Increasing Success Rates Through Relationship Development Intervention: Dr. Steven Gutstein

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Relationship Development Intervention RDI® Raising the Bar for Autism
Dr. Steven Gutstein, PhD
Director Connections Center Founder, Gilbert Hall School: President, Foundation for Autism Research and Remediation (FARR)
connections center™
February, 2008
Building new pathways to change through RDI
Presented by: Carmen Augustin, LCSW RDI® Program Certified Consultant Sweeney Augustin and Associates 5225 Old Orchard Road Suite 44 Skokie, Illinois 60077 847-583-9492 ext. 1
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
Static Intelligence
• • • • 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
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? IQ tests measure Static Thinking People with ASD may have excellent Static Thinking
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 What you do with what you know in a information
complex, continually changing, interconnected world
Success rates for the “high functioning”
IQ > 100 Language within normal range
• Employment = 12% • Independent living = 3% • Friendship & Marriage = <1%
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 • Everchanging • Simultaneo us • Surprising • Imperfect • Emotional
The MESSIE Curriculum
Learning to conduct a continuous process of evaluating and adapting to an ever-changing world Going “off course” is inevitable in the realworld. Success depends on rapidly evaluating the effect of our actions and making continual “course corrections
Learning to manage Alternative, 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?
Best Education Practices
Learning must be an active, dynamic process, where children own their learning and perceive it as opening doors to new challenges and discoveries
Guided Participation
Children’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, architect of The guide is the orchestrator and1991
dynamic learning, designing experiences that will lead the child to make meaningful
1. Bio-psycho-social Readiness:
– – –
RDI Dynamic Thinking Remediation
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 & parent 3. Carefully evaluating the child’s “zone” of challenge 4. Long-term emphasis: Marathon not Sprint 5. Providing opportunities throughout the day for discovery and mastery, through gradual transfer of ability and responsibility 6. Providing the “cognitive apprentice” with
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
Gutstein, S., Burgess, A. & Montfort, K. (2007). Evaluation of the Relationship Development Intervention Program. Autism, 11, 397-412. •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
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-Post Changes in ADOS 62.5% moved to “Non-Autism” category
14 12 10
6 4 2
Pre-RDI Post-RDI
Post-RDI Pre-RDI
ADOS & ADIR Changes
ADOS Social/Communication: From Mean of 16 to 06 ADIR Social/Communication: From Mean of 31 to 10 20
18 16 14 Score 12 10 8 6 4 2 0 ADOS Comm. & Social ADI Social ADI Communication Pre-RDI Follow up
Changes in educational placement
Initially 7% (1/14) were in mainstream classes At follow-up, 85% were in mainstream classes w/o aides
14 12 10 8 6 4 2 0 Special Ed or 1:1 Aide Mainstream w/o aide Home Pre-RDI Follow up
Dramatic increase in parents’ perception of their child’s flexibility and adaptation: From 16 to over 71% of the time