The evidence for Intensive Interaction reducing Challenging Behaviours?

I and a number of my colleagues here in Leeds have just submitted a paper for publication looking at the successful use of Intensive Interaction with service users admitted to our Trust's learning disability Assessment and Treatment Unit - these service users generally exhibiting some form of severe challenging behaviour. I believe that this paper makes a very strong case for using the approach with such service users. 

However, when writing up this paper it was difficult to find much in the way of other published research evidence of any direct relationship between the use of Intensive Interaction and a decrease in the frequency and severity of challenging behaviour - despite there being a huge amount of anecdotal evidence of many successful cases (including my own very extensive professional experience when working with such service users).

In a paper published in 2012 (Sharma, V. & Firth, G. (2012) ‘Effective Engagement through Intensive Interaction’, Learning Disability Practice, 15 (9), 20-2) we looked for and found only a limited number of peer reviewed journal articles providing some (also limited) evidence of positive challenging behaviour outcomes directly linked to the use of Intensive Interaction. These articles included:

Zeedyk, Davies, Parry & Caldwell (2009) who taught Intensive Interaction to 12 volunteers at a Romanian day centre for children with varying physical and cognitive disabilities. The results indicated a decrease in distress and self-harm behaviours in 39% (7) of the children. However the claims in this paper were methodologically weakened as there was no assessment of the prevalence of the challenging behaviour prior to the use of Intensive Interaction, and the post-intervention assessments were based only on the volunteers’ stated views.

Kellett (2003) offers a more methodologically robust study. Her research participant (aged 8) was observed over a 5 weeks baseline, followed by 42 weeks of Intensive Interaction. Over the Intensive Interaction sessions the challenging behaviour reduced significantly from an average of 15.8 recorded incidents pre-Intensive Interaction, to 1.34 incidents post-Intensive Interaction.

However, in contrast Elgie & Maguire (2001) recorded no observable change in their participant’s self-injurious behaviour (SIB), despite improvements in sociability (in comparison to baseline measures), although the researchers suggested this was due to the participant being in the early stages of intervention, and that she had been self-harming for most of her life.

In our paper we concluded that: 'Overall the limited research offers tentative support to the hypothesis that Intensive Interaction can be effective in reducing the severity and frequency of challenging behaviour' in individuals with severe or profound and multiple learning disabilities. We also said that what research there has been 'suffers from a variety of methodological limitations, including small samples and a lack of objective assessment pre- and post-intervention. Furthermore there appears to be a lack of measures to account for procedural integrity over what type and how Intensive Interaction was performed'.

This is now an area within which Intensive Interaction is often used (and in my experience very successfully) - but it is an area that I believe is chronically under researched (perhaps you can identify some more recently published papers: I do hope so!) ... and surely this is a state of affairs that needs to be rectified. 

Elgie, A. & Maguire, N. (2001) 'Intensive interaction with a woman with multiple and profound disabilities: a case study'. Tizard Learning Disability Review. 6, 3, 18-24.

Kellett, M. (2003) 'Jacob’s journey: developing sociability and communication in a young boy with severe and complex learning difficulties using the intensive interaction teaching approach'. Journal of Research in Special Educational Needs. 3, 1, 1-16.

Sharma, V. & Firth, G. (2012) ‘Effective Engagement through Intensive Interaction’, Learning Disability Practice, 15 (9), 20-2.

Zeedyk, M., Davies, C., Parry, S & Caldwell, P. (2009) 'Fostering social engagement in Romanian children with communicative impairments: the experiences of newly trained practitioners of Intensive Interaction'. British Journal of Learning Disabilities. 37, 3, 186-196.