Introduction to Relationship Development Intervention (RDI )

Transcription

1 Introduction to Relationship Development Intervention (RDI ) Ruth M. Strunz RDI Program Certified Consultant Developmental Education Specialist ruth.strunz@gmail.com (705)

2 Welcome! Kindly shhh your devices! Self-regulate: move, sip, chew, doodle, lose the shoes Ruth: Bio & adoptive mother; personally & professionally invested in building & sustaining relationships RDI & developmental counselling; supporting families & professionals; collaborating with Drs./healthcare providers; nurturing wider Canadian RDI community San Diego > RDI in funded, team-based setting; opened RDI school & directly supported families Previous career > education & developmental services

3 Agenda 1. Early markers for autism spectrum disorders (ASD) 2. Behavioural vs developmental interventions for ASD 3. The guided participation relationship (GPR) 4. Developing dynamic intelligence 5. Progression of the RDI Program 6. Video: Before & after RDI 7. Questions/ideas/discussion

4 Because Why is RDI relevant to you, professionally? ASD: a developmental, not a behavioural disability development is co-constructed, within a social milieu; you work directly with those who are co-constructing it! your profession values parent intuition/observation ( He can hear, and he is not hearing me. ) many markers for ASD are recognizable at 6-12 months of age parents often know a lot about their child s body, and almost nothing about their brain! (Siegel 2011) RDI emerges from an apprenticeship model of cognitive development (Rogoff, 1990)

5 Early signs of ASD include combinations of: Head lag when pulled up by hands (6-9 mths) Plays repetitively with objects (12 mths) Excessively absorbed by electronic devices (12 mths) Not pointing to initiate joint attention or not responding to an adult pointing (12 mths) Not responding to own name (12-14 mths ) Not interested in exploring a novel object in which adult is clearly interested, at 12 mths (Mind Institute, CA) Not walking (16-20 mths) Persistently echolalic language development (24 mths) Doesn t look at camera, or smile, on demand (24 mths)

6 The best treatment: What is the best treatment for ASD? fits with the family culture enables this child to reach their full developmental potential improves quality of life for this family connects the child with their community in a meaningful, sustainable way

7 What distinguishes RDI from other interventions? RDI provides a re-do of typical early development, at a pace this child can handle! Deconstructs & repeats typical development, 0-24 months Provides framed experiences requiring and causing development of new neural pathways; narrows gap between deficits & strengths Fosters parent-child feedback loop ( co-regulation Fogel, 1991; mutual regulation Tronick, 1989) Equips & empowers parents; respects family systems Moves at the child s pace; customized to meet the family s needs

8 What do we know about the human brain & parenting? The brain is an experience-dependant organ. (Doidge, 2007) Cognitive development is an apprenticeship ;; happens within relationship. (Rogoff, 1990) (Hobson, 2002) Parents are more invested than professionals, to help their own child reach their potential. (Gutstein, 2009) Humans learn to regulate emotion dyadically. (Sroufe, 1995) This research forms the theoretical foundations of the RDI Program.

9 The Guided Participation Relationship (GPR) Clarify GPR: the parent-child relationship by which humans pass on culture. Roles of guide & apprentice within the GPR Guide role: support apprentice to know where to attend, how and what information to gather; spotlight competence Apprentice role: engage with the guide. Typically, GPR is firmly in place by 20 months. (Role reversal is a significant socio-developmental problem!)

10 ASD What disrupts the development of the GPR? Avoidant/ambivalent attachment (adoptionrelated) Some intellectual and some learning disabilities Excessive anxiety/low self-esteem Hearing loss in infancy Expressive or receptive communication disorders Severe family disruption/prolonged separation

11 RDI remediates the GPR Overriding goal of RDI remediating the GPR; essential for development of dynamic intelligence. We remediate the GPR by: Drawing parent s attention to their own, and the child s needs & obstacles Identifying the child s developmental deficits Teaching parents to guide their child; competence is the best motivator! Clearing obstacles and supporting child to become parent s cognitive apprentice

12 Dynamic intelligence & core deficits perspective of ASD GPR is essential for the development of the child s dynamic intelligence. ASD is a neurological (not a behavioural) disorder characterised by 5 core deficits. 1. Flexible thinking 2. Experience sharing communication 3. Social referencing 4. Emotional regulation 5. Emotional memory

13 In real life, these deficits cause difficulty with: 1 Flexible thinking: identifying alternative solutions; considering someone else s perspective 2 Experience sharing communication: sharing own world-view &/or showing interest in another person s 3 Social referencing: interpreting social cues; reduced referencing, due to reduced capacity for broadband communication 4 Sensory/emotional regulation: managing emotions; hypo or hyper-reactive to sensory stimuli 5 Emotional memory: remembering how something felt in the past (but often excellent semantic memory!)

14 Static & dynamic intelligence Static intelligence > I.Q. > facts, maps, lists etc. Dynamic intelligence > E.Q. > what we do with what we know, in an unpredictable, everchanging world. Sum of these core deficits is weak dynamic intelligence; when static intelligence overrides dynamic, diagnosis = ASD

15 Weak dynamic intelligence impacts quality of life Dys-regulation/aggressive behaviours Eating, sleeping or toileting issues Underachievement at school; unable to make/sustain friendships Learned helplessness Fight, flight or freeze responses to uncertainty Sensory issues, poor personal hygiene (hypersensitivity > hair, nails, skin etc.), restrictions on family life Underdeveloped social skills Inflexible adherence to rules & routines Pervasive anxiety, depression, low self-esteem etc.

16 Within the family Parental fatigue, depression or anxiety Spousal/marital stress Sibling jealousy or anger Children s birth order roles often confused (younger child taking care of older etc.) Family system & all sub-systems break down in multiple directions

17 Behavioural vs. Developmental Interventions Behavioural Based on classic behaviourism, reward-&- punishment Minimal sustainable remedial effects Addresses the what of behaviour Fosters compliance, & therefore vulnerability Is quick! Ex: ABA, IBI, PRT etc Developmental Based on typical development Addresses the why of behaviour Fosters curiosity, motivation, natural outcomes Strengthens individuals, families & communities Takes longer; results sustainable Ex: RDI, Floortime, biomedical etc.

18 Structure of an RDI program 1. Baseline assessment completed, parents & child together 2. Parent education stage weekly meetings & reflective homework assignments 3. Relationship Development Assessment (RDA) Goal identification & development > parent & child objectives 4. Ongoing consultation Bi-weekly meetings online, at home or clinic setting Parents work with child, supported by consultant Video uploads, feedback & RDI Platform

19 Sample child objectives Flexible & relative thinking (problem solving) Increased self-awareness & self-regulation Referencing/gazing Understanding & using multiple channels of communication Experience-sharing Increased competence > taking on more responsibility > reduced dependence Motivation, initiative & risk-assessment Perspective taking (later) Sibling or peer relationships (later)

20 Sample parent objectives Increasing self-regulation & self-awareness ( Mindful Guidance!) Creating space/time for remediation Experience-sharing communication (speech, facial, gestural etc.) Limit setting & personal boundaries Supporting child to manage uncertainty Framing & scaffolding for competence Spotlighting competence Including siblings/extended family in remediation

21 RDI program progress 1 Stage 1: identify & clear obstacles to remediation Parents & consultant explore: Bio = gut > toxicity issues, seizures, co-occurring disorders. Psycho = anxiety, depression, resistance, confusion etc Social = parental issues (depression, anxiety, loss of perspective, marital issues etc.) Social also = school & community involvement, excessive screen-based activity, over-programming etc.

22 RDI program progress 2 Stage 2: support parents to explore family patterns, empower to move into guide role. Parents are learning to: Guide their child; framing, scaffolding & spotlighting Set & maintain consistent limits Adjust communication; invite child to engage Child is: Starting to experience and enjoy low-demand engagement; co-regulation.

23 RDI program progress 3 Stage 3: refine guiding abilities; adjust program to move child s development along as typical a pathway as possible Parents are: Becoming expert at analysing their videoed interactions Moving RDI into school, community & extended family. Child is: Showing evidence of developmental progress > increased motivation to engage, curiosity, referencing & gazing, initiating etc.

24 RDI program progress 4 Stage 4 & beyond Parents & child are: Expert in roles of guide & apprentice Able to self-reflect after interaction; able to identify what to change/keep Participating in the life of their community Making plans for the future Independent of consultant; may check-in periodically

25 Life beyond RDI! After approx. two years, many children are no longer diagnosable with ASD, or have moved a (DSM-V) severity level down. A committed family can achieve this, even with some unexpected life happening! Let s watch Ely s before and after RDI video!

26 In summary: RDI is a developmental intervention that: Supports & fosters healthy development Empowers parents, & respects families Addresses the core deficits of ASD Is done throughout the day, in all settings Is focused on quality of life, rather than performance! Is publicly funded in BC, Alberta and Nova Scotia and not yet in Ontario.

27 A thought is there anything wrong with being proactive? 1:88 children are diagnosed with ASD in Ontario (HSC, Toronto). What if we assumed every baby was high-risk? What would we do differently as professionals? As parents? Many physicians now believe diagnoses of ASD by age 1 is possible (and desirable in terms of early intervention); consider pre-language communication, play skills, emotional regulation, etc. If we were wrong, typical development would take over; if we were correct, we would have equipped & empowered parents to shift the developmental trajectory as early and effectively as possible!

28 Further information and resources: Contact Ruth directly: or for further consult, questions or workshops/speaking engagements. Visit Ruth s website at Explore Read The RDI Book by Dr. Steve Gutstein With sincere gratitude to Drs. S. Gutstein R. Sheely, RDIConnect, Houston TX.

29 References Doidge, N. (2007) The Brain That Changes Itself. London, England: Penguin Books. Fogel, A. (1991) Developing Through Relationships. Chicago, IL: University of Chicago Press. Gopnik, A, Meltzoff, A. & Kuhl, P. (1999) The Scientist in the Crib. New York, NY: Harper Collins. Gutstein, S. (2009) The RDI Book. Houston, TX: Connections Center Publishing. Hobson, P. (2002) The Cradle of Thought. London, England: Pan McMillan Ltd. Rogoff, B. (1990) Apprenticeship In Thinking. New York, NY: Oxford University Press. Siegel, D. (2011) The Whole-Brain Child. New York, NY: Random House Publishing.

30 Further video resources (YouTube) Making Pudding with Dad (child aged about 8) A Mom uses laundry chores as remedial activities with her son! Same mom and child, learning to just hang out!