Fostering Social Engagement in Romanian Children with Communicative Impairments: Reflections by newly trained practitioners on the use of Intensive Interaction

Zeedyk, M. S., Davies, C., Parry, S. & Caldwell, P. (2009) British Journal of Learning Disabilities, 37 (3), 186-196.

This paper reports on a study on the effectiveness of Intensive Interaction being used in Romania with children with severe communicative impairments. The children, aged 4–15 years in state care, attended a specialist day centre. The children displayed severe developmental delays; no diagnoses were available but their behaviours suggested autism, profound learning disabilities, and sensory impairments). All were socially withdrawn and frequently engaged in self-harm (e.g. biting, scratching or hitting themselves). Many also had difficulties in walking or feeding themselves. 

In this study a group of UK volunteers (aged 16-25 years) worked closely with the children for a 2-week period. They were given a brief training session in the basics of Intensive Interaction, and then encouraged to use it with the children.  After 2 days’ experience, the volunteers were asked to reflect on their experiences of using this approach.

Results and Discussion: Some of the most frequently cited changes in the children’s behaviour were perceived to be: an increase in the children’s attention to their partner; an increase in the amount of positive affect displayed by the children; and an increase in their proximity to others. Such shifts were frequently associated with changes in vocalisations and animation. Finally, increased flexibility and ease in interactions seemed to provide a particularly strong indicator of increased engagement. Also reported was a noticeable decrease in distress and self-harming behaviour in more than one third of the children.

For a small number of children, an additional positive outcome was an increase in the level of their attention to the wider environment, strengthening the evidence that Intensive Interaction promotes interests across a range of domains, rather than the social domain alone.

Overall, the study found that the behavioural shifts predicted in the Intensive Interaction literature were observed by the volunteers. Although the study did not examine the children’s behaviour in detail, the volunteers perceived dramatic and prolonged increases in the children’s social engagement. Below are some extracts from the volunteers’ testimony:

‘I started by just imitating Paula’s actions for a few minutes… then I introduced sounds…  over the next 10 minutes of imitation, she was right next to me and put her hand in my lap, allowing me to stroke her hand and was smiling and even giggling, which I haven’t really seen her do before’. 

‘Today has been amazing … I imitated Andrei, via clapping in different rhythms and also clapping around him, not just the way he prefers to. It means it does feel you are having a conversation with him, or playing a game’. 

‘For the first part of the week, Mircea was very quiet, making only infrequent noises…. When Intensive Interaction was tried, Mircea became much more engaged and began to look directly at the person holding him, rather than over their shoulder’.

‘I think the technique really worked.  Paula didn’t get anxious or upset during the whole session, which really amazed me because normally she gets upset at least once during the session’. 

‘By the end of the week, Flavius actually picked up a toy from the grass, and I’ve never seen him do that’. 

Conclusions: The authors interpret the results of this study as providing qualitative evidence that Intensive Interaction is effective in promoting social engagement in children with severe communicative impairments that arise from (or are at least exacerbated by) poor early care. The findings also demonstrate that such increases can be identified by practitioners as soon as they complete their training i.e. it appears that practitioners begin to be able to generate such encouraging outcomes with minimal training.  

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