So how did I become a pediatric physical therapist in Charlotte, NC who is also a Certified Relationship Development Intervention (RDI) Provider? It started when Joanna Felder, a RDI certified therapist at the time, came and spoke to the Child and Family Development team. She said that she was ABA certified but had become RDI certified. She was impressed with the changes she had seen in her clients with the implementation of RDI. Well, at the time, I was treating several children with autism, and I consistently felt very inadequate in making differences that really mattered for these children and their families. I had a lot of experience treating many different types of problems but felt the children with autism were my most challenging. I didn't feel as a physical therapist that I had a real plan. Sometimes working on the next developmental step in their gross motor skills doesn't feel like you are addressing the core of their problems. Something was missing but I just didn't know what. My clients with autism were often emotionally labile, rigid, and poorly connected with me. They had real trouble performing activities on request or in imitation. I wasn't finding my awesome toys or personal charm were getting me anywhere. I settled into thinking I was doing good treatment if I could simply over time increase the number and variety of activities they would engage in with me. Usually these activities were very sensory based.
I remember performing a Physical Therapy Evaluation on a child at a school. He had autism. Gross motor skills were unquestionably one of his highest skills. I could hardly catch him as he ran across the playground during recess, much less evaluate him. He could negotiate the classroom and move from room to room in his school. He was safe on stairs. His mother was frustrated when I didn't recommend PT. His mother complained that he didn't have the skills to play with the other children. He wouldn't catch a ball much less throw it back. I didn't change my mind, partly because I didn't know how to help her child. I would if he had cerebral palsy or Down syndrome, but how would you teach play skills to a child with Autism...especially if I couldn't catch him on the playground. I have never forgotten that mother's frustration with me.
I began to get more children on my caseload with autism. I am a very competent therapist, but this area made me feel very incompetent. I started thinking I needed more training. I decided to go in 2006 to the Two Day Introduction to RDI workshop in Florida. Dr. Steven Gutstein was impressive. He talked about the importance of developing dynamic intelligence. He worked from a remediation model. People with autism have trouble coordinating with others. "Dynamic Intelligence is what allows us to successfully solve complicated problems, prioritize multiple demands, carry on meaningful relationships and achieve long term goals. Jobs, friendships, marriages and most aspects of daily life are primarily 'dynamic' in nature...Almost all human communication and interaction occurs during dynamic encounters." *
Just this short workshop dramatically changed how I interacted with my clients. Dr. Gutstein showed videos of lifestyle changes and activities that I could easily incorporate in physical therapy. I did this and I began to see changes in my clients. Several of my client families encouraged me, and in 2007 I went on to take the week long Beginning and Intermediate Certification courses in Houston. I was assigned a Supervising RDI Instructor and began submitting videotaped assignments. I have to say it was a long, involved and often very frustrating process. If I had not seen the changes in my treatments and in my children and families, I would have quit. I have never been in such an involved certification process. Two years later I was finally allowed to take the Advanced Certification course and became a Certified RDI Therapist. I still attend a weekly chat with the Connections Center and soon will need to start my yearly Re-certification process. Ugh....
But in my children I have seen better coordination with others, meaningful visual referencing, modification of their behavior to coordinate better with others, visually monitoring of their environment, improved imitation and the ability to role play or switch roles, and more flexible thinking. I now feel like I have a road map that follows a remediation model that focuses on the core deficits to help children with autism get a second chance to learn the steps they missed along the way. In my parents, I have seen them become better guides for their children, have stronger skills at framing activities for success, develop communication strategies that are more effective, learn stronger skills in limit setting, and bring more joy to interactions with their children.
I am delighted with Relationship Development Intervention. I think its emphasis on Dynamic Intelligence is the missing link for my work with Autism. I am excited about the changes I am seeing and hope to see in the future. Currently, along with my Physical Therapy work, I offer RDI evaluation and treatment for people with autism here in Charlotte at our Midtown clinic. For more information about Relationship Development Intervention (RDI), go to
www.rdiconnect.com.
*Quotations are from the MESSIER brochure provided by the Connection Center
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