A Practical Guide to Intensive Interaction

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Typical of the cases is Jacob (Kellett, 2003), who is reported to have shown significantly decreased levels of self-injury and stereotypical behaviours pre- to post-intervention. In addition, the staff who knew him well saw him as a much happier child and described a change in his personality: they ‘had discovered a delightfully humorous, mischievous side to his character that they had not known before’. In psychotherapeutic terms, it can be suggested that the intensive interaction intervention enabled the one-to-one worker to develop a meaningful relationship with Jacob and that this promoted his psychological well-being (made him happier) and enabled him to show his potential (humour and mischief). Ephraim, G.W.E. (1979). Developmental processes in mental handicap: A generative structure approach. Unpublished PhD thesis, Department of Psychology, Brunel University. Zeedyk, S, Caldwell, P. and Davies, C (2009) ‘How Rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities?’ European Journal of Special Needs Education, Vol 24. 2009, p.119-137 Zeedyk, M.S. (Ed.) (2008). Promoting social interaction for individuals with communicative impairments. London: Jessica Kingsley. Williams , D. (1993) ‘My experience with Autism, Emotion and Behaviour’Documentary with Connie Chung, USA

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. I sit beside him and respond to each of his small sounds, tuning into how they make me feel, but altering the rhythm or pitch occasionally. I am answering rather than copying. At first he is half turned away from me but he gives me his hand which I shake in time to the sounds we are exchanging. He becomes more interested and turns round to face me, laughing. He introduces new sounds and movements to which I respond. We are soon engaged in a complex non-verbal interactive conversation. Caldwell, P. (2008) Intensive Interaction: Getting in Touch with a Child with Severe Autism’ in Zeedyk, S. Ed. ‘Promoting Social Integration for Individuals with Communicative Impairments’ Jessica Kingsley Publishers At the broadest level, intensive interaction is consistent with three major schools of psychological thought – humanistic psychology, attachment theory and positive psychology. All these approaches share a core tenet that positive human relationships are crucial to our sense of self-worth, ability to realise our potential, and our psychological well-being. 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.

Background Reading

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 Emigration to New Zealand followed in the footsteps of the European explorers, such as Captain Cook (1769-70): first came sealers, whalers, missionaries, and traders. By 1838, the British New Zealand Company had begun buying land from the Maori tribes, and selling it to settlers, and, after the Treaty of Waitangi in 1840, many British families set out on the arduous six month journey from Britain to Aotearoa to start a new life. Early immigrants include: Playwright David Hare wrote the award-winning play Racing Demon, highlighting the plight of inner-city clergy. During his research, Hare interviewed Bob, and the play, performed in the National Theatre, has strong resonances of Bob’s ministry and the strains that he faced. He lives on the edge of an airport runway and is distressed by the high frequency engine whine of incoming planes. He responds to these by lifting his head and rolling his eyes up to the left towards the sound. When he is anxious, he touches the fringe of the lampshade beside his chair and runs his hand down the stand. His father says that when he is angry he will sit in the hall and bang the door with his fist. Grove, N., & Walker, M. (1990). The Makaton Vocabulary: using manual signs and graphic symbols to develop interpersonal communication. Augmentative and Alternative Communication, 6 (1),15-28.

Iacoboni, M., Woods, R.P., Brass, M. et al. (1999). Cortical mechanisms of human imitation. Science, 286, 5449. 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. The Berkeley Vale Project report indicates the main reasons for the decline in water vole populations. These are given as loss of habitat, isolation of populations, predation by an introduced species ( American mink), inappropriate river management, draining of wetlands, building development and intensification in agricultural practices. Appendix E of the report summarises the work done on surveying, mink control and habitat restoration and creation schemes. [3] Restoration [ edit ] 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. 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.In the 1980s, Geraint Ephraim,Consultant Psychologist at Harperbury Hospital, introduced the idea of using body language to communicate with people whose ability to communicate was impaired by severe intellectual disabilities. This approach was so successful that it was taken up by Nind and Hewett who named it Intensive Interaction. (Nind and Hewett 1994). I worked for four years under the supervision of Ephraim during tenure of a Joseph Rowntree Foundation Fellowship and subsequently (although not exclusively), specialised in using it with children and adults on the severe end of the autistic spectrum. My experience as a Practitioner using Intensive Interaction extends over twenty years and I have worked with literally hundreds of adults and children, many of whose behaviour was extremely distressed. 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.

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 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. It was Friday around teatime. I was on my way to investigate a case of criminal damage, and through a crowd I could see this person running towards me at quite a speed. We collided and as we both got up his shirt came off the shoulder, and I could see he was bleeding – he'd been stabbed in the shoulder. I was also covered in blood. He kept on running and I set off in vain pursuit – just to help him, as I could see he was badly hurt. Some other people maybe thought I was trying to arrest him. They were saying, 'What are you doing? Why are you chasing him?' The man carried on running, so I put it on the radio. It was only afterwards that I heard people were calling me a catalyst. I became very concerned that I'd done something wrong. I was still a new policeman – I didn't want to lose my job." Caldwell, P.(2004) ‘Creative Conversations’Pavilion Press.Intensive Interaction being used with people with multiple disabilities, mainly severe Cerebral Palsy.Before the weekend was over, more than 350 police officers had been injured and about two dozen buildings were gutted by fires. By the end of 1981's summer of urban discontent, fuelled by mass unemployment and simmering resentment at oppressive, sometimes openly racist policing, similar scenes ravaged parts of Liverpool, Manchester and Birmingham. Melanie began her teaching career in special schools as a teacher of students with severe and complex learning difficulties. It is here that she developed and evaluated the teaching approach of Intensive Interaction for which she is best known. She has also taught in further education colleges where she has coordinated support for students with learning difficulties and disabilities. In higher education she has worked as an associate research fellow in the Centre for Autism Studies at the University of Hertfordshire, as a senior lecturer in special education at Oxford Brookes University and at The Open University developing and teaching undergraduate and postgraduate distance learning courses in inclusive education. She joined University of Southampton as a Reader in 2004 and gained her personal chair in 2007. Prizes Jolliffe, T, Lansdown ,R. and Robinson, C. (1992) ‘Autism: A Personal Account’. Communication 26. 3. 12-19.

So success is dependent on maintenance. But even here we have a problem in matching outcomes to our expectations. For example, there is the question of getting our partners to conform to what society considers to be ‘normal’, without taking in to account the sensory distortions stemming from processing difficulties, the overloading input into the autonomic nervous system and the anxiety this induces. A classic example is that of taking people with autism shopping in a supermarket, where the sensory overload of high pitched hums, the lighting, the ‘pings’ and moving patterns of people, are for some a sensory nightmare. (Williams, D 1995).However, even here it is sometimes possible to guide a partner through this kaleidoscope by constantly supplying sounds or movements or gestures that are part of their repertoire. These act as landmarks that the brain can focus on and exclude the avalanche of stimuli that threaten to overwhelm them. Dr Peter Coia, a clinical psychologist from Wakefield, has proposed a neural mechanism that goes some way to explaining the responses produced by intensive interaction. A mirror neuron is a neuron that fires both when an animal acts, and when the animal observes the same action performed by another. In humans, brain activity consistent with mirror neurons has been found in the pre-motor cortex and the inferior parietal cortex (Iacoboni et al., 1999). Coia believes that mirror neurons might play a very important role in language acquisition via behavioural and vocal imitation –?they enable all of us to recognise and pay attention to our own behaviour when it is mirrored by someone else (Coia, 2008). Research psychologist Dr Suzanne Zeedyk and her team at Dundee University have for several years been using intensive interaction techniques when working with a wide range of individuals with communicative impairments, both within the UK and abroad. The team has investigated the effectiveness of intensive interaction, with a special focus on microanalytic methods of coding video tapes. She presented this to the conference, and also covers it in Zeedyk (2008). Past records stated that Susan liked drawing, so we took paper and crayons to our sessions. Susan immediately engaged with us, requesting that we draw particular objects such as flowers, faces and cars. Susan also made attempts to involve the direct care staff in interaction: she would hold up the pictures to them and invite them to ‘look at that’ with a beaming smile (she also interacted with us in this way). The activity expanded into sharing songs when Susan started to sing ‘Round and round the garden’ as we drew flowers, and her expressed vocabulary expanded as the sessions progressed. For example, she requested ‘more petals’ on a ‘sunflower’.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. Water voles are fully protected under Section 9 of the Wildlife and Countryside Act 1981 (as amended). This legal protection means that due care must be paid to the presence of water voles. [7]