The relationship development assessment - research version: preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism.

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.

Empowering families through Relationship Development Intervention: an important part of the biopsychosocial management of autism spectrum disorders.

BACKGROUND: Relationship Development Intervention (RDI) is a program designed to empower and guide parents of children, adolescents and young adults with autism spectrum disorders (ASD) and similar developmental disorders to function as facilitators for their children's mental development. RDI teaches parents to play an important role in improving critical emotional, social, and metacognitive abilities through carefully graduated, guided interaction in daily activities. METHODS: The paper reviews RDI's theoretical underpinnings, current methodology and preliminary research results. The clinical utilization of RDI is discussed as an important part of the biopsychosocial management of ASD. RESULTS: Although a controlled, blinded study of RDI has yet to be done, preliminary research suggests that parents, through the RDI curriculum and consultation process, have the potential to exert a powerful impact on their ASD children's experience-sharing communication, social interaction, and adaptive functioning. CONCLUSIONS: RDI should be considered as part of a comprehensive treatment regimen, in which the physician plays a clinical management role, providing medical and psychiatric consultation. The RDI clinician can function as a remediation specialist, providing accurate feedback to the physician, along with individualized training and guidance to family members.

Evaluation of the relationship development intervention program.

This study is the second in a series evaluating the effectiveness of Relationship Development Intervention (RDI) to address unique deficits inherent in autism spectrum disorders. RDI is a parent-based, cognitive-developmental approach, in which primary caregivers are trained to provide daily opportunities for successful functioning in increasingly challenging dynamic systems. This study reviewed the progress of 16 children who participated in RDI between 2000 and 2005. Changes in the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R), flexibility, and school placement were compared prior to treatment and at a minimum 30 month follow-up period. While all children met ADOS/ADI-R criteria for autism prior to treatment, no child met criteria at follow-up. Similar positive results were found in relation to flexibility and educational placement. Generalizability of current findings is limited by the lack of a control or comparison group, constraints on age and IQ of treated children, parent self-selection, and parent education conducted through a single clinic setting.

Quality of Life for People with Autism: Raising the Standard for Evaluating Successful Outcomes.

Quality of Life (QoL) is a critical measure of treatment outcome for people with mental and physical health concerns. However, little research has been conducted toward evaluating outcomes in autism by utilizing real-world measures, such as employability, self-sufficiency, and social support to gauge treatment success, despite longitudinal research that indicates poor outcomes for people with autism. Utilizing QoL indicators as the standard for developing treatments and evaluating outcomes in autism is advantageous. After a brief description of the domains and indicators comprising QoL, this paper reviews the literature describing the course of autism, followed by an examination of indicators which contribute to QoL for people with autism in particular. In conclusion, a model for utilizing QoL indicators to measure and evaluate outcome for people with autism will be proposed.