Intensive Interaction … and the potential for social communication regression or ‘Holiday effect’?

If anyone has attended our Intensive Interaction Institute training, they will have heard me talk about the ‘Dual Aspect Process Model‘ of Intensive Interaction (BJLD, 2008). With this model, I claim that the initial phase of communicative development with Intensive Interaction is based on the social inclusion process (when a practitioner of Intensive Interaction successfully develops their person-centred practice to make social interactivity accessible to the recipient person) … and when this inclusion process successfully transpires, then we can often see a quite rapid expansion of the person’s ‘sociability and communicative practice as latent communicative skills are expressed in response to an Intensive Interaction intervention‘ – (see the diagrammatic representation above).

Now, although I didn’t see it at the time of writing, I now realise that I probably missed the most important issue arising from a consideration of this model – that issue being, that if a person (child or adult) can quite rapidly express latent ‘sociability and communicative practice‘, then at some point in the past something must have changed to stop them, or at least not continue to support them, in their active expression of these social communication abilities. Given that, we might plausibly conclude that for such people, their social skills (and/or their motivation to enact these skills) fell away or faded back into a latent state through lack of continuous use; which is a sad, but I would say highly plausible contention.

Indeed, this model was developed because, prior to writing the paper, I had been training over 20 NHS care staff working with adults with either severe or profound and multiple learning difficulties who were reporting just such rapid rises in their sociability (i.e. in days and weeks) after the onset of the use of Intensive Interaction; presumably evidencing the reclaiming of latent sociability skills already present within their adult clients (the timescales being too short to plausibly claim that they were learning these complex and interrelated skills and understandings for the very first time in later life).

So, if this rise in their clients’ sociability was due to the reclaiming of latent skills and understandings, then obviously at some point they must have regressed from a previous position when they did successfully develop and use such prosocial skills and understandings – presumable in their earlier lives; perhaps even back in their childhood.

So something must have gone wrong, and they were no longer able to sufficiently engage and practice their skills of sociability, or they then failed to experience the kinds of meaningful social responses from those around them that would have sustained their sociability at that previous, more elevated or developed level; therefore suggesting a regression or ‘holiday effect’ from interrupted or discontinued use of Intensive Interaction.

But that is only an anecdotally supported contention – even if it is highly plausible. But actually there is some more direct research evidence that supports my contention of a potential ‘holiday effect’ with the discontinued use of Intensive Interaction:

The paper ‘From the Inside Looking Out [FILO] – an Intensive Interaction group for people with profound and multiple learning disabilities‘ (Leaning & Watson; BJLD, 2006) reported on a study of 5 participants with profound and multiple learning difficulties attending a day service. The 5 participants were engaged across 8 sessions (over 8 weeks) with 2 staff using Intensive Interaction with them, and all 5 were evidenced (via video analysis) to have improved in some aspect of their social presentation. However, 4 weeks after the last of their 8 sessions there was a ‘follow-up session’ where it was found that ‘the altered (i.e. improved) frequency of (sociable) behaviours demonstrated by the participants during group sessions reverted back to a rate similar to that of baseline conditions when the follow-up data was recorded’.

So, that evidence of really quite rapid regression – ‘back to a rate similar to that of baseline conditions’ within a month – should be a worry to us all. Also, when I read Mary Kellett’s paper, ‘Sam’s Story’ (SfL, 2000) about a 5-year-old boy with severe and complex learning difficulties, and saw a graph for his ‘average scores for joint focus/attention‘ I thought I also saw some evidence of social communication regression in the scores at the start of each term (which were lower than the average of the previous term). Indeed, it reminded me of my time as a key-stage one primary school teacher who saw, and planned for such a regressive ‘holiday effect’ in the reading levels of Year 1 or Year 2 children – especially after the long summer holiday, after which we would go back two books on the reading scheme to quickly and easily bring their now latent reading performance back up to where it had been before the holiday break.

Now, taken together these two pieces of supportive evidence of a regressive ‘holiday effect’ from Intensive Interaction can not be taken as proof, even with the substantial body of anecdotal evidence being considered as well … but my general feeling about this is that it is certainly so. Why? Well, because I can not think of any other plausible explanation for this phenomenon to be seen so often.

So, if the regressive ‘holiday effect’ in the absence of sustained Intensive Interaction is likely to be present, and to present quite rapidly, then we must acknowledge the possibility of this happening, and then plan to make sure that it doesn’t!

If someone has developed their sociability through the use of Intensive Interaction, then I would say that we all have a duty of care to make sure that the availability of Intensive Interaction is sustained to avoid the potential for this regressive holiday effect. We have to think about generalising the availability of Intensive Interaction across all educational and/or therapeutic services, across all care and health settings, and for all ages and make sure we do so for all the individuals whose lives are so much improved by the social inclusion and developmental progression that comes through the use of Intensive Interaction.

So, once started with Intensive Interaction, we simply should not countenance the possibility of any regression from its vital, life-enhancing effects, and we must do whatever we can to make sure that it continues!

References:

Firth, G. (2008) ‘The ‘Dual Aspect Process Model’ of Intensive Interaction’, British Journal of Learning Disabilities, 37, p.43–49.

Leaning, B. & Watson T. (2006) ‘From the Inside Looking Out [FILO] – an Intensive Interaction group for people with profound and multiple learning disabilities’, British Journal of Learning Disabilities, 34, 103-109.

Kellett, M. (2000) ‘Sam’s Story: Evaluating Intensive Interaction in Terms of its Effect on the Social and Communicative Ability of a Young Child with Severe Learning Difficulties’, Support for Learning, 15 (4), 165-171.