Inclusion of RDI Therapy in ATAA and State Insurance Legislation sign now

We, the undersigned, have signed this petition to demonstrate our strong support for recognizing the position of Relationship Development Intervention (RDI) as a cost effective, research guided, and evidence-based intervention approach for remediating Autism Spectrum Disorders (ASD). This petition was originated in response to the pending Autism Treatment Acceleration Act (ATAA) bill but can and will be sent more broadly to federal and state legislators, regional centers and other state and federal administrative bodies, insurance companies, school districts and any other organizations or individuals who are seeking to determine or influence the selection and delivery of best autism practices. Recent governmental decisions have supported RDI as meeting best practice criteria. For example:

"The FSCD Panel finds it to be a fact that the rehabilitative practices, strategies and approaches upon which RDI is based are established, reasonable, least intrusive and demonstrated to be effective. According to Dr. Darcy Fleming's [Quality Control Analyst for Alberta's Family Supports for Children with Disabilities program] analysis of RDI, "RDI teaches parents strategies to promote and engage in experience sharing opportunities with their child. Through enhanced parent/child interaction the child is taught to develop 'relationship intelligence'". During his verbal testimony, Dr. Fleming acknowledged that RDI is "based on practices that are commonly used". The FSCD Panel finds that RDI is based on parent/child interaction and naturalistic teaching. These are the oldest methods of teaching known to man. To suggest that they are not established, reasonable, least intrusive and demonstrated to be effective would defy both logic and common sense" (HATT FSCD Appeal Panel Decision document, 2006).

Each of us has in some way experienced the powerful effectiveness of RDI treatment either in our clients that we serve, our own children, our relatives or the children or other family members of loved ones and friends. We speak now with one voice to ensure that RDIs effectiveness and efficiency is recognized by those upon whom the families of our state and country depend for continued support and funding and insurance coverage. If this powerful treatment is not recognized as a covered intervention in the Autism Treatment Acceleration Act and other federal and state insurance reform initiatives, many families will lose access to RDI Programs already in progress, programs that already have shown benefit in remediating the childs autism; further, many families will be denied access to RDI altogether.

The purpose of RDI is to develop intersubjectivity, the agreed upon core of autisms social and communicative deficits (Baron-Cohen, 2000). Intersubjectivity subsumes joint attention, social referencing, theory of mind, social reciprocity, and communication for experience sharing purposes. RDI has a foundation of research and theoretical support, and a growing body of empirical evidence for its practices.

RDI is also a unique treatment in its holistic and comprehensive focus on preserving the integrity and influence and involvement of the family in treating its member with autism. RDI is a program that trains Guides (usually parents but sometimes relatives or other adults involved intimately with a family) to interact intersubjectively and remedially with the affected person on an ongoing basis, all day long.

Based on comprehensive reviews of ASD treatment research, expert consensus is that no evidence exists that any one approach is better than any other approach (National Research Council, 2001; Rogers, 2006; Goulden, 2006; Fleming, 2006; Prizant, 2009). Further, the field of study of ASD is still very early in the process of determining what kinds of interventions are most efficacious for whom, for what, and when (Rogers & Vismara, 2008). Consequently, applying an evidence-based practice (EBP) approach, espousing a combination of the best available research, clinical expertise, and patient characteristics and preferences (APA 2006) for decision making becomes ever more critical for treatment decision making for ASD (Twachtman-Cullen, 2009). The RDI program has peer-reviewed evidence to support its efficacy for children with ASD (Gutstein, 2005; Gutstein, Burgess & Montfort, 2007; Hobson, Hobson, Gustein, Ballarani, & Bargiota, 2008) and further studies are in progress. A broader examination of the literature demonstrates a growing body of empirical research evidence and best practices recommendations supporting the practices embedded in RDI. Specifically, RDI is a family-centered, intensive, objective driven, individualized intervention targeting the developmental components and processes of joint attention and social communication in the context of the parent-child relationship. The summary below outlines the evidence supporting core components of RDI, reflecting why it is a viable and desirable EBP for treating ASD.

SUPPORT FOR RDI in remediating the core deficits of autism in a developmental progression (e.g. joint attention, social communication, and theory of mind)

Aldred C, Green J, and Adams C. (2004). A new social communication intervention for children with autism: pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology & Psychiatry and Allied Disciplines; 1420-30.

Mahoney, G., and F. Perales (2004). Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study. Journal of Developmental & Behavioral Pediatrics 26, 77-85.

Jones EA, Carr EG, Feeley KM (2006). Multiple effects of joint attention intervention for children with autism. Behavior Modification. Nov 30 (6):782-834.

Schertz, H.H., Odom, S.L. (2007). Promoting joint attention in toddlers with autism: a parent-mediated developmental model. Journal of Autism and Developmental Disorders. Sep; 37(8) pp. 1562-75.

Solomon, R., Necheles, J., Ferch, C. & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program. Autism 11, no. 3 (2007) 205-224.

Howlin, P. (2008). Can children with autism spectrum disorders be helped to acquire a theory of mind? Revista de Logopediay Audiologia, Vol 28, 7, 74-89.

Whalen, C. and Schreibman, L. (2003). Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry 44 (3) 456-468.

Kasari C, Freeman S, Paparella T. (2006). Joint attention and symbolic play in young children with autism: a randomized controlled intervention study Journal of Child Psychology and Psychiatry. 47(6) 611-20.

Siller, M. & Sigman, M. (2005). Modeling longitudinal change in the language abilities of children with autism: parent behaviors and child characteristics as predictors of change. Journal of Developmental & Behavioral Pediatrics. 26(2)77-85.

Keen D, Rodger S, Doussin K, Braithwaite M. (2007) Pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism. Autism, 11 (1), 63-71.

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Yvette MercerBy:
SustainabilityIn:
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ATAA Committee Members, Senators, Congressmen and State Legislators

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