A Review of Relationship Development Intervention for Autism Treatment Lisa Berkstresser Erin Chambe

1
A Review of Relationship Development
Intervention for Autism TreatmentLisa
Berkstresser Erin Chambers Sandra R. GomesDawn
HornerCaldwell College Graduate Programs in
Applied Behavior Analysis
2
What is Relationship Development
Intervention(RDI)?

• Developed and trademarked by husband and wife
  team Steven Gutstein, Ph. D and Rachelle K.
  Sheely, Ph.D.
• Both are clinical psychologists

3
Backgroundon Dr. Steven Gutstein

• Prior to 1987, Dr. Gutstein was a nationally
  renowned developer of innovative clinical
  programs for children with high-risk conditions.
• 1983 received grant from Hogg Foundation for
  Mental Health.
• Earned his Ph.D in Clinical Psychology from Case
  Western Reserve University.
• Served as Assistant Professor of Psychiatry and
  Pediatrics at Baylor College of Medicine and the
  University of Texas Medical School.

4
Background on Dr. Steven Gutstein

• During this period, Dr. Gutstein also served as
  the director of Pediatric Psychology for Texas
  Childrens Hospital.
• Currently Director of The Connections Center in
  Houston, TX.
• Formed Foundation for Autism Research and
  Remediation (FARR) in 2004

5
Publications of Dr. Gutstein

• Gutstein, S. (2003). Can my Baby Learn to Dance
  Exploring the Friendships of Asperger Teens. In
  Lianne Holliday Willey (Ed.). Asperger Syndrome
  in Adolescence. Jessica Kingsley Publications
  London.
• Gutstein, S. Sheely, R. (2002). Relationship
  Development Intervention Activities for Children,
  Adolescents and Adults. Jessica Kingsley
  Publications London.

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Publications of Gutstein

• Gutstein, S. Sheely, R. (2002). Relationship
  Development Intervention Activities for Young
  Children. Jessica Kingsley Publications London.
• Gutstein, S.E. (2001). Autism/ Asperger's
  Solving the Relationship Puzzle. Future Horizons
  Press Arlington, Texas.
• Gutstein, S. E. (2007). The Relationship
  Development Intervention (RDI) Program and
  Education. Connections Center Publishing Houston.

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What Does RDI Claim to do?

• RDI is a treatment program proposed for autistic
  spectrum disorders.
• Claims to of found the missing link in autism.
• Focus of RDI is to teach parents and others how
  to motivate and enable those with autism to
  experience dynamic social relationships.
• Social and emotional developmental activities

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How do children with autism differ from children
without autism?

• Lack five core areas of thinking about.
• Referencing
• Co-regulation
• Experience-sharing Communication
• Flexible Thinking
• Episodic Memory
• Type of thinking which tells us how child will do
  in dynamic, changing environments.
• We refer to this areas as Dynamic Intelligence.

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Dynamic Intelligence

• Dr. Gutstein found that even the most capable
  individuals on the autism spectrum lacked certain
  environments that are dynamic and changing.
• Many different abilities are essential for
  success in dynamic systems.
• Foundations of dynamic intelligence underlie
  success in life.

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Dynamic Intelligence

• Experience Sharing
• Sharing different perspectives, integrating
  multiple information channels and determining
  good enough levels of comprehension.
• Dynamic Analysis
• Determine relative meaning and value to
  information. Ongoing evaluation of change.
• Flexible and Creative Problem-Solving
• Ability to obtain meaning base upon the larger
  context. Solving problems that have no right-and
  wrong solutions.

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Dynamic Intelligence

• Episodic Memory and Self-awareness (Foresight and
  Hindsight)
• Ability to reflect on past experiences and
  anticipate potential future scenarios in a
  productive manner.
• Resilience
• Coping with a messy unpredictable world where
  setbacks and errors are unavoidable.

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So what does this mean?

• Creating a good quality of life for those on the
  spectrum.
• Without the foundations of Dynamic Intelligence,
  an individual on the spectrum will always be
  deprived.
• Deprived of the happiness of being connected to
  another with a smile or intimate glance from
  across the room the thrill of playing on a team
  or self-confidence of living independently.
• RDI states dont loose hope for the future.

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The Goal of RDI

• RDI states that children with autism are lacking
  Dynamic Intelligence.
• RDI aims to teach this in a systematic and
  practical way.
• Goal of COMPETENCE
• Parent-based treatment method.

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7 Core Principles of RDI

• Current RDI program is based on a framework of
  seven core principles.
• 1. Prioritize remediation but maintain balance
  with treating co-occurring conditions and using
  short-term compensations.
• Aid parents in clearly understanding what autism
  is vs. co-occurring conditions.

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7 Core Principles of RDI

• 2. Set appropriate objectives
• Stop thinking about programs and start thinking
  about specific objectives and goals for the
  child.
• Help parents evaluate if they are making progress
  in treating autism.
• The RDI Program Curriculum
• 24 Stages and 400 activities

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7 Core Principles of RDI

• 3. Develop a customized treatment plan reflecting
  the child and familys unique needs.
• No two children are alike and no two families are
  alike, so no two treatment plans can be alike.
• Assessing strengths and obstacles as part of a
  customized treatment plan is critical for
  success.

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7 Core Principles of RDI

• 4. Teach parents to conduct Guided Participation.
  
• Parents are the ones who are the primary
  reference points for helping their children
  interpret and gain meaning from the world.
• 5. Modify family communication to promote
  thoughtfulness and experience-sharing.
• Do not confuse speech with communication.
• Guide families to create an experience-sharing
  communication environment with their child on the
  spectrum, whether or not their child is verbal or
  non-verbal.

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7 Core Principles of RDI

• 6. Develop episodic memories of competence in
  dynamic systems.
• Type of memories which combine events with
  personal feelings and meaning, and which connect
  past and future.
• Research???

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7 Core Principles of RDI

• 7. Modify lifestyle for family heath and
  opportunities for a master-apprentice
  relationship.
• Need to create an RDI Lifestyle.
• Getting out of crisis, prioritizing, simplifying
  life, creating a workable reality and using
  everyday activities for doing the RDI program.

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How to get started!

• Phone consultation
• 2 Day Introductory Workshop
• 4 Day Parent Seminar
• Relationship Development Assessment

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The Relationship Curriculum

• Composed of six levels and 24 stages
• -Each of the six levels represents a dramatic
  developmental shift in the central focus of
  relationships.
• Each level has four stages
• Level I Novice
• -Students are referred to as Novices
• Level II Apprentice
• -The student has earner the rank of Apprentice
• Level III Challenger
• -Students referred to as Challengers
• Level IV Voyager
• -Students referred to as Voyagers
• Level V Explorer
• -Students referred to as Explorers
• Level VI Partner
• -Students referred to as Partners

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Level I Novice

• Summary
• To develop a core relationship between the parent
  and the child.
• Participants
• The Coach and Novice are the sole participants in
  Level I.
• Settings
• Bare rooms.
• Language
• Used to enhance facial referencing and not
  distract from or compete with it.
• Coaching Points
• Remain firmly in charge of the structure of all
  activities.
• Watch out for a tendency for the Novice to try
  and control the interaction.
• It is critical for activities to be exciting and
  produce happiness. They should never be done when
  the parent or novice is tired or in a bad mood.

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Stage 1 Attend

• 1- My words are important
• 2- I lost my voice
• 3- Unexpected sounds and actions
• 4- Chant
• 5-Unexpected Labels
• 6- Two Coach Approach
• 7-The tunnel
• 8- Climbing and Jumping
• 9- Affection Sharing
• 10- Now You See Me, Now You Dont

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Stage 2 Reference

• 20- Sneaky partner
• 21- Sneaky Pete
• 22- Disappearing Coach
• 23- Save Me
• 24- Non-Verbal Towers
• 25- Follow my Eyes to the Prize
• 26- Trading Places
• 27- Mother May I
• 28- You Lose
• 29- Silent Card Game
• 30- Stay Tuned to this Station

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Stage 3 Regulate

• 31- Assistant
• 32- Bill Ding
• 33- Matching
• 34- Guiding
• 35- Transition
• 36- Incomplete Completion
• 37- Expression

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Stage 4 Coordinate

• 38- Beanbag Mountain
• 39- Breaking the Chain
• 40- Vegetable Delivery
• 41- Store
• 42- Stop and Go
• 43- Start and Stop
• 44- Role Actions
• 45- Parallel Pretend Play
• 46- Cars and Ramps
• 47- Crashing Cars
• 48- Two Ball Roll

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Level II Apprentice

• Summary
• Children are ready to become co-regulators.
• Participants
• Introduction of peer partners into activities.
• Settings
• Careful restriction of settings which contain
  activities.
• Language
• Used to teach enactment, to communicate need for
  regulatory actions.
• Coaching Points
• Allow the child to gradually introduce more
  variation into joint activities.
• Continue to carefully monitor your use of
  language.
• Carefully monitor your pacing during activities.
  Always sacrifice speed for coordination.

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Stage 5 Variation

• 55- Degrees of Change
• 56- Car Crash Variations
• 57- Number Crash
• 58- Ball Rolling Variations
• 59- Drum Changes
• 60- Walking Changes
• 61- Too Close or Too Far
• 62- Degrees of Happy
• 63- The sound of Excitement
• 64- Getting Better

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Stage 6 Transformation

• 65- Activity Transformations
• 66- Function Transformations
• 67- Rule Changes
• 68- Opposite World
• 69- Unexpected Jokes
• 70- Morphing Emotions
• 71- Role Reversals
• 72- Transforming Rhythms

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Stage 7 Synchronization

• 73- Are You Ready
• 74- Talk to Yourself
• 75- Synchronized Rhythms
• 76- Tricky Partner
• 77- Synchronized Roles
• 78- Synchronized Humor
• 79- Conversation Frameworks
• 80- Anticipation

31
Stage 8 Duets

• 81- Reviews for Duets
• 84- Mixed up Puzzles
• 85- Are we Connected?
• 86- Partner Pretend Play
• 87- Partner Role-Plays
• 88- Curious Conversations

32
Level III Challenger

• Summary
• Children learn how to add variation while
  maintaining coordination with a peer partner.
• Participants
• Peers partners take more responsibility.
• Settings
• Physical movement and actions settings.
• Language
• Language is used as a major interaction enhancer.
• Coaching Points
• Celebrate each challengers co-creations.
• Record co-creations in journals and photographs.
• Parents are still in charge of the pace and
  progression of activities.

33
Stage 9 Collaboration

• 89- Ball and Net
• 90- Lifting and Carrying
• 91- Its dark!
• 92- Buddy Baseball
• 93- Parking Garage
• 94- The Beltway
• 95- Self Instruction
• 96- Replays
• 97- Musical Variations
• 98- Buddy Walkers
• 99- Relay Race
• 100- Shark and Fishermen
• 101- The Monster Again
• 102- Map Reader and Scout

34
Stage 10 Co-Creation

• 103- Created Rhythms
• 104- Art Car
• 105- Created Songs
• 106- Our Song
• 107- Created Phrases
• 108- Created Games
• 109- Created Role Plays
• 110- Joke Factory
• 111- Created Structures
• 112- Created Sculptures

35
Stage 11 Improvisation

• 113- Improvised Activities
• 114- Improvised Structures
• 115- Improvised Rules
• 116- Improvised Rhythms
• 117- Improvised Music
• 118- Improvised Songs
• 119- Improvised Movement
• 120- Improvised Role-Plays
• 121- Improvised Jokes

36
Stage 12 Running Mates

• 122- Emotions
• 123- Talk Without Words
• 124- Can You Hear Me Now?
• 125- Pass it on
• 126- Wordless Drawings
• 127- Connected Conversations
• 128- Learning How to Lose
• 129- It Takes Two
• 130- Joining in
• 131- Discovery Boxes
• 132- What do you See

37
Level IV Voyager

• Summary
• Beginning of a permanent, dramatic change.
• Participants
• Peers begin choosing peers over adults.
• Settings
• Not distracted so easily.
• Language
• Becomes more creative.
• Regulation and Repair
• Attempting to understand.
• Coaching Points
• Be careful to distinguish pointing.
• Faces are main reference.
• Self talk and narration are critical skills.

38
Stage 13 Perspective

• Goals
• Introduction to the world of relative versus the
  absolute.
• Activity summary
• Begin with activities geared towards sharing
  personal experience.
• Ending with introduction to concepts of strategy
  and the use of perspective.

39
Stage 13 PerspectiveActivities

• 71 Returning from a journey
• 72 Play-by-Play
• 73 Video Narration
• 74 Video Documentary
• 75 Comparing
• 76 Watching
• 77 Shared Journey
• 78 Strategies
• 79 Different Versions

40
Stage 14 ImaginationActivities

• 80 You Think Its Funny But I Dont
• 81 Enhancing or Changing
• 82 Silly Captions
• 83 Silly Soundtracks
• 84 Imaginative Role-Plays
• 85 What Could This Be?

41
Stage 15 Group FoundationsActivities

• 86 Integrating Ideas
• 87 Group Structures
• 88 Group Games
• 89 - Joining in 2
• 90 Our World
• 91 Group Journeys

42
Stage 16 Emotional RegulationActivities

• 92 Stress 1
• 93 Agreements and Conflicts
• 94 Faces and Voices
• 95 Expanding the Feelings Vocabulary
• 96 Representing Emotions
• 97 Rejection
• 98 Inviting a Friend

43
Level V Explorer

• Summary
• Friendship progressed to level of pre-adolescent.
• Participants
• Geared for larger groups.
• Settings
• Largely irrelevant.
• Language
• Is now critical.
• Regulation/Repair
• Expected to be skilled.
• Coaching Points
• Learn to be a good listener.

44
Stage 17 Ideas

• Objective facts and subjective beliefs Goals and
  Objectives
• Learn to understand their interests, preferences,
  and emotional reactions.
• Activity Summary
• Begins with activities making sure it is
  understood that they have and can express their
  own ideas and ends with the difference between.

45
Stage 17 IdeasActivities

• 99 Idea poems
• 100 Integrating Ideas
• 101 Sill Questions
• 102 Shared Stories
• 103 I know Some Things You Dont
• 104 You are Master, I am Novice
• 105 Good Enough Solutions
• 106 Appreciating Alternatives
• 107 Interest
• 108 - Preferences
• 109 Opinions
• 110 Emotional Reactions
• 111 - It Cant e Wrong. Its Mine!

46
Stage 18 Whats Inside?Activities

• 112 Should You Believe?
• 113 - Pretend Feelings
• 114 I am Only Joking
• 115 Absurd Facts
• 116 - Imagine the Future
• 117 - Could Something Go Wrong?
• 118 - Accidental Deliberate?
• 119 - Teasing
• 120 - Who am I Now?
• 121 - Empathy?

47
Stage 19 ConversationsActivities

• 122 Conversation Functions
• 123 Conversation Enhancement
• 124 - Conversational Tennis
• 125 Conversation Rhythms
• 126 Understanding and
  misunderstanding
• 127 Boring
• 128 In Demand

48
Stage 20 AllyActivities

• 129 Stress 2
• 130 Mistakes 2
• 131 Friends have Fights
• 132 How to Kill a Friendship
• 133 - Friend Maps
• 134 Ally Contract

49
Level VI Partner

• Summary
• Marks the emergence of a real interest in family.
• Participants
• Any number.
• Settings
• No specific setting required.
• Language
• Is critical.
• Repair
• Includes the concept of damage to a relationship.
• Coaching Points
• Maintain Coach relationship.

50
Stage 21 Shared Selves

• Goals and Objectives
• Share intimate information, and feel safe to make
  self-disclosures.
• Activity Summary
• Begins with concept of Personal Identity and ends
  with ways in which others view them.

51
Stage 21 Shared SelvesActivities

• 135 Layers of Me
• 136 Loneliness
• 137 Beliefs
• 138 Strong and Weak
• 139 How do you see me?
• 140 Private Me
• 141 Me Executive Summary

52
Stage 22 Family RootsActivities

• 142 Family Maps 1
• 143 Family Maps 2
• 144 Family Maps 3
• 145 Family Appreciations
• 146 Family Stories
• 147 Family Emotions Bank

53
Stage 23 Group ConnectionsActivities

• 148 Group Diagrams
• 149 Group Roles
• 150 Group Influence
• 151 Group Problem Solving

54
Stage 24 Intimate RelationsActivities

• 152 Different Kinds of Friendship
• 153 Trust
• 154 Friendship Maintenance
• 155 - Advanced Friend Maps
• 156 - Friends Forever

55
Appendix A The Relationship Development
Questionnaire
56
Appendix B Progress Tracking Form
57
Video Clip

• http//www.youtube.com/watch?vRF_XOp01UEYfeature
  related
• http//www.youtube.com/watch?vp9rR7-9sPdgfeature
  related
• http//www.youtube.com/watch?vIG9uo-AZzv4feature
  related

58
RDI Certification Process

• Includes completion of three, 4-day intensive
  training seminars
• Supervision via videotape and demonstration of
  proficiency in the Relationship Development
  Assessment (RDA)
• Submission of video footage with two families
• a supervision family.
• a case presentation family.
• Process generally takes 12-18 months

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RDI Certification Process

• You will learn
• how to help families understand autism and RDI so
  you can be an effective educator and prepare them
  for the process.
• how to coach parents, help them when they get
  stuck, and become a good consultant.
• how to administer the RDA effectively.
• how to develop highly effective customized
  intervention plans.

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RDI Certification Process

• Certification fees are 9,240 USD
• It is claimed that most professionals recoup
  their investment in the training very quickly.

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RDI Certification Process 2 Day Introductory
Workshop

• Goal is to be thoroughly introduced to the RDI
  Program to ensure it is a good fit for you.
• Workshop provides a good background about the
  latest research from the fields of
• autism
• the brain
• developmental psychology and learn how it relates
  to the RDI Program.

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RDI Certification Process 2 Day Introductory
Workshop

• Workshop provides strategies for learning how
  families can
• Adapt their communication style to bring about
  dramatic changes in relating.
• Develop a new type of memory to create motivation
  for genuine relationships.
• Adapt everyday activities so they can use RDI
  Program concepts as a regular part of their daily
  life.

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RDI Certification Process Beginning Seminar
Information

• A theoretical and practical approach to the
  implementation of the RDI Program
• Prerequisites
• Read Solving the Relationship Puzzle
• Two-day Introductory RDI Program workshop or DVD,
  "Going to the Heart of Autism"
• Bachelor's degree and Professional experience in
  related clinical interventions
• Application for Certification

64
RDI Certification Process Beginning Seminar
Information

• Prerequisites (cont)
• Parents of a child on the Autism Spectrum must
  have a letter of recommendation from an RDI
  Consultant.
• Letter must include
• verification of having mastered all parent
  objectives through stage 4 and currently working
  on stage 5.
• verification of having consistently met with RDI
  Consultant every 2 weeks over the last 6 months.
• verification of having consistently submitted
  video clips to consultant of your work with your
  child every 2 weeks over the last 6 months.

65
RDI Certification Process Beginning Seminar
Information

• Four-day seminar develops the clinician's ability
  to
• Evaluate parent and child readiness
• Consult with parents to frame activities for
  effective intervention
• Consult with parents to incorporate RDI Program
  into real-life activities
• Consult with parents to use appropriate
  scaffolding and spotlighting techniques
• Consult with parents to implement regulation into
  all aspects of their childs day before
  introducing challenge

66
RDI Certification Process Intermediate Seminar
Information

• Both theoretical and practical, this four-day
  seminar focuses on
• Pathogenesis of Autism Spectrum Disorders.
• The Process of Guided Participation.
• Functioning as an RDI Program Consultant.
• Using the RDA to evaluate the parent-child
  relationship.
• Developing hypotheses for treatment planning,
  including system readiness, strengths and
  obstacles.

67
RDI Certification Process Supervision
Expectations

• Following the back-to-back Beginning and
  Intermediate Seminars, Consultants-in-Training
  are required to work with two families through
  the RDIos (online communication system.)
• These families must have a child formally
  diagnosed with an Autism Spectrum Disorder.
• This work will be submitted via our secure server
  for review by a supervising Consultant.
• If you do not believe you will have two dedicated
  families, please wait to register for a future
  Beginning/Intermediate.

68
RDI Certification Process Supervision
Expectations

• Deadline for Tape 1 (NT RDA1) 5 weeks after
  Intermediate Seminar.
• Deadline for Subsequent Tapes Typically, two
  weeks after previous tape is approved.
• You must be able to comply with these deadlines
  to register.

69
RDI Certification Process Supervision
Expectations

• Consultants-in-Training must demonstrate
  competency in the following areas
• RDA1 administration with a typical child.
• Proficiency in addressing Education and Readiness
  Commitment Stages with parents.
• Full RDA administration, scoring, and
  intervention planning with your supervision
  families.
• Proficiency in addressing subsequent parent
  stages with your supervision families.
• Supervision of 14 consecutive RDI Program
  assignments which are typically submitted every
  two weeks.

70
RDI Certification Process Supervision
Expectations

• Prerequisite
• Completion of Beginning and Intermediate Seminars
  
• Professionals must begin professional supervision
  within six months of attending the Beginning
  Seminar. Failure to do so results in "inactive"
  status. If inactive status lasts for longer than
  six months, the related professional supervision
  payment will be lost.

71
RDI Certification Process Advanced Seminar
Information

• Four-day seminar where Consultants-in-Training
  demonstrate ability to analyze parental readiness
  and parent-child process.
• Consultants-in-Training are to demonstrate
  ability to screen for potential co-occurring
  disorders and to use referrals and professional
  services in an appropriate manner.
• Training is provided on breaking objectives down
  into assignments.
• Training is provided on using the various
  feedback methods in the RDIos.
• Training is provided on ethics of consultation.
• How to evaluate your own efficacy, obstacles,
  problems, and progress as a consultant.

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RDI Certification Process Advanced Seminar
Information

• Prerequisites
• Completion of prior beginning and intermediate
  seminars.
• Approval of Tapes 1-4
• All seminars are facilitated by Dr. Steven
  Gustein and/or Dr. Rachelle Sheely.

73
RDI Certification Process

• Certified Consultants of the RDI Program are
  listed on the RDI Connect Website.
• Some are highlighted with One Star upon
  successfully. completing the certification or
  re-certification process.
• Some are highlighted with a diamond signifying
  consultants who have attained supervisory status
  for at least one year and continue to maintain
  it.

74
Solid Research?
Ps

• Questions asked of those
  considering certification
• Have (you) already been intuitively using RDI
  principles and methods in your work?
• Do you feel excited about being on the cutting
  edge of a clinical intervention for autism which
  is based on solid research?

75
Pseudoscience

• Lets look at the natural process and slow it
  down..what happens if we take the same process
  and break it down, and then teach Parents what
  theyre already capable of intuitively.
  Dr. Steven Gutstein.

76
Dr. Gutstein Interview with Rhonda Brunett
KPDQ 06/01/2006
I began to study the research and the clinical
practice and I found that they dont overlap.
I ran a school, its no longer an operation
and it was a great experience.
77
Dr. Gutstein Interview with Georgene Rice KPDQ
03/21/2006
Retraining myself. Empowering families with
what God created them to do. Were attempting
to teach parents how to be able to think
flexibly.

78
Gustein et al. 2007

• Evaluation of RDI program
• Purpose of the study
• - Study examines the effectiveness of a
  cognitive developmental parent training model
  (RDI) and is a follow-up to a preliminary
  evaluation study.
• Hypothesis
• Gustein hypothesized children would be highly
  flexible and adaptive after RDI treatment.
• Any gains made would not be related to IQ.

79
Research supporting RDI
Gutsteins preliminary study is still in
press According to Dr. Wendy Stone, the
co-author of Does my child have autism? and
the co-developer of Screening tools for autism in
two year olds, There are currently no
scientific, controlled studies assessing the
effectiveness of the RDI model (Stone, 2006)
80
Possible Confounds

• According to archives from the U.S. National
  Library of Medicine, generability of current
  findings is limited by the lack of control or
  comparison group.
• In his own press release, Dr. Gutstein admits
  The small sample size needs to be taken into
  account when considering the implications of the
  research.

81
Testimonials

• What we read up on autism therapy was not
  helpful. Kenneth should be as happy and Natural
  as possible. Hui Boon, Singapore

82
Testimonials

• His ADOS score has gone from 20 in March
  2005.to 8 in March 2006. He has mastered stage
  1 and has had 3 assessments with our RDI
  consultant this past year. Catherine
  Shropshire, England

83
References

• Gustein, E. S., Burgess, F. A., Montfort, K.
  (2007) Evaluation of the relationship
  intervention
• program. Autism, 11, 397.
• Gutstein, S. Sheely, R. (2002). Relationship
  Development Intervention Activities for
• Children, Adolescents and Adults. Jessica
  Kingsley Publications London.
• Gutstein, S. Sheely, R. (2002).
  Relationship Development Intervention Activities
  for Young
• Children. Kingsley Publications London.
• Retrieved June 6, 2008, from http//www.rdiconnect
  .com.
• Retrieved June 5, 2008 from http//autismsupportce
  nter.org.
• Retrieved June 5, 2008 from http//www.crossroads-
  solutions.net/rdi.html.
• Retrieved June 9, 2008 from http//www.portal.wpsp
  ublish.com/portal.html.