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Mental Health and Learning Disabilities
Research and Practice
Volume 3Number 1
April 2006
With all of us in mind
Intensive Interaction: a Research Review
Graham Firth1
1Leeds Mental Health Teaching NHS Trust
Mental Health and Learning Disabilities Research and Practice, 2006, 3, 53 - 63
Intensive Interaction – a Research Review
Graham Firth
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.
Key words: intensive interaction, learning disabilities, research review.
Intensive Interaction: a Research Review
According to the British Institute of Learning Disabilities (BILD) Intensive
Interaction is:
‘… a practical approach to interacting with people with learning
disabilities who do not find it easy communicating or being social….’
(accessed at on
Intensive Interaction was originally developed in the 1980’s and was
described by teachers Dave Hewett and Melanie Nind in ‘Access to
Communication: Developing the basics of communication with people with
severe learning difficulties through Intensive Interaction’ (1994). Eschewing
the prevalent behaviourally inspired pedagogy and skill analysis model of
curriculum formulation that prioritised self-help or independent living skills,
Intensive Interaction instead aimed to facilitate the acquisition of
fundamental communication skills and sociability of people with severe or
profound and multiple learning difficulties (it has also been used with
people with severe Autistic Spectrum Disorder). The approach was built on
the concept of ‘Augmented Mothering’ developed by psychologist Gary
Graham Firth
Ephraim (1982), who argued for the use of naturalistic interactions with
learning disabled clients based on ‘infant-caregiver’ interactional
The techniques of Intensive Interaction include the use of non-task
associated physical proximity, responsive eye contact and facial signalling,
physical contact, vocal echoing and behavioural mirroring. According to
Hewett and Nind (1998),
‘Intensive Interaction is characterised by regular, frequent
interactions between the practitioner … and individual with learning
disabilities, in which there is no task or outcome focus, but in which
the primary concern is the quality of the interaction itself’ (p.2).
During the interactions the practitioner endeavours to follow the client’s
lead, thus responding contingently to their behaviour or activities to create a
joint focus and increased social acknowledgement and interpersonal
signalling (this generally being non-verbal in nature).
With increased use and advocacy across disciplines (e.g. teaching, speech
& language therapy, psychology, social care), Intensive Interaction is now
seen more widely as a way of teaching fundamental communication, as a
means of relationship building, or simply as a way of spending time with
people who are remote or find difficulty in being social.
This article concerns itself with published research papers that are clearly
focussed on the social responses of the learning disabled person to the
approach. Appropriate papers for inclusion were identified by initially
accessing a published list of specific Intensive Interaction research articles
(via ) combined with a process of actively
following a reference trail through the appropriate papers. Specific papers
were then selected to include papers from differing researchers or research
teams, and to accommodate articles from a breadth of learning disability
and special educational journals. Due to the brevity of this article only six
papers are summarized below; three are studies that were carried out with
adult participants and three with children.
Research with Adults Participants
The three papers briefly discussed below (Nind, 1996; Lovell, Jones and
Ephraim, 1998; Elgie and Maguire, 2001) employ varying methodologies,
and were carried out in different settings: an adult special educational
arena; a long-stay residential hospital; and a small group home. However,
across the studies there emerge the common themes of increased or novel
interactive responses by the research participants with severe or profound
and multiple learning disabilities. Collectively the papers’ findings include
increased frequency of social contact demonstrated through raised levels of
contingent smiling, enhanced use of socially significant physical contact,
raised levels of joint attention, and increased use of vocalisation.
In Nind’s (1996) research
(‘Efficacy of Intensive Interaction: developing
sociability and communication in people with severe and complex learning
difficulties using an approach based on caregiver - infant interaction’)
adult students with severe and complex learning difficulties, who attended a
Intensive Interaction: a Research Review
school within the grounds of a long stay residential hospital, were engaged
with an Intensive Interaction intervention.
This research employed a ‘multiple-baseline interrupted time series
methodology’. Thus the students’ interactional behaviour was recorded
during both a ‘base-line phase’ (of up to six months) and an ‘intervention
phase’ with daily sessions of Intensive Interaction (lasting up to 18 months).
Data was generated by employing video analysis and a number of
observation schedules, including the
Pre-Verbal Communication Schedule
(Kieran and Reid, 1987).
As a result of the Intensive Interaction, the researcher claimed that each
student developed new interactive behaviour, such as ‘contingent smiling’,
‘maintaining a state of joint focus’ or ‘contingent vocalisation’. More
generally all of the students made advances in their communication abilities
as measured on the
Pre-Verbal Communication Schedule
, with progress
noted particularly in the areas of vocal imitation, communication through
gesture, and communication through the use of sounds. According to the
author, there were no significant events concurrent with the onset of the
Intensive Interaction intervention, and therefore no rival explanations for the
A study by Lovell, Jones, and Ephraim (1998)
(‘The Effect of Intensive
Interaction on the Sociability of a Man with Severe Intellectual Disabilities’
investigated the use of Intensive Interaction with a socially withdrawn, 53-
year-old man with severe intellectual disabilities who lived within a large
residential hospital. The client was observed in two differing social
scenarios: in one, a clinical psychologist engaged him with Intensive
Interaction; in the second, the same psychologist remained close to the
client but did not interact with him (these were termed ‘proximity sessions’).
Comparative observational data was gathered from each session using ‘10
second momentary time sampling’ of video-recordings. The same method
had previously been employed to gain base-line observations of the client
in his normal environment, where he was usually observed to be sitting
alone in a corner.
The findings of this research claimed to indicate that during the Intensive
Interaction sessions the client initiated much more physical contact than
prior to the intervention, when it was never evidenced. There were also
claims for more physical contact during the Intensive Interaction than in the
‘proximity sessions’, where it was only occasionally observed. Also
indicated was an increased time spent ‘looking at people’ during Intensive
Interaction, and doing so with more consistency than in the ‘proximity
sessions’. No episodes of joint attention were recorded prior to the
interventions and just one instance was recorded in the ‘proximity
sessions’. However, the client demonstrated many episodes of joint
attention during the Intensive Interaction sessions.
The authors also claimed that there were additional benefits to the use of
Intensive Interaction in terms of changes in the client’s mood. The client
was observed to smile, laugh and vocalise more in the Intensive Interaction
sessions than prior to the interventions, when no examples of these
responses were recorded. However, due to an unrelated injury to the client,
this research endeavour had to be prematurely curtailed and so the findings
should be judged as incomplete.
Graham Firth
A study by Elgie and Maguire (2001) (‘
Intensive Interaction with a Woman
with Multiple and Profound Disabilities; a case study’
) reported on the use
of Intensive Interaction with an extremely socially withdrawn woman with
profound learning disabilities. This lady had engaged, since childhood, in
serious self-injurious behaviour which damaged her face and eyes, and she
was therefore blind. She had no verbal skills and was reported as using
only very limited non-verbal communication.
After base-line measurements, a 16 week Intensive Interaction intervention
was employed using physical contact (especially hand holding), vocal
commentary with intonation, and sensitively timed vocal imitation.
According to the authors, one result of this intervention was increased
spontaneous hand contact, which contrasted with the client’s previous
behaviour when no spontaneous reaching out had been observed. The
authors also reported evidence of increased vocalisations during the
Intensive Interaction sessions, as compared to when the lady was alone.
Somewhat disappointingly from the authors’ perspective, there was no
appreciable change observed in the level of the client’s self injurious
behaviour over time. However, the authors claimed that this was to be
expected at such an early stage of the Intensive Interaction intervention.
Research with Child Participants
The claims made as a result of research into the responses of children to
Intensive Interaction are similar to those for adults, with claims for
increased social responsiveness. However, again it should be
acknowledged that the body of research is not large.
The three papers summarised below were all carried out in an educational
setting and employed varying methodologies. Again, common themes
emerged indicating increased levels of joint attention, active participation
and turn taking. However, one potentially important factor for research in
this area is the consideration that children’s development could be
accounted for by a process of general maturation rather than any specific
intervention. Therefore any causal links identified on the basis of evidence
generated in this area should always be judged with this in mind.
One study into children’s responses, carried out by Watson and Knight
((1991) ‘
An Evaluation of Intensive Interactive Teaching with Pupils with
Very Severe Learning Difficulties’
) explored the use of Intensive Interaction
with six pupils with severe learning difficulties at a special school in
Scotland. The children’s responses were studied over a whole school year.
Six members of staff worked consistently with the same child, and used
toys or objects to generate interactive games. Evidence was gathered
using video recordings, contemporaneous staff records and interviews with
staff members.
From this study the researchers claimed that staff-pupil pairs built up
individual interaction styles that created potentially enabling changes in the
children’s social behaviour. Such developments for individual children
included increased levels of alertness; increased instances of eye contact;
increased turn taking and sharing of objects; increased socially significant
Intensive Interaction: a Research Review
vocalisations; increased active participation; and for one child, indications
of improved gross motor control.
More subjectively, but perhaps equally as important, the staff emphasised
that they believed that Intensive Interaction enabled the development of
good pupil-staff relationships. The staff members also indicated other
effects of Intensive Interaction as significant from their own perspective,
including staff being more relaxed, tolerant and willing to wait for the
children’s responses.
With a view to generating more comparative data, Watson and Fisher
Evaluating the Effectiveness of Intensive Interaction Teaching with
Pupils with Profound and Complex Learning Disabilities
) evaluated two
teaching methods, teacher-directed activity and Intensive Interaction, over
a nine-month period, for pupils with very severe learning difficulties and
multiple impairments. From Pre-verbal Communication Schedule
assessments (Kiernan and Reid, 1987) and data from sessional
videotapes, the authors claimed that there were some ‘striking’ examples of
social or communicative behaviours evidenced during sessions of Intensive
Interaction. It was also claimed that these behaviours were not observed
during other, more didactic classroom activities. There was evidence of
increased movement; the development of turn-taking sequences; and more
pupil initiated activity.
Generally, according to the authors, during the Intensive Interaction
sessions all the pupils ‘demonstrated higher levels of active participation
and enjoyment’. This contrasted with the teacher-directed group activities,
where there was a tendency for pupils to take on the role of ‘passive
recipients’ toward the activities. Based on these observations the authors
concluded that Intensive Interaction was ‘a more rewarding social
experience’ for the pupils, and one ‘in which they showed initiative and
A single case study by Kellett (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
) concerned a five-year-old
boy, Sam, at a community special school (this paper reported on just one
case out of a larger longitudinal study involving six children with severe
learning disabilities). Sam often engaged in self-stimulatory behaviour and
was indicated by the school staff as living ‘in a world of his own’. He did not
use any symbolic language or formal signs, made no eye contact with other
people, and appeared not to observe nor respond to other peoples’ facial
The researcher used a ‘multiple-baseline interrupted time series’
methodology, employing systematic video-recorded observation over one
academic year. The observed progress made by Sam after the initiation of
daily 10 minute sessions of Intensive Interaction was identified as:
! ‘Modest progress’ in the incidence of ‘social physical contact’
! ‘Clearly evident’ progression for Sam in the incidence of ‘eye contact’
! ‘Huge steps’ forward in ‘looking at or towards a partner’s face’
! Sam’s ability or willingness to engage in joint focus or joint activity with
the teacher ‘developed dramatically’
Graham Firth
! Sam beginning ‘to use his vocalising ability to respond contingently and
to initiate contact’
It should be noted that the often emotive terminology used by the author in
this paper stands in contrast to the more generally accepted scientific or
quantitative vernacular. However, the author also wisely cautions against
over-generalisation from such a single case study, identifying this paper as
adding to the body of consistently reported increases in social
responsiveness associated with the adoption of Intensive Interaction
For pragmatic reasons such a brief paper as this has a limited scope, and
therefore cannot claim to give a comprehensive view across all current
research into Intensive Interaction. However, the body of evidence arising
from the research papers reviewed in this article appears consistently
supportive of claims of increased social responses from the research
participants associated with the onset of Intensive Interaction interventions.
There are repeated claims of novel or increased socially interactive
behaviours manifest through greater use of eye contact; increased
toleration of, or engagement in, physical contact activities; additional
episodes of sustained joint attention; increased use of potentially
communicative vocalisations; and an increased regard for facial signalling.
There is also evidence of greater initiation of social interaction by some of
the research participants.
However, in some aspects the findings from these research endeavours
were not wholly consistent, and due to the different time scales employed
not directly comparable. Nind (1996) makes a claim for reductions in the
levels of the participants’ ritualistic or self-stimulatory behaviours as new
interactive behaviours emerge, whereas in the much shorter case study of
Elgie and Maguire (2001) no significant change in the levels of their client’s
self-injurious behaviour was evidenced.
It could be argued that the body of evidence is still limited in its
generalisabilty due to the methodologies employed, that is the use of small-
scale or single case studies without experimental controls. The limited time
scale of some of the research studies could also be seen as a potential
weakness with respect to the validity of the findings in terms of sustainable
changes to the behaviours measured. It should also be noted that the main
body of research carried out into the use of Intensive Interaction has been
conducted by a relatively small number of practitioners and advocates of
the approach, generally educationalists and clinical psychologists. There is
therefore also an issue of unintentional bias to be considered in the
operationalisation and reporting of studies closely tied to the researchers
own professional endeavours.
Another potential criticism of the body of research concerns the claims
made concerning process. For those papers written from an explicitly
educational perspective (and published in educational journals) there is an
assumption, sometimes explicitly stated, that the novel or increased social
responses arise out of a teaching or learning process, i.e. that there is
social skill acquisition
. The other, non-educational researchers
Intensive Interaction: a Research Review
seem to be indicating a much more rapid ‘social inclusion’ model of
increased responsiveness, and indeed these research endeavours were
generally much shorter, with social skill acquisition presumably much less
likely within the given time frames (e.g. 10 or 16 weeks). Such a ‘social
inclusion’ model seems to acknowledge the potential for the client or
students’ latent social skills or behaviour to be increasingly expressed as
increased opportunities are presented to them in a socially inclusive way.
Some consideration within the research literature of cognitive or learning
theory might help elucidate this apparent duality. Indeed some situated
learning theories, e.g. Legitimate Peripheral Participation (Lave and
Wenger, 1991) explicitly view authentic engagement in activities or ‘joint
enterprises’ (in this case social and communicative enterprises) as a
necessary precursor to conceptual development and skill acquisition. Thus,
from such a perspective the educational or social processes underlying
Intensive interaction could be viewed as seamless and phenomenologically
co-dependant. Nevertheless, whatever the view taken on process,
increased interactional activity has been systematically evidenced, but
perhaps future research could benefit from being more conceptually aware
of such a potential duality.
Taken together, despite the possible critiques and the potential for dual
process, the research findings indicated in this review could be viewed as
adding credible support to the case that if social occasions are purposefully
generated in such a way as to facilitate the social participation of people
with severe or profound learning disabilities, then this can lead to increased
social engagement on their part.
Interestingly, despite Intensive Interaction being increasingly reported on,
researched, and even indicated as accepted practice by a number of large
voluntary and government agencies (British Institute of Learning Disabilities
); The Foundation for People with Learning Disabilities (2001, p. 28);
The Qualifications and Curriculum Authority (2001, p.18)) no large scale,
centrally funded research into the approach has as yet been undertaken.
But certainly it is this author’s view that in times which increasingly focus on
and value evidence-based practice, it is vital that further empirical research
takes place to build on the already emergent body of evidence. However,
such research would not only have to ensure robust validity and
generalisability, but would also need to take complete account of the
complexity of human interactional behaviour whilst acknowledging its full
contextual depth.
Valuing People, the Government’s Strategy for Learning Disability policy in
the 21st Century, states that ‘people with learning disabilities are often
socially isolated’ (7:39, p. 81). It also clearly states in Objective 7 that
people should be enabled to ‘…develop a range of friendships, activities
and relationships’ (p. 127). If this objective is to genuinely transpire,
particularly for those people with the most profound and complex learning
disabilities, then further structured investigation into Intensive Interaction as
a potential means for developing such activities, interests and relationships
is undoubtedly required.
Graham Firth
British Institute of Learning Disabilities 2005 on-line at (accessed 2/07/05).
Department of Health 2001. Valuing People: A New Strategy for Learning
Disability for the 21st Century [Cm 5086]. London: The Stationery Office.
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.
Ephraim, G. 1982. Developmental processes in mental handicap: a
generative structure approach, Unpublished PhD thesis, Brunel University
Hewett, D. & Nind, M. 1998 (eds) Interaction in Action: reflections on the
use of Intensive Interaction, David Fulton, London.
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.
Kiernan, C. & Reid, B. 1987. Pre-Verbal Communication Schedule. NFER-
Nelson, Windsor.
Lave, J. & Wenger, E. 1991. Situated Learning: Legitimate peripheral
participation, University of Cambridge Press, Cambridge.
Lovell, D., Jones, R. & Ephraim, G. 1998. The effect of intensive interaction
on the sociability of a man with severe intellectual disabilities, The
International Journal of Practical Approaches to Disability, 22 (2/3), 3-8.
Nind, M. & Hewett, D. 1994. Access to Communication: Developing the
basics of communication with people with severe learning difficulties
through Intensive Interaction, David Fulton, London.
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, The European
Journal of Special Educational Needs, 11 (1), 48-66.
The Qualifications and Curriculum Authority 2001. Planning, teaching and
assessing the curriculum for pupils with learning difficulties: general
guidelines, QCA Publications, London.
The Foundation for People with Learning Disabilities 2001. All About
Autistic Spectrum Disorders, The Mental Health Foundation, London.
Watson J. & Fisher A. 1997. Evaluating the effectiveness of Intensive
Interaction teaching with pupils with profound and complex learning
disabilities, The British Journal of Special Education, 24 (2), 80-87.
Intensive Interaction: a Research Review
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.
Graham Firth
... This approach is grounded upon the principals of the developmental and social model and aims to bring together therapeutic and educational practices (Nind and Hewett 1988). It is an approach that highlights the process rather than the outcome of an interaction and is based on non-verbal communication, physical contact, waiting and timing, behavioural mirroring and contingent responding (Argyropoulou and Papoudi 2012;Firth 2006). ...
... The efficacy of intensive interaction in enhancing children's social and communication skills has been widely examined and acknowledged by the academic world (Argyropoulou and Papoudi 2012;Firth 2006;Kellett 2000Kellett , 2004. Jones and Howley (2010) have also highlighted the positive impact of intensive interaction on the development of quality relationships between the teachers and the learners. ...
The research investigates the thoughts, needs, wishes and preferences of a pupil diagnosed with autism spectrum condition in regard to her daily experiences in a mainstream early years’ setting, in a small Greek island. The purpose of this case study was to explore and provide an example of how the designing of the Individual Learning Plan could be tailored to a specific pupil’s strengths and preferences, rather than the areas of need. The data were collected through observations, intensive interaction sessions, cameras, activities and questionnaires for parents, teacher and the pupil. The result depicted the pupil’s significant sensory needs, her desire for structured routine and visual aid, and her favourite places and activities. A special bond between the pupil and her one-to-one teacher was also apparent in all the tools. The ILP was implemented for the whole of spring and summer terms and had a positive impact on both the academic progress and social and emotional development of the pupil.
... Yet, in both England and Scotland, evaluations of current curricular approaches for this group of learners have been scarce (Lacey, 2011). In addition, although there is an increasing body of evidence highlighting the positive impact of 'intensive interaction' as a means of encouraging pupils' interaction and communication (Firth, 2006), there are still very few evaluative studies of other specific teaching approaches. The Doran review (The Right Help at the Right Place at the Right Time, Doran, 2012), which reviewed educational provision for children and young people with complex additional support needs in Scotland, supported a curriculum Framework for all. ...
... Intensive Interaction (Firth, 2006) • Music (for example, Sounds of Intent; Ockleford, 2000). ...
Full-text available
This paper details the development, implementation and evaluation of the South Lanarkshire Framework for Supporting Children with Severe and Profound Learning Needs (“The Framework”). The document assists Scottish schools in taking forward the Curriculum for Excellence for this group of learners and in building capacity amongst staff. The guidance and resources place emphasis on the identification of relevant and individualised learning outcomes and on teaching approaches which promote pupils’ development in key areas. Seven Additional Support Needs (ASN) establishments in South Lanarkshire completed a pre- and post- audit of curricular practice and 24 staff completed an evaluative questionnaire. Eight staff also participated in semi-structured interviews. Analyses indicated that the Framework has influenced teachers in terms of their mind-set, practice and ability to set appropriate targets. Responses also suggested that the document has led to increased collaboration amongst staff and has been shared positively with parents. The findings are discussed in relation to implications for practice and future research directions.
... Intensive Interaction (II) aims to improve the interactional competence of both the patient and the caregiver (Firth et al., 2008). II utilizes techniques such as facial signalling, vocal echoing, responsive eye contact, physical contact and behavioural mirroring (Firth, 2006). Hewett and Nind (1998, p.2) describe II as involving regular interaction between the caregiver and the person with ID in which 'there is no task outcome focus, but in which the primary concern is the quality of the interaction itself'. ...
... It has been argued that II may be useful in using naturalistic communicational approaches for people with autism, but these claims are speculative at present (Nind & Powell, 2000). In a review of the current research, Firth (2006) concluded that, whilst increased client social interaction was reported in most cases, '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' (p. 54). ...
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A series of abuse scandals in recent years have stimulated debate regarding appropriate ways to care for people with intellectual disabilities and challenging behaviour, with policy emphasising the need to move beyond reactive and aversive approaches. This thesis presents a qualitative study of the use of Discovery Awareness; a non-aversive video-analysis based approach to challenging behaviour which aims to improve relational aspects of care. Fieldwork was undertaken over a 10 month period in two Assessment and Treatment Units on a single site in the UK. During this period, 7 Discovery Awareness sessions were filmed and 12 interviews were conducted with staff who had experience of attending DA sessions. The filmed DA sessions were analysed using Conversation Analysis (CA) whilst the interview data explored staff accounts and perceptions of using DA in practice. The findings demonstrate that method integrity is an interactionally achieved phenomenon accomplished by the chairperson establishing interactional frameworks, shaping the conditional relevance of turns in line with the aims of the session, and through signalling transgressions in situ. There was no one interactional rule that applied to the whole DA session, making participant transgressions probable. Stance and interpretation were central actions related to video analysis in the session. Participants in DA utilised vague language to reduce the ‘degree of liability’ that a speaker may face. Participants also employed experiential formulations when interpreting the patients’ behaviour. This both minimises the basis for disagreement and enables participants to bring to the surface tacit dimensions of knowledge regarding the patient. These skills may be valuable in care environments, where staff have to make decisions based on signs interpreted from patients in the moment. The conversation analytic work also uncovered the prevalent use of ‘imagined constructed inner dialogue’, in which staff members talk as the patients’ inner voice. This formulation was used to perform a variety of actions such as evidencing participants’ stances, gist formulating the turn of another speaker, and to imagine alternative courses of events from the patient’s point of view. The use of imagined constructed inner dialogue also enabled speakers to give voice to non-aligning turns which offer alternative assessments without the need for prefacing non-alignment and minimising disagreement commonly found in every day conversations. Whilst imagined constituted dialogue fulfils an epistemic function, it also enabled participants to fulfil one of the remits of a DA session; to try to see the world from the patient’s point of view. By speaking as the patient, staff take an empathetic stance and affiliate with the patient’s imagined experience whilst keeping the patient’s voice central, and debatable, in the sessions. The interview findings suggest that DA is perceived as a valuable tool in helping staff reflect on the behaviour and personhood of the patient, as well as their own role in interactions with the patient. Whilst a variety of positive outcomes were reported, there was no consensus about how or whether these factors resulted in a reduction in challenging behaviour. However DA was perceived as having a beneficial effect on the culture of the units and in promoting recognition of personal and collective skills relating to understanding and exploring the patients’ behaviour. Possible impediments to implementation were also identified through analysis of the sessions, staff interviews, and through a literature review focusing on the factors which promote or impede the use of methods in ID practice. The findings contribute to existing conversation analytic work on studying intellectual disability services from an interactional perspective. They also build on work examining how methods are implemented interactionally. This has relevance for understanding how ID methods are implemented in real world situations, and for ID policy and practice.
... Maguire (2001), Kellett (2000), Lovell, Jones, and Ephraim (1998). However, the use of intensive interaction has been highlighted as needing further systematic research (Firth, 2006) due to the use of small scale or single case studies without experimental controls and the limited time scale of some of the research studies. ...
Conference Paper
In this study, I aimed to consider how and in what ways the sense of smell could support the education of pupils with Profound and Multiple Learning Disabilities (PMLD). I had two aims: first, I wanted to explore an approach to supporting teaching and learning for the PMLD cohort. Second, since the sense of smell is an under-researched and under-valued subject, I wanted to make my own contribution to providing evidence of the potential of this sense as an important tool for learning. At the centre of this study were seven pupils with PMLD all but one of whom I had taught before the research commenced. Although their difficulties were such that it was not possible to interview them, I was able to conduct interviews and joint observations with their parents and teaching professionals. I adopted a qualitative, interpretivist methodology, which was well suited to this close and detailed interview- and observation- focussed investigation. The fieldwork for this study was conducted over an eight-week period, in one London special school, in the spring and summer terms of 2014. I used three main methods to generate data: firstly, sourcing of information about the pupils from educational and healthcare documents and conducting initial observations (Spring Term, 2014); secondly, interviewing 15 adult participants including five teachers, seven parents, two senior leaders and the school therapist (Summer Term, 2014); thirdly, carrying out 92 video-recorded observations of pupils’ reactions to smell within sensory based activities over the eight-week fieldwork period and individually interviewing the parents, teachers and school therapist on their perceptions of the video-recordings (Summer Term, 2014). This research provided evidence to suggest that the use of smell was performing useful functions in supporting cognitive development and in the experience of eating and drinking. What also emerged was that the use of this sense offered an additional means through which pupils with PMLD could better understand and gain information about their immediate environment. The evidence and insights presented in this thesis have already been used to inform teaching and learning practices within my own school context and it is hoped that they can be used to better support the teaching and learning of other cohorts of pupils with PMLD.
... In reviews of the literature (Firth, 2006;Sharma & Firth 2012), research on Intensive Interaction has been identified to be limited in scope and scale, with the studies often being case studies because empirical investigation of Intensive Interaction is challenging to conduct. The published research has not been systematically reviewed nor assessed for quality. ...
Full-text available
Background Intensive Interaction is an approach used for communicating with people with profound and multiple intellectual disabilities or autism. It has gained increased recognition as a helpful technique, but the evidence has not been systematically reviewed.Method Computerized and hand searches of the literature were conducted using synonyms for ‘intellectual disabilities’, ‘autism’ and ‘intensive interaction’.ResultsFifteen quantitative and three qualitative papers were identified examining the efficacy of the approach with participants across the age range in both educational and residential settings.Conclusions Studies were limited by the quality of reporting and difficulties conducting good quality, ethically sound research with participants with PMID. Staff support should be considered in training to aid implementation of interventions. Studies attempted to investigate whether Intensive Interaction builds social interactions or reduces repetitive or self-injurious behaviour. More research needs to be conducted before conclusions can be drawn regarding the efficacy of this approach.
... tudies can be generalised'(Samuel et al, 2008 p.114).Ware(2005) argued that evaluating the efficacy of Intensive Interaction is difficult as it claims it is about the process rather than the end product and that it had not been directly compared with other approaches but it was clear that it does contribute towards the development of communication.Firth, (2006) suggested that the limited time scale employed by much of the research could highlight a weakness in terms of validity in that the research does not mention if the changes in behaviour were sustained over time (p.59). He also mentioned that because much of the research is of a small scale and often uses single cases the results are hard ...
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Social communication and sensory processing disorder are two factors that interact with each other and the difficulties they find in them impact on different neurodevelopmental disorders such as autism. More specifically, sociability is shown to play a key role in dealing with sensory processing difficulties and the interventions related to it can be implemented in a school setting as well within a therapeutic setting and even at home. The design of these interventions with a focus on sociability aims on the one hand to reduce sensory difficulties and on the other hand to provide meaningful communication when working with children with autism or severe or generalized learning difficulties. This article’s goal is to compile research findings regarding the impact of sociability on children with sensory difficulties through a literature review. Specifically, many interventions with pillars the social communication have been studied to help children with autism and other syndromes The outcomes demonstrated a direct link between sociability and sensory processing disorder with interventions and therapeutic programs implemented in many nations with favorable outcomes in many facets of how children with these issues behave. One of the most effective interventions that helps are Intensive Interaction with high contribution to the sensory regulation of children mainly with autism. Students with neurodevelopmental problems were the samples for the interventions' participants. Application of these programs on a weekly basis, two to three times, is helpful in the right direction.
The intervention of Intensive Interaction is gaining attention for its demonstrated effectiveness in promoting social engagement in individuals with severe communicative impairments. The present study sought to extend the evidence base for this intervention by investigating the rapidity with which an increase in engagement becomes apparent. Videotapes of the first Intensive Interaction session for 10 adults with profound learning disabilities were microanalytically coded for four measures of engagement: eye gaze, bodily orientation to partner, proximity to partner, and emotional valence. Results showed an increase for all participants on at least two measures, while 70% of the sample showed increases on all four measures. Such shifts occurred within only a few minutes of the onset of the session (ranging from three to 14 minutes). Non‐parametric analyses confirmed that this robust pattern of increases would not have been predicted to occur by chance. These findings indicate that Intensive Interaction is effective in rapidly promoting social engagement, even for individuals with a long history of apparent social avoidance. Suggestions for future lines of enquiry, at both the empirical and conceptual levels, are discussed.
Intensive interaction (II) recognises the pre-verbal nature of adults with profound learning disabilities and mimics the early attachment process to develop the very beginnings of communication and sociability. This paper Reports on the use of II with a remote and withdrawn adult with severe learning disabilities and visual impairments, who engaged in serious self-injurious behaviour. The results indicate that the intervention was successful in facilitating the development of the first stages of social and communication skills.
Intensive Interaction was developed as a teaching approach for students who experienced severe difficulties in learning and in relating to others. The approach recognizes the pre‐verbal nature of the learners and addresses their need to develop the very beginnings of sociability and communication. Intensive Interaction is based on the process of caregiver‐infant interaction in which the first stages of sociability and communication develop. This paper summarizes the first major study of Intensive Interaction which investigated whether it could similarly facilitate this fundamental social and communication development in the target group of people with severe developmental disabilities who demonstrated ritualistic behaviours. A multiple baseline across subjects interrupted time‐series design was employed and the six subjects were all residents of a long‐stay hospital. The measures included real‐time observation schedules, video analysis, Kiernan and Reid's Pre‐Verbal Communication Schedule and an adaptation of Brazelton's Cuddliness Scale. Results showed improved pre‐communication and informal communication abilities, ‘cuddliness’ and ability to maintain and initiate social contact, and a trend towards reduction in ritualistic behaviour.
Judith Watson, lecturer and Anne Fisher, teacher, present encouraging results from two research studies which evaluated the effectiveness of Intensive Interactive teaching with pupils who had profound and complex learning difficulties. The method is compared with the effects of other classroom experiences over the course of one school year.
Sam’s story began a little over a year ago, when he participated in a longitudinal research project to evaluate the efficacy of Intensive Interaction on the sociability and communication abilities of young children with severe and complex learning difficulties (SLD). The project spanned an academic year and involved six SLD children in two community special schools and one nursery. Significant levels of social and communicative progress were made.
The effect of intensive interaction on the sociability of a man with severe intellectual disabilities, The International Journal of Practical Approaches to Disability
  • D Lovell
  • R Jones
  • G Ephraim
Lovell, D., Jones, R. & Ephraim, G. 1998. The effect of intensive interaction on the sociability of a man with severe intellectual disabilities, The International Journal of Practical Approaches to Disability, 22 (2/3), 3-8.