Interaction in Action

Reflections on the Use of Intensive Interaction

Dave Hewett, Melanie Nind

• Publisher: David Fulton Publishers
• Year: 2013
• Print ISBN:
  9781853464614
• eBook ISBN:
  9781136610103
• Topic: Education
• Subtopic: Education General

First Published in 1998. The authors' aim in editing Interaction in Action is to follow up on the thinking and practical guidance contained in their previous work on Intensive Interaction: They hope to illustrate that Intensive Interaction is not just something that goes on in hospital schools. Here we see the approach used not only by teachers, but also by speech therapists, occupational therapists, social workers, psychologists and parents. We see the approach used in people's homes as well as in education and day centres. The contributors have been asked to share their insights, the way they think about Intensive Interaction as well as the way that they 'do' it. This means that the chapters contain both reflective analysis and vivid description. The contributions illustrate how Intensive Interaction has grown and developed as an educational approach and as a way of being with people, and they illustrate the impact on all those involved.

Chapter 1

Introduction: Recent Developments in Interactive Approaches

Dave Hewett and Melanie Nind

Introduction: the approach

Most readers of this book will already be familiar with Intensive Interaction, through reading, staff development or practice. As familiarity cannot be assumed for all readers, however, and as many may appreciate some recapping, a summary of the main features and a rationale for Intensive Interaction is given below. These are explained in full in Access to Communication (Nind and Hewett, 1994).

Intensive Interaction is an approach to teaching and spending time with people with learning disabilities which is aimed specifically at facilitating the development of the most fundamental social and communication abilities. Intensive Interaction is based on the model of caregiver-infant interaction and makes use of the implicit pedagogical style (Carlson and Bricker, 1982) which characterises the playful interactive process. The underlying premises are that:

• for individuals with severe and complex learning disabilities, developing these abilities to relate to others and to communicate are the primary learning needs and the priority for quality of life
• making developments here will make all subsequent teaching and learning easier and more enjoyable
• the processes fundamental to the interaction sequences which take place between caregivers and infants in the early months provide a model for how these developments are facilitated
• these processes can be applied in our work but this needs to be done with intensity, sensitivity and critical reflection.

The intention is to make use of what we know about how the rudiments of sociability and communication are ordinarily learned in infancy and to extrapolate from this a model for teaching and relating. This means taking into account what we know about normal and delayed or abnormal development, and it means using a combination of intuitive processes (we teach infants to communicate without knowing how we do it) and intelligent reflection on these processes. It does not mean an attempt to re-parent or to compensate for missed experiences, nor does it advocate treating individuals with learning disabilities as if they were babies.

Intensive Interaction is characterised by regular, frequent interactions between the practitioner (be that teacher, carer, professional from a range of disciplines) 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. For this summary we use the term ‘learner’ to refer to the person with learning disabilities who is learning through the process about sociability and communication, but do not intend any assumption that this learner is only in a formal educational setting. The method can be summed up as follows:

• The practitioner of Intensive Interaction begins by subjectively getting to know the learner, getting a feel for the kinds of interactions which might be enjoyable, tentatively trying out various activities and tempos, working towards an initial connection (‘accessing’).
• This early work is developed into a familiar repertoire of mutually enjoyable interactive games and playful ritualised routines.
• These interactions gradually become more sophisticated and reciprocal and the learner is enabled to take a more active role.
• Throughout the interactions the practitioner modifies her/his interpersonal behaviours to make her/his facial expressions, body language, vocal and gaze behaviours interesting and meaningful. This often means joining in with or imitating aspects of the learner's behaviour and using a much simplified style of speech.
• The practitioner makes careful use of watching, waiting and timing. This may involve rhythms of activity blended with the rhythms of the learner's behaviour or dramatically timed pauses and bursts of activity.
• The practitioner responds contingently to the learner's behaviour. This creates a sense in which the activities are led by the learner who is thus given considerable control over their content and duration.
• The practitioner imputes intentionality. S/he credits the learner with thoughts, feelings and intentions. S/he attributes social meaning to actions and responds to behaviours as if they have intentional and communicative significance, long before this is so. This intentionality is clear in the responsive behaviour of the practitioner to the learner.

These features of the approach clearly have a basis in what the psychological literature has highlighted as significant processes in caregiver–infant interaction. The repertoire of playful routines provides the safe and stimulating context for exploring the effects of one's behaviour (McConkey, 1989) and for learning the conversational rules of joint reference and turn-taking (Field, 1979). The absence of task means that one's efforts are not judged against concepts of ‘rightness’ or ‘wrongness’ but that learning takes place in an overriding positive context. The practitioner has a role in ‘scaffolding’ the experiences so that there is an optimum balance of the known and the challenging (Bruner, 1983). The modified interpersonal behaviours are like those which infants elicit from their caregivers which are most helpful to development at their particular stage (Stern, 1974; Pawlby, 1977). The simplified linguistic code is like the ‘motherese’ which Snow (1977) found to be important in supporting language development. The emphasis on timing comes from the role this plays in infant development in creating turn-taking (Kaye, 1977), and maintaining optimum levels of arousal (Beebe, 1985). The contingent responding was found by Goldberg (1977) to create the all important sense of efficacy for the infant. The significance of imputing intentionality for facilitating the transition to truly intentional communication behaviour can be seen in the work of Schaffer (1977) and Newson(1979).

The premise which underlies Intensive Interaction is that learning to communicate and to be social is not like learning a basic skill which can be task-analysed and its constituent sub-skills taught separately in a structured programme. Learning to communicate involves learning about oneself and others, it involves learning that we can have an effect on others and that we can share meaning. To be effective communicators we have to want to communicate, to have a concept of what communication is all about, and simultaneously to apply many complex and inter-related skills. The only model we have for teaching all this is in caregiver–infant interaction.

When practitioners apply principles from caregiver–infant interaction to work with older children and adults with learning disabilities in Intensive Interaction, they are faced with all kinds of challenges and dilemmas. Some of these are practical and some are philosophical. Successful practitioners of Intensive Interaction manage to combine spontaneous, intuitive responding with extreme sensitivity to the idiosyncratic needs and behaviours of the individual and an intellectualisation of the developmental principles being applied. They develop an interactive ‘style’ which permeates their whole way of being with the learner(s), creating an optimal environment for communication to develop. The challenges they face are not just with the learners themselves, however, but with how others see their role. Controversial issues such as age appropriateness, which arise with the use of this method, are discussed in our earlier work (see for example, Nind and Hewett, 1996), and are included here in the reflections of the various contributors to this volume.

Where are we now – in practice?

There is clearly a well-established and still growing interest in Intensive interaction and interactive techniques in general in work with people with severe learning difficulties. Travelling around the country, it is easy to meet professionals everywhere in education, social services, health and the voluntary sector who know about interactive approaches or who are keen to know more. In many schools, day centres and residential establishments, it is possible to see staff employing the techniques. Interactive techniques are included on courses for special needs teaching and books on these matters can be found in the libraries of universities where teacher education takes place. A large county social services authority has set up a long-term evaluation project on Intensive Interaction and ensures that all staff who work with people with learning difficulties have at least initial training in the approach. Other social services authorities have adopted similar service-wide training commitments. Virtually all of the speech and communication therapists one meets seem at least academically conversant with the issues.

There continues to be a healthy debate in special education about the relative worth and the conflicts between objectives-driven curricula and process-orientated ones. Interactive approaches are referred to by both ‘camps’ in the debate and the work given to the implementation of the National Curriculum in special schools does not seem to have dulled it.

From our point of view as advocates of interactive approaches and of one interactive approach in particular, we could be beguiled into believing that something akin to a general adoption of what we are interested in has taken place. We might be misled into thinking that Intensive Interaction is well established in the armoury of practitioners in our field. We do not believe this to be the case.

It is our perception that with the approach for which we are responsible, we are well into a period of establishing the adoption of it. However, we are most assuredly still within the period of establishing its general use. It may even be a fragile period for the work that we advocate. We estimate that there are still so many more professionals everywhere who are not versed in the ideas, have not even heard the ideas, than those who have familiarity or are already integrating them into their practice.

As part of a research project to find where and why Intensive Interaction is used (Nind, 1996–98, Oxford Brookes University) data have been gathered which give a more informed picture of the extent of take-up of interactive approaches generally and Intensive Interaction in particular. Questionnaires were sent to 118 special schools, units and resource bases across the four counties of Berkshire, Buckinghamshire, Hertfordshire and Oxfordshire with approximately half (58) returned. Of these returned about 70 per cent (40) use interactive approaches and about 20 per cent (11) use Intensive Interaction. Removal of the schools where one would not regard Intensive Interaction as appropriate (providers for pupils who are hearing impaired, in hospital education, have moderate learning difficulties, have specific learning difficulties, have emotional and behavioural difficulties, and who do not have additional severe or complex learning disabilities) gives a more accurate indication of the take up. This leaves 32 respondents, a third of whom indicate that Intensive Interaction is used by them or their school. Of those who indicate that Intensive Interaction is used, half (5) indicate that it is used ‘occasionally’ and half (6) indicate that it is ‘part’ of their curriculum, used alongside other approaches. None of this sample indicated that Intensive Interaction was ‘central to’ their curriculum, though some said they would like it to be!

Early analysis of the data indicates that the major factor which encourages teachers to use Intensive Interaction is being faced with learners who do not know how to communicate, who ‘don't join in’ and whose needs were not being met. One teacher highlighted the trigger of having ‘one particular child who seemed stuck’ and another summed it up as ‘desperation’. The data on what discourages these teachers from using the approach, or what challenges its use presents, indicate that they are being held back by practical factors (staffing levels, time factors) or factors related to a conflict with the whole school ethos (lack of management support, lack of confidence, lack of wider commitment, age-appropriateness issues, accountability, ‘feeling okay in the face of OFSTED’).

For those teachers who indicated that they did not use Intensive Interaction, lack of knowledge about, or lack of experience of using the approach, dominated the responses. Understandably perhaps, none of the respondents working in provision for pupils with moderate learning difficulties, hearing impaired pupils or pupils with specific learning difficulties had heard of Intensive Interaction. Some of those working with the appropriate pupil group with severe and complex learning difficulties were also unfamiliar (4). For those who were familiar with the approach, through reading or staff development, reasons for not employing it were mostly voiced in terms of practical factors (high staff turnover or newness of the provision). One response gave the reason of other initiatives currently in use. The questionnaire included a question about ‘what teaching approach or approaches are primarily used?’ This has yielded interesting data about other approaches used alongside or instead of Intensive Interaction. Whilst many respondents indicate that a variety of approaches are used, TEACCH¹ is the most commonly cited specific approach (8 schools/units), with approaches based on Waldon² (3 schools), gentle teaching, conductive education and EDY³ also mentioned. Interestingly, with the exception of conductive education, these approaches co-exist in schools alongside Intensive Interaction, although the staff and pupil groups may of course differ.

We do not in any way feel depressed or daunted by a state of affairs where we are still apparently some distance from a general take-up of Intensive Interaction in service provision. We accept it as being simply an obvious and understandable reality. The general ‘noise’ about interactive techniques really only commenced in the mid to late eighties. Collis and Lacey (1996) cite the 1987 Westhill College, Birmingham, Conference on interactive approaches in special education as a particular milestone. We concur with that view, meeting still other teachers who were present and who still refer to it. Ten to fifteen years is not a long time for what amounts to a transformation in thought, philosophy and practice to take place. It almost seems appropriate that progress toward the adoption of large-scale alternative or additional approaches to what went before is slow. In addition, we make the point later in this chapter, and in the final chapter, that even those of us who research, write and work constantly with the topics are probably still at early stages of understanding the full ramifications.

Nonetheless, we do maintain that for people who are still in the earliest stages of learning, who are pre-verbal, not making rich, fulfilling contact with other people, there are now some articulately described methodologies for staff to help them relate better and know more about communication. We do look forward to a situation where there is a pervasive adoption of these approaches and to the flexible, imaginative thinking and staff behaviour which goes with them becoming general – the ‘norm’ everywhere. We look forward also to the available literature continuing to grow, with further vital contributions by academic researchers, but also vitally, a healthy growth in the number of ordinary teachers, care staff and other professionals who take it upon themselves to reflect upon and write about their work.

Interaction in action

Intensive Interaction has been the subject of doctoral research (Nind, 1993; Hewett 1995) and the subject of various evaluations (Watson and Knight, 1991; Nind, 1996; Watson and Fisher, 1997). These studies have incorporated ...

Table of contents

• Cover
• Full Title
• Copyright
• Contents
• Preface
• List of Contributors
• 1 Introduction: Recent Developments in Interactive Approaches
• 2 Using Intensive Interaction with Pupils who have Multi-Sensory Impairment
• 3 Jamie's Story: Intensive Interaction in a College of Further Education
• 4 Sabrina's Story: Curriculum in the Early Years
• 5 Commentary One: Practice and Progress
• 6 Addressing the Needs of Adults with Profound and Multiple Learning Disabilities in Social Services Provision
• 7 Introducing Intensive Interaction for People with Profound Learning Disabilities Living in Small Staffed Houses in the Community
• 8 The Gradual Development of Intensive Interaction in a School Setting
• 9 Commentary Two: Getting Intensive Interaction Established in Different Settings – Institutional Issues
• 10 Ben's Story: Developing the Communication Abilities of a Pupil with Autism
• 11 Gary's Story: Parents Doing Intensive Interaction
• 12 Francesca's Story: Facilitating the Earliest Developments
• 13 Commentary Three: Learners with Autism. Parents Doing Intensive Interactions
• 14 Conclusion: Future Developments
• Author Index
• Subject Index