Intensive Interaction Institute - Publications and Bibliography

@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.  

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@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.},

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@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.},

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@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.},

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@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. },

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@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.},

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@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.},

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}

@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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@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}

}

@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}

}

@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.},

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pubstate = {published},

tppubtype = {article}

}

@article{Leaning2006,

title = {From the inside looking out – an Intensive Interaction group for people with profound and multiple learning disabilities},

author = {Brian Leaning and Tessa Watson},

doi = { https://doi.org/10.1111/j.1468-3156.2005.00374.x},

issn = {1468-3156},

year  = {2006},

date = {2006-06-01},

urldate = {2006-04-21},

journal = {British Journal of Learning Disabilities},

volume = {34},

number = {2},

pages = {103-109},

abstract = {This paper reported on a series of workshops in an adult learning disability day centre for groups of clients and carers. Intensive Interaction was used with five people with profound and multiple learning disabilities over 8 weeks, with the aims of developing: meaningful dialogue; the ability to relate and communicate with others; an awareness of themselves as separate; alternatives to self-stimulatory behaviour. 



Method: The participants with profound and multiple learning difficulties (3 female and 2 male) were videoed for 50 minutes prior to the sessions as a baseline measure. All the participants were preverbal, all had very limited non-verbal communication, and all were said to avoid interaction. The video was analysed, using momentary time sampling techniques, to observe behaviours that were viewed as being important for either interaction or for avoidance of interaction, and 5 such behaviours were described: eye contact with others, object-orientated eye contact, self-stimulation (e.g. rocking, breath holding, face slapping), smiling and active avoidant behaviour (moving or turning away from others, covering the face to block the view of others).



After the assessment phase the group was run for eight weekly 50-minute sessions with two facilitators (a Music Therapist and a Clinical Psychologist). 

Each session began and ended with 5 minutes of music to signify a transition in and out of the session. A box was placed in the middle of the room that contained a variety of sensory items (e.g. balls, silk materials, musical chimes) which were used in interactions. In each session each facilitator would engage with clients who indicated their wish, or readiness, to do so, often building a game from an action, facial expression or sound made by the client. 

Each session was videotaped and each of the five behaviours measured for each individual. One follow-up session was conducted one month after the end of the last group. A researcher who was not involved in the group conducted all the video ratings and analysis. In both the baseline and follow-up sessions the participants were engaged in the group sessions with the members of staff from the day service. Four different types of groups were observed to measure the baseline and follow-up (music and movement, massage, communication, and news and views). 



Results: Across the group there was an increased use of eye contact, to others and to objects, suggesting that the participants developed a greater interest in interacting than they had demonstrated during baseline or follow-up phases. An increased incidence in smiling throughout the group also pointed towards a higher level of enjoyment during interaction than at baseline or follow-up. A reduction in both self-stimulation and active avoidant behaviours suggested that the participants felt more comfortable interacting during these group sessions, and it was suggested that the facilitators were better able to build greater understanding of the participants. However, when the data was analysed from the follow-up session (one month after the final session), the frequency of behaviours shown by the participants reverted back to a rate similar to that of the baseline. This appears to indicate that the mechanisms learnt in the group were not, at that time, generalised to other areas of the participant’s lives.



Discussion: Through the analysis of the changes in positive and negative behaviours, this study suggests that there was an increase in the ability of all the participants to engage with the facilitators. Therefore, they concluded that this study supports the idea of FILO and the use of Intensive Interaction principles in working with people with profound intellectual disabilities. 



It was the author’s belief that Intensive Interaction principles can be taught to staff (over a three to four session training course, with ongoing supervision), and that such training supports the government policy aim ‘to ensure that social and health care staff working with people with learning disabilities are appropriately skilled, trained and qualified’ (DoH 2001, p.26). },

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@article{Firth2006,

title = {Intensive Interaction: a Research Review},

author = {Graham Firth},

url = {https://www.mhldrp.org.uk/article/id/368/},

doi = {https://doi.org/10.5920/mhldrp.2006.3153},

issn = {5920-3153},

year  = {2006},

date = {2006-04-18},

journal = {Mental Health & Learning Disabilities Research and Practice},

volume = {3},

number = {1},

pages = {53-58},

abstract = {Intensive Interaction is a socially interactive approach to supporting and developing the pre verbal communication and sociability of people with severe or profound learning disabilities, or severe autism. Developed in the 1980’s from the psychological model of ‘augmented mothering’ the approach currently has an increasing number of proponents who make claims for increased social responsiveness due to the use of the approach. This short paper aims to evaluate some of the evidential claims of consequential increased social responses from people with severe and profound and multiple learning disabilities due to the use of Intensive Interaction techniques. Thus the paper presents a review of findings presented in relevant research papers which have been published in generally recognised academic journals. From this review the author concludes that although expanding, the current body of research has been limited in scope and scale, and has generally been conducted by a small number of Intensive Interaction practitioners and advocates. However, increased client social responsiveness was consistently reported across the research projects reviewed. In conclusion, this paper advocates for further systematic research into the approach by the wider research community to further develop the evidential base of the approach.},

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@article{Forster2006,

title = {Using Intensive Interaction - A case study},

author = {S Forster and M Taylor

},

year  = {2006},

date = {2006-01-01},

journal = {Acquiring Knowledge in Speech, Language & Hearing},

volume = {8},

number = {1},

pages = {12-15},

abstract = {This study focused on Cameron, a young man with a profound intellectual disability, severe vision impairment and a physical disability, who attended a small day service five days a week. The study was conducted over 6 months with 9 DSWs participating, two being interviewed regarding their reflections on the intervention. 



Design: Data were gathered both retrospectively and prospectively. Multiple sources of data (reports, assessments, observation, reflections by participants, and interviews) were collated to compare to the pre-intervention data.  50 interaction reflection forms were completed by DSWs immediately following an I.I. session. Follow-up data included a re-administered Triple C (completed by the service speech pathologist with two DSWs), videoed observations of interactions with Cameron, and two semi-structured interviews with DSWs (which were transcribed, and thematically analysed and coded).



Results: In 2002 (before the I.I. intervention), Cameron’s communication was assessed as consistent with the pre-intentional reflexive communication stage (stage 1 - Bloomberg & West, 1999), with some skills in the reactive stage. This indicated that Cameron was showing minimal reactions to people, activities and objects, and his responses were mainly reflexive. Cameron also showed very few person engagements, a few engagements with objects (e.g. sucking objects) and was largely involved in self-engagement behaviours.  



In mid 2004, the service received a consultation on Intensive Interaction, and the manager of the service and the service speech pathologist supported the establishment of daily interaction sessions for Cameron.  These one-to-one sessions varied from 15 minutes to 2 hours (occasionally occurring twice a day) and following the interaction, staff completed the interaction reflection forms. A content analysis was completed on the 50 reflection sheets, with the following findings being of particular note: 



There was a change in the interactions occurring separate from other clients, to interactions occurring in the same rooms as other clients, often on the periphery of established programs like art or music;

New skills were recorded e.g. increased eye contact, searching for his interaction partner’s hand;

There was a shift from negative ascription of behaviour to seeing the behaviour as communicating a need, and problem solving to address that need,

Some staff reported using the same techniques continuously, whereas other staff reported trying out new techniques to extend the interactions. 

Six months later the Triple C was re-administered and Cameron’s recorded skills had increased to being consistent with the pre-intentional reactive stage of communication (stage 2).  Behaviours observed in 2005, but not in 2002 included smiling, reacting to the voices of particular staff and beginning to show anticipation – although it was noted that any new observations might have indicated that Cameron’s communication skills had improved, and/or that his DSW’s were more observant of his interactive behaviours.



The two DWSs interviewed were also video recorded in 5 minutes of Intensive Interaction with Cameron. The videos were reviewed and written observations made (i.e. video interactions were not coded, but used to provide general descriptions of behaviours).  The observations showed that the DWSs showed positive regard towards Cameron through their words to him and their physical positioning (e.g. sitting with their face close and body oriented towards Cameron).  They used techniques such as burst-pause, whereby they would rock or pat Cameron and then pause to see his response, and they imitated Cameron’s sounds to capture his interest. They also just sat with their hand on his chest or legs, making small movements to signal their presence.  



The results of the Triple C and reflections by staff utilising Intensive interaction indicated that improvements in individuals’ communication skills and positive staff perceptions were seen in this case study. The staff reported positively on the use of Intensive Interaction, though challenges of gaining resources for staff availability and ongoing training were acknowledged. 



Conclusions: The analysis of the data gathered suggests that improvements did occur both in Cameron’s communication skills, and in the perceptions of staff following the intervention.  The promising results of this case study indicate the potential usefulness of Intensive Interaction for people with PID.  Also indicated was the need for more rigorous research to demonstrate the efficacy of using Intensive Interaction as a means of increasing communication interactions between with adults who have PID and their significant communication partners. },

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tppubtype = {article}

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@article{Kellett2005,

title = {Catherine’s Legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies},

author = {Mary Kellett},

url = {https://doi.org/10.1111/j.0952-3383.2005.00383.x},

doi = {10.1111/j.0952-3383.2005.00383.x},

issn = {0952-3383},

year  = {2005},

date = {2005-09-01},

urldate = {2005-08-31},

journal = {British Journal of Special Education},

volume = {32},

number = {3},

pages = {116 – 121},

abstract = {This paper summarises case study evidence of how an 11-year-old girl’s quality of life was transformed by the adoption of Intensive Interaction. Despite the objective research perspective of such a paper, published as it was in such a highly regarded academic journal, what emerges is a very emotive and powerful story about one young girl’s dramatic social development in the last few months of her short life. 

 

In this paper Dr Kellett, of the Children’s Research Centre at the Open University, also explores the methodological and ethical considerations concerning research with children with the most profound disabilities and fragile life expectancies, and the likely implications that individual life experiences may have for policy and practice in this area. 

 

The Participant: Catherine, the focus of this paper, was 11 years old and at home with her family. She had profound learning disabilities compounded by quadriplegia, perceptual impairments and severe and frequent muscle spasms and seizures. She was physically very frail and suffered frequent infections and illnesses. 

 

The Method: prior to the Intensive Interaction intervention at her school, Catherine was perceived by staff as being entirely passive, making no eye contact or vocalisations. Once the Intensive Interaction sessions commenced and a limited amount of video footage was gathered and analysed, dramatic developments were observed in two particular areas, those of eye contact and the ability to attend to joint focus activities. 

 

The Results: Catherine’s engagement in eye contact was seen by the researchers as ‘a tremendously important development’ as it had changed from ‘zero incidences’ prior to the use of Intensive Interaction. Also noted were new behaviours that developed shortly before Catherine died, one being a ‘turn-taking’ vocalisation activity using ‘tutting’ sounds based around Catherine constantly blowing saliva bubbles, which developed into a ‘raspberry blowing’ game, and it was during this activity that staff felt they were ‘really connecting’ with her. The video on which the observations were based are described as ‘alive with smiles, eye contact, warm physical interaction and the sound of Catherine using her tongue in a ‘tutting’ sound as part of a playful imitative game’. 

 

Also reported were the development of similar interactive communication within Catherine’s family and the generalisation of new found communication outside of the research scenario. Catherine’s mother started to use the approach after watching some of the research sessions, and was reported to particularly enjoy the ‘tutting’ and ‘bubble blowing’ games with Catherine. During these times Catherine’s mother was happily ‘rewarded with smiles and eye contact’ and she also described the joy of the family in being able to finally connect with Catherine. She also very movingly stated that the ‘last few months were their happiest times together’. 

 

Some Discussion: As Dr Kellett concludes, Catherine’s study ‘adds to our knowledge and understanding of communication development for individuals who are similarly frail and profoundly impaired’, and she goes on to state that ‘Catherine is no longer with us but she has left a rich legacy behind her’.},

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pubstate = {published},

tppubtype = {article}

}

@article{Culham2004,

title = {Getting in Touch with our Feminine Sides? Men's Difficulties and Concerns with Doing Intensive Interaction},

author = {Andrew Culham},

doi = { https://doi.org/10.1111/j.0952-3383.2004.00333.x},

issn = {0952-3383},

year  = {2004},

date = {2004-06-01},

urldate = {2004-05-28},

journal = {British Journal of Special Education},

volume = {31},

number = {2},

pages = {81-88},

abstract = {Methodology: This research addressed a number of issues faced by male practitioners using Intensive Interaction (I.I.) Using both questionnaires and interviews, data was gathered from over 35 practitioners, including F.E. lecturers, teachers, day-centre staff, psychologists, and speech & language therapists. Over half of the practitioners questioned had between 2 to over 10 years experienced in I.I. (the others having only limited experience of the approach).



General Results: The majority of practitioners reported using I.I. with students/clients with severe and profound learning disability, and a minority reported used the approach with a other groups of people such as those with sensory disabilities, emotional and behavioural difficulties, neurological difficulties, retirement home residents, clients with autism and people who were electively mute. The majority of respondents reported using I.I. as a ‘vehicle’ to support various sessions across the curriculum. Many noted that I.I. worked very well in supporting curriculum areas such as independence skills, sensory activities, and basic skills. The remaining practitioners, including psychologists, day-centre staff, residential support workers and parents, used I.I. as a communication tool with their clients. 



Some respondents identified a difficulty with the lack of clear criteria or standards in I.I. Some respondents found it difficult to reverse the traditional didactic teaching methods of their initial training, and found communication with the student as ‘an equal’ difficult. Some respondents regarded the development of professional and practical skills through the use of I.I. as a primary benefit. Reported gains included improvements in communication styles, teamwork and collaboration; greater knowledge of students; and curriculum development. Many of the respondents felt that they needed more training and guidance with the practical skills of I.I., and some observed that too much time was spent intellectualising the approach and not enough time developing practical, classroom-based skills.



One teacher noted that parents are very supportive and are often astounded at I.I.’s results: ‘It works… parents, many of whom like to become involved with developing their child’s communication, can see it work for their children.’ A third of those questioned regarded ‘developing relationships’ as a distinct benefit of I.I. At least half of these respondents enjoyed the freedom that I.I. afforded them – an F.E. lecturer remarked: ‘I.I. allows me to engage with my students in a way that is uncharacteristic of my normal teaching practice, to sit back and enjoy the ride.’ 



For some it was the creation of ‘communication opportunities’ that was the most rewarding aspect of using I.I. with people with learning disabilities: ‘For the first time, I am able to enjoy another human being’s company for its own sake.’ However, a third of respondents indicated a concern with the negative perceptions and attitudes held by ‘mainstream’ staff, from various agencies, with regard to the value and appropriateness of I.I.. One practitioner remarked: ‘I find the reaction of others, who do not understand the individual and the procedure of communicating with them, difficult. Some people are unable to see the depth of both the students and I.I. and pass a judgement of failure or irrelevance.’



Results pertaining to being a male practitioner: Half of the respondents reported that the issues of touch, working with female students and the fear of allegations of sexual assault have prevented them from doing I.I. One practitioner noted: ‘My practice of I.I. is limited due to my fears and unease of working with female clients at the house.’ Another respondent noted that his team has had numerous staff development sessions regarding physical touch and gaining permission to touch, which had assisted male members of the team to be more comfortable around students/clients: ‘The whole business about touch… male practitioners need to feel reasonably secure, that they know what the boundaries are and that they know what the establishment rules are on permission.’



Another issue arising concerned support: the level and success of support was seen as dependent upon individual teams, personalities and managers. A respondent noted the difficulties around peer support: ‘I feel slightly uncomfortable in certain situations because of the male/female divide … but I try not to let this affect my practice.’ Managerial support of I.I. practitioners was also a concern: whilst some celebrated their manager’s proactive work and support, many questioned their manager’s understanding of I.I. Lack of support from line managers and senior members caused some staff distress, alienation and in some instances ridicule. One therapist reported that ‘Some senior managers can be dismissive of what we do.’

The male practitioners revealed that, on average, only 20% of the team they worked with were male. Also, one respondent noted that many of his female colleagues looked to him to take responsibility for discipline and restraint, possibly because of his gender. 



Conclusions: Although it isn’t always clear what difficulties relate specifically to maleness, and what difficulties exist for practitioners of either gender, this research clearly illustrates the need of male practitioners for further support and development in the area of I.I.},

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pubstate = {published},

tppubtype = {article}

}

@article{Kellett2004,

title = {Intensive Interaction in the inclusive classroom: using interactive pedagogy to connect with students who are hardest to reach},

author = {Mary Kellett},

url = {https://doi.org/10.1080/0140672040270207},

doi = {10.1080/0140672040270207},

issn = {1470-1359},

year  = {2004},

date = {2004-01-01},

urldate = {2010-12-02},

journal = {Westminster Studies in Education},

volume = {27},

number = {2},

pages = {175-188},

abstract = {In this paper Kellet looks at the pedagogical role of I.I. for students with severe and complex learning difficulties. She begins with an overview of the theoretical context of ‘interactive pedagogy’, and describes how I.I. can support sociability and communication development for the pupils who are the hardest to reach, with one case study (Finn) being used as an exemplar. Kellet gives some context as to how interactive pedagogies developed in response to ‘a growing disquiet that behaviourist styles of teaching did not promote real learning’. 

 

Kellet states how I.I. ‘focusses on making the curriculum fit the student rather than the other way round’, and that the responsive nature of I.I. begins by ‘respecting whatever stage that individual is at in her or his development and celebrating what she or he is capable of doing’, with I.I. providing a ‘first point of connection which is at the heart of inclusive ideology’. 

 

The case study: Finn was aged 6 and had severe learning difficulties. He was ‘passive’, with staff finding it difficult to engage him in any form of social interaction. He often lay on the floor or had his head down on a table, spending much of his time chewing his clothing, or other items he could get. A teacher and 2 TA assistants worked as a team in Finn’s class: none had any previous I.I. experience. All 3 attended a one day of I.I. training and were keen to try the approach. 

 

Baseline data was collected for 6 weeks prior to any I.I., after which Finn had a daily I.I. session of 15-20 minutes with a TA. However, after 3 months the class teacher changed and the I.I. sessions become less regular as the new teacher increasingly prioritised other activities. At weekly intervals (later reduced to fortnightly) over a 1 year period, 5 minute video observations of Finn were made during the I.I. sessions, and at other times, across both the baseline and I.I. intervention phases. 

 From the video data, eye contact, looking at/towards the face of the interactive partner, smiling, vocalisation, and ‘engagement’ (i.e. ‘a state of absorbed intellectual or emotional arousal and connectedness’) were coded, analysed and changed into %s for ease of comparison - with inter-observer agreement = 96.1%, and intra- observer agreement = 96.3%. 

 

Findings: During the baseline phase the incidence of Finn looking at or towards the face of his interactive partner averaged only 5%. This changed rapidly once the I.I. sessions began and increased to a mean of 31% over the intervention phase. Similar progress was made in Finn’s ability to make social physical contact, increasing from a baseline mean of 2.5% to a mean of 28.2% in the intervention phase. The incidence of Finn making eye contact before I.I. started was virtually non-existent, but progress shown in this area was seen to be ‘extremely encouraging, given that eye contact is such an important element in sociability and communication’. 

 

Increases in Finn’s ability to attend to a joint focus and his levels of ‘engagement’ demonstrated how positively Finn responded to the I.I. approach. A mean score of 14% in the baseline phase for joint focus increased to a mean of 67% in the intervention phase, with two high peaks of 93%. The data for engagement was also seen to represent ‘important evidence of sustained and absorbed social interaction’: a baseline mean of 2% changed rapidly once the I.I. started with a ‘steadily rising incidence marred only by regressions related to the loss of continuity of vacation periods’. 

 

The importance of teamwork: Kellet argues that from of this research we should understand that ‘for interactive pedagogy such as Intensive interaction to be implemented with optimal outcomes then effective teamwork is essential’. Visible, tangible support for needs to be evident at the managerial level from the earliest possible stage, and also that senior management should be involved in 'I.I. workshops alongside staff who intend to practise’ with such training ideally done ‘as a whole-school exercise on a nominated training day, with senior managers visibly participating’. 

 

Some final reflections: according to Kellet, ‘for those students who have not yet learned the fundamentals of early social communication, developing sociability and communication is an essential first step in their learning. Without it learning cannot become meaningful’. She then goes on to state that I.I. is one approach within an ‘umbrella of interactive pedagogies’ that has been shown to be particularly successful. This paper finally argues the case for its wider adoption in inclusive mainstream schools.},

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@article{Kellett2003,

title = {Jacob’s journey: developing sociability and communication in a young boy with severe and complex learning disabilities using the Intensive Interaction teaching approach},

author = {Mary Kellett},

url = {https://doi.org/10.1111/j.1471-3802.2003.00181.x},

doi = {10.1111/j.1471-3802.2003.00181.x},

issn = {1471-3802},

year  = {2003},

date = {2003-03-01},

urldate = {2004-01-26},

journal = {Journal of Research in Special Educational Needs},

volume = {3},

number = {1},

pages = {18–34},

abstract = {This paper reports on the use of Intensive Interaction with Jacob, an 8 years old boy with severe learning difficulties. A multiple-method methodology was used, with the findings showing substantial progress in sociability and communication: Jacob’s stereotyped behaviour was also observed to substantially reduce. 

 

Methodology: a multiple baseline interrupted time series methodology was used, with 6 children (across 3 special schools) given different baseline and staggered intervention phase starts. Video data was gathered alongside 2 assessment schedules (see below). Jacob was filmed over a 5 week baseline and a 42 week intervention phase, and various social behaviours were coded. Also a teacher’s log was kept alongside sessional I.I. reflection sheets. 

 

Jacob’s profile: Jacob had severe learning difficulties (he was pre-verbal) and also epilepsy and physical impairments. He was unable to weight-bear or sit for long periods, and would often become distressed and was prone to self-injury e.g. banging his head or elbow. He was reported to spend most of his time in social isolation, engaged in various forms of stereotyped activity. 

 

The Intensive Interaction sessions: a teaching assistant, Emma, volunteered to work with Jacob with the support of the class teacher. Initially Emma had to work hard to gain Jacob’s attention, and she decided to work with Jacob out of his wheelchair. She sat Jacob face to face on her knee, and responded to any of his actions (even burps & sneezes) with an imitation or a positive comment. Jacob continued to engage in his rocking activity when on Emma’s knee, but she turned it into a game: rocking rhythmically with him and singing ‘Row, row, row the boat.’ Jacob loved this - indicating his pleasure with smiles. Soon Jacob was initiating the game, taking hold of Emma’s hands and starting the rocking himself. Other games were introduced e.g. the teasing rhyme ‘if you see the crocodile, don’t forget to scream’, with Emma and Jacob both ‘screaming’ together. As time went by Jacob became more interested in his interaction with Emma, and he would scrutinise her face and engage in eye contact and, on occasions, even stroke her hand or face. 

 

The findings: 

•	In the baseline phase the percentage incidence of Jacob not interacting averaged 82.9%, but there was an immediate and substantial change once Intensive Interaction sessions began (the average incidence of no interactive behaviours fell to 11.6% in the intervention phase). 

•	As soon as the Intensive Interaction started Jacob began to look at or towards Emma’s face, with a surge to 75.7% incidence after week 1 of the I.I. sessions. There was also a second surge to 85% at week 26, after an 11 week gap in the I.I when Emma was ill*. Despite this setback the average incidence of looking at or towards Emma’s face went from 8.4% at baseline, to 48% in the intervention phase. 

•	Another early and sustained development was the ability to attend to a joint focus, with this increasing from an average of 3.7% at baseline to an average of 65.5% during the Intensive Interaction. 

•	Two other behaviours that emerged were eye contact and social physical contact e.g. the touching of a hand or a hug, with both these behaviours being completely absent from Jacob’s communicative repertoire before the onset of Intensive Interaction. 

•	Jacob’s engagement (i.e. a state when Jacob was completely absorbed in his interaction with Emma) showed average incidence figures of 46.4% during the intervention phase compared with 2.6% at baseline. 

 

Observation data from the video was triangulated by the two assessment schedules: Kiernan & Reid’s Pre-Verbal Communication Assessment Schedule and Brazelton’s Cuddliness Scale – these schedules showed no progress in the five weeks of baseline. Jacob was able to achieve 14.3% of the pre-verbal communication descriptors during baseline, but at the end of the study this figure had risen to 56.6%. 

Jacob’s baseline scores on the Brazelton’s Cuddliness Scale (a measure of physical sociability) showed him as responding passively to social physical contact - ‘neither actively resisting nor participating’. But after 5 weeks of Intensive Interaction, this had moved up to point 5 on the scale - ‘usually relaxes and moulds when first held’. At the end Jacob progressed even further where he, himself, was initiating the social physical contact. 

 

Staff and researcher observations: Discussions with staff showed unanimous acknowledgement of the immense progress Jacob had made since starting out on his Intensive Interaction journey: his self-injurious behaviours had all but vanished; his stereotypical behaviours had greatly reduced; he was much more alert and aware of his peers and environment; he was able to participate in group activities. 

Staff were also of the opinion that Jacob had become a much happier child. He had progressed from being a ‘hard to reach’ child, who spent the majority of his time in self-injurious stereotypy, to a happy, socially interactive child who could participate in joint activities, engage in purposeful social interaction and was beginning to use some formal communication skills. 

(*unfortunately Emma was off work for 3 months, and the effects of this are referred to in the analysis of the data).},

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@article{Nind2002,

title = {Inclusive curricula? Pupils on the margins of special schools},

author = {Melanie Nind and Steve Cochrane },

url = {https://www.tandfonline.com/doi/pdf/10.1080/13603110110067217?needAccess=true},

doi = {https://doi.org/10.1080/13603110110067217},

issn = {1360-3110},

year  = {2002},

date = {2002-11-10},

journal = {International Journal of Inclusive Education},

volume = {6},

number = {2},

pages = {185-198},

abstract = {This paper discusses an inclusion initiative and action research project involving the special schools and services of an education administration (Local Education Authority) in the UK. The project is concerned with the classroom contexts and dynamics that create difficulty. It is not intended to produce incremental change along a developmental path, but rather to stimulate transformation of thinking within the schools. The focus is on pupils who provide the greatest challenge to the routine confidence and competence of teachers. The local education administration aims to avoid placement of these pupils out of the locality in specialist provision elsewhere in the country by developing appropriate curricula, pedagogy and support locally. The part of the project reported here makes use of Intensive Interaction, an interactive approach that emphasizes the quality of teacher-learner interaction, as a vehicle for reviewing and transforming practice. The emphasis is on intuitive teaching combined with critical reflection and collaborative problem-solving, rather than on the notion of specialist ‘experts’. The planning, action and developments of the initial year of the project are reported and themes related to the challenge of inclusion are discussed.},

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pubstate = {published},

tppubtype = {article}

}