Back too many years ago, when I was a fledgling speech-language pathologist, my first placement was in Napa Valley Unified School District in the great state of California. I was too naive to know that my caseload of 87 children was crazy high and I was also completely unable to understand Spanish, which all my students spoke.

As difficult as that first job was, I received two life-changing gifts while there that I carried with me when I left California. First, a budding love of Mexican culture and the Spanish language which much later led me to my wonderful husband and his warm family, and second, a well-worn paperback manual. As a parting gift, my office-mate gave me her copy of, Relationship Development Intervention with Young Children, written by, Steven E. Gutstein and Rachelle K. Sheely (2002)

That paperback book contained rich and provoking information that resonated deeply with my experiences working with children and their families. So valuable was this knowledge, that it became a prized possession of mine through many moves across states and jobs. Even when I briefly moved into a women’s shelter with two toddlers and a single garbage bag of our possessions, that book came with us into our tiny room.

I can say with certainty, that the alternative view of therapy presented in this book positively shaped my career in immeasurable ways and impacted the lives of so many children and their families I have been blessed to work with. I have recommended it to many people and have lent it out many times to both colleagues and families. However, as great as I think it is, it is not nearly as well-known or accepted as a paradoxically different therapy approach known as Applied Behavior Analysis.

Over the last two decades, I’ve observed Applied Behavior Analysis (ABA) rise, achieve seeming dominance, and begin to undergo criticism from former attendees who are now grown adults. ABA centers are appearing everywhere with multiple locations in my city and I can understand the draw. They have the funding, the studies, the insurance endorsements, wrap-around care, and the visibility that is desperately needed for families when their children are initially diagnosed with autism.

But as our understanding of autism evolves, many parents and professionals are seeing a need to seek alternatives that focus on the heart of human connection: relationships. One such approach is Relationship Development Intervention (RDI), a therapy approach designed to nurture and strengthen relationships as the basis for building future skills.

Developed by Dr. Steven Gutstein and Dr. Rachelle Sheely, RDI takes a family-centered approach, with a heavy emphasis on coaching parents on how to guide their children through meaningful social and emotional experiences. Rather than focusing solely on behaviors, RDI aims to help individuals with autism learn to think flexibly, engage in social problem-solving, and build genuine relationships as a precursor and framework for later skill development.

What Does the Research Say?

RDI has received significant attention from the autism community and related professionals over the years, but since the science backing its effectiveness is still developing many people are unaware of this alternative framework in contrast to the well-known ABA treatment programs. As of 2019, the Wisconsin Department of Health Services reviewed RDI and continued to find that there wasn’t enough evidence to prove its treatment as evidence-based. Similarly, on websites heavily used within the autism community such as The Association for Science in Autism Treatment, the stance presented for RDI as a evidenced based method cite a lone study from 2007 as having weak scientific support to claim a benefit.

Why the limitations?

The core of RDI is relational and dynamic, making the very nature of assessing outcomes through traditional research methods difficult. Unlike structured behavioral therapies like ABA, RDI focuses on nuanced progress, such as emotional connections and flexible thinking-which unfortunately don’t always fit into the rigor of scientific research methods. To determine controls for this sort of research, I imagine it would be almost impossible and daunting. However, a recent study conducted in China did show some promising trends and benefits. As encouraging as these results are, I still wonder:

Do we absolutely need numbers to validate the benefit of human relationships?

Such as:

How do we quantify connection? How do we measure shared joy?

Should we discount an approach as not having value if a method does not fit into the scientific model?

Many parts of life bring us joy and connection but can’t be measured.

The beauty of music
The feeling of home
A bond with a pet
The depth of a meaningful conversation
Feeling love

The most profound joys and connections often transcend measurement, reminding us that not everything valuable can be counted and measured by an amount.

Maslow’s Hierarchy of Needs: A Framework for Understanding RDI

I don’t have my PhD, I am not a doctor of anything but a lifelong seeker, an absorber of books, and a student of intuition. As such, I have to wonder if the benefits of RDI can be found through Maslow’s well-known hierarchy of needs. His framework reminds us that human growth builds on foundational needs being met. RDI seems to operate on this framework. From my experience and success, this seems to make the most sense.

By strengthening relationships, RDI helps fulfill the basic need for belonging, creating a secure foundation for children to develop confidence and emotional resilience. These are the building blocks needed to reach higher levels of learning and later independence.

**Without foundational needs met, further skills can’t develop to their full potential regardless of diagnosis or ability level.**

What Does this Mean for Speech Therapy?

As a speech-language pathologist, I can’t help but connect RDI’s emphasis on relationships to my approach to speech and language therapy. Communication is inherently relational-it’s not just about vocabulary, syntax, or sounds.

It’s about connection.

However, our field, like ABA, has uncomfortable roots in behaviorism based heavily on the works of B.F. Skinner. This model views communication at it’s essence as an explicitly learned behavior due to rewards-based operant conditioning. I am as guilty as anyone else for making children undergo trials of out-of-context flashcards to create nice percentages on data sheets. The ability to admit this error has caused me to seek to do better and to do more for the individuals I serve. While behaviorism has contributed valuable tools to our field, we must ask ourselves an uncomfortable question:

When exactly did relationships become separated from communication and do we have to continue on that trajectory to maintain the status quo?

Perhaps in the field of speech-language pathology, new approaches are taking into consideration this philosophical question but until then, the guidance I have found to bridge the gap between relationships and communication has been my well-worn first-edition copy of RDI. Without this book, I might never have arrived at the need to expand my horizons beyond traditional behaviorist therapy approaches because frankly a strict model of goal writing, and data collection necessitates a behaviorist framework, whether we want to admit it or not.

However, just from being a human, I’ve observed that communication happens almost exclusively within the context of relationships and not as a discreet and separate skill. Acknowledging this, I’ve had to reach beyond my field throughout my career to fill in the missing pieces and thankfully my RDI manual was one such tool that I’ve used to enhance and cultivate my now more holistic practice.

A Call to Reflect and Do Better

The creation of RDI and the recently acknowledged criticisms of ABA therapies invite us to rethink how we approach the therapy model. It’s not about pitting one method against the other; it’s about evolving, adapting, and enhancing. How can we prioritize relationships in everything we do? How can we integrate dynamic thinking and emotional growth into our therapeutic practices? If I can’t find the research directly in my field; where do I need to look?

Supporting individuals on the autism spectrum means meeting them where they are, not just in their behaviors but in their humanity as fellow spirits sharing this life journey at the same time. By embracing relational approaches like RDI to enhance therapy for individuals with and without autism, we open our minds to novel and new ideas outside of traditional speech therapy.

Let’s work together to ensure that therapies reflect the full spectrum of human connection.

After all, relationships are at the heart of who we are as humans.

When Speech Therapy and Relationships Align: Autism and RDI Therapy