Preliminary Efficacy of Relationship Development Intervention® and Parent-Implemented Applied Behavior Analysis/Verbal Behavior on Joint Attention and Communication of Preschool Children with Autism

Background:  Acquiring joint attention (JA) and functional spoken language by the time a child with autism enters school around the age of 5 years old are critical. Involving parents in treatment maximizes the child’s opportunities to learn. Relationship Development Intervention^® (RDI) is a relationship-based intervention focusing on recreating developmental milestones through meaningful interactions with parents with a primary goal of increasing JA. However, little research has evaluated the efficacy of this intervention. In contrast, a model based on Skinner’s Analysis of Verbal Behavior (ABA/VB) increases spoken language directly when implemented by therapist and teachers; however, this approach has not been evaluated when implemented by parents. RDI and ABA/VB have different primary targets for intervention; however, both approaches assume that language and JA, respectively, will emerge as a corollary effect of the intervention.

Objectives:  The purpose of this pilot study is to compare the efficacy of two parent-implemented adjunctive interventions, RDI and ABA/VB, against Services As Usual (SAU) on JA and language in children 2-6 year old with ASD.

Methods:  Participants were 36 children diagnosed with autism spectrum disorder (ASD) by community providers and the Autism Diagnostic Observation Schedule-2™.  Participants were randomly assigned to RDI, parent-implemented ABA/VB, or SAU conditions. All parents, regardless of assigned condition, reported weekly on the type and extent of services delivered. The intervention consisted of 16 sessions over 14 weeks delivered in the home. Assessments were conducted pre-treatment and end of treatment (3 months). The primary outcome measure was direct observation of parents and children interacting under different scenarios designed to implement conditions most likely to produce the behavior targeted by the interventions (e.g., joint attention, specific language skills) including prompts that involved having the child ask the parent for preferred items and engaging the child in a conversation about family photographs. The direct observations were coded by research assistants blind to treatment condition and trained to interobserver reliability levels of 80% or above on a coding taxonomy that included an array of parent and child behavior related to joint attention, language, and problem behavior. In addition, two standardized assessments were also administered (Mullen Scales of Early Learning and Communication and Symbolic Behavior Scales).

Results:  All participants for the study have been recruited and 29 children have completed the treatment and post-assessment. Preliminary results indicate that both RDI and ABA/VB produced gains in the child’s following of bids for joint attention, three-point gazes, and initiating verbalizations while SAU did not result in any gains for any of these behaviors. 

Conclusions:  This pilot study examines the efficacy of parent-implemented RDI and ABA/VB against SAU on social and emotional communication and language via direct observation and standardized measures. Preliminary results indicate that both interventions are able of producing gains in joint attention and verbal behavior, even though the two interventions differ in primary intervention targets. Furthermore, children in SAU condition did not show evidence of change. These results support that parents can serve as effective agents of change in the implementation of empirically supported early interventions for ASD.