Controlled study of the impact on child behaviour problems of Intensive Interaction for children with ASD

Abi Tee & Phil Reed (2017) Journal of Research in Sp. Ed Needs, 17 (3), p.179–186.

This study explored the effect of a home-based Intensive Interaction programme on 40 boys with autism, with the boys’ levels of challenging behaviours compared to a control group. The study also looked at predictors of the success of the intervention, including levels of depression in mothers.

Materials: The Social Communication Questionnaire (SCQ) was used to evaluate ASD symptoms; the Strengths & Difficulties Questionnaire (SDQ) used to evaluate the emotional and behavioural disorders, and the Hospital Anxiety & Depression Scale (HADS) used to assess the severity of anxiety and depression in mothers.

Interventions: 1-2 hour Intensive Interaction sessions were conducted 5 days a week in the child’s home after school by university student tutors who were trained in Intensive Interaction. These tutors followed the child’s lead by joining in with, imitating or commenting on their actions, with timing and rhythm used to gain and hold the child’s attention. The children in the control group were involved in group/outdoor activities in the 1-2 hour period; they did not receive Intensive Interaction.

Procedure: Prior to the intervention, a child psychologist assessed the children’s intellectual and language functioning; with both groups matched on these functioning variables as well as by age. Also the children’s mothers completed the SDQ, SCQ, and HADS questionnaires. After the 6 month programme period, mothers rated their children’s behaviour again by completing another SDQ.

Results: There were no differences in SDQ scores prior to the intervention. The problem behaviour scores decreased in both groups over the 6 months, with the Intensive Interaction group’s score only slightly more than the control. A between-subject analysis of covariance revealed no statistically significant effect of intervention;   3 participants in the Intensive Interaction group showed a clinically significant reduction in problem behaviour, whilst using the same criteria, 3 participants in the control group also showed a clinically significant reduction in problem behaviour.

Discussion: A number of potential factors were identified to explain the results; firstly, this study was the first to compare the effectiveness of Intensive Interaction to a control group. Secondly, participants in the control group went to a SEN school where staff are well-trained in ASD, thus the effects of employing a home-based intervention may not be noticeable. Finally, receiving 1-2 hours of Intensive Interaction for 6 months may not have been long enough to show a significant advantage over the control group.

The results do provide some insight into the predictors of improvement; less challenging pupils responded best to the programme, and therefore more appropriate targeting of Intensive Interaction could benefit some children. In addition, the child’s progress could be mediated by levels of the mother’s depression, highlighting the importance of working closely with parents in the planning of interventions.

Although the results suggest that Intensive Interaction is not effective in reducing problem behaviour in children with ASD, the literature demonstrates that pupils with problems besides ASD benefit from Intensive Interaction. Future studies should therefore include a wider range of outcome measures (e.g. adaptive and social functioning) to enhance our understanding of the impact of Intensive Interaction.

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