I am writing this blog here while all is still relevantly fresh, in hope to give some understanding to those looking for what Intensive interaction is, why it is recommended and to share our personal experience with it.
The first time I heard the words “Intensive Interaction”, was probably in our first private speech and language assessment when child was around 2years and 3 months old. The Speech and language therapist had shown us a pyramid of communication, something like this
but told us, that our child was not even on the pyramid, she was under the listening and attention block. Our child had no attention. She was lost in her world and had no interest in observing the environment or people around her. She could do a bit of a play with a toy but would not engage with the adults or peers. I am sure that somewhere in that meeting the words “intensive interaction” were mentioned. There were a further 4 sessions plus a nursery observation and then a report that highlighted this
When the NHS speech and language assessments started at age 2y 8 months on onwards the parents and nursery had been doing intensive interaction (from what little they new at that time without formal training). The NHS report was also full of “intensive interaction” as as shown below by this report that is based on 4 or so SLT sessions.
Her ASD diagnosis at age 2 years 10 months also mentioned Intensive Interaction as part the recommendations, as shown below.
So , we have now established, that Intensive Interaction , is a major tool, in the tool box of Speech and Language therapists. It’s main task is to get a child to start to engage socially and to start to listen and improve attentions and share space and play. As you can see, both parents and nursery got training in Intensive Interaction. I’ll share the training slides when I get a chance. We were encouraged to do Intensive Interaction all days from at least a few minutes a day and to capitalise on opportunities when they arise. Nursery were also reporting that they were doing intensive interaction and that child was showing improved levels of engagement, and showing smiles etc.
We continued to do intensive interaction and so did the nursery. From age 2 to 5, she changed 3 nurseries. One was a bit far from home and noisy. The next was closer, smaller class room sizes and had a one-to-one staff. The third was state/school Nursery , much busier, but she continued to have a one-to-one staff and the staff had access to state funded training, access to Speech and Language Therapists, educational psychologists etc that the private nurseries didn’t have.
So after nearly 3 years of intensive interaction, while “some” progress was made, our child was still stuck in her own world, unaware of her surroundings and her communication limited to using two PECS cards.
There can be multiple reasons for this. Some would say this is success, considering the base line from where she began, I would consider it a failure, in our case, and try to put together some thoughts on why I think so.
First and foremost, when we talk about ASD/ASC each and every child is different and in their own unique spectrum of strengths and weaknesses.
For some children or adults who have profound difficulties and needs, even making the slight sign on acknowledgment of a peer or a brief moment of eye contact may be a huge achievement. For our child it was achieved on and off throughout these three years, but then I feel Intensive Interaction fails to transition into further learning and capitalising on these achievements. No where in the parent training of Intensive Interaction does it say what to do when your child gives you attention. The Intensive Interaction guide stops at the point your child is now giving attention/eye contact, and is now ready for next step.
Even with this accomplished, the Speech and Language Therapist were clueless, and continued to prescribe Intensive Interaction. I had a long call with our NHS SLT, begging them to capitalise on our child now being vocal (due to ABA) and to try and get some real speech and language help in place, but they were adamant that they would still prescribe Intensive Interaction and PECS. They said there was nothing else in there toolkit. It was not until and educational tribunal and an independent speech and language assessment that the NHS SLT change the tune, accepted the child’s needs for speech improvement.
My seconds thought why I consider Intensive Interaction to have failed us is because of what I have read in the research. According to Wikipedia, Intensive interaction was developed by teachers Dave Hewett and Melanie Nind at Harperbury Hospital School in Southern England during the 1980s.
I would encourage parents to read the Wikipedia article but also have a read of intensive interaction research review linked below. Without going into too much detail,
https://www.researchgate.net/publication/271103215_Intensive_Interaction_a_Research_Review
https://www.nationalelfservice.net/learning-disabilities/profound-and-multiple-learning-disability/is-intensive-interaction-effective/
it seems that while Intensive Interaction is hugely popular, there is not enough significant evidence to support that is actually helps. However, the most interesting aspect for me in the research review is that where ever it has been “claimed” to have had an affect, it has been delivered by highly trained doctors, nursing staff, or educators under supervision of the scientists. Yet, when it comes to actually using it generally, it is left to parents and nursery staff who get some rudimentary training, and some new “tips and tricks” to try by the speech and language therapists once every term. And that is it.
This is just not enough. My issue with it all is that if we’d not started the ABA programme, gone to tribunal, and sourced help from professionals who think outside the box, we’d still be doing intensive interaction.
While it may be something that works well with some children, it is in y opinion a tool that needs to be used in a certain way.
It needs to be used by experienced professional in one-to-one capacity, and not left for parents and TAs to do.
There is no data gathering and data analytics associated with this intervention, and thus its efficacy is not measurable and it is difficult to know when a plateau has been reached. Due to lack of data gathering, when left in the hands of parents and TAs, it is prone to low quality of delivery (people making it up as they go along), as there is no corrective feedback, or the feedback is very irregular.
It is to be noted that it is scientific fact that the children’s brains are more plastic when they are young. Thus time and time again, early intervention is prescribed and said to be extremely important. There is a small window of opportunity from age to about 7 when a child can learn a lot. An intervention like intensive interaction that is slow to act and laggard is not suitable for this age bracket in my opinion. By employing this approach we are loosing out on this precious time. Approaches that engage/motivate a child and teach in an accelerated manner are more appropriate, again in my own personal opinion.
I hope that other parents will find our experience of some use, and that they will spend some time doing their own research and check the suitability of approaches that are being suggested for their children, be that Intensive interaction, LEGO therapy, animal therapy , PECS etc.