The Effectiveness of Intensive Interaction: A Systematic Literature Review

Hutchinson, N. & Bodicoat, A. (2015) Journal of Applied Research in Intellectual Disabilities, 28 (6), 437-454.

This paper looked at 15 quantitative and 3 qualitative peer-reviewed papers which examined the efficacy of Intensive Interaction (I.I.) with participants of different ages in both educational and residential settings:

In Nind’s 1996 study, a multiple-baseline study with 6 adult participants, there was some evidence that all participants gained in their sociability and communication, although according to the authors these improvements were not always directly concurrent with the start of the Intensive Interaction, casting some doubt as to the cause.  However, the authors state that Nind gave persuasive arguments for the link i.e. that the participants had long-standing communicative difficulties, many behaviours occurred for the first time after the Intensive Interaction began, and no other events were known to be concurrent with the improvements.

The various studies by Kellett (2000/3/4/5) were said to have unstable baselines and variability in the scores coded, thus limiting the conclusions that could be drawn. In Barber’s study (2008) the extended baseline to post-Intensive Interaction measurement cast doubt on the cause of the improved sociability (and data from only 3 of 11 students was given). Leaning & Watson (2006) reported data from only 3 of 5 participants, although these did show improvements, but the missing data again raised bias issues.  Samuel et al. (2008) reported an increase in social behaviour, but these increases were small (<5% were classed as a ‘noticeable increase’).

Other papers also used video, with Zeedyk simplifying the analysis, thus making it easier to see that all participants increased on their levels of ‘Engagement’ with Intensive Interaction The use of an ABA methodological design by Argyropoulou & Papoudi (2012) provided strong support for Intensive Interaction being responsible for increasing the amount of initiations from the child participant in their study. In all three of the qualitative papers reviewed, sociability was perceived to be enhanced by Intensive Interaction; however, validity was limited in two studies by a lack of clear methodology.

According to the authors the conclusions that can reasonably be drawn from the evidence did not reflect the positive anecdotal evidence reported by practitioners of Intensive Interaction: however, as the authors point out, in a systematic review anecdotal reports are considered ‘insufficient evidence’, and books and dissertations are excluded due to the lack of peer reviewing.

Conclusions: according to the authors ‘any conclusions [about Intensive Interaction] should be cautious due to findings being limited by unstable baselines, AB designs and small improvementsHowever, all papers reviewed found at least some increase in sociability. The research so far could indicate that Intensive Interaction may help to develop communicative abilities; however, the limitations of the studies prevent firm conclusions being drawn’.

The limited empirical evidence did not, in the authors’ opinion, support the powerful claims made by the people who were conducting the Intensive Interaction However they say that this may be due to the difficulty in conducting good quality, methodologically and ethically sound research with people with intellectual disabilities. The authors also commented that the use of video coding of social behaviours in relation to an approach like Intensive Interaction seemed potentially reductionist, and that other methods of assessment might be more appropriate

Summary: Because the studies had clear limitations, the authors stated that they could not firmly conclude whether Intensive Interaction is likely to be a helpful for people with learning disabilities and/or autism.  But, based on the studies examined in this paper, the authors positively offered several ways of increasing the effectiveness of the approach. These include a team based approach and support, so that in-depth exploration of difficult issues can be a component of any Intensive Interaction.

The authors also stated that: ‘to provide Intensive Interaction with the evidence base it lacks at present, the methodological quality of both quantitative and qualitative studies needs to be examined closely, and research, once finished should be submitted to peer-reviewed journals’.

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