Clinical Utility of the Relationship Development Assessment - Research Version (RDA-RV) for Children with Autism in a Preschool Setting

Background: Recent studies have demonstrated the reliability and clinical utility of the Relationship Development Assessment - Research Version (RDA-RV) for assessing quality of parent-child interaction among children with autism and their caregivers. The RDA-RV has been strongly associated with calibrated severity scores on the ADOS, and shown sensitivity to change in parent-child dyads taking part in Relationship Development Intervention (RDI). However, to date, clinical comparisons on the RDA-RV between matched children with and without autism have been limited to a school-age, verbally able sample. These comparisons revealed areas of strength (e.g. sustaining coordinated attention) alongside areas of weakness (e.g. rigid co-regulation, and action-focused interpersonal engagement) for verbally able school-age children with autism and their parents.

Objectives:  The first aim of this study was to compare matched groups of young children with and without autism, attending a developmentally-based preschool, on the RDA-RV. We predicted that the RDA-RV would reveal areas of difficulty in coordinated attention, co-regulation, and interpersonal engagement. Our second aim was to ascertain whether the RDA-RV revealed patterns of change in a subset of the children with autism, those who (with their parents) received Relationship Development Intervention in a preschool setting.

Methods:  The study included 32 children, between the ages of 3 - 6 years, and their parents. There were 16 children (8 girls) who were diagnosed with developmental disabilities but did not show features of autism, and a matched group of 16 children (7 girls) with a previous diagnosis of autism. At the beginning of the school-year, children were administered the ADOS, RDA-RV (a semi-structured play-based assessment of parent-child interaction), and a language assessment. The children with autism were in two separate classes (each class n = 8) in the same preschool. One of the classes added RDI to the daily curriculum. RDI was delivered within the classroom, and via parent sessions provided on site throughout the school year. At the end of the school year, all of the children with autism (and their parents) were assessed again, with the ADOS, RDA-RV, and a language assessment.

Results: Coding on the RDA-RV is underway, and is being conducted by two experienced researchers blind to the diagnosis and clinical status of the children. Children with autism made gains in their language over the course of the school year (RDI, M = 9 months; non-RDI, M = 7 months). On a group level, ADOS calibrated severity scores remained stable, although there was also individual variability among the children. 

Conclusions: Results of the present study should prove useful in extending previous results of the RDA-RV downward to a younger, more language-impaired, sample of children with autism.  Profiles on the RDA-RV in these children, compared with matched developmentally delayed children without autism, will be helpful in elucidating the specific effects of autism on quality of parent-child interaction. In addition, the RDA-RV may reveal improvements in quality of parent-child interaction when this is a treatment focus.