Maisie Soetantyo , RDI Consultant
A growing number of parents raising children with Autism Spectrum Disorders (ASD) worry about their youngsters’ chances of attaining a long term quality of life. As they watch their children getting older, they may wonder –
“Will they be able to live independently?”
“Will they be able to get married?”
“Will they have friends?”
“Will they be able to have personal growth?”
“Will they be able to have a fulfilling job?”
The new generation of ASD treatments is now returning to more relationship-based and parent-focused approaches. Current research findings on ASD, social communication, self-regulation, parental involvements, and brain plasticity support the importance of early Guided Participation Relationship (GPR) development between a parent and a child. One recent study by Wetherby et al. (2014) included a randomized controlled trial with 82 toddlers diagnosed with ASD whose parents received coaching for social communication strategies using daily opportunities, and the results showed faster improvements in areas of social, communication and functional daily living skills. In contrast, the control group indicated worsening or no significant changes in the same areas.
The Guided Participation Relationship
The Relationship Development Intervention (RDI) TM Program, developed by renowned clinical psychologists, Dr. Steven Gutstein and Dr. Rachelle Sheely in Houston, Texas, is one of the foremost parent-based interventions available to families with children diagnosed with ASD. Based on the latest research on neuroplasticity, the RDI program aims to improve neural connectivity in individuals with ASD, as well as many other childhood neurological disorders such as Reactive Attachment Disorder, ADHD, Tourette Syndrome, etc.
The theory of neuroplasticity provides hope to many parents and individuals diagnosed with a variety of neurological diagnoses, because with the right kind of experiences the brain can be rewired regardless of the age of individuals. One of the experts in neuroplasticity theory, Dr. Norman Doidge, M.D. has written a book called “The Brain’s Way of Healing”, in which he describes how it is possible to train new parts of the brain to take over damaged parts. Specifically for individuals with Autism, Dr. Doidge described the disorder as a mind-body disconnection caused by inflammations that can be improved by rebuilding neural pathways to increase neural integration (Doidge, 2015).
The RDI program provides a step-by-step individualized set of objectives aimed at restoring the natural Guided Participation Relationship (GPR) between parent and child where it has been disrupted or never developed due to atypical development. As a result of this disruption, parents often describe a high level of anxiety in their special needs children which is expressed in inflexibility, behavioral problems, learning difficulties, social, emotional and communication challenges. The breakdown of GPR causes ‘domino effects’ in both the parent and the child’s ability to function as a guide and as an apprentice. Thus, complex obstacles prevent the achievement of critical developmental milestones and impede normal family life.
One area significantly impaired by the breakdown of the GPR is social communication. Because of the lack of feedback loops between parent-child, parents learn to overcompensate for their child very early on by using static types of communication consisting mainly of verbal instructions and closed-ended questions. Therefore a habit of using only a single channel of communication instead of integrating non-verbal communication channels such as voice inflections, body orientation, eye gaze and gestures quickly develops. Due to this failure to integrate multiple channels of communication, even as the children learn to complete tasks and develop certain skills, they continue to need constant prompting by others.
Other tendencies frequently resulting from the loss of GPR are the entire families’ inclination towards sameness in daily routines, topics of conversations, repetitive behaviors or preferred activities. Many parents have unknowingly narrowed their child’s exposure to real world dynamic experiences for fear of ‘rocking the boat’. Without the motivation to adapt to new opportunities, even the highest functioning of individuals with ASD would struggle with long-term independence and relationships with others.
The goal of the RDI Program is an ambitious one, in that it seeks to change the neuro-pathways of an ASD brain to function optimally, instead of just masking behavioral excesses or deficits. In order to do this, the immediate focus is to help parents restore the disrupted GPR by shifting parents’ mindset, priorities, expectations, goals and life style. Once the GPR is back on track, an apprentice and his/her guide are ready to learn the ways of the world!
How does the RDI Program Work?
New RDI parents begin the program through online parent education objectives designed to help them understand the core deficits of ASD, which include lack of experience sharing, lack of self awareness, lack of dynamic appraisal, lack of Episodic Memory and lack of creative problem solving abilities. To anchor parents’ commitment to their remediation journey, beginning parent education objectives cover the concepts of Dynamic Intelligence and its role in rebuilding pathways for optimized neural integration. At this stage of the program, parents can subscribe to the RDI Online Learning platform and learn about the RDI program goals through webinars, interactions with other RDI families, video clips of actual intervention sessions and updated research findings at their own pace (www.HYPERLINK “http://rdiconnect.com/” \t “_blank”RDIConnect.com).
Once parents are ready to implement their customized RDI program and in-home hands-on training, then a comprehensive assessment is administered and ongoing parent coaching sessions are provided by their RDI consultant. An individualized set of objectives may include such lifestyle changes as simplifying the home environment, slowing down the pace of life, practicing new opportunities, balancing the entire family’s schedule and building a life outside of a special needs diagnosis. The RDI program believes that making lasting, meaningful and positive change begins at home with the parents, and that the remediation process should take place amidst each family’s unique culture and relationships.
The frequency and format of ongoing supervision for each family varies depending on the progress and the objective at the moment. It is common that parents and consultant would meet without the child whether it’s a face-to-face meeting, Skype or phone consultations. Home visits and community outings are also important for an RDI family to practice in their most natural settings. An RDI consultant might utilize modeling, role playing, planning ahead, watching video clips of daily interactions, as well direct work during coaching sessions. The ultimate goal of RDI consultants is to work themselves out of a job, once parents have moved out of crisis, normalized their family lives and developed competence in guiding their child through daily opportunities.
Parent Readiness First
A critical component in the RDI Program is building each parent’s competence, and this may look different for each parent. One typical goal is to ‘slow down’ and ‘simplify’ on a personal level, as well as a couple. Difficult questions are often asked of parents, such as;
“Are you taking care of yourself and your marriage?”, “Are you on the same page as your spouse?”, “Are you making time for quality engagement opportunities with each child?”, “Are you still in a panic mode trying to fix behaviors without working on the developmental readiness?”, “Are you depressed?” or “What is holding you back?”. The guide’s readiness is parallel to the child’s readiness, and in order for improvements to be internalized, both parents and the child must go through the process of making new discoveries together.
The bottom up approach in an RDI program requires investments not only in time, but also in emotional, mental and physical presence from both parents and their young apprentice. Although there is no exact prescription for how many hours parents should practice their RDI objectives with their child each day, most parents learn to incorporate their current objective into their existing family routines. The child’s dynamic intelligence is developed through shared experiences in meaningful activities, gradual exposure to real world problems and mindful decision making.
In part 2 and 3 of this series, learn about how RDI parents work on parent readiness objectives as a couple, and how to implement mindful guiding at home.
Doidge, N. (2015). The brain’s way of healing. New York, NY: Penguin Group.
Wetherby, A., Guthrie, W., Woods, J., Schatschneider, C., Holland, R., Morgan, L, & Lord, C. (2014). Parent-implemented social intervention for toddlers with Autism: An RCT. Journal of the American Academy of Pediatrics, 134(6), 1084-1093. doi:10.1542/peds.2014-0757.
Maisie Soetantyo, M.Ed. is a 23 yr. veteran in the field of ASD remediation, and has been providing RDI supervision and training for families in California and S.E. for the past 12 years. To learn more about her work, please visit www.catchclinic.com.For additional questions or comments about this article, contact Maisie at: firstname.lastname@example.org