Evidence

Relationship Development Intervention® is a developmentally sequenced relationship and cognitive program designed to address the core deficits of autism rather than the resulting skill deficits.  Over fifteen years ago, by integrating the fields of developmental psychology and brain research Dr. Steven Gutstein developed a treatment protocol for autism.  The program is continually updated based on the latest in neurological and developmental psychological research.   The RDI Program is repeatedly being supported by new neurological research and efficacy studies.   Its effectiveness is not limited to children with autism.  It has been helpful to families and children with a variety of other executive functioning or neuro-developmental difficulties.

 

RDI initially targets the parent/child relationship as the developmentally appropriate avenue for beginning and repairing the development of relating, thinking, and decision making.  There is a specific developmental sequence of goals that are periodically assessed and updated.  But there is also a great capacity to individualize the program to address each child’s specific strengths and obstacles to growth.  The program is extended to other caretakers and teachers and children do best when home and school collaborate to provide both similar and complementary approaches.  The parents and other adults become the “mind guides” of the child, designing their communication, interaction and activities with the child to foster the development of self, relating to others, thinking, decision making, problem solving, and a host of other abilities that underpin dynamic real life functioning.  Once a child has developed a strong sense of self and is able to be an active participant and contributor inside a learning relationship with others the program shifts to specific dynamic intelligence objectives.  Eventually the child him/herself can take on the role of planning his/her own goals.

 

The longterm goal of RDI® is to allow each child the possibility of the best quality of life he/she can attain.  That possibility only becomes available if the core deficits of autism and the resulting skill deficits are targeted in a developmental sequence.  RDI® should be an integral part of any educational plan for children on the autism spectrum.  It is educationally important because it targets the child’s ability to learn from others, to function within an educational environment, to be an active participant in their learning, and to develop crucial dynamic intelligence abilities that will enable them to be more independent, employable, and sociable in life.

 

The RDI Program is based on hundreds of the latest research studies from the fields of autism, neurology and developmental psychology.   Below is a brief review of those that are specifically related to the RDI® program and/or its basic concepts with summaries or abstracts included.

 

J, Hobson, L Tarver, N Beurkens, R.P, Hobson (2015/16)The Relation between Severity of Autism and Caregiver-Child Interaction: a Study in the Context of Relationship Development Intervention.Journal of Abnormal Psychology, (online) August 2015. pp 1-11. (print) May 2016, Volume 44, Issue 4,pp 745-755.

The aim of this study was to examine the relations between severity of children’s autism and qualities of parent-child interaction. We studied these variables at two points of time in children receiving a treatment that has a focus on social engagement, Relationship Development Intervention (RDI; Gutstein 2009). Participants were 18 parent-child dyads where the child (16 boys, 2 girls) had a diagnosis of autism and was between the ages of 2 and 12 years. The severity of the children’s autism was assessed at baseline and later in treatment using the autism severity metric of the Autism Diagnostic Observation Schedule (ADOS; Gotham et al. Journal of Autism and Developmental Disorders, 39, 693-705 2009). Although the ADOS was designed as a diagnostic measure, ADOS calibrated severity scores (CSS) are increasingly used as one index of change (e.g., Locke et al. Autism, 18, 370-375 2014). Videotapes of parent-child interaction at baseline and later in treatment were rated by independent coders, for a) overall qualities of interpersonal relatedness using the Dyadic Coding Scales (DCS; Humber and Moss The American Journal of Orthopsychiatry, 75, 128-141 2005), and b) second-by-second parent-child Co-Regulation and Intersubjective Engagement (processes targeted by the treatment approach of RDI). Severity of autism was correlated with lower quality of parent-child interaction. Ratings on each of these variables changed over the course of treatment, and there was evidence that improvement was specifically related to the quality of parent-child interaction at baseline.

 

Palmiotto, Jennifer, Psy.D. (2015).A qualitative content analysis of parent-child interactions in autism within RDI. Doctoral dissertation ALLIANT INTERNATIONAL UNIVERSITY, 2015, 288 pages; 3702866

This study aimed to improve understanding of interactions between parent-child with autism within two domains central to autism; intersubjectivity and social regulation. In this qualitative study, the researcher examined the Relationship Development Assessment-Adapted (RDA-RV) Coding Scales, a novel observational measure used to assess the quality of interactions between parent and child with autism, within the context of Relationship Development Intervention (RDI) treatment and pretreatment. The researcher used qualitative content analysis to describe each of the subcategories of the RDA-RV Coding Scales within the two main categories—Intersubjective Engagement Statesand Interactive Regulation States. Eleven parent-child dyads participated by providing short video recordings of parent-child interactions in RDI guiding engagements and a pretreatment video. With review of textual transcriptions and video, the researcher’s findings included three themes that were tracked in each of the four predetermined subcategories of the Intersubjective Engagement States. The themes found were: (a) quality of affective connection/relatedness, (b) quality of communication, and (c) quality of gaze. In addition, within the four predetermined subcategories of Interactive Regulation States, three unique themes emerged: (a) quality of monitoring and aligning(b) dynamic-ness(c) complexity of the shared endeavor. The researcher deconstructed each theme into subthemes distinguishing each subcategory as a different and distinct levels of interaction that also related to the respective main category. The researcher formulated the findings into a codebook to increase clinical and research utility of the RDA-RV Coding Scales. The results may directly influence the assessment and ongoing treatment of developmental-relational approaches, namely RDI, by increasing the usability of the RDA-RV Coding Scales.

 

Larkin F, Guerin S, Hobson JA, Gutstein SE. (2014).  The Relationship Development Assessment – Research Version: Preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism. Clinical Child Psychology and Psychiatry:2015 Apr: 20(2):239-60.

The aim of this project was to replicate and extend findings from two recent studies on parent-child relatedness in autism (Beurkens, Hobson, & Hobson, 2013; Hobson, Tarver, Beurkens, & Hobson, 2013, under review) by adapting an observational assessment and coding schemes of parent-child relatedness for the clinical context and examining their validity and reliability. The coding schemes focussed on three aspects of relatedness: joint attentional focus (Adamson, Bakeman, & Deckner, 2004), the capacity to co-regulate an interaction and the capacity to share emotional experiences. The participants were 40 children (20 with autism, 20 without autism) aged 6-14, and their parents. Parent-child dyads took part in the observational assessment and were coded on these schemes. Comparisons were made with standardised measures of autism severity (Autism Diagnostic Observation Schedule, ADOS: Lord, Rutter, DiLavore, & Risi, 2001; Social Responsiveness Scale, SRS: Constantino & Gruber, 2005), relationship quality (Parent Child Relationship Inventory, PCRI: Gerard, 1994) and quality of parent-child interaction (Dyadic Coding Scales, DCS: Humber & Moss, 2005). Inter-rater reliability was very good and, as predicted, codes both diverged from the measure of parent-child relationship and converged with a separate measure of parent-child interaction quality. A detailed profile review revealed nuanced areas of group and individual differences which may be specific to verbally-able school-age children. The results support the utility of the Relationship Development Assessment – Research Version for clinical practice.

 

J, Hobson (2013) Autism severity and qualities of parent-child relations.J Autism Dev Disord.  2013 Jan;43(1):168-78.

The aim of this study was to examine how severity of autism affects children’s interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children’s autism was assessed using the calibrated severity metric of the Autism Diagnostic Observation Schedule (Gotham et al. in J Autism Dev Disord 39:693-705, 2009). Parent-child dyads were videotaped in 10-min semi-structured play interactions, and qualities of interpersonal relatedness were rated with the Dyadic Coding Scales (Humber and Moss in Am J Orthopsychiatr 75(1):128-141, 2005). Quality of relationships between parents and children were evaluated with a parent self-report measure, the Parent Child Relationship Inventory (Gerard in Parent-Child Relationship Inventory (PCRI) manual. WPS, Los Angeles, 1994). Multivariate regression analysis revealed that severity of autism was inversely related to patterns of parent-child interaction but not to reported quality of parent-child relationship. We consider the implications for thinking about relatedness and relationships among children with autism, and opportunities for intervention.

Beurkens NM, Hobson JA, Hobson RP (2013). Autism severity and qualities of parent-child relations. Journal of Autism and Developmental Disorders. Jan;43(1):168-78.

The aim of this study was to examine how severity of autism affects children’s interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children’s autism was assessed using the calibrated severity metric of the Autism Diagnostic Observation Schedule (Gotham et al. in J Autism Dev Disord 39:693-705, 2009). Parent-child dyads were videotaped in 10-min semi-structured play interactions, and qualities of interpersonal relatedness were rated with the Dyadic Coding Scales (Humber and Moss in Am J Orthopsychiatr 75(1):128-141, 2005). Quality of relationships between parents and children were evaluated with a parent self-report measure, the Parent Child Relationship Inventory (Gerard in Parent-Child Relationship Inventory (PCRI) manual. WPS, Los Angeles, 1994). Multivariate regression analysis revealed that severity of autism was inversely related to patterns of parent-child interaction but not to reported quality of parent-child relationship. We consider the implications for thinking about relatedness and relationships among children with autism, and opportunities for intervention.

 

 

Stiller, M., Hutman, T., Sigman, M. (2013)  A Parent-mediated Intervention to Increase Responsive Parental Behaviors and Child Communicating in Children with ASD:  A Radomized Clinical Trial.  J Autism Developmental  Disorders, 43(3): 540-555.

Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder (ASD). To investigate the underlying causal mechanisms, we conducted a randomized clinical trial of an experimental intervention (Focused Playtime Intervention, FPI) that aims to enhance responsive parental communication (N = 70). Results showed a significant treatment effect of FPI on responsive parental behaviors. Findings also revealed a conditional effect of FPI on children’s expressive language outcomes at 12-month follow up, suggesting that children with baseline language skills below 12 months (N = 24) are most likely to benefit from FPI. Parents of children with more advanced language skills may require intervention strategies that go beyond FPI’s focus on responsive communication.

 

Casenhiser D, Shanker SG, Stieben J. (2011) Learning Through Social Interactions in Children with Autism: Preliminary Data from a Social-Communications-Based Intervention. Autism 26 Sept: 1-22.

The study evaluates a social-communication-based approach to autism intervention aimed at improving the social interaction skills of children with autism spectrum disorder. We report preliminary results from an ongoing randomized controlled trial of 51 children aged 2 years 0 months to 4 years 11 months. Participants were assigned to either a target treatment or community treatment group. Families in the target treatment group were given 2 hours of therapy and coaching each week in an intervention emphasizing social-interaction and the parent-child relationship. Children in the community treatment group received a variety of services averaging 3.9 hours per week. After 12 months, outcomes were measured to determine changes in the groups in social interaction and communication. In addition, a regression analysis was conducted to determine whether changes in social interaction skills were associated with language development. Results suggest that children in the treatment group made significantly greater gains in social interaction skills in comparison to the community treatment group, but no between-group differences were found for standard language assessments. Initiation of joint attention, involvement, and severity of language delay were found to be significantly associated with improvement of language skills in children with autism. Finally caregiver skills targeted by the intervention were found to be significantly associated with changes in children’s interaction skills.

 

A. Hobson1and P. Hobson2(2011). Emotional Regulation In Autism: A Relational, Therapeutic Perspective. (1)Institute of Child Health, London, United Kingdom, Institute of Child Health, (2) University College London and Tavistock Clinic, London, London, United Kingdom . International Meeting for Autism Research: Emotional Regulation in Autism: A Relational Therapeutic Perspective. International Society for Autism Research.

The present study reports objectively evaluated improvements in parent-child interaction within families receiving RDI, and now comparison with control groups is indicated.  The relation between changes in dyadic interaction and changes in children’s social-communication will be reported.  Treatment approaches which focus on interaction between children with autism and their caregivers have the potential to affect the children’s emotion regulation abilities which, in turn, are likely to influence other areas of emotional, cognitive, and social development.

 

Landa, R.J., Holman, K.C., O’Neill, A.H., Stuart, E.A. (2011) Intervention targeting
development of socially synchronous engagement in toddlers with autism
spectrum disorder: a randomized controlled trial. Journal of Child Psychology
and Psychiatry. 52:1, pp 13-21.

A significant treatment effect was found for socially engaged imitation (p = .02), with more than doubling (17% to 42%) of imitated acts paired with eye contact in the Interpersonal Synchrony group after the intervention. This skill was generalized to unfamiliar contexts and maintained through follow-up. Similar gains were observed for initiation of joint attention and shared positive affect, but between-group differences did not reach statistical significance. A significant time effect was found for all outcomes (p < .001); greatest change occurred during the intervention period, particularly in the Interpersonal Synchrony group.

 

Kasari C, Gulsrud AC, Wong C, Kwon S and Locke J (2010) Randomized controlled
caregiver mediated joint engagement intervention for toddlers with
autism.Journal of Autism and Developmental Disorders40(9): 1045–1056.

This study aimed to determine if a joint attention intervention would result in greater joint engagement between caregivers and toddlers with autism. The intervention consisted of 24 caregiver-mediated sessions with follow-up 1 year later. Compared to caregivers and toddlers randomized to the waitlist control group the immediate treatment (IT) group made significant improvements in targeted areas of joint engagement. The IT group demonstrated significant improvements with medium to large effect sizes in their responsiveness to joint attention and their diversity of functional play acts after the intervention with maintenance of these skills 1 year post-intervention. These are among the first randomized controlled data to suggest that short-term parent-mediated interventions can have important effects on core impairments in toddlers with autism.

 

Gutstein, S.E. (2009). Empowering families through Relationship Development Intervention: An important part of the biopsychosocial management of autism spectrum disorders. Annals of Clinical Psychiatry 2009;21(3):174-182.

Conclusions: RDI should be considered as part of a comprehensive treatment regimen, in which the physician plays a clinical management role, providing medical and psychiatric consultation. The RDI clinician can function as a remediation specialist, providing accurate feedback to the physician, along with individualized training and guidance to family members.

 

Prizant, B. (2009). Creating a culture of family-centered practice for the autism community”,Autism Spectrum Quarterly, Summer, 30-33.

 

Prizant, B. (2008). Treatment Options and Parent Choice: An Individualize Approach to Intervention”, Autism Spectrum Quarterly, Winter, 34-37.

These two articles are part of a series examining issues related to treatment options and parent choice in the field of ASD. The concept of family-centered philosophy and practice is explored, and current practices in educational and treatment approaches for children with ASD are critically reviewed from that perspective.  Author reports that family centered practice is considered the “gold standard” of practice for children with developmental disabilities (including autism) and their families.  Yet many of the current, predominate practices in the field of autism are inconsistent with, and often actually violate, these principles. One factor that leads to better outcomes for children with Autism Spectrum Disorders is family involvement and collaboration in their child’s          educational programming. The author describes how parents need to be empowered with the knowledge and skills necessary to make the best choice for their child and the family unit as a whole. This article supports the key practices embedded in Relationship Development Intervention® of collaboration between parents and professionals in decision making. Namely, within RDI®, parents are respected as experts regarding their child, and the professionals consider each family’s unique strengths and needs within the dynamic family system.

 

Hobson, J. A., Hobson, P., Gutstein, S., Ballarani, A., Bargiota, K. (2008, April) Caregiver-child relatedness in autism, what changes with intervention?Poster presented at the meeting of the International Meeting for Autism Research.

In an ASD sample (N=30, 3-13 y.o.), this paper demonstrated changes in personal relatedness, but not attachment characteristics, after receiving Relationship Development Intervention® (RDI®), a parent-implemented intervention for 9-38 months. Results reported in this conference poster showed significant changes in parent-child interactions in dyads’moment-to-moment relatedness e.g., time spent in connected states of attention, concluding that atypical relatedness may change with intervention.

 

Kasari, C., Paparella, T., Freeman, S., & Jahromi, L.B. (2008). Language outcome in
autism: randomized comparison of joint attention and play interventions.Journal
of Consulting and Clinical Psychology, 76(1), 125-137.

This study reports results of a randomized controlled trial aimed at joint attention (JA) and symbolic play (SP) in preschool children with autism, with prediction to language outcome 12 months later. Participants were 58 children (46 boys) with autism between 3 and 4 years of age. Children were randomized to a JA intervention, an SP intervention, or control group. Interventions were conducted 30 min daily for 5-6 weeks. Assessments of JA skills, SP skills, mother-child interactions, and language development were collected at 4 time points: pre- and postintervention and 6 and 12 months postintervention by independent testers. Results indicate that expressive language gains were greater for both treatment groups compared with the control group, and results could not be explained by differences in other interventions in which children participated. For children beginning treatment with the lowest language levels, the JA intervention improved language outcome significantly more than did the SP or control interventions. These findings suggest clinically significant benefits of actively treating JA and SP skills in young children with autism.

 

Keen, D.,Rodger, S.,Doussin, K.,Braithwaite, M. (2007) Pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism. Autism, 11(1), 63-71.

This pilot study (N=16, 24-48 mo, dx ASD) used a pre-post test, quasi-experimental         design to investigate the effects of a parent training program (Stronger Families Project)            focused on a social-pragmatic intervention which emphasized child initiation, motivation, and spontaneity within naturally occurring events and activities. It found significant changes in communication and symbolic behavior based on caregiver scores, [Parenting Stress Index (PSI), Parenting Sense of Competence (PSOC), Communication and Symbolic Behaviour Scales Developmental Profile (CSBS-DP), and Scales of Independent Behaviour Revised (SIB-R)] with the social component approaching significance.  Independent observers did not note the same changes. Authors attribute this   to possible caregiver bias, or to the ability of parents (caregivers) to note subtle changes in their child’s behavior, especially as they observe over much greater time periods and contextual situations than the independent observers, who rated only a 30 minute period, were able to do. The study supports the effectiveness of parent training programs in addressing delays in child initiation, motivation and spontaneity within naturally occurring settings.

 

McConachie, H, Diggle, T. (2007). “Parent implemented early intervention for young children with autism spectrum disorder: a systematic review.”Journal of Evaluation in Clinical Practice. Feb, 13(1), 120-129.

This research review looks at the effectiveness of parent implemented intervention for children age 1 yr. to 6 yrs 11 mo. with a dx on the autism spectrum. The review included 12 studies that met the inclusion criteria. Both randomized and controlled studies suggest that parent training leads to improved child communicative behavior, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression. The results of this review support the use of parent training as a model for intervention with young children affected by ASD. This research review suggests that parent training leads to increased parental skills – allowing for continual opportunity for child learning in a variety of situations. This in turn leads to improved maternal communication style, enhanced parent child interaction, and reduced parent and child stress.

 

Gutstein, S.E., Burgess, A.F., & Montfort, K. (2007).  Evaluation of the Relationship Development Intervention® ProgramAutism, 11, 397-411.

This study is the second in a series evaluating the effectiveness of Relationship Development Intervention(RDI) to address unique deficits inherent in autism spectrum disorders. RDI is a parent-based, cognitive-developmental approach, in which primary caregivers are trained to provide daily opportunities for successful functioning in increasingly challenging dynamic systems. This study reviewed the progress of 16 children who participated in RDI between 2000 and 2005. Changes in the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R), flexibility, and school placement were compared prior to treatment and at a minimum 30 month follow-up period. While all children met ADOS/ADI-R criteria for autism prior to treatment, no child met criteria at follow-up. Similar positive results were found in relation to flexibility and educational placement. Generalizability of current findings is limited by the lack of a control or comparison group, constraints on age and IQ of treated children, parent self-selection, and parent education conducted through a single clinic setting.

 

McConachie, H., Randle, V., Hammal, D., & Le Couteur, A. (2005). A controlled trial of a training course for parents of children with suspected autism spectrum disorder. Journal of Pediatrics, 147, (3), 335-340.

This controlled trial (N=51) of children aged 24 to 48 months compared the effects of a parent training course between two groups; one who received immediate intervention and a second that had delayed access to the training course. At recruitment children were identified with a language delay and exhibited characteristics of autism. The course ran for 7 months and consisted of weekly group training sessions, 3 home visits, with parent       follow-through at home. Targeted areas included parent skills in facilitating communication, parent stress level, parent adaptation to the child, child’s vocabulary size, child’s behavior, and child’s social communication skills.  There were no significant group differences for social communication or child behavior problems  (Autism Diagnostic Observation Schedule and Behavior Screening Questionnaire). There were no significant differences in parental stress or adaptation (Questionnaire on Resources and Stress, and Parent Feelings Questionnaire). Results show a significant difference between groups in terms of children’s vocabulary size (MacArthur Communicative Development Inventory) and a significant advantage for the intervention group in parents’ use of facilitative strategies (The Joy and Fun Assessment). The training course was well- received by parents and had a measurable effect on both parents’ and children’s communication skills.

 

Mahoney, G., and F. Perales (2005). Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study. Journal of Developmental & Behavioral Pediatrics, 26(2), 77-85.

This group comparison study (N=50, 12-54mo. old) looked at intervention effects for ASD and DD (developmental disabilities) groups. Both groups received a parent consultation intervention teaching parents responsiveness strategies (using a manualized curriculum) to strengthen attention, persistence, interest, initiation, cooperation, joint attention and affect (called “pivotal developmental behaviors”) and to improve developmental outcomes. This study showed greater improvements in the ASD group for parent responsiveness, child communication and social emotional outcomes such as, detached (as measured by the TABS), under-reactivity (TABS), self regulation (ITSEA & TABS) and improvements in social competence (ITSEA). This study supports the use of developmental parent consultation models for children dx with ASD for improving communication and social emotional outcomes.

 

Gutstein, Steven E. (2005). Relationship Development Intervention: Developing a Treatment Program to Address the Unique Social and Emotional Deficits in Autism Spectrum Disorder. Winter 2005, Autism Spectrum Quarterly.

Preliminary research compared 31 ASD children who participated in RDI and 14 children with ASD who participated in other treatments. After 16 months, 70% of the RDI children improved at least one diagnostic category (autism, autism spectrum and non-autism) on the ADOS (Autism Diagnostic Observation Schedule) and 13 of the RDI children began attending a regular educational setting without significant support.  None of the non-RDI children improved an ADOS category or were able to move to a regular educational setting.

 

Ingersoll, Brooke, A. Dvortcsak, C. Whalen, and D. Sikora. (2005) “The Effects of a
Developmental, Social-Pragmatic Language Intervention on Rate of Expressive
Language Production in Young Children With Autistic Spectrum
Disorders.” Focus of Autism and Other Developmental Disorders 20(4), 213-222.

Developmental, social—pragmatic (DSP) interventions are based on the study of interactions betWeen typically developing infants and their mothers. Despite the fact that DSP approaches are firmly grounded in developmental theory, there is limited research on the efficacy of these interventions for promoting social-communicative behavior in young children With autism. This study used a single-subject, multiple-baseline design to examine the effectiveness of a DSP language intervention on three children With autistic spectrum disorders (ASD). Results indicate the children exhibited increases in their use of spontaneous speech With the therapist as Well as With their parents, Who had not been trained in the intervention. These findings provide preliminary support for the effectiveness of language therapy using a developmental, social—pragmatic approach With young children With ASD.

 

McConachie HV. Randle, D. Hammal, and A. Le Couteur (2005). “A controlled trial of a
training course for parents of children with suspected autism spectrum
disorder.”Journal of Pediatrics 147,  335-340.

Taking into account scores at recruitment, child’s level of ability, diagnostic grouping, and the interval between assessments, a significant advantage was found for the intervention group in parents’ observed use of facilitative strategies and in children’s vocabulary size.  The training course is well received by parents and has a measurable effect on both parents’ and children’s communication skills.

 

Aldred, C., Green, J., and Adams, C. (2004). A new social communication intervention for children with autism: pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology & Psychiatry, 45(8), 1420-1430.

This randomized controlled trial (N=28) of 2-6y.o. compared existing care with 12 months of a parent training group. Participants were diagnosed as ASD using the ADOS.  Results showed significant improvement among those receiving parent training as compared to those receiving routine care. Improvement occurred in the following variables: reciprocal social communication (as measured by ADOS), communicative initiation, parent-child interaction, and expressive language. Parent training focused on communication synchrony, which improved. Shared attention was not directly targeted in treatment and did not change.

 

Mahoney G and Perales F (2003) Using relationship-focused intervention to enhance
the social emotional functioning of young children with autism spectrum
disorders.Topics in Early Childhood Special Education 23(2): 74–86.

This study compares the effects of relationship-focused early intervention on toddlers and preschool-age children who were classified as having either pervasive developmental disorders (PDDs) (N = 20) or developmental disabilities (DDs) (N = 30). The intervention was conducted over a 1-year period through weekly individual parent-child sessions. It focused on helping parents use responsive teaching strategies to encourage their children to acquire and use pivotal developmental behaviors that addressed their individualized developmental needs. Before and after comparisons indicated significant increases in parents’ responsiveness and children’s pivotal behavior. Both groups of children made significant improvements in their cognitive, communication, and socioemotional functioning. However, children with PDDs made statistically greater improvements on the developmental measures than children with DDs. On several developmental measures, children’s improvements were related to increases in both their parents’ responsiveness and their own pivotal behavior. J Dev Behav Pediatr 26:77–85, 2005. Index terms: early intervention, pervasive developmental disorders, relationship focused intervention.

 

Drew, A., G. Baird, S. Baron-Cohen, A. Cox, V. Slonim, S. Wheelwright, J. Swettenham, B. Berry, and T. Charman. (2002). “A pilot randomized control trial of parent training intervention for pre-school children with autism.” European Child & Adolescent Psychiatry, 11, 266-272.

This randomized control trial (N=24, mean age 23 months) of children diagnosed with Childhood Autism compared standard treatment services (home visits plus speech, occupational, and physio-therapy as appropriate) with parent consultation (consultation on behavior management, promoting compliance, training in the development of early precursors to social and communicative competence, and how to guide their child within joint action routines). Consultation focused on developing social-pragmatic skills, specifically the development of joint attention skills and joint action routines.  All children met diagnostic criteria using the CHAT, ADI-R and a structured child-adult interaction assessment. Participants were randomly placed in one of the two groups.  Initial baseline and 12 month follow-up measures include the MacArthur Communication Development Inventory, the Griffins Scale of Infant Development, and ADI-R and the Parent Stress Inventory. In this consultant-led model the parents acted as the everyday therapists. Consultants taught, modeled, monitored, and provided feedback. Results indicated that the children from the parent training group had a slightly higher score on language comprehension on the CDI.  Significant differences were noted in words understood, gestures understood, and in a decrease in parent stress.  More children from the parent training group moved from ‘non-verbal’ to using single words or phrases. No significant differences between the two groups was noted in number of words produced or gestures produced.

 

Siller, M., & Sigman M. (2002). The behaviors of parents of children with autism
predict the subsequent development of their children’s communication.Journal
of Autism and Developmental Disorders, 32(2), 77-89.

The present study focused on behaviors that caregivers of children with autism show during play interactions, particularly the extent to which the caregiver’s behavior is synchronized with the child’s focus of attention and ongoing activity. The study had two major findings. First, caregivers of children with autism synchronized their behaviors to their children’s attention and activities as much as did caregivers of children with developmental delay and caregivers of typically developing children, matched on language capacities. Second, caregivers of children with autism who showed higher levels of synchronization during initial play interactions had children who developed superior joint attention and language over a period of 1, 10, and 16 years than did children of caregivers who showed lower levels of synchronization initially. These findings suggest a developmental link between parental sensitivity and the child’s subsequent development of communication skills in children with autism. Implications for parent training interventions are discussed.