Jacob’s journey: developing sociability and communication in a young boy with severe and complex learning disabilities using the Intensive Interaction teaching approach.

Kellett, M. (2003) Journal of Research in Special Educational Needs, 3(1), 18–34.

This paper reports on the use of Intensive Interaction with Jacob, an 8 years old boy with severe learning difficulties. A multiple-method methodology was used, with the findings showing substantial progress in sociability and communication: Jacob’s stereotyped behaviour was also observed to substantially reduce.  

Methodology: a multiple baseline interrupted time series methodology was used, with 6 children (across 3 special schools) given different baseline and staggered intervention phase starts.  Video data was gathered alongside 2 assessment schedules (see below). Jacob was filmed over a 5 week baseline and a 42 week intervention phase, and various social behaviours were coded. Also a teacher’s log was kept alongside sessional Intensive Interaction reflection sheets. 

Jacob’s profile: Jacob had severe learning difficulties (he was pre-verbal) and also epilepsy and physical impairments. He was unable to weight-bear or sit for long periods, and would often become distressed and was prone to self-injury e.g. banging his head or elbow. He was reported to spend most of his time in social isolation, engaged in various forms of stereotyped activity.

The Intensive Interaction sessions: a teaching assistant, Emma, volunteered to work with Jacob with the support of the class teacher. Initially Emma had to work hard to gain Jacob’s attention, and she decided to work with Jacob out of his wheelchair. She sat Jacob face to face on her knee, and responded to any of his actions (even burps & sneezes) with an imitation or a positive comment.  Jacob continued to engage in his rocking activity when on Emma’s knee, but she turned it into a game: rocking rhythmically with him and singing ‘Row, row, row the boat.’ Jacob loved this – indicating his pleasure with smiles. Soon Jacob was initiating the game, taking hold of Emma’s hands and starting the rocking himself. Other games were introduced e.g. the teasing rhyme ‘if you see the crocodile, don’t forget to scream’, with Emma and Jacob both ‘screaming’ together. As time went by Jacob became more interested in his interaction with Emma, and he would scrutinise her face and engage in eye contact and, on occasions, even stroke her hand or face.

The findings:

• In the baseline phase the percentage incidence of Jacob not interacting averaged 82.9%, but there was an immediate and substantial change once Intensive Interaction sessions began (the average incidence of no interactive behaviours fell to 11.6% in the intervention phase).
• As soon as the Intensive Interaction started Jacob began to look at or towards Emma’s face, with a surge to 75.7% incidence after week 1 of the Intensive Interaction sessions. There was also a second surge to 85% at week 26, after an 11 week gap in the I.I when Emma was ill*. Despite this setback the average incidence of looking at or towards Emma’s face went from 8.4% at baseline, to 48% in the intervention phase.
• Another early and sustained development was the ability to attend to a joint focus, with this increasing from an average of 3.7% at baseline to an average of 65.5% during the Intensive Interaction.
• Two other behaviours that emerged were eye contact and social physical contact e.g. the touching of a hand or a hug, with both these behaviours being completely absent from Jacob’s communicative repertoire before the onset of Intensive Interaction.
• Jacob’s engagement (i.e. a state when Jacob was completely absorbed in his interaction with Emma) showed average incidence figures of 46.4% during the intervention phase compared with 2.6% at baseline.

Observation data from the video was triangulated by the two assessment schedules: Kiernan & Reid’s Pre-Verbal Communication Assessment Schedule and Brazelton’s Cuddliness Scale – these schedules showed no progress in the five weeks of baseline. Jacob was able to achieve 14.3% of the pre-verbal communication descriptors during baseline, but at the end of the study this figure had risen to 56.6%.

Jacob’s baseline scores on the Brazelton’s Cuddliness Scale (a measure of physical sociability) showed him as responding passively to social physical contact – ‘neither actively resisting nor participating’.  But after 5 weeks of Intensive Interaction, this had moved up to point 5 on the scale – ‘usually relaxes and moulds when first held’.  At the end Jacob progressed even further where he, himself, was initiating the social physical contact.

Staff and researcher observations: Discussions with staff showed unanimous acknowledgement of the immense progress Jacob had made since starting out on his Intensive Interaction journey: his self-injurious behaviours had all but vanished; his stereotypical behaviours had greatly reduced; he was much more alert and aware of his peers and environment; he was able to participate in group activities.

Staff were also of the opinion that Jacob had become a much happier child. He had progressed from being a ‘hard to reach’ child, who spent the majority of his time in self-injurious stereotypy, to a happy, socially interactive child who could participate in joint activities, engage in purposeful social interaction and was beginning to use some formal communication skills.