Responding to individuals with severe learning difficulties and stereotyped behaviour: challenges for an inclusive era

Traditionally, professionals working with individuals with severe learning difficulties who demonstrate stereotyped behaviours, such as rocking and hand-flapping, have viewed such behaviours as undesirable, inappropriate and in need of reduction or elimination. This perspective is influenced by notions of readying those individuals for mixed settings, educating, training or modifying them to help gain their acceptance. Intensive Interaction is an alternative approach for working with individuals with complex difficulties that responds positively to them and their stereotyped behaviours, sometimes using these as a point of connection. Intensive Interaction sets out to enhance social and communication abilities and not to reduce stereotyped behaviours. However, findings from two studies of Intensive Interaction that show some reduction in stereotyped behaviours are reported and discussed. The authors consider the way in which more inclusive thinking connects with changes in thinking about stereotyped behaviour and the individuals who engage in them.     

Catherine's legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies

In this article, Mary Kellett, of the Children's Research Centre at the Open University, draws on case study evidence to illustrate how an 11–year-old girl's quality of life was transformed in the last few months before she died when an Intensive Interaction intervention approach was adopted. The study raises issues about the way we respond to individuals with the most profound disabilities who are hardest to reach and have fragile life expectancies. It also examines the role of the researcher in situations where a participant dies; how this impacts on data processing - particularly where this involves video footage of a participant -and the complex ethics which need to be considered. Initially, the sadness of the situation and the incompleteness of the data overshadowed the findings. Due attention was not given to the contribution Catherine's data could make to our knowledge and understanding of the lived experiences of children like her and the implications this has for policy and practice. However, 'interrupted' findings from her case study point to the effectiveness of the Intensive Interaction approach in developing sociability, particularly with regard to eye contact and the ability to attend to a joint focus. This article affirms the principle that it is never too late to start an intervention; that severity of impairment should not be a barrier to this; and that the social interaction Intensive Interaction promotes can make a crucial difference to quality of life.     

The Social Sensitivity of Preschoolers in Peer Conflicts: Do Children Act Differently with Different Peers?

This study sought to demonstrate that many aspects of preschoolers' peer conflict behavior are sensitive to the subtle change in social situation that occurs when a child plays with a different partner. Twenty-seven pairs of preschoolers were videotaped over four 15-minute play sessions; in the fourth session, half of the pairs played with a different partner, while half were with the same partner. Frequency and theme of conflicts, strategies used, frequency of yielding to partner, and percentage of conflicts solved were observed. Initiating and negotiating behavior in early sessions better predicted behavior in the fourth session for the same-partner (vs. change-partner) group, and thus emerged as behaviors sensitive to social context changes. Results indicate that preschoolers have a remarkably varied array of conflict behaviors and that much of their conflict behavior is sensitive to influences inherent to social interaction with a specific partner. Ways in which the apparent sophistication in young children's social understanding can inform developmental approaches to early childhood education as well as both preventative and therapeutic conflict resolution programs are discussed.     

A school-based intervention on elementary students’ school engagement

Prior research has reported signs of low engagement in the early stages of schooling. The present study assessed the effectiveness of a school-based intervention that promotes cognitive, emotional, and behavioral engagement in elementary school children through a story tool. The study followed a cluster-randomized design with 259 fourth graders nested in 12 classes; the classes, not the individuals, were randomly assigned to an intervention or control group. Both groups were assessed in four waves in two measures for each engagement dimension. Data were analyzed with a multilevel approach. Findings show that the intervention enhanced students’ cognitive, emotional, and behavioral engagement. Still, there is a delay before the intervention program exhibits a beneficial effect.Moreover, gender discrepancies were found. Before the intervention, girls showed higher cognitive and emotional engagement, but boys exhibited higher emotional engagement after the intervention. In addition, current results indicate that the program benefited the boys more than the girls. Finally, there was no evidence that the engagement outcomes differed depending on the parent’s educational level. Findings provide valuable information for future research and educational practice.     

Promoting Independent Interactions Between Preschoolers with Autism and Their Nondisabled Peers: An Analysis of Self-Monitoring

This study examined the effects of self-monitoring on the activity engagement and social interaction of three preschoolers with autism. Each child participated in daily play activities with one nondisabled peer and received little adult direction during an initial baseline phase. Two intervention procedures were then implemented in an alternating fashion during a second condition. The first procedure required an adult to prompt the children to exchange social overtures. The adult also moved beads to record completed exchanges and provided a small post session reward to each child if they accomplished a criterion number of exchanges. During the second monitoring procedure the children moved their own beads while the adult provided fewer prompts and gave a post session reward. The child monitoring procedure was then implemented without prompts during a final follow-up phase. A combined alternating treatment and multiple baseline design were used to examine the effects of each experimental condition. Although all three children exhibited high levels of active engagement during baseline, most of their responses occurred in a solitary fashion. The adult and child monitoring procedures produced equal increases in children's engagement with nondisabled peers during the alternating intervention phase. The child monitoring procedure also maintained children's independent interactions during the follow-up condition. Supplemental observations in follow-up also indicated that children exchanged a wide range of different overtures and exhibited varying levels of consistency in their self monitoring.     

The Comparative Impacts of Social Justice Educational Methods on Political Participation,Civic Engagement,and Multicultural Activism

This cross-sectional, repeated measures, quasi-experimental study evaluates changes in college students’ commitment toward, and confidence in, political participation, civic engagement, and multicultural activism. Our sample (n = 653) consisted of college students in a Midwestern university who participated in one of three social justice education course types (service learning, intergroup dialogue, or lecture-based diversity classes) or in an “introduction to psychology” course (the non-intervention group). After completion of a social justice education course, students reported an increase in political participation and multicultural activism, whereas students enrolled in the non-intervention group reported no changes in these measures. Service learning course participants started and ended their course with the highest reported levels of political participation, civic engagement, and multicultural activism but did not demonstrate an increase in any of the three outcomes. Intergroup dialogue participants demonstrated increases in all three outcomes, while participants of lecture-based classes focusing on social justice issues demonstrated increases in political participation and multicultural activism, but not civic engagement. Our findings suggest that participation in social justice education courses is associated with increases in political participation and multicultural activism.     

Intensive Interaction and autism: a useful approach?

The very challenging nature of many individuals with autism has meant, for some, a focus on 'special', as opposed to 'naturalistic', intervention processes. There has been much recent media interest in parental campaigns, Melanie Nind, senior lecturer in the School of Education, Oxford Brookes University, addresses the potential usefulness of Intensive Interaction for pupils whose learning difficulties are compounded by autism. She considers empirical case-study evidence together with questionnaire and interview data from teachers using the approach.     

Jacob's journey: developing sociability and communication in a young boy with severe and complex learning difficulties using the Intensive Interaction teaching approach

This case study evaluates the efficacy of Intensive Interaction in developing the social and communication ability of a young boy with severe learning difficulties. The Intensive Interaction approach is based on the model of caregiver–infant interaction and underpinned by theoretical foundations of psychological literature of early development. A multiple-method approach was adopted mixing quantitative and qualitative data. An intricate system of behaviour coding was devised so that progress could be measured via video-recorded observation. Findings showed that substantial progress was made in sociability and communication, with some new behaviours such as eye contact emerging. Stereotypy was also observed to reduce substantially.     

Autism,Intensive Interaction and the development of non-verbal communication in a teenager diagnosed with PDD-NOS: a case study

In this paper, the authors report on the importance of using Intensive Interaction for the development of non-verbal communication for people with autism. The complexity of learning non-verbal communication means that it cannot be taught in any sense in a traditional, didactic manner. While a person may have the cognitive abilities to follow instructions and be taught the need to behave a certain way in social situations, which will not allow them to properly assimilate and understand social expectations and how to operate in social contexts. This paper suggests that the use of Intensive Interaction creates frequent opportunities for a person to take part in face-to-face interactions and consequently allow for the gradual development of non-verbal communication.     

Editorial

This case study evaluates the efficacy of Intensive Interaction in developing the social and communication ability of a young boy with severe learning difficulties. The Intensive Interaction approach is based on the model of caregiver–infant interaction and underpinned by theoretical foundations of psychological literature of early development. A multiple‐method approach was adopted mixing quantitative and qualitative data. An intricate system of behaviour coding was devised so that progress could be measured via video‐recorded observation. Findings showed that substantial progress was made in sociability and communication, with some new behaviours such as eye contact emerging. Stereotypy was also observed to reduce substantially.     

School engagement and rights‐respecting schools

Disengagement in school is associated with behavioral problems and decreased academic achievement. In contrast, pupils who are engaged in school develop the academic and social efficacies that underlie successful adulthood. Moreover, engagement promotes educational resilience. This study examines pupils’ self‐reported level of engagement in schools that are explicitly respecting of children’s rights compared with pupils in traditional schools. The Young Students’ Engagement in School Scale was developed and used with 1289 9‐ to 11‐year‐olds from 18 schools, six of which had fully implemented the Hampshire Education Authority’s Rights Respect and Responsibility (RRR) Initiative. Factor analysis indicated four dimensions of engagement: rights‐respecting climate; interpersonal harmony; academic orientation; and participation. Pupils in RRR schools had higher scores on all but the academic dimension. The findings suggest the potential of rights‐respecting schools in promoting engagement and the potential utility of the measure in identifying areas in which pupils’ engagement may need intervention.     

Vagal Reactivity and Affective Adjustment in Infants during Interaction Challenges

Respiratory sinus arrhythmia (RSA) and heart period were evaluated in 5-month-old infants (N = 40) during interaction challenges requiring affective adjustment. The paradigm consisted of four 2-min experimental conditions designed to elicit behavioral and autonomic responses to object-mediated (Picture Attention and Toy Attention) and person-mediated (Still Face and Social Interaction) engagement. The data demonstrated that autonomic state systematically changed during engagement and disengagement with the environment. During the object-mediated challenge, increases in RSA were uniquely related to positive engagement. During the person-mediated challenge, there was a more complex integration of autonomic and behavioral responses characterized by concordant increases and decreases in RSA, heart period, positive engagement, negative affect, and motor activity. When participants were partitioned into two groups, based on their RSA response pattern during the person-mediated challenge, only participants who exhibited a pattern of RSA decrease from Toy Attention to Still Face followed by a rapid recovery during Social Interaction demonstrated regulation of behavioral activity, including concordant recovery from stress. These findings provide additional empirical support for the role of vagal regulation of the heart in the modulation of affective adjustment and engagement behavior.     

Beyond the ‘classic’ nurture group model: an evaluation of part‐time and cross‐age nurture groups in a Scottish local authority

This study begins to explore ways in which the principles underpinning the traditional ‘nurture group’ model could be altered and age ranges extended while continuing to deliver the proven success of nurture groups in promoting children's social and emotional development. Part‐time nurture groups were established in four different primary schools within the same council area. A total of 25 pupils ranging from age four to ten years attended the nurture groups for the 2006/7 school session and a control group was established within each school. All fifty children were tested using the Boxall Profile, literacy, numeracy and motor skills baseline assessments at pre‐, mid‐ and post‐nurture group intervention. Analysis of the results showed that for the children who had received a part‐time nurture group experience, statistically significant gains were made in the areas of development assessed by the Boxall Profile. Gains were also made in the areas of literacy, numeracy and motor skills; however, these gains were not at a statistically significant level. Results also show that the younger the pupil accessed the nurture group, the more significant gains were made in the measures used.     

Promoting social interaction of children with disabilities in integrated preschools: a failure to generalize.

In this study, the Classwide Social Skills Program (CSSP) was introduced for all children in four integrated preschool classes, and generalization of effects was measured across settings and over time for 14 children with disabilities between the ages of 3 and 5 years. Results indicated that the CSSP increased the positive play of children with disabilities to levels comparable to classmates without disabilities. Levels of teacher reinforcement toward the children with disabilities increased as well. These increases in teacher and child behaviors, however, did not generalize to 3- or 6-month follow-up periods nor to another play session in the day. Implications for promoting social interaction in integrated preschool settings are discussed.     

Using Performance Feedback To Decrease Classroom Transition Time And Examine Collateral Effects On Academic Engagement

Performance feedback has been described as a necessary component of consultation. Although feedback has been used to improve academic performance of individual students, less research has examined the effects on classroom academic engagement when implementation of classroom management variables is the source of feedback. Using a multiple-baseline design, the effects of performance feedback with goal setting was examined across three high school biology teachers who were first provided with feedback on the number of seconds devoted to transitions and then successful implementation of classroom time management strategies. Feedback on the number of transition minutes alone led to decreases in transition time and corresponding increases in student academic engagement for all teachers. One teacher benefited from additional feedback on classroom time management strategies. For all teachers, low rates of transition time and high rates of academic engagement were maintained when the intervention was faded and after it was terminated.     

Using video self-modelling to increase active learning responses during small-group reading instruction for primary school pupils with social emotional and mental health difficulties

Effectiveness of a video self-modelling (VSM) intervention was examined with primary schoolchildren who attended a full-time special education programme for pupils with social emotional and behavioural difficulties and who exhibited inappropriate behaviour during small-group reading instruction. A randomised multiple-probe baseline design was used in this study in four subjects with a follow-up phase 6 weeks after intervention. Four children aged 10 were videotaped during reading instruction to determine levels of active learning and behavioural difficulties. Intervention took place at the teacher’s desk or table 3–5 minutes immediately before the child’s designated time for reading group instruction. During intervention, the children were shown carefully selected brief segments of their own video that had been recorded during the previous session. Results indicated VSM was an effective intervention for increasing active learning responses and for reducing behavioural difficulties during reading instruction. Optimum results were maintained for more than 8 weeks after intervention. These results support VSM as an effective antecedent intervention and add to the growing body of evidence-based practices for elementary school pupils who have social emotional and mental health difficulties.     

Adapting Active Support Interactive Training to a special school context to upskill classroom staff and increase engagement in pupils

Research indicates that engagement acts as an important precursor for learning, yet sustaining the engagement of pupils with special educational needs can be a challenge for classroom staff. An Active Support staff training package, Interactive Training, has been demonstrated as an effective way of increasing engagement in adults accessing learning disability services. In theory the logic of Active Support Interactive Training could extend to a school environment, with the aim of achieving similar outcomes. The current study evaluated a special school-adapted version of Active Support Interactive Training with the aim of increasing engagement in pupils during group-based learning. Findings showed an increase in engagement in pupils for all three settings (classrooms) immediately after intervention, which continued to either increase or stabilise at three-month follow-up. Further research could test the engagement behaviour of staff pre- and post- training intervention and explore practice leadership within the school leadership team to address maintenance.     

Getting in Touch with our Feminine Sides? Men's Difficulties and Concerns with Doing Intensive Interaction

Andrew Culham has been a lecturer in further education for seven years. During this time he has worked primarily with students with learning difficulties. He now works for Oxford and Chen/veil College as a coordinator of provision for students with profound and multiple learning difficulties within the supported learning curriculum unit. In this article, Andrew Culham addresses a number of concerns expressed by male practitioners using Intensive Interaction.
The issues raised in this article are based on the outcomes of a research project that used a mix of qualitative and quantitative approaches. The results indicate that men who use Intensive Interaction are concerned about issues of touch, especially when working with female clients, and about the potential for their interactions with learners to be misinterpreted and misrepresented. Respondents suggest that targeted professional development opportunities are required to support men in delivering programmes of Intensive Interaction and to provide practical responses to their difficulties. Intensive Interaction has been demonstrated to be of benefit to people with learning difficulties. Andrew Culham proposes that professionals, colleagues and managers can support male practitioners more effectively through policy creation, staff development and professional dialogue. He argues that an 'inclusive' support structure should be established to provide all staff with practice-focused advice and guidance.     

Monitoring and the transfer of individual problem solving

A monitoring interpretation of the transfer of complete concept learning skills was discussed. Individual and group monitoring in the learning session were promoted through required vocalization of reasoning and working with a partner, respectively. All subjects completed the transfer session as nonvocalizing individuals. Both sources of monitoring were expected to facilitate performance in the learning session. Only individual monitoring was expected to facilitate performance in the individual transfer session. Ninety-six male and female undergraduates were randomly assigned to one of four groups, composed of vocalizing or nonvocalizing pairs or individuals. In the learning session, pairs required fewer trials to solution and used more efficient selection strategies than did the individuals. However, the superior performance of the previously paired subjects was not evident in the transfer session. Individual monitoring through vocalization during the learning session served to partially ameliorate the negative group-to-individual transfer, as well as the less effective individual performance in the learning session. It is suggested that transfer may be promoted by inducing self-monitoring during the initial learning.