Intensive Interaction with a Woman with Multiple and Profound Disabilities: a case study

Elgie, S. & Maguire, N. (2001) Tizard Learning Disability Review, 6 (3), 18-24.

The Participant: This study reports on the use of Intensive Interaction with a remote and withdrawn 39-year-old woman, Anna, who engaged in serious self-injurious behaviour (SIB). Anna was a blind woman with profound learning disabilities who had lived all her life within the care system. She was ‘extremely emotionally and socially isolated’ and had ‘effectively cut herself off from the outside world’. She was reported as having no verbal skills and ‘used very limited non-verbal communication’.

Anna had engaged in serious self-injurious behaviour since childhood ‘to the extent that her face and eyes had become extremely disfigured’.  To protect her from damaging her face and eyes further she wore plastic arm splints for 25 minutes in every hour.

Prior to the intervention, baseline measures of Anna’s self-injurious behaviours were collated for six months prior to the start of Intensive Interaction. When Anna’s splints were removed she immediately started to self-injure, by eye gouging or pressing her fingers under her collarbone. During the intervention Anna was seen three times a week in her room for 16 weeks by both therapists (a psychologist and an assistant psychologist, named as the authors above), and this was carried out whilst her arms were splinted. The sessions of Intensive Interaction contained physical contact (esp. hand holding), vocal commentary with intonation and sensitively timed vocal imitation. These sessions lasted up to 25 minutes.

The Results: There was ‘an obvious increase in the amount of hand contact’ spontaneous initiated by Anna after the Intensive Interaction began. This was in contrast to her behaviour prior to the Intensive Interactionintervention when no spontaneous reaching out by Anna had been observed, despite the fact that Anna had been receiving the same amount of individual time with a therapist in the six months before the intervention (when the first author was unsuccessfully attempting to engage her in a behavioural program involving reward and tactile stimulation). This new behaviour was seen to be ‘an exciting and striking response to Intensive Interaction’.

The results also showed that Anna made more vocalisations during the Intensive Interaction sessions than when she was alone. According to the authors, ‘the decrease in vocalisation when Anna was alone suggests that Anna’s noises were attempts to communicate with and respond to the therapists’ interactions in a dialogue type fashion’.

However, also included in the findings was the assertion that ‘there was no appreciable change’ in the presentation of the Anna’s SIB (self-injurious behaviour) over time; this was indicated by the authors as being ‘expected at this early stage of intervention, given that she had used self-injurious forms of stimulation for most of her life’.

Some Discussion: Generally, the authors concluded that this study provided further evidence of the effectiveness of Intensive Interaction in ‘the development of social and communicative skills’.

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