Autism Spectrum Disorder (ASD) is classified as a neurodevelopmental disorder and is characterised by persistent challenges with social communication and interaction, and restricted and repetitive patterns of behaviour (American Psychiatric Association, 2013). ASD may present as difficulties with nonverbal communicative behaviours; social-emotional reciprocity; and developing, maintaining, and understanding relationships (American Psychiatric Association, 2013). Currently, one in 100 Australians and one in 160 people globally have a diagnosis of ASD (Australian Bureau of Statistics, 2015; World Health Organisation, 2021). We understand that debate currently exists in the autism community around the use of language (Dwyer, 2022). In this article, the terms ‘autistic people’ or ‘autistic children’ will be used as we align with terminology commonly used in the neurodiversity movement that reframes disability as a strength hence promoting the use of identity-first language (Bury et al., 2023).

While the presentation and functional impacts of ASD vary greatly, challenges related to an autistic child’s ability to express and understand emotions are commonly discussed (Gutstein & Sheely, 2001; Palmiotto, 2015). In particular, evidence suggests that autistic children may not provide emotional feedback that is understandable to their parents or easily interpret their parents’ emotions. Potential challenges with expressing and understanding emotions can create difficulties for parents in attending to their child’s needs and supporting their development (Gutstein & Sheely, 2001; Palmiotto, 2015). Complex interactions between an autistic child’s nature (e.g., potential challenges in expressing and providing emotional feedback) and nurture (e.g., challenges in the parent-child relationship) may affect the child’s ability to develop and maintain relationships with peers (Sameroff, 2009). The difficulties autistic children may experience when establishing peer relationships can limit their opportunity to develop important skills learnt through friendships, including problem-solving, communication, and self-regulation (Gutstein & Sheely, 2001). These factors may have a negative impact on autistic children’s lives: a lack of peer relationships amongst autistic children is associated with higher rates of mental illness (Fuld, 2018).

Although it is widely accepted that early intervention for ASD reduces the risk of autistic children developing challenging behaviours and mental illness, there is disagreement surrounding which interventions are most effective (Palmiotto, 2015; Reichow, 2012; Smith & Iadarola, 2015). Applied Behaviour Analysis (ABA) is one of the most widely applied interventions for ASD (Eldevik et al., 2009; Prior et al., 2011). ABA involves autistic people engaging in 10 – 40 h of intervention delivered by a trained clinician, focusing on adapting their behaviours (Palmiotto, 2015). Although there is established evidence supporting ABA in terms of effects on specific behaviours (such as communication, self-help, and social skills) there is a concern that ABA does not cater to individual developmental needs. Further, ABA’s use of cues and prompting may limit its application outside of controlled/monitored environments (Palmiotto, 2015). There is also a focus on the autistic child as ‘the problem’ rather than a consideration of their broader social context. In response to these concerns, there has been a recent shift towards relationship-focused interventions, such as Relationship Development Intervention (RDI), which facilitates an improved social interaction between autistic children and their parents (Dawson et al., 2010; Green et al., 2010; Larkin et al., 2015). Relationship-focused interventions acknowledge the integral role of parents in their child’s development (Palmiotto, 2015). RDI is a parent-led program aiming to remediate the parent-child ‘Guided Participation Relationship’, which is where a child is conceptualised to be an ‘apprentice’ who is guided through new challenges by their parents (Rogoff, 1990). Throughout the intervention process, the RDI Consultants assume key roles in supporting parental skill development to facilitate reciprocal communication between parents and their children in everyday life. The Consultants predominantly and intensively work with parents, guiding them to learn about autism and model interactions with their children (RDI Consultants Australia, 2021). The frequency of intervention sessions depends on the needs of individual families; however, during the session, the Consultants work closely with parents so that the learned skills are seamlessly incorporated into their everyday activities (Gutstein et al., 2007). The Consultants take the lead in coaching parents to create opportunities for the parent-child relationship to develop by introducing challenges in a graded and systematic way (Gutstein, 2009; Gutstein & Sheely, 2001; Palmiotto, 2015).

There is emerging evidence suggesting the effectiveness of RDI in supporting social skills development among autistic children (National Autism Center, 2015). Gutstein and colleagues (2007) conducted a study that reviewed Autism Diagnostic Observation Schedule (ADOS: Lord et al., 2000) scores, Autism Diagnostic Interview-Revised (ADI-R: Lord et al., 1994) scores, levels of flexibility, and school placement for 16 children who participated in RDI between 2000 and 2005. The results at the 30-month follow-up showed a reduction of ADOS and ADI-R scores and improved social relatedness, communication, school function, and adaptive behaviour among participants (Gutstein et al., 2007). Hobson and colleagues (2016) measured the severity of ASD, using ADOS and the quality of parent-child interactions among 18 parents and autistic children at baseline and later during the RDI intervention. Compared to the baseline, the ADOS score was significantly reduced after receiving RDI. Their results also suggest that the quality of parent-child engagement improved over the course of participation in RDI (Hobson et al., 2016). Finally, Larkin et al. (2015) investigated parent-child dyads, such as responsiveness and emotional expression between preschool-aged autistic children (n = 16) and their parents. Half of the children (n = 8) and their parents received RDI over an academic year while the other half (n = 8) received treatment as usual, involving support from schoolteachers, Speech and Language Therapists, and Occupational Therapists. The results of their study showed improvement in parent-child dyads amongst children who received RDI while the results for those children who received treatment as usual did not show any improvement. Taken together, this research suggests that RDI might be an effective addition, or alternative, to the more commonly used behavioural approaches.

Although evidence is emerging, further research to develop stronger evidence for RDI is required for parents to make well-informed decisions when considering a therapeutic option for their autistic children (Badge, 2013; Palmiotto, 2015). Most existing studies have been conducted in the United States and have focused on the efficacy of RDI using quantitative methods rather than the experiences of participants (Gutstein et al., 2007; Hobson et al., 2016; Larkin et al., 2015). Qualitative investigations are important in intervention research as they provide an in-depth, holistic understanding of social experiences and the meanings attached (Needleman & Needleman, 1996). Further, qualitative methods can provide a rich perspective of the lived experiences of autistic people and others around them (van Schalkwyk & Dewinter, 2020). Considering the key role of RDI Consultants in enabling parents to develop skills and create opportunities that facilitate parent-child relationships, their perspectives are imperative in providing a holistic understanding of RDI. These findings can then be used to educate clinicians, autistic children, and their families on the therapeutic options available for autism, by increasing their awareness and understanding of RDI as well as providing direction for future research (van Schalkwyk & Dewinter, 2020).

The overall aim of this study was to explore the experiences of RDI Consultants in delivering RDI. More specifically, the research questions were:

  1. (i)

    What are the lived experiences of RDI Consultants in delivering RDI to autistic children and their families?

  2. (ii)

    What are RDI Consultants’ perspectives regarding the outcomes of engaging in RDI for autistic children and their families?

Method

Study Design

This study followed a descriptive qualitative approach grounded in relativism, aiming to provide an understanding of the experiences of RDI Consultants. This approach allows for examination of participants’ subjective experiences and their own sense-making while minimising pre-existing theoretical preconceptions (Braun & Clarke, 2019). The research team partnered with an RDI Consultant who had gatekeeper access to other RDI Consultants across Australia and provided stakeholder input into the research process. We followed the Standards for Reporting of Qualitative Research (O’Brien et al., 2014) and the Consolidated Criteria for Reporting Qualitative Research (COREQ: Tong et al., 2007), to generate and report our findings.

Participant Recruitment

Participants were eligible if they were certified RDI Consultants who had been continuously practicing RDI for at least 12 months in Australia in the past three years. To our knowledge, all Australian RDI Consultants are members of RDI Consultants Australia. Researchers aimed to recruit all 17 eligible RDI Consultants at the time of recruitment (RDI Consultants Australia, 2021). The primary method of recruitment was through the partnered RDI Consultant who is a member of the RDI Consultants Australia. The research team forwarded an invitation letter, information sheet, consent form, and demographic questionnaire to the partnered Consultant, and this Consultant distributed them to all eligible RDI Consultants via email. The demographics questionnaire was a nine-question survey asking the participant’s age, gender, professional background, and involvement with RDI. Participants who wished to participate returned the signed consent form and demographics questionnaire to the second author via email, and the second author checked the eligibility of each participant. Recruitment ceased if prospective participants did not respond after second attempt to contact via email. No incentive was offered to the participants.

Participants

Of the 17 RDI Consultants invited to participate in interviews, four did not respond to initial contact emails and two others did not return consent forms. As a result, we had 11 participants who were aged between 40 and 73, all identified as female, and were geographically dispersed across Australia. None of them were known to the interviewer. The range of years participants had practiced RDI was between one and 16 years. There were four Consultants who were trained Speech and Language Pathologists, three were Occupational Therapists, one was a Nurse, and one was a Psychologist. The remaining two participants had non-health-related professional backgrounds. Further participant demographics can be found in Table 1. Some participant information, such as ethnicity and socioeconomic status, has been intentionally withheld to protect the confidentiality of participants, due to the small number of RDI Consultants in Australia.

Table 1 Participant Demographics
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Data Collection

The authors developed a semi-structured interview guide that explored: the RDI Consultant’s professional experience with RDI; the changes RDI Consultants have noticed in families who have participated in RDI, and how/whether RDI facilitated these changes; perceived benefits/challenges of participating in RDI for families; and benefits/challenges of being an RDI Consultant. The interview guide included questions, such as ‘Please describe your experiences of delivering RDI to autistic children and their families’ and ‘How do you think RDI facilitates changes in families’. The partnered RDI Consultant provided feedback on the interview guide, and a pilot interview was conducted with a health professional who did not use RDI but could discuss using related techniques. As a result of this pilot, the wording was adjusted to improve its clarity. All participants provided written and verbal consent before their interviews. Individual interviews were conducted between February and August 2020 by the second author (BA) who was a final year Occupational Therapy (OT) student. The first author (TM: an OT with a research interest in the health and wellbeing of parents of children with a disability) and the third author (JS: an experienced qualitative researcher, physiotherapist, and sociologist) provided training to BA, giving her an opportunity to refine her interviewing techniques before interviews commenced. Interviews were conducted in the participant’s chosen environment, telephonically or via a video conference system (i.e., Zoom) due to geographical distance and COVID-19 restrictions. The interviews lasted between 30 min and 1 h and were audio-recorded. Interview recordings were transcribed verbatim by BA. Field notes were recorded by BA after each interview and included in the data analysis as required. The research protocol was approved by the University of Queensland’s Human Research Ethics Committee (2021/HE000640).

Data Analysis

The interview transcripts were analysed by all three researchers using reflexive thematic analysis as described by Braun and Clarke (2019). A relatively descriptive approach to this type of thematic analysis was used as it explores, with minimal interpretation, the experiences, and perspectives of participants in relation to their thoughts, feelings, and actions. All authors became familiar with a transcript by reading the textual data line-by-line, before re-reading the text and adding annotations. Then the authors discussed this initial analysis during a team meeting. The second author then assumed the main role in generating initial codes from the remaining transcripts, inductively labelling data relevant to the research questions. The first and third authors reviewed the initial codes and provided input, such as considering other patterns of data. The second author then constructed themes based on the key patterns they identified and reviewed these themes for relevancy and importance to the research questions. The first and third authors then reviewed these themes and provided further input, including discussing the fit of the themes to the data and research questions. Once the themes were established, the second author defined and named the themes, extracted relevant data and interpreted the data further. The first and third authors reviewed this to consider whether the themes highlighted the overall patterns across the dataset. The partnered RDI consultant was not involved in the analysis process.

Reflexivity and Trustworthiness

Rigour was maintained by using Braun and Clarke’s guide to ensure the appropriate use of reflexive thematic analysis, for example, while engaging in meetings with the first and third authors who were supervisors for the second author, the second author was asked to clarify and explain her thinking and explore alternative ways to understand the data, and this process acted as a tool for reflexivity (Braun & Clarke, 2021). Although none of us are RDI consultants, we are all health professionals (two occupational therapists, one physiotherapist with a PhD in psychology), and none of us identify as autistic. The research team tried to keep in mind their positionings in relation to the topic of this study, for example, as we all have professional employment in the health sector, we asked ourselves how RDI might be perceived by non-health professionals or experienced by families with only one parent. We worked to question these types of assumptions we might have made based on these life experiences by iteratively reviewing codes and themes as they developed, demonstrating the practice of reflexivity further. Additionally, trustworthiness was ensured by providing a description of the analysis process, including regular engagement with all authors over the course of analysis process and also by presenting sufficient quotes (Braun & Clarke, 2021).

Results

RDI Consultants discussed their experiences using RDI with autistic children and their families. Three main themes were derived from the analysis: (1) RDI helps autistic children reach their potential; (2) Parents learn to embrace parenthood through RDI, and (3) Consultants form a team with parents. A series of subthemes were identified for themes 1 and 2 (see Fig. 1). The first research question about the lived experiences of the Consultants was addressed by theme 3 and the second research question about the perceived outcome of RDI was addressed by themes 1 and 2.

Fig. 1
figure 1

Theme and subthemes structure

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Theme 1: RDI Helps Autistic Children Reach Their Potential

This theme depicts participants perception that RDI facilitates autistic children to set and achieve their life goals. Participants described RDI as helping autistic children to reach their potential by facilitating: the development of parent-child and peer relationships, children’s ability to cope with uncertainty/change, and children’s independence.

RDI Helps Extending or Expanding Relationships

Participants consistently identified that when using RDI with a new family, they initially focus on developing the parent-child ‘Guided Participation Relationship’. This is an RDI term for the relationship between a parent and child, where parents guide their child through new challenges, such as situations where routines unexpectedly need to be changed. Many participants suggested that this type of relationship can be missing or disrupted between an autistic child and their parent, as it requires the active participation of both the parent and child. Participants explained that autistic children commonly have difficulty actively contributing to this relationship. The importance of creating a parent-child Guided Participation Relationship was described by all participants, suggesting that it was helpful in developing social skills. Participants suggested that once this relationship is created, children can then begin transferring the social skills they learn into new, more complex environments to develop relationships with peers. Linda provided an example of this:

Two RDI parents have got together… and so they have playdates now. Today was the first time when [the children]… related with each other. They actually… got on the bed together and were rolling around and one talked to the other. [The mother said] “I’ve never heard him talk to another child before.”

RDI Allows Children to Successfully Navigate the World

Many participants recognised that autistic children commonly have difficulty coping with uncertainty and change, and this can result in some behaviours that parents and other people find hard to navigate. Participants highlighted that many behavioural interventions for ASD attempt to reduce the frequency of such behaviours by utilising tools, including visual schedules/prompts. However, participants consistently felt that these tools do not prepare children for how changeable life is. For example, Kimberly stated:

Visual prompts work but what happens if the visual prompt says, “Friday we go to the pool…” and Friday it's raining… He's going to have a meltdown… “But the prompt tells me it's Friday… It's time to go to the pool.” Well, that's exactly right. But life is dynamic.

Participants stated that instead, RDI encourages flexible thinking. Specifically, they suggested that by restoring the parent-child Guided Participation Relationship, RDI allows children to develop flexible thinking through observing and imitating their parents. For example, Rose suggested that RDI addresses the “part of [the] relationship in which the child is able to borrow the parent’s perspective.” Therefore, through this relationship, RDI fosters a child’s ability to navigate the real world, where change and uncertainty are inevitable. Judith summarised this idea, stating “[RDI is about] allowing the child to be empowered to cope in an everchanging world… being able to cope with the world so that … you can solve problems.”

Some participants recognised, however, that RDI does not eliminate all challenging behaviours. Instead, they suggested that it was important to coach parents to recognise common factors that cause their child emotional distress and develop strategies to assist their child to cope with these factors. For example, Nadine acknowledged that “things can still go pear-shaped [go wrong],”; however, she went on to explain that she “had a family who said ‘we had this massive meltdown at the dentist the other day but… I knew how to handle it.’” Nadine’s example demonstrated that RDI provides the skills to navigate challenges as they arise.

Thus, participants believed that RDI helps autistic children, and their parents develop ways to successfully navigate a world filled with uncertainty and change. As a result, participants identified reduced frequency of behaviours that parents and others had difficulty navigating and/or better equipped parents to respond to such behaviours.

Scaffolding for Independence through RDI

Participants identified that RDI utilises the parent-child Guided Participation Relationship to introduce ‘challenges’ for autistic children, with the intention of encouraging the development of independence. Nadia explained that RDI Consultants teach parents to “[find] a role for [their] child… where they feel competent and independent that they can participate in without having to ask for help.” Participants commonly discussed the need for setting ‘just right’ challenges and highlighted that RDI focuses on coaching parents to embed these challenges into their child’s day-to-day life. Most participants further identified that when appropriate challenges are provided, children begin to develop confidence in their skills and abilities. Specifically, multiple participants said that they notice children becoming more able to initiate and complete tasks on their own. Linda provided an example from her practice:

Mum had four bowls of breakfast… the idea was that [her son] would carry [the bowls] over to the table himself…by the time he got the third one, you could see… this satisfaction with himself that “I can do things. I'm confident. I’m helping... I'm doing my own thing.”

However, some participants identified the risks associated with providing challenges that are too difficult. Flora suggested that children may withdraw or “act out” if they feel they are failing. Further, Alessandra suggested that challenges that are too difficult may cause children to feel “incapable, which can be difficult to recover from.” Participants recognised the need for RDI Consultants and parents to determine the appropriate level of challenge to ensure the child develops independence, rather than feelings of incompetence.

Theme 2: Parents Learn to Embrace Parenthood through RDI

This theme encompasses RDI Consultants’ descriptions of how RDI helps overcome common difficulties experienced by parents of autistic children, and the positive impacts that overcoming these can have on parental roles. Specifically, participants identified that RDI can help parents to understand and embrace their child as a (neurodiverse) person rather than focussing on their diagnosis. Consultants discussed how this can impact parent and child well-being and facilitate new parenting approaches.

Embracing Autistic Children for Who They Are

Participants suggested that some parents have difficulty understanding and accepting their child’s diagnosis of ASD, which can impact their reactions to their child’s behaviours. Participants highlighted that part of their role is to develop the parent’s knowledge and understanding of ASD, to help them embrace their child as a (neurodiverse) person. For example, Mai explained that she works with parents to understand that “it's not… that the child is lazy or does not want to play. It is a child [who does things differently]. It's a matter of the parent to accept those [different ways]” Participants suggested that once parents understand ASD and what their child is experiencing, they can better engage with and support them. Some participants also identified that when parents understand ASD, they begin seeing their child in a more positive light. For example, Nadia stated that she notices “[parents] become more optimistic… more hopeful and … more invested in their child.”

Impacts of Parental Well-being on Family Function

Many participants highlighted that when parents first come to RDI they have often lost hope for a better future. They discussed multiple reasons for parents feeling this way, including that many parents of autistic children prioritise the health and well-being of their child over their own. Some participants described these families to be in ‘crisis mode’, where they get “meshed in with the stress… and there’s no way forward” (Alessandra). Participants suggested that part of their initial role is to act as emotional support for parents. Alessandra summarised this idea when she stated:

When [parents are] in crisis, they've lost hope. To say you can [help] seems like a really big thing that perhaps they're not ready to think about. If you can first deal with that, then you're opening up an opportunity to do… developmental work.

Participants stated that once families exit the state of crisis “they find life more settled…their child becomes more tuned into them… more motivated to be with them. They… can do things with less hassle. They’re not as reactionary and walking on eggshells” (Patricia). As a result, participants said that families begin engaging in new activities, functioning better, and feeling more joy in their interactions. Rose stated that “for [parents] to be able to do, and be with their child in, an activity: to have the child laugh and smile with them, it's a huge thing.” Some participants stated that parental stress levels appear to go down when “a change in the child’s behaviour” (Kimberly) happens as the progress of their children allows parents to “feel in control [in their parenting process and]…see a pathway” for their child and families (Judith).

Changing Parental Approach through Intensive Involvement

All participants emphasised the importance of intensive engagement of parents in the RDI process, explaining that it is essential that they took a proactive role in their relationship with their child. However, some participants identified that, due to the demands placed on parents for a family’s successful RDI engagement, RDI is not possible for all parents. Patricia reported:

A lot of parents don't feel competent… [Parents] want the therapy approach where it's done to the child. Parents often want the child fixed. We don't fix. Parents often don't trust themselves to be able to do this. They're too busy, they want someone else to do it.

Most participants identified that RDI supports parents to take proactive roles through teaching them to adapt their own behaviours, to facilitate those of their child. This support included teaching parents to adjust their communication style. For example, Nadia highlighted that “rather than being instructive and directive… [parents need to] be more invitational with communication.” She went on to explain that “taking demand away and making things invitational… opened up [the parent’s] relationship with their child.” Thus, participants suggested that RDI supports parents to restore relationships with their children through facilitating new parental approaches to communication and being more collaborative. The participants felt that the emphasis on the parent-child Guided Participation Relationship was a core aspect of RDI which was commonly missed in other interventions for ASD.

Theme 3: Consultants Form a Team with Parents

This theme discusses how participants felt that RDI enables them to provide the best practice by collaborating with families. As the key factor for successful RDI is parental commitment, the majority of participants discussed the importance of “getting to know the families”, understanding “where they [parents] are coming from” and their needs in everyday practice. All participants highlighted that they find RDI rewarding due to this sense of being in a collaborative team with autistic children and their families. Debra stated “…it was really rewarding working with [a parent] because you feel like you’re…part of the team and it’s a collaboration”. They identified that, unlike many other interventions that they used previously, with RDI they build trusting relationships with families where parents feel empowered and supported. Nadia suggested the importance of building strong relationships with parents, stating “[parents] need somebody in their corner to say ‘yes, it is okay to say no to this…’, and ‘yes, there will be blowback, but you will survive that with your child.’ Despite acknowledging the importance of forming an allyship with parents, some participants described challenges in forming this relationship. For example, Patricia stated:

RDI is… not suited to every parent. Parents have to… be able to establish the relationship with [the RDI Consultant]. So, they have to be able to give [the RDI Consultant] feedback and receive feedback... So that relationship, that’s the main obstacle.

Discussion

This was the first study to explore the experiences of RDI Consultants using RDI with autistic children and their families, and the RDI Consultants’ perspectives of the impacts of RDI on the life of families who participate. There were three key findings. First, according to Australian RDI consultants, RDI seems to support autistic children with their interactions with others. Second, parenting seems to be enhanced with the use of RDI, with RDI Consultants reporting that parents are actively involved in their autistic child’s life. Finally, RDI Consultants reported that the use of RDI provides them with a sense of satisfaction as service providers through taking a collaborative approach with families. These findings aligned with, and elaborated on, previous research by providing insight into the lived experiences of RDI Consultants.

The results of this study suggest that RDI is perceived to support autistic children in actively contributing to their family interactions as participants. Previous research has shown that autistic children and their families (and others) can experience some difficulties forming relationships, including interacting with each other (Beurkens et al., 2013; De Clercq et al., 2022; Rutgers et al., 2007). These interactional difficulties can be frustrating for parents and children, and commonly, families go through a journey to learn their children’s subtle communication styles to understand their needs (De Clercq et al., 2022). There is a growing interest in the parent-child relationship as part of ASD interventions (Larkin et al., 2015). When autistic children and parents have strong relationships, the children have been found to demonstrate better social skills, levels of joint attention, and play behaviour than their counterparts (Van IJzendoorn et al., 2007; Naber et al., 2008). In our study, RDI Consultants attributed the increased social engagement of their clients (i.e., autistic children) to the development of the parent-child Guided Participation Relationship where parents learn new approaches to engaging with their children, and as a result, children learn new skills from their parents. These results align with other research which suggests that functional parent-child relationships that provide explicit guides for autistic children can facilitate their social skill development (Wolfberg et al., 2015). Therefore, therapeutic interventions that foster parent-child relationships, such as RDI, should be further promoted to support autistic children’s social skill development.

Our results suggest that RDI supports parents towards more satisfying and less stressful parenting. There is a large body of evidence to suggest that parents of autistic children experience some challenges with their parenting role and approaches (Benson, 2006; De Clercq et al., 2022; Estes et al., 2013, 2019; Ooi et al., 2016). High stress levels and depressive symptoms are commonly noted among these parents (Estes et al., 2013, 2021; Ooi et al., 2016). One of the issues with increased parental stress levels is the possibility that stress proliferation may negatively affect other areas, such as parental efficacy (Benson, 2006). Parental efficacy is a salient factor when considering parenting. A recent systematic review has found associations between parental self-efficacy and both parent and child wellbeing, and moreover, that it is related to effective parenting behaviour, such as responsive parenting (Albanese et al., 2019). While addressing parental stress levels appears to be pivotal when working with parents of autistic children, intense parental involvement in children’s interventions has been found to be one of the factors that can contribute to increased parental stress levels (Karst & Van Hecke, 2012). The current study found that while the RDI Consultants pointed to the need for intensive parental involvement for successful RDI delivery, Consultants actively provided emotional support for parents to alleviate their stress levels so parents would be ready to support their children. Future intervention programs that expect a high parental involvement should, therefore, consider and address parental stress levels to foster a sense of parent efficacy prior to starting an intervention.

The results indicate the importance of taking a collaborative approach that is built upon a trusting therapeutic relationship with families. Establishing a sound therapeutic relationship is critical for clients and their families to feel satisfied and ready to work cooperatively with their health professionals (Cohen & Mosek, 2019; Hand et al., 2021). A previous study has found that parental satisfaction with the support provided by health professionals is associated with family quality of life, and this association is mediated by the quality of therapeutic relationship (Balcells-Balcells et al., 2019). Interestingly, the current results suggest that the RDI provides a platform for the consultants to collaborate with parents and their children while developing a therapeutic relationship. This act of collaboration is likely to allow the consultants to feel satisfied with their service provision. The RDI consultants reported developing a relationship with families through understanding family needs as central to their practice, and when this relationship is developed and sustained, their work was considered rewarding. While the significance of therapeutic relationships in service provisions from the client and their family’s perspectives has been widely discussed (An & Palisano, 2014; Cohen & Mosek, 2019; Hand et al., 2021; Mössler et al., 2017), the current results suggest the importance of therapeutic relationships in shaping job satisfaction among health professionals.

Limitations and Future Research

This research was the first qualitative study into RDI from the perspectives of RDI Consultants, providing in-depth insights into their experience. However, several methodological considerations should be noted when considering the results of this study. First, as there are few RDI Consultants working in Australia, the sample size was limited by eligible participants. However, we believe that we were able to achieve considerable depth and repetition in the data with the number of participants recruited due to the open-ended questions and engagement of the participants in the subject matter. Second, as the study was set in Australia, findings are specific to the Australian culture and norms. This may impact the international transferability of the findings; however, the findings are likely to be most relevant in countries with similar healthcare systems to Australia. Future research can consider recruiting RDI Consultants from other countries, to enhance the transferability of results. Third, although no members of the research team are trained RDI Consultants, all have a healthcare background. We attempted to attend to our preconceptions by remaining open-minded and reflexively acknowledging/challenging any assumptions we made. Fourth, due to the inclusion criteria, all participants were currently practicing RDI Consultants. This meant it was likely that participants would view RDI positively. To mitigate this, we attempted to avoid presenting overly positive findings. The process of analysis was likely helped by none of the researchers being RDI consultants, and all participants having other professional backgrounds prior to commencing RDI. For example, many participants reflected on their use of other ASD interventions (e.g., ABA). Finally, while the current findings have added insights from the Consultants to the RDI research area, to further develop evidence, future research should explore the experiences of parents who participate in RDI, another important stakeholder in delivering this intervention with autistic children.

Conclusion

This study used qualitative methods to provide insight into RDI Consultants’ experiences of delivering RDI, and their perspectives of its impacts on the lives of autistic children and their families. Our findings supported and elaborated on current literature, suggesting that RDI enables trained RDI Consultants to provide interventions that support the unique needs of autistic children and their families, such as children’s social skills and parenting approaches. RDI Consultants guide parents to better communicate and engage with their autistic child, towards fostering the development of the parent-child relationships which support children’s social and emotional development. Delivering RDI appears to be rewarding for RDI Consultants, who work collaboratively with families of autistic children. The study extends the current evidence for RDI as an intervention approach for autistic children, and their families. Through this study we hope to provide clinicians, autistic children and their families an increased understanding and awareness of the therapeutic options available for autism, to assist them to decide on the most appropriate intervention approach. Although further research is needed on RDI’s efficacy, the current result is encouraging, and the intervention could be more widely promoted and funded in Australia.