Updated by:
David Celiberti, PhD, BCBA-D, Skye Nelson, MA, BCBA, and Eric Larsson, PhD, BCBA-D
Association for Science in Autism Treatment

Autism Treatments SummaryDescription: Relationship Development Intervention (RDI®) is a treatment program proposed for autism spectrum disorders. Proponents of the intervention claim that this model is “based on the latest scientific research into the human brain” and “allows for neuro-cognitive changes to occur over time…” (An Introduction to RDI®, accessed April 21, 2025). It was developed and trademarked by clinical psychologists Steven Gutstein, PhD and Rachelle K. Sheely, PhD. Parents are typically trained as the primary intervention providers, learning to motivate and support their autistic children in increasing flexible thinking and dynamic social relationships. This occurs through daily “social and emotional developmental activities” that are carefully graduated, and guided (Gutstein, 2009). More specifically, the existing RDI® literature discussed helping parents play an important role in improving critical emotional, social, and metacognitive abilities such as learning from the emotional experiences of others, developing language to support active participation in relationships, developing flexibility both with respect to thoughts and actions, and increasing capacity to foresee future events based on past experiences. Gutstein (2009) argued that sufficient dynamic intelligence is needed to navigate a “complex, messy world of partially misunderstood communication, multiple demands and goals, gray areas, makeshift solutions, conflicted feelings, and ‘good-enough’ performance” (p. 175).

Research Summary: Since the first mention of the term RDI® in 2004, there have only been two published peer-reviewed studies of the effects of RDI®. To date, there are no studies with strong experimental designs that have evaluated the effectiveness of this intervention. The preliminary data from these two lower quality studies, which may support RDI®, have been cited on the developers’ website, including one published, but uncontrolled study which reported results on one group only (Gutstein et al., 2007). In other words, all of the participants in this study were in the RDI® intervention group, which means that their progress could not be compared to children receiving no intervention and/or other interventions. In this study, the researchers reviewed previous records of children who participated in RDI® treatment at the Connections Center in Houston, Texas. The study reported improvements in Autism Diagnostic Observation Schedule (ADOS) scores, increases in “age-appropriate flexibility” and enhanced participation in less restrictive educational settings. However, the study had significant methodological shortcomings, including an inadequate description of intervention components, a lack of reliability measures across assessments, and a weak pre- and post-test design, undermining these conclusions (Zane, 2010). Furthermore, the study relied on retrospective chart review only to identify changes, and focused on the ADOS to measure changes, even though the ADOS is not considered a valid tool to use to measure outcomes in most applications (Carruthers et al. 2021).

In a subsequent study, Hobson et al. (2016) examined the relationship between autism symptom severity and the quality of the parent-child interaction over the course of the RDI® program. The study assessed interactions by scoring videotaped assessments conducted both at the onset and later stages of the intervention in a clinic where all clinicians were certified as RDI® consultants. The authors reported improvements in parent-child interactions regardless of the initial severity of autism symptoms. However, as with the earlier study, notable methodological flaws, such as the lack of a clear description of the treatments and an absence of a control group, warrant caution when interpreting these findings.

Although published data on the subject is limited, the website for RDI®Connect®—where Dr. Gutstein serves as Chief Executive Officer —lists seven citations under the heading: “Following are peer-reviewed articles that document evidence of its efficacy for children with ASD” (RDIconnect®, n.d.), as of the time this article was published. The presentation of these citations can be found here. Aside from the two studies discussed above, the other five citations provided on the website are either not peer-reviewed articles or do not reflect treatment outcome research. Gutstein (2004) is an abstract of a presentation given at the Annual Meeting of the Society for Developmental and Behavioral Pediatrics in Chicago in 2004. Gutstein (2005) cannot be found online. Gutstein (2009) is an abstract of a paper in a nonexistent issue of Annals of Clinical Psychiatry (21(3):174-182, August 2009), which can also not be found online. The abstract states, “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.” Hobson et al. (2008) is a poster presented at the International Meeting for Autism Research with no text available online. The last citation, Larkin et al. (2013), is a publication in the journal Clinical Child Psychology and Psychiatry, but it is not an evaluation of the RDI® method. Instead, it is a “preliminary report” on a potential assessment called the “Relationship Development Assessment – Research Version.” Research that examines the utility of an assessment tool is different from research that tests the impact of an intervention that uses that tool (or any other dependent measure). In summary, it is misleading to consumers to suggest that each of these studies objectively demonstrates the merits of RDI®.

Finally, it is important to note that recent task force reports specific to the treatment of ASD make no mention of RDI®. The National Standards Project: Phase 2 (2015) did not highlight any research studies that employed the use of RDI® in the treatment of autism. In a review by Hume et al. (2021), no information about RDI® was included. Furthermore, a recent Australian review titled Interventions for children on the autism spectrum: A synthesis of research evidence (Whitehouse et al., 2020) similarly did not reference RDI®. In other words, multiple objective, systematic reviews of the literature did not include RDI® because RDI® researchers have not produced published research that actually met the inclusion standards of these independent task forces. Taken together, the limited and methodologically weak evidence on RDI®, contrasted with unsubstantiated claims on the RDIconnect® website, raises significant questions about its efficacy for children with ASD. Additional, rigorous, and controlled research is needed before determining if RDI® is beneficial for this population.

Recommendations: From a research standpoint, randomized control studies conducted by independent researchers without conflicts of interest and using naive raters, objective outcome measures, and measures of treatment fidelity are warranted. This research should be direct assessments of the treatment effects of RDI®. Studies are needed that clearly define and tease out which elements of the intervention are associated with strong outcomes and we look forward to these contributions to the scientific literature. Nearly 20 years have passed since Gutstein et al. (2007) was published; it is the responsibility of RDI® proponents to conduct the research needed to support and guide their work to move it forward. Unless treatment outcome research is provided via peer-reviewed research studies with greater methodological rigor, 1) it is unlikely that future systematic reviews and meta-analyses like those cited above will support RDI® as an evidence-based practice for the treatment of ASD, and 2) claims by RDI® proponents that it is an evidence-based approach would remain unsupported and scientifically inaccurate.

Despite this void in published research, it is important to acknowledge that there are a multitude of RDI® providers. Providers trained in or considering becoming trained in RDI® are urged to review their discipline’s ethical guidelines about offering and/or recommending interventions that lack evidence, as there are strong prohibitions against these types of recommendations amongst many disciplines. Please see Principle of Ethics I: Rule M and Principle of Ethics II: Rule A of the ASHA Code of Ethics, Principles # 1 and # 2 of the Ethical Code for Occupational Therapists, Section 2.04 of the Ethical Principles of Psychologists and Code of Conduct, and Section 2 of the Ethics Code for Behavior Analysts.

Additionally, in the spirit of transparency and objectivity, and to fulfill their obligations to secure informed consent, providers should present RDI® as an inadequately tested treatment for individuals with autism spectrum disorder and should encourage families who are considering this intervention to consider treatments that already have scientific support.

Regardless of the credentials of the providers, consumers should view this intervention as not currently evidence-based and consider use of this intervention with great caution. We recognize that this can be confusing given that there are individuals who publicize, advertise, or otherwise tout certification in RDI® as a relevant credential. It is important for consumers to keep in mind that just because a provider is certified in a particular modality does not mean that the intervention itself possesses verifiable scientific merit.

Furthermore, consumers should be aware that some providers may boast an evidence-base by mere association with other interventions that possess scientific support. This argument is flawed as illustrated by the examples below:

    • A bobcat has characteristics similar to cats.
    • Cats can be safe pets.
    • Bobcats can be safe pets.

Now we are applying this to autism intervention.

    • Intervention A overlaps a bit with Interventions B and C.
    • Interventions B and C are evidence-based.
    • Intervention A is therefore evidence-based.

The important takeaway is that RDI® will be positioned to claim scientific merit only after a body of research is published that directly tests RDI®, as opposed to interventions that overlap in some small way with RDI®. To be clear, it is the responsibility of RDI® proponents to conduct the research needed to support and guide their work. Publishing article after article that speaks to the important need for children with autism to develop relationships with others, to gain flexibility, and to learn from the emotional experiences of others may seem logical and compelling to the consumer, but it is not equivalent to actual research on how to accomplish such goals. This would apply to retrospective accounts shared years later as well (e.g., Gutstein & Sheely, 2023). These leaps do no service to those who are looking for interventions that have actually been shown to improve these skills in children with autism.

In the meantime, if families decide to use RDI® (as many already do), they are encouraged to work with providers to carefully define the treatment targets, implement RDI® carefully in a consistent and thorough manner, collect objective data to measure benefits, and to use those data with their providers to make decisions about the path forward.

Systematic Reviews of Scientific Studies

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 51, 4013-4032. https://doi.org/10.1007/s10803-020-04844-2

National Autism Center. (2015). Findings and conclusions: National Standards Project, Phase 2. Author. https://nationalautismcenter.org/national-standards/phase-2-2015/

Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with autism. https://files.eric.ed.gov/fulltext/ED609029.pdf

Whitehouse, A., Varcin, K., Waddington, H., Sulek, R., Bent, C., Ashburner, J., Eapen, V., Goodall, E., Hudry, K., Roberts, J., Silove, N., & Trembath, D. (2020). Interventions for children on the autism spectrum: A synthesis of research evidence. Autism CRC, Brisbane.

Selected Scientific Studies:

Gutstein, S. E., Burgess, A. F., & Montfort, K. (2007). Evaluation of the Relationship Development Intervention program. Autism, 11(5), 397-411. https://doi.org/10.1177/1362361307079603​

Hobson, J. A., Tarver, L., Beurkens, N., & Hobson, R. P. (2016). The relation between severity of autism and caregiver-child interaction: A study in the context of Relationship Development Intervention. Journal of Abnormal Child Psychology, 44(4), 745-755. https://doi.org/10.1007/s10802-015-0067-y

Other Cited Articles:

Carruthers, S., Charman, T., El Hawi, N., Kim, Y. A., Randle, R., Lord, C., Pickles, A., & PACT Consortium (2021). Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent-Mediated Early Autism Intervention. Autism Research, 14(2), 411-425. https://doi.org/10.1002/aur.2449

Gutstein, S. (2004). The effectiveness of Relationship Development Intervention® in remediating core deficits of autism-spectrum children. Journal of Developmental and Behavioral Pediatrics, 25(5), 375.

Gutstein, S. (2005). Relationship Development Intervention®: Developing a treatment program to address the unique social and emotional deficits in autism spectrum disorder. Autism Spectrum Quarterly, Winter, 8-12.

Gutstein, S. E. (2009). Empowering families through Relationship Development Intervention: An important part of the biopsychosocial management of autism spectrum disorders. Annals of Clinical Psychiatry, 21(3), 174-182.

Gutstein, S. E., & Sheely, R. K. (2023). Transforming the well-being of persons with autism. Psychoanalytic Inquiry, 43(3), 158-183. https://doi.org/10.1080/07351690.2023.2185062

Hobson, J. A., Hobson, P., Gutstein, S., Ballarani, A., & Bargiota, K. (2008). Caregiver-child relatedness in autism: What changes with intervention? Poster presented at the meeting of the International Meeting for Autism Research.

Larkin, F., Guerin, S., Hobson, J. A., & Gutstein, S. E. (2015). The Relationship Development Assessment – Research Version: Preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism. Clinical Child Psychology and Psychiatry, 20(2), 239-260. https://doi.org/10.1177/135910451351406

Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., & Schopler, E. (1989). Autism Diagnostic Observation Schedule (ADOS) [Database record]. PsycTESTS. https://doi.org/10.1037/t54175-000

RDIConnect. (n.d.). Relationship Development Intervention. https://www.rdiconnect.com/

Zane, T. (2010). Is there science behind that?: Relationship Development Intervention: A review of its effectiveness. Science in Autism Treatment, 7(3), 1-2.

Reference for this article:

Celiberti, D., Nelson, S., & Larsson, E. (2025). A treatment summary of Relationship Development Intervention. Science in Autism Treatment, 22(5).

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