Intensive interaction

Intensive Interaction is a person-centred social communication approach that directly promotes social inclusion and communication for people with social or communication difficulties or differences, irrespective of their age.

Intensive Interaction is an approach to communication that acknowledges and values each person's unique communication means, with practitioners of the approach consciously adjusting their communicative style in response to an individual, in order to facilitate mutual social engagement and connection.

Therefore, Intensive Interaction helps people with social or communication difficulties or differences e.g. people with learning difficulties or autism (and those who care for or support them) to socially communicate and connect more successfully. Intensive Interaction is used by parents, carers, teachers and many others to better communicate with someone (a child or adult) who finds communicating difficult, and also to support a person's developmental progression in acquiring the skills and understandings of social communication. With intensive Interaction the practitioner tunes in to the individual they are supporting and responds to them by joining in with or reflecting back to them elements of their current behavioural repertoire.

Intensive Interaction mainly focuses on the use of the 'Fundamentals of Communication', to promote shared understanding and acknowledgement. These Fundamentals of Communication include: sharing personal space; taking turns in exchanges of behaviour, or sequencing activities with another; exchanging eye contacts and facial expressions; exchanging vocalisations (symbolic or non-symbolic) with meaning; using sociable physical contacts; and developing mutual enjoyment within the social interactivity.

History

Intensive Interaction was developed by teachers Dave Hewett and Melanie Nind at Harperbury Hospital School in Southern England during the 1980s. The development of the approach came about as a result of the Harperbury teaching team rejecting a then prevalent crude behaviourist approach to teaching, instead looking for more naturalistic teaching methods to meet their students' primary learning needs.

The late Dr Geraint Ephraim, a clinical psychologist working at Leavesden Mental Hospital, pointed the Harperbury team to the then-current research on the infant-caregiver model of social development. Nind and Hewett took this responsive social model as a basis for developing an 'Appropriate Communication Environment', and later labelled their approach as "Intensive Interaction". In 1988 Nind and Hewett published the first paper on their approach - 'Interaction as Curriculum' in the British Journal of Special Education.

The gradual dissemination of the Intensive Interaction approach since the late 1980s has been mainly practitioner-led, although it is now increasingly acknowledged in professional or governmental guidance. Intensive Interaction is now common practice in special schools and adult services all over the United Kingdom. Interest worldwide is growing and developing.

There are now a range of books and other resources and materials available and a burgeoning community of Intensive Interaction practitioners, with some Intensive Interaction books and teaching resources having been translated into German, Russian, Hungarian, Romanian, Danish, Finnish and French.

Intended use

Intensive interaction is intended to be used to address the social communication needs of people who have social or communication difficulties or differences, e.g.:

• people who are still in the pre-verbal or non-verbal stages of communication development i.e. with few or limited communicative behaviours.
• people who are extremely socially withdrawn, and do not positively interact with other people.
• people who display various stereotyped or self-stimulatory behaviours that may exclude the social participation of other people.[1]

The focus of Intensive Interaction engagements

Intensive Interaction allows access to the "fundamentals of communication" for people who find it difficult to socially engage with others. These "fundamentals of communication" are those aspects of social practice that ordinarily develop before language, and include:

• enjoying being with another person
• developing the ability to attend to another person
• learning to take turns or engage in a sequence of activities with another person
• sharing personal space
• using and understanding eye contacts and facial expressions
• using and understanding sociable physical contacts
• using vocalisations with meaning (for some, speech development)
• learning to attune and co-regulate arousal levels with another person

Further reading

• Barber, M. & Firth, G. (2019) Delivering Intensive Interaction Across Settings. KDP: Melbourne.

• Caldwell, P. (2008) Using Intensive Interaction and Sensory Integration: A Handbook for Those who Support People with Severe Autistic Spectrum Disorder. London: Jessica Kingsley Publishers.

• Firth, G., Berry, R. & Irvine, C. (2010) Understanding Intensive Interaction: Context and Concepts for Professionals and Families. London: Jessica Kingsley Publishers.

• Firth, G. & Barber, M. (2011) Using Intensive Interaction with a Person with a Social or Communicative Impairment. London: Jessica Kingsley Publishers.

• Hewett, D. (Ed) (2011) Intensive Interaction - Theoretical Perspectives. London: Sage Publications.

• Hewett, D., Firth, G., Barber, M. & Harrison, T. (2012) The Intensive Interaction Handbook. London: Sage Publications.

• Hewett, D. & Nind, M. (Eds) (1998) Interaction in Action: Reflections on the Use of Intensive Interaction. London: David Fulton.

• Kellett, M. & Nind, M. (2003) Implementing Intensive Interaction in Schools: Guidance for Practitioners, Managers and Coordinators. London: David Fulton.

• Mourière, A. & McKim, J. (2017) Integrating Intensive Interaction: Developing Communication Practice in Services for Children and Adults with Severe Learning Difficulties, Profound and Multiple Learning Difficulties and Autism. London: Routledge.

• Mourière, A. & Smith, P. (2021) The Intensive Interaction Classroom Guide: Social Communication Learning and Curriculum for Children with Autism, Profound and Multiple Learning Difficulties, or Communication Difficulties'. London: Routledge.

• 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.

• Nind, M. & Hewett, D. (2001) The Practical Guide to Intensive Interaction. BILD: Kidderminster.

The published research papers on Intensive Interaction

• Argyropoulou, Z. & Papoudi, D. (2012) ‘The training of a child with autism in a Greek preschool inclusive class through Intensive Interaction: a case study.’ European Journal of Special Needs Education, 27 (1), 99-114.

• Barber, M. (2008) ‘Using Intensive Interaction to add to the palette of interactive possibilities in teacher-pupil communication.’ European Journal of Special Needs Education, 23 (4), 393–402.

• Berridge, S. & Hutchinson, N. (2021) 'Staff experience of the implementation of Intensive Interaction within their places of work with people with learning disabilities and/or autism'. Journal of Applied Research in Intellectual Disabilities, 34(1), 1-15.

• Berridge, S. & Hutchinson, N. (2021) 'Mothers’ Experience of Intensive Interaction'. Journal of Intellectual Disabilities, 26(2), 391–406.

• Berry, R., Firth, G., Leeming, C. & Sharma, V. (2013) ‘Clinical Psychologists’ Views of Intensive Interaction as an Intervention in Learning Disability Services’, Clinical Psychology & Psychotherapy, 21 (5), 403–410.

• Calveley, J. (2017) 'Gaining the power of initiation through Intensive Interaction', Learning Disability Practice, 20(1), 19-23.

• Clegg, J., Black, R., Smith, A. & Brumfitt, S. (2020) 'Examining the impact of a city-wide Intensive Interaction staff training program for adults with profound and multiple learning disability: a mixed methods evaluation'. Disability and Rehabilitation, 40(2), 201-210.

• Elgie, S. & Maguire, N. (2001) 'Intensive Interaction with a Woman with Multiple and Profound Disabilities; a case study.’ Tizard Learning Disability Review, (6) 3, 18-24.

• Firth, G., Elford, H., Leeming, C., & Crabbe, M. (2008) ‘Intensive Interaction as a Novel Approach in Social Care: Care Staff’s Views on the Practice Change Process.’ Journal of Applied Research in Intellectual Disabilities, 21, 58–69.

• Firth, G., Glyde, M. & Denby, G. (2020) 'A qualitative study of the practice‐related decision‐making of Intensive Interaction practitioners'. British Journal of Learning Disabilities, 49(2), 117-128.

• Fraser, C. (2011) ‘Can adults on the autism spectrum be affected positively by the use of intensive interaction in supported living services?’, Good Autism Practice, 12 (2), 37–42.

• Harris, C. & Wolverson, E. (2014) ‘Intensive Interaction: to build fulfilling relationships’, The Journal of Dementia Care, 22 (6), p. 27-30.

• Heap, C. J. & Wolverson, W. (2020) 'Intensive Interaction and discourses of personhood: A focus group study with dementia caregivers'. Dementia, 19(6), 2018-2037.

• Hutchinson, N. & Bodicoat, A. (2015) ‘The Effectiveness of Intensive Interaction: A Systematic Literature Review’, Journal of Applied Research in Intellectual Disabilities, 28 (6), 437–454.

• Karimi, S., Asgari, P. & Heydari, A. (2019) 'The Effect of Intensive Interaction Intervention on the Social Interactions and Communication of Children with Autism Spectrum Disorder'. Journal of Jondishapour Medicine, 18(6), 603-614.

• Kellett, M. (2000) ‘Sam’s Story: Evaluating Intensive Interaction in Terms of its Effect on the Social and Communicative ability of a Young Child With Severe Learning Difficulties’, Support for Learning, 15 (4), 165–171.

• Kellett, M. (2005) ‘Catherine’s Legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies.’ British Journal of Special Education, 32 (3), 116–121.

• Leaning, B. & Watson T. (2006) ‘From the inside looking out – an Intensive Interaction group for people with profound and multiple learning disabilities.’ British Journal of Learning Disabilities, 34, 103–109.

• Lovell, D., Jones, S. & Ephraim, G. (1998) ‘The Effect of Intensive Interaction on the Sociability of a Man with Severe Intellectual Disabilities.’ International Journal of Practical Approaches to Disability, 22 (2/3), 3–8.

• McKim, J. & Samuel, J. (2020) ‘The use of Intensive Interaction within a positive behavioural support framework’, British Journal of Learning Disabilities, 49(2), 129–137.

• Mourière, A. & Hewett, D. (2021) 'Autism, Intensive Interaction, and the Development of Non-Verbal Communication in a Teenager Diagnosed with PDD-NOS: A Case Study'. Support for Learning, 36(3), 400-420.

• Mourière, A. & Scott-Roberts, S. (2017) 'Measuring the impact of Intensive Interaction on joint attention and intentional communication: using the FOCAL wheels'. Good Autism Practice, 18 (1), 24-45.

• Nagra, M., White, R., Appiah, A. & Rayner, K. (2017) 'Intensive Interaction Training for Paid Carers: ‘Looking, Looking and Find Out When They Want to Relate to You’'. Journal of Applied Research in Intellectual Disabilities, 30(4), 648-660.

• Nind, M. (1996) ‘Efficacy of Intensive Interaction; Developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver- infant interaction.’ European Journal of Special Educational Needs, 11 (1), 48–66.

• Rayner, K., Bradley, S., Johnson, G., Mrozik, J., Appiah, A. & Nagra, M. (2016) ‘Teaching Intensive Interaction to paid carers: using the ‘communities of practice’ model to inform training’, British Journal of Learning Disabilities, 44 (1), 63–70.

• Samuel, J., Nind, M., Volans, A. & Scriven, I. (2008) ‘An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities.' Journal of Intellectual Disabilities, 12, 111-126.

• Sharma, V. & Firth, G. (2012) ‘Effective engagement through Intensive Interaction’, Learning Disability Practice, 15 (9), 20–23.

• Shearer, K. & Parkhouse, C. (2020) 'Intensive Interaction: an evaluation of two different recording formats'. Good Autism Practice, 21 (2), p. 23-32.

• Strange, J. (2021) 'Improvised music to support Intensive Interaction for children with complex needs: A feasibility study of brief adjunctive music therapy'. British Journal of Music Therapy, 35(2), 43–52.

• Tee, A. & Reed, P. (2017) 'Controlled study of the impact on child behaviour problems of Intensive Interaction for children with ASD'. Journal of Research in Special Educational Needs, 17 (3), 179–186.

• Watson, J. & Fisher, A. (1997) ‘Evaluating the Effectiveness of Intensive Interaction Teaching with Pupils with Profound and Complex Learning Disabilities.’ British Journal of Special Education, 24 (2), 80–87.

• Watson, J. & Knight, C. (1991) ‘An Evaluation of Intensive Interactive Teaching with Pupils with Very Severe Learning Difficulties.’ Child Language Teaching and Therapy, 7 (3), 310–25.

• Weedle, S. (2016) 'The use of Intensive Interaction with people with severe-profound intellectual disability'. Learning Disability Practice, 19(9), 27-34.

• Zeedyk, S., Davies, C., Parry, S. & Caldwell, P. (2009) ‘Fostering social engagement in Romanian children with communicative impairments: The experiences of newly trained practitioners of Intensive Interaction.’ British Journal of Learning Disabilities, 37 (3), 186–196.

• Zeedyk, S., Caldwell, P. & Davies, C. (2009) ‘How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities and communicative impairments?’ European Journal of Special Needs Education, 24 (2), 119–137.

External links

• Intensive Interaction Institute, an organization for the advancement of intensive interaction