What is Intensive Interaction

What Is Intensive Interaction

Imagine you are walking through a supermarket and you hear a person making an odd ululating sound a couple of aisles over. As you continue walking, you can hear other people talking loudly and the shrieking gets louder and more intense. Then you see a girl running towards the sound and as you round the corner, you see her standing beside a boy in a reclined wheelchair, vocalizing to him in a calm, quiet manner and motioning her hands in a strange way. As you watch, the boys piercing sounds quiet and his lashing about calms to gentle hand motions. You have just witnessed Intensive Interaction Therapy at work. The girl was able to communicate with the boy in his own language which, in turn, calmed his anxiety. In his world, being in the store and having the other people with him talking aloud became a sensory overload that aggravated and distressed him. He was unable to communicate in words that the lights of the store were too bright, the amount of stuff on the shelf was overwhelming his thought process and the antagonistic conversation between his siblings was making him upset. His way of relating his distress was to scream and flail because that was his way of interacting and communicating his emotions. The girl was able to understand that and relate to him and calm him down.

Intensive Interaction is an approach for teaching communication skills to children and adults who have autism, severe learning difficulties and profound and multiple learning difficulties who are still at early stages of development (1).

Communication is very different for children and adults who have disabilities and sensory issues. “Talking” is unique for each individual intensive interaction in practice case because no two children who are labeled as being autistic or as having severe disabilities have the same method of interacting with the outside world. For those of us who are “neurotypical” (2), observing the interaction that is deemed “communication” through the Intensive Interaction Therapy, can be perplexing at best, as is seen in the example above.

Intensive Interaction was originally termed “Augmented Mothering” in 1986 by a man named Gary Ephraim who, at that time, was Principal Psychologist at Harperbury Hospital (3) located in London (4). The background on the definition of the therapy name is explained as the back-and-forth interactions that babies receive from their mothers at birth, both vocal words and sounds as well as the body language they read, or communicate with, to and from each other. After a while, it was re-termed to it’s current designation as Intensive Interaction Therapy or IIT, by Melanie Nind and Dave Hewett (see 3). “It became evident that these fundamental abilities are usually learned in the first year of life without being consciously taught…” (5). Not to say that babies that are found to have autism have mothers that do not communicate or hold them, but these babies were born unable to decipher the senses around them in the same way that neurotypical babies are. A soft teddy bear would make a neurotypical baby coo or laugh, but a baby that is possibly autistic may have a very negative reaction such as screaming or clawing at the bear to get it away. It is recommended that babies that suffer from negative touch sensory symptoms should be seen by their paediatrician and possibly referred to a paediatrician who specializes in Autism Spectrum Disorder and touch sensory processing issues. If the issues are addressed early, it is sometimes possible to teach the child to communicate with words but not always likely. The capability of imparting the competence of the skill of speech is typically determined by the child’s severity of disabilities.

The characteristics of each unique case vary widely on the spectrum, but as of the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ASD has now become an umbrella term that has replaced the previous sub-divisions of autism, Asperger’s Syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS). Based on these new criteria, there are 3 levels of severity, level 3 being the most severe and requiring very substantial support. But even the most severe cases can benefit, to an extent, by engaging in IIT, if only for the caregivers’ ability to help the patient be calm in his chaotic world. IIT offers a way for the caregivers to converse on the patients’ level…“We start with ‘observation’ –…We need to think in terms of a “listening with all our senses” to any minute movements, gestures or sounds and especially to focus on what this person is doing at this particular moment… our aim being to draw their attention from their solitary inner world onto ourselves in the world outside, so that their sensory monologue becomes a dialogue, an interactional conversation that we can now share… we need to be aware that a person’s attention may be focused on as little as a small click of the tongue or even their own breathing rhythm, activities that we overlook because they do not have significance for us” (6)

Socialising with an autistic child A neurotypical person generally communicates using a variety of skills that are developed very early on. These skills become almost second nature, meaning the person can accomplish the tasks without consciously thinking about doing them. The skills can be carried out without conscious thought because the brain has subconsciously learned them. They are imbedded and easily performed without active consideration. Some of these skills include being able to concentrate on the person they are speaking to, regardless of outside interference, such as a TV or radio playing, or a conversation going at the next table; learning the nuances of body language, like a bored person nodding off or looking at their phone; understanding facial expression, for instance, a smile showing a person is happy; understanding speech patterns, for example, a lilt at the end of a word in a sentence generally implies a question is being asked; and making eye contact during a conversation which demonstrates to the other person you are engaged in the conversation. All these abilities are needed just to hold a simple conversation. Imagine if you were unable to understand what a smile or a frown meant. Being able to achieve these is commonplace for a neurotypical person, but for a person with autism, their sensory ability to process “normal” communication is, so to speak, shorted out. They process the world differently, therefore, they communicate with it differently. Once the therapist or caregiver can focus on the person’s inner monologue, or self-communication, they notice distinct patterns of behavior in certain situations and the way the person’s body communicates in those situations. For example, in times of distress, the person’s body is rigid, they flail their arms forcefully, and they repetitively wail a loud two note message. When a therapist interjects by wailing the same two notes with just a hint of a change, in most cases, the person will recognize their own intonation and react in the same fashion by repeating or imitating the sound back. In time, this interaction will begin to calm the person and ease his distress. “Our aim is to interact with the child’s brain in a way that does not raise their stress level… As their perception of the world becomes less scary their behavior and capacity to join the world round them normally improves” (7). Once you initiate this interaction, you begin to build a more logical form of communication with the person, which, in turn, starts to build trust and a meaningful relationship between caregiver/parent/therapist and ward/child/patient.

Sometimes, IIT does not work right away. There are times when it may take the person a while to interpret your interaction. This is because the person’s sensory skills are trying to process and decipher your attempt at communication. Your first few attempts at communication may prove futile, but the third or fourth try may elicit a startling laugh out of the person who you didn’t know was even capable of laughing until now. Once parents begin to recognize the messages that their child has been attempting to communicate to them, regardless of the way in which they are communicated, they are better able to understand and care for the needs of their child and to give the child a calmer and, in general, happier life.

Given the advancements in IIT and the capability of these advancements to improve the way of life for thousands of people with autism and severe learning disabilities, it is easy to see why so many people are turning to this type of therapy for help. Intensive Interaction Therapy is not for every person on the spectrum or every disabled person, but after months, or maybe even years, of wondering how they can help their child or the person they care for to be able to communicate their needs, people may want to consider the IIT route for them. It is, at least, a peace of mind knowing that some form of communication may possibly be within reach.

1 https://en.wikipedia.org/wiki/Intensive_interaction

2 individuals whose neurological pathology renders their sensory functioning, social skills and cognitive skills typical… used by autistic individuals to reference the unique subset of differences that define life on the autism spectrum,

3 Phoebe Caldwell, Finding You Finding Me, 1st ed. (London N1 9JB, UK: Jessica Kingsley Publishers, 2006), 13.

5 Melanie Nind and Dave Hewett, Access to Communication, 2nd ed. (New York, New York: David Fulton Publishers, 2005),

6 http://www.intellectualdisability.info/how-to-guides/articles/intensive-interaction-using-body-language-to-communicate

7 http://www.phoebecaldwell.co.uk/work.asp

“About Autism Talk…”

“I can remember the frustration of not being able to talk. I knew what I wanted to say, but I could not get the words out, so I would just scream.”

Temple Grandin

“Autistic children are extremely bright if you can connect to them and bring them into our world. Socially it’s really hard for them, but it can happen.”

Adele Devine