Relationship Development Intervention RDI® Raising the Bar for Autism

Dr. Steven Gutstein, PhDDirector Connections Center

www.rdiconnect.com

Founder, Gilbert Hall School: www.gilberthallschool.com

President, Foundation for Autism Research and Remediation (FARR)www.farrsite.org

connections centerconnections center™™Building new pathways to change through RDIBuilding new pathways to change through RDI

www.rdiconnect.comwww.rdiconnect.comFebruary, 2008

Presented by: Carmen Augustin, LCSWRDI® Program Certified ConsultantSweeney Augustin and Associates5225 Old Orchard Road Suite 44

Skokie, Illinois 60077847-583-9492 ext. 1Sloop23@aol.com

February, 2008

What Autism is NOT

• Behavior Problem• Lost in their own world• Single etiology or part of the brain• Mental Retardation• Speech disorder

What Autism IS

• Bio-psycho-social, chronic disorder• A neural collaboration problem• Complex information processing disorder• Many possible co-morbid conditions• Devastating, even in its milder forms

Two Types of Intelligence and Two Types of Brain Connectivity

• How you learn rules, procedures and formulas• How you perform actions that are associated with specific problems and

settings• How you learn specific skills that can be applied in specific tasks• How you remember and communicate specific pieces of information

IQ tests measure Static ThinkingPeople with ASD may have excellent Static Thinking

Static Intelligence

How are an apple and a pear the same?Who was the 16th President of the U.S.?How do you compute the area of an isosceles triangle?

Dynamic Intelligence• How you manage continual change• How you solve “unsolvable” problems• How you connect your past, present

and future• How you collaborate with many

different minds• How you juggle multiple demands• How you effectively filter tons of

information

What you do with what you know in a complex, continually changing, inter-connected world

Success rates for the “high functioning”

• Employment = 12%• Independent living = 3%• Friendship & Marriage = <1%

IQ > 100Language within normal range

How RDI is getting there• Investing in building minds, not shaping

behaviors• Developing the dynamic abilities needed for

real-world success• Applying modern, “best practices” for learning• Investing in families first• Including older children, teens and adult• Tailoring intervention to each person’s unique

needs

The Real World is MESSIE

• Multiple• Ever-changing• Simultaneous• Surprising• Imperfect• Emotional

The MESSIE Curriculum

Learning to conduct a continuous process continuous process of of evaluating and adapting evaluating and adapting to an ever-changing worldto an ever-changing world

Going “off course” is inevitable

in the real-world. Success

depends on rapidly evaluating

the effect of our actions and

making continual “course

corrections

Learning to manageAlternative, Multiple & Simultaneous

information & demands

• Generating and evaluating alternative plans,

solutions and perspectives

• Managing simultaneous goals, demands &

problems

• Juggling the multiple roles we play

• Engaging in multiple relationships

• Integrating simultaneous communication channels

Learning to be“good enough” in an imperfect world

Most real-world problems do not have perfect solutions.

Success depends on learning to operate on a “good enough”

basis - allocating resources to meet specific standards,

depending on the nature of the problem

– How careful should I be about grammar and spelling?

– What degree of mutual comprehension is sufficient in a

conversation?

– How many mistakes do you make each day?

Best Education PracticesLearning must be an active, dynamic process, where children own their learning and perceive it as opening doors to new challenges and discoveries

Learning must be an active, dynamic process, where children own their learning and perceive it as opening doors to new challenges and discoveries

Guided ParticipationChildren’s cognitive development is an apprenticeship. It occurs through guided participation in social activity with companions who support and stretch children’s understanding of and skill in using the tools of culture.” Barbara Rogoff, 1991

The guide is the orchestrator and architect of dynamic learning, designing experiences that will lead the child to

make meaningful connections

RDI Dynamic Thinking Remediation1. Bio-psycho-social Readiness:

– Body and brain cannot be under stress. They must be functioning optimally

– Reduce daily environmental stress– Reduce family stress

2. Customized for unique needs of each child & parent3. Carefully evaluating the child’s “zone” of challenge4. Long-term emphasis: Marathon not Sprint5. Providing opportunities throughout the day for discovery

and mastery, through gradual transfer of ability and responsibility

6. Providing the “cognitive apprentice” with appropriate, active and authentic roles, alongside more experienced guides

The Process of RDI• Certified RDI Consultants• Train parents in Guided Participation• Train other family members and helpers• Select and train primary school “guides”• Train school resource teachers, primary teachers, aides and

other staff• Children take on increasing ownership for their own

progress and growth• Set up on-line progress-tracking and communication

systems• Provide a flexible mix of potential daily experiences that

can be customized for each child• Use an integrated dynamic/static curriculum in a

developmentally appropriate manner

Gutstein Dynamic Intelligence Curriculum

• Developmental progression of objectives for parents and teachers as well as children

• “Reverse-engineered” into thousands of very small documentable steps

• Building developmental foundations• Carefully introducing opportunities for new

cognitive discoveries• Elaborating discoveries so they transfer into

many areas

Evaluation of RDI, Study #2

•Sample Size = 16

•Treatment Length: Minimum 2 years of RDI

•IQ ranged from 70-124

•Age at RDI start ranged from 21 to 111 months

Gutstein, S., Burgess, A. & Montfort, K. (2007). Evaluation of the Relationship Development Intervention Program. Autism, 11, 397-412.

Dependent Variables• Autism Diagnostic Observation Schedules (ADOS)

– Communication Problems

– Social Interaction Problems

• Autism Diagnostic Interview (ADI-R)

– Social Interaction Problems

– Communication Problems

– Repetitive/Restrictive Behavior Problems

• Flexibility & Adaptation

• School Placement

• IQ and ADOS/ADI Change were not significantly correlated

• Age at Start and ADOS/ADI change were not significantly correlated

• Amount of behavioral treatment prior to RDI was not significantly correlated with improvement

• A negative relationship was found between amount of behavioral treatment received during RDI and improvement (-.40 correlation)

Pre-RDI

Pre-RDI

Pre-RDIPost-RDI

Post-RDI

Post-RDI

0

2

4

6

8

10

12

14

Autism Spectrum Non-Autism

Pre-RDI

Post-RDI

Pre-Post Changes in ADOS 62.5% moved to “Non-Autism” category

13

03

06

10

0

ADOS & ADIR Changes

0

2

4

6

8

10

12

14

16

18

20

ADOS Comm. &Social

ADI Social ADI Communication

Score

Pre-RDI

Follow up

ADOS Social/Communication: From Mean of 16 to 06 ADIR Social/Communication: From Mean of 31 to 10

Changes in educational placement

0

2

4

6

8

10

12

14

Special Ed or 1:1Aide

Mainstream w/o aide Home

Pre-RDI

Follow up

Initially 7% (1/14) were in mainstream classesAt follow-up, 85% were in mainstream classes w/o aides

Dramatic increase in parents’ perception of their child’s flexibility and adaptation: From 16 to over 71% of the time