Breaking down the barriers by using an Intensive Interaction approach with individuals with severe autism or communication delay

Non-verbal individuals who have major learning difficulties or “severe” autism are often very difficult to interact with. Not only do they have major difficulties understanding, but may also be unable to express their own needs or feelings. By “severely” autistic, I refer to those individuals that are non-verbal, noncommunicative, and often described as “in their own world”. These individuals have difficulty following instructions and may also display challenging behaviour if approached or encouraged to do something.

Intensive interaction tries to create a communication environment that is enjoyable and non-threatening to the individual on the autistic spectrum, or severe learning difficulties. In some respects the model of the approach is taken from the way we first start to communicate with naturally developing infants, where interactions are short, and involve noises, touch and eye contact. Interactions are brief but can grow over time. Ultimately we are looking for the individual to:

• Accept our presence

• Allow some presence in personal space

• Attend to another person (even fleetingly at first)

• Allow and use some touch

• Engage in eye contact

• Use facial expression

• Focus on body language and facial expression

• Take turns in communicative behaviour

• Take turns using vocalization which may start to have meaning

• Experiment with communication

• Learn cause and effect

The individual is an active participant who is motivated to communicate and who will take the lead and feel a sense of control over the communicative situation. Through this approach carers can make a connection with an individual, create an enjoyable exchange, reduce challenging behaviour, and develop communication skills. To begin with, sessions may be very short, but expanded over time and varied in activity. Sessions should take place several times daily on a one-to-one basis.

When we observe these individuals their behaviour will often revolve around them communicating with themselves through a variety of ways:

• Touch - stroking, knocking objects, hitting themselves

• Rocking

• Making sounds - vocalizing, tapping objects etc

• Visual - flapping with fingers or spinning objects etc

As a communication partner, we need to reflect back these movements and sounds, as that is the language they are using and are familiar with. A session will involve spending some time with the individual in a quiet relaxed environment and observing and following their lead. If they make a movement, respond by copying the movement, if they vocalize copy the vocalization.
These sessions may be very brief to start with, but as the individual becomes more relaxed around the communication partner the sessions increase and the individual's responses, and ultimately initiation, increase. This is more than just copying, it is more like developing a conversation, responding, turntaking and developing an interaction. The copying can be altered, varied, added to, or done in different forms as well, and this will help the process develop. The individual's development of simple communication skills will increase their acceptance of other people being around them, which in turn may reduce their stress levels and challenging behaviour. Intensive interaction goes some way to “opening the doors” for the individuals who are very non-communicative and do not initiate. This process can also be a pre-cursor to developing more complex communication skills.

Intensive Interaction has proved highly successful with many individuals with severe learning and communication difficulties. It has created a more positive communication environment and also allowed for enjoyable interaction for the individual and the people that work and live with him. It is important to involve a suitably qualified professional such as a speech and language pathologist/therapist to initiate and offer guidance during this program.

Other factors to take into account

The Environment - to create fulfilling communication we also need to create a good communication environment. If the environment is noisy with lots of interruptions, cramped or uncomfortable, the individual is unlikely to relax and engage.

Sensory issues - be aware of the individuals sensory sensitivities such as touch, sound or vision. This is important not only when communicating, but when thinking about the communication environment.

Alternative communication and minimal speech - remember, always have an awareness of your own communication and the comprehension level of the individual. Use alternative communication options when trying to communicate a message, such as picture cards or sign, alongside speech. Also use the minimal speech approach, keeping speech to 1 or 2 words. There is often an assumption that some non-verbal individuals have a good level of understanding. This may not be the case, and a reason for some challenging behaviour. Talk slowly, allow time for your message to be processed and repeat your message if necessary. See here for more information on minimal speech and alternative communication.

Hearing - a factor that is often overlooked is an individual's hearing. Hearing Impairment is common amongst individuals with learning difficulties, and they may not have had access to audiological services.

A downloadable version of this article, with a suggested reading list, is available for viewing and / or downloading from the Autism Section of the Downloads Centre.