This poster was shared at this years IMFAR conference... detailing the study out of Rowan University with side by side comparison. We are thrilled that research is being conducted and having RDI show the gains in joint attention. Colleen Gangemi is the RDI Certified Consultant involved in this study.
Monday, April 4, 2016
Are you the type of person who springs out of bed, ready to start the day, with a plan and purpose? Or are you more of the person who lays in bed uttering under your breath “please just 5 more minutes.” I think I fall somewhere in between. A huge factor to me was where I was in life…so I would absolutely without a doubt say when I was facing Autism head on…I would cling to my pillow trying to will the time to be wrong!
As I reflect, I know that it’s simply human nature to get up easier when you feel like you have a “good” day ahead. Defining a good day, now that is trickier. A spa day, Yes! A beach day, Yes! An IEP meeting, No!!!! My kids are older now but it does not take too much to reach back into my memory, when I was waste high in AUTISM, trying to figure out what to do with them…trying to make a day “good”
Ultimately, I was pretty successful when I ditched trying to make them behave how I thought they should, and instead focused on helping them to connect with me and their world around them. Amazingly enough, when I did this, they did behave. I was building in their own motivation to be with me, and not to try and get away from me.
I didn’t go it alone though. I dumped our existing program that heavily focused on compliance and behaviors and went with RDI ( Relationship Development Intervention) which focuses on building motivation to relate to other people. The basic focus was I wanted my kids to not want to stay in their own world, but to want to GROW and seek out challenges, with other people. This means, instead of them working for something ( object, etc) the EXPERIENCES was the work. Shedding the old way was quite liberating for this Momma.
Ok so as I spent a few years remediating Autism, ( and deciding if I should actually go get trained as a consultant) it was quite the mind shift to trust that when I help my child revisit developmental milestones, those skills I was working on with rewards, those skills would actually emerge when my child could make meaning and sense of the WHY we were relating to each other in the first place. I mean great, my kid can now ask me for juice, but does he want me to have some juice with him to share?
And it wasn’t easy. Thankfully I knew a few interactions, truly meaningful interactions where my son knew I was not just trying to get him to do something, but that I truly wanted to do it with him, helped him not want to control everything or take off at the thought of interacting with me!
To help this process in RDI, We call it Framing an activity. Choosing a goal ( given by an Consultant after an assessment) and choosing the activity that we could practice that goal.
Here is an example
Primary Objective- Co regulation of a pattern
Select an activity/prop - ____Putting silverware away__
Possible Obstacles Possible solutions
Trying to walk away Position yourself so that is difficult
Not referencing Pause and make a sound to add a moment
Not wanting to do it Keep activity short to start, the important part if child walking away with competence
For example, my son was super focused on controlling everything and objects so I framed this activity like this
Goal- co regulation…staying with his partner, recognizing and repairing when he and his partner are not together.
Activity, Moving pillows
Potential obstacles- walk away Potential solutions- stand closer and be on the outside
Potential Obstacles- not wanting to do it Potential solutions- short/end successful
Here is a sample-
When doing RDI each day, Those small connected moments meant more to me than any hour of drills. Thankfully I did not have to do RDI 24/7. I scheduled a few RDI times during the day to help my child in the process of seeking new experiences. To do this I had to introduce novelty into his day, as for him, I really could not compete with all his toys.
We stuck to a lot of social games, games where it was just he and I. I did not make him do anything at first, the only rule was he had to stay with me. When he saw It was safe, that I wanted him to make his own decision, he joined in! We also did a lot of chores where I would give him a role, like cleaning the windows, he was the sprayer and I was the wiper, then we would switch. The chores were not fun in itself, so this spotlighted for him, that I was the important part of what was happening. I made sure there was plenty of laughing happening. At first, I was the only one laughing, but soon, my son was able to match my affect. I knew he could, I knew he had it in him, even though I was told he was severely Autistic and would never talk. I just needed to give him opportunity to express it. That’s easy…its just not simple. I wanted to jump. I had to stop myself and just be IN the moment. I had to wait for his processing!
My experience, helped me to feel competent with incorporating RDI into many of my daily happenings.
There are moments everywhere. Close your eyes. You wake up, you brush your hair. You and your child can brush each others hair. You both can brush your teeth together. You can eat breakfast together, drinking together. If mornings are hectic, set time aside at night, to incorporate RDI into the nightly routine. Take the throw pillows off the bed together, get into your pj’s together. Each of these activities can be different depending on the goal. Mismatched Pj’s or breakfast for dinner for variations. Go for a walk. We love social games and changing the words to them to match your child. If you want to incorporate toys, I always made sure we each had something to do. That no one was controlling each other. In any activity I did with my child, I was never a passive command giver. We each had a meaningful part in what we were doing as an RDI activity. When something needed to get done quickly, that was not the time for RDI and I was ok for that. There was a time for everything.
For the families I work with, I tell them to choose 4 times in the day where you are not placing a demand on your child. Times that you can spend 5 minutes doing a simple activity. It can be any activity, but it should be framed. The goal can be just hanging out with no expectations. That way when you are tossing wash to your child, you are not trying to get it done…the goal is again, hanging out with no expectations. That means you can put the wash on your head, or your childs head. Help them EXPERIENCE the experience instead of looking at it like it is a task to complete and leave. We want YOU to be more of a draw then any electronic or object. Another goal could be gaze shifting. We don’t want eye contact from our kids, we want them to glance over at us and look at what we are looking at, and then look at us again…true curiosity and joint attention.
An RDI consultant can help you with goals that are unique to your child. Take those two goals I gave you, and try it! Write down 4-5 activities you are already doing in your day, that you could slow down, and include your child in. Sometimes a small portion of the activity if you are just starting. For example, if you are making cookies, your child could help put them on the tray. They could help take them off the tray. Break down these mini relating moments and slowly add, depending where your child is and how much they can tolerate. ( as they progress in RDI that tolerance builds and THAT is exciting). Reflect on how it went. What can you add for next time? Can your child tolerate a longer period of time? Was anyone trying to control the activity or was it even steven?
Autism makes us all feel not very competent. As you build on your own child’s competence, it’s a win win for them and for you.
Would love to hear from you if you have any questions or need some ideas! I have lists
More then 12 years ago, when I was first introduced to RDI, I asked the question what is RDI? The answer I was given made some sense, but I still didn’t get it. I heard things like, you slow down with your child, or you don’t ask questions. Great because fast and questions was my normal so why would I want to do RDI?! J I read articles and ultimately I did an entire blog called what is RDI to try and help answer that question. It’s here http://whatisrdi.blogspot.com/2012/08/details-on-rdi-program.html
In reality it’s hard to take what you read about RDI and not exclaim “ what does that mean for my family?” That is because RDI is not a program where you are trying to change your child’s mind through teaching behaviors or skills. Don’t get me wrong, those can be good goals. The difference is RDI is working WITH your child’s own mind, leading, guiding them to make new connections and discoveries that make sense to them, and that helps them to relate to others and learn from those experiences. Helping them learn through each interaction in the relationship. Frankly that looks a little different with each child an within every family. That is a good thing.
I believe there is entirely too much brain work being done in the field of Autism, where new connections are being made that are NOT fostering thinking and flexibility and a child’s own intrinsic motivation. They are not focused on relationships but instead on getting the child to do something with prompts and reinforcers. This is why the research is clear on how development unfolds and what our kids true obstacles are. Side note- Behaviors are just the symptoms. Think about what happens at age 21 if ONLY skills are taught?! You can teach a child a skill…but RDI is about teaching the child the function behind the skill…AND the skill. Cool thing is a lot of times when you help an individual relate to their partner in a new experience, skills emerge naturally. Those that don’t, you can then work on them. . I can tell you that when I focused on the motivation for my own kids, it helped me get off the hamster wheel of having to teach every single discreet skill. I was constantly amazed to watch my kids get things I never taught them, because they were picking it up by observing and monitoring, just like in typical development. They were back on their own personal developmental trajectory
Now, lets go over a few RDI strategies that are out there.. so the next time you hear “RDI is just about fill in the blank “or another professional says, “yes we sort of do RDI in our program”, you can have a reference to think about.
RDI is slowing down- We want to slow down our pace so that we are someone who our kids don’t feel like they have to avoid! Our faster pace can be a whirlwind for them, we want them to be able to take in what is happening around them and this takes longer at first until we can build up their processing speed. The more they feel competent, the more they are motivated to practice…the more they will seek out wanting to grow. Giving them the model during activities where you re not rushed, where you stop and say Oh I wonder what will happen if we do this, helps them to know that you will wait for their thought. The more this happens the less they will want to engage in self stimulatory behavior to avoid feeling incompetent. The truth of the matter is we ALL want to feel competent.
RDI is not talking- Behind this strategy is being mindful of your communication and how much talking we as parents do because we aren’t getting that same feedback. By not talking as much, we get to see other opportunities and are more in tune to the subtle non verbals going on. What I tend to see if parents think they cant talk is they start pointing to everything, which is just as much a prompt. Less talking helps with being more mindful that the talking in the interaction is not about the end result. You can definitely talk with RDI, we just prefer it be more Experience sharing language. Here is an example http://www.pathwaystreatmentcenter.org/declarative-vs-imperative/
RDI is not asking questions- This is just a continuation from above, again the process is just getting used to activities with an experience sharing Focus. You can ask questions.. you can ask questions you do NOT know the answer too. If you know the answer to a question, why ask it right? Example, what color is this? You know the color…so a more experience sharing way to communicate with your child would be, Ohhh I love this color and pause and see what they say. You have activated tons more brain neurons by helping your child relate to you before thinking about what color it is. Lets build plenty of engagement neural pathways! Boo to those static pathways.
RDI is videoing yourself and then you are told by your consultant what you did wrong. Self evaluation is the worse. I heard Johnny Depp never watches himself on film …so we are not alone. As an RDI consultant, I love to watch videos on how the interaction unfolded and how to change things up to see what would happen. This is called exploring and experimenting. Does it make you feel better if I were to say, I don’t think anything is wrong in a video? THAT is not the purpose. The reason for video is so that we can both see how the activity went down, and which milestones were in play…what the child has and what is an obstacle. It is not possible to be in an activity and also get the most of what to plan for next time/next activity. Video is a positive tool to help us really see all the subtle events happening moment to moment. Its common for a parent to say, Ohh I talked too much, or I didn’t wait long enough. I don’t see that as wrong because we want our kids to be flexible and be able to adjust in dynamic environments. However that reflection is a wonderful tool to help with planning in the next activity. Its not wrong, its just information to celebrate and build on.
RDI is saying we did it together after every activity- Research tells us that our brain is set to receive negative responses within seconds. This is because if a car is heading towards us our brain needs to say ‘GET OUT OF THE WAY”. For this reason, the brain can encode negative experiences and memories faster…. A sort of direct line. Contrast this with positive experiences. Ever hear someone say, “ let me stand here for a second and soak this in!” That is because it takes the brain longer to encode a positive memory. Given this information, we can see how many of our kids gravitate towards negative emotions and experiences. In RDI we spotlight the positive parts of any interaction,, during the activity, and want to end with something positive that the child takes away. We don’t want a child walking away not knowing what he got out of any interaction. By spotlighting, we are helping his brain see the positive. This is another reason we are not task focused in RDI, because we don’t want the focus to be on the task. This is why sometimes Ill tell a family to just involve their child in the middle of an activity and don’t worry about “finishing” with their child We want the takeaway to be the child relating to their partner. This is also why we tend to keep activities short in the beginning to begin to build more pathways for positive. Ending in a positive note is huge for encoding success for our kids. Its sounds simple, but once our child is interacting we want to keep going. Then ultimately if they disengage we have lost the opportunity to encode succees. Through video reflections we keep that edge of where they feel safe and competent growing and stretching so that interactions can be longer
RDI is doing chores around the house. The truth is chores can be used but so can play, social games, baking cooking etc. RDI is considered the untherapy because we actually are trying to insert your child into activities you are already doing. Social games and open ended activities are my favorite because it is harder to focus on the end task…and since I want the focus to be the experience of that is good. Chores are great because there is nothing reinforcing about putting silverware away or doing wash. That’s good too because it gives the opportunity to help both parent and child relate and focus on one another, giving each other a role. Yes Chores can be fun..anything can be fun when the focus is the relationship. If you are hearing Im bored or your child is walking away, it means the engagement has to be worked on.
This is just a glimpse of some of the strategies in RDI. These strategies are about optimizing the environment. When learning how to relate, prepping the environment for the goals and objectives that will be worked on is the crux of RDI. Your family and your RDI consultant team up with unique goals to increase engagement, Experience sharing and Growth seeking ( not afraid of new experiences and actually begins to prefer them over the same old same old)) Skills become part of the process once functions are in place, the why bother of skills.
That is when you see remediation. You see meaningful engagement ( where they observe not just engage with you to get their needs met) Gaze shift ( meaningful eye contact) Experience sharing- sharing perspectives and growth seeking ( wanting small manageable challenges/wanting to try hard things, over sameness/not having challenge)
If you do not currently have a consultant start practicing some of the above strategies to get you ready!
Saturday, April 2, 2016
Ok so its not like I was not parenting my children with ASD.. however it was quite different then parenting my “typical” eldest son and youngest daughter.
In some ways I was wonder woman super parent, researching, investigating and devouring books on the subject of Autism. I was becoming smarter in knowledge yet when it came to connecting with my son, I felt my only direction with him was to try and get him to do stuff and teaching him skills like looking at pictures and putting them in order, or counting, or reading. Mind you all good things…but ultimately he would do these tasks because he knew either there was a reward that followed or he knew when he got it done he could leave and go be by himself again… as a mom that did not give me warm and fuzzys! I was not relating to my sons and they were not relating to me. I mean there were moments, but I knew there could be much more…I wanted more. I did not want to accept what I have heard many times-“.well what do you expect, they have Autism.” Some may have called it denial, I called it persistence.
This continued for a few years. Ultimately when school proved to be challenging when it came to social interactions, thankfully I had come across a program that did not believe my sons were done and that there was much more I could help them with. It was a program where relating to others was a strong focus, that we learn through our experiences and this is the best way to foster not only engagement but also learning. I had discovered that we, well I in my quest to help my kids behave or learn, missed what research says about building motivation so relating to other people makes skills and learning flow naturally. At the same time, really helping my kids share experiences with me and want to know my perspective.
What I learned was my boys wanted sameness in those early years and we know that no two days unfold quite the same. After the meltdowns, tantrums, etc as we worked on those behaviors, they were getting less because I was putting them on extinction or not giving any negative reinforce. Success? Well not really, what was I teaching them? What replaced the behaviors was a greater desire to disengage which meant less motivation to actually have an experience with me…and more wanting to do their own thing. Basically avoiding me as much as possible unless there was a need. This meant I parented very differently with my 2 kids as compared with my other 2.. I started doing all the thinking, all the work in the relationship because I did not get any back and forth communication as with my other kids. I felt this on some level just could not put a clinical name to it.
That was until I learned about RDI in 2004… RDI stands for Relationshp Development Intervention. What is RDI? http://www.rdiconnect.com/about-rdi/
What I was experiencing when my 2 boys were little was not my own incompetence as a parent, although I definitely felt that way. I was experiencing the loss of the guiding relationship. What is it? http://www.rdiconnect.com/the-guiding-relationship-what-experts-say/ The Loss of the guiding relationship was making me feel incompetent! With typical kids, Guiding is what we do…so intuitively we don’t even know it. We guide them to monitor and learn about their environment and we guide them in make sense of the world and communication. Our typical kids know that our relationship with them is safe and they can take those small day to day changes with stride, and adjust, because they see the larger picture…. Their thought process is not tied to objects but instead to making meaning of what is going on around them through their relationships. They seek new experiences because of the excitement of challenge.. They are what we call Growth seekers in RDI. My kids with ASD, were not growth seekers…they were same seekers. Uncertainty made their world feel unsafe so they sought out keeping everything the same. I became really good at helping them do that to prevent a meltdown. That was an exhasting way to live since the world is constantly changing and shifting and the need to be flexible is crucial.
Fostering the desire to engage and the focus of building upon small challenges in very collaborative activities helped the process of revisiting milestones missed in development. This showed my kids the important piece is the experience, that attunement with another person, and helped them to be ok with unpredictability.
Engagement, Observing, social referencing, experience sharing, perspective taking, Multi channel communication and growth seeking are just a fe beginning foundations for RDI. These important mental processes began to restore the Guiding relationship for my family… and ultimately the success for both my children and their future!
Friday, April 1, 2016
Autism Speaks website says Autism is characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. The CDC says Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people.
ASHA says treatment may include any combination of traditional speech and language approaches, alternative communication, and behavioral interventions. If you look under treatments for Autism you see a wide vast array of options.
However, to the point, What does the evidence say is at the core of Autism? The repetitive behaviors, the difficulties in social interactions, they are symptoms but not the Core.
Even though research says Autism is a developmental disorder, most treatments look at symptoms like behaviors or language. The treatment is fixing behaviors. We know, because we see that individuals aging out of “behavioral treatments” for Autism are struggling with independent living and understanding social cues. With current information, looking at long term for our kids, we need to look at how to develop a mind and brain that can succeed in this society and lead meaningful independent lives. Programs that just address skills are putting a bandaid on the underlying core of what our kids need. Many times kids are prompted through their learning with token boards, but this is not real life preparation.
Our kids are not born without motivation, it just gets squashed because they are overwhelmed with making sense of the world. We need to activate that understanding through relationships and not replace this motivation with artificial rewards and token systems that have been shown to only be effective short term if at all. What are some core mental processes that we can build from the ground up? The evidence says the following functions are some of the core obstacles in Autism.
Our kids struggle with disassociating from their surroundings, so they tune out. They struggle with Monitoring that rapid constant information.
They struggle with reflecting on experiences and Experience sharing with others, aware as they are moving through life…to be able to use their internal world decisions, feelings etc. for their own self knowledge. They struggle with the dialogues in their heads to think through things and consider others perspectives, Recognize personal feelings…knowing what they dislike or what they like or are they just stuck in the familiar?
This Self awareness is huge because If you cant be aware of your own state, how can you understand that mental states of others? Thinking about what they are good at? Reflecting and using emotions as an effective tool to know how they are feeling
Many times because of this lack of self awareness, there are Negative monologues that they get stuck in
They struggle with Functioning in complex environments that have many different variations ( nothing unfolds the same way) They struggle to BE able to see the big picture…instead they focus on the small variations ( and get upset about changes)
This is why you can either change the brain to a more static way of learning by just focusing on behaviors or we can focus on functions and skills and help individuals make sense of the world which fosters brain changes for flexibility, and problem solving, and perspective taking, which also works on behaviors from the ground up. The later is what remediation looks like.
How to turn on this motivation and begin the process of remediation? Introducing just a small enough challenge where they are excited and not overwhelmed Providing experiences where there is challenge and a successful ending that they can encode as they did it…with THEIR COMPETENCE being their reinforce! The I did it Factor.
We want our kids to have the energy to want to engage and this takes getting your child comfortable with being with you with no expectations. This has to start short, slow and simple, ending activities successful. They cant learn about engagement if they aren’t with you. As activities get longer and more successful make sure you both have roles and create patterns in your interactions that help your child feel safe and competent. This connection will continue to build motivation, we want to give your child opportunities as moving towards the person ,eliminate the performance demand and sets up the environment for growth seeking.
The current research tells us that just addressing symptoms is not a long term solution. We want relationships and connection. Taking a look beyond JUST symptoms and getting to the core, to the heart of Autism and the obstacles that it causes for our kids prepares our kids to have success when it matters at 21 when all the prompting and reinforcers stop. Start building intrinsic motivation now for your child! That is the reality of the long term solution to help our kids be who they can be!
The RDI Program is an evidence based program that has a specific curriculum for motivation, experience sharing and revisiting developmental milestones.
Feel free to contact me at firstname.lastname@example.org and visit RDI's main site at www.rdiconnect.com