Access to Communication

Developing the Basics of Communication with People with Severe Learning Difficulties Through Intensive Interaction

Melanie Nind, Dave Hewett

• Publisher: David Fulton Publishers
• Year: 2012
• ISBN:
  9781136613531
• Edition: 2
• Topic: Education
• Subtopic: Education General

The award-winning creators of Intensive Interaction bring this groundbreaking book up to date with new material covering inclusion and emotional literacy. The book also includes:

• a brand new section looking at the program's implementation in preschool settings
• the particular benefits of Intensive Interaction for children who have Autistic Spectrum Disorders
• a 'how to do it' chapter including ideas for assessment
• case studies to help practitioners get to grips with the realities of using Intensive Interaction.

This book has been updated to include the new SEN Disability Act (SENDA), and developments in new technology.

1

What is Intensive Interaction?

BACKGROUND TO THE DEVELOPMENT OF INTENSIVE INTERACTION

To place Intensive Interaction in context we will begin by describing the development work that took place at Harperbury Hospital School from the mid-1980s. The school was for young adults with severe learning difficulties in a long-stay hospital. Our school population comprised those residents who were younger, who experienced the most severe learning difficulties and who, because of their behaviour or multiple disabilities, were least likely to be accommodated in other centres.

Historically, the school catered for the children living in the institution and they were offered opportunities, in an educational context, to play with sand, water and paint, to build with blocks, to thread beads, and to complete basic puzzles. The curriculum also focused on the teaching of self-help skills: the ability to dress, eat and go to the toilet with maximum independence (see Hewett and Nind 1992).

As society’s expectations of people with learning difficulties changed, children were increasingly accommodated within the community and only those young people with the most severe developmental disabilities, additional sensory and physical disabilities, and extreme behaviour, became residents of the institution. A large proportion of our student group showed very limited understanding of their immediate environment; most were unable to interact with others in ways that we could find meaningful. Many of our students had diagnoses of autism, and others experienced complex or profound and multiple difficulties in learning and in relating to others. Often their lifestyles were characterised by stereotyped, ritualistic behaviour, aggressive defence of their own isolation and apparent total self-absorption. These students posed massive challenges in terms of appropriate curricular provision. With behaviourism in its heyday, behavioural approaches and the skills analysis model (see Crawford 1980; Gardner and Crawford 1983) offered an obvious solution.

Core areas of development were subdivided into components and each component had a list of target behaviours. Very structured teaching programmes were devised with specific objectives for each student, related to how they fitted against the checklist of skills. Core areas included:

• motor development;

• social skills;

• self-help;

• language.

• cognition;

• play/leisure skills; and

• behaviour.

Once the stages of a task were analysed in detail these stages were taught discretely, aided by techniques of shaping, prompting, fading and chaining, as well as by the use of extrinsic rewards, usually food (see Kiernan et al. 1978; Gardner and Crawford 1983). In practice, priority was given to the teaching of discrimination and self-help skills as this was tangible and lent itself to skills analysis. Similarly, in the absence of knowing anything better to do, individual teaching time was given over to the completion of superficially purposeful tabletop activities that had the attraction that the teacher could physically prompt the student to make a correct response. Programmes were also devised to respond to what were perceived as aggressive and antisocial behaviours with the withdrawal of rewards, periods in ‘time-out’ cubicles, and exclusion.

By the mid-1980s, the school curriculum had settled into a mixture of unstructured activity, highly structured teaching of discrimination and self-help skills, and behavioural programmes based largely around the use of ‘timeout’. Staff turnover had been high, with people leaving after short periods of very stressful work. There was a new staff group forming, with a large number of teachers who were largely inexperienced and in their probationary year. There was growing unease with a curriculum which seemed to produce regular failure for both the teacher and the student. There was growing discomfort also with the inflexibility of a curriculum structure that gave little scope for following up the students’ interests and strengths. To summarise what was in fact a gradual and untidy process, we as a teaching staff began to question both the ethics and the effectiveness of the methods we were using. We began to recognise that much of the behaviour of our students was a response to situations that they did not understand and that they were often demonstrating communication difficulties rather than behavioural difficulties. This led us to look afresh at the students and their fundamental learning needs (see Hewett and Nind 1992).

We came to the conclusion that these needs were almost always within the realm of communication and sociability and that the existing curriculum rarely even touched upon addressing such needs. We felt that if we could begin to establish a relationship with the students, and if we could establish a basis for communication, then all other spheres of teaching and learning would become easier and more meaningful. We were conscious that our existing behavioural techniques were inadequate when addressing the complexities of communication and sociability. We knew how to prompt the use of a Makaton sign in a certain situation, but we did not know how to make this have meaningful intent, how to facilitate genuine facial expressions, or how to teach positive ways of relating to others. With the realisation that there were no readily available answers about how to teach the earliest stages of communicating and being social to young people with such learning difficulties, we began to seek a new way of teaching for ourselves. We entered a period in which practical experimentation in the classroom and theoretical inquiry complemented and informed each other, and from which new ways of working evolved.

With our interest sparked by Gary Ephraim’s (1979) ideas on using ‘augmented mothering’, our theoretical inquiry began with looking at the literature on caregiver-infant interaction where we found a model for understanding how communication and sociability develop naturally in a typical child. It became evident that these fundamental abilities are usually learned in the first year of life without being consciously taught. Analysis of videos of mothers and infants interacting has provided insights into the form that their interactive play takes and researchers have shown that this interactive play has a crucial role in ongoing development (see chapter two).

We began to incorporate interactive play into our daily routines in school. Dressing situations, for example, changed from being a non-personal and stressful routine in which skills were prompted and reinforced, into the context for a peek-a-boo type game where we were playful, offered warm physical contact, and gently narrated the action. In escorting students to different parts of the building we nagged less, and instead blended our walking rhythm with that of the student, building some mutuality based on shared timing of movement. Such changes in approach were immediately rewarding, both because the students responded positively and because our work in itself became more enjoyable.

There followed a spiralling effect of positive change. Gentler, more playful work with individual students was found to be more enjoyable and effective and so was generalised to work with other students. Rudimentary game sequences like ‘I’m going to get you …’ were repeated and developed such that students not only laughed at the game, but began to anticipate its climax and signal a desire for more. Gradually, this kind of activity moved from the periphery of the school curriculum to its core. We began to use playful approaches to bring students to the table to perform a task, but the task soon diminished in importance in favour of the play itself. With many individuals we tended to stop doing tabletop activities such as inset puzzles in individual teaching slots and instead engaged in free-flowing interactive play, usually without any equipment or prescribed task. With different expectations we freed ourselves to go and sit in the corner on the floor with students, where they felt safe, and to join them there in their self-absorbed world. By gently joining in with their rocking or humming rhythms we were able to capture their attention and establish some mutual pleasure; achieving this with students who had previously always rejected our approaches was really encouraging.

Without at first realising it we stopped dominating the classroom with our rules and choice of activity and began to be responsive in a very basic kind of negotiation. In allowing ourselves to use our natural teaching styles we adjusted our interpersonal behaviours with the students, which made us more interesting and accessible to them. With this and our improving abilities to read the students’ signals, we were able to avoid many of the violent outbursts to which we had become accustomed. The emerging calm and non-confrontational atmosphere also meant that the more anxious students were able to relax, the more active students began to slow down, and the challenging behaviours became less frequent and less challenging.

Aware of the demands of accountability we began to formalise our new curriculum. We re-wrote individual programmes with new aims and new strategies and explored ways of recording our activities and our students’ progress. We addressed the growing gulf between our written curriculum and our actual practice and we looked more and more to the theoretical literature to understand and talk about the new structure of our work.

As the students made significant gains in relatively short periods of time we became aware that the work we were doing was important. We shared what we were doing with other teachers and increasingly with staff groups working in social services and health authority day centres and residential establishments, finding what was (and continues to be) great interest in the approach. We (the authors) undertook formal research projects to gain greater understanding of how the approach worked, the results of using it, and how effective it was in enhancing social and communication development. This dissemination and research has continued. The adoption of Intensive Interaction is widespread, though inconsistent. The evidence base has grown and this is discussed in chapter five.

WHAT IS INTENSIVE INTERACTION?

Intensive Interaction is the name we have given to the approach that culminated from the period of curriculum innovation we have described. Intensive Interaction makes use of the range of interactive games that have been shown to occur in interactions between infants and their primary caregivers. Some aspects of the caregiver role in such interactions are emulated by the person using Intensive Interaction. The practitioner attempts to engage the learner in one-to-one interactive games with the emphasis being on pleasure first and foremost. This involves practitioners in modifying their usual body language, voice and face, in order to make themselves attractive and interesting to their less sophisticated partners. A central principle is that the content and the flow of the activity follows the lead of the learner through the practitioner’s responding to her/his behaviour. The intention is that the teacher and the learner become jointly focused on each other, that they share some mutuality, and that they want to repeat this enjoyable experience. There is generally no particular task to be achieved and the focus is the quality of the activity of the two participants, often with the practitioner building a game from an action, facial expression or sound made by the other person. Teachers using Intensive Interaction substitute the formal pre-structured teaching role with intuitive abilities to interact at this fundamental level.

The interactions are often brief in the early stages and largely exploratory, though it is the intention that they become longer and more sophisticated over time. The practitioner facilitates the learner’s increasing involvement in the games, such that they become more active and the exchange becomes more mutual. With the learner’s involvement in increasingly elaborate games, the process brings about the development of more complex communication abilities such as use of facial expression, anticipation and turn-taking.

As well as playfulness, sensitivity is a major theme of Intensive Interaction. The interactive sequence can be seen to be a highly sensitive response network to the signals and feedback of the learner. The practitioner continuously and largely unconsciously adjusts her or his input to gain and maintain the person’s interest and emotional arousal. With more sensitive interpersonal contact, the learner’s behaviours – which may have been regarded as meaningless – can become readable cues and be treated as communications. The learner’s signals of desire to change or end an interactive game are respected and staff learn ‘when to initiate or respond to a variation, when to “play safe”, when to continue, and when to cool down’ (Nind and Hewett 1988: 56).

The content of the interactive sequences in Intensive Interaction varies with each pair of participants and with every occasion; what happens is spontaneous and responsive rather than pre-planned. The nature and intensity of the activity varies between, for instance, noisy rough and tumble, intense mutual face-to-face studying or simply sitting together in physical contact. Though never exactly the same, some games are repeated over and over and some have widespread popularity. We include in this the games that centre around tension and expectancy, such as peek-a-boo, ‘I’m going to get you …’ and ‘round and round the garden’; games that involve shared rhythm, such as rocking in unison, swinging arms as you walk, taking turns to hum; and games that involve bodily contact and movement, such as blowing raspberries and rough and tumble. Many of the learners with whom this approach is used start from a position of avoiding all contact with other human beings, therefore sharing personal space and getting involved in simple games such as these are achievements in themselves.

Much of the content of Intensive Interaction will be familiar to readers as part of what they do in their everyday communications and good practice. Use of interactive game becomes Intensive Interaction when we give structure and deliberate progression to the interactive processes that are not normally rationalised or intellectualised. Indeed, one of the challenges of the method is to retain the power of intuitive responding, while supplementing it with the benefits of careful analysis to maximise the potential of the interactions. Intensive Interaction facilitates the learner’s progression from passivity or non-engagement in the games, through reciprocity in which the learner has an active role and is aware of this, to eventual initiation and leading of interactive games. The approach involves the participants in the kind of learning experiences and processes through which sociability, emotional well-being and communication usually develop in infancy. It is the process rather than the outcome of the sequences that is central to the method.

INTENSIVE INTERACTION BEYOND THE CLASSROOM AND THE INSTITUTION

Although Intensive Interaction was initially developed as an educational approach it has since developed as a way of working for anyone who is in direct contact with people with severe learning difficulties who are pre-verbal. It is particularly for those who have a desire to find more effective ways of relating, who want to facilitate better communication, to enhance general development, and who want to enjoy better social contact with their clients/students/children.

We have spent some years now travelling around different establishments sharing our experiences and exchanging ideas with practitioners from all disciplines. It is noteworthy that Intensive Interaction is as interesting and relevant to social workers, carers and therapists as it is to teachers.

Perhaps one of the beauties of Intensive Interaction is that most of us already have most of the skills and abilities the approach requires. Intensive Interaction is less about formal teaching, instructing or training and more about facilitating learning. Investigation of the processes of caregiver-infant interaction shows us that what the caregiver does, guided by feedback and signals from the infant, is to provide a social environment in which the infant feels safe and motivated and in which competence and understanding can develop. Providing such an environment for people with severe learning difficulties who are pre-verbal is not just a concern for teachers.

Intensive Interaction can be used, as it was at Harperbury, as the essence of what you do for the majority of the student/client group, or it can be used in part with one or two people. Some practitioners are using aspects of the approach to inform their movement sessions, to guide the quality of their caring routines, or to try to reach one individual for whom all else has failed. After adapting their interpersonal behaviours and becoming sensitive to the subtle cues of the person they are trying to reach, however, staff invariably find that they do not want to (and cannot) limit this to a particular person or time of the day. Intensive Interaction can be taken up in different ways, but it does have its own momentum.

The practical guidelines and case studies later in the book will illustrate that interactive games can take place anywhere – a spontaneous sequence whilst preparing food together can be just as worthwhile as anything happening in a classroom. The fact that this approach does not entail pre-planning or structure in the usual rigid sense, actually makes the classroom a less ideal environment than the living room or kitchen. Classrooms can, of course, change to become more relaxed. From our experienc...

Table of contents

• Cover
• Halftitle
• Dedication
• Title
• Copyright
• Contents
• Acknowledgements
• Introduction
• 1 What is Intensive Interaction?
• 2 The Theoretical Background to Intensive Interaction
• 3 How Knowledge of Infant Learning Helped the Development of Intensive Interaction
• 4 How to do Intensive Interaction
• 5 Wider and Related Issues
• 6 Case Studies
• Glossary
• Bibliography
• Appendix: Contacts and further resources
• Index