Enhanced Interaction Training

Cameron, L. & Bell, D. (2001) Working with People who have a Learning Disability, 18 (3), 8-15.

This article focused on a multidisciplinary intervention to introduce staff to Intensive Interaction and support them in using it with their own clients.

An Introduction: It has been estimated that 50% of people with learning disabilities have significant communication problems (Scottish Executive Review of Services, 2000). However, the diagnosis of a communication problem often masks the other (i.e. the learning disability), and staff working with learning disabled people are typically poor at communicating within their client’s level of understanding (Bradshaw, 2001). It is suggested by Bott et al (1997) that a person’slevel of communication difficulties is also highly related to the frequency of their challenging behaviour.

The Initial Clinical Approach: A young man with a severe communication disorder, severe learning disability and serious challenging behaviour was referred to the authors. He communicated only through vocalisations and a few repetitive words. The authors observed and assessed the client in his normal environment and found staff to be over-estimating his level of verbal comprehension and also the level of intent behind his actions. His attempts to communicate non-verbally were not being observed or responded to. The authors designed a programme aimed at improving staff observation and non-verbal communication. They used sensory objects to promote Intensive Interaction with the client.

The Intensive Interaction sessions resulted in increased eye contact, increased initiation of communication, more frequent vocalisations, and repetitive words said with a more communicative context. There was no challenging behaviour within the sessions. The staff, however, did not accept the progress. They were happy that the client could now express pleasure through clapping, but thought that it would be seen negatively in public. The authors felt that in order for this approach to be clinically effective it would require further commitment from staff.

The Revised Clinical Approach: It was decided that the carer attitude to the client, to the possibility of progress, and to the demands that would result from changing the client’s communicative behaviour would need to be addressed. The authors then saw a non-verbal young woman with self-injurious behaviour. There were six sessions of Intensive Interaction in the client’s home where one author would interact with the client whilst the staff member watched. These sessions were video-recorded and reviewed. The staff member then gradually took over the interactive role.

The Results: Due to the Intensive Interaction intervention, the client made significant communicative changes and the staff member showed an improved ability to match their communication to the client. The improvements included increased responsiveness to non-verbal cues, reduced use of verbal language and an increase in the time given for a response. These gains lasted for over a year.