notable that the RDA™ process includes a cost/benefit analysis (page 58) comparing the RDI® Consultants’ proposed treatment plan to other plans in terms of financial costs, time requirements, or other direct or indirect costs, (Gutstein & Sheely, 2002c). In a traditional marketing and sales environment, this would be considered a selling tool to demonstrate the “features and benefits” of the products or services being sold that is of particular utility when the salesperson is attempting to convert a potential customer from a competitor’s product, and when the cost of the proposed products or services represents a large financial investment.

Selling Hope
Last, but certainly not least, is the concern that The Connections Center™ is essentially “selling hope,” to desperate parents. Heartfelt testimonials about how the RDI® program helped their child abound on the website and in RDI® literature. What parent would not want their child with ASD to be more socially available? What mother would not want their husband to be more comfortable interacting with their disabled child? But the question remains, should this be the primary treatment modality for these children that we cherish, or a resource for ideas about how to attempt to enhance social skills training as part of a comprehensive program designed to address all of the complex needs of individuals identified with ASD?

Here are some quotes from the RDIconnect.com website:

“Learn how you can feel empowered today and hopeful about the future.”

“You can receive one-on-one support, so you feel confident every step of the way.”

“Over 4 days, you will leave behind a sense of crisis & prepare for a new, rewarding lifestyle.”

“Start in a way which feels comfortable and empowering.”

“It promises to change our view of what treatment may achieve.”

“The RDI Program breaks the cycle of failure…for both the parent and child.”

“Dramatic improvement in meaningful communication and desire to interact with peers.”

“Going beyond short-term compensating to life-long solutions.”

“The foundations of Relationship Intelligence underlie success in life.”

“Finally, families reported that the RDI Program model made it easier for both parents, but especially fathers, to participate and to accrue the benefits described above.” (In reference to “feeling like a competent parent for the first time.”)

Conclusions
In summary, the theories and philosophies underlying RDI® strategies are not supported by evidence, nor is there widespread “agreement among researchers” that concur with many of the theoretical conclusions that are the basis for the RDI® treatment design. The diagnostic criteria of ASD’s have not been modified, nor is there widespread agreement among researchers or clinicians that a modification that limits diagnosis based only on social deficits is either warranted or appropriate.

Much of the RDI® terminology is different, which makes it difficult to compare to other autism interventions, but many of the strategies are actually the same or similar to strategies used in many ABA and non-ABA programs. There are certainly some benefits associated with the RDI® educational approach, including some creative curriculum and instructional strategies, parent training, and an enhanced focus on social skills training.

However, there are number of clinical concerns, and a profound absence of evidence supporting many RDI® claims. Future research may prove these concerns to be unwarranted, but at this time there is insufficient evidence to support these efficacy claims, and eliminating other aspects of a child’s individualized education plan to focus solely on RDI® goals and objectives may not adequately address a child’s complex needs.

There are also numerous concerns about the marketing strategies and branding strategies utilized by The Connections Center™ including utilization of the RDA™, the RDI™ Consultant “certification” process, overstatement of research findings, and extensive use of testimonials. While proponents contend that an RDI® program is less costly than an intensive ABA program, it is only less costly if it results in good outcomes for children, their families, and communities. If it wastes our children’s precious time, then the cost is incalculable.

References

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Greenspan, S.I., Wieder, S., & Simons, R., (1998). The Child With Special Needs: Encouraging Intellectual and Emotional Growth. Perseus Books.

Gutstein, S.E., (2004). Going to the Heart of Autism: The Relationship Develepment Intervention Program, (DVD). The Connection Center Publishing.

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