Congratulations to RDI Certified Consultant, Dr. Jessica Hobson and her co-authors Peter Hobson, Nicole Beurkens and Laura Tarveron on their newly published research article.

The Relation between Severity of Autism and Caregiver-Child Interaction: a Study in the Context of Relationship Development Intervention was published this month in the Journal of Abnormal Psychology.

The article is the culmination of a seven-year study that examined the relationship between parent-child interactions and the severity of autism in the children studied. The researchers focused on children and parents involved in Relationship Development Intervention and determined that there was improvement in the severity of autism that was specifically related to the quality of parent-child interactions.

Read more here!

http://link.springer.com/article/10.1007/s10802-015-0067-y

Is Dr Ed Tronick describing ASD or Chronic Stress?

The chronic experience of failure without
recovery has a catastrophic result:

1. [Unavailability] The infant establishes a self-directed style of avoidance behavior. (i.e. turning away, escaping, becoming perceptually unavailable) to control negative affect.
2. [Fearful responding] Avoiding potential negative affect becomes the infant’s primary goal and preempts other possible goals
3. [Loss of trust] With accumulation of failure, the infant develops a representation of himself as ineffective and of the caretaker as unreliable.
4. [Indiscriminate defensiveness] To the extent that these self-directed regulatory behaviours are successful in controlling the negative affect, the infant begins to deploy them automatically, inflexibly and indiscriminately.
5. [Pre-empting opportunities] Pathological behaviours develop which preclude the anticipated experience of negative affect, even in situations where it might not occur.

Dr. Edward Tronick, Harvard

A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders

Iliana Magiati, Tony Charman and Patricia Howlin

Article first published online: 19 JUL 2007

Journal of Child Psychology and Psychiatry
Volume 48, Issue 8, pages 803–812, August 2007

Keywords:
Autism Spectrum Disorders (ASD);Early Intensive Behavioural Intervention (EIBI);autism-specific nursery provision;outcome

Background:  This prospective study compared outcome for pre-school children with autism spectrum disorders (ASD) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions (EIBI) in a community setting.

Methods:  Forty-four 23- to 53-month-old children with ASD participated (28 in EIBI home-based programmes; 16 in autism-specific nurseries). Cognitive, language, play, adaptive behaviour skills and severity of autism were assessed at intake and 2 years later.

Results:  Both groups showed improvements in age equivalent scores but standard scores changed little over time. At follow-up, there were no significant group differences in cognitive ability, language, play or severity of autism. The only difference approaching significance (p = .06), in favour of the EIBI group, was for Vineland Daily Living Skills standard scores. However, there were large individual differences in progress, with intake IQ and language level best predicting overall progress.

Conclusions:  Home-based EIBI, as implemented in the community, and autism-specific nursery provision produced comparable outcomes after two years of intervention.

“Studies, yes,” he wrote in the preface, but “why stories, or cases?” Because, he explained, the understanding of disease cannot be separated from the understanding of the person. They are interwoven, and this has been forgotten in our era of scans, tests, genetics, and procedures. He compared the modern clinical practitioner to the man who mistook his wife for a hat—able to register many details yet still miss the person entirely. “To restore the human subject at the centre—the suffering, afflicted, fighting, human subject—we must deepen a case history to a narrative or tale,”

Oliver Sacks was like no other clinician, or writer. He was drawn to the homes of the sick, the institutions of the most frail and disabled, the company of the unusual and the “abnormal.” He wanted to see humanity in its many variants and to do so in his own, almost anachronistic way—face to face, over time, away from our burgeoning apparatus of computers and algorithms. And, through his writing, he showed us what he saw.

Sacks had asked me whether I’d read Forster’s “The Machine Stops.” I hadn’t, but his letter prompted me to, and I see why he was so drawn to it. It’s about a world in which individuals live isolated in cells, fearful of self-reliance and direct experience, dependent on plate screens, instant messages, and the ministrations of an all-competent Machine. Yet there is also a boy who, like Sacks, saw what was missing. The boy tells his mother, “The Machine is much, but it is not everything. I see something like you in this plate, but I do not see you. I hear something like you through this telephone, but I do not hear you. That is why I want you to come. Pay me a visit, so that we can meet face to face, and talk about the hopes that are in my mind.” ♦

By ATUL GAWANDE

Congrats to all of the authors on recent RDI studies. Our side of the field is producing quality research that is the impetus for us being included in the new MCFD Under 6 Funding handbook (Page 28) here in British Columbia along with our colleagues in DIR/Floortime and other Social Pragmatic-Developmental approaches. They can no longer say we lack ‘evidence’ or ‘research’, in fact ours seems to be growing and stronger than other approaches that have yet to provide a replication of their decades old so-called ‘gold standard’ research. We have arrived.

Here are just a few samples of what has been published:

Article

Abstract

The aim of this study was to examine the relations between severity of children’s autism and qualities of parent-child interaction. We studied these variables at two points of time in children receiving a treatment that has a focus on social engagement, Relationship Development Intervention (RDI; Gutstein 2009). Participants were 18 parent-child dyads where the child (16 boys, 2 girls) had a diagnosis of autism and was between the ages of 2 and 12 years. The severity of the children’s autism was assessed at baseline and later in treatment using the autism severity metric of the Autism Diagnostic Observation Schedule (ADOS; Gotham et al. Journal of Autism and Developmental Disorders, 39, 693–705 2009). Although the ADOS was designed as a diagnostic measure, ADOS calibrated severity scores (CSS) are increasingly used as one index of change (e.g., Locke et al. Autism, 18, 370–375 2014). Videotapes of parent-child interaction at baseline and later in treatment were rated by independent coders, for a) overall qualities of interpersonal relatedness using the Dyadic Coding Scales (DCS; Humber and Moss The American Journal of Orthopsychiatry, 75, 128-141 2005), and b) second-by-second parent-child Co-Regulation and Intersubjective Engagement (processes targeted by the treatment approach of RDI). Severity of autism was correlated with lower quality of parent-child interaction. Ratings on each of these variables changed over the course of treatment, and there was evidence that improvement was specifically related to the quality of parent-child interaction at baseline.

The Relationship Development Assessment – Research Version: Preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism

Abstract

The aim of this project was to replicate and extend findings from two recent studies on parent-child relatedness in autism (Beurkens, Hobson, & Hobson, 2013; Hobson, Tarver, Beurkens, & Hobson, 2013, under review) by adapting an observational assessment and coding schemes of parent-child relatedness for the clinical context and examining their validity and reliability. The coding schemes focussed on three aspects of relatedness: joint attentional focus (Adamson, Bakeman, & Deckner, 2004), the capacity to co-regulate an interaction and the capacity to share emotional experiences. The participants were 40 children (20 with autism, 20 without autism) aged 6–14, and their parents. Parent-child dyads took part in the observational assessment and were coded on these schemes. Comparisons were made with standardised measures of autism severity (Autism Diagnostic Observation Schedule, ADOS: Lord, Rutter, DiLavore, & Risi, 2001; Social Responsiveness Scale, SRS: Constantino & Gruber, 2005), relationship quality (Parent Child Relationship Inventory, PCRI: Gerard, 1994) and quality of parent-child interaction (Dyadic Coding Scales, DCS: Humber & Moss, 2005). Inter-rater reliability was very good and, as predicted, codes both diverged from the measure of parent-child relationship and converged with a separate measure of parent-child interaction quality. A detailed profile review revealed nuanced areas of group and individual differences which may be specific to verbally-able school-age children. The results support the utility of the Relationship Development Assessment – Research Version for clinical practice.

http://www.rdiconnect.com/new-reaserch-supporting-rda-in-clinical-practice/

The development of a sense of self is a process that begins through the emotionally based relationship between parent and child from birth (and some would argue prior to birth based on exciting new research on prenatal-maternal development). It is described beautifully in Peter Hobson’s seminal work ‘Cradle of Thought’. Within the early parent-child relationship, the dance of ‘intersubjectivity’ (between us, subjective)(Fogel) begins to unlock our genetics based on our experiences which are primarily affective (emotional-non verbal) and sensory based. This process is universal and happens in every culture since the beginning of human history. This intuitive process is what Barbara Rogoff (Apprenticehsip in Thinking) has described as the ‘guided participation relationship’. It is through this guiding relationship that mental development and development of a sense of self begins to form, first within the coregulatory intersubjective parent-child relationship, then internalizes as a gradual mental transfer of responsibility occurs from parent to child and finally becomes strengthened as the child becomes more self aware, self reflective and able to self regulate (sense of self) and is able to practice their new capacities in the self-other relationship with trusted adults and within peer relationships. This is one of primary focuses in RDI, to re-establish the emotionally based intersubjective guiding relationship to begin to allow for the guided mental development of a sense of self. This process cannot be taught as a skill or behaviour, it is a process and needs to be deliberately redone by training teh primary agents of change in a child’s life, ‘their parents’.