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Intensive Interaction

 Intensive Interaction in action

'Intensive Interaction is a practical approach to interacting with people with severe or profound and multiple learning disabilities and/or autism. There is nothing difficult or expert about Intensive Interaction, it is a very practical approach to communication and socialising with people who do not find it easy communicating or being social.'

'The approach helps the person with learning difficulties and their communication partner to relate better to each other and enjoy each other's company more. It helps them develop their communication abilities. In Intensive interaction the carer, support worker, speech and language therapist or teacher works at being a better communication partner and so supports the person with learning disabilities develop confidence and competence as a communicator'.

'The approach was developed by teachers Dave Hewett and Melanie Nind in the 1980’s. The approach can be used as a way of teaching fundamental communication, as a means of relationship building, or simply as a way of pleasurably spending time with people'.      

 (Extracts from the Brisitsh Institute of Learning Disabilities 'Intensive Interaction Factsheet')

 Who is Intensive Interaction for?

It is intended that Intensive Interaction will address the needs of:

• People who are pre-verbal, with few or limited communicative behaviours.
• People who are extremely socially withdrawn, and do not positively interact with other people.
• People who display various stereotyped or self-stimulatory behaviours that exclude the participation of other people.

Originally Intensive Interaction was used with people with severe or profound intellectual disabilities and/or severe autism. However, in recent years Intensive Interaction has started to be successfully used with other groups of people who also find social communication difficult. These peolpe have included some people with multi-sensory impairments, some with Acquired Brain Injury and some people with Late Stage Dementia. 

Do you have to be an expert or can anyone do it?

There is nothing difficult or expert about Intensive Interaction. It is a very practical approach to communication and socialising that employs natural and easily recognisable techniques. It is theoretically very straightforward, and was developed from a model of ‘infant/caregiver interactions’, and therefore it involves the kind of activities through which sociability and communication normally develop in infancy.

Intensive Interaction should be a mutually pleasurable process and can be used as a way of teaching fundamental communication, as a means of relationship building, or simply as a way of pleasurably spending time with people. Depending on the personal preferences of who it is being used with, the nature and intensity of the Intensive Interaction activities might vary between noisy rough and tumble activities, intense mutual face-to-face studying or simply sitting quietly together in close physical proximity.

By using the various activities as a catalyst for social interaction we hope to facilitate a progression from passivity or social non-engagement, through turn-taking and contingent action, to the eventual initiation and leading of interactive games.

When we adopt Intensive Interaction as an approach we go about things in a particular way - we adopt a particular interactive style. We try to develop a calm, accepting atmosphere, recognising that the motivation for each participant to socially interact with us has to be right - any interactive activity has to be within their realm of interest.

We adjust our interpersonal behaviours, trying to make ourselves more interesting by perhaps altering our voice or body language. We may also follow the person’s lead - responding to the things they do, involving ourselves in their activity in a way that does not make any demands on them that they cannot cope with. We use timing and rhythm in the interactions, trying to make them mutually enjoyable - adding anticipation and drama to hold the person's attention. We try to create the feeling of taking turns. We communicate that we value them and enjoy being with them.

The most commonly recognised techniques that enable Intensive Interaction to take place include:

Sharing Personal Space: with Intensive Interaction we often look to share physical proximity in an equitable and mutually pleasurable way e.g. lying/sitting/standing together, quietly or otherwise, touching or apart.

Vocal Echoing: echoing some aspect of a person's vocalisations (including any non-symbolic sounds) can develop into socially inclusive conversation-like sequences e.g. echoing of a person's verbal or non-verbal vocalisations; echoing a person's breathing patterns; using dramatised or exaggerated intonation when echoing sounds.

Behavioural Mirroring: mirroring some aspect of a person's posture, movements or behaviour can develop into dynamic action sequences e.g. mirroring of a person's movements or some aspect of their physical activity; adopting someone's posture; mirroring the sounds made by a person's physical activity.

Physical Contact: sensitive and non-task focused physical contact can sometimes be vital to the approach, promoting mutual trust and sociability e.g. holding, rubbing, squeezing or clapping hands together; hand-over-hand games; rhythmically stroking arms or shoulders; walking arm-in-arm; touching foreheads or rubbing noses.

Making Eye Contact: sensitively sharing eye contact can be an important means for giving and receiving inclusive social signals e.g. looking at, and looking away games, making dramatic glances; looking in the mirror together.

Exchanging Facial Expressions: using sustained facial expressions with clear communicative intent, and creating opportunities for these to be reciprocated e.g. clear and sustained smiling, winking; pulling dramatised faces.

Joint Focus Activity: this is when both people focus their attention on the same object or activity whilst also on each other, structuring their engagement around a shared activity or focal point e.g. jointly exploring objects, books, photographs, or magazines either visually or physically; moving objects through a person's field of vision or hearing; reading to a person; actively listening to music together.

Joint Action: this is similar to a joint focus activity, but with joint action both interactive partners act simultaneously on the same object, or simultaneously engage in the same physical contact activity e.g. physically exploring objects together at the same time; playing ‘tug-of-war' with an object; doing a ‘row-row-row your boat' type activity together.

Turn Taking: where both individuals share and acknowledge a sequenced exchange, in whatever form it might take, and are aware of their role and their turn e.g. via sequenced vocalisations; via sequenced facial signalling; via sequenced physical actions e.g. sequenced clapping, or passing things to and fro, etc.

Burst-Pause Sequences: this is when an action is intentionally preceded by a deliberately extended pause, thus building anticipation and expectancy that something is about to happen e.g. hide-and-appear games; playing 'catch' with a ‘1-2-3' or ‘ready-steady-go' countdown; noise escalation games that build gradually then abruptly go quiet.

• Using ‘Running Commentaries': the sensitive use of a positive and affirming ‘running commentary' e.g. commenting on someone's actions, can provide an added socialising element to an Intensive Interaction engagement e.g. using limited language with a person to describe their activity "wow, great, yeah...", "here he comes now...", "I can see you looking...", "from me to you...".

There are also 3 other procedural concepts that underpin the use of Intensive Interaction:

Intentionality: this is done by ascribing communicative intent to a person's actions, even if such intentions are not obviously present. This can be achieved by verbal commentary on a person's actions e.g. ‘I know what you're looking at', or 'are you saying yes? Yes you are, yes'; thus adding to the ‘conversational' nature of an interaction.

Tasklessness: this is achieved by there being no set ‘task' to complete during an interaction i.e. there are no targets set prior to the activity: it is the quality of the interaction that is important, not any predetermined outcomes.

Establishing Mutual Pleasure: with Intensive Interaction we endeavour to make every interactive episode enjoyable and therefore rewarding to take a part in, and this is done by remembering that all people can be fun to be with, and that people who are fun to be with are therefore interesting.

What are the potential outcomes?

The body of evidence concerning the responses of people with severe or profound learning disabilities to Intensive Interaction is currently unambiguously supportive. Across a growing body of published Intensive Interation research (see some examples below) there are repeated claims of novel or increased socially interactive behaviours.

Such positive interactive developments have been found to include: greater use of sociable eye contact; increased toleration of, or engagement in, sociable physical contact activities; additional episodes of sustained joint attention; increased use of potentially communicative vocalisations; and an increased regard for facial signalling. There was also some additional evidence of greater initiation of social interaction by some of the research participants, both in children and adults.

Valuing People Now (VPN) - Dept of Health

According to the strategy document ‘Valuing People Now: ‘Making it happen for everyone’ (DoH, 2009) the UK Government’s vision is that all people with learning disabilities ‘are supported to become empowered citizens’. This document, a follow up to the original 'Valuing People' Document (2001), explicitly states that, for people with complex needs, where social inclusion is concerned:

1.6 addressing the issues for people with complex needs is really about embedding the principles of personalisation within all aspects of planning, commissioning and delivery of support services. It is also about recognising that the very particular support needs of an individual will mean very individualised support packages, including systems for facilitating meaningful two-way communication.

Page 38 of this 'Valuing People Now' document is completely given over to an exposition of Intensive Interaction, with some historical background, comments on the strategies involved, and a brief passage on the possible beneficial outcomes.  It goes on to state that people with learning disabilities should be enabled and supported to ‘develop and use appropriate communication systems where people have little or no verbal communication’ (p.39).


Some Useful Intensive Interaction Documents to Download (as pdf. documents):

An Introduction to Intensive Interaction (2016)

Intensive Interaction - Published Research Summaries Document (2016)


Some Useful Intensive Interaction Websites:

The Official Intensive Interaction Institute website


Some Useful Further Reading - influential research papers:

Some of the most informative and influential Intensive Interaction research papers with child participants include:

  • Watson, J. & Knight, C. (1991) ‘An Evaluation of Intensive Interactive Teaching with Pupils with Very Severe Learning Difficulties’, Child Language Teaching and Therapy, 7 (3), p.310-25.
  • Watson, J. & Fisher, A. (1997) ‘Evaluating the Effectiveness 0f Intensive Interaction Teaching with Pupils with Profound and Complex Learning Disabilities’, British Journal of Special Education, 24 (2), p.80-87.
  • Kellett, M. (2000) ‘Sam’s Story: Evaluating Intensive Interaction in Terms of its Effect on the Social and Communicative ability of a Young Child With Severe Learning Difficulties’, Support for Learning, 15 (4), p.165-171.
  • Kellett, M. (2005) ‘Catherine’s Legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies’, British Journal of Special Education, 32 (3), p.116-121.
  • Zeedyk, S., Davies, C., Parry, S. & Caldwell, P. (2009) ‘Fostering social engagement in Romanian children with communicative impairments: The experiences of newly trained practitioners of Intensive Interaction.’ British Journal of Learning Disabilities, 37 (3), p. 186-196.
  • Jones, K. & Howley, M. (2010) ‘An investigation into an interaction programme for children on the autism spectrum: outcomes for children, perceptions of schools and a model for training’, Journal of Research in Special Educational Needs, 10 (2), p.115-123. 
  • Argyropoulou, Z. & Papoudi, D. (2012) ‘The training of a child with autism in a Greek preschool inclusive class through intensive interaction: a case study’, European Journal of Special Needs Education, 27 (1), p.99-114.  

 

Some of the most informative and influential Intensive Interaction research papers with adult participants include: 

  • Nind, M. (1996) ‘Efficacy of Intensive Interaction; Developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver- infant interaction’, European Journal of Special Educational Needs, 11 (1), p.48-66.
  • Lovell, D., Jones, S. and Ephraim, G. (1998) ‘The Effect of Intensive Interaction on the Sociability of a Man with Severe Intellectual Disabilities’, International Journal of Practical Approaches to Disability, 22 (2/3), p.3-8.
  • Elgie, S. & Maguire, N. (2001) Intensive Interaction with a Woman with Multiple and Profound Disabilities; a case study’, Tizard Learning Disability Review, (6) 3, p.18-24.
  • Leaning, B. and Watson T. (2006) ‘From the inside looking out – an Intensive Interaction group for people with profound and multiple learning disabilities’, British Journal of Learning Disabilities, 34, p.103-109.
  • Firth, G., Elford, H., Leeming, C., & Crabbe, M. (2008) ‘Intensive Interaction as a Novel Approach in Social Care: Care Staff’s Views on the Practice Change Process,’ Journal of Applied Research in Intellectual Disabilities, 21, p.58-69.
  • Samuel, J., Nind, M., Volans, A. & Scriven, I. (2008) ‘An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities’, Journal of Intellectual Disabilities, 12, p.111-126.
  • Zeedyk, S., Caldwell, P. & Davies, C. (2009) ‘How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities and communicative impairments?’ European Journal of Special Needs Education, 24 (2), p.119–137.
  • Fraser, C. (2011) ‘Can adults on the autism spectrum be affected positively by the use of intensive interaction in supported living services?’ Good Autism Practice, 12 (2), p37-42.
  • Harris, C. & Wolverson, E. (2014) 'Intensive Interaction:to build fulfilling relationships', Journal of Dementia Care, 22(6), 27-30.

SOME FURTHER READING - other influential Intensive Interaction papers include:
  • Nind, M. & Powell, S. (2000) ‘Intensive Interaction and autism: some theoretical concerns’, Children and Society, 14 (2), p.98-109.
  • Kennedy, A. (2001) ‘Intensive Interaction’, Learning Disability Practice, 4 (3), p.14-15.
  • Barber, M.  (2007) 'Imitation, interaction and dialogue using Intensive Interaction: tea party rules', Support for Learning, 22, (3), p.124-130. 
  • Firth, G. (2008) ‘A Dual Aspect Process Model of Intensive Interaction’, British Journal of Learning Disabilities, 37, p.43-49.
  • Sharma, V. & Firth, G. (2012) ‘Effective Engagement through Intensive Interaction’, Learning Disability Practice, 15 (9), p.20-23.
  • Berry, R., Firth, G., Leeming, C. & Sharma, V. (2014) ‘Clinical Psychologists’ Views of Intensive Interaction as an Intervention in Learning Disability Services’, Clinical Psychology & Psychotherapy, 21 (5), p.403-410.
  • Hutchinson, N. & Bodicoat, A. (2015) ‘The Effectiveness of Intensive Interaction: A Systematic Literature Review', Journal of Applied Research in Intellectual Disabilities28 (6), 437-454.