Effective Engagement through Intensive Interaction

Sharma, V. & Firth, G. (2012) Learning Disability Practice, 15 (9), 20-23.

This paper reviews research on the effects of Intensive Interaction on the conduct, health and wellbeing of people with learning disabilities who exhibit severe challenging behaviour, and on the wellbeing of their carers.  The authors conclude that Intensive Interaction can benefit clients, carers and staff, but that research is required to encourage developments in policy and practice, and that additional staff training is needed to ensure that Intensive Interaction strategies can succeed.

The authors describe how individuals with severe and/or profound and multiple learning disabilities (S/PMLD) and/or autism may present with severe challenging behaviour, this is ‘behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy’ (Emerson et al, 1988).  Such behaviours can include, but are not limited to, head banging, punching and biting (Oliver, et al., 2003).

The authors also point to a contrasting perspective by Ephraim (1998) that there is no such thing as severe challenging behaviours, and that these are socially aberrant forms of communication i.e. ‘A punch in the face’ is an act of communication, although the message behind the punch may not be understood.

The paper goes on to review existing research with differing results as to the effectiveness of Intensive Interaction in reducing the severity and/or frequency of severe challenging behaviours in individuals with S/PMLD and/or autism (Caldwell, 2010; Nind and Hewett, 2005).

However, the authors mention that previous research suffers from a number of methodological limitations, such as small sample sizes (Elgie and Maguire, 2001), varying practitioner ability/experience (Zeedyk, et al., 2009), varying definitions of “challenging behaviour” and a lack of objective assessment of behaviour pre- and post-Intensive Interaction interventions (Irvine, 2001). These limitations hinder the ability to generalise findings across user groups, and may also explain the lack of adoption of Intensive Interaction by learning disability services.  As such, further methodologically robust research is requested by the authors.

In conclusion the authors suggest that the current body of research indicates that Intensive Interaction techniques can reduce the severity and frequency of severe challenging behaviours, and improve the health and wellbeing of individuals with S/PMLD.  Moreover, viewing the behaviours as a form of communication (Ephraim, 1998) suggests that carers need to ‘learn the language’ of their clients or service users.  Thus, Intensive Interaction encourages carers to listen to and understand what individuals are saying with their body language and facial expressions. 

It is also the author’s view that by adopting Intensive Interaction techniques, staff can communicate more effectively with people with S/PMLD, and introduce them to new worlds of social interaction. 

Finally the authors propose that further evidence of the benefits may encourage policy makers and practitioners to adopt Intensive Interaction practices, thereby enabling individuals with S/PMLD and their families to achieve a better quality of life.

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