After writing a recent Blog on The use of Intensive Interaction within a Positive Behavioural Support framework (2020, BJLD), it reminded me of a case study that looked at the use of Intensive Interaction with a 67 year-old man with autism in residential care. Below I have copied out a summary of this Good Autism Practice paper:
‘Can adults on the autism spectrum be affected positively by the use of intensive interaction in supported living services?’
Fraser, C. (2011) Good Autism Practice, 12 (2), 37-42.
The case study: Derek was a 67 year-old man with a diagnosis of autism and epilepsy. He lived in a supported living home (and had done for 9 years) and sometimes displayed behaviours identified by staff as ‘challenging’ e.g. incontinence, shouting, repetitiveness, withdrawing to his room, switching lights on and off, pulling his fingernails out. In order to judge the effectiveness of an Intensive Interaction intervention, CF (the author, a residential manager) noted the frequency of these behaviours during and after the onset of Intensive Interaction.
Results and evaluation: when first using Intensive Interaction CF felt that Derek wasn’t showing any real interest in her, preferring to seek out his support worker. But then, after a few sessions of Intensive interaction, the first social response was identified as the exchange of a sigh, with a loud ‘blowing out’ sound. Derek did this and CF echoed it back to him, and Derek then gave a very brief sideways glance towards her. From then on, as CF arrived, Derek immediately sighed; as if to say “Hello”.
During session 3 Derek used CF’s name, and when CF arrived for session 5 Derek’s support worker went to his room and said “Derek, Catherine is here”, at which point Derek said “Catherine”, smiled and jumped up from his bed. During session 8 Derek was observed to use sustained eye contact for the first time.
To increase the reliability of the findings Derek’s support team were asked for their observations. One comment was that Derek had started asking when CF would next come. Other positive changes in Derek’s behaviour, as identified by staff members were:
- He started to spend more time in the lounge (than in his bedroom) and had started to interact more with his fellow residents
- He had stopped flicking lights on and off
- The time Derek spent listening to music through headphones had reduced
- He appeared more patient and did not invade other people’s personal space as much.
Generally, after the use of Intensive Interaction, the observations from the staff team showed an increase in sociability, matched with a corresponding decrease in the number of recorded episodes of ‘challenging behaviour’ (see Table 1 below).
|Behaviour / Frequency||February||March||April||May||June||July|
Concluding comments: in concluding this paper the author (CF) noted that, as a single case study, there was no control or comparison data, making it impossible to conclude that the changes were directly due to the Intensive Interaction intervention. However, during this intervention period, there were no changes in the level of Derek’s support, nor any change in the number of family visits, and no significant changes to Derek’s health, making CF conclude that the use of Intensive interaction ‘might well have been’ the key element in any change (‘No S**t Sherlock’ – GF!).
So, from the evidence generated in this study, it would seem plausible to conclude that for Derek, proactively changing the social environment around him (through the socially inclusive use of Intensive Interaction) positively affected his sociability and behaviour i.e. increasing pro-social behaviours and seeing a corresponding decrease in the frequency of behaviours that challenged staff (and Derek as well).
If Intensive Interaction worked for Derek (and let’s be frank – it did!), I would suggest that it is highly plausible that it will work for many other people in similar circumstances – but unfortunately, we still need more evidence to convince others (including many in positions of power to define ‘good practice’ in such services) to see the obvious positive changes Intensive Interaction can bring for all the Dereks of this world.