The Relationship Development Intervention (also known as RDI or the RDI program) is a parent-led approach which focuses on a child's difficulties with flexibility of thought, emotional regulation and perspective-taking.
RDI is based on the idea that autistic children have missed key developmental milestones (such as social referencing and joint attention) that enable them to think flexibly, regulate their emotions, and understand social situations.
RDI seeks to give children another chance to master these milestones in the same way that they are mastered by typically developing children: through their relationship with their parents.
An RDI consultant guides the parent to change their communication and interaction style so that they can support their child to fill in the developmental gaps they missed. This is done through everyday activities such as washing up, cooking, going for a walk, etc. - some of which are video recorded and shared with the family's consultant who then provides feedback on progress.
There is a very limited amount of research evidence (a single, very low quality study) into the use of RDI for autistic children.
The single study we identified has some major methodological weaknesses, which means that it cannot be considered scientifically valid or reliable.
Because the quality of that research evidence is so poor we cannot determine whether RDI is likely to provide any benefits to anyone who is autistic. We must wait for further research of sufficiently high quality to be completed.
However, given the claims made for RDI and the level of the existing anecdotal evidence, we feel that further, objective research into the programme is justified.
That research should use scientifically robust, experimental methodologies with larger numbers of more diverse participants. That research should investigate whether RDI is more or less effective than other interventions designed to provide the same benefits and whether specific individuals are more likely to benefit from RDI than other individuals.
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According to the RDIConnect website, accessed on 8 June 2018,
“Relationship Development Intervention (RDI) offers treatment programs for individuals and families that face Autism Spectrum Disorders and other developmental difficulties.”
According to the Connections Center website (the predecessor to the RDIConnect website), accessed on 10 October 2008,
"We find that all people on the autism spectrum can benefit from the RDI Program. It appears to be helpful regardless of IQ, language, gender or diagnosis. The most important factor in determining the rate of improvement is the degree to which we have to overcome obstacles like the child's desire to control others, and the presence of co-occurring illnesses."
The aim of RDI is to develop what Gutstein, the co-founder of the RDI programme, calls "dynamic intelligence" (Gutstein, 2009). He defines this as the ability to flexibly and creatively respond to novel situations.
According to DeAngelo, L. (2008)
"The RDI program systematically develops dynamic intelligence so that autistic people can achieve the flexible thinking critical to regulate social interactions. With improved ability to form social connections comes a greater quality of life for the autistic person and those around him or her."
According to Morris, B.K. (200?)
"Instead of trying to directly alter behavior, RDI focuses on cultivating the building blocks of social connection - such as referencing, emotion sharing, and experience sharing - that normally develop in infancy and early childhood. The RDI program provides a path for people on the autistic spectrum to learn friendship, empathy and a love of sharing their world with others."
According to Thompson, personal correspondence (2009)
"The aim of RDI is to enable parents to re-introduce the 'guided participation relationship' (GPR) with their autistic children. The GPR is the mechanism through which every baby, toddler and child learns from its parents, in every culture all over the world. It is something parents do intuitively without thinking about it and involves gently challenging the child at the edge of their competence, scaffolding if necessary to ensure that the child is successful in achieving something new. In autism, something happens in the child's brain, which means that they are unable to take part in the GPR. This is why the thinking of children with autism becomes static and rigid, and why they have so much difficulty coping with change."
According to the RDIConnect website, accessed on 8 June 2018,
“RDI programs teach parents how to guide their child to seek out and succeed in truly reciprocal relationships, while addressing key core issues such as motivation, communication, emotional regulation, episodic memory, rapid attention-shifting, self awareness, appraisal, executive functioning, flexible thinking and creative problem solving.”
The Connections Center website (the predecessor to the RDIConnect website), accessed on 10 October 2008, made a number of claims for RDI including
The Relationship Development Intervention (also known as RDI or the RDI program) is a parent-led approach which focuses on a child's difficulties with flexibility of thought, emotional regulation and perspective-taking.
A consultant evaluates the child's relationship skills and then develops a set of objectives which are designed to take the child to successive levels of skills. These objectives are taken from the RDI Programme curriculum, which consists of many hundreds of objectives, organised within 12 essential elements.
If the child has already mastered a particular set of skills, such as the ability to share emotion, he or she will be given objectives related to the next set of skills, such as social referencing. When he or she has mastered that stage, he or she will move on to the next stage. Because the stages build on each other, only one stage can be worked on at a time.
Once the objectives have been determined for the individual child, the consultant shows the parents the best way to help their child achieve those objectives. This is done over several days, during which the consultant works directly with the parents and also with the child. The consultant may also provide ongoing support to parents through videotape reviews and written feedback for many months or years after this initial training.
The parents work with the child during “lab time” but they may also make use of any learning opportunities which occur at other times, including everyday activities such as washing up, cooking, going for a walk, etc. During “lab time” the parents engage the child in a series of exercises, such as passing a "hot potato" rapidly back and forth or duplicating facial expressions shown in pictures.
When the child is ready, he or she is matched with another child at a similar level. Gradually other children are added, and the number of settings is increased, so that the child learns to form and maintain relationships in a number of different groups and contexts.
The cost of using an RDI program will depend on a number of factors including the supplier, the specific services that they provide, the length and frequency of treatment.
For example, the Dynamic Connections website, accessed on 8 June 2018, states that "Even in the first (and most expensive) year, an RDI program typically costs approximately $5000' [£3,250].
However it is important to bear in mind that there may be additional costs (such as travel and accommodation, equipment and materials).
In the USA some of the costs may be covered by some insurance policies.
RDI is usually a lengthy and fairly labour-intensive intervention which may last for many years. Parent and children usually undertake at least 3 hours a week of 'lab time', along with numerous teaching opportunities that happen during the day.
According to the Connections Center website (the predecessor to the RDIConnect website), accessed on 10 October 2008,
"Treating the core problems of Autism and Asperger's Syndrome is a marathon and not a sprint. Many of our families continue working on higher level objectives throughout childhood and adolescence.
"RDI is an ongoing process; however, how long one chooses to continue the program depends on each child's specific needs, parental goals for the child, and family commitment. If the program remains consistent, the children progress into dyads and small groups with peers at similar levels of functioning while parents still continue to work with their children at home."
According to Thompson (2009)
"Families can work on one objective at a time. There are currently 1138 objectives (48 of which are parent objectives), housed in 12 'stages'. Objectives are all developmentally staged and cover every area of development necessary for attaining a good quality of life."
In addition to the time spent with children, the Connections Center recommends that parents invest in its workshops and seminars, a personalised assessment and training programme, and various forms of ongoing support.
According to Thompson (2009)
"Parents are supported in their role of 'mentor' to their child's 'apprentice' by an RDI Consultant who has been through a special training programme developed and certified by the Connections Centre in Houston, Texas.
"Parents aim to undertake RDI activities with their child on a regular basis, and to film some of these interactions. Footage and written commentary on the footage are then uploaded on a regular basis to an online application (the RDI 'operating system' or RDIos) that enables parents to communicate with their Consultant. The Consultant reviews the footage and commentary and feeds back to parents on their family's progress via the RDIos.
"The RDIos contains: a library of video clips that demonstrate each objective, online forums for parents and Consultants, webinars (web based tutorials on various aspects of RDI), e-learning modules, an e-continuing education programme for Consultants, and details of upcoming training and publications.
"Families take part in detailed 6 monthly face-to-face assessments with their Consultant to review progress and further develop their intervention programmes."
There are no known hazards for RDI.
There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for RDI.
RDI is only available through RDI Program Certified Consultants, although the latter operate in a number of countries including the USA and the UK.
The Connections Center website (the predecessor to the RDIConnect website), accessed on 10 October 2008, states that RDI can only be delivered through RDI Program Certified Consultants who have completed the RDI Program Certification process.
According to Thompson (2009), consultants must undertake re-certification every year.
The certification process is not recognised by any external authorities and the certificate therefore appears to have no external, objective validity.
RDI was developed by clinical psychologists Steven Gutstein and Rachelle Sheely in the 1980s. They went on to found the Connections Center in Houston Texas in 2001 in order to deliver and market the intervention.
We have identified a single article* published in English-language, peer-reviewed journals which evaluates the efficacy of RDI as an intervention for pre-school and primary school autistic children.
This study was a retrospective chart review of 16 autistic children, aged between 21 and 94 months at the start of the intervention, although most of the children were of school age. The gender balance was overwhelmingly male, with a ratio of 15:1. Five children met diagnostic criteria for autistic disorder, while seven were diagnosed with Asperger’s syndrome and four with pervasive developmental disorder - not otherwise specified.
The participants had IQ scores which ranged from 70 to 118, which the researchers described as the “high-functioning” segment of the ASD population. Some of the participants has additional diagnoses including language disorder (eight), ADHD (five), bipolar disorder (one), and food allergies (one).
The children would have been taught by their parents in a one to one setting in their own homes, although this was not explicitly stated in the study. All of the children had been taught for a minimum of 30 months, although it is unclear how many hours training a day they received and how many days a week as this was not stated in the study.
14 of the children were also receiving some form of formal education at the same time as they received the RDI: (1) mainstream classroom placement with no special services required, (2) mainstream with pullout services, where the child spent parts of each day in a resource room to help with non-behavioral issues, such as reading, (3) partial special education in mainstream placement, with the child spending part of each day in a special education environment due to behavioral and adaptational concerns, and (4) full-time special education placement due to difficulties in behavior and adaptation, or placement in a typical class with a full-time aide.
*Please note: we have not included any of the other studies written by Gutstein and colleagues for a range of reasons. This includes a study (Gutstein, undated) that was withdrawn from publication; a study (Gutstein, 2004) that does not seem to have actually been published; and a study (Gutstein, 2009) which did not examine the efficacy of RDI as a treatment.
This study (Gutstein, Burgess and Montfort 2007) reported a number of significant benefits including,
“While all children met ADOS/ADI—R criteria for autism prior to treatment, no child met criteria at follow-up.”
“After a median of 41.5 months in treatment, no child met ADOS criteria for an autism diagnosis, six children met criteria for autism spectrum, and 10 children were rated in the ‘non-autism’ diagnostic category. Five children initially rated in the ‘autism’ category achieved a ‘non-autism’ rating.”
“Children who participated in RDI became significantly more socially related, engaged in more reciprocal communication, functioned in school settings with less adult participation, and also were perceived by parents as behaving in a dramatically more flexible and adaptive manner.”
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,
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’
We have been unable to identify any studies into RDI that are currently underway. If you know of any other studies we should include please email info@researchautism.net with the details. Thank you.
There is a very limited amount of research evidence (a single, very low quality study) into the use of RDI for autistic individuals.
The single study we identified has some major methodological weaknesses, which means that it cannot be considered scientifically valid or reliable.
Because the quality of that research evidence is so poor we cannot determine whether RDI is likely to provide any benefits to anyone who is autistic. We must wait for further research of sufficiently high quality to be completed.
We believe that further, objective research into RDI is justified.
That research should use scientifically robust, experimental methodologies with larger numbers of more diverse participants. That research should
This section provides details of scientific studies into the effectiveness of RDI for autistic people which have been published in English.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
This section provides details of other publications on this topic.
You can find more publications on this topic in our publications database.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
According to Morris, (200?), "Proponents of RDI believe that while conventional treatments such as Applied Behavior Analysis teach discrete skills, the social outcomes that result often lack the emotional components of communication as they rely on scripted and predictable actions. They believe that such training may result in improved discrete skills, such as eye contact, emotion recognition (of static images) and turn taking, but that it does not teach social intelligence."
Opponents of RDI claim that the theories and philosophies underlying RDI strategies are not supported by evidence. They raise concerns about the lack of detailed information about what actually takes place during the RDI programme. They also raise concerns about the marketing strategies and branding strategies utilised by The Connections Center.
Milton (2014) has criticised the concept of dynamic intelligence within RDI
"Relationship Development Intervention (RDI) shares many similarities in theory and practice with the Floortime approach, in terms of 'functional relationships' being the main aim of the intervention. This programme is based on the concept that autistic people are deficient in what is termed 'dynamic intelligence', a somewhat umbrella term that includes thinking flexibly, theory of mind, coping with change, and processing more than one piece of information at the same time. By working upon these qualities, those who follow RDI suggest that the quality of life for children on the autism spectrum can improve. Unfortunately, RDI supporters seem to have fallen into the same trap as previous approaches, with large claims being made from scant evidence. Also, the use of the term 'dynamic thinking' can be criticised for being too all-encompassing a term, especially when others have used the exact same words to describe a more direct and sensory experience of one's environment."