(Based on ‘The History and Development of Intensive Interaction: What is it? … and where did it come from?‘ by Graham Firth in Doswell & Ellis (Eds) (2026) Integrating Intensive Interaction Principles into Psychological Practice, London: Routledge.)
So, what is Intensive Interaction?
An early and concise definition of Intensive Interaction was put forward by the British Institute of Learning Disabilities (BILD), which stated that:
‘Intensive Interaction is a practical approach to interacting with people with learning disabilities who do not find it easy communicating or being social … In Intensive Interaction, the carer, support worker, speech and language therapist or teacher works on being a better communication partner and so supports the person with learning disabilities develop confidence and competence as a communicator.’
(Accessed at: http://www.bild.org.uk/docs/05faqs/ii.doc on 13.10.07)
So, perhaps at its most basic level, Intensive Interaction should be seen as an interactional process that aims to develop and sustain positive, developmentally pertinent social communication for and with people who, for a number of reasons, have difficulty interacting and being social.
Acknowledging the socially inclusive nature, whilst underlining the clear developmental aim of the approach, Melanie Nind and Dave Hewett (the originators of the approach) say that Intensive Interaction is ‘… an approach to teaching and spending time with people with learning disabilities, which is aimed specifically at the development of the most fundamental social and communication abilities’ (2001).
In the early stages of the development and dissemination of Intensive Interaction, the people who were then seen as potentially benefiting from the use of the approach were people with severe or profound learning disabilities, sometimes also combined with a diagnosis of autism. Indeed, the first groups of people with whom Intensive Interaction was used during its development were those perceived as socially remote or passive. Therefore, the early recipients of Intensive Interaction were generally people who didn’t tend to initiate social interactions with other people, and who might also engage in a variety of repetitive self-stimulatory behaviours. The approach was also used with people with multi-sensory impairments who, at the time, were perceived as uninterested (or unable) to engage sociably with those around them.
Generally, Intensive Interaction was then seen as an approach to providing people with positive, developmentally useful experiences of social inclusion and emotional connection, where such experiences had previously been absent. It provided people with opportunities to gradually acquire and develop the fundamental communication skills necessary for social interaction. Thus, Intensive Interaction enabled such people to socially and emotionally connect with those people closest to them, both physically and emotionally.
These Fundamentals of Communication (FoCs), as identified by Nind and Hewett (1994, 2001), are the foundational social communication skills and understandings that, in typical development, are generally learned before the development of symbolic language. Therefore, a central feature of the approach is that Intensive Interaction is built around the social practices and understanding which most of us already possess, since they are those that we mainly intuitively use when sociably interacting with pre-verbal infants, i.e. by being unconditionally responsive to what the infant does, and shaping our interactive behaviour to fit it within their current level of social understanding.
Looking at the process in more detail, the generally accepted techniques of Intensive Interaction are those associated with infant-caregiver interactions and were initially described in the first book: Access to Communication: Developing basic communication with people who have severe learning difficulties (Nind, M. & Hewett, D. 1994). But perhaps a more succinct description is that given by Melanie Nind in her 1996 paper ‘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), who identified ‘5 Central Features’ of the approach:
- The creation of mutual pleasure and interactive games – being together with the sole purpose of enjoying each other.
- People adjust their interpersonal behaviours (e.g., their gaze, voice, posture, facial expression) to become more engaging and meaningful to the person with a learning disability.
- Interactions flow naturally in time – with pauses, repetitions and blended rhythms.
- Accrediting Intentionality: accrediting people, even with severe or profound disabilities, with thoughts and intentions, and responding to their behaviours as if they are intentionally communicative.
- The use of contingent responding: following the person’s lead and sharing control of the activity.
Actual sessions or periods of Intensive Interaction can vary widely between participants and occasions, with individual techniques employed in highly person-centred ways. Thus, the intensity, form, and pacing of any interactive episode can vary widely within and across sessions, depending on the participant’s current presentation.
Therefore, it is perhaps an overarching Intensive Interaction philosophy that sets the approach apart. Intensive Interaction has a clear value base in which people are seen as positive social agents, who should be valued on a human level for who they are, rather than being defined by what they can or cannot do. According to Adrian Kennedy (a Learning Disability nurse), ‘The difference between participation and compliance is at the very core of the Intensive Interaction approach…’ (LDP, 2001). The socially responsive philosophy of Intensive Interaction could perhaps best be characterised as a combination of the following:
- A desire on the part of the practitioner (a carer or support worker, a teacher, or a therapist) to sociably interact with someone with a communication or social impairment in a way that is meaningful to him or her, and through such interactions come to know the person better.
- A desire on the part of the practitioner to develop an equitable and mutually respectful relationship with the person.
- A determination on the part of the practitioner to socially and emotionally attune to the person and achieve the maximum level of social and emotional connection by allowing the person to dictate the form, intensity, and pace of the interaction.
- A determination by the practitioner to create an emotionally secure and empathic social environment around the person, paying particular attention to the person’s moment-by-moment feedback, in whatever form it takes.
Generally, the techniques used for Intensive Interaction are those based on the ‘infant-caregiver’ model of interactivity, and thus might include a combination of: the sensitive use of non-task associated physical proximity; contingent and responsive eye contact and facial signalling (sometimes with overtly dramatised or characterised facial expressions); some forms of socially significant physical contact (perhaps with a rhythmical basis); vocal echoing and responsiveness with clear and inclusive intonation; some form of behavioural mirroring and/or joint-focus activities or well-rehearsed game like interactions.
So, when practically applying the approach, the practitioner uses the person’s behavioural repertoire, and personal interests or motivating factors, as a starting point and guide. Thus, any interactional activity is either initiated by, or contingent on, the positive engagement of the person. Also important are the general issues of tasklessness and mutual pleasure that set the demand-free agenda for any Intensive Interaction activity or session, rather than focusing on the accomplishment of any predetermined outcome or structured task. Any social interactivity thus takes place within familiar and enjoyable interactions; the content and flow of the activity being defined by letting the person lead the interaction, with the carer, support worker, teacher or therapist responding to and joining in with the person’s current behaviour.
Such a combination of the general philosophy and the practical techniques of Intensive Interaction might make the approach seem hypothetically complex and thus difficult to apply in practice, but because it is naturalistically grounded in the infant-caregiver model of interactivity, most people find Intensive Interaction unproblematic and often quite enjoyable to do. However, like many things in life, the skills of utilising Intensive Interaction tend to further develop with continued practise and subsequent supported reflection.
Perhaps of central importance to the Intensive Interaction philosophy, whereas some approaches started from a perspective of seeing a person with a learning disability and/or autism to be in some way an impaired or inferior version of some normalised ideal (i.e. someone who needs to be supported to change in some specified ways identified by practitioners with specified qualifications), Intensive Interaction starts with the premise that anyone can do it, and that anyone who receives it is already interesting and enjoyable to be with. As one parent (anonymous) once said of Intensive Interaction: ‘through Intensive Interaction we can shift our vision of our sons and daughters from impaired versions of us, to fulfilled versions of themselves’.
To set out a richer, more contextualised picture of Intensive Interaction, a historical view of its development might be helpful.
The history of Intensive Interaction development:
Before Intensive Interaction: what was going on?
Before setting out the initial development of what was to become Intensive Interaction, it is perhaps useful to know something of the general learning-disabilities provision before the staff team at Harperbury Hospital School began their action-research endeavour that resulted in the approach known as Intensive Interaction. The history of educational and care provision for people (both children and adults) with severe or profound learning disabilities may provide a contrasting and informative backdrop to the development of the more person-centred approaches generally accepted as good practice and therefore more widely used today.
In the UK, before 1970, children with severe and profound learning disabilities were statutorily deemed to be ‘ineducable’. However, things changed with the Education (Handicapped Children) Act 1970, when responsibility for the education of this group of children shifted from the Department of Health to the Department of Education. From this point onward, all children were entitled to some kind of education.
Also at this time, for adults with severe or profound levels of learning disability, life-long hospital care (or incarceration) was often accepted as the norm. There was little agreement on what to do with such people, and thus, the major focus was on personal care. This phase of specialist care and provision has been described simply as ‘Tender Loving Care’ (Ouvry, 1991) with little or no thought given to educational or psychological development.
Then came a phase generally identified as ‘Stimulation’, aimed at usefully challenging the perceived passivity of this ‘TLC’ viewpoint. Thus, activities were developed to interest and, in some ways, perceptually or even physically stimulate the participants, e.g. via multi-sensory rooms, musical activities and/or ‘rebound’ activities (supported trampolining). However, such stimulatory activities generally lacked clearly defined educational or developmental aims. Thus, such learners (if that was the right description) were often engaged in activities that they had not chosen and had little or no control over. Also, they were often given no choice, and probably had little or no understanding of the purpose of such activities.
The next identifiable phase has been labelled the Behavioural phase (Irvine, 2010), which attempted to address the inadequacies of stimulation by predeterminedly structuring activities and identifying externally formulated behavioural outcomes for the person. Thus, teaching became outcome or goal-oriented, with specified learning targets being set for individuals and programmes written and carried out by staff. Again, the learner had little or no control over what was being done to them. It was during this phase, when the special education use of ‘behaviourism’ was at its most prevalent, that some educational, psychological and care practitioners began to question what they were doing and why (see: McConkey, R., 1981).
(For a more detailed description of these care and educational phases, see Cath Irvine (pages 22-25) in Understanding Intensive Interaction: context and concepts for professionals and families (JKP; 2010))
The Intensive Interaction Development stage – Harperbury Hospital School:
The early development work on the approach that has become known as Intensive Interaction came about due to the teaching staff at Harperbury Hospital School (in Hertfordshire, England) rejecting what they saw as the application of ineffective and ethically questionable behaviour modification techniques with their student group, young adults with severe or profound and multiple learning disabilities. They recognised that communication was their students’ primary learning need as it was the key to all subsequent learning, but then also questioned why they were trying to teach representational signing to students who did not have any apparent understanding of symbolic language. They therefore saw little educational sense in what they were doing.
The staff team then employed an action-research methodology to initially identify their students’ ‘primary learning needs’, these being the skills, understandings, and motivation to want to socially interact with those people around them. To achieve these learning outcomes, the staff team, led most notably by Dave Hewett and then Melanie Nind, started to collectively reflect on how they might best facilitate their students’ learning, or further support the development of their ‘fundamental communication’ abilities (Nind & Hewett, 1994).
In 1981, the Harperbury team began discussing and testing ways to develop a curriculum that focused more on their students’ social communication skills and understanding, rather than on their perceived deficiencies in symbolic communication. They endeavoured to foster sociability in the classroom, and thus to begin building positive, even playful, relationships with the students.
Early on, the idea of creating an ‘Appropriate Communication Environment’ (ACE) emerged; this ACE idea established a central requirement for staff to promote engagement by being more playful and responsive in their interactions with their student group. The Harperbury staff team also started to use what would now be termed ‘video analysis’, with staff looking back analytically at recently recorded video (using the earliest widely available video technology) to reflect on the observable outcomes of their interactions and consider how they might improve their interactive practices.
In 1982, some of the staff began to look at the work of clinical psychologist Geraint Ephraim, who was working at another ‘Hospital for the Mentally Handicapped’ in the locality. Dr Ephraim was using an approach to developmentally informed care that he called ‘Augmented Mothering’ (1982). Dr Ephraim had developed this ‘Augmented Mothering’ approach by advocating for interactions based on a continued adoption of a ‘caregiver-infant’ model of interactivity, even into adulthood. During meetings with some of the Harperbury staff team, Dr Ephraim encouraged them to build on their work by accessing the then-available literature on ‘parent-infant’ or ‘caregiver-infant’ interactions; this they, mainly Melanie Nind and Dave Hewett, did over the subsequent years.
Finally, by 1987, Nind and Hewett had become confident in clearly defining their approach, now called Intensive Interaction, and had seen compelling evidence of its educational efficacy, i.e. highly significant positive outcomes for many of their students in the development of their sociability and fundamental communication skills. That year, they were invited to give a presentation on their work at a conference called ‘Interactive Approaches to the Education of Children with Severe Learning Difficulties’, held at Westhill College, Birmingham (even though they had initially only been attending as delegates). This conference is often cited as the beginning of the Interactive phase of care and educational provision for people with learning disabilities.
This initial presentation on Intensive Interaction was then followed by an article ‘Interaction as Curriculum’ in the British Journal of Special Education (June, 1988). It was at this time that the generally ‘bottom-up’, practitioner-led dissemination of Intensive Interaction began, with Nind and Hewett giving further presentations on the approach at a number of conferences and providing training sessions for staff teams across the UK.
The theoretical background to Intensive Interaction
The development of Intensive Interaction was underpinned by an increasing understanding of the developmental research and literature then available in the 1980s. Nind and Hewett focused particularly on academic research and associated theory, focusing on the development of communication and sociability within ‘the interactive process in the natural model of infancy’ (2005, p.16). They identified three important themes that ran through their extensive search across this body of literature:
1. Early social and communication development takes place within a dynamic social process (e.g. Schaffer, 1977; Newson, 1979).
2. The developing infant is an active participant in their own social and communication development (e.g. Brazelton et al, 1974; Schaffer, 1977; and others).
3. There are evidenced differences in the social learning environments created for infants with or without developmental disabilities (Bromwich, 1981; Walker, 1982; and others).
Nind and Hewett went on to look in further depth at what they describe as the ‘dynamic social context of early learning’ (2005, p.17). They point to the influential work on socialisation and development by Bell (1968) and Lewis & Goldberg (1969) in this area as demonstrating the mutuality and interdependence of this early caregiver-infant reciprocity.
From the 1970s, the works of Brazelton et al (1974) and Trevarthen (1974, 1979) set out in some detail the dynamic nature of this ‘transactional model’, one in which ‘the infant has an effect on the environment, and the environment has an effect on the infant, and so on’ (2005, p.18). The overall picture emerging was that of the infant as an active agent in their own developmental process, rather than a passive recipient of caregiver stimulation. The work of Stern (1974) also pointed to the modified caregiver facial and vocal behaviours observed in caregiver-infant dyads, with the term ‘motherese’ used to describe a particularly rhythmic and intoned vocal register.
Also seen as intrinsic to the process of early interactivity (and subsequently with Intensive Interaction) is the development of mutual pleasure; this also being the primary motivation for its continuation and frequent repetition. Stern et al (1977), Trevarthen (1979) and Bruner (1983) all point to the evolution of such mutually generated pleasure within interpersonalised games and playful routines, with such social exchanges being dynamically ‘scaffolded’ (Bruner, 1983) by the adult participant in such a way to maximise the engagement of the child – again this process being replicated in Intensive Interaction exchanges.
Overall, across their studies into the supporting academic literature, Nind and Hewett identified an interactive style that seemed ‘optimal in terms of the developmental and learning outcomes’ accruing for the child (2005, p.25). Citing the work of Bruner (1975; 1983), the social, emotional, and cognitive development of the child was seen as ‘intertwined’ and ‘interdependent’, progressing together with the development of mutual trust and secure attachment, which are integral to the process.
(For a more detailed description of the theoretical background to Intensive Interaction, see Nind, M. & Hewett, D. (2005) Access to Communication: Developing basic communication with people who have severe learning difficulties (2nd Ed). London: David Fulton Publishers. pages 16-41)
The post 1988 dissemination stage:
At this time, the responsive, naturalistic nature of Intensive Interaction was seen by many as extremely radical, drawing both positive and negative responses from practitioners and academics in the field as the approach became more widely recognised and practised.
As the practices and understanding of Intensive Interaction gradually disseminated in the early stages, its introduction into care settings and classrooms where behavioural techniques had previously been used prompted keen reflection and, at times, resistance among some staff. Carers and teachers were now being asked to join in with, or reflect back to people, activities and/or behaviours that they had previously been taught to ignore, discourage, or even prevent. Some staff were worried they might be reinforcing functionally ineffective or even inappropriate behaviours, rather than seeing a person’s behavioural repertoire as a form of communication that they might acknowledge and use to make a social and emotional connection.
Another stumbling block to the early dissemination of Intensive Interaction in the 1990s was the principles of ‘Normalisation’ (Nirje, 1969), which were widely embraced by learning disability services at that time. Initially developed in Scandinavia in the 1960s, Normalisation was a set of principles that sought to give people with learning disabilities access to living conditions and a culture of respect that more closely matched that enjoyed by most other people across society. Unfortunately, in many adult settings in particular, normalisation then evolved into a less nuanced set of ‘age-appropriateness’ principles which pointed services and staff to unreflectively promote activities based on a person’s chronological age, rather than on what would be deemed developmentally appropriate, i.e., activities at a level that someone with learning disabilities could understand and join in with.
So, the introduction of Intensive Interaction with its basis in ‘infant-caregiver’ interaction models, into settings where ‘age-appropriateness’ principles had been, and perhaps still might be unreflectively applied, was (and sometimes even now, continues to be) problematic. However, moving forward, the general dissemination of Intensive Interaction was aided by the increasing acceptance of the ‘person-centred’ philosophy of care, which specified individual care or educational needs. This subsequently made Intensive Interaction seem more relevant and/or appropriate for some services.
The further dissemination and development of Intensive Interaction can perhaps best be represented by a number of continuing steps forward in its broader recognition and understanding:
- The 1990s saw the first Intensive Interaction research papers published in academic, peer-reviewed learning disability journals. These early research studies (e.g. Watson & Knight (1991) An evaluation of Intensive Interactive teaching with pupils with very severe learning difficulties) started to provide increasingly compelling empirical evidence of the positive outcomes of Intensive Interaction.
- In 1994, Nind and Hewett published the first book on Intensive Interaction, ‘Access to Communication: Developing the Basics of Communication with People with Severe Learning Difficulties Through Intensive Interaction’. From this point onward, the principles and practices of Intensive Interaction became increasingly accessible to staff working in learning disability provisions. Thus, at an increasing rate, Intensive Interaction was becoming established in more and more special schools, and also in some adult services across the UK. It was also at this time that Intensive Interaction began to gain more recognition and practice internationally.
- In 1996, the European Journal of Special Educational Needs published a pivotal research paper by Melanie Nind titled ‘Efficacy of Intensive Interaction: developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver-infant interaction.‘ This paper clearly sets out robust findings of positive developmental outcomes across all its participants.
- In 1998, the second Intensive Interaction book was published: Interaction in Action: Reflections on the Use of Intensive Interaction (edited by Hewett and Nind). This book included chapters not only from Dave Hewett and Melanie Nind, but also by parents, carers and professionals describing their day-to-day work using Intensive Interaction. This book helped clarify the purpose and practical application of Intensive Interaction, whilst also providing the first multi-disciplinary view of the approach.
A new millennium for Intensive Interaction
After 2000, Intensive Interaction became much more widespread in schools and services across the UK, with interest in the approach continuing to grow in a number of countries worldwide. In the early part of the new millennium practitioners from various disciplines, including clinical psychology e.g. Samuel, J. (2001) ‘Intensive Interaction’ in Clinical Psychology Forum, and Samuel, J. (2001) ‘Intensive Interaction in Context’ in the Tizard Learning Disability Review, increasingly added their voice and views into the body of literature supporting the approach, publishing research studies and important position papers that significantly moved Intensive Interaction forward.
At this time, a number of new books were also published, followed by the first training video (Caldwell, P. (2003) Learning the Language. Pavilion Publishing) and the availability of online Intensive Interaction learning resources. A quarterly Intensive Interaction Newsletter was established, and annual Intensive Interaction conferences became a feature of dissemination and development, including in Australia (starting in Brisbane in 2008).
Two important Intensive Interaction milestones occurred in 2009. Firstly, Intensive Interaction was included in the then Qualifications and Curriculum Authority (2009) Planning, teaching and assessing the Curriculum for Pupils with Learning Difficulties: General Guidance document, which covered special educational provision in England and Wales. Also, in terms of adult social care provision, the UK Department of Health policy document Valuing People Now: A new three-year strategy for people with learning disabilities (2009) explicitly stated that people with complex needs should have ‘very individualised support packages, including systems for facilitating meaningful two-way communication’ (p. 37), with Intensive Interaction being explicitly identified as the means of achieving such person-centred communication (p.38).
Where is, and what is Intensive Interaction now?
Things have moved on since the first definitions of the practices and principles of Intensive Interaction were set out, with the conceptualisation and application of Intensive Interaction now broader in its use across a wider range of client groups. Indeed, Intensive Interaction is now used with wider groups of people who might more generally be described as having communication or social difficulties or differences. Such people might include those with multi-sensory impairments, those who have behaviour that challenges, people with serious mental health problems, and some who evidence potentially trauma-related psychological or psychiatric issues such as withdrawal, anxiety, depression and self-injurious behaviour.
Intensive Interaction is also being used with some people who have already developed some or even high levels of speech and/or symbolic understanding, but who, for a number of reasons, e.g. severe autism or demand avoidance, might benefit from further developing their use and understanding of the more foundational aspects of human social interactivity, i.e. the Fundamentals of Communication.
There are also reports of Intensive Interaction now being used with people who have lost their previously attained abilities in the social domain due to late-stage dementia (see Ellis & Astell (2017), Adaptive Interaction and Dementia, JKP), or with those in Minimally Conscious States or with Profound Disturbances of Consciousness. However, with the current use of Intensive Interaction now seen to address the needs of so many groups, it should not be seen as a cure-all or magic wand; it still retains its original purpose, principles, and practices.
No matter who Intensive Interaction is used with, or by whom, or within which care, educational or therapeutic context, there are still clear areas of agreement as to what the approach consists of and is its initial primary purpose. Initially, the main stated focus of Intensive Interaction was the development of ‘fundamental communication’ skills and ‘sociability’. However, more recently, the approach is increasingly seen primarily as a means of building rapport and relationships, or as a way of just sociably ‘being with’ people who find it difficult to be social.
As clinical psychologist Dr Ruth Berry wrote (2010): ‘Intensive Interaction is different things to different people. For a teacher, it is a method of developing a pupil’s communication skills. For a care worker, it is a way of spending pleasurable time with someone who can’t hold an “ordinary” conversation. For a Clinical Psychologist, it can be a way of establishing a therapeutic relationship with someone’.
What a practitioner does, or thinks they do, when engaging in Intensive Interaction can depend on many factors; it is strongly influenced by the characteristics and history of the two people involved, their expectations of the process, and their current context. But perhaps one way to look more generally at Intensive Interaction is to see it as an all-embracing humanistic care philosophy that promotes unconditional social inclusion, truly person-centred social responsiveness, and equitable sharing of the power to define an appropriate form of sociable exchange.
Such a general working philosophy of Intensive Interaction should be seen to encompass the differing aims and professional roles of those who might wish to employ the approach. Such a working philosophy is always there when the Intensive Interaction approach is used to work with different partners or clients, and sometimes with quite radically different working contexts, agendas and hoped-for aims. Such a working philosophy might be used to frame a learning environment to develop fundamental communication skills, to help develop sociability and enhance relationship-building, or to address mental health issues in a therapeutic manner.
So, what sort of thing is Intensive Interaction now? Well, to recap, Intensive Interaction is now considered to have a number of uses, namely, social, educational, and therapeutic. The form that Intensive Interaction takes does not necessarily differ among these three, but the practitioner’s aims may well do.
Perhaps for direct care or support staff, including parents, Intensive Interaction may be a primary tool for developing sociability and mutual responsiveness; for teachers, educationalists and speech and language therapists, it is perhaps primarily a tool for developing a learner or person’s fundamental communication skills. Perhaps a clinical psychologist is more likely to see it as a therapeutic tool used to alleviate a person’s emotional distress and thus promote their emotional well-being. Of course, this is a simplification, as people who fulfil all of these roles might also use Intensive Interaction to fulfil a number of aims simultaneously.
Interestingly, it should also be realised that the benefits of Intensive Interaction can go both ways, with the communication partner, be they family members, carers or support staff, also benefiting from improved communication and social interactivity with the person they care for or work with.
However, as one of the originators of the approach, Dr Dave Hewett OBE once said, the development and dissemination of Intensive Interaction ‘is still a work in progress’.
References:
Department of Education and Science (1970) Education (Handicapped Children) Act. London: HMSO.
Ellis, M. & Astell, A. (2017) Adaptive Interaction and Dementia. JKP: London.
Ephraim, G. (1986) A Brief Introduction to Augmented Mothering. Radlett. Harperbury School.
Firth, G., Berry, R. & Irvine, C. (2010) Understanding Intensive Interaction: context and concepts for professionals and families. JKP: London.
Hewett, D. & Nind, M. (eds) (1998) Interaction in Action: Reflections on the use of Intensive Interaction, London, David Fulton.
Kennedy, A. (2001) ‘Intensive Interaction’. Learning Disability Practice, 4 (3), 14-17.
McConkey, R. (1981) ‘Education without Understanding?’ Special Education: Forward Trends, 8, (3), 8-10.
Nirje, B. (1969) ‘The normalization principle and its human management implications’, in Kugel, R. & Wolfensberger, W. (eds) Changing Patterns in Residential Services for the Mentally Retarded. Presidential Committee on Mental Retardation: Washington DC.
Nind, M. & Hewett, D. (1988) ‘Interaction as Curriculum’. British Journal of Special Education. 15 (2) 55-57.
Nind, M. & Hewett, D. (1994) Access to Communication: Developing the basics of communication with people with severe learning difficulties through Intensive Interaction. David Fulton, London.
Nind, M. & Hewett, D. (2001) A Practical Guide to Intensive Interaction. BILD: London.
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’. The European Journal of Special Educational Needs, 11 (1), 48-66.
Ouvry, C. (1991) Strategies to meet the needs of people with profound and multiple learning difficulties. BILD: London.
Watson J. & Knight C. (1991) ‘An evaluation of Intensive Interactive teaching with pupils with very severe learning difficulties’. Child Language Teaching and Therapy, 7 (3), 310-325.
Connecting with Intensive Interaction 