RDI workshop and activities for non-verbal kids - Jimjams and others

[Saker]

We are currently attending the 4-day RDI (relationship development intervention) workshop this week. We have done three days out of four and it is really good. Everything about the technique makes loads of sense and we have seen a lot of video clips etc of it in action and the positive effects it can have.

I know there has been some discussion about whether it is suitable for non-verbal children and severely autistic children and I wanted to report back what we have seen. Dr Gutstein (whose brainchild it is) is adamant that it is actually easier to work with non-verbal children rather than verbal ones in the first instance because the language doesn’t get in the way or distract them. The sort of activities you start off with are similar for both verbal and non-verbal kids, just tailored more to the individual child. They are very simple “regulation” activities which help the child to see a pattern into which you start to introduce variations. For example – putting laundry into the laundry basket – you might do this with your child hand over hand making a different noise every time you do it, inserting pauses at unexpected moments etc. Another child we saw on the video was pouring water into a bottle hand over hand with his mother. Basically you can do any activity that is simple enough for your child to succeed at - the activity itself isn't relevant but the idea is to give your child the feeling of competence and to learn to regulate their behaviour in response to yours. Oh it's hard to summarise everything we've seen and all the theory but it is very clear to me that it is no different for non-verbal or verbal children. They have moved way beyond the sort of activities described in the RDI book. I just wanted to feed this back for people who are interested.

It is interesting to me about the motivation and the ability to do it because Ds2's salt said to me the other week that she believed that if he really wanted to do something it actually overcame some of his motor difficulties and helped him to do it. But if he wasn't well-motivated he just couldn't push himself that extra step. She didn't just mean that he didn't try because he wasn't interested but that the extra motivation maybe actually physically helped him to do it, a bit like a sportsman keeping going with a terrible injury or something. It does sort of make sense for him because he has quite poor fine motor skills and can't seem to hold a pen properly or even scribble yet he can just about stick pieces of lego together. He finds it hard but he really wants to and he has a lot more success relatively.

But normally developing children have fully functioning mirror neurones. Many autistic children don't. So how do you get round the brain damage? This is why I get the impression its going to work with some children and not others- depending on the amount/type of brain damage you have.

The recent research on mirror neurones is showing that the ability to understand others is impaired - in a neurological sense.

See for example \link{http://www.sciencedaily.com/releases/2004/12/041219181405.htm\here}

Now personally I think that autism is a collection of different disorders, and that some autistics may have well functioning mirror neurones, some will be completely buggered and some somewhere inbetween it's interesting in that little link how they make the link between imitation and language learning- and that's why I think there is often a fundamental difference between the "properly" non verbal (by which I mean not including all those just 3 year olds who would eventually talk whatever you did with them) and those who are higher functioning.

Although thinking about it there could be some exceptions- Roz Balckburn for example- very verbal, but I suspect unable to interpret other actions.

I don't know- I just get a feeling that RDI can be potentially helpful once you have certain skills in place, but if you don;t have those its not going to teach them.

But Ds2 can talk and he doesn't interpret any actions or expressions! My head is practically falling off with the amount of vigorous shaking and nodding I have been doing over the last few days trying to get him to understand yes and no non-verbally. And I have always understood that to be a huge problem for a lot of children with Aspergers and dyspraxia that they are not understanding that someone is getting bored, angry etc so they don't modify their response accordingly.

I can see how you might be sceptical that that deficit can be corrected but I do think it is a major problem for most children with autism, whether high or low functioning. It may be easier to teach higher-functioning kids by rote that this expression means angry or this gesture means look over there but I think that information can still be hard for them to use.

I asked Gutstein if he believed there was an actual physiological neurological rewiring as part of RDI and he said yes, so maybe he would argue that if those neurones are damaged or absent they can repair or be rewired?

But I think that is different from not being able to interpret that me putting a cup onto a table is the same action as if he puts a cup onto a table.

Certainly mirror neurone functioning can be improved by training, but the only way ds1 has learned to imitate anything (whether how to drink out of a cup, or puta toy tomato in a box, or clapping hands) is hand over hand, with fading prompts and reinforcers. It's related, but a long way from not being able to interpret sad etc.

I'm off to bed, but an interesting post has just come through on RDI-UK- am watching for the replies!

yes I just saw that and thought this could be interesting!

It's interesting what you are saying and I have seen some studies suggesting that ability to copy motor actions is a predictor for language in ASD. Ds2 has pretty strong dyspraxic signs and can't copy actions but he is quite good (although not brilliant) at copying verbally. We were practising his speech therapy exercises at the weekend and he can copy what I am saying although not always perfectly and the actual clarity is poor. So it may be that his ability to imitate is not influenced by mirror neurones but by poor motor planning and that is why his speech is so ahead of his motor skills. But I think I am right in saying your Ds1 is dyspraxic also so it's possible that makes it more difficult for him.

I do find it all fascinating in its own right outside of my interest in it for Ds2's sake.

does your ds "get" copying though? I mean if you say copy this- will he try- even if he can't do it well? Ds1 doesn't even understand what it is, he really doesn't have any concept of imitation (well that;s not quite right, he does have some following ABA- but its very patchy). i must go to bed!

Saker sounds like you have grasped RDI far quicker than I, whilst our consultant was her I introduced him to some other families and he was trying to emphasise the basis of RDI by explaining how a 9 month old baby (one of the mums has brought with them) was spontaneously referencing their mum for enjoyment/reassurance etc.

JJ I got v.confused with referencing and regulating initially, our consultant sat and popped up a huge glove puppet clown with an excited "isn't this funny" expression on his face,dd showed no emotion, (he could have been holding up an empty hand) I initially thought she wasn't referencing but she was, she wasn't regulating herself to show him that she was sharing in his amusement of the puppet IFKWIM.

If your ds enjoys peekaboo/teasing he must be referencing to some degree perhaps just not regulating his response accordingly, referencing isn't about imitating you it's about a spontaneous response of anykind to show he is sharing/enjoying the moment of excitement.

Do you think he uses teasing mode to distract from the activity? if he appears to do it knowingly. If you were trying an RDI activity and he showed non interest ie. running/jumping modes I would try holding on to him/hugging,rocking,swaying,singing simple songs,if he gets tuned into you try engaging him and going for a simple shared excitement ie. sing favourite song eg. teletubbies hesitate before "po" with a big (sometimes) shared smile.
You could also try productive uncertainty to overcome non compliance.

In any case it's a very difficult transition to make from ABA, you would certainly be encouraged to reduce direct prompts and keep activities similar to how you would with ABA short/discreet trials.

Just seen you mirror neurones link JJ (yep still awake with bloody arthritus) v.interesting,the "weaker activity" described in the ASD study has really struck a chord, the more I work with dd using RDI the more it seems I am working on a "weak muscle" (to quote RnB) even to the point if I let RDI slip for a few days the muscle I am working on with dd gets weaker again!
Must try and get some rest for my weak muscles:o

He teases to interact- it's a social thing for him, he can't sit down and have a conversation with us, so he teases.

This morning has been typical (although a bit extreme). We woke to the sound of giggling- he'd wet his bed and thought that was hilarious (knows he's not allowed to). Eventually came running up and climbed into bed with me- launched onto my face with a "ayown" (hads down) and proceeded to pretend to pinch, do little pinches repeatedly until I got up. We came downstairs where I made ds3's breakfast and he repeatedly interfered. So he kept holding his hand out - just above but not quite touching- ds3's food whilst giggling manically.

I know referencing and imitation are different- but what I'm saying is that because ds1 can't imitate he can't begin to understand someone's actions. Pyhysical actions, not just emotions. It's not that he can't imitate accurately- it;s just that he doesn't even know what it is. So if I say "look do it like this" he doesn't know how to look at what I am doing and then try and apply it to himself, he doesn't even know that you can do that. Once you've got that stage- then yes I can see that you can begin to use RDI, but without that? How? (Incidentally this doesn't just apply to autism- there is a rare condition where people lose their sense of proprioception- they can't map their own body unless they can see it- and they also find it difficult to understand others actions).

His non-compliance is usually compulsion related. So he suddenly thinks, oh I just want to go and look at the bathroom window with my head on one side, or I just want to go and stare at the microwave. That's a another reason why ABA can work so well with him. The structure means he knows how long he has to switch his compulsions off. Trying to hug him in those running circumstances wouldn't work because he would just struggle and scream to go off and complete the compulsion. Being physically prevented seems to heighten the need. Sometimes he can be talked around, "x first, then door" whatever works quite well- he is beginning to be able to control his compulsions himself, but he does not like being physically prevented.

This has all got far too technical for me! There seems to be a lot of "Gutstein says", "Gutstein believes" etc which all sounds like speculation to me. I heard years ago that it is believed that neurological pathways that are missing can be stimulated or (re)wired using ABA although as far as I know there is no hard evidence for that.
DS is very good at imitating, although he had to be taught it with ABA, he also likes to tease and interact etc although usually only with adults.

Davros

The reason I say "Gutstein says" etc is because I am hesitant to state what I have learned at the workshop etc as set in stone when I haven't actually read it myself. To be fair to Steve Gutstein he has done extensive reading - each section of notes we have is supported and referenced and there are a total of 565 references to work published on autistic spectrum and normal devlopment in the seminar booklet we have got.

It isn't surprising if you can rewire the brain with ABA or RDI as the whole process of learning and development involves growth and development of new neurological pathways and you would expect whatever you do will have some impact on that.

Jimjams

Ds2 can't imitate physically at all really. He finds that really really hard and doesn't seem to have a clue how to go about it. But he has bad proprioception and motor planning and this may impact on that a lot. He did learn to use a cup by himself but he still hasn't learned many many things even like taking off shoes.

I think the idea of the regulation activities in RDI would be to teach your Ds1 to first self-regulate, then regulate with respect to someone else. That would enable him to control his impulses but also the idea is that it also means he wants to do it less as he works through RDI.

Monica, can I borrow the RDI DVD? I've been meaning to look at it for ages. It's all sounding very technical to me too!
Jimjams, DD can't imitate. Finds it totally meaningless. We're trying to get her into it using activity boards so she has to copy a certain switch or whatever and musical instruments, all in trial format with reward, of course. Hope you feel better Monica
ps Your DS sounds like such a monkey Jimjams!

I do have a great video clip of ds1. Second session of ABA. "DO this" and a toy tomato went into a box. DS1 ignored, was fully prompted etc. Then suddenly one one trial "do this", a sly, wicked smile came onto his face and he breezily picked the toy tomato up held it out without looking at it and just dropped it from an outstretched arm into the box. Hit tutor went wild, picked him up in his chair, (chair as well) and leapt around the room with him. First thing he ever imitated.

It has given him the idea, but it's nowhere near fully developed. JakB - I always think your dd sounds similar to ds1. How's school going for her? Have you had your AB visit yet? :o

I don't know how she did it! Afterwards he was jumping up asking her to pick him up again- and brought her his chair. I had been a bit concerned about ABA (heard all the rubbish that is said), but when I saw that I realised how good it could be :-)

snap- the problems of a passive child. Also the opposite probem- not much that is really hated, which can make it difficult to intorduce consequences for bad behaviour.

Imitation isn't worked on in RDI (as a bevioural skill) the nearest objective in RDI I would say is "Referencing for Instruction "(Attends and observes carefully to learn appropriate role actions, while participating in parallel/complementary activities ie. stacking/blocks/block in bucket etc. This objective is in "Stage 2: Social Referencing". A child would have to have achieved the objectives in "Stage 1:Emotion Sharing" (which involves attending the coach/face to face gazing to intensify joy/excitement etc.)before attempting this.
The idea would be, once a child has learnt the 8 objectives in Stage1, (emotion sharing) if asked to imitate by referencing you face for instruction, ie. you put block in bucket, the child attends,observes,references to check what his role is in the activity, you would non verbally move the block nearer to the child glance at him then at the bucket (no verbal/physical prompt).
Tried to make that as none technical as poss btw :o I do understand where you are coming from JJ and think I'm out of my depth trying to help you tbh, but if you ever get to do an online chat with Dr Sheeley I would v interested in her reply.

JakB our dh's ex colleague JS still has the dvd, your first on this list as soon as we get it back! Don't be put off by the technicalities btw, you and dh do loads of emotion sharing activities with dd as well as in your fab VB programme. In fact last time I was round dd wandered in you grabbed her hugged her and whilst rocking singing (her name etc.) you raised your voice at the key point of the song (that would be the spotlighting on the emotion sharing bit) dd loved this bit and referenced your face. Also all the rough and tumble stuff dh does with her/therapists anticpation games, waiting for dd to reference before repeating the leg lifts/grabbing hands etc.

Socci you can see from above that lots of the activities can be worked on during normal day to day interactions rather than setting out a time as with ABA.