Intensive Interaction

Intensive Interaction is an approach based on our first exchanges in the parent-infant dialogue. The baby initiates a sound or movement, the parent confirms it and, in due course, the baby moves on. For example, the baby may say ‘boo’, to which the parent responds ‘boo’, confirming what the baby has said. After some trial and error, the baby moves on to try out another sound, say, ‘da’. In this way, the baby learns that if they make an initiative (or invitation to communicate), it will elicit a meaningful response.

Intensive Interaction is a way of working with someone using sensory signals with which that person is so familiar that the signals do not trigger sensory distortions or sensitivities. Intensive Interaction uses the individual’s own body language to build up emotional engagement.

Intensive Interaction begins with observation. What is this individual doing? What are they focusing on? We need to look not only at their face, but at all their bodily behaviour – are they scratching their hands? Wriggling their feet? We also need to look at any activities the individual engages in which focus on a particular aspect of the world outside themselves.

The brain may fixate on any of a multitude of activities, ranging from as little as the individual’s breathing rhythm, to fixations on certain activities or themes such as Thomas the Tank Engine, specific computer games or particular tunes or movements. What such activities have in common is that they allow the individual to cut down on the external stimuli which are overloading their brain,  enabling the individual to focus instead on a conversation between their brain and the sensation they are getting from the stimulus.

For example, the brain may say to the finger ‘scratch your hand’ and the hand will send back a sensation message to the brain saying that it has done this. Since the autistic brain often has difficulty in switching off messages, it is easy for it to get caught up in a repetitive dialogue between itself and the source of its feedback –  a ‘do this/done it’ brain/body conversation that goes on and on (perseverates) and makes it difficult for us to get the individual’s attention.

These repetitive behaviours are more than just ‘comforting’, they are the language that the brain understands without having to go through elaborate processing – the sounds, images or feelings seem to be hard-wired in. Far from trying to stop such behaviours, Intensive Interaction actively uses them to engage the individual’s attention. With children and adults on the autistic spectrum, we can use this approach to bypass the sensory processing difficulties they experience.

When we use Intensive Interaction, we are trying to shift our conversation partner’s attention from solitary self-stimulation to shared activity, remembering that what is important is not just what they are doing but how they are doing it. As soon as the individual’s brain perceives something that it recognises as part of its own repertoire, their attention is attracted like iron filings to a magnet.

So we look at what the individual is doing. What we are interested in is not their cognitive capabilities but what they do when they are ‘doing nothing’ – or nothing that we would recognise as so-called organised or purposive activity. Nor must we be judgemental about their activity if they are focusing on something we might wish to discourage, for example, touching the walls, spitting, rocking or banging their heads. It may not be what we want them to do but this is what has meaning for them at that point in time. In the midst of sensory confusion, when they engage in that particular behaviour, they know what they are doing. As parents and practitioners, we have to learn their language so that we can begin to have a conversation with them.

Like the infant in the parent-infant dialogue, the individual needs to know that when they make a sound or movement, they will get a response. The question is, what is the most effective way of building this bridge between us?

If we merely mirror the individual’s behaviours, we may catch their attention but after a while they have a tendency to lose interest. Interaction tapers off. One of the questions often asked by care-givers is ‘what do we do next?’ The answer is, rather than just imitating what the individual is doing, we need to treat everything they do as elements of a language and think of our responses to their initiatives as responses in an open-ended conversation. Using elements of the individual’s communicative repertoire, we respond in ways which echo their rhythms but which also recast the elements in a slightly different way, something like jazz where you have a theme and variations.

For example, in answer to the sound ‘er-er’ we might make the same sound, ‘er-er’ (imitation). Or we might make the same sound but elongate it, ‘eerrr’, or shift the pitch up or down, or raise it at the end (a good way of asking a question). We might alter the rhythm or shift the mode, answering the sound with a tap, or drawing with our finger the shape of the sound on their arm. All of this gives the individual’s brain something it recognises but also something new,  a slight ‘jolt’ – ‘that’s something I recognise but it’s also slightly different’.

It is this ‘difference’ that shifts the individual’s interest from attention (there’s something out there I recognise) to engagement (I want more of this). At this stage the individual becomes interested in the source, they start to follow up their next initiative by looking at their conversation partner to see what they make of it.

When we use Intensive Interaction, we use empathy to tune in to the individual’s sounds or movements but we do not use words, since words are difficult for the individual’s brain to process. Our aim is to interact with the individual’s brain in a way that does not raise their stress level. What we find is that, as the brain relaxes, the individual becomes capable of a range of activities and responses not normally associated with the autistic spectrum.

Using frame-by-frame analysis of film footage of Intensive Interaction being used, Zeedyk, Caldwell and Davies (How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities? [2009]) have shown that the individual’s eye contact increases, they accept greater physical proximity from their conversation partner and are generally more socially responsive. As stress levels reduce, the individual may also experience cognitive improvements, such as the ability to generalise (within the limits of their condition), refer back to what has gone before and, in particular, to copy hand movements. Aloneness becomes shared interest. As the individual’s experience of the world becomes less scary, so their presentation and their capacity to join in the world around them improve. They show pleasure.