Relationship Development Intervention and Autism Ranking: Insufficient/Mixed evidence

Status Research

According to the authors of the single study identified to date (Gutstein, Burgess and Montfort, 2007), there are a number of methodological weaknesses with that study including,

"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."

More importantly, we have identified a number of other, very serious limitations to that study which make it impossible to draw any firm conclusions. For example,

  • The study was authored by three staff at the Connections Center, the commercial organisation which delivers and markets the intervention. This makes it susceptible to claims of bias on the part of the authors, however subconscious that bias might be.
  • The study was based on a retrospective chart review, which is an especially weak methodology for determining the efficacy or otherwise of an intervention.
  • The study included 16 participants, whch is a relatively small number for a chart review. 
  • It is not clear why these 16 participants were included and whether any other participants who had also received RDI program at the same time had been excluded for some reason.
  • The study did not provide enough information about the intervention and how it was actually delivered. For example, the RDI program was described in general terms but without any detail about the specific techniques used, the settings, the number of hours involved etc.
  • The study looked at participants who had been receiving the RDI program for a minimum of 30 months meaning that any changes in the participants could have been due to their natural development rather than the intervention.
  • The study used four outcome measures but one of these, the Flexibility Interview, was a non-standard measure devised by the authors, which used a simple Likert scale and relied on the subjective judgements of the parents.
  • ADOS scores were only available for 12 of the 16 children at the beginning of the study whereas ADOS scores were available for all 16 at the end of the study. This means that the researchers were not comparing like with like at the beginning and end of the study.
  • The authors chose to use only 13 items deemed to be “most representative of experience sharing” from the ADI–R and ADOS instead of using all of the items from these two measures or instead of using all of the items from a specific module from these measures.
  • The study did not provide any data on the effect size of the outcomes reported.
  • The study did not appear to involve autistic people (and parents and carers) in the design, development and evaluation of those studies.

Please note: We have chosen not to list the limitations of the other studies authored by Gutstein and colleagues since we have not included them in our evaluation. However those other studies have been widely criticised by a number of other people. For more details please see the article by Letso (2007).

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’


17 Jun 2022
Last Review
01 Oct 2018
Next Review
01 Nov 2024