The ‘Efficacy of Intensive Interaction’ … 25 years on from Melanie Nind’s ground-breaking Intensive Interaction research paper.

Posted by Graham FirthPosted in Research Summaries with Adult ParticipantsTags: Published Research SummariesEditEfficacy of Intensive Interaction: Developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver- infant interaction

This almost snuck past me, but I’ve just realised that it is now 25 years since Melanie Nind had her ground-breaking paper on the ‘Efficacy of Intensive Interaction‘ published in the European Journal of Special Educational Needs.

This research was carried out with 6 students who then lived in an old-fashioned, long-stay residential hospital (for the ‘Mentally Handicapped’ as their learning disability would then have been termed), and they were part-time students at the hospital school. In terms of the methodology of the research, after a ‘baseline phase’ of up to 6 months, daily sessions of Intensive Interaction were then introduced by the staff practitioners, the commencement of the socially interactive sessions being staggered across the student group. This was termed the ‘intervention phase’, which then lasted between 12 and 18 months.

To look at any potential changes in the students’ social presentation, measurements of the students’ behaviour was carried out using specially developed observation schedules and time sampled video analysis. Kieran & Reid’s Pre-Verbal Communication Schedule and Brazelton’s Cuddliness Scale (what a great title!) were also used to triangulate the findings in terms of ‘pre-verbal communication abilities, alertness, responsivity, and warmth’.

In terms of the ‘Results’ of this massive research endeavour … well they will come as no surprise to those of us who have used intensive Interaction in the intervening 25 years. The results included:

  • Each student developed some new interactive behaviour, and these included: ‘looking at the teacher’s face’; ‘contingent smiling’; ‘nestling into the teacher’; ‘exploring the teacher’s face with hands’; ‘maintaining a state of joint focus’; ‘contingent vocalisation’, and ‘taking the hand of the teacher’.
  • There was a greater frequency of initiation of social contact, or the initiation of social contact as a new phenomenon, for all 6 students.
  • All of the students made advances in their communication abilities as measured by the Pre-Verbal Communication Schedule, with progress particularly evident in the areas of vocal imitation, communication through gesture, and communication through the use of sounds.
  • All the students made progress in their reciprocation of warm physical contact as measured by the Cuddliness Scale (look, there it is again, human warmth; is there anything ultimately more important than that? If you know of anything that is, then please let me know!).
  • There was an increase in responses to proximity or physical contact in all the students, such as ‘looking at the teacher’s face’ (3 students), ‘making eye contact’ (2 students), and ‘happy vocalisations’ (2 students). ‘Smiling in a response to a teacher’ also increased for all the students.
  • The frequency of ritualistic behaviours (or ‘organised self-involvement’) was indicated to have decreased for 4 of the students. Also, 2 students whose whole behavioural repertoire had been dominated by ritualistic self-involved behaviours, paused from this in order to engage in socially interactive games.
  • 3 students for the first time ‘spontaneously made contact with a member of staff’.
  • And finally, 2 students who had never been able to make eye contact before, began to do so.

On an individual level (as if all the other multiple findings above weren’t enough), one student changed from being a person ‘no one could relate to, to someone with whom all the staff enjoyed interactive games’, and another student who was ‘mostly sleepy and unmotivated, became alert and responsive, vocalising and waving her arms with the excitement of an interactive game’.

So, in terms of drawing conclusion from this absolutely seminal piece of work (whose importance to people with social or communication impairments can never be over-estimated – I’ve really tried, and I really can’t) this research showed the world that after Intensive Interaction was introduced, all the students made observable gains in terms of their social and communication abilities, with new interactive behaviours seen to emerge as ritualistic and self-involved behaviours decreased.

The research also showed that there were no significant other events concurrent with the onset of Intensive Interaction, and therefore no plausible rival explanations for the developments being caused by anything other than the use of Intensive Interaction.

We are truly indebted to Melanie and her action research team, and of course, the 6 students who were central to the whole research process. They have collectively left us with such a powerful (and methodologically sound) piece of evidence that clearly indicates the vital efficacy of our Intensive Interaction approach.

For the serious students of Intensive Interaction, the full reference for Melanie’s paper is: Nind, M. (1996) ‘Efficacy of Intensive Interaction: Developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver- infant interaction’, European Journal of Special Educational Needs, 11 (1), 48-66.

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