Inclusion of RDI Therapy in ATAA and State Insurance Legislation

  • Author:
    n/a
  • Send To:
    Co-sponsors of the Autism Treatment Acceleration Act (ATAA) bill, U.S. Senators, U.S. Congressmen, and State Legislators
  • Sponsored By:
    Championing RDI
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We, the undersigned, have signed this petition to demonstrate our strong support for 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 v. Family Supports for Children with Disabilities [FSCD] Appeal Panel Decision document).

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 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.

Tannock, R., Girolametto, L. & Siegal, L. (1992) Language intervention with children who have developmental delays: Effects of an interactive approach. American Journal on Mental Retardation 97, 145-160.

Hobson, J. A., Hobson, P., Gutstein, S., Ballarani, A., Bargiota, K. (2008, April) Caregiver-child relatedness in autism, what changes with intervention? Poster presented at the meeting of the International Meeting for Autism Research.

SUPPORT FOR RDI for improving overall functioning related to ASD:(outcome research: ADOS diagnostic category, special education placement, flexibility, joint attention)

Gutstein, S, (2005) Relationship Development Intervention: Developing a Treatment Program to Address the Unique Social and Emotional Deficits in Autism Spectrum Disorder. Autism Spectrum Quarterly, Winter, 8-12.

Gutstein, S., Burgess, A. & Montfort, K. (2007). Evaluation of the Relationship Development Intervention Program. Autism, 11, 397-411.

Hobson, J. A., Hobson, P., Gutstein, S., Ballarani, A., Bargiota, K. (2008) Caregiver-child relatedness in autism, what changes with intervention? Poster presented at the meeting of the International Meeting for Autism Research.

SUPPORT FOR RDI for systematically training parents with ongoing consultation and using the parent-child relationship as a natural context for child learning and growth:

Drew, A., G. Baird, S. Baron-Cohen, A. Cox, V. Slonim, S. Wheelwright, J. Swettenham, B. Berry, and T. Charman. A pilot randomized control trial of parent training intervention for pre-school children with autism. European Child & Adolescent Psychiatry 11, (2002): 266-272.

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.

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.

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.

McConachie H, Diggle T. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. J Evaluation in Clinical Practice. 2007 Feb;13(1):120-9.

McConachie H., Randle, V., Hammal, D., & Le Couteur, A. (2005). A controlled trial of a training course for parents of children with suspected autism spectrum disorder. Journal of Pediatrics 147, (3) (2005): 335-340.

SUPPORT FOR RDI for intervening in the child and familys natural environment by incorporating intervention into daily routines that account for caregiver needs and child functioning:

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.

Prizant, B. (2009). Creating a culture of family-centered practice for the autism community, Autism Spectrum Quarterly, Summer, 30-33.


The research evidence above is not an exhaustive list.

2853 Signatures

  • Laura B. DeAngelo
    • Parent, Relative and/or Professional Designation
    • RDI Parent, RDI Program Certified Consultant
  • Blair Armstrong
    • Parent, Relative and/or Professional Designation
    • Autism Consultant
    • Comment
    • As a professional in the field of Autism Treatment for over 15 years, it is hard to fathom that one therapy modality would be sponsored over others. Autism is a spectrum disorder and relies on the clinical relationship and judgement of the team surrounding the family/individual with autism to determine the appropriate therapy that each individual child requires. RDI is based on evidence and research in the field of autism and child developmental psychology, how the path of development occurs and has normed this against the pathway that Autism develops. By focusing on returning the child back to this neuro typical path of development with the parent as the primary guide and the child as the cognitive apprentice, you in fact build the mental processes that any child would need to be successful in our dynamic world. This approach has helped restore families to normalcy, shift the family system from crisis to competence and proven children can develop the dynamic mental processes needed for a quality of life
  • Kathy Darrow
    • Parent, Relative and/or Professional Designation
    • Parent and RDI Consultant in training
    • Comment
    • I am a parent of 4 children, in which two are on the spectrum. I have been involved with Autism and Autism therapies for over 10 years. I was introduced to RDI about 5 years ago, after I realized that my children's current therapies at the time were only fulfulling a short term goal of memorization and skills. Because I wanted the long term goals of problem solving and independant thinking, and ultimately a typical quality of life as an adult, I needed to look at more recent studies and treatments. In RDI, I found that restoring the typical path of development within my children would mean that they could function in a world that is ever changing. This understanding of the world around them and a reduction in behaviors typically associated with Autism due to feeling competent in their world had a huge impact on my family. So much so that I am now training to be an RDI consultant so that I can equip families to overcome the challenging behaviors of Autism.
  • Jennifer Paget, M.S.
    • Parent, Relative and/or Professional Designation
    • RDI Program Certified Consultant
    • Comment
    • I had been an educator focused on young children and their parents for 20 years when I first learned about RDI. I had encountered many children on the autism spectrum over the years. I was familiar with existing treatments. When I learned about RDI, however, I found a treatment that addressed everything I deemed critical in treating autism: addressing the core deficits of autism; preserving and strengthening the parent-child relationship; measuring success in terms of short and long-term quality of life; providing a systematic but dynamic, relationship-based curriculum that helps parents be and feel competent as parents; assuming that the brain is plastic and new neural connections can develop at any age. I lost no time in becoming certified! The change that moves me most is when parents tell me they have formed the kind of relationship with their child they had thought would never be possible. Autism treatment will continue to evolve. Legislation must open the door to a variety of options for families.
  • Janet L. Bowden
    • Parent, Relative and/or Professional Designation
    • Parent and Marriage and Family Therapist
    • Comment
    • I have worked in the field of autism personally for 22 years and professionally for 12 years. I have focused my work on helping people with autism related proficiently to others and be able to function optimally in society. I have researched autism treatments extensively and have implemented many within my own practice. None of them compares to the remarkable efficacy of RDI. It has been able to produce results with people I literally never thought possible. The training I have had to CONTINUOUSLY undergo to become and maintain my status as an RDI consultant was easily MORE rigorous and difficult than than the masters degree program I undertook for my counseling degree. The method is STRONGLY supported by modern, cutting-edge neuroscientific research concerning the impact of autism on the brain and it targets those deficits directly and effectively. I strongly believe it would be a tragedy to deny this modality anything but top recognition for its results and brilliance as a therapeutic modality.
  • Tamara Sepe
    • Parent, Relative and/or Professional Designation
    • Speech Language Pathologist
    • Comment
    • I have worked with children with autism and their families for over 10 years as a speech language pathologist. During that time, I was able to make some changes for the children I worked with, but I never felt I was getting to the heart of autism. RDI filled that gap, helping me to help families become competent in teaching their children real world skills for connecting and relating to other people. This is no gimmick or quick fix. The training was rigorous (more so than my masters degree in many ways) and families have to work hard, but the pay off is so worth it. I am watching children do things I never thought were possible to teach. Limiting families access to RDI (which is far less expensive than many other treatments) by omitting it in this legislation would tragically result in a great deal of unmet child potential.
  • Deborah Berrang
    • Parent, Relative and/or Professional Designation
    • Autism Consultant
    • Comment
    • I have worked with families for almost 20 years as an educator and as an autism consultant. During my teaching years I felt I helped children affected by Autism Spectrum Disorders make progress, but there was always a point at which we got stuck. When I learned about RDI I recognized the critical elements that were missing from the interventions I had been using. I went through the rigorous and ongoing training to gain and maintain my RDI certification. Now I am able to truly join families in making significant, lasting changes that help their children become competent, dynamic contributors to their life community. Every family and individual affected by ASD is different. No one model of intervention is right for every situation. Clinical experience, judgement, and knowledge of current research and evidence based practices can help each family determine the method that best meets their familys needs. Families deserve to have a choice. Legislation must open the door to a variety of options.
  • Susan Hudkins
    • Parent, Relative and/or Professional Designation
    • Parent and Professional
    • Comment
    • I am signing this petition for many reason, but the one that stands out as the most important at this time is that I want a choice for my children - like every other parent. I want to make mindful and well-educated decisions about what is best for my children. I want to know that when it comes to the development of my children, that I am still the one that makes the choices and knows what is best. Above all, I want to know that for my two sons with Autism, that I am doing everything possible to help them develop and have the highest quality of life possible, just like their sister. RDI gives me that ability.
  • Kimberly Kiernan
    • Parent, Relative and/or Professional Designation
    • parent
  • Lisa Palasti
    • Parent, Relative and/or Professional Designation
    • Parent
    • Comment
    • RDI helped remediate my son's autism, he is now functioning independently in school, he has friends and he is happy. He is 10 years old. Prior to RDI we tried ABA/VB for 3 years. We spent over $120,000.00 and we did not see the gains in 3 years with ABA that we did after 1 year with RDI at a fraction of the cost!
  • Diane Maitland
    • Parent, Relative and/or Professional Designation
    • Parent
  • Alicia Burns
    • Parent, Relative and/or Professional Designation
    • parent
    • Comment
    • RDI has been so much more effective for our two sons with autism than the behavioral therapies that we had done. So much more bang for your buck in terms of real-world functioning.
  • Susan Thomas
    • Parent, Relative and/or Professional Designation
    • Parent
    • Comment
    • Quite simply RDI has changed the life of my daughter diagnosed with autism and our family. We have seen tremendous growth and development and have tremendous hope for her future. RDI is a much more cost effective therapy with much better results.
  • Katherine Lee
    • Parent, Relative and/or Professional Designation
    • Parent and Professional
    • Comment
    • At this time, coverage for autism treatment needs to be broad, not limited to one treatment form.
  • Deirdre Hickey Sturm
    • Parent, Relative and/or Professional Designation
    • Professional
  • Karen Cody
  • Julie Tone
    • Parent, Relative and/or Professional Designation
    • Parent
  • Maureen Roberts
    • Parent, Relative and/or Professional Designation
    • Parent
  • Jennifer Lemke-Pawlak
    • Parent, Relative and/or Professional Designation
    • Parent
  • Carolyn Riviello
    • Comment
    • I am the mother of 2 boys on the autism spectrum and we have been an RDI family since 2006. The RDI program has empowered us as parents of these boys to remediate the deficits they have ourselves, something that is taken away from parents with many other autism treatment programs. We see a bright future for our boys and that is a direct result of RDI and the tremendous progress we have seen since we started.
  • Beth Croley
  • Debora Geary
    • Parent, Relative and/or Professional Designation
    • parent
  • Darlene Cooper-Perez
  • Jeff Hudkins
    • Parent, Relative and/or Professional Designation
    • Parent
  • David Riviello
    • Parent, Relative and/or Professional Designation
    • Parent
  • karla m. cavanagh
  • Kathy Weber
    • Parent, Relative and/or Professional Designation
    • parent
  • April Boden
    • Parent, Relative and/or Professional Designation
    • Parent
  • Amy Leventhal
    • Parent, Relative and/or Professional Designation
    • Psychologist
    • Comment
    • As a co-author of this petition with a strong group of multidisciplinary RDI professionals, I feel strongly about sharing this information about RDI with the broader community so that families from all over can choose RDI and it can be considered a viable, cost-effective, funded, evidence based practice for ASD.
  • Kim Cornell
    • Parent, Relative and/or Professional Designation
    • parent
  • Ellen De Angelo
  • James Groves
  • Michael DeAngelo
  • Mary Meadows Livingston
  • Barbara B. Burke
    • Parent, Relative and/or Professional Designation
    • Relative
  • Carol Tone
  • Ruth G. Thomas
    • Parent, Relative and/or Professional Designation
    • Relative
    • Comment
    • My granddaughter's life is and will be immeasureably improved as a result of her family's use of RDI
  • Edward Graham
  • Michelle Cohen
  • Melody Schaff
  • Ruth McGivern, M.A., CCC-SLP
    • Parent, Relative and/or Professional Designation
    • Parent and Speech-Language Pathologist
  • Laura Hynes, LMSW
    • Parent, Relative and/or Professional Designation
    • RDI program certified consultant
  • Jaime Bassman MS OTR/L
    • Parent, Relative and/or Professional Designation
    • Occupational Therapist
    • Comment
    • RDI is just as measurable as ABA if not more so, with 2000+ objectives broken into sub-objective categories etc. with progress measured and evaluated on a continual basis. At the same time, it addresses the incremental developmental stages leading to real world engagement in a way that ABA cannot. It is also the truest example of therapy in the "Natural environment" with parents carrying it over and feeling empowered for a lifetime. My son has had both RDI and ABA, and the RDI related gains are huge in comparison.
  • Timothy Hynes
  • Dr. Eric Kuelker
    • Parent, Relative and/or Professional Designation
    • Parent and Professional
    • Comment
    • As a psychologist and parent of child on the spectrum, I see tremendous value in RDI
  • Diane Cinami
    • Parent, Relative and/or Professional Designation
    • Parent
    • Comment
    • RDI has been a valuable remediation for our son and we would like to see it available to all individuals.
  • Carrie Sheppard
    • Parent, Relative and/or Professional Designation
    • parent and professional
    • Comment
    • My now-15-year-old son's life has been transformed as a result of RDI, in areas that other treatments did not touch. Additionally, as a professional who has now worked with more than 400 children on the autism spectrum, the individuals I have seen make the most meaningful gains are the ones whose families have remained devoted to their RDI programs. RDI allows for greater expansion in flexible thinking, connection with others and development of skill sets that are needed for success in the "real world." RDI should be covered on par with other legitimate autism treatments as a standard intervention for all individuals with ASD.
  • Moira Coakley
    • Parent, Relative and/or Professional Designation
    • RN
  • Lisa Strata M.S.,Ed
    • Parent, Relative and/or Professional Designation
    • Professional
    • Comment
    • The most rewarding job helping and teaching families vs. being the therapist to do the therapy!
  • Heather Honey
    • Parent, Relative and/or Professional Designation
    • Parent