A Practical Guide to Intensive Interaction

Product Information

Zeedyk, S. ed. (2008) ‘Promoting Social Interaction for Individuals with Communicative Impairments’. Jessica Kingsley Publishers

Caldwell, P.(2004) ‘Creative Conversations’Pavilion Press.Intensive Interaction being used with people with multiple disabilities, mainly severe Cerebral Palsy. But the first question that parents almost always ask is, ‘when will my child speak?’ For them, the ability to talk is paramount and success is measured by the time when they are able to engage with their child by talking to them. And while speech is sometimes released in non-verbal people when one is engaging with them through their body language, this is only an indicator of reduced stress level that allows the brain to function more effectively. Perhaps even more important is the desire to engage, and what has been expressed by a number of families as, ‘I have a happy child now.’ Then there's the covered market, granted grade II listing last year, less for its 1930s vaulted arcades than for its iconic status at the centre of British Caribbean history. For years it remained bustling but somewhat decrepit, with a series of empty stallfronts. Gentrification has seen many filled with pricey delis, coffee bars and restaurants, followed, perhaps inevitably, by a steep rise in rents and complaints from established traders that they are being pushed out. We start with ‘observation’ - but need to think of observation not so much as a period ofshadowingbut rather as the development of an ongoing picture of what our conversation partner is doing now, this minute. Particularly, we want to avoid the pitfall of drawing up a list of activities we ‘do’ with them, since it is absolutely essential that our responses are contingent, not only to their initiative but also as to how this initiative is made, since it is the ‘how’ that will allow us to tune into their affective state. I have to empty myself of any behavioural expectations and learn to ‘be with’ this person as they are at present, using their initiatives, gestures, rhythms and sounds to respond in a way that has meaning for them.

Hewett and Nind put the learner and communication at the centre of their teaching practice and, using communication techniques developed from ‘infant-caregiver’ interactional models, the staff endeavoured to join their learners in ‘their own world’. They did this by responding to what the young people were already doing, creating jointly focused activities, and by developing interactions with a mixture of blended repetitions and imitations of the learners’ physical behaviours. Hart, P. (2008) ‘Sharing Communicative Landscapes with Congenitally Deaf-Blind People’ in Zeedyk, S. Ed. ‘Promoting Social Integration for Individuals with Communicative Impairments’Jessica Kingsley Publishers Field, T., Field, T., Sanders, C. and Nadel, J.(2001) ‘Children with autism display more social behaviours after repeated imitation sessions.’ Autism 5. 3. 317-323 Mainstream (that is, non-learning disability) research provides some evidence that depressed mothers are poorly attuned to their infants and that this can lead to a lasting depressed state in their children (see Trevarthen and Aitkin, 2001, for a review). However, Hundeide’s (1991) work with children who have suffered extreme deprivation in orphanages suggested that such effects can be remediated. Nind, M. & Hewett, D. (1994). Access to communication: Developing the basics of communication with people with severe learning difficulties through intensive interaction. London: David Fulton.

Bob inherited a church with a distinguished history, prominently located by Brixton Town Hall. It could seat 1900, but was now attended by a faithful few; the area was becoming racially diverse and regarded by many as problematic. Goldbart,J. (2010) ‘Communication and people with the most complex needs: what works and why this is essential’. Mencap Publications

Nind, M. (1999) ‘Intensive Interaction and autism: a useful approach?’ British Journal of Special Education. 26 2. 96-102 Pranve also makes sounds, a particular rhythm, ‘er-er-er’, which turn out to be a pre-verbal version of ‘Where’s Charlene?’, his sister who no longer lives with the family. This is the only thing he has ever been known to say. Coia, P. (2008). Mirror neurons: A neural basis for interpersonal attunement and intensive interaction? Retrieved 19 June 2009 from www.intensiveinteraction.co.uk/documents/MNsBirmingham2008.ppt Dinstein, I., Thomas, C., Behrmann, M. & Heeger, D.J. (2008). A mirror up to nature. Current Biology, 18(1), 13–18.

One practical example of the approach I observed was with a client who would self-stimulate by rubbing his thumb into the palm of his hand. Initially the staff member would rub her thumb into the client’s hand, and then with time they ended up being able to rub each other’s thumbs. As this fundamental communication and trust grew, further ways of communicating developed, including smiling, ‘dancing’ and ‘singing’ together. During this time the client’s behaviour became less ritualistic and he became more involved with his environment and more interactive with those around him. Intensive Interaction is about learning and using the language that has meaning for an individual to build a relationship with them. It is not a ‘cure’, in the sense that we do a few sessions and the person responds and so we can stop using it. If we do this, they will regress, because what we have done is to learn their language, use it with them and then walk away, slamming the door to relationship in their faces. All their distressed behaviour will return. We have to use it as a continuing way of communication and use it to explore and build on the relationship that it fosters. When the brain is no longer under processing pressure it begins to work more effectively on its own account, within the limitations of its learning disability if this is present. This is especially true for people with autism who are so vulnerable to environmental stress.

Bob’s ministry was demanding and costly and one casualty was the breakdown of his marriage. Nine years later, he married Bridget Walker. BORN in Burford 91 years ago, Bob Nind attended Blundell’s School, in Devon, and trained for ministry in Oxford. In 1956, he served a curacy in Spalding, Lincolnshire, and then spent seven formative years in Jamaica. On his return to England, he ministered for three years in Battersea, before moving, in 1970, to Brixton, where he served as Vicar of St Matthew’s for 12 years. Brixton was one of the pinnacles of his ministry. With this vast experience behind him, he became an industrial chaplain in both Southwark and Oxford dioceses. On retirement, he served in many capacities in and around Oxford. Nind, M. (1996) ‘Efficacy of Intensive Interaction: Developing sociability and communication in people with severe and complex learning difficulties using an approach based on the caregiver-infant interaction’. European Journal of Special educational Needs 11, 1, 48-66 And as Pranve’s parents become more proficient in using his body language to communicate with him, his behaviour becomes less stressed and he is able to return on a part-time basis to the day centre from which he had been excluded. Two months later his mother tells me that while he has the odd off-day, on the whole they could now interact with him and manage his behaviour. And he is calmer. More direct evidence to support these speculations comes from the case studies of Nind (1996) and Kellett (2000, 2003, 2005), which have all involved provision of comprehensive intensive interaction input as the intervention. Nind’s study involved six residents of a long-stay hospital, and Kellett’s replication involved children from three community special schools. Both researchers have investigated the use of intensive interaction as an educational tool, but their work has employed the most robust methodology of the published evidence, and provide support for what can be seen as psychotherapeutic changes.

We communicate in two different ways. Most of what we are consciously aware can be called Functional Communication, informing each other of our needs, on the level of ‘Do you want a cup of tea?’, or sharing more sophisticated information. In people who are non-verbal, functional communication may be assisted by sign systems such as Makaton (Grove and Walker 1990) or PECS (Picture Exchange Communication System). What we are all less aware of, is how we inform and monitor each other’s emotional states all the time.Jolliffe, T, Lansdown ,R. and Robinson, C. (1992) ‘Autism: A Personal Account’. Communication 26. 3. 12-19. Nind and colleagues point out that the mental health needs of people with severe and profound learning difficulties have often been neglected in the past. They claim that intensive interaction offers a positive way of gaining insights into a person’s state of mental health and of promoting their emotional well-being. Traditionally II has been used with clients with severe or profound and multiple learning disabilities and/or autism, but at an II conference in 2008, claims were made that intensive interaction can be used with other clients who have profound communication problems; including using the approach with people with sensory problems, dementia, stroke and even brain injury. During the three hours I am with Pranve, apart from the one time that I startle him, he shows no aggressive intent and is clearly delighted with our interactions. But also, after about twenty minutes, he is no longer reacting to the scream of the planes passing over the house, so close their wheels are down for landing. His interest in our conversation is overriding his hypersensitivity to the high frequency whines of the jet engines. (Caldwell 2006a)