A Practical Guide to Intensive Interaction

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I sit beside him and respond to each of his small sounds, tuning into how they make me feel, but altering the rhythm or pitch occasionally. I am answering rather than copying. At first he is half turned away from me but he gives me his hand which I shake in time to the sounds we are exchanging. He becomes more interested and turns round to face me, laughing. He introduces new sounds and movements to which I respond. We are soon engaged in a complex non-verbal interactive conversation. Before the weekend was over, more than 350 police officers had been injured and about two dozen buildings were gutted by fires. By the end of 1981's summer of urban discontent, fuelled by mass unemployment and simmering resentment at oppressive, sometimes openly racist policing, similar scenes ravaged parts of Liverpool, Manchester and Birmingham. Pranve constantly rubs his hands together - a very common way that people on the spectrum self-confirm. He carries a ball of strings underneath his armpit and spends time pulling these out and sorting them.

Nind, M. and Kellett, M. (2002) Responding to individuals with severe learning difficulties and stereotyped behaviour. Challenges for an inclusive era. European Journal of Special Needs Education 3. 265-282 In the 1980s, Geraint Ephraim,Consultant Psychologist at Harperbury Hospital, introduced the idea of using body language to communicate with people whose ability to communicate was impaired by severe intellectual disabilities. This approach was so successful that it was taken up by Nind and Hewett who named it Intensive Interaction. (Nind and Hewett 1994). I worked for four years under the supervision of Ephraim during tenure of a Joseph Rowntree Foundation Fellowship and subsequently (although not exclusively), specialised in using it with children and adults on the severe end of the autistic spectrum. My experience as a Practitioner using Intensive Interaction extends over twenty years and I have worked with literally hundreds of adults and children, many of whose behaviour was extremely distressed. Intensive interaction is an approach for enhancing the communication abilities of children and adults who have severe sensory problems, severe learning difficulties or autism. According to Nind and Hewett (1994), intensive interaction employs the ‘fundamentals of communication’ to build social interactivity. These ‘fundamentals’ include: The potential benefits associated with intensive interaction are thrilling to many who use the approach, including a large body of unheralded individuals who work directly with the clients. This is especially so if you consider that there are very few alternative approaches that can be used with people with severe or profound and multiple learning disabilities, sensory impairments and ‘challenging behaviours’. While II is by no means a ‘magic wand’, its reflective nature, relative simplicity, and evidence-based philosophy and methods are very interesting. I?believe the approach deserves more interest from psychology. This is increasingly true as intensive interaction is being used on an ever widening number of people with different communication problems. Psychology can assist the debate on what intensive interaction is and how it works, and so further its potential use as an educational, therapeutic and social approach.Field, T., Field, T., Sanders, C. and Nadel, J.(2001) ‘Children with autism display more social behaviours after repeated imitation sessions.’ Autism 5. 3. 317-323

During the three hours I am with Pranve, apart from the one time that I startle him, he shows no aggressive intent and is clearly delighted with our interactions. But also, after about twenty minutes, he is no longer reacting to the scream of the planes passing over the house, so close their wheels are down for landing. His interest in our conversation is overriding his hypersensitivity to the high frequency whines of the jet engines. (Caldwell 2006a)Past records stated that Susan liked drawing, so we took paper and crayons to our sessions. Susan immediately engaged with us, requesting that we draw particular objects such as flowers, faces and cars. Susan also made attempts to involve the direct care staff in interaction: she would hold up the pictures to them and invite them to ‘look at that’ with a beaming smile (she also interacted with us in this way). The activity expanded into sharing songs when Susan started to sing ‘Round and round the garden’ as we drew flowers, and her expressed vocabulary expanded as the sessions progressed. For example, she requested ‘more petals’ on a ‘sunflower’.

Nind Nature Reserve ( grid reference ST755915) is a 3.75-hectare (9.3-acre) nature reserve in Gloucestershire. [1] [2] As Pranve becomes more relaxed his brain finds it easier to organise his muscular responses and he says clearly, ‘Where’s Charlene? ‘instead of muttering the rhythm and then goes on to astonish his family by introducing the nursery rhyme.

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And as Pranve’s parents become more proficient in using his body language to communicate with him, his behaviour becomes less stressed and he is able to return on a part-time basis to the day centre from which he had been excluded. Two months later his mother tells me that while he has the odd off-day, on the whole they could now interact with him and manage his behaviour. And he is calmer. Intensive Interaction is about learning and using the language that has meaning for an individual to build a relationship with them. It is not a ‘cure’, in the sense that we do a few sessions and the person responds and so we can stop using it. If we do this, they will regress, because what we have done is to learn their language, use it with them and then walk away, slamming the door to relationship in their faces. All their distressed behaviour will return. We have to use it as a continuing way of communication and use it to explore and build on the relationship that it fosters. When the brain is no longer under processing pressure it begins to work more effectively on its own account, within the limitations of its learning disability if this is present. This is especially true for people with autism who are so vulnerable to environmental stress. Pranve also makes sounds, a particular rhythm, ‘er-er-er’, which turn out to be a pre-verbal version of ‘Where’s Charlene?’, his sister who no longer lives with the family. This is the only thing he has ever been known to say. Zeedyk, S, Caldwell, P. and Davies, C (2009) ‘How Rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities?’ European Journal of Special Needs Education, Vol 24. 2009, p.119-137 Iacoboni, M., Woods, R.P., Brass, M. et al. (1999). Cortical mechanisms of human imitation. Science, 286, 5449.