Decision making is all the more challenging and anxiety provoking when our children have communication difficulties.
We have to make choices on their behalf and we want it all to be right. When we are faced with a vast array of interventions all claiming to be the best, it can be bewildering. This article is about Intensive Interaction.
We want to help you so we’ve created a series of blogs in which we will discuss some of the most common Autism Interventions such as Intensive Interaction, Applied Behavioural Analysis, Verbal Behaviour, ‘Son-Rise’ and ‘Floortime’.
We are not advocating or discrediting any particular intervention but instead aim to present some of the most common interventions and their features alongside one another. These are just our opinions but we hope they will clarify things a little.
As you will see, Autism interventions are as varied as the condition itself (hence its definition as a spectrum condition). Due to the nature of a spectrum it’s really important we entertain and understand the individual differences of each intervention in order to compliment and tailor toward the unique characteristics/ needs a child with autism may present.
Hopefully by outlining the most common interventions throughout this series it will become easier to compare and contrast between, helping to identify which one, or combination of will best suit your child.
Firstly we will take a look at a frequently used approach in England – Intensive Interaction (Hewitt and Nind, 1993).
‘Intensive Interaction’ is not strictly a language intervention. It aims to facilitate the development of ‘The Fundamentals of Social and Communication,’ prerequisites to acquiring language. It is geared towards people said to be ‘communicatively difficult to reach’ or who experience some level of social isolation, and is predominantly led by the child. Rather than having a direct learning objective the teaching requires a highly responsive approach where there is no focus on task or outcome but the emphasis is on the quality of the interaction itself.
The techniques employed are based around the understandings as to how infants in the first 2 years acquire such complex concepts of communication. These foundations are vital in acquiring language as a communicative tool, such as; developing ability to attend to a person, using and understanding gestures, eye-contact, sharing personal space, turn-taking, using and understanding non-verbal communication, facial expressions and enjoying interaction with another person.
The approach is based upon initial caregiver-child conversation, for example when an infant initiates a sound and the caregiver confirms this sound, often through repetition and the infant (eventually) moves on. Similarly ‘Intensive Interaction’ utilizes and imitates the child’s repertoire of noises, interests and body movements to gain access to the child’s attention. Traditional forms of ‘Intensive Interaction’ discourage the use of words initially as they can be difficult to process.
We are talking here about relationship building. This is the cornerstone of all interaction. Think about a parent and infant and what happens in that interaction (when the baby isn’t crying that is!). You can observe the adult being completely present and singularly attentive to the child. It’s as if nothing else matters. There is no agenda, no expectations, no demands – just complete acceptance of what is happening at that moment. The baby takes the lead and what follows is a beautiful ‘dance’ of reciprocity and synchronicity. Why is this so crucial in the development of communication? What this does is to enable the baby to feel safe – ‘I know this person is on my wavelength and understands me’. For people with a communication disorder this is a vital component to establish in the first instance.
This process begins with observation; often the ‘unconventional’ behaviours of children with autism serve a similar function, to reduce the external stimuli, which may cause an overload of sensory input. Rather than trying to deter such behaviours, ‘Intensive Interaction’ uses these to gain the child’s attention, compiling a ‘language toolkit’ using familiar sounds, movements or behaviour (modelled from the child) that bypass any difficulties in processing unfamiliar information they may experience. By attributing social meaning to the actions and treating all behaviours as if they have intentional and communicative significance helps
to construct a more natural exchange.
A common misperception of ‘Intensive Interaction’ is that it depends solely on the repetition of the child’s behaviour, although important to initially gain attention this will soon become dull. As in early development the caregiver does not persist to purely imitate, it is natural to progress with the responses, forming a more natural conversational type exchange. It is essential we still use elements of the child’s original repertoire, for example, making the same sound but with different intonation or tone, therefore introducing no unfamiliar information but enhancing the interaction. It is the ‘difference’ that shifts the child’s interest from attention to engagement (I want more of this). This is where the child will become interested in the source (you) and begin to see you as a conversational partner. Although it may seem unconventional, ‘Intensive Interaction’ implies we must first learn their language if we expect them to do the same. The aim is to interact with a child’s brain in a familiar way that does not raise their stress level, a common consequence of unfamiliar sounds and/ or behaviours.
The objective of ‘Intensive Interaction’ is to achieve ‘shared interest’, generally on the child’s terms. It is claimed that as the brain relaxes in a familiar surroundings of sounds and behaviours (modelled from the child) then characteristics such as increased eye contact, sharing personal space and interest in others begin to emerge.
Not every child or person with ASD will need ‘Intensive Interaction’. Some may not have the level of social interaction difficulties this intervention is targeted towards. Nevertheless, the relationship building principles encompassed by this approach are all important to any form of therapy.
The film ‘Autism and Intensive Interaction.
Using Body Language to Reach Children on the Autistic Spectrum’ by Phoebe Caldwell provides a great insight into the implementation of ‘Intensive Interaction’ and the impact it can have. Phoebe Caldwell also has a book available, ‘Finding you finding me’, the book can be accessed online here.
A slightly heavier read, but this article discusses the value of Intensive Interaction and Autism, discussing empirical evidence from a few scientific studies.
In our next post we will discuss Applied Behavioural Analysis (ABA). Feel free to comment or contact us for any additional information.
Sean and Julie
Hewett, D. & Nind, M. (1993) ‘Access to Communication. Intensive Interaction: an approach to helping learners who are still in the pre-speech stages of communication learning’ in Information Exchange, May 1993.