Publications and Bibliography
Reference Guide to Publications
2015
Lloyd, Eleanor M
Intensive Interaction in the mainstream classroom: evaluating staff attitudes towards an inclusive socio-communicative intervention Journal Article
In: Good Autism Practice, vol. 16, no. 2, pp. 49-68, 2015, ISSN: 1466-2973.
@article{Lloyd2015,
title = {Intensive Interaction in the mainstream classroom: evaluating staff attitudes towards an inclusive socio-communicative intervention },
author = {Eleanor M Lloyd},
url = {https://www.ingentaconnect.com/content/bild/gap/2015/00000016/00000002/art00008},
issn = {1466-2973},
year = {2015},
date = {2015-10-02},
journal = {Good Autism Practice},
volume = {16},
number = {2},
pages = {49-68},
abstract = {Introduction: The inclusion of children with autism in mainstream schools is an important area for practice and research. Unfortunately current national strategies require children to be taught more often in whole class groupings, this being particularly challenging for pupils with autism. This project investigated the possibility of achieving inclusion via daily 15 to 20 minute sessions of a classroom-based activity called ‘Communiplay’ which was based on Intensive Interaction. However, Communiplay differed from ‘traditional’ Intensive Interaction in that it took place in small groups and was structured around play with a LEGO construction set: this being seen as inherently rewarding for the pupils with autism, whilst also promoting child initiation and adult imitation in mutually enjoyable interactions.
The project involved 6 classes (of <30 pupils aged 5-7 years) in an inner-city mainstream school. The classes included one or more pupils with a language or socio-communicative disorder. The staff teams were a teacher and two Teaching Assistants (TAs), who had a 70 minute training session on Intensive Interaction and Communiplay. Three Communiplay groups were formed in each class, consisting of: one child with a diagnosis of SEN (the ‘focus pupil’ who was partnered with the adult for Intensive Interaction) and two other pupils matched as play partners for each other. The teacher and TAs participated in one Communiplay group each day, and in the other groups once or twice a week.
Research design: This project combined qualitative elements with a quasi-experimental design, and collected data on the views of the teachers and TAs via: a Relationship Interaction Assessment, a Team Evaluation Form, an Everyday Communiplay Log, a Mid-Invention Review, an Evaluation Focus Group, and a Structured Observation Schedule.
Findings: the findings of this study indicated ‘that Communiplay may be effective in strengthening positive staff-pupil relationships and the amount of pupil initiated interaction with staff’. Also the author states that ‘staff-pupil interactions in the class as a whole may have been positively influenced by the intervention, even though the majority of children did not participate in a Communiplay trio’.
10 elements were seen by staff as relevant to the quality of pupils’ interactivity. These were:
1. An expectation of peer conversation
2. Staff being approachable and interested
3. A relaxed pace to arriving in class
4. Staff deliberately giving attention to focus pupils
5. Staff sitting at the child’s level and children interacting while standing
6. Pupils having freedom to choose from a range of activities
7. Mutual laughter
8. Informal physical contact conveying connection
9. Extended interactions
10. Staff being available to relate, rather than being busy with tasks.
The study also found that most staff were comfortable doing Communiplay in the classroom, although some did find the practice uncomfortable. However, the staff also found it impractical to fit 3 sessions of Communiplay into their daily schedules, and that the single training session on I.I. proved insufficient to achieve consistency of practice. The difficulty teachers had fitting Communiplay into the timetable apparently indicated an unwillingness to prioritise it over other, more instructional, teaching tasks.
In conclusion: despite a number of acknowledged limitations to this study, the findings confirm the difficultly a class teacher, under pressure to deliver the National Curriculum, has in making I.I. available in a mainstream classroom. According to the author, radical shifts are needed in staff preparedness, deployment and practice. Also a more individualised application of the National Curriculum is necessary to enable pupils with autism to develop their socio-communicative abilities.
The value of this study is in documenting the use of Intensive Interaction within mainstream classrooms. This intervention created intrinsically motivating and inclusive learning environments that contributed to the social development and well-being of children with autism and their peers with SEN. In terms of inclusion, creating communication enabling classrooms that focus on the responsiveness of staff is likely to yield the most benefits.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction: The inclusion of children with autism in mainstream schools is an important area for practice and research. Unfortunately current national strategies require children to be taught more often in whole class groupings, this being particularly challenging for pupils with autism. This project investigated the possibility of achieving inclusion via daily 15 to 20 minute sessions of a classroom-based activity called ‘Communiplay’ which was based on Intensive Interaction. However, Communiplay differed from ‘traditional’ Intensive Interaction in that it took place in small groups and was structured around play with a LEGO construction set: this being seen as inherently rewarding for the pupils with autism, whilst also promoting child initiation and adult imitation in mutually enjoyable interactions.
The project involved 6 classes (of <30 pupils aged 5-7 years) in an inner-city mainstream school. The classes included one or more pupils with a language or socio-communicative disorder. The staff teams were a teacher and two Teaching Assistants (TAs), who had a 70 minute training session on Intensive Interaction and Communiplay. Three Communiplay groups were formed in each class, consisting of: one child with a diagnosis of SEN (the ‘focus pupil’ who was partnered with the adult for Intensive Interaction) and two other pupils matched as play partners for each other. The teacher and TAs participated in one Communiplay group each day, and in the other groups once or twice a week.
Research design: This project combined qualitative elements with a quasi-experimental design, and collected data on the views of the teachers and TAs via: a Relationship Interaction Assessment, a Team Evaluation Form, an Everyday Communiplay Log, a Mid-Invention Review, an Evaluation Focus Group, and a Structured Observation Schedule.
Findings: the findings of this study indicated ‘that Communiplay may be effective in strengthening positive staff-pupil relationships and the amount of pupil initiated interaction with staff’. Also the author states that ‘staff-pupil interactions in the class as a whole may have been positively influenced by the intervention, even though the majority of children did not participate in a Communiplay trio’.
10 elements were seen by staff as relevant to the quality of pupils’ interactivity. These were:
1. An expectation of peer conversation
2. Staff being approachable and interested
3. A relaxed pace to arriving in class
4. Staff deliberately giving attention to focus pupils
5. Staff sitting at the child’s level and children interacting while standing
6. Pupils having freedom to choose from a range of activities
7. Mutual laughter
8. Informal physical contact conveying connection
9. Extended interactions
10. Staff being available to relate, rather than being busy with tasks.
The study also found that most staff were comfortable doing Communiplay in the classroom, although some did find the practice uncomfortable. However, the staff also found it impractical to fit 3 sessions of Communiplay into their daily schedules, and that the single training session on I.I. proved insufficient to achieve consistency of practice. The difficulty teachers had fitting Communiplay into the timetable apparently indicated an unwillingness to prioritise it over other, more instructional, teaching tasks.
In conclusion: despite a number of acknowledged limitations to this study, the findings confirm the difficultly a class teacher, under pressure to deliver the National Curriculum, has in making I.I. available in a mainstream classroom. According to the author, radical shifts are needed in staff preparedness, deployment and practice. Also a more individualised application of the National Curriculum is necessary to enable pupils with autism to develop their socio-communicative abilities.
The value of this study is in documenting the use of Intensive Interaction within mainstream classrooms. This intervention created intrinsically motivating and inclusive learning environments that contributed to the social development and well-being of children with autism and their peers with SEN. In terms of inclusion, creating communication enabling classrooms that focus on the responsiveness of staff is likely to yield the most benefits.
The project involved 6 classes (of <30 pupils aged 5-7 years) in an inner-city mainstream school. The classes included one or more pupils with a language or socio-communicative disorder. The staff teams were a teacher and two Teaching Assistants (TAs), who had a 70 minute training session on Intensive Interaction and Communiplay. Three Communiplay groups were formed in each class, consisting of: one child with a diagnosis of SEN (the ‘focus pupil’ who was partnered with the adult for Intensive Interaction) and two other pupils matched as play partners for each other. The teacher and TAs participated in one Communiplay group each day, and in the other groups once or twice a week.
Research design: This project combined qualitative elements with a quasi-experimental design, and collected data on the views of the teachers and TAs via: a Relationship Interaction Assessment, a Team Evaluation Form, an Everyday Communiplay Log, a Mid-Invention Review, an Evaluation Focus Group, and a Structured Observation Schedule.
Findings: the findings of this study indicated ‘that Communiplay may be effective in strengthening positive staff-pupil relationships and the amount of pupil initiated interaction with staff’. Also the author states that ‘staff-pupil interactions in the class as a whole may have been positively influenced by the intervention, even though the majority of children did not participate in a Communiplay trio’.
10 elements were seen by staff as relevant to the quality of pupils’ interactivity. These were:
1. An expectation of peer conversation
2. Staff being approachable and interested
3. A relaxed pace to arriving in class
4. Staff deliberately giving attention to focus pupils
5. Staff sitting at the child’s level and children interacting while standing
6. Pupils having freedom to choose from a range of activities
7. Mutual laughter
8. Informal physical contact conveying connection
9. Extended interactions
10. Staff being available to relate, rather than being busy with tasks.
The study also found that most staff were comfortable doing Communiplay in the classroom, although some did find the practice uncomfortable. However, the staff also found it impractical to fit 3 sessions of Communiplay into their daily schedules, and that the single training session on I.I. proved insufficient to achieve consistency of practice. The difficulty teachers had fitting Communiplay into the timetable apparently indicated an unwillingness to prioritise it over other, more instructional, teaching tasks.
In conclusion: despite a number of acknowledged limitations to this study, the findings confirm the difficultly a class teacher, under pressure to deliver the National Curriculum, has in making I.I. available in a mainstream classroom. According to the author, radical shifts are needed in staff preparedness, deployment and practice. Also a more individualised application of the National Curriculum is necessary to enable pupils with autism to develop their socio-communicative abilities.
The value of this study is in documenting the use of Intensive Interaction within mainstream classrooms. This intervention created intrinsically motivating and inclusive learning environments that contributed to the social development and well-being of children with autism and their peers with SEN. In terms of inclusion, creating communication enabling classrooms that focus on the responsiveness of staff is likely to yield the most benefits.
2014
Berry, Ruth; Firth, Graham
Clinical Psychologists' Views of Intensive Interaction as an Intervention in Learning Disability Services Journal Article
In: Clinical Psychology & Psychotherapy, vol. 21, no. 5, pp. 403-410, 2014, ISSN: 1002-1846.
@article{Berry2014,
title = {Clinical Psychologists' Views of Intensive Interaction as an Intervention in Learning Disability Services},
author = {Ruth Berry and Graham Firth },
doi = {https://doi.org/10.1002/cpp.1846},
issn = {1002-1846},
year = {2014},
date = {2014-09-01},
urldate = {2014-10-03},
journal = {Clinical Psychology & Psychotherapy},
volume = {21},
number = {5},
pages = {403-410},
abstract = {Some Background
This explored clinical psychologists’ views of Intensive Interaction as an intervention in learning disability services in terms of its theoretical underpinning and empirical support. It was also hoped that the study might illuminate significant issues influencing clinical psychologists’ adoption of the approach, including the participants’ thinking about the relevance of established psychological models and theories.
Overview of the Study
This qualitative study involved interviews with eight clinical psychologists from across the UK who were known to be working with adult clients with severe or profound intellectual disabilities, and to be using or advocating Intensive Interaction. The study utilised a grounded theory approach to analyse and categorise the resulting data.
Results & Discussion
All the participants were asked whether they saw Intensive Interaction as being concordant with any established psychological theories and were given specific exemplars. The models that were spoken about were attachment theory, developmental theory, Person-Centred Therapy (PCT), social role valorisation/normalisation, behaviourism, Ephraim’s ‘augmented mothering’, attribution theory, sensory integration, psychoanalytic models, social constructionism and humanistic psychology.
Of the six participants who spoke about attachment theory, all described Intensive Interaction as being consistent with it. Under the category of ‘theory’, one of the specific concepts was labelled ‘person-centred counselling/therapy/theory’, but little material was coded there. In contrast, there was considerably more interview data categorised under the label ‘the psychologising of Intensive Interaction’. This category contained statements in which the participants used psychological language to talk about Intensive Interaction rather than making specific reference to a theory or therapy.
To summarise: what the participants talked about when using Intensive Interaction and their comments about its benefits, can be best understood in Person-Centred Therapy terms; they described it as a means for establishing psychological contact.
First impression taken from the interviews was that the participants seemed to be acting out of character for psychologists i.e. they were perhaps deliberately using prosaic or commonplace language to describe complex psychological issues and perspectives.
Upon reflection, the authors realised that they themselves were not fully confident about their own understanding of the psychological underpinnings of Intensive Interaction. Being limited by the dearth of psychologically based literature on the approach, they decided to re-visit Geraint Ephraim’s doctoral thesis and his subsequent publications on ‘augmented mothering’. In so doing, the authors anticipated that they would find a clear theoretical rationale for ‘augmented mothering’ against which they might compare the conceptualisations of Intensive Interaction by the clinical psychologist participants. This expectation, however, was not fulfilled.
Finally, the authors stated that what is needed from clinical psychology is a more rigorously scientific approach involving theory development and testing via clinical case studies. Without a coherent process of theory development, and the systematic generation of an evidence base for a psychological model of Intensive Interaction, the approach is open to being dismissed as more commonplace than scientific. },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Some Background
This explored clinical psychologists’ views of Intensive Interaction as an intervention in learning disability services in terms of its theoretical underpinning and empirical support. It was also hoped that the study might illuminate significant issues influencing clinical psychologists’ adoption of the approach, including the participants’ thinking about the relevance of established psychological models and theories.
Overview of the Study
This qualitative study involved interviews with eight clinical psychologists from across the UK who were known to be working with adult clients with severe or profound intellectual disabilities, and to be using or advocating Intensive Interaction. The study utilised a grounded theory approach to analyse and categorise the resulting data.
Results & Discussion
All the participants were asked whether they saw Intensive Interaction as being concordant with any established psychological theories and were given specific exemplars. The models that were spoken about were attachment theory, developmental theory, Person-Centred Therapy (PCT), social role valorisation/normalisation, behaviourism, Ephraim’s ‘augmented mothering’, attribution theory, sensory integration, psychoanalytic models, social constructionism and humanistic psychology.
Of the six participants who spoke about attachment theory, all described Intensive Interaction as being consistent with it. Under the category of ‘theory’, one of the specific concepts was labelled ‘person-centred counselling/therapy/theory’, but little material was coded there. In contrast, there was considerably more interview data categorised under the label ‘the psychologising of Intensive Interaction’. This category contained statements in which the participants used psychological language to talk about Intensive Interaction rather than making specific reference to a theory or therapy.
To summarise: what the participants talked about when using Intensive Interaction and their comments about its benefits, can be best understood in Person-Centred Therapy terms; they described it as a means for establishing psychological contact.
First impression taken from the interviews was that the participants seemed to be acting out of character for psychologists i.e. they were perhaps deliberately using prosaic or commonplace language to describe complex psychological issues and perspectives.
Upon reflection, the authors realised that they themselves were not fully confident about their own understanding of the psychological underpinnings of Intensive Interaction. Being limited by the dearth of psychologically based literature on the approach, they decided to re-visit Geraint Ephraim’s doctoral thesis and his subsequent publications on ‘augmented mothering’. In so doing, the authors anticipated that they would find a clear theoretical rationale for ‘augmented mothering’ against which they might compare the conceptualisations of Intensive Interaction by the clinical psychologist participants. This expectation, however, was not fulfilled.
Finally, the authors stated that what is needed from clinical psychology is a more rigorously scientific approach involving theory development and testing via clinical case studies. Without a coherent process of theory development, and the systematic generation of an evidence base for a psychological model of Intensive Interaction, the approach is open to being dismissed as more commonplace than scientific.
This explored clinical psychologists’ views of Intensive Interaction as an intervention in learning disability services in terms of its theoretical underpinning and empirical support. It was also hoped that the study might illuminate significant issues influencing clinical psychologists’ adoption of the approach, including the participants’ thinking about the relevance of established psychological models and theories.
Overview of the Study
This qualitative study involved interviews with eight clinical psychologists from across the UK who were known to be working with adult clients with severe or profound intellectual disabilities, and to be using or advocating Intensive Interaction. The study utilised a grounded theory approach to analyse and categorise the resulting data.
Results & Discussion
All the participants were asked whether they saw Intensive Interaction as being concordant with any established psychological theories and were given specific exemplars. The models that were spoken about were attachment theory, developmental theory, Person-Centred Therapy (PCT), social role valorisation/normalisation, behaviourism, Ephraim’s ‘augmented mothering’, attribution theory, sensory integration, psychoanalytic models, social constructionism and humanistic psychology.
Of the six participants who spoke about attachment theory, all described Intensive Interaction as being consistent with it. Under the category of ‘theory’, one of the specific concepts was labelled ‘person-centred counselling/therapy/theory’, but little material was coded there. In contrast, there was considerably more interview data categorised under the label ‘the psychologising of Intensive Interaction’. This category contained statements in which the participants used psychological language to talk about Intensive Interaction rather than making specific reference to a theory or therapy.
To summarise: what the participants talked about when using Intensive Interaction and their comments about its benefits, can be best understood in Person-Centred Therapy terms; they described it as a means for establishing psychological contact.
First impression taken from the interviews was that the participants seemed to be acting out of character for psychologists i.e. they were perhaps deliberately using prosaic or commonplace language to describe complex psychological issues and perspectives.
Upon reflection, the authors realised that they themselves were not fully confident about their own understanding of the psychological underpinnings of Intensive Interaction. Being limited by the dearth of psychologically based literature on the approach, they decided to re-visit Geraint Ephraim’s doctoral thesis and his subsequent publications on ‘augmented mothering’. In so doing, the authors anticipated that they would find a clear theoretical rationale for ‘augmented mothering’ against which they might compare the conceptualisations of Intensive Interaction by the clinical psychologist participants. This expectation, however, was not fulfilled.
Finally, the authors stated that what is needed from clinical psychology is a more rigorously scientific approach involving theory development and testing via clinical case studies. Without a coherent process of theory development, and the systematic generation of an evidence base for a psychological model of Intensive Interaction, the approach is open to being dismissed as more commonplace than scientific.
Harris, Charly; Wolverson, Emma
Intensive Interaction: To build fulfilling relationships Journal Article
In: The Journal of Dementia Care, vol. 22, no. 6, pp. 27-30, 2014.
@article{Harris2014b,
title = {Intensive Interaction: To build fulfilling relationships},
author = {Charly Harris and Emma Wolverson},
year = {2014},
date = {2014-01-01},
journal = {The Journal of Dementia Care},
volume = {22},
number = {6},
pages = {27-30},
abstract = {In this paper the authors share their experiences of using Intensive Interaction (I.I.) to support people living in the later stages of dementia.
Communication in dementia: The authors point out that dementia care experts have warned that people with dementia who no longer have speech are at risk of becoming socially isolated and disempowered. For families and staff, the breakdown in communication can be a significant source of stress in care giving. There is growing recognition of the importance of reciprocity in dementia care, and I.I. could potentially be a means to this end.
The authors muted that some people may question I.I. for people with dementia given its origins in parent-child interactions. Also there are concerns that I.I. will not lead to cumulative improvements over time, due to the progressive nature of dementia. Despite such concerns, as I.I. focuses on social inclusion and emotional connectedness through meeting a person at their current level and allowing them to lead the interaction, this makes I.I. an approach that could offer structure and support to communication in advanced dementia.
The authors’ experience of using I.I.: For EW [a clinical psychologist] I.I. is especially useful when working with people who present with challenging behaviours – a sign that needs are unmet, often due to a communication breakdown. CH [a SLT] first used I.I. when working with adults with learning disabilities, but when she began working with people with dementia, she soon realised that their communication needs tended to be neglected, and so she continued to use I.I. whenever she thinks it appropriate.
CH researched the use I.I. with people with dementia: for the three participants in CH’s research, she found a sense of relationship development over the week of the study, and also in the following weeks. Two of the participants in particular also showed signs of engagement and social interaction, such as ‘looking at carer’, ‘vocalising’, ‘initiating’, ‘smiling / laughing’, which were more prominent in the I.I. session than in the standard interaction.
For one participant Mr D (who was bed-bound) I.I. gave him an opportunity to initiate interactions to control another person’s social behaviour e.g. moving his hand to his ear as CH sang. Mr D also started to change his vocalisations: outside of the I.I. sessions he vocalised loudly and constantly (it almost sounding painful), but shortly into the first I.I. session he began to adapt his vocalisations so that were gentler (mirroring CH’s sound): it felt like the give and take of a true conversation and led to a feeling of profound connection: basically, I.I. enabled Mr D to demonstrate areas of retained function which had been overlooked when relying on verbal interaction.
Mrs K flinched at touch and was isolated through her constant walking. She allowed the CH to join her on her stroll. During sessions there were shared moments of laughter and game playing as Mrs K showed CH her favoured routes and routines. As the sessions progressed Mrs K allowed CH to gently touch her arm, and this eventually developed, much to the shock of observing staff, into twirling each other’s hair while she watched CH intently. Perhaps most important of all was Mrs K’s husband’s comment that for the first time in months she had made eye contact with him.
The study was small and exploratory, but the results suggest great potential for the use of I.I. with people with dementia and the impact it can have on their relationships and well-being.
Reflections on teaching I.I. to staff groups: In many ways I.I. training for staff has been about permission giving and encouragement and as such appears to have positive effects on self-esteem. Also as I.I. can be emotionally and physically demanding so ongoing supervision and support is also essential. Training and supervision take time and I.I. also requires time and patience, so ultimately a culture change in services is required where services can move away from models of reactive communication towards proactively seeking out ongoing dialogues and building trust.
Concerns and queries: Given the concerns of some staff, it is legitimate to consider the suitability of I.I. for people who once had full verbal communication. Staff do need to be careful when trying to access the changing levels of both receptive and expressive communication in people with dementia. Therefore the author’s believe that personalisation is the key, and that means communicating in a way that has meaning for the person.
Concerns about the use of touch in healthcare settings have been common barriers to I.I. Also stereotypes about personal space and respect for older people have also been cited as a reason not to touch. Therefore for I.I. to be embraced, dementia care services need to develop person-specific touch guidelines. Given all these concerns, the authors observe that I.I. has demonstrated the potential to be renewing and transformative for staff.
Reflections on using I.I. with families: The authors note that family caregivers have been very interested in I.I. and also that when working with families the authors have found that many family caregivers automatically move into communicating in an I.I. manner having spent a lifetime already tuned into one another, recognising particularly the value of touch, delighting in all interactions.
Conclusion: The authors state that I.I. can be an approach to improving well-being in dementia, that respects personhood, adds quality to the working lives of staff, and reintroduces a bond based on fun and understanding.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this paper the authors share their experiences of using Intensive Interaction (I.I.) to support people living in the later stages of dementia.
Communication in dementia: The authors point out that dementia care experts have warned that people with dementia who no longer have speech are at risk of becoming socially isolated and disempowered. For families and staff, the breakdown in communication can be a significant source of stress in care giving. There is growing recognition of the importance of reciprocity in dementia care, and I.I. could potentially be a means to this end.
The authors muted that some people may question I.I. for people with dementia given its origins in parent-child interactions. Also there are concerns that I.I. will not lead to cumulative improvements over time, due to the progressive nature of dementia. Despite such concerns, as I.I. focuses on social inclusion and emotional connectedness through meeting a person at their current level and allowing them to lead the interaction, this makes I.I. an approach that could offer structure and support to communication in advanced dementia.
The authors’ experience of using I.I.: For EW [a clinical psychologist] I.I. is especially useful when working with people who present with challenging behaviours – a sign that needs are unmet, often due to a communication breakdown. CH [a SLT] first used I.I. when working with adults with learning disabilities, but when she began working with people with dementia, she soon realised that their communication needs tended to be neglected, and so she continued to use I.I. whenever she thinks it appropriate.
CH researched the use I.I. with people with dementia: for the three participants in CH’s research, she found a sense of relationship development over the week of the study, and also in the following weeks. Two of the participants in particular also showed signs of engagement and social interaction, such as ‘looking at carer’, ‘vocalising’, ‘initiating’, ‘smiling / laughing’, which were more prominent in the I.I. session than in the standard interaction.
For one participant Mr D (who was bed-bound) I.I. gave him an opportunity to initiate interactions to control another person’s social behaviour e.g. moving his hand to his ear as CH sang. Mr D also started to change his vocalisations: outside of the I.I. sessions he vocalised loudly and constantly (it almost sounding painful), but shortly into the first I.I. session he began to adapt his vocalisations so that were gentler (mirroring CH’s sound): it felt like the give and take of a true conversation and led to a feeling of profound connection: basically, I.I. enabled Mr D to demonstrate areas of retained function which had been overlooked when relying on verbal interaction.
Mrs K flinched at touch and was isolated through her constant walking. She allowed the CH to join her on her stroll. During sessions there were shared moments of laughter and game playing as Mrs K showed CH her favoured routes and routines. As the sessions progressed Mrs K allowed CH to gently touch her arm, and this eventually developed, much to the shock of observing staff, into twirling each other’s hair while she watched CH intently. Perhaps most important of all was Mrs K’s husband’s comment that for the first time in months she had made eye contact with him.
The study was small and exploratory, but the results suggest great potential for the use of I.I. with people with dementia and the impact it can have on their relationships and well-being.
Reflections on teaching I.I. to staff groups: In many ways I.I. training for staff has been about permission giving and encouragement and as such appears to have positive effects on self-esteem. Also as I.I. can be emotionally and physically demanding so ongoing supervision and support is also essential. Training and supervision take time and I.I. also requires time and patience, so ultimately a culture change in services is required where services can move away from models of reactive communication towards proactively seeking out ongoing dialogues and building trust.
Concerns and queries: Given the concerns of some staff, it is legitimate to consider the suitability of I.I. for people who once had full verbal communication. Staff do need to be careful when trying to access the changing levels of both receptive and expressive communication in people with dementia. Therefore the author’s believe that personalisation is the key, and that means communicating in a way that has meaning for the person.
Concerns about the use of touch in healthcare settings have been common barriers to I.I. Also stereotypes about personal space and respect for older people have also been cited as a reason not to touch. Therefore for I.I. to be embraced, dementia care services need to develop person-specific touch guidelines. Given all these concerns, the authors observe that I.I. has demonstrated the potential to be renewing and transformative for staff.
Reflections on using I.I. with families: The authors note that family caregivers have been very interested in I.I. and also that when working with families the authors have found that many family caregivers automatically move into communicating in an I.I. manner having spent a lifetime already tuned into one another, recognising particularly the value of touch, delighting in all interactions.
Conclusion: The authors state that I.I. can be an approach to improving well-being in dementia, that respects personhood, adds quality to the working lives of staff, and reintroduces a bond based on fun and understanding.
Communication in dementia: The authors point out that dementia care experts have warned that people with dementia who no longer have speech are at risk of becoming socially isolated and disempowered. For families and staff, the breakdown in communication can be a significant source of stress in care giving. There is growing recognition of the importance of reciprocity in dementia care, and I.I. could potentially be a means to this end.
The authors muted that some people may question I.I. for people with dementia given its origins in parent-child interactions. Also there are concerns that I.I. will not lead to cumulative improvements over time, due to the progressive nature of dementia. Despite such concerns, as I.I. focuses on social inclusion and emotional connectedness through meeting a person at their current level and allowing them to lead the interaction, this makes I.I. an approach that could offer structure and support to communication in advanced dementia.
The authors’ experience of using I.I.: For EW [a clinical psychologist] I.I. is especially useful when working with people who present with challenging behaviours – a sign that needs are unmet, often due to a communication breakdown. CH [a SLT] first used I.I. when working with adults with learning disabilities, but when she began working with people with dementia, she soon realised that their communication needs tended to be neglected, and so she continued to use I.I. whenever she thinks it appropriate.
CH researched the use I.I. with people with dementia: for the three participants in CH’s research, she found a sense of relationship development over the week of the study, and also in the following weeks. Two of the participants in particular also showed signs of engagement and social interaction, such as ‘looking at carer’, ‘vocalising’, ‘initiating’, ‘smiling / laughing’, which were more prominent in the I.I. session than in the standard interaction.
For one participant Mr D (who was bed-bound) I.I. gave him an opportunity to initiate interactions to control another person’s social behaviour e.g. moving his hand to his ear as CH sang. Mr D also started to change his vocalisations: outside of the I.I. sessions he vocalised loudly and constantly (it almost sounding painful), but shortly into the first I.I. session he began to adapt his vocalisations so that were gentler (mirroring CH’s sound): it felt like the give and take of a true conversation and led to a feeling of profound connection: basically, I.I. enabled Mr D to demonstrate areas of retained function which had been overlooked when relying on verbal interaction.
Mrs K flinched at touch and was isolated through her constant walking. She allowed the CH to join her on her stroll. During sessions there were shared moments of laughter and game playing as Mrs K showed CH her favoured routes and routines. As the sessions progressed Mrs K allowed CH to gently touch her arm, and this eventually developed, much to the shock of observing staff, into twirling each other’s hair while she watched CH intently. Perhaps most important of all was Mrs K’s husband’s comment that for the first time in months she had made eye contact with him.
The study was small and exploratory, but the results suggest great potential for the use of I.I. with people with dementia and the impact it can have on their relationships and well-being.
Reflections on teaching I.I. to staff groups: In many ways I.I. training for staff has been about permission giving and encouragement and as such appears to have positive effects on self-esteem. Also as I.I. can be emotionally and physically demanding so ongoing supervision and support is also essential. Training and supervision take time and I.I. also requires time and patience, so ultimately a culture change in services is required where services can move away from models of reactive communication towards proactively seeking out ongoing dialogues and building trust.
Concerns and queries: Given the concerns of some staff, it is legitimate to consider the suitability of I.I. for people who once had full verbal communication. Staff do need to be careful when trying to access the changing levels of both receptive and expressive communication in people with dementia. Therefore the author’s believe that personalisation is the key, and that means communicating in a way that has meaning for the person.
Concerns about the use of touch in healthcare settings have been common barriers to I.I. Also stereotypes about personal space and respect for older people have also been cited as a reason not to touch. Therefore for I.I. to be embraced, dementia care services need to develop person-specific touch guidelines. Given all these concerns, the authors observe that I.I. has demonstrated the potential to be renewing and transformative for staff.
Reflections on using I.I. with families: The authors note that family caregivers have been very interested in I.I. and also that when working with families the authors have found that many family caregivers automatically move into communicating in an I.I. manner having spent a lifetime already tuned into one another, recognising particularly the value of touch, delighting in all interactions.
Conclusion: The authors state that I.I. can be an approach to improving well-being in dementia, that respects personhood, adds quality to the working lives of staff, and reintroduces a bond based on fun and understanding.
2013
Firth, Graham; Poyser, Charlotte; Guthrie, Nicola
Training care staff in intensive interactions Journal Article
In: Learning Disability Practice, vol. 16, no. 10, pp. 14-19, 2013, ISSN: 7748-1499.
@article{Firth2013,
title = {Training care staff in intensive interactions},
author = {Graham Firth and Charlotte Poyser and Nicola Guthrie },
url = {https://www.researchgate.net/publication/272698043_Training_care_staff_in_intensive_interactions},
doi = {DOI:10.7748/ldp2013.12.16.10.14.e1499},
issn = {7748-1499},
year = {2013},
date = {2013-11-28},
journal = {Learning Disability Practice},
volume = {16},
number = {10},
pages = {14-19},
abstract = {Intensive interaction is a way of improving communication with children and adults who have severe or profound learning disabilities and/or autism. Research shows intensive interaction interventions often lead to more or new responses. This article discusses the Leeds NHS intensive interaction programme, which was developed to help staff implement the approach with individual service users. It also describes an evaluation of the programme during which feedback was generally positive and respondents said they would recommend the programme to other services.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Intensive interaction is a way of improving communication with children and adults who have severe or profound learning disabilities and/or autism. Research shows intensive interaction interventions often lead to more or new responses. This article discusses the Leeds NHS intensive interaction programme, which was developed to help staff implement the approach with individual service users. It also describes an evaluation of the programme during which feedback was generally positive and respondents said they would recommend the programme to other services.
2012
Sharma, Vishal; Firth, Graham
Effective Engagement through Intensive Interaction Journal Article
In: Learning Disability Practice, vol. 15, no. 9, pp. 20-23, 2012.
@article{Sharma2012,
title = {Effective Engagement through Intensive Interaction},
author = {Vishal Sharma and Graham Firth },
doi = {10.7748/ldp2012.11.15.9.20.c9380},
year = {2012},
date = {2012-10-31},
journal = {Learning Disability Practice},
volume = {15},
number = {9},
pages = {20-23},
abstract = {This paper reviews research on the effects of Intensive Interaction on the conduct, health and wellbeing of people with learning disabilities who exhibit severe challenging behaviour, and on the wellbeing of their carers. The authors conclude that Intensive Interaction can benefit clients, carers and staff, but that research is required to encourage developments in policy and practice, and that additional staff training is needed to ensure that Intensive Interaction strategies can succeed.
The authors describe how individuals with severe and/or profound and multiple learning disabilities (S/PMLD) and/or autism may present with severe challenging behaviour, this is ‘behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy’ (Emerson et al, 1988). Such behaviours can include, but are not limited to, head banging, punching and biting (Oliver, et al., 2003).
The authors also point to a contrasting perspective by Ephraim (1998) that there is no such thing as severe challenging behaviours, and that these are socially aberrant forms of communication i.e. ‘A punch in the face’ is an act of communication, although the message behind the punch may not be understood.
The paper goes on to review existing research with differing results as to the effectiveness of Intensive Interaction in reducing the severity and/or frequency of severe challenging behaviours in individuals with S/PMLD and/or autism (Caldwell, 2010; Nind and Hewett, 2005).
However, the authors mention that previous research suffers from a number of methodological limitations, such as small sample sizes (Elgie and Maguire, 2001), varying practitioner ability/experience (Zeedyk, et al., 2009), varying definitions of “challenging behaviour” and a lack of objective assessment of behaviour pre- and post-Intensive Interaction interventions (Irvine, 2001). These limitations hinder the ability to generalise findings across user groups, and may also explain the lack of adoption of Intensive Interaction by learning disability services. As such, further methodologically robust research is requested by the authors.
In conclusion the authors suggest that the current body of research indicates that Intensive Interaction techniques can reduce the severity and frequency of severe challenging behaviours, and improve the health and wellbeing of individuals with S/PMLD. Moreover, viewing the behaviours as a form of communication (Ephraim, 1998) suggests that carers need to ‘learn the language’ of their clients or service users. Thus, Intensive Interaction encourages carers to listen to and understand what individuals are saying with their body language and facial expressions.
It is also the author’s view that by adopting Intensive Interaction techniques, staff can communicate more effectively with people with S/PMLD, and introduce them to new worlds of social interaction.
Finally the authors propose that further evidence of the benefits may encourage policy makers and practitioners to adopt Intensive Interaction practices, thereby enabling individuals with S/PMLD and their families to achieve a better quality of life.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This paper reviews research on the effects of Intensive Interaction on the conduct, health and wellbeing of people with learning disabilities who exhibit severe challenging behaviour, and on the wellbeing of their carers. The authors conclude that Intensive Interaction can benefit clients, carers and staff, but that research is required to encourage developments in policy and practice, and that additional staff training is needed to ensure that Intensive Interaction strategies can succeed.
The authors describe how individuals with severe and/or profound and multiple learning disabilities (S/PMLD) and/or autism may present with severe challenging behaviour, this is ‘behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy’ (Emerson et al, 1988). Such behaviours can include, but are not limited to, head banging, punching and biting (Oliver, et al., 2003).
The authors also point to a contrasting perspective by Ephraim (1998) that there is no such thing as severe challenging behaviours, and that these are socially aberrant forms of communication i.e. ‘A punch in the face’ is an act of communication, although the message behind the punch may not be understood.
The paper goes on to review existing research with differing results as to the effectiveness of Intensive Interaction in reducing the severity and/or frequency of severe challenging behaviours in individuals with S/PMLD and/or autism (Caldwell, 2010; Nind and Hewett, 2005).
However, the authors mention that previous research suffers from a number of methodological limitations, such as small sample sizes (Elgie and Maguire, 2001), varying practitioner ability/experience (Zeedyk, et al., 2009), varying definitions of “challenging behaviour” and a lack of objective assessment of behaviour pre- and post-Intensive Interaction interventions (Irvine, 2001). These limitations hinder the ability to generalise findings across user groups, and may also explain the lack of adoption of Intensive Interaction by learning disability services. As such, further methodologically robust research is requested by the authors.
In conclusion the authors suggest that the current body of research indicates that Intensive Interaction techniques can reduce the severity and frequency of severe challenging behaviours, and improve the health and wellbeing of individuals with S/PMLD. Moreover, viewing the behaviours as a form of communication (Ephraim, 1998) suggests that carers need to ‘learn the language’ of their clients or service users. Thus, Intensive Interaction encourages carers to listen to and understand what individuals are saying with their body language and facial expressions.
It is also the author’s view that by adopting Intensive Interaction techniques, staff can communicate more effectively with people with S/PMLD, and introduce them to new worlds of social interaction.
Finally the authors propose that further evidence of the benefits may encourage policy makers and practitioners to adopt Intensive Interaction practices, thereby enabling individuals with S/PMLD and their families to achieve a better quality of life.
The authors describe how individuals with severe and/or profound and multiple learning disabilities (S/PMLD) and/or autism may present with severe challenging behaviour, this is ‘behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy’ (Emerson et al, 1988). Such behaviours can include, but are not limited to, head banging, punching and biting (Oliver, et al., 2003).
The authors also point to a contrasting perspective by Ephraim (1998) that there is no such thing as severe challenging behaviours, and that these are socially aberrant forms of communication i.e. ‘A punch in the face’ is an act of communication, although the message behind the punch may not be understood.
The paper goes on to review existing research with differing results as to the effectiveness of Intensive Interaction in reducing the severity and/or frequency of severe challenging behaviours in individuals with S/PMLD and/or autism (Caldwell, 2010; Nind and Hewett, 2005).
However, the authors mention that previous research suffers from a number of methodological limitations, such as small sample sizes (Elgie and Maguire, 2001), varying practitioner ability/experience (Zeedyk, et al., 2009), varying definitions of “challenging behaviour” and a lack of objective assessment of behaviour pre- and post-Intensive Interaction interventions (Irvine, 2001). These limitations hinder the ability to generalise findings across user groups, and may also explain the lack of adoption of Intensive Interaction by learning disability services. As such, further methodologically robust research is requested by the authors.
In conclusion the authors suggest that the current body of research indicates that Intensive Interaction techniques can reduce the severity and frequency of severe challenging behaviours, and improve the health and wellbeing of individuals with S/PMLD. Moreover, viewing the behaviours as a form of communication (Ephraim, 1998) suggests that carers need to ‘learn the language’ of their clients or service users. Thus, Intensive Interaction encourages carers to listen to and understand what individuals are saying with their body language and facial expressions.
It is also the author’s view that by adopting Intensive Interaction techniques, staff can communicate more effectively with people with S/PMLD, and introduce them to new worlds of social interaction.
Finally the authors propose that further evidence of the benefits may encourage policy makers and practitioners to adopt Intensive Interaction practices, thereby enabling individuals with S/PMLD and their families to achieve a better quality of life.
Argyropoulou, Zoe; Papoudi, Despina
The training of a child with autism in a Greek preschool inclusive class through intensive interaction: a case study Journal Article
In: European Journal of Special Needs Education, vol. 27, no. 1, pp. 99-114, 2012, ISSN: 0885-6257.
@article{Argyropoulou2012,
title = {The training of a child with autism in a Greek preschool inclusive class through intensive interaction: a case study},
author = {Zoe Argyropoulou and Despina Papoudi},
doi = {https://doi.org/10.1080/08856257.2011.640489},
issn = {0885-6257},
year = {2012},
date = {2012-01-11},
journal = { European Journal of Special Needs Education},
volume = {27},
number = {1},
pages = {99-114},
abstract = {This study examined social interactions during play between a young boy with autism and a typically developing girl, before and after the boy was trained by his teacher through intensive interaction.
Method: This study, conducted in a preschool inclusive class in a school in Athens, concerned a 6-year old boy (Philippe) who presented several key features of autism including social isolation, echolalic speech, and ritualistic behaviours. A girl, Anna with a highly developed sense of empathy, was selected as the boy’s play partner. A range of materials and toys were made available during the sessions to facilitate verbal and non-verbal communication.
The two month study used an ABA single case design, with the data recorded in three different phases, baseline (A1), post-training (B) and follow-up (A2). Each phase included five sessions of 10-15 minutes over two weeks, session being videotaped and the first author keeping field notes. The children were told that the purpose was ‘playing to have fun’.
Baseline Phase A1: to observe the children’s behaviour to provide a baseline.
Training phase: in this phase the researcher used the same play materials used during Phase A1 and ‘Intensive Interaction’ techniques were used. Each session was followed by a play session between the two children.
Phase B – post training: to assess the effectiveness of the training of Philippe. The play materials remained the same. It was hoped that the ‘training’ would increase Philippe’s desire to interact with Anna.
Phase A2: in this phase the training was withdrawn and the conditions of Phase A1 re-established.
Measurement: The success of the training was judged by coding the children’s social behaviours which were categorised as initiations and responses. For each initiation, the other child’s response, positive or negative, was recorded. All the data was videoed, social interactions coded, and categorised. Initiations included (a) waiving to or holding the other child’s hand; (b) drawing attention to an object or activity; (c) verbal communication, i.e. making a verbal initiation or asking something of the other child; (d) body contact, i.e. kissing or cuddling the other child: and (e) giving a toy or initiating a game.
A ‘response’ was defined as a behaviour which followed a social behaviour by the other child. These were coded as ‘positive’ if a child answered a question, obeyed an order, responded positively or imitated the actions of the other child. ‘Negative’ responses included: (a) avoidance, when the child looked/moved away, pushed him/her, closed his eyes and did not respond when called; (b) aggressiveness when the child pushed, pulled, or scared the other child.
Results
Philippe’s initiations and Anna’s responses: From Phase A1 to B, the number of Philippe’s initiations increased from 16 to 28. From Phase B to A2 the number of Philippe’s initiations returned to the level of Phase A1. From Phase A1 to A2 there was an increase in the percentage of positive responses of Anna of 33%.
Anna’s initiations and Philippe’s responses: From Phase A1 to B there was an increase of positive responses by Philippe of 460%. From Phase B to A2, the number of Anna’s initiations decreased from 39 to 28 (28%). From Phase A1 to A2 the number of Anna’s initiations increased from 11 to 28 (155%). In Phase A2 71% of Philippe’s responses were positive and 29% negative, with an increase in Philippe’s positive responses of 300%. Philippe’s social behaviour changed after training, during Phase B - Philippe’s initiations increased by 75%, with a 144% increase in his positive responses. During Phase A2 Philippe’s positive responses remained higher, reaching 72% of his total responses and decreasing only to 71% in Phase A2. This suggests that the withdrawal of training influenced the initiation level but not the level of the child’s positive responses, a fact that might be explained by emotional intimacy that was created between the two children.
Before the research Philippe and Anna were acquainted but were not playing together. After the study, Anna and other peers were initiating contact with Philippe and tried to include him in their games. Philippe responded positively when with the children and seemed happy. Sometimes Philippe also made initiations to Anna. During Philippe’s training a detailed sessional diary evidenced improvements in his social and emotional engagement, eye contact, verbalisations, body orientation and contact, and smile from the first session onwards.
Conclusion: This study showed that ‘Intensive Interaction’ helped a child with autism to increase his social engagement. His initiations increased in the post training phase but returned to the initial level in the follow up phase. However, his increased levels of positive responses to the peer’s initiations remained at a high level post training.
Overall, the results of this study accord with the findings of previous research. Firstly, children with autism are more likely to engage with someone if that person provides active input. Secondly, such input is more effective when it ‘scaffolds’ the child with a disability through Intensive Interaction and interactive play. Lastly, 1-to-1 peer to target child ratio increases the likelihood of social initiations and interactions between a child with autism and his peer.
Naturally, a single case study during a short time period is limited, with inherent problems of generalizability. Further research is needed to determine how such ‘Intensive Interaction’ training can be applied in order to help the social interaction between children with communication difficulties and their peers in mainstream settings. },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study examined social interactions during play between a young boy with autism and a typically developing girl, before and after the boy was trained by his teacher through intensive interaction.
Method: This study, conducted in a preschool inclusive class in a school in Athens, concerned a 6-year old boy (Philippe) who presented several key features of autism including social isolation, echolalic speech, and ritualistic behaviours. A girl, Anna with a highly developed sense of empathy, was selected as the boy’s play partner. A range of materials and toys were made available during the sessions to facilitate verbal and non-verbal communication.
The two month study used an ABA single case design, with the data recorded in three different phases, baseline (A1), post-training (B) and follow-up (A2). Each phase included five sessions of 10-15 minutes over two weeks, session being videotaped and the first author keeping field notes. The children were told that the purpose was ‘playing to have fun’.
Baseline Phase A1: to observe the children’s behaviour to provide a baseline.
Training phase: in this phase the researcher used the same play materials used during Phase A1 and ‘Intensive Interaction’ techniques were used. Each session was followed by a play session between the two children.
Phase B – post training: to assess the effectiveness of the training of Philippe. The play materials remained the same. It was hoped that the ‘training’ would increase Philippe’s desire to interact with Anna.
Phase A2: in this phase the training was withdrawn and the conditions of Phase A1 re-established.
Measurement: The success of the training was judged by coding the children’s social behaviours which were categorised as initiations and responses. For each initiation, the other child’s response, positive or negative, was recorded. All the data was videoed, social interactions coded, and categorised. Initiations included (a) waiving to or holding the other child’s hand; (b) drawing attention to an object or activity; (c) verbal communication, i.e. making a verbal initiation or asking something of the other child; (d) body contact, i.e. kissing or cuddling the other child: and (e) giving a toy or initiating a game.
A ‘response’ was defined as a behaviour which followed a social behaviour by the other child. These were coded as ‘positive’ if a child answered a question, obeyed an order, responded positively or imitated the actions of the other child. ‘Negative’ responses included: (a) avoidance, when the child looked/moved away, pushed him/her, closed his eyes and did not respond when called; (b) aggressiveness when the child pushed, pulled, or scared the other child.
Results
Philippe’s initiations and Anna’s responses: From Phase A1 to B, the number of Philippe’s initiations increased from 16 to 28. From Phase B to A2 the number of Philippe’s initiations returned to the level of Phase A1. From Phase A1 to A2 there was an increase in the percentage of positive responses of Anna of 33%.
Anna’s initiations and Philippe’s responses: From Phase A1 to B there was an increase of positive responses by Philippe of 460%. From Phase B to A2, the number of Anna’s initiations decreased from 39 to 28 (28%). From Phase A1 to A2 the number of Anna’s initiations increased from 11 to 28 (155%). In Phase A2 71% of Philippe’s responses were positive and 29% negative, with an increase in Philippe’s positive responses of 300%. Philippe’s social behaviour changed after training, during Phase B - Philippe’s initiations increased by 75%, with a 144% increase in his positive responses. During Phase A2 Philippe’s positive responses remained higher, reaching 72% of his total responses and decreasing only to 71% in Phase A2. This suggests that the withdrawal of training influenced the initiation level but not the level of the child’s positive responses, a fact that might be explained by emotional intimacy that was created between the two children.
Before the research Philippe and Anna were acquainted but were not playing together. After the study, Anna and other peers were initiating contact with Philippe and tried to include him in their games. Philippe responded positively when with the children and seemed happy. Sometimes Philippe also made initiations to Anna. During Philippe’s training a detailed sessional diary evidenced improvements in his social and emotional engagement, eye contact, verbalisations, body orientation and contact, and smile from the first session onwards.
Conclusion: This study showed that ‘Intensive Interaction’ helped a child with autism to increase his social engagement. His initiations increased in the post training phase but returned to the initial level in the follow up phase. However, his increased levels of positive responses to the peer’s initiations remained at a high level post training.
Overall, the results of this study accord with the findings of previous research. Firstly, children with autism are more likely to engage with someone if that person provides active input. Secondly, such input is more effective when it ‘scaffolds’ the child with a disability through Intensive Interaction and interactive play. Lastly, 1-to-1 peer to target child ratio increases the likelihood of social initiations and interactions between a child with autism and his peer.
Naturally, a single case study during a short time period is limited, with inherent problems of generalizability. Further research is needed to determine how such ‘Intensive Interaction’ training can be applied in order to help the social interaction between children with communication difficulties and their peers in mainstream settings.
Method: This study, conducted in a preschool inclusive class in a school in Athens, concerned a 6-year old boy (Philippe) who presented several key features of autism including social isolation, echolalic speech, and ritualistic behaviours. A girl, Anna with a highly developed sense of empathy, was selected as the boy’s play partner. A range of materials and toys were made available during the sessions to facilitate verbal and non-verbal communication.
The two month study used an ABA single case design, with the data recorded in three different phases, baseline (A1), post-training (B) and follow-up (A2). Each phase included five sessions of 10-15 minutes over two weeks, session being videotaped and the first author keeping field notes. The children were told that the purpose was ‘playing to have fun’.
Baseline Phase A1: to observe the children’s behaviour to provide a baseline.
Training phase: in this phase the researcher used the same play materials used during Phase A1 and ‘Intensive Interaction’ techniques were used. Each session was followed by a play session between the two children.
Phase B – post training: to assess the effectiveness of the training of Philippe. The play materials remained the same. It was hoped that the ‘training’ would increase Philippe’s desire to interact with Anna.
Phase A2: in this phase the training was withdrawn and the conditions of Phase A1 re-established.
Measurement: The success of the training was judged by coding the children’s social behaviours which were categorised as initiations and responses. For each initiation, the other child’s response, positive or negative, was recorded. All the data was videoed, social interactions coded, and categorised. Initiations included (a) waiving to or holding the other child’s hand; (b) drawing attention to an object or activity; (c) verbal communication, i.e. making a verbal initiation or asking something of the other child; (d) body contact, i.e. kissing or cuddling the other child: and (e) giving a toy or initiating a game.
A ‘response’ was defined as a behaviour which followed a social behaviour by the other child. These were coded as ‘positive’ if a child answered a question, obeyed an order, responded positively or imitated the actions of the other child. ‘Negative’ responses included: (a) avoidance, when the child looked/moved away, pushed him/her, closed his eyes and did not respond when called; (b) aggressiveness when the child pushed, pulled, or scared the other child.
Results
Philippe’s initiations and Anna’s responses: From Phase A1 to B, the number of Philippe’s initiations increased from 16 to 28. From Phase B to A2 the number of Philippe’s initiations returned to the level of Phase A1. From Phase A1 to A2 there was an increase in the percentage of positive responses of Anna of 33%.
Anna’s initiations and Philippe’s responses: From Phase A1 to B there was an increase of positive responses by Philippe of 460%. From Phase B to A2, the number of Anna’s initiations decreased from 39 to 28 (28%). From Phase A1 to A2 the number of Anna’s initiations increased from 11 to 28 (155%). In Phase A2 71% of Philippe’s responses were positive and 29% negative, with an increase in Philippe’s positive responses of 300%. Philippe’s social behaviour changed after training, during Phase B - Philippe’s initiations increased by 75%, with a 144% increase in his positive responses. During Phase A2 Philippe’s positive responses remained higher, reaching 72% of his total responses and decreasing only to 71% in Phase A2. This suggests that the withdrawal of training influenced the initiation level but not the level of the child’s positive responses, a fact that might be explained by emotional intimacy that was created between the two children.
Before the research Philippe and Anna were acquainted but were not playing together. After the study, Anna and other peers were initiating contact with Philippe and tried to include him in their games. Philippe responded positively when with the children and seemed happy. Sometimes Philippe also made initiations to Anna. During Philippe’s training a detailed sessional diary evidenced improvements in his social and emotional engagement, eye contact, verbalisations, body orientation and contact, and smile from the first session onwards.
Conclusion: This study showed that ‘Intensive Interaction’ helped a child with autism to increase his social engagement. His initiations increased in the post training phase but returned to the initial level in the follow up phase. However, his increased levels of positive responses to the peer’s initiations remained at a high level post training.
Overall, the results of this study accord with the findings of previous research. Firstly, children with autism are more likely to engage with someone if that person provides active input. Secondly, such input is more effective when it ‘scaffolds’ the child with a disability through Intensive Interaction and interactive play. Lastly, 1-to-1 peer to target child ratio increases the likelihood of social initiations and interactions between a child with autism and his peer.
Naturally, a single case study during a short time period is limited, with inherent problems of generalizability. Further research is needed to determine how such ‘Intensive Interaction’ training can be applied in order to help the social interaction between children with communication difficulties and their peers in mainstream settings.
2011
Fraser, Catherine
Can adults on the autism spectrum be affected positively by the use of intensive interaction in supported living services? Journal Article
In: Good Autism Practice, vol. 12, no. 2, pp. 37-42, 2011, ISSN: 1466-2973.
@article{Fraser2011,
title = {Can adults on the autism spectrum be affected positively by the use of intensive interaction in supported living services?},
author = {Catherine Fraser},
issn = {1466-2973},
year = {2011},
date = {2011-10-31},
journal = {Good Autism Practice},
volume = {12},
number = {2},
pages = {37-42},
abstract = {In this paper the author CF (a residential service manager) stated that people who cannot communicate verbally are often not communicated with effectively, and this was why she was interested in Intensive Interaction (I.I.).
The case study: Derek was a man of 67 years with a diagnosis of autism and epilepsy. He had lived in the same supported living setting for 9 years. Derek sometimes displayed behaviours that were challenging e.g. incontinence; screaming and shouting at others; repetitiveness; withdrawing to his room for long periods; switching lights on and off; pulling his finger nails off. These behaviours were described as ‘agitated behaviour’. In order to judge the effectiveness of I.I., CF decided to record the frequency of these behaviours during and after the intervention.
When at home Derek had 1-to-1 support, and also attended a day centre five days a week. He communicated using words (singly or as a short ‘string’), gestures, and by pointing. When using I.I. with Derek, CF decided to work ‘instinctively’, only using speech when she deemed it to ‘fit’. One of the common interactions initiated by Derek was to talk about colours: Derek: “Colour” (pointing to a gold button) … CF: “Gold” … Derek: “Gold colour” … CF: ”Gold colour” … Derek: “Nice colour Ha Ha” (laughing) … CF: “Nice gold colour”
Derek appeared to respond positively to this interaction (he laughed, smiled and used eye contact), but this would not have happened prior to the introduction of I.I.. His support team tended to talk to him using full sentences as illustrated here: Derek: “Colour?” (pointing to some flowers) … Support Worker: “The flowers are yellow, where did you get them from?” … Derek: “Yellow” … Support Worker: “I asked you where you got them from Derek” … Derek did not respond and sat quietly.
Aims: CF’s stated aim of the I.I. was to develop more individual conversations rather than a prescriptive list of how to react. From observation Derek’s common movements and sounds were identified, giving an indication of what he might recognise.
Results and evaluation: When first using I.I. CF felt that Derek wasn’t showing any interest in her, preferring to seek out his support worker. After a few sessions the first shared interaction was a sigh, with a loud ‘blowing out’ sound. Derek did this and CF echoed it, and then Derek gave a very brief sideways glance towards CF. As the sessions went on, this interaction built up until one day as CF arrived Derek immediately sighed: it felt like they now had a meaningful way to say “Hello”.
During session 3 Derek used CF’s name. When CF arrived for session 5, Derek’s support worker took her to his room (where he was watching TV) and said: “Derek, Catherine is here”, at which point Derek said “Catherine” and smiled and jumped up from his bed. During session 8 Derek used sustained eye contact for the first time. CF found these signs of progression exhilarating and encouraging, to her it was a sign that the I.I. sessions were having a positive effect on Derek.
To increase the reliability of the findings CF met with Derek’s support team and asked them for their observations. One comment was that Derek had started asking when CF would next come. Other changes agreed by the team members were:
Derek had started spending more time in the lounge than his bedroom.
Derek had started interacting more with his fellow service-users.
Derek was more likely to complete activities with his support worker, and had stopped flicking lights on and off.
The amount of time Derek spent listening to music through headphones had reduced.
Derek appeared more patient, and did not invade other people’s personal space as much as he did before.
Generally the observations from the staff team showed an increase in sociability and a decrease in behaviours that challenged
Concluding comments: When evaluating this study CF stated that a research should consider any other factors which may have affected Derek’s behaviour, but then noted that there were no changes in the level of Derek’s support, or in the number of family visits and no significant changes to his health. CF also noted that there was no control or comparison data, making it impossible to conclude that the changes were directly due to the I.I., but CF states that this might well have been the case, and that there was no evidence to suggest that the I.I. caused any regression in his emotional state or behaviour.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this paper the author CF (a residential service manager) stated that people who cannot communicate verbally are often not communicated with effectively, and this was why she was interested in Intensive Interaction (I.I.).
The case study: Derek was a man of 67 years with a diagnosis of autism and epilepsy. He had lived in the same supported living setting for 9 years. Derek sometimes displayed behaviours that were challenging e.g. incontinence; screaming and shouting at others; repetitiveness; withdrawing to his room for long periods; switching lights on and off; pulling his finger nails off. These behaviours were described as ‘agitated behaviour’. In order to judge the effectiveness of I.I., CF decided to record the frequency of these behaviours during and after the intervention.
When at home Derek had 1-to-1 support, and also attended a day centre five days a week. He communicated using words (singly or as a short ‘string’), gestures, and by pointing. When using I.I. with Derek, CF decided to work ‘instinctively’, only using speech when she deemed it to ‘fit’. One of the common interactions initiated by Derek was to talk about colours: Derek: “Colour” (pointing to a gold button) … CF: “Gold” … Derek: “Gold colour” … CF: ”Gold colour” … Derek: “Nice colour Ha Ha” (laughing) … CF: “Nice gold colour”
Derek appeared to respond positively to this interaction (he laughed, smiled and used eye contact), but this would not have happened prior to the introduction of I.I.. His support team tended to talk to him using full sentences as illustrated here: Derek: “Colour?” (pointing to some flowers) … Support Worker: “The flowers are yellow, where did you get them from?” … Derek: “Yellow” … Support Worker: “I asked you where you got them from Derek” … Derek did not respond and sat quietly.
Aims: CF’s stated aim of the I.I. was to develop more individual conversations rather than a prescriptive list of how to react. From observation Derek’s common movements and sounds were identified, giving an indication of what he might recognise.
Results and evaluation: When first using I.I. CF felt that Derek wasn’t showing any interest in her, preferring to seek out his support worker. After a few sessions the first shared interaction was a sigh, with a loud ‘blowing out’ sound. Derek did this and CF echoed it, and then Derek gave a very brief sideways glance towards CF. As the sessions went on, this interaction built up until one day as CF arrived Derek immediately sighed: it felt like they now had a meaningful way to say “Hello”.
During session 3 Derek used CF’s name. When CF arrived for session 5, Derek’s support worker took her to his room (where he was watching TV) and said: “Derek, Catherine is here”, at which point Derek said “Catherine” and smiled and jumped up from his bed. During session 8 Derek used sustained eye contact for the first time. CF found these signs of progression exhilarating and encouraging, to her it was a sign that the I.I. sessions were having a positive effect on Derek.
To increase the reliability of the findings CF met with Derek’s support team and asked them for their observations. One comment was that Derek had started asking when CF would next come. Other changes agreed by the team members were:
Derek had started spending more time in the lounge than his bedroom.
Derek had started interacting more with his fellow service-users.
Derek was more likely to complete activities with his support worker, and had stopped flicking lights on and off.
The amount of time Derek spent listening to music through headphones had reduced.
Derek appeared more patient, and did not invade other people’s personal space as much as he did before.
Generally the observations from the staff team showed an increase in sociability and a decrease in behaviours that challenged
Concluding comments: When evaluating this study CF stated that a research should consider any other factors which may have affected Derek’s behaviour, but then noted that there were no changes in the level of Derek’s support, or in the number of family visits and no significant changes to his health. CF also noted that there was no control or comparison data, making it impossible to conclude that the changes were directly due to the I.I., but CF states that this might well have been the case, and that there was no evidence to suggest that the I.I. caused any regression in his emotional state or behaviour.
The case study: Derek was a man of 67 years with a diagnosis of autism and epilepsy. He had lived in the same supported living setting for 9 years. Derek sometimes displayed behaviours that were challenging e.g. incontinence; screaming and shouting at others; repetitiveness; withdrawing to his room for long periods; switching lights on and off; pulling his finger nails off. These behaviours were described as ‘agitated behaviour’. In order to judge the effectiveness of I.I., CF decided to record the frequency of these behaviours during and after the intervention.
When at home Derek had 1-to-1 support, and also attended a day centre five days a week. He communicated using words (singly or as a short ‘string’), gestures, and by pointing. When using I.I. with Derek, CF decided to work ‘instinctively’, only using speech when she deemed it to ‘fit’. One of the common interactions initiated by Derek was to talk about colours: Derek: “Colour” (pointing to a gold button) … CF: “Gold” … Derek: “Gold colour” … CF: ”Gold colour” … Derek: “Nice colour Ha Ha” (laughing) … CF: “Nice gold colour”
Derek appeared to respond positively to this interaction (he laughed, smiled and used eye contact), but this would not have happened prior to the introduction of I.I.. His support team tended to talk to him using full sentences as illustrated here: Derek: “Colour?” (pointing to some flowers) … Support Worker: “The flowers are yellow, where did you get them from?” … Derek: “Yellow” … Support Worker: “I asked you where you got them from Derek” … Derek did not respond and sat quietly.
Aims: CF’s stated aim of the I.I. was to develop more individual conversations rather than a prescriptive list of how to react. From observation Derek’s common movements and sounds were identified, giving an indication of what he might recognise.
Results and evaluation: When first using I.I. CF felt that Derek wasn’t showing any interest in her, preferring to seek out his support worker. After a few sessions the first shared interaction was a sigh, with a loud ‘blowing out’ sound. Derek did this and CF echoed it, and then Derek gave a very brief sideways glance towards CF. As the sessions went on, this interaction built up until one day as CF arrived Derek immediately sighed: it felt like they now had a meaningful way to say “Hello”.
During session 3 Derek used CF’s name. When CF arrived for session 5, Derek’s support worker took her to his room (where he was watching TV) and said: “Derek, Catherine is here”, at which point Derek said “Catherine” and smiled and jumped up from his bed. During session 8 Derek used sustained eye contact for the first time. CF found these signs of progression exhilarating and encouraging, to her it was a sign that the I.I. sessions were having a positive effect on Derek.
To increase the reliability of the findings CF met with Derek’s support team and asked them for their observations. One comment was that Derek had started asking when CF would next come. Other changes agreed by the team members were:
Derek had started spending more time in the lounge than his bedroom.
Derek had started interacting more with his fellow service-users.
Derek was more likely to complete activities with his support worker, and had stopped flicking lights on and off.
The amount of time Derek spent listening to music through headphones had reduced.
Derek appeared more patient, and did not invade other people’s personal space as much as he did before.
Generally the observations from the staff team showed an increase in sociability and a decrease in behaviours that challenged
Concluding comments: When evaluating this study CF stated that a research should consider any other factors which may have affected Derek’s behaviour, but then noted that there were no changes in the level of Derek’s support, or in the number of family visits and no significant changes to his health. CF also noted that there was no control or comparison data, making it impossible to conclude that the changes were directly due to the I.I., but CF states that this might well have been the case, and that there was no evidence to suggest that the I.I. caused any regression in his emotional state or behaviour.
Nind, Melanie
Enhancing the communication learning environment of an early years unit through action research Journal Article
In: Educational Action Research, vol. 11, no. 3, pp. 347-63, 2011, ISSN: 0965-0790.
@article{Nind2011,
title = {Enhancing the communication learning environment of an early years unit through action research},
author = {Melanie Nind},
url = {https://www.tandfonline.com/doi/pdf/10.1080/09650790300200226?needAccess=true},
doi = {https://doi.org/10.1080/09650790300200226},
issn = {0965-0790},
year = {2011},
date = {2011-02-08},
journal = {Educational Action Research},
volume = {11},
number = {3},
pages = {347-63},
abstract = {This article reports on an action research project in which an external consultant, special educational needs coordinator and staff of the early years unit of a mainstream school worked together to understand and enhance the communication learning environment provided for 3-5 year-old pupils. A transactional rather than deficit model was adopted, such that bi-directional influences in communication difficulties and communication learning were fully recognised. The focus for deliberation and action was the role, style, talk and interaction behaviour of the adults. Concepts of optimal interactive styles from studies of caregiver–infant interaction were applied. Activity included a mixture of observation, discussion and reflection on current and changing practice and related research. Developments evolved that were judged to have enhanced the communication learning environment, including increased use of small group time and greater use of child-led ‘show and tell’ and sharing time. The article is written from the perspective of the external consultant and includes discussion of the action research process.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This article reports on an action research project in which an external consultant, special educational needs coordinator and staff of the early years unit of a mainstream school worked together to understand and enhance the communication learning environment provided for 3-5 year-old pupils. A transactional rather than deficit model was adopted, such that bi-directional influences in communication difficulties and communication learning were fully recognised. The focus for deliberation and action was the role, style, talk and interaction behaviour of the adults. Concepts of optimal interactive styles from studies of caregiver–infant interaction were applied. Activity included a mixture of observation, discussion and reflection on current and changing practice and related research. Developments evolved that were judged to have enhanced the communication learning environment, including increased use of small group time and greater use of child-led ‘show and tell’ and sharing time. The article is written from the perspective of the external consultant and includes discussion of the action research process.
Hewett, Dave; Firth, Graham; Barber, Mark; Harrison, Tandy
The Intensive Interaction Handbook Book
1st, Sage Publications, 1 Oliver's Yard, 55 City Road, London, EC1Y 1SP, 2011, ISBN: 978-0-85702-491-6.
@book{Hewett2011,
title = {The Intensive Interaction Handbook},
author = {Dave Hewett and Graham Firth and Mark Barber and Tandy Harrison},
isbn = {978-0-85702-491-6},
year = {2011},
date = {2011-01-01},
publisher = {Sage Publications},
address = {1 Oliver's Yard, 55 City Road, London, EC1Y 1SP},
edition = {1st},
abstract = {This book is a practical guide to help those wishing to implement Intensive Interaction in their setting, and it provides detailed advice and step-by-step guidance as well as a consideration of all the issues associated with carrying out this approach
This book considers: preparing for Intensive Interaction; observing Intensive Interaction in progress; doing Intensive Interaction at home and at work; teamwork; wellbeing; and, record-keeping. This book is a straightforward guide for anyone wanting to use Intensive Interaction with people with severe and complex learning difficulties, people who have very severe learning difficulties, profound and multiple learning difficulties, multi-sensory impairments, and people who have a diagnosis of autism.},
keywords = {},
pubstate = {published},
tppubtype = {book}
}
This book is a practical guide to help those wishing to implement Intensive Interaction in their setting, and it provides detailed advice and step-by-step guidance as well as a consideration of all the issues associated with carrying out this approach
This book considers: preparing for Intensive Interaction; observing Intensive Interaction in progress; doing Intensive Interaction at home and at work; teamwork; wellbeing; and, record-keeping. This book is a straightforward guide for anyone wanting to use Intensive Interaction with people with severe and complex learning difficulties, people who have very severe learning difficulties, profound and multiple learning difficulties, multi-sensory impairments, and people who have a diagnosis of autism.
This book considers: preparing for Intensive Interaction; observing Intensive Interaction in progress; doing Intensive Interaction at home and at work; teamwork; wellbeing; and, record-keeping. This book is a straightforward guide for anyone wanting to use Intensive Interaction with people with severe and complex learning difficulties, people who have very severe learning difficulties, profound and multiple learning difficulties, multi-sensory impairments, and people who have a diagnosis of autism.
2010
Jones, Kyffin; Howley, Marie
In: Journal of Research in Special Educational Needs, vol. 10, no. 2, pp. 115-123, 2010, ISSN: 1471-3802.
@article{Jones2010,
title = {An investigation into an interaction programme for children on the autism spectrum: outcomes for children, perceptions of schools and a model for training},
author = {Kyffin Jones and Marie Howley},
url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-3802.2010.01153.x},
doi = {https://doi.org/10.1111/j.1471-3802.2010.01153.x},
issn = {1471-3802},
year = {2010},
date = {2010-06-01},
journal = {Journal of Research in Special Educational Needs},
volume = {10},
number = {2},
pages = {115-123},
abstract = {This study looked at a system of training in interactive skill building with children on the autism spectrum. The study focused on outcomes for children, the impact of the training and key features of the system of delivering the training.
The Background: The Learning and Autism Support team (LAST) is a team within the Special Needs Teaching Service (SNTS) - a multi-team resource supporting schools in one English Local Authority (LA) area. Historically, the SNTS employed play and music specialists with children with communication difficulties. What became clear, however, was the issue of continuity; while the specialists were able to forge meaningful relationships with children, these were not sustained after the intervention. Aligned to this was an increase in children with autism mainstream provision and the need to address the training needs of staff in mainstream settings. A full-time interaction specialist (Interactionist) was given the role to include the training of TAs (trainees) as an integral part of the project.
The programme was informed by approaches based on parents-infants interactions (‘Intensive Interaction’ - Nind & Hewett, 2001; ‘Enabling Communication in Children with Autism’ - Potter & Whittaker, 2001). One-to-one sessions included children engaging with the ‘Interactionist’, and engaging with trainees as the Interactionist mentored them.
Research approach: The research was interpretive to ‘interpret the phenomena of the world in attempts to get shared meanings with others’. The research allowed the researchers to explore the perceptions of staff in relation to the impact of the interaction programme. Key research questions were identified from the outset as:
What are the specific outcomes for children undertaking the interaction programme?
What is the impact of the programme for trainees and schools?
What are the key features of this system of delivering training?
Methods: Five primary schools which completed the programme over 1-year participated. The children were identified as having autism, Asperger Syndrome and autism with learning difficulties. Views were collected from SENCos, trainees and teachers in each school. The participants’ views were gathered via a variety of methods e.g. questionnaires which were and followed up by semi-structured interviews. Questionnaires were also given to parents of the five children, with one returned. All interviews were recorded, transcribed and thematically analysed.
Findings: Overall, outcomes for the children were reported as positive in relation to relationships with peers and adults, improved communication skills, behaviour and enjoyment of interaction. Interaction with peers and improved friendships were described by both class teachers and trainees:
‘He is now beginning to interact with a small number of children…’ (Class teacher)
‘Interaction with children in the playground has been the most obvious immediate benefit.’ (Trainee)
‘…her teacher came down and said ‘I have had the longest conversation I have ever had with him.’ (SENCo)
‘She really has enjoyed it and her behaviour… in the classroom has improved… ’ (Trainee)
‘He can now play with two other children around home …. he is calmer for longer and can play family games.’ (Parent)
Despite some initial anxieties, most trainees viewed the programme as positive: ‘…I didn’t really have a clear understanding or idea of what the aim was, but I thought “interactive play, that sounds like a brilliant idea and a fantastic concept, yes please ‘(Trainee). Trainees indicated high levels of satisfaction with the programme which included modelling of one-to-one sessions with the Interactionist. The training was reported to have a direct impact upon trainees’ confidence in how to implement interaction approaches. The partnership between the trainee and the Interactionist was identified as a key component of the approach. Other key features included on-going monitoring, evaluation and recording. It also became clear that the key factors central to achieving the programme aims was the development of partnerships within a systemic approach. All of the schools indicated that they would continue the programme and were keen to train other TAs.
Discussion: whilst acknowledging the positive outcomes indicated for children and schools, the authors recommended caution in generalising the findings due to the small-scale nature of this study. However, regarding the impact upon children, the positive outcomes demonstrated that the aims and principles of interactive approaches have relevance for children, regardless of their cognitive ability and that such approaches can be incorporated into a mainstream practices.
It was also clear from the research that the programme design provided a clearly delineated process of professional development and support. The programme enabled TAs to participate in a journey from the trainee to autonomous programme deliverer. This study also evidenced the ability of support services to identify innovative ways of working. Implicit within this is the view that imposing an external ‘expert’ upon school staff can have a ‘deskilling’ impact, and serve to propagate the view that effective SEN support is the remit of a minority of skilled individuals.
The authors finally conclude that vital to the maintenance of an effective system are the roles, responsibilities and remits of all the key players. In the context of this study, all participants felt a sense of ownership of their respective spheres, while engaging in a partnership to ensure the success of the programme as a whole.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study looked at a system of training in interactive skill building with children on the autism spectrum. The study focused on outcomes for children, the impact of the training and key features of the system of delivering the training.
The Background: The Learning and Autism Support team (LAST) is a team within the Special Needs Teaching Service (SNTS) - a multi-team resource supporting schools in one English Local Authority (LA) area. Historically, the SNTS employed play and music specialists with children with communication difficulties. What became clear, however, was the issue of continuity; while the specialists were able to forge meaningful relationships with children, these were not sustained after the intervention. Aligned to this was an increase in children with autism mainstream provision and the need to address the training needs of staff in mainstream settings. A full-time interaction specialist (Interactionist) was given the role to include the training of TAs (trainees) as an integral part of the project.
The programme was informed by approaches based on parents-infants interactions (‘Intensive Interaction’ - Nind & Hewett, 2001; ‘Enabling Communication in Children with Autism’ - Potter & Whittaker, 2001). One-to-one sessions included children engaging with the ‘Interactionist’, and engaging with trainees as the Interactionist mentored them.
Research approach: The research was interpretive to ‘interpret the phenomena of the world in attempts to get shared meanings with others’. The research allowed the researchers to explore the perceptions of staff in relation to the impact of the interaction programme. Key research questions were identified from the outset as:
What are the specific outcomes for children undertaking the interaction programme?
What is the impact of the programme for trainees and schools?
What are the key features of this system of delivering training?
Methods: Five primary schools which completed the programme over 1-year participated. The children were identified as having autism, Asperger Syndrome and autism with learning difficulties. Views were collected from SENCos, trainees and teachers in each school. The participants’ views were gathered via a variety of methods e.g. questionnaires which were and followed up by semi-structured interviews. Questionnaires were also given to parents of the five children, with one returned. All interviews were recorded, transcribed and thematically analysed.
Findings: Overall, outcomes for the children were reported as positive in relation to relationships with peers and adults, improved communication skills, behaviour and enjoyment of interaction. Interaction with peers and improved friendships were described by both class teachers and trainees:
‘He is now beginning to interact with a small number of children…’ (Class teacher)
‘Interaction with children in the playground has been the most obvious immediate benefit.’ (Trainee)
‘…her teacher came down and said ‘I have had the longest conversation I have ever had with him.’ (SENCo)
‘She really has enjoyed it and her behaviour… in the classroom has improved… ’ (Trainee)
‘He can now play with two other children around home …. he is calmer for longer and can play family games.’ (Parent)
Despite some initial anxieties, most trainees viewed the programme as positive: ‘…I didn’t really have a clear understanding or idea of what the aim was, but I thought “interactive play, that sounds like a brilliant idea and a fantastic concept, yes please ‘(Trainee). Trainees indicated high levels of satisfaction with the programme which included modelling of one-to-one sessions with the Interactionist. The training was reported to have a direct impact upon trainees’ confidence in how to implement interaction approaches. The partnership between the trainee and the Interactionist was identified as a key component of the approach. Other key features included on-going monitoring, evaluation and recording. It also became clear that the key factors central to achieving the programme aims was the development of partnerships within a systemic approach. All of the schools indicated that they would continue the programme and were keen to train other TAs.
Discussion: whilst acknowledging the positive outcomes indicated for children and schools, the authors recommended caution in generalising the findings due to the small-scale nature of this study. However, regarding the impact upon children, the positive outcomes demonstrated that the aims and principles of interactive approaches have relevance for children, regardless of their cognitive ability and that such approaches can be incorporated into a mainstream practices.
It was also clear from the research that the programme design provided a clearly delineated process of professional development and support. The programme enabled TAs to participate in a journey from the trainee to autonomous programme deliverer. This study also evidenced the ability of support services to identify innovative ways of working. Implicit within this is the view that imposing an external ‘expert’ upon school staff can have a ‘deskilling’ impact, and serve to propagate the view that effective SEN support is the remit of a minority of skilled individuals.
The authors finally conclude that vital to the maintenance of an effective system are the roles, responsibilities and remits of all the key players. In the context of this study, all participants felt a sense of ownership of their respective spheres, while engaging in a partnership to ensure the success of the programme as a whole.
The Background: The Learning and Autism Support team (LAST) is a team within the Special Needs Teaching Service (SNTS) - a multi-team resource supporting schools in one English Local Authority (LA) area. Historically, the SNTS employed play and music specialists with children with communication difficulties. What became clear, however, was the issue of continuity; while the specialists were able to forge meaningful relationships with children, these were not sustained after the intervention. Aligned to this was an increase in children with autism mainstream provision and the need to address the training needs of staff in mainstream settings. A full-time interaction specialist (Interactionist) was given the role to include the training of TAs (trainees) as an integral part of the project.
The programme was informed by approaches based on parents-infants interactions (‘Intensive Interaction’ - Nind & Hewett, 2001; ‘Enabling Communication in Children with Autism’ - Potter & Whittaker, 2001). One-to-one sessions included children engaging with the ‘Interactionist’, and engaging with trainees as the Interactionist mentored them.
Research approach: The research was interpretive to ‘interpret the phenomena of the world in attempts to get shared meanings with others’. The research allowed the researchers to explore the perceptions of staff in relation to the impact of the interaction programme. Key research questions were identified from the outset as:
What are the specific outcomes for children undertaking the interaction programme?
What is the impact of the programme for trainees and schools?
What are the key features of this system of delivering training?
Methods: Five primary schools which completed the programme over 1-year participated. The children were identified as having autism, Asperger Syndrome and autism with learning difficulties. Views were collected from SENCos, trainees and teachers in each school. The participants’ views were gathered via a variety of methods e.g. questionnaires which were and followed up by semi-structured interviews. Questionnaires were also given to parents of the five children, with one returned. All interviews were recorded, transcribed and thematically analysed.
Findings: Overall, outcomes for the children were reported as positive in relation to relationships with peers and adults, improved communication skills, behaviour and enjoyment of interaction. Interaction with peers and improved friendships were described by both class teachers and trainees:
‘He is now beginning to interact with a small number of children…’ (Class teacher)
‘Interaction with children in the playground has been the most obvious immediate benefit.’ (Trainee)
‘…her teacher came down and said ‘I have had the longest conversation I have ever had with him.’ (SENCo)
‘She really has enjoyed it and her behaviour… in the classroom has improved… ’ (Trainee)
‘He can now play with two other children around home …. he is calmer for longer and can play family games.’ (Parent)
Despite some initial anxieties, most trainees viewed the programme as positive: ‘…I didn’t really have a clear understanding or idea of what the aim was, but I thought “interactive play, that sounds like a brilliant idea and a fantastic concept, yes please ‘(Trainee). Trainees indicated high levels of satisfaction with the programme which included modelling of one-to-one sessions with the Interactionist. The training was reported to have a direct impact upon trainees’ confidence in how to implement interaction approaches. The partnership between the trainee and the Interactionist was identified as a key component of the approach. Other key features included on-going monitoring, evaluation and recording. It also became clear that the key factors central to achieving the programme aims was the development of partnerships within a systemic approach. All of the schools indicated that they would continue the programme and were keen to train other TAs.
Discussion: whilst acknowledging the positive outcomes indicated for children and schools, the authors recommended caution in generalising the findings due to the small-scale nature of this study. However, regarding the impact upon children, the positive outcomes demonstrated that the aims and principles of interactive approaches have relevance for children, regardless of their cognitive ability and that such approaches can be incorporated into a mainstream practices.
It was also clear from the research that the programme design provided a clearly delineated process of professional development and support. The programme enabled TAs to participate in a journey from the trainee to autonomous programme deliverer. This study also evidenced the ability of support services to identify innovative ways of working. Implicit within this is the view that imposing an external ‘expert’ upon school staff can have a ‘deskilling’ impact, and serve to propagate the view that effective SEN support is the remit of a minority of skilled individuals.
The authors finally conclude that vital to the maintenance of an effective system are the roles, responsibilities and remits of all the key players. In the context of this study, all participants felt a sense of ownership of their respective spheres, while engaging in a partnership to ensure the success of the programme as a whole.
2009
Zeedyk, M Suzanne; Davies, Cliff; Parry, Sarah; Caldwell, Phoebe
In: British Journal of Learning Disabilities, vol. 37, no. 3, pp. 186-196, 2009, ISSN: 1468-3156.
@article{Zeedyk2009,
title = {Fostering Social Engagement in Romanian Children with Communicative Impairments: Reflections by newly trained practitioners on the use of Intensive Interaction},
author = {M Suzanne Zeedyk and Cliff Davies and Sarah Parry and Phoebe Caldwell},
url = {https://doi.org/10.1111/j.1468-3156.2009.00545.x},
doi = {10.1111/j.1468-3156.2009.00545.x},
issn = {1468-3156},
year = {2009},
date = {2009-09-01},
urldate = {2009-08-18},
journal = {British Journal of Learning Disabilities},
volume = {37},
number = {3},
pages = {186-196},
abstract = {This paper reports on a study on the effectiveness of Intensive Interaction being used in Romania with children with severe communicative impairments. The children, in state care having been either orphaned or abandoned, attended a specialist day care centre on a daily basis. They were aged 4–15 years and displayed severe developmental delays (although no diagnoses were available their behaviours suggested autism, profound learning disabilities, and sensory impairments). All were socially withdrawn and frequently engaged in self-harm (e.g. biting their hand, scratching themselves, hitting their head). Many also had difficulties in walking or feeding themselves.
In this study, a group of UK volunteers (aged 16-25 years) worked closely with the children for a 2-week period. They were given a brief training session in the basics of Intensive Interaction, and then encouraged to use it with the children. After two days’ experience, the volunteers were asked to write an account reflecting on their experiences of using this approach. This paper provides a qualitative analysis of those written accounts.
Results and Discussion: Some of the most frequently cited changes in the children’s behaviour were perceived to be: an increase in the children’s attention to their partner; an increase in the amount of positive affect displayed by the children; and an increase in their proximity to others. Such shifts were frequently associated with changes in vocalisations and animation. Finally, increased flexibility and ease in interactions seemed to provide a particularly strong indicator of increased engagement. Also reported by 8 of the 12 volunteers was a noticeable decrease in distress and self-harming behaviour in more than one third of the children with whom they interacted. For a small number of children, an additional positive outcome was an increase in the level of their attention to the wider environment, strengthening the evidence that Intensive Interaction promotes interests across a range of domains, rather than the social domain alone.
Overall, the study found that the kinds of behavioural shifts predicted in the Intensive Interaction literature were observed by the volunteers. Although the study did not examine the children’s behaviour in detail, the volunteers perceived dramatic and prolonged increases in the children’s social engagement. Such reports indicate that one does not need to be an experienced practitioner to be aware of those changes.
Below are just a few of the many extracts from the volunteers’ testimony:
‘I started by just imitating Paula’s actions for a few minutes… then I introduced sounds… over the next 10 minutes of imitation, she was right next to me and put her hand in my lap, allowing me to stroke her hand and was smiling and even giggling, which I haven’t really seen her do before’.
‘Today has been amazing … I imitated Andrei, via clapping in different rhythms and also clapping around him, not just the way he prefers to. It means it does feel you are having a conversation with him, or playing a game’.
‘For the first part of the week, Mircea was very quiet, making only infrequent noises…. When Intensive Interaction was tried, Mircea became much more engaged and began to look directly at the person holding him, rather than over their shoulder’.
‘I think the technique really worked. Paula didn’t get anxious or upset during the whole session, which really amazed me because normally she gets upset at least once during the session’.
‘By the end of the week, Flavius actually picked up a toy from the grass, and I’ve never seen him do that’.
Conclusions: The authors interpret the results of this study as providing qualitative evidence that Intensive Interaction is effective in promoting social engagement in children with severe communicative impairments that arise from (or are at least exacerbated by) poor early care. The findings also demonstrate that such increases can be identified by practitioners as soon as they complete their training - extensive experience is not required. Indeed, it appears that practitioners begin to be able to generate such encouraging outcomes with minimal training.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This paper reports on a study on the effectiveness of Intensive Interaction being used in Romania with children with severe communicative impairments. The children, in state care having been either orphaned or abandoned, attended a specialist day care centre on a daily basis. They were aged 4–15 years and displayed severe developmental delays (although no diagnoses were available their behaviours suggested autism, profound learning disabilities, and sensory impairments). All were socially withdrawn and frequently engaged in self-harm (e.g. biting their hand, scratching themselves, hitting their head). Many also had difficulties in walking or feeding themselves.
In this study, a group of UK volunteers (aged 16-25 years) worked closely with the children for a 2-week period. They were given a brief training session in the basics of Intensive Interaction, and then encouraged to use it with the children. After two days’ experience, the volunteers were asked to write an account reflecting on their experiences of using this approach. This paper provides a qualitative analysis of those written accounts.
Results and Discussion: Some of the most frequently cited changes in the children’s behaviour were perceived to be: an increase in the children’s attention to their partner; an increase in the amount of positive affect displayed by the children; and an increase in their proximity to others. Such shifts were frequently associated with changes in vocalisations and animation. Finally, increased flexibility and ease in interactions seemed to provide a particularly strong indicator of increased engagement. Also reported by 8 of the 12 volunteers was a noticeable decrease in distress and self-harming behaviour in more than one third of the children with whom they interacted. For a small number of children, an additional positive outcome was an increase in the level of their attention to the wider environment, strengthening the evidence that Intensive Interaction promotes interests across a range of domains, rather than the social domain alone.
Overall, the study found that the kinds of behavioural shifts predicted in the Intensive Interaction literature were observed by the volunteers. Although the study did not examine the children’s behaviour in detail, the volunteers perceived dramatic and prolonged increases in the children’s social engagement. Such reports indicate that one does not need to be an experienced practitioner to be aware of those changes.
Below are just a few of the many extracts from the volunteers’ testimony:
‘I started by just imitating Paula’s actions for a few minutes… then I introduced sounds… over the next 10 minutes of imitation, she was right next to me and put her hand in my lap, allowing me to stroke her hand and was smiling and even giggling, which I haven’t really seen her do before’.
‘Today has been amazing … I imitated Andrei, via clapping in different rhythms and also clapping around him, not just the way he prefers to. It means it does feel you are having a conversation with him, or playing a game’.
‘For the first part of the week, Mircea was very quiet, making only infrequent noises…. When Intensive Interaction was tried, Mircea became much more engaged and began to look directly at the person holding him, rather than over their shoulder’.
‘I think the technique really worked. Paula didn’t get anxious or upset during the whole session, which really amazed me because normally she gets upset at least once during the session’.
‘By the end of the week, Flavius actually picked up a toy from the grass, and I’ve never seen him do that’.
Conclusions: The authors interpret the results of this study as providing qualitative evidence that Intensive Interaction is effective in promoting social engagement in children with severe communicative impairments that arise from (or are at least exacerbated by) poor early care. The findings also demonstrate that such increases can be identified by practitioners as soon as they complete their training - extensive experience is not required. Indeed, it appears that practitioners begin to be able to generate such encouraging outcomes with minimal training.
In this study, a group of UK volunteers (aged 16-25 years) worked closely with the children for a 2-week period. They were given a brief training session in the basics of Intensive Interaction, and then encouraged to use it with the children. After two days’ experience, the volunteers were asked to write an account reflecting on their experiences of using this approach. This paper provides a qualitative analysis of those written accounts.
Results and Discussion: Some of the most frequently cited changes in the children’s behaviour were perceived to be: an increase in the children’s attention to their partner; an increase in the amount of positive affect displayed by the children; and an increase in their proximity to others. Such shifts were frequently associated with changes in vocalisations and animation. Finally, increased flexibility and ease in interactions seemed to provide a particularly strong indicator of increased engagement. Also reported by 8 of the 12 volunteers was a noticeable decrease in distress and self-harming behaviour in more than one third of the children with whom they interacted. For a small number of children, an additional positive outcome was an increase in the level of their attention to the wider environment, strengthening the evidence that Intensive Interaction promotes interests across a range of domains, rather than the social domain alone.
Overall, the study found that the kinds of behavioural shifts predicted in the Intensive Interaction literature were observed by the volunteers. Although the study did not examine the children’s behaviour in detail, the volunteers perceived dramatic and prolonged increases in the children’s social engagement. Such reports indicate that one does not need to be an experienced practitioner to be aware of those changes.
Below are just a few of the many extracts from the volunteers’ testimony:
‘I started by just imitating Paula’s actions for a few minutes… then I introduced sounds… over the next 10 minutes of imitation, she was right next to me and put her hand in my lap, allowing me to stroke her hand and was smiling and even giggling, which I haven’t really seen her do before’.
‘Today has been amazing … I imitated Andrei, via clapping in different rhythms and also clapping around him, not just the way he prefers to. It means it does feel you are having a conversation with him, or playing a game’.
‘For the first part of the week, Mircea was very quiet, making only infrequent noises…. When Intensive Interaction was tried, Mircea became much more engaged and began to look directly at the person holding him, rather than over their shoulder’.
‘I think the technique really worked. Paula didn’t get anxious or upset during the whole session, which really amazed me because normally she gets upset at least once during the session’.
‘By the end of the week, Flavius actually picked up a toy from the grass, and I’ve never seen him do that’.
Conclusions: The authors interpret the results of this study as providing qualitative evidence that Intensive Interaction is effective in promoting social engagement in children with severe communicative impairments that arise from (or are at least exacerbated by) poor early care. The findings also demonstrate that such increases can be identified by practitioners as soon as they complete their training - extensive experience is not required. Indeed, it appears that practitioners begin to be able to generate such encouraging outcomes with minimal training.
Zeedyk, M Suzanne; Caldwell, Phoebe; Davies, Clifford E
How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities? Journal Article
In: European Journal of Special Needs Education, vol. 24, no. 2, pp. 119-137, 2009, ISSN: 0885-6250.
@article{Zeedyk2009b,
title = {How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities?},
author = {M Suzanne Zeedyk and Phoebe Caldwell and Clifford E Davies},
doi = {https://doi.org/10.1080/08856250902793545},
issn = {0885-6250},
year = {2009},
date = {2009-04-02},
journal = {European Journal of Special Needs Education},
volume = {24},
number = {2},
pages = {119-137},
abstract = {This study investigates levels of engagement in individuals with profound learning disabilities (PLD) participating in their first Intensive Interaction session. The authors had two specific aims: to determine how quickly observable increases in engagement behaviours take place, and to investigate individual differences in patterns of change across the sample.
Participants: Ten non-linguistic individuals with profound learning disabilities took part (6 female, 4 male, aged late teens to early 60s). No formal diagnoses were available; however, informal reports from staff indicate diagnoses of autism, cerebral palsy and global intellectual delay were likely.
Method: The authors used an observational, multiple-case design to investigate levels of social engagement in clients participating in their first Intensive Interaction session. Videotaped material, randomly selected from an archive owned by Phoebe Caldwell, was analysed using micro-analytic techniques.
The Intensive Interaction sessions in question took place in residential or day centres and lasted between 30 minutes and several hours, however, the present analysis focused on the initial section of the interactions: coding commenced when the session began and ceased when the first break in interaction occurred. Consequently, analysed sessions ranged from approximately 3 to 14 minutes.
Coding aimed to record three key behavioural indicators of clients’ interest in their interaction partner:
eye gaze to partner ([a] away from partner, [b] toward partner’s body, [c] toward partner’s face);
bodily orientation to partner ([a] away from partner, [b] toward partner, [c] facing partner directly); and,
proximity to partner ([a] far/beyond touching distance, [b] close/within touching distance, [c] touching).
The emotional valence of client’s actions was also coded as either: (a) neutral/negative; (b) positive; or (c) very positive. Inter-rater reliability of coding was assessed by having a second coder, who was blind to the hypothesis, code 20% of the footage. The mean intra-class correlation between the two raters was 0.89, indicating acceptable levels of reliability.
Findings: Data analysis began by dividing the interaction sessions into four equal quarters. Next, an ‘Engagement Index Score’ (EIS) was calculated for each of the three key social behaviours to represent the extent to which a participant was socially engaged in that quarter of the session. The EIS scores ranged from 0 to 100, with a score of ‘0’ indicating that the participant had spent the entire quarter of the session at the lowest level of engagement for that behaviour (e.g. for eye gaze to partner, ‘0’ would mean eye gaze was oriented away from the partner for the whole quarter) and a score of ‘100’, meaning that the participant was constantly at the highest level of engagement (e.g. for eye gaze to partner, ‘100’ would mean that the participant looked only towards their partner’s face in that quarter).
Comparisons were made between the EIS for segment one and segment four of the Intensive Interaction sessions to determine how many participants showed an increase in engagement over the session. It was found that index scores generally increased from section one to section four. Nine out of ten participants showed increased eye gaze, eight out of nine showed an increase in proximity to partner, and six out of eight displayed an increase in orientation to their partner. Emotional valence also increased in 9 out of ten participants. A non-parametric Fisher-Exact probability analysis was used to determine the probability that these increases in engagement occurred by chance. All tests were significant at the 0.005 level, indicating that the increases in engagement can be attributed to the intervention and that Intensive Interaction had an effect on all four of the behaviours measured.
A separate analysis was used to investigate the patterns of change for each participant in more detail. Engagement Index Scores were depicted graphically for each participant and each quarter of the Intensive Interaction session, revealing that the overall pattern of increasing engagement was subject to considerable variation. There was large variation in both the degree by which engagement increased between quarters and in the trajectory of change (i.e. linear vs. fluctuating increases). The secondary analysis demonstrated that all participants showed increases in at least some measures and that the majority (7/10) showed increases for all four measures.
Discussion: This study has shown that Intensive Interaction is an effective tool in promoting social engagement with key social behaviours showing increases in the first Intensive Interaction session. In order to investigate if the recorded increases in sociability were a product of Intensive Interaction per se or whether they would result from any form of attentive social interaction, future research must employ a design that compares Intensive Interaction with other forms of intervention, as well as with standard, non-intervention interactions. The authors also relate their findings to the existing literature, suggesting that further work may be done to investigate exactly what conditions are necessary for improvements in engagement and why Intensive Interaction seems to be particularly useful in creating these conditions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study investigates levels of engagement in individuals with profound learning disabilities (PLD) participating in their first Intensive Interaction session. The authors had two specific aims: to determine how quickly observable increases in engagement behaviours take place, and to investigate individual differences in patterns of change across the sample.
Participants: Ten non-linguistic individuals with profound learning disabilities took part (6 female, 4 male, aged late teens to early 60s). No formal diagnoses were available; however, informal reports from staff indicate diagnoses of autism, cerebral palsy and global intellectual delay were likely.
Method: The authors used an observational, multiple-case design to investigate levels of social engagement in clients participating in their first Intensive Interaction session. Videotaped material, randomly selected from an archive owned by Phoebe Caldwell, was analysed using micro-analytic techniques.
The Intensive Interaction sessions in question took place in residential or day centres and lasted between 30 minutes and several hours, however, the present analysis focused on the initial section of the interactions: coding commenced when the session began and ceased when the first break in interaction occurred. Consequently, analysed sessions ranged from approximately 3 to 14 minutes.
Coding aimed to record three key behavioural indicators of clients’ interest in their interaction partner:
eye gaze to partner ([a] away from partner, [b] toward partner’s body, [c] toward partner’s face);
bodily orientation to partner ([a] away from partner, [b] toward partner, [c] facing partner directly); and,
proximity to partner ([a] far/beyond touching distance, [b] close/within touching distance, [c] touching).
The emotional valence of client’s actions was also coded as either: (a) neutral/negative; (b) positive; or (c) very positive. Inter-rater reliability of coding was assessed by having a second coder, who was blind to the hypothesis, code 20% of the footage. The mean intra-class correlation between the two raters was 0.89, indicating acceptable levels of reliability.
Findings: Data analysis began by dividing the interaction sessions into four equal quarters. Next, an ‘Engagement Index Score’ (EIS) was calculated for each of the three key social behaviours to represent the extent to which a participant was socially engaged in that quarter of the session. The EIS scores ranged from 0 to 100, with a score of ‘0’ indicating that the participant had spent the entire quarter of the session at the lowest level of engagement for that behaviour (e.g. for eye gaze to partner, ‘0’ would mean eye gaze was oriented away from the partner for the whole quarter) and a score of ‘100’, meaning that the participant was constantly at the highest level of engagement (e.g. for eye gaze to partner, ‘100’ would mean that the participant looked only towards their partner’s face in that quarter).
Comparisons were made between the EIS for segment one and segment four of the Intensive Interaction sessions to determine how many participants showed an increase in engagement over the session. It was found that index scores generally increased from section one to section four. Nine out of ten participants showed increased eye gaze, eight out of nine showed an increase in proximity to partner, and six out of eight displayed an increase in orientation to their partner. Emotional valence also increased in 9 out of ten participants. A non-parametric Fisher-Exact probability analysis was used to determine the probability that these increases in engagement occurred by chance. All tests were significant at the 0.005 level, indicating that the increases in engagement can be attributed to the intervention and that Intensive Interaction had an effect on all four of the behaviours measured.
A separate analysis was used to investigate the patterns of change for each participant in more detail. Engagement Index Scores were depicted graphically for each participant and each quarter of the Intensive Interaction session, revealing that the overall pattern of increasing engagement was subject to considerable variation. There was large variation in both the degree by which engagement increased between quarters and in the trajectory of change (i.e. linear vs. fluctuating increases). The secondary analysis demonstrated that all participants showed increases in at least some measures and that the majority (7/10) showed increases for all four measures.
Discussion: This study has shown that Intensive Interaction is an effective tool in promoting social engagement with key social behaviours showing increases in the first Intensive Interaction session. In order to investigate if the recorded increases in sociability were a product of Intensive Interaction per se or whether they would result from any form of attentive social interaction, future research must employ a design that compares Intensive Interaction with other forms of intervention, as well as with standard, non-intervention interactions. The authors also relate their findings to the existing literature, suggesting that further work may be done to investigate exactly what conditions are necessary for improvements in engagement and why Intensive Interaction seems to be particularly useful in creating these conditions.
Participants: Ten non-linguistic individuals with profound learning disabilities took part (6 female, 4 male, aged late teens to early 60s). No formal diagnoses were available; however, informal reports from staff indicate diagnoses of autism, cerebral palsy and global intellectual delay were likely.
Method: The authors used an observational, multiple-case design to investigate levels of social engagement in clients participating in their first Intensive Interaction session. Videotaped material, randomly selected from an archive owned by Phoebe Caldwell, was analysed using micro-analytic techniques.
The Intensive Interaction sessions in question took place in residential or day centres and lasted between 30 minutes and several hours, however, the present analysis focused on the initial section of the interactions: coding commenced when the session began and ceased when the first break in interaction occurred. Consequently, analysed sessions ranged from approximately 3 to 14 minutes.
Coding aimed to record three key behavioural indicators of clients’ interest in their interaction partner:
eye gaze to partner ([a] away from partner, [b] toward partner’s body, [c] toward partner’s face);
bodily orientation to partner ([a] away from partner, [b] toward partner, [c] facing partner directly); and,
proximity to partner ([a] far/beyond touching distance, [b] close/within touching distance, [c] touching).
The emotional valence of client’s actions was also coded as either: (a) neutral/negative; (b) positive; or (c) very positive. Inter-rater reliability of coding was assessed by having a second coder, who was blind to the hypothesis, code 20% of the footage. The mean intra-class correlation between the two raters was 0.89, indicating acceptable levels of reliability.
Findings: Data analysis began by dividing the interaction sessions into four equal quarters. Next, an ‘Engagement Index Score’ (EIS) was calculated for each of the three key social behaviours to represent the extent to which a participant was socially engaged in that quarter of the session. The EIS scores ranged from 0 to 100, with a score of ‘0’ indicating that the participant had spent the entire quarter of the session at the lowest level of engagement for that behaviour (e.g. for eye gaze to partner, ‘0’ would mean eye gaze was oriented away from the partner for the whole quarter) and a score of ‘100’, meaning that the participant was constantly at the highest level of engagement (e.g. for eye gaze to partner, ‘100’ would mean that the participant looked only towards their partner’s face in that quarter).
Comparisons were made between the EIS for segment one and segment four of the Intensive Interaction sessions to determine how many participants showed an increase in engagement over the session. It was found that index scores generally increased from section one to section four. Nine out of ten participants showed increased eye gaze, eight out of nine showed an increase in proximity to partner, and six out of eight displayed an increase in orientation to their partner. Emotional valence also increased in 9 out of ten participants. A non-parametric Fisher-Exact probability analysis was used to determine the probability that these increases in engagement occurred by chance. All tests were significant at the 0.005 level, indicating that the increases in engagement can be attributed to the intervention and that Intensive Interaction had an effect on all four of the behaviours measured.
A separate analysis was used to investigate the patterns of change for each participant in more detail. Engagement Index Scores were depicted graphically for each participant and each quarter of the Intensive Interaction session, revealing that the overall pattern of increasing engagement was subject to considerable variation. There was large variation in both the degree by which engagement increased between quarters and in the trajectory of change (i.e. linear vs. fluctuating increases). The secondary analysis demonstrated that all participants showed increases in at least some measures and that the majority (7/10) showed increases for all four measures.
Discussion: This study has shown that Intensive Interaction is an effective tool in promoting social engagement with key social behaviours showing increases in the first Intensive Interaction session. In order to investigate if the recorded increases in sociability were a product of Intensive Interaction per se or whether they would result from any form of attentive social interaction, future research must employ a design that compares Intensive Interaction with other forms of intervention, as well as with standard, non-intervention interactions. The authors also relate their findings to the existing literature, suggesting that further work may be done to investigate exactly what conditions are necessary for improvements in engagement and why Intensive Interaction seems to be particularly useful in creating these conditions.
Firth, Graham
A Dual Aspect Process Model of Intensive Interaction Journal Article
In: British Journal of Learning Disabilities, vol. 37, no. 1, pp. 43-49, 2009, ISSN: 1468-3156.
@article{Firth2009,
title = {A Dual Aspect Process Model of Intensive Interaction},
author = {Graham Firth},
url = {https://www.researchgate.net/publication/229935692_A_Dual_Aspect_Process_Model_of_Intensive_Interaction/link/59edc25c4585158fe5340306/download},
doi = { https://doi.org/10.1111/j.1468-3156.2008.00505.x},
issn = {1468-3156},
year = {2009},
date = {2009-02-23},
journal = {British Journal of Learning Disabilities},
volume = {37},
number = {1},
pages = {43-49},
abstract = {Since the 1980s, intensive Interaction has been employed to meet the social and communicative needs of people with severe or profound and multiple learning difficulties and/or autism. The approach, which employs naturalistic interactions with learning disabled people based on the ‘infant-caregiver’ interactional model, was initially developed by teachers Dave Hewett and Melanie Nind (Access to Communication, 1994).
However, in this paper the author contends that certain aspects of the approach are not universally conceptualised, and that published definitions of the approach do not necessarily advance a single consistent conceptualisation or procedural philosophy. It is also the author’s view that, in the majority of cases across the multi-disciplinary community of Intensive Interaction practitioners and advocates, there emerge two general process models that are used to describe or conceptualise Intensive Interaction.
Firstly, there is a ‘Social Inclusion Process Model’. This model advocates a primary aim of inclusively responding to a learning-disabled person's communication, however it is expressed. When alluding to this model, practitioners tend to use terminology such as ‘communication’1, ‘understanding’1, ‘shared language’2 and ‘connecting’2 to describe the process. This process model appears to be evidenced by practitioners who recount instances of an initial rapid expansion of a learning-disabled person’s sociability and communicative practice, presumably as their latent communicative means are expressed in response to Intensive Interaction techniques.
Secondly, and subsequent to the first model, there is a ‘Developmental Process Model’ of communicative skill progression and acquisition. This model espouses a need to have educative or developmental goals when using Intensive Interaction. Indeed, with such a ‘Developmental Process Model’ it is any resultant communicative or cognitive skill acquisition that is the major aim of any Intensive Interaction intervention. When alluding to this process model practitioners tend to use terminology such as ‘learning’1+2, ‘developmental’2, and ‘extending’2.
As can be seen in the diagrammatic representation of what the author calls a ‘Dual Aspect Process Model’ of Intensive Interaction both process models may be seen as representing differing aspects or stages of Intensive Interaction. Lying between the stages is what the author calls a transitional phase, which begins as the initial rapid expansion of interactive behaviour associated with a ‘Social Inclusion Process Model’ tails off. The author also states that such a transitional phase is already described by the term ‘plateauing’ (Nind & Hewett, 2nd ed. 2005, p.134). Any progress subsequent to this ‘plateauing’ requires the onset of the ‘Developmental Process Model’ during which a more gradual development of the learning-disabled person’s communicative skills takes place.
Interestingly, across the body of published research into Intensive Interaction, shorter, generally non-educational research carried out over days or weeks, according to the author, seems to support a rapid ‘social inclusion process model’ of increased responsiveness. In contrast, in those papers written from an educational perspective (carried out over months, terms or years), there are claims made that the novel or increased social responses arise out of an extended learning or developmental process. And thus, the author claims, these longer-term research studies provide evidence for a ‘Developmental Process Model’.
This paper goes on to give a broader analysis of learning theory to help describe the process through which social inclusion supports developmental progression. It is suggested that Lave and Wenger’s (1991) situated learning theory of ‘Legitimate Peripheral Participation’ provides a good theoretical representation of how authentic engagement in collective activities (in this case Intensive Interaction) is a necessary precursor to conceptual development and skill acquisition. ‘Legitimate Peripheral Participation’ shows how a learner can gradually become part of a ‘community of social interactors’ once their emergent communicative and sociable behaviours are legitimised and responded to with Intensive Interaction. Initially the learning-disabled person’s engagement in such a ‘community of social interactors’ might well be halting, tentative and exploratory, however, through repeated joint experience (in this case of Intensive Interaction), the collaboratively organised social activity develops greater levels of sophistication i.e. developmental progression takes place.
According to the author, the ‘Dual Aspect Process Model’ of Intensive Interaction is a reflective response to his own experiences of practicing and contemplating Intensive Interaction, and it is his hope that the model may help others to identify more clearly their main purpose in employing Intensive Interaction.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Since the 1980s, intensive Interaction has been employed to meet the social and communicative needs of people with severe or profound and multiple learning difficulties and/or autism. The approach, which employs naturalistic interactions with learning disabled people based on the ‘infant-caregiver’ interactional model, was initially developed by teachers Dave Hewett and Melanie Nind (Access to Communication, 1994).
However, in this paper the author contends that certain aspects of the approach are not universally conceptualised, and that published definitions of the approach do not necessarily advance a single consistent conceptualisation or procedural philosophy. It is also the author’s view that, in the majority of cases across the multi-disciplinary community of Intensive Interaction practitioners and advocates, there emerge two general process models that are used to describe or conceptualise Intensive Interaction.
Firstly, there is a ‘Social Inclusion Process Model’. This model advocates a primary aim of inclusively responding to a learning-disabled person's communication, however it is expressed. When alluding to this model, practitioners tend to use terminology such as ‘communication’1, ‘understanding’1, ‘shared language’2 and ‘connecting’2 to describe the process. This process model appears to be evidenced by practitioners who recount instances of an initial rapid expansion of a learning-disabled person’s sociability and communicative practice, presumably as their latent communicative means are expressed in response to Intensive Interaction techniques.
Secondly, and subsequent to the first model, there is a ‘Developmental Process Model’ of communicative skill progression and acquisition. This model espouses a need to have educative or developmental goals when using Intensive Interaction. Indeed, with such a ‘Developmental Process Model’ it is any resultant communicative or cognitive skill acquisition that is the major aim of any Intensive Interaction intervention. When alluding to this process model practitioners tend to use terminology such as ‘learning’1+2, ‘developmental’2, and ‘extending’2.
As can be seen in the diagrammatic representation of what the author calls a ‘Dual Aspect Process Model’ of Intensive Interaction both process models may be seen as representing differing aspects or stages of Intensive Interaction. Lying between the stages is what the author calls a transitional phase, which begins as the initial rapid expansion of interactive behaviour associated with a ‘Social Inclusion Process Model’ tails off. The author also states that such a transitional phase is already described by the term ‘plateauing’ (Nind & Hewett, 2nd ed. 2005, p.134). Any progress subsequent to this ‘plateauing’ requires the onset of the ‘Developmental Process Model’ during which a more gradual development of the learning-disabled person’s communicative skills takes place.
Interestingly, across the body of published research into Intensive Interaction, shorter, generally non-educational research carried out over days or weeks, according to the author, seems to support a rapid ‘social inclusion process model’ of increased responsiveness. In contrast, in those papers written from an educational perspective (carried out over months, terms or years), there are claims made that the novel or increased social responses arise out of an extended learning or developmental process. And thus, the author claims, these longer-term research studies provide evidence for a ‘Developmental Process Model’.
This paper goes on to give a broader analysis of learning theory to help describe the process through which social inclusion supports developmental progression. It is suggested that Lave and Wenger’s (1991) situated learning theory of ‘Legitimate Peripheral Participation’ provides a good theoretical representation of how authentic engagement in collective activities (in this case Intensive Interaction) is a necessary precursor to conceptual development and skill acquisition. ‘Legitimate Peripheral Participation’ shows how a learner can gradually become part of a ‘community of social interactors’ once their emergent communicative and sociable behaviours are legitimised and responded to with Intensive Interaction. Initially the learning-disabled person’s engagement in such a ‘community of social interactors’ might well be halting, tentative and exploratory, however, through repeated joint experience (in this case of Intensive Interaction), the collaboratively organised social activity develops greater levels of sophistication i.e. developmental progression takes place.
According to the author, the ‘Dual Aspect Process Model’ of Intensive Interaction is a reflective response to his own experiences of practicing and contemplating Intensive Interaction, and it is his hope that the model may help others to identify more clearly their main purpose in employing Intensive Interaction.
However, in this paper the author contends that certain aspects of the approach are not universally conceptualised, and that published definitions of the approach do not necessarily advance a single consistent conceptualisation or procedural philosophy. It is also the author’s view that, in the majority of cases across the multi-disciplinary community of Intensive Interaction practitioners and advocates, there emerge two general process models that are used to describe or conceptualise Intensive Interaction.
Firstly, there is a ‘Social Inclusion Process Model’. This model advocates a primary aim of inclusively responding to a learning-disabled person's communication, however it is expressed. When alluding to this model, practitioners tend to use terminology such as ‘communication’1, ‘understanding’1, ‘shared language’2 and ‘connecting’2 to describe the process. This process model appears to be evidenced by practitioners who recount instances of an initial rapid expansion of a learning-disabled person’s sociability and communicative practice, presumably as their latent communicative means are expressed in response to Intensive Interaction techniques.
Secondly, and subsequent to the first model, there is a ‘Developmental Process Model’ of communicative skill progression and acquisition. This model espouses a need to have educative or developmental goals when using Intensive Interaction. Indeed, with such a ‘Developmental Process Model’ it is any resultant communicative or cognitive skill acquisition that is the major aim of any Intensive Interaction intervention. When alluding to this process model practitioners tend to use terminology such as ‘learning’1+2, ‘developmental’2, and ‘extending’2.
As can be seen in the diagrammatic representation of what the author calls a ‘Dual Aspect Process Model’ of Intensive Interaction both process models may be seen as representing differing aspects or stages of Intensive Interaction. Lying between the stages is what the author calls a transitional phase, which begins as the initial rapid expansion of interactive behaviour associated with a ‘Social Inclusion Process Model’ tails off. The author also states that such a transitional phase is already described by the term ‘plateauing’ (Nind & Hewett, 2nd ed. 2005, p.134). Any progress subsequent to this ‘plateauing’ requires the onset of the ‘Developmental Process Model’ during which a more gradual development of the learning-disabled person’s communicative skills takes place.
Interestingly, across the body of published research into Intensive Interaction, shorter, generally non-educational research carried out over days or weeks, according to the author, seems to support a rapid ‘social inclusion process model’ of increased responsiveness. In contrast, in those papers written from an educational perspective (carried out over months, terms or years), there are claims made that the novel or increased social responses arise out of an extended learning or developmental process. And thus, the author claims, these longer-term research studies provide evidence for a ‘Developmental Process Model’.
This paper goes on to give a broader analysis of learning theory to help describe the process through which social inclusion supports developmental progression. It is suggested that Lave and Wenger’s (1991) situated learning theory of ‘Legitimate Peripheral Participation’ provides a good theoretical representation of how authentic engagement in collective activities (in this case Intensive Interaction) is a necessary precursor to conceptual development and skill acquisition. ‘Legitimate Peripheral Participation’ shows how a learner can gradually become part of a ‘community of social interactors’ once their emergent communicative and sociable behaviours are legitimised and responded to with Intensive Interaction. Initially the learning-disabled person’s engagement in such a ‘community of social interactors’ might well be halting, tentative and exploratory, however, through repeated joint experience (in this case of Intensive Interaction), the collaboratively organised social activity develops greater levels of sophistication i.e. developmental progression takes place.
According to the author, the ‘Dual Aspect Process Model’ of Intensive Interaction is a reflective response to his own experiences of practicing and contemplating Intensive Interaction, and it is his hope that the model may help others to identify more clearly their main purpose in employing Intensive Interaction.
2008
Samuel, Judith; Nind, Melanie; Volans, Amy; Scriven, Issy
An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities Journal Article
In: Journal of Intellectual Disabilities, vol. 12, no. 2, pp. 111-126, 2008, ISSN: 1744-6295.
@article{Samuel2008,
title = {An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities },
author = {Judith Samuel and Melanie Nind and Amy Volans and Issy Scriven},
url = {https://journals.sagepub.com/doi/pdf/10.1177/1744629508090983},
doi = {https://doi.org/10.1177/1744629508090983},
issn = {1744-6295},
year = {2008},
date = {2008-06-01},
journal = {Journal of Intellectual Disabilities},
volume = {12},
number = {2},
pages = {111-126},
abstract = {This research took place in a service for adults with profound intellectual disabilities where Intensive Interaction (I.I.) was an emerging practice. The study looked at two hypotheses: 1. That support staff as novice practitioners could learn the principles of Intensive Interaction, and 2. That novel use of I.I. would have a positive impact on, (a) the communication and social abilities of people with profound learning disabilities and, (b) the quality of relationship between them. A ‘time-series multiple-baseline’ design was used, and three features were measured: (i) if novice practitioners could learn the principles of intensive interaction, (ii) the impact on communication and social abilities of the participants, and (iii) the impact of the quality of relationship between the practitioner and participant.
The Participants & Measures: Four participants took part in this research, Alice (32), Betty (56), Clare (46) and Diana (23). The research took place in four different bungalows with distinct support teams. The participants had no previous involvement of intensive interaction. The staff comprised three ‘practitioners’ and three observers per participant. An assistant psychologist visited weekly and filmed the interaction (and acted as an additional practitioner). The I.I. training given to staff comprised a ½ day workshop, service guidelines, reflection recording forms and a support group. The Intervention comprised of 5 sessions of I.I. per week (100 sessions in all).
The Results: During the study fewer than 100 sessions of I.I. were actually recorded (although practitioners did indicate that there were more sessions, and the historical logs revealed that there was ill-health for all of the participants which caused reduced filming). The I.I. sessions for the 4 participants ranged from 3 to 60 minutes.
Hypothesis 1: Video data showed that the staff practitioners learned to use mirroring of movements and vocalisation and contingent responding more. It was however noted that the frequency and extent of reflection records completion declined over time, and that the analysis showed evidence of the use of the principles of Intensive Interaction, but not of any progression. Only ½ the staff practitioners attended a support group, and they were reluctant to watch their own videos, reducing the potential for reflective practice.
Hypothesis 2(a): Each of the participants developed differently, but there was early evidence of the impact of the intervention on ‘looking behaviours’, although for Alice this began before the study. The ability to become ‘socially engaged’ and to do ‘joint-focus’ activity became apparent later on. Also the development of initiation of ‘social/physical contact’ was noted as patchy. For ‘positive interaction’ all of the participants showed improvements by the end of the intervention, whilst for Alice & Diana, ‘vocal imitation’ was also improved, and Clare showed improvements in ‘attention seeking’, ‘simple negation’ and ‘understanding non-vocal communication’. The Interactive Sequence showed improvements for Betty and Clare (rated by practitioners) and for Diana (rated by observes), and reflection records reported ‘eye contact’ throughout for all the participants and, with the exception of Diana, frequent smiling. The staff questionnaires indicated an increased expectation amongst staff that I.I. would enhance skills of participants and would gradually lead to success and maintained progress.
Hypothesis 2(b): The code applied to most practitioner data in the staff questionnaires was ‘team cohesion’, whereas ‘benefits for staff (in general)’ was applied most to observer data. The code ‘reciprocal relationship building (with participant)’ fitted only 3 of 58 practitioners and the same amount in the observer comments. Practitioners also made some comments that were coded as ‘reciprocal relationship building’, although the observers made none. At the end of the study one practitioner commented that ‘we have learned to read each other’, and it was also noted that Betty twice sought interaction with a practitioner, when previously she would sit alone on sofas and never seek out the company of others. Overall, I.I. was generally rated as ‘positive’ for both participants and practitioners.
Discussion & Conclusions: The findings of this study add to the I.I. evidence base, furthering knowledge about I.I. but also raising some issues. Service demands which compete with I.I. may need to be addressed and better planning and supervision may have made more impact in this study. The record keeping was sparse, and more specificity in recording formats may help to prompt practitioners to use the I.I. principles they overlook.
The findings of this study complement the existing evidence about the development of communication and sociability for people with profound intellectual disabilities through Intensive Interaction. Use of I.I. in Supported Living by novice practitioners appears to offer some potential, both for staff to learn some of the principles of the approach and for the impact this might have on the communication and social abilities of the clients and their relationship with them. },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This research took place in a service for adults with profound intellectual disabilities where Intensive Interaction (I.I.) was an emerging practice. The study looked at two hypotheses: 1. That support staff as novice practitioners could learn the principles of Intensive Interaction, and 2. That novel use of I.I. would have a positive impact on, (a) the communication and social abilities of people with profound learning disabilities and, (b) the quality of relationship between them. A ‘time-series multiple-baseline’ design was used, and three features were measured: (i) if novice practitioners could learn the principles of intensive interaction, (ii) the impact on communication and social abilities of the participants, and (iii) the impact of the quality of relationship between the practitioner and participant.
The Participants & Measures: Four participants took part in this research, Alice (32), Betty (56), Clare (46) and Diana (23). The research took place in four different bungalows with distinct support teams. The participants had no previous involvement of intensive interaction. The staff comprised three ‘practitioners’ and three observers per participant. An assistant psychologist visited weekly and filmed the interaction (and acted as an additional practitioner). The I.I. training given to staff comprised a ½ day workshop, service guidelines, reflection recording forms and a support group. The Intervention comprised of 5 sessions of I.I. per week (100 sessions in all).
The Results: During the study fewer than 100 sessions of I.I. were actually recorded (although practitioners did indicate that there were more sessions, and the historical logs revealed that there was ill-health for all of the participants which caused reduced filming). The I.I. sessions for the 4 participants ranged from 3 to 60 minutes.
Hypothesis 1: Video data showed that the staff practitioners learned to use mirroring of movements and vocalisation and contingent responding more. It was however noted that the frequency and extent of reflection records completion declined over time, and that the analysis showed evidence of the use of the principles of Intensive Interaction, but not of any progression. Only ½ the staff practitioners attended a support group, and they were reluctant to watch their own videos, reducing the potential for reflective practice.
Hypothesis 2(a): Each of the participants developed differently, but there was early evidence of the impact of the intervention on ‘looking behaviours’, although for Alice this began before the study. The ability to become ‘socially engaged’ and to do ‘joint-focus’ activity became apparent later on. Also the development of initiation of ‘social/physical contact’ was noted as patchy. For ‘positive interaction’ all of the participants showed improvements by the end of the intervention, whilst for Alice & Diana, ‘vocal imitation’ was also improved, and Clare showed improvements in ‘attention seeking’, ‘simple negation’ and ‘understanding non-vocal communication’. The Interactive Sequence showed improvements for Betty and Clare (rated by practitioners) and for Diana (rated by observes), and reflection records reported ‘eye contact’ throughout for all the participants and, with the exception of Diana, frequent smiling. The staff questionnaires indicated an increased expectation amongst staff that I.I. would enhance skills of participants and would gradually lead to success and maintained progress.
Hypothesis 2(b): The code applied to most practitioner data in the staff questionnaires was ‘team cohesion’, whereas ‘benefits for staff (in general)’ was applied most to observer data. The code ‘reciprocal relationship building (with participant)’ fitted only 3 of 58 practitioners and the same amount in the observer comments. Practitioners also made some comments that were coded as ‘reciprocal relationship building’, although the observers made none. At the end of the study one practitioner commented that ‘we have learned to read each other’, and it was also noted that Betty twice sought interaction with a practitioner, when previously she would sit alone on sofas and never seek out the company of others. Overall, I.I. was generally rated as ‘positive’ for both participants and practitioners.
Discussion & Conclusions: The findings of this study add to the I.I. evidence base, furthering knowledge about I.I. but also raising some issues. Service demands which compete with I.I. may need to be addressed and better planning and supervision may have made more impact in this study. The record keeping was sparse, and more specificity in recording formats may help to prompt practitioners to use the I.I. principles they overlook.
The findings of this study complement the existing evidence about the development of communication and sociability for people with profound intellectual disabilities through Intensive Interaction. Use of I.I. in Supported Living by novice practitioners appears to offer some potential, both for staff to learn some of the principles of the approach and for the impact this might have on the communication and social abilities of the clients and their relationship with them.
The Participants & Measures: Four participants took part in this research, Alice (32), Betty (56), Clare (46) and Diana (23). The research took place in four different bungalows with distinct support teams. The participants had no previous involvement of intensive interaction. The staff comprised three ‘practitioners’ and three observers per participant. An assistant psychologist visited weekly and filmed the interaction (and acted as an additional practitioner). The I.I. training given to staff comprised a ½ day workshop, service guidelines, reflection recording forms and a support group. The Intervention comprised of 5 sessions of I.I. per week (100 sessions in all).
The Results: During the study fewer than 100 sessions of I.I. were actually recorded (although practitioners did indicate that there were more sessions, and the historical logs revealed that there was ill-health for all of the participants which caused reduced filming). The I.I. sessions for the 4 participants ranged from 3 to 60 minutes.
Hypothesis 1: Video data showed that the staff practitioners learned to use mirroring of movements and vocalisation and contingent responding more. It was however noted that the frequency and extent of reflection records completion declined over time, and that the analysis showed evidence of the use of the principles of Intensive Interaction, but not of any progression. Only ½ the staff practitioners attended a support group, and they were reluctant to watch their own videos, reducing the potential for reflective practice.
Hypothesis 2(a): Each of the participants developed differently, but there was early evidence of the impact of the intervention on ‘looking behaviours’, although for Alice this began before the study. The ability to become ‘socially engaged’ and to do ‘joint-focus’ activity became apparent later on. Also the development of initiation of ‘social/physical contact’ was noted as patchy. For ‘positive interaction’ all of the participants showed improvements by the end of the intervention, whilst for Alice & Diana, ‘vocal imitation’ was also improved, and Clare showed improvements in ‘attention seeking’, ‘simple negation’ and ‘understanding non-vocal communication’. The Interactive Sequence showed improvements for Betty and Clare (rated by practitioners) and for Diana (rated by observes), and reflection records reported ‘eye contact’ throughout for all the participants and, with the exception of Diana, frequent smiling. The staff questionnaires indicated an increased expectation amongst staff that I.I. would enhance skills of participants and would gradually lead to success and maintained progress.
Hypothesis 2(b): The code applied to most practitioner data in the staff questionnaires was ‘team cohesion’, whereas ‘benefits for staff (in general)’ was applied most to observer data. The code ‘reciprocal relationship building (with participant)’ fitted only 3 of 58 practitioners and the same amount in the observer comments. Practitioners also made some comments that were coded as ‘reciprocal relationship building’, although the observers made none. At the end of the study one practitioner commented that ‘we have learned to read each other’, and it was also noted that Betty twice sought interaction with a practitioner, when previously she would sit alone on sofas and never seek out the company of others. Overall, I.I. was generally rated as ‘positive’ for both participants and practitioners.
Discussion & Conclusions: The findings of this study add to the I.I. evidence base, furthering knowledge about I.I. but also raising some issues. Service demands which compete with I.I. may need to be addressed and better planning and supervision may have made more impact in this study. The record keeping was sparse, and more specificity in recording formats may help to prompt practitioners to use the I.I. principles they overlook.
The findings of this study complement the existing evidence about the development of communication and sociability for people with profound intellectual disabilities through Intensive Interaction. Use of I.I. in Supported Living by novice practitioners appears to offer some potential, both for staff to learn some of the principles of the approach and for the impact this might have on the communication and social abilities of the clients and their relationship with them.
Firth, Graham
A Dual Aspect Process Model of Intensive Interaction Journal Article
In: British Journal of Learning Disabilities, vol. 37, no. 1, pp. 43-49, 2008, ISSN: 1468-3156.
@article{Firth2008,
title = {A Dual Aspect Process Model of Intensive Interaction},
author = {Graham Firth},
url = {https://doi.org/10.1111/j.1468-3156.2008.00505.x},
doi = {10.1111/j.1468-3156.2008.00505.x},
issn = {1468-3156},
year = {2008},
date = {2008-03-01},
urldate = {2009-02-23},
journal = {British Journal of Learning Disabilities},
volume = {37},
number = {1},
pages = {43-49},
publisher = {John Wiley & Sons, Inc.},
address = {The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, UK},
abstract = {Since the 1980s Intensive Interaction has been employed to meet the social and communicative needs of people with severe or profound and multiple learning difficulties and/or autism. The approach, which employs naturalistic interactions with learning disabled people based on the ‘infant-caregiver’ interactional model, was initially developed by teachers Dave Hewett and Melanie Nind (Access to Communication, 1994).
However, in this paper the author contends that certain aspects of the approach are not universally conceptualised, and that published definitions of the approach do not necessarily advance a single consistent conceptualisation or procedural philosophy. It is also the author’s view that, in the majority of cases across the multi-disciplinary community of Intensive Interaction practitioners and advocates, there emerge two general process models that are used to describe or conceptualise Intensive Interaction.
Firstly there is a ‘Social Inclusion Process Model’. This model advocates a primary aim of inclusively responding to a learning disabled person's communication, however it is expressed. When alluding to this model, practitioners tend to use terminology such as ‘communication’, ‘understanding’, ‘shared language’ and ‘connecting’ to describe the process. This process model appears to be evidenced by practitioners who recount instances of an initial rapid expansion of a learning disabled person’s sociability and communicative practice, presumably as their latent communicative means are expressed in response to Intensive Interaction techniques.
Secondly, and subsequent to the first model, there is a ‘Developmental Process Model’ of communicative skill progression and acquisition. This model espouses a need to have educative or developmental goals when using Intensive Interaction. Indeed with such a ‘Developmental Process Model’ it is any resultant communicative or cognitive skill acquisition that is the major aim of any Intensive Interaction intervention. When alluding to this process model practitioners tend to use terminology such as ‘learning’, ‘developmental’, and ‘extending’.
As can be seen in the diagrammatic representation of what the author calls a ‘Dual Aspect Process Model’ of Intensive Interaction both process models may be seen as representing differing aspects or stages of Intensive Interaction. Lying between the stages is what the author calls a transitional phase, which begins as the initial rapid expansion of interactive behaviour associated with a ‘Social Inclusion Process Model’ tails off. The author also states that such a transitional phase is already described by the term ‘plateauing’ (Nind & Hewett, 2nd ed. 2005, p.134).
Any progress subsequent to this ‘plateauing’ requires the onset of the ‘Developmental Process Model’ during which a more gradual development of the learning disabled person’s communicative skills takes place. Interestingly, across the body of published research into Intensive Interaction, shorter, generally non-educational research carried out over days or weeks, according to the author, seems to support a rapid ‘social inclusion process model’ of increased responsiveness. In contrast, in those papers written from an educational perspective (carried out over months, terms or years), there are claims made that the novel or increased social responses arise out of an extended learning or developmental process. And thus, the author claims, these longer-term research studies provide evidence for a ‘Developmental Process Model’.
This paper goes on to give a broader analysis of learning theory to help describe the process through which social inclusion supports developmental progression. It is suggested that Lave and Wenger’s (1991) situated learning theory of ‘Legitimate Peripheral Participation’ provides a good theoretical representation of how authentic engagement in collective activities (in this case I.I.) is a necessary precursor to conceptual development and skill acquisition. ‘Legitimate Peripheral Participation’ shows how a learner can gradually become part of a ‘community of social interactors’ once their emergent communicative and sociable behaviours are legitimised and responded to with Intensive Interaction. Initially the learning disabled person’s engagement in such a ‘community of social interactors’ might well be halting, tentative and exploratory, however, through repeated joint experience (in this case of Intensive Interaction), the collaboratively organised social activity develops greater levels of sophistication i.e. developmental progression takes place.
According to the author, the ‘Dual Aspect Process Model’ of Intensive Interaction is a reflective response to his own experiences of practicing and contemplating Intensive Interaction, and it is his hope that the model may help others to identify more clearly their main purpose in employing Intensive Interaction.
References:
Lave, J. & Wenger E. (1991) ‘Situated Learning: Legitimate Peripheral Participation’ in Bredo, E. ‘Reconstructing Educational Psychology’ in Murphy, P. (Ed) (1999) Learners, Learning & Assessment, London, Chapman Publishing.
Nind, M. & Hewett, D. (2nd ed. 2005) Access to Communication: Developing the basics of communication with people with severe learning difficulties through Intensive Interaction. David Fulton, London.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Since the 1980s Intensive Interaction has been employed to meet the social and communicative needs of people with severe or profound and multiple learning difficulties and/or autism. The approach, which employs naturalistic interactions with learning disabled people based on the ‘infant-caregiver’ interactional model, was initially developed by teachers Dave Hewett and Melanie Nind (Access to Communication, 1994).
However, in this paper the author contends that certain aspects of the approach are not universally conceptualised, and that published definitions of the approach do not necessarily advance a single consistent conceptualisation or procedural philosophy. It is also the author’s view that, in the majority of cases across the multi-disciplinary community of Intensive Interaction practitioners and advocates, there emerge two general process models that are used to describe or conceptualise Intensive Interaction.
Firstly there is a ‘Social Inclusion Process Model’. This model advocates a primary aim of inclusively responding to a learning disabled person's communication, however it is expressed. When alluding to this model, practitioners tend to use terminology such as ‘communication’, ‘understanding’, ‘shared language’ and ‘connecting’ to describe the process. This process model appears to be evidenced by practitioners who recount instances of an initial rapid expansion of a learning disabled person’s sociability and communicative practice, presumably as their latent communicative means are expressed in response to Intensive Interaction techniques.
Secondly, and subsequent to the first model, there is a ‘Developmental Process Model’ of communicative skill progression and acquisition. This model espouses a need to have educative or developmental goals when using Intensive Interaction. Indeed with such a ‘Developmental Process Model’ it is any resultant communicative or cognitive skill acquisition that is the major aim of any Intensive Interaction intervention. When alluding to this process model practitioners tend to use terminology such as ‘learning’, ‘developmental’, and ‘extending’.
As can be seen in the diagrammatic representation of what the author calls a ‘Dual Aspect Process Model’ of Intensive Interaction both process models may be seen as representing differing aspects or stages of Intensive Interaction. Lying between the stages is what the author calls a transitional phase, which begins as the initial rapid expansion of interactive behaviour associated with a ‘Social Inclusion Process Model’ tails off. The author also states that such a transitional phase is already described by the term ‘plateauing’ (Nind & Hewett, 2nd ed. 2005, p.134).
Any progress subsequent to this ‘plateauing’ requires the onset of the ‘Developmental Process Model’ during which a more gradual development of the learning disabled person’s communicative skills takes place. Interestingly, across the body of published research into Intensive Interaction, shorter, generally non-educational research carried out over days or weeks, according to the author, seems to support a rapid ‘social inclusion process model’ of increased responsiveness. In contrast, in those papers written from an educational perspective (carried out over months, terms or years), there are claims made that the novel or increased social responses arise out of an extended learning or developmental process. And thus, the author claims, these longer-term research studies provide evidence for a ‘Developmental Process Model’.
This paper goes on to give a broader analysis of learning theory to help describe the process through which social inclusion supports developmental progression. It is suggested that Lave and Wenger’s (1991) situated learning theory of ‘Legitimate Peripheral Participation’ provides a good theoretical representation of how authentic engagement in collective activities (in this case I.I.) is a necessary precursor to conceptual development and skill acquisition. ‘Legitimate Peripheral Participation’ shows how a learner can gradually become part of a ‘community of social interactors’ once their emergent communicative and sociable behaviours are legitimised and responded to with Intensive Interaction. Initially the learning disabled person’s engagement in such a ‘community of social interactors’ might well be halting, tentative and exploratory, however, through repeated joint experience (in this case of Intensive Interaction), the collaboratively organised social activity develops greater levels of sophistication i.e. developmental progression takes place.
According to the author, the ‘Dual Aspect Process Model’ of Intensive Interaction is a reflective response to his own experiences of practicing and contemplating Intensive Interaction, and it is his hope that the model may help others to identify more clearly their main purpose in employing Intensive Interaction.
References:
Lave, J. & Wenger E. (1991) ‘Situated Learning: Legitimate Peripheral Participation’ in Bredo, E. ‘Reconstructing Educational Psychology’ in Murphy, P. (Ed) (1999) Learners, Learning & Assessment, London, Chapman Publishing.
Nind, M. & Hewett, D. (2nd ed. 2005) Access to Communication: Developing the basics of communication with people with severe learning difficulties through Intensive Interaction. David Fulton, London.
However, in this paper the author contends that certain aspects of the approach are not universally conceptualised, and that published definitions of the approach do not necessarily advance a single consistent conceptualisation or procedural philosophy. It is also the author’s view that, in the majority of cases across the multi-disciplinary community of Intensive Interaction practitioners and advocates, there emerge two general process models that are used to describe or conceptualise Intensive Interaction.
Firstly there is a ‘Social Inclusion Process Model’. This model advocates a primary aim of inclusively responding to a learning disabled person's communication, however it is expressed. When alluding to this model, practitioners tend to use terminology such as ‘communication’, ‘understanding’, ‘shared language’ and ‘connecting’ to describe the process. This process model appears to be evidenced by practitioners who recount instances of an initial rapid expansion of a learning disabled person’s sociability and communicative practice, presumably as their latent communicative means are expressed in response to Intensive Interaction techniques.
Secondly, and subsequent to the first model, there is a ‘Developmental Process Model’ of communicative skill progression and acquisition. This model espouses a need to have educative or developmental goals when using Intensive Interaction. Indeed with such a ‘Developmental Process Model’ it is any resultant communicative or cognitive skill acquisition that is the major aim of any Intensive Interaction intervention. When alluding to this process model practitioners tend to use terminology such as ‘learning’, ‘developmental’, and ‘extending’.
As can be seen in the diagrammatic representation of what the author calls a ‘Dual Aspect Process Model’ of Intensive Interaction both process models may be seen as representing differing aspects or stages of Intensive Interaction. Lying between the stages is what the author calls a transitional phase, which begins as the initial rapid expansion of interactive behaviour associated with a ‘Social Inclusion Process Model’ tails off. The author also states that such a transitional phase is already described by the term ‘plateauing’ (Nind & Hewett, 2nd ed. 2005, p.134).
Any progress subsequent to this ‘plateauing’ requires the onset of the ‘Developmental Process Model’ during which a more gradual development of the learning disabled person’s communicative skills takes place. Interestingly, across the body of published research into Intensive Interaction, shorter, generally non-educational research carried out over days or weeks, according to the author, seems to support a rapid ‘social inclusion process model’ of increased responsiveness. In contrast, in those papers written from an educational perspective (carried out over months, terms or years), there are claims made that the novel or increased social responses arise out of an extended learning or developmental process. And thus, the author claims, these longer-term research studies provide evidence for a ‘Developmental Process Model’.
This paper goes on to give a broader analysis of learning theory to help describe the process through which social inclusion supports developmental progression. It is suggested that Lave and Wenger’s (1991) situated learning theory of ‘Legitimate Peripheral Participation’ provides a good theoretical representation of how authentic engagement in collective activities (in this case I.I.) is a necessary precursor to conceptual development and skill acquisition. ‘Legitimate Peripheral Participation’ shows how a learner can gradually become part of a ‘community of social interactors’ once their emergent communicative and sociable behaviours are legitimised and responded to with Intensive Interaction. Initially the learning disabled person’s engagement in such a ‘community of social interactors’ might well be halting, tentative and exploratory, however, through repeated joint experience (in this case of Intensive Interaction), the collaboratively organised social activity develops greater levels of sophistication i.e. developmental progression takes place.
According to the author, the ‘Dual Aspect Process Model’ of Intensive Interaction is a reflective response to his own experiences of practicing and contemplating Intensive Interaction, and it is his hope that the model may help others to identify more clearly their main purpose in employing Intensive Interaction.
References:
Lave, J. & Wenger E. (1991) ‘Situated Learning: Legitimate Peripheral Participation’ in Bredo, E. ‘Reconstructing Educational Psychology’ in Murphy, P. (Ed) (1999) Learners, Learning & Assessment, London, Chapman Publishing.
Nind, M. & Hewett, D. (2nd ed. 2005) Access to Communication: Developing the basics of communication with people with severe learning difficulties through Intensive Interaction. David Fulton, London.
Barber, Mark
Using Intensive Interaction to add to the palette of interactive possibilities in teacher-pupil communication Journal Article
In: European Journal of Special Needs Education, vol. 23, no. 4, pp. 393-402, 2008.
@article{Barber2008,
title = {Using Intensive Interaction to add to the palette of interactive possibilities in teacher-pupil communication},
author = {Mark Barber},
url = {https://doi.org/10.1080/08856250802387380},
doi = {10.1080/08856250802387380},
year = {2008},
date = {2008-01-01},
urldate = {2010-11-09},
journal = {European Journal of Special Needs Education},
volume = {23},
number = {4},
pages = {393-402},
abstract = {In 2003 a scheme was launched to introduce Intensive Interaction to Bayside Special Developmental School in Melbourne, Australia. The school had 80 pupils with moderate to profound learning disabilities, with ages from 2-18 years. Class sizes varied from 4 to 8 pupils staffed by one teacher and one support worker.
After initial staff training, 11 pupils were selected as being suitable for the study, the selection criteria including the pupils’ apparent communication difficulties, high levels of social isolation, as well as ‘large amounts of time spent in ritualised, self-oriented behaviours’. Staff were asked to record the participants’ baseline behaviours, and to think about how to interact or make their presence known. Baseline videos of at least five minutes length were made for each pupil showing them in group activities and ‘individual teaching sessions’.
Intervention: During the 30 week intervention period staff interacted with pupils using Intensive Interaction techniques, rather than ones which were task or outcome focused. These were often initiated by pupils themselves during “downtime” and informal periods. Staff observed the activities that appeared to lead to increased sociability and positive affect. When the pupils did not appear to show interest, staff tried to “intrigue” them into becoming involved.
Evaluation: Staff met and discussed the video footage to reflect on their success during the process. After 30 weeks Intensive Interaction was being used more widely in the school in formal and informal settings. Videos were made of 6-15 minutes duration, and these were rated on a second by second basis, and staff looked for the following “indicators of involvement” (adapted from Kellett & Nind, 2003) were noted and compared: “No interactive behaviour”; “look at face”; “smile”; “socially directive physical contact”; and “engaged”.
Discussion: the data collected appeared to show an increase in the social activity and engagement of the pupils, and this, taken together with comments from staff about the increased “trust” of the learners, would suggest that Intensive Interaction has been useful. The periods of “no interactive behaviours” decreased between the baseline and evaluation period. This may reflect the difference between the pupil and the teacher interacting in the conventional sense i.e. a pupil responding to a set task or object of focus, and the teacher confirming this response, and the more relaxed dialogue of Intensive Interaction where the teacher responds to their pupil’s idiosyncratic, potentially communicative behaviour.
There was also an increase in the pupil initiating and engaging in social contact with their communicative partner. Things like physical proximity, touch, turn taking and interactive game playing increased much more after the intervention period. It was noted that student “J” regularly used touch as a communication tool and student “A” was prompted to use touch a lot more as a result of the support worker’s use of spinning saucers.
It was noted that the students (all with ASD) appeared to want to engage the communicative partner from a social point of view, not a purely functional one. Also, positive affect increased and the pupils gazed more directly at their partners and the pupils engaged for longer periods.
Conclusion: The report recognises that, while the results are limited, it appears to show the positive effects of adopting Intensive Interaction in schools as a means of increasing the sociability and expression of pupils with profound multiple learning disabilities and autistic spectrum disorder.
The paper also acknowledges the effect that teachers can have when they employ the approach. Teachers are not as limited when a session is not outcome focused, and this makes a session more enjoyable for both teacher and pupil, and more satisfying interactions take place when the teacher responds to the student’s individual behaviours.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In 2003 a scheme was launched to introduce Intensive Interaction to Bayside Special Developmental School in Melbourne, Australia. The school had 80 pupils with moderate to profound learning disabilities, with ages from 2-18 years. Class sizes varied from 4 to 8 pupils staffed by one teacher and one support worker.
After initial staff training, 11 pupils were selected as being suitable for the study, the selection criteria including the pupils’ apparent communication difficulties, high levels of social isolation, as well as ‘large amounts of time spent in ritualised, self-oriented behaviours’. Staff were asked to record the participants’ baseline behaviours, and to think about how to interact or make their presence known. Baseline videos of at least five minutes length were made for each pupil showing them in group activities and ‘individual teaching sessions’.
Intervention: During the 30 week intervention period staff interacted with pupils using Intensive Interaction techniques, rather than ones which were task or outcome focused. These were often initiated by pupils themselves during “downtime” and informal periods. Staff observed the activities that appeared to lead to increased sociability and positive affect. When the pupils did not appear to show interest, staff tried to “intrigue” them into becoming involved.
Evaluation: Staff met and discussed the video footage to reflect on their success during the process. After 30 weeks Intensive Interaction was being used more widely in the school in formal and informal settings. Videos were made of 6-15 minutes duration, and these were rated on a second by second basis, and staff looked for the following “indicators of involvement” (adapted from Kellett & Nind, 2003) were noted and compared: “No interactive behaviour”; “look at face”; “smile”; “socially directive physical contact”; and “engaged”.
Discussion: the data collected appeared to show an increase in the social activity and engagement of the pupils, and this, taken together with comments from staff about the increased “trust” of the learners, would suggest that Intensive Interaction has been useful. The periods of “no interactive behaviours” decreased between the baseline and evaluation period. This may reflect the difference between the pupil and the teacher interacting in the conventional sense i.e. a pupil responding to a set task or object of focus, and the teacher confirming this response, and the more relaxed dialogue of Intensive Interaction where the teacher responds to their pupil’s idiosyncratic, potentially communicative behaviour.
There was also an increase in the pupil initiating and engaging in social contact with their communicative partner. Things like physical proximity, touch, turn taking and interactive game playing increased much more after the intervention period. It was noted that student “J” regularly used touch as a communication tool and student “A” was prompted to use touch a lot more as a result of the support worker’s use of spinning saucers.
It was noted that the students (all with ASD) appeared to want to engage the communicative partner from a social point of view, not a purely functional one. Also, positive affect increased and the pupils gazed more directly at their partners and the pupils engaged for longer periods.
Conclusion: The report recognises that, while the results are limited, it appears to show the positive effects of adopting Intensive Interaction in schools as a means of increasing the sociability and expression of pupils with profound multiple learning disabilities and autistic spectrum disorder.
The paper also acknowledges the effect that teachers can have when they employ the approach. Teachers are not as limited when a session is not outcome focused, and this makes a session more enjoyable for both teacher and pupil, and more satisfying interactions take place when the teacher responds to the student’s individual behaviours.
After initial staff training, 11 pupils were selected as being suitable for the study, the selection criteria including the pupils’ apparent communication difficulties, high levels of social isolation, as well as ‘large amounts of time spent in ritualised, self-oriented behaviours’. Staff were asked to record the participants’ baseline behaviours, and to think about how to interact or make their presence known. Baseline videos of at least five minutes length were made for each pupil showing them in group activities and ‘individual teaching sessions’.
Intervention: During the 30 week intervention period staff interacted with pupils using Intensive Interaction techniques, rather than ones which were task or outcome focused. These were often initiated by pupils themselves during “downtime” and informal periods. Staff observed the activities that appeared to lead to increased sociability and positive affect. When the pupils did not appear to show interest, staff tried to “intrigue” them into becoming involved.
Evaluation: Staff met and discussed the video footage to reflect on their success during the process. After 30 weeks Intensive Interaction was being used more widely in the school in formal and informal settings. Videos were made of 6-15 minutes duration, and these were rated on a second by second basis, and staff looked for the following “indicators of involvement” (adapted from Kellett & Nind, 2003) were noted and compared: “No interactive behaviour”; “look at face”; “smile”; “socially directive physical contact”; and “engaged”.
Discussion: the data collected appeared to show an increase in the social activity and engagement of the pupils, and this, taken together with comments from staff about the increased “trust” of the learners, would suggest that Intensive Interaction has been useful. The periods of “no interactive behaviours” decreased between the baseline and evaluation period. This may reflect the difference between the pupil and the teacher interacting in the conventional sense i.e. a pupil responding to a set task or object of focus, and the teacher confirming this response, and the more relaxed dialogue of Intensive Interaction where the teacher responds to their pupil’s idiosyncratic, potentially communicative behaviour.
There was also an increase in the pupil initiating and engaging in social contact with their communicative partner. Things like physical proximity, touch, turn taking and interactive game playing increased much more after the intervention period. It was noted that student “J” regularly used touch as a communication tool and student “A” was prompted to use touch a lot more as a result of the support worker’s use of spinning saucers.
It was noted that the students (all with ASD) appeared to want to engage the communicative partner from a social point of view, not a purely functional one. Also, positive affect increased and the pupils gazed more directly at their partners and the pupils engaged for longer periods.
Conclusion: The report recognises that, while the results are limited, it appears to show the positive effects of adopting Intensive Interaction in schools as a means of increasing the sociability and expression of pupils with profound multiple learning disabilities and autistic spectrum disorder.
The paper also acknowledges the effect that teachers can have when they employ the approach. Teachers are not as limited when a session is not outcome focused, and this makes a session more enjoyable for both teacher and pupil, and more satisfying interactions take place when the teacher responds to the student’s individual behaviours.
Firth, Graham; Elford, Helen; Leeming, Catherine; Crabbe, Marion
Intensive Interaction as a Novel Approach in Social Care: Care Staff's Views on the Practice Change Process Journal Article
In: Journal of Applied Research in Intellectual Disabilities, vol. 21, no. 1, pp. 58-69, 2008, ISSN: 1468-3148.
@article{Firth2008b,
title = {Intensive Interaction as a Novel Approach in Social Care: Care Staff's Views on the Practice Change Process},
author = {Graham Firth and Helen Elford and Catherine Leeming and Marion Crabbe},
doi = { https://doi.org/10.1111/j.1468-3148.2007.00369.x},
issn = {1468-3148},
year = {2008},
date = {2008-01-01},
urldate = {2007-07-02},
journal = {Journal of Applied Research in Intellectual Disabilities},
volume = {21},
number = {1},
pages = {58-69},
abstract = {This study relates to an intervention in 4 NHS staffed group homes in the north of England. 29 staff members were trained in the use of Intensive Interaction (II) and subsequently supported in implementing the approach with their clients over a 6-month period. Data was collected via researcher field-notes and semi-structured interviews, the data then being analysed using a grounded theory approach (Charmaz, 2003). During analysis the data was categorised into 7 major thematic headings, and the data illuminated a number of potential conceptual, philosophical and practical issues that appeared to influence staff’s adoption of Intensive Interaction.
1. Levels of client responses attributed to II: Client responses to II ranged from the clearly beneficial and novel, to there being little or no response. The novel responses ranged from improved awareness of the social environment, to non-task associated physical contact. It also emerged that client responses were crucial, with staff using ’feedback’ to decide whether or not to continue, and successful interactions made staff interact more with certain clients.
2. Staff’s conceptualisation of II and its potential outcomes: a range of conceptualisations of II emerged, with some staff seeing II as: a form of communication; relationship building; client led activity. The most common view was that II was a means of communicating with clients through their own communicative means and at their level.
3. Staff’s view of client’s communicative means, personal attributes, and level of understanding: Staff’s views of their clients’ personal attributes also influenced the II used. This was at times a barrier as some staff were deterministic about their client’s behaviour, or thought that clients might not like it: but this wasn’t always the case, and some staff’s views changed: ‘[the staff] have seen clients do things that they didn’t think they would’.
4. Issues related to staff - client relationships: it was noted by some staff that staff-client relationships varied which potentially affected the levels of social interaction. II was seen as a potential tool to build relationships with clients.
5. Philosophical issues influencing the care environment: some staff voiced concerns about II being based on ‘infant-caregiver’ activity and felt that ‘age-appropriate’ methods should be favoured. Some staff also had concerns about how using II ‘in public’ might look to outside observers.
6. Practical, personal and temporal issues affecting the use of II: there were some aspects of II that staff used more often, whilst there were some techniques which some staff were unsure about using due to a number of reasons. Also time related issues emerged; one being that II was competing with other tasks for finite staff time.
7. Issues related to the momentum of approach adoption: the study data indicated that, over time, there was an apparent decline in the level of interest and involvement in II.: ‘Its fallen down the wayside a bit, not through any other reason than ... you’re cooking, cleaning, shopping’ [quote from a home manager]. There were a variety of practical suggestions given about how to support the continued use of the approach in the longer term e.g. by making II part of induction training, improved staffing levels and a II facilitator to support staff.
Discussion: Although during the research there were clear benefits of II, there still appeared to be a number of philosophical, practical and organisational barriers. Overall this research found varying levels of acceptance by staff of the practice changes required to fully implement II. In response to II the study reported: some clients evidenced greater frequency of initiation of social contact, improved sociability, client led interactions and increased client involvement. The research also found evidence of improved attempts at building relationships, with this emerging as an important potential outcome of the approach. This outcome also was noted to correspond with previous research where II enabled ‘confidence and trust’ to be built, with staff seeing Intensive Interaction as useful in improving relationships with clients, even when they had previously worked together. However, some staff felt they were already doing II, but this research suggests that some such claims could potentially be exaggerated. Also the issue of ‘age appropriateness’ was still identified as an obstacle to using II, with some staff feeling it could potentially damage their clients’ image in public.
Another issue identified in this research was an apparent decline in II use over time, or ‘initiative decay’ as described by Buchanan et al (1999), with such decay happening as the ‘novelty fades’ during a practice change intervention. It was suggested that future Intensive Interaction interventions should take ‘initiative decay’ into account. Also it was posited that future research should look at organisational structures to support Intensive Interaction adoption, with Golembiewski’s (1976) hierarchical order of organisational change being used as potentially a more reliable framework for sustained approach adoption.
Finally the paper noted that ‘Valuing People’ (DoH, 2001) states that an objective for learning disability services is to enable people to develop ‘a range of activities including leisure, interests, friendships and relationships’ (p7), and it is the authors’ contention that a more effective and sustained adoption of Intensive Interaction could significantly enable such aims to become a reality, particularly for clients with profound and multiple learning disabilities. },
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}
This study relates to an intervention in 4 NHS staffed group homes in the north of England. 29 staff members were trained in the use of Intensive Interaction (II) and subsequently supported in implementing the approach with their clients over a 6-month period. Data was collected via researcher field-notes and semi-structured interviews, the data then being analysed using a grounded theory approach (Charmaz, 2003). During analysis the data was categorised into 7 major thematic headings, and the data illuminated a number of potential conceptual, philosophical and practical issues that appeared to influence staff’s adoption of Intensive Interaction.
1. Levels of client responses attributed to II: Client responses to II ranged from the clearly beneficial and novel, to there being little or no response. The novel responses ranged from improved awareness of the social environment, to non-task associated physical contact. It also emerged that client responses were crucial, with staff using ’feedback’ to decide whether or not to continue, and successful interactions made staff interact more with certain clients.
2. Staff’s conceptualisation of II and its potential outcomes: a range of conceptualisations of II emerged, with some staff seeing II as: a form of communication; relationship building; client led activity. The most common view was that II was a means of communicating with clients through their own communicative means and at their level.
3. Staff’s view of client’s communicative means, personal attributes, and level of understanding: Staff’s views of their clients’ personal attributes also influenced the II used. This was at times a barrier as some staff were deterministic about their client’s behaviour, or thought that clients might not like it: but this wasn’t always the case, and some staff’s views changed: ‘[the staff] have seen clients do things that they didn’t think they would’.
4. Issues related to staff - client relationships: it was noted by some staff that staff-client relationships varied which potentially affected the levels of social interaction. II was seen as a potential tool to build relationships with clients.
5. Philosophical issues influencing the care environment: some staff voiced concerns about II being based on ‘infant-caregiver’ activity and felt that ‘age-appropriate’ methods should be favoured. Some staff also had concerns about how using II ‘in public’ might look to outside observers.
6. Practical, personal and temporal issues affecting the use of II: there were some aspects of II that staff used more often, whilst there were some techniques which some staff were unsure about using due to a number of reasons. Also time related issues emerged; one being that II was competing with other tasks for finite staff time.
7. Issues related to the momentum of approach adoption: the study data indicated that, over time, there was an apparent decline in the level of interest and involvement in II.: ‘Its fallen down the wayside a bit, not through any other reason than ... you’re cooking, cleaning, shopping’ [quote from a home manager]. There were a variety of practical suggestions given about how to support the continued use of the approach in the longer term e.g. by making II part of induction training, improved staffing levels and a II facilitator to support staff.
Discussion: Although during the research there were clear benefits of II, there still appeared to be a number of philosophical, practical and organisational barriers. Overall this research found varying levels of acceptance by staff of the practice changes required to fully implement II. In response to II the study reported: some clients evidenced greater frequency of initiation of social contact, improved sociability, client led interactions and increased client involvement. The research also found evidence of improved attempts at building relationships, with this emerging as an important potential outcome of the approach. This outcome also was noted to correspond with previous research where II enabled ‘confidence and trust’ to be built, with staff seeing Intensive Interaction as useful in improving relationships with clients, even when they had previously worked together. However, some staff felt they were already doing II, but this research suggests that some such claims could potentially be exaggerated. Also the issue of ‘age appropriateness’ was still identified as an obstacle to using II, with some staff feeling it could potentially damage their clients’ image in public.
Another issue identified in this research was an apparent decline in II use over time, or ‘initiative decay’ as described by Buchanan et al (1999), with such decay happening as the ‘novelty fades’ during a practice change intervention. It was suggested that future Intensive Interaction interventions should take ‘initiative decay’ into account. Also it was posited that future research should look at organisational structures to support Intensive Interaction adoption, with Golembiewski’s (1976) hierarchical order of organisational change being used as potentially a more reliable framework for sustained approach adoption.
Finally the paper noted that ‘Valuing People’ (DoH, 2001) states that an objective for learning disability services is to enable people to develop ‘a range of activities including leisure, interests, friendships and relationships’ (p7), and it is the authors’ contention that a more effective and sustained adoption of Intensive Interaction could significantly enable such aims to become a reality, particularly for clients with profound and multiple learning disabilities.
1. Levels of client responses attributed to II: Client responses to II ranged from the clearly beneficial and novel, to there being little or no response. The novel responses ranged from improved awareness of the social environment, to non-task associated physical contact. It also emerged that client responses were crucial, with staff using ’feedback’ to decide whether or not to continue, and successful interactions made staff interact more with certain clients.
2. Staff’s conceptualisation of II and its potential outcomes: a range of conceptualisations of II emerged, with some staff seeing II as: a form of communication; relationship building; client led activity. The most common view was that II was a means of communicating with clients through their own communicative means and at their level.
3. Staff’s view of client’s communicative means, personal attributes, and level of understanding: Staff’s views of their clients’ personal attributes also influenced the II used. This was at times a barrier as some staff were deterministic about their client’s behaviour, or thought that clients might not like it: but this wasn’t always the case, and some staff’s views changed: ‘[the staff] have seen clients do things that they didn’t think they would’.
4. Issues related to staff - client relationships: it was noted by some staff that staff-client relationships varied which potentially affected the levels of social interaction. II was seen as a potential tool to build relationships with clients.
5. Philosophical issues influencing the care environment: some staff voiced concerns about II being based on ‘infant-caregiver’ activity and felt that ‘age-appropriate’ methods should be favoured. Some staff also had concerns about how using II ‘in public’ might look to outside observers.
6. Practical, personal and temporal issues affecting the use of II: there were some aspects of II that staff used more often, whilst there were some techniques which some staff were unsure about using due to a number of reasons. Also time related issues emerged; one being that II was competing with other tasks for finite staff time.
7. Issues related to the momentum of approach adoption: the study data indicated that, over time, there was an apparent decline in the level of interest and involvement in II.: ‘Its fallen down the wayside a bit, not through any other reason than ... you’re cooking, cleaning, shopping’ [quote from a home manager]. There were a variety of practical suggestions given about how to support the continued use of the approach in the longer term e.g. by making II part of induction training, improved staffing levels and a II facilitator to support staff.
Discussion: Although during the research there were clear benefits of II, there still appeared to be a number of philosophical, practical and organisational barriers. Overall this research found varying levels of acceptance by staff of the practice changes required to fully implement II. In response to II the study reported: some clients evidenced greater frequency of initiation of social contact, improved sociability, client led interactions and increased client involvement. The research also found evidence of improved attempts at building relationships, with this emerging as an important potential outcome of the approach. This outcome also was noted to correspond with previous research where II enabled ‘confidence and trust’ to be built, with staff seeing Intensive Interaction as useful in improving relationships with clients, even when they had previously worked together. However, some staff felt they were already doing II, but this research suggests that some such claims could potentially be exaggerated. Also the issue of ‘age appropriateness’ was still identified as an obstacle to using II, with some staff feeling it could potentially damage their clients’ image in public.
Another issue identified in this research was an apparent decline in II use over time, or ‘initiative decay’ as described by Buchanan et al (1999), with such decay happening as the ‘novelty fades’ during a practice change intervention. It was suggested that future Intensive Interaction interventions should take ‘initiative decay’ into account. Also it was posited that future research should look at organisational structures to support Intensive Interaction adoption, with Golembiewski’s (1976) hierarchical order of organisational change being used as potentially a more reliable framework for sustained approach adoption.
Finally the paper noted that ‘Valuing People’ (DoH, 2001) states that an objective for learning disability services is to enable people to develop ‘a range of activities including leisure, interests, friendships and relationships’ (p7), and it is the authors’ contention that a more effective and sustained adoption of Intensive Interaction could significantly enable such aims to become a reality, particularly for clients with profound and multiple learning disabilities.
2007
Barber, Mark
Imitation, interaction and dialogue using Intensive Interaction: tea party rules Journal Article
In: Support for Learning, vol. 22, no. 3, pp. 124-130, 2007, ISSN: 1467-9604.
@article{Barber2007,
title = {Imitation, interaction and dialogue using Intensive Interaction: tea party rules},
author = {Mark Barber},
url = {https://nasenjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1467-9604.2007.00459.x},
doi = {https://doi.org/10.1111/j.1467-9604.2007.00459.x},
issn = {1467-9604},
year = {2007},
date = {2007-08-07},
journal = {Support for Learning},
volume = {22},
number = {3},
pages = {124-130},
abstract = {Intensive Interaction has become widely used when building up communication with children with profound learning difficulties. Often practitioners understand Intensive Interaction to be primarily about imitation and Mark Barber shows how this can be a misunderstanding that limits the kinds of interactions that can be enjoyed by conversation partners. The article explores how instead of just imitating, practitioners need to develop (wordless) conversations so they can follow the child's lead, introduce their own closely related ideas, provide variations and generally keep to the ‘tea-party rules’ developed by typically developing young children at play.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Intensive Interaction has become widely used when building up communication with children with profound learning difficulties. Often practitioners understand Intensive Interaction to be primarily about imitation and Mark Barber shows how this can be a misunderstanding that limits the kinds of interactions that can be enjoyed by conversation partners. The article explores how instead of just imitating, practitioners need to develop (wordless) conversations so they can follow the child's lead, introduce their own closely related ideas, provide variations and generally keep to the ‘tea-party rules’ developed by typically developing young children at play.
Hewett, Dave
Do touch: physical contact and people who have severe, profound and multiple learning difficulties Journal Article
In: Support for Learning, vol. 22, no. 3, pp. 116, 2007, ISSN: 1467-9604.
@article{Hewett2007,
title = {Do touch: physical contact and people who have severe, profound and multiple learning difficulties},
author = {Dave Hewett},
url = {https://nasenjournals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-9604.2007.00458.x},
doi = {https://doi.org/10.1111/j.1467-9604.2007.00458.x},
issn = {1467-9604},
year = {2007},
date = {2007-08-07},
journal = {Support for Learning},
volume = {22},
number = {3},
pages = {116},
abstract = {Dave Hewett PhD. is well known within the education and care fields for his invaluable work on communication with both children and adults who have severe and profound learning difficulties (with or without autism). However, because his work until recent times has tended to occur within more segregated services, he is only now becoming known to staff working in mainstream education as the children with more severe learning and communication difficulties are beginning to receive inclusive schooling. In this article he shares his thoughts, backed up with research, on the importance of touch for us all, but focusing on the reasons this needs special attention for those who have profound additional disabilities. Before concluding, the author offers us some very useful tools when working with children where touch and intensive interaction may be part of a teaching programme to help in building a relationship, and opening early communication channels.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Dave Hewett PhD. is well known within the education and care fields for his invaluable work on communication with both children and adults who have severe and profound learning difficulties (with or without autism). However, because his work until recent times has tended to occur within more segregated services, he is only now becoming known to staff working in mainstream education as the children with more severe learning and communication difficulties are beginning to receive inclusive schooling. In this article he shares his thoughts, backed up with research, on the importance of touch for us all, but focusing on the reasons this needs special attention for those who have profound additional disabilities. Before concluding, the author offers us some very useful tools when working with children where touch and intensive interaction may be part of a teaching programme to help in building a relationship, and opening early communication channels.
2006
Anderson, Carolyn
Early Communication strategies: using video analysis to support teachers working with preverbal pupils Journal Article
In: British Journal of Special Education, vol. 33, no. 3, pp. 114-120, 2006, ISSN: 1467-8578.
@article{Anderson2006,
title = {Early Communication strategies: using video analysis to support teachers working with preverbal pupils},
author = {Carolyn Anderson},
url = {https://doi.org/10.1111/j.1467-8578.2006.00426.x},
doi = {10.1111/j.1467-8578.2006.00426.x},
issn = {1467-8578},
year = {2006},
date = {2006-09-01},
urldate = {2006-08-24},
journal = {British Journal of Special Education},
volume = {33},
number = {3},
pages = {114-120},
abstract = {Introduction: Based on the view that children with complex learning difficulties have special educational needs, this article examines communication interactions between teachers and pupils. The aim is to see if the communication strategies employed impact the interaction. Past research has shown that adults frequently did not respond to children’s communication attempts nor did they allow pupils to initiate interaction (Ware and Evans, 1986).
Furthermore Beveridge and Hurrell (1980) found that teachers could maintain an interaction by immediately responding either verbally or non-verbally or could discourage pupils by ignoring or not responding to an initiation. Nind, Kellett and Hopkins (2001) observed that teachers with a wider range of ‘motherese’ techniques tended to be more successful in engaging students.
Aims and Objectives: The purpose of the research was to identify strategies teachers and pupils used during interaction across three aspects:
1 – The number of turns pupils and teachers took during interactions.
2 – The three language function strategies used most frequently to initiate and respond.
3 – Average word counts and average information carrying words used by teachers and pupils.
Methodology: 8 teachers and 12 pupils participated in the study. The teachers experience in working with pupils with learning difficulties ranged from under a year to over 18 years. The pupils ranged in age from 5 to 16 years old, and were at the earliest stages of communication development, functioning at or below the ‘two-words together’ level of language. Twenty-eight video-taped sessions were sampled purposively (purposive sampling is where a sample is selected in a deliberate and non-random fashion to achieve a certain goal). 36% of the videos were coded by the author’s supervisor; giving an inter-observer reliability of over 0.9.
The videos were transcribed for both verbal and non-verbal behaviours and then coded using qualitative analysis for:
a) Turns – a verbal element or utterance and non-verbal elements, or both.
b) Initiations – a conversation or causing a change in topic or subject shift.
c) Responses and strategies – these are turns where a reply is made to an initiation which relates to the shared subject or slightly extends it, or checks that the turn was understood by the listener.
Results: Turns - Teachers took the lowest number of turns when adopting intensive interaction principles than when using the “traditional” teacher-dominant approach. When looking at the same pupil with different teachers the results indicate that the teacher’s interaction styles determine how much of the conversation is shared between the two partners.
Strategies – The strategies used most frequently by the teachers to initiate an interaction were questioning, commenting, or gaining the pupil’s attention. Teachers used commenting, gaining attention or repeating/simplifying most to respond in an interaction. The pupils initiated interaction most frequently by showing interest, commenting, and vocalising. Their most frequent responses were by showing interest, making an affective response, or by comments.
Word counts – For the teachers the number of words used ranged from 0 (teacher adopting Intensive Interaction principles) to an average of 4 words. However the number of words used varied based on the individual abilities of the child, for instance for an easily distractible child the teacher used less words and relied more on Makaton signs with verbal cues.
Conclusion: The results indicate that the manner in which a teacher communicates with someone with a learning disability does affect how the interaction progresses and the level of engagement from the individual. Adopting teaching styles to match the pupil’s level of understanding and idiosyncrasies allows for greater participation from the pupil and perhaps a more rewarding experience for them.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction: Based on the view that children with complex learning difficulties have special educational needs, this article examines communication interactions between teachers and pupils. The aim is to see if the communication strategies employed impact the interaction. Past research has shown that adults frequently did not respond to children’s communication attempts nor did they allow pupils to initiate interaction (Ware and Evans, 1986).
Furthermore Beveridge and Hurrell (1980) found that teachers could maintain an interaction by immediately responding either verbally or non-verbally or could discourage pupils by ignoring or not responding to an initiation. Nind, Kellett and Hopkins (2001) observed that teachers with a wider range of ‘motherese’ techniques tended to be more successful in engaging students.
Aims and Objectives: The purpose of the research was to identify strategies teachers and pupils used during interaction across three aspects:
1 – The number of turns pupils and teachers took during interactions.
2 – The three language function strategies used most frequently to initiate and respond.
3 – Average word counts and average information carrying words used by teachers and pupils.
Methodology: 8 teachers and 12 pupils participated in the study. The teachers experience in working with pupils with learning difficulties ranged from under a year to over 18 years. The pupils ranged in age from 5 to 16 years old, and were at the earliest stages of communication development, functioning at or below the ‘two-words together’ level of language. Twenty-eight video-taped sessions were sampled purposively (purposive sampling is where a sample is selected in a deliberate and non-random fashion to achieve a certain goal). 36% of the videos were coded by the author’s supervisor; giving an inter-observer reliability of over 0.9.
The videos were transcribed for both verbal and non-verbal behaviours and then coded using qualitative analysis for:
a) Turns – a verbal element or utterance and non-verbal elements, or both.
b) Initiations – a conversation or causing a change in topic or subject shift.
c) Responses and strategies – these are turns where a reply is made to an initiation which relates to the shared subject or slightly extends it, or checks that the turn was understood by the listener.
Results: Turns - Teachers took the lowest number of turns when adopting intensive interaction principles than when using the “traditional” teacher-dominant approach. When looking at the same pupil with different teachers the results indicate that the teacher’s interaction styles determine how much of the conversation is shared between the two partners.
Strategies – The strategies used most frequently by the teachers to initiate an interaction were questioning, commenting, or gaining the pupil’s attention. Teachers used commenting, gaining attention or repeating/simplifying most to respond in an interaction. The pupils initiated interaction most frequently by showing interest, commenting, and vocalising. Their most frequent responses were by showing interest, making an affective response, or by comments.
Word counts – For the teachers the number of words used ranged from 0 (teacher adopting Intensive Interaction principles) to an average of 4 words. However the number of words used varied based on the individual abilities of the child, for instance for an easily distractible child the teacher used less words and relied more on Makaton signs with verbal cues.
Conclusion: The results indicate that the manner in which a teacher communicates with someone with a learning disability does affect how the interaction progresses and the level of engagement from the individual. Adopting teaching styles to match the pupil’s level of understanding and idiosyncrasies allows for greater participation from the pupil and perhaps a more rewarding experience for them.
Furthermore Beveridge and Hurrell (1980) found that teachers could maintain an interaction by immediately responding either verbally or non-verbally or could discourage pupils by ignoring or not responding to an initiation. Nind, Kellett and Hopkins (2001) observed that teachers with a wider range of ‘motherese’ techniques tended to be more successful in engaging students.
Aims and Objectives: The purpose of the research was to identify strategies teachers and pupils used during interaction across three aspects:
1 – The number of turns pupils and teachers took during interactions.
2 – The three language function strategies used most frequently to initiate and respond.
3 – Average word counts and average information carrying words used by teachers and pupils.
Methodology: 8 teachers and 12 pupils participated in the study. The teachers experience in working with pupils with learning difficulties ranged from under a year to over 18 years. The pupils ranged in age from 5 to 16 years old, and were at the earliest stages of communication development, functioning at or below the ‘two-words together’ level of language. Twenty-eight video-taped sessions were sampled purposively (purposive sampling is where a sample is selected in a deliberate and non-random fashion to achieve a certain goal). 36% of the videos were coded by the author’s supervisor; giving an inter-observer reliability of over 0.9.
The videos were transcribed for both verbal and non-verbal behaviours and then coded using qualitative analysis for:
a) Turns – a verbal element or utterance and non-verbal elements, or both.
b) Initiations – a conversation or causing a change in topic or subject shift.
c) Responses and strategies – these are turns where a reply is made to an initiation which relates to the shared subject or slightly extends it, or checks that the turn was understood by the listener.
Results: Turns - Teachers took the lowest number of turns when adopting intensive interaction principles than when using the “traditional” teacher-dominant approach. When looking at the same pupil with different teachers the results indicate that the teacher’s interaction styles determine how much of the conversation is shared between the two partners.
Strategies – The strategies used most frequently by the teachers to initiate an interaction were questioning, commenting, or gaining the pupil’s attention. Teachers used commenting, gaining attention or repeating/simplifying most to respond in an interaction. The pupils initiated interaction most frequently by showing interest, commenting, and vocalising. Their most frequent responses were by showing interest, making an affective response, or by comments.
Word counts – For the teachers the number of words used ranged from 0 (teacher adopting Intensive Interaction principles) to an average of 4 words. However the number of words used varied based on the individual abilities of the child, for instance for an easily distractible child the teacher used less words and relied more on Makaton signs with verbal cues.
Conclusion: The results indicate that the manner in which a teacher communicates with someone with a learning disability does affect how the interaction progresses and the level of engagement from the individual. Adopting teaching styles to match the pupil’s level of understanding and idiosyncrasies allows for greater participation from the pupil and perhaps a more rewarding experience for them.