Iacoboni, M., Woods, R.P., Brass, M. et al. (1999). Cortical mechanisms of human imitation. Science, 286, 5449. Graham Firth, the intensive interaction project leader at Leeds Partnerships NHS Trust introduced me further to the philosophy and techniques of intensive interaction. On the Leeds course, generally attended by residential care or day service staff, it became clear that for most people intensive interaction is actually a relatively uncomplicated approach to learn. As intensive interaction is based on ‘infant–caregiver’ models of interaction we can see some of the basic strategies of the approach whenever we see an adult interacting with a baby, e.g. big open eyes and vocal echoing (‘goo gooing’ together), communicating via body language, or vocal tone and generally communicating without verbal language. It could be argued that the basics of II are universal within us all. During the II training students learn to reflect on the possible meanings and motivation behind the behaviours of their clients. Furthermore, on the course the students are asked to look at the person’s emotions/affect, any cognitions that may be involved and the role of sensation. Ephraim, G.W.E. (1979). Developmental processes in mental handicap: A generative structure approach. Unpublished PhD thesis, Department of Psychology, Brunel University. Mainstream (that is, non-learning disability) research provides some evidence that depressed mothers are poorly attuned to their infants and that this can lead to a lasting depressed state in their children (see Trevarthen and Aitkin, 2001, for a review). However, Hundeide’s (1991) work with children who have suffered extreme deprivation in orphanages suggested that such effects can be remediated. But how can this best be done? Lott (1998) proposes that talking therapy may not be effective with severely maltreated children as they may be in a state of persistent hyperarousal. Rather, it is proposed that ‘[w]hat will get through is tone of voice, demeanour, facial expressions and a sense of empathy that is rooted in the early psychobiological attunement between mother and infant’ (p.3). Intensive interaction aims to provide social encounters at precisely this level and so has the potential to function as a powerful therapeutic intervention for people who struggle to use words to express their emotional state and for whom social interactions are difficult.

Research psychologist Dr Suzanne Zeedyk and her team at Dundee University have for several years been using intensive interaction techniques when working with a wide range of individuals with communicative impairments, both within the UK and abroad. The team has investigated the effectiveness of intensive interaction, with a special focus on microanalytic methods of coding video tapes. She presented this to the conference, and also covers it in Zeedyk (2008).Then there's the covered market, granted grade II listing last year, less for its 1930s vaulted arcades than for its iconic status at the centre of British Caribbean history. For years it remained bustling but somewhat decrepit, with a series of empty stallfronts. Gentrification has seen many filled with pricey delis, coffee bars and restaurants, followed, perhaps inevitably, by a steep rise in rents and complaints from established traders that they are being pushed out. One practical example of the approach I observed was with a client who would self-stimulate by rubbing his thumb into the palm of his hand. Initially the staff member would rub her thumb into the client’s hand, and then with time they ended up being able to rub each other’s thumbs. As this fundamental communication and trust grew, further ways of communicating developed, including smiling, ‘dancing’ and ‘singing’ together. During this time the client’s behaviour became less ritualistic and he became more involved with his environment and more interactive with those around him. We start with ‘observation’ - but need to think of observation not so much as a period ofshadowingbut rather as the development of an ongoing picture of what our conversation partner is doing now, this minute. Particularly, we want to avoid the pitfall of drawing up a list of activities we ‘do’ with them, since it is absolutely essential that our responses are contingent, not only to their initiative but also as to how this initiative is made, since it is the ‘how’ that will allow us to tune into their affective state. I have to empty myself of any behavioural expectations and learn to ‘be with’ this person as they are at present, using their initiatives, gestures, rhythms and sounds to respond in a way that has meaning for them. Dr Peter Coia, a clinical psychologist from Wakefield, has proposed a neural mechanism that goes some way to explaining the responses produced by intensive interaction. A mirror neuron is a neuron that fires both when an animal acts, and when the animal observes the same action performed by another. In humans, brain activity consistent with mirror neurons has been found in the pre-motor cortex and the inferior parietal cortex (Iacoboni et al., 1999). Coia believes that mirror neurons might play a very important role in language acquisition via behavioural and vocal imitation –?they enable all of us to recognise and pay attention to our own behaviour when it is mirrored by someone else (Coia, 2008).

Intensive Interaction is about learning and using the language that has meaning for an individual to build a relationship with them. It is not a ‘cure’, in the sense that we do a few sessions and the person responds and so we can stop using it. If we do this, they will regress, because what we have done is to learn their language, use it with them and then walk away, slamming the door to relationship in their faces. All their distressed behaviour will return. We have to use it as a continuing way of communication and use it to explore and build on the relationship that it fosters. When the brain is no longer under processing pressure it begins to work more effectively on its own account, within the limitations of its learning disability if this is present. This is especially true for people with autism who are so vulnerable to environmental stress.Hart, P. (2008) ‘Sharing Communicative Landscapes with Congenitally Deaf-Blind People’ in Zeedyk, S. Ed. ‘Promoting Social Integration for Individuals with Communicative Impairments’Jessica Kingsley Publishers Caldwell, P. (2008) Intensive Interaction: Getting in Touch with a Child with Severe Autism’ in Zeedyk, S. Ed. ‘Promoting Social Integration for Individuals with Communicative Impairments’ Jessica Kingsley Publishers In the 1980s, Geraint Ephraim,Consultant Psychologist at Harperbury Hospital, introduced the idea of using body language to communicate with people whose ability to communicate was impaired by severe intellectual disabilities. This approach was so successful that it was taken up by Nind and Hewett who named it Intensive Interaction. (Nind and Hewett 1994). I worked for four years under the supervision of Ephraim during tenure of a Joseph Rowntree Foundation Fellowship and subsequently (although not exclusively), specialised in using it with children and adults on the severe end of the autistic spectrum. My experience as a Practitioner using Intensive Interaction extends over twenty years and I have worked with literally hundreds of adults and children, many of whose behaviour was extremely distressed. This article introduces an approach that allows us to engage with children and adults with whom we find it hard to get in touch. Many are on the autistic spectrum. We find it hard to communicate with them and they with us. Many are very distressed.In the context of autism, I use the term ‘distressed behaviour’ in preference to ‘challenging behaviour’, since outbursts in autism are triggered by sensory overload and the word ‘challenging’ sets up oppositional expectations.

Caldwell, P.(2004) ‘Creative Conversations’Pavilion Press.Intensive Interaction being used with people with multiple disabilities, mainly severe Cerebral Palsy. So success is dependent on maintenance. But even here we have a problem in matching outcomes to our expectations. For example, there is the question of getting our partners to conform to what society considers to be ‘normal’, without taking in to account the sensory distortions stemming from processing difficulties, the overloading input into the autonomic nervous system and the anxiety this induces. A classic example is that of taking people with autism shopping in a supermarket, where the sensory overload of high pitched hums, the lighting, the ‘pings’ and moving patterns of people, are for some a sensory nightmare. (Williams, D 1995).However, even here it is sometimes possible to guide a partner through this kaleidoscope by constantly supplying sounds or movements or gestures that are part of their repertoire. These act as landmarks that the brain can focus on and exclude the avalanche of stimuli that threaten to overwhelm them. Melanie began her teaching career in special schools as a teacher of students with severe and complex learning difficulties. It is here that she developed and evaluated the teaching approach of Intensive Interaction for which she is best known. She has also taught in further education colleges where she has coordinated support for students with learning difficulties and disabilities. In higher education she has worked as an associate research fellow in the Centre for Autism Studies at the University of Hertfordshire, as a senior lecturer in special education at Oxford Brookes University and at The Open University developing and teaching undergraduate and postgraduate distance learning courses in inclusive education. She joined University of Southampton as a Reader in 2004 and gained her personal chair in 2007. Prizes During the three hours I am with Pranve, apart from the one time that I startle him, he shows no aggressive intent and is clearly delighted with our interactions. But also, after about twenty minutes, he is no longer reacting to the scream of the planes passing over the house, so close their wheels are down for landing. His interest in our conversation is overriding his hypersensitivity to the high frequency whines of the jet engines. (Caldwell 2006a)Zeedyk, M.S. (Ed.) (2008). Promoting social interaction for individuals with communicative impairments. London: Jessica Kingsley. Intensive interaction (II) was an approach originally conceived at Harperbury Hospital School during the 1980s by teachers Dave Hewett and Melanie Nind. The school was for young people with profound learning disabilities, sensory or physical disability and ‘challenging behaviour’. Their curriculum was traditionally based around rewards, rewards withdrawal, periods in ‘time out’ and exclusion (Nind & Hewett, 1994). At the time it was becoming increasingly clear to the staff at the school that the traditional approach of teaching simply was not working for their learners. Influenced in part by psychologist Geraint Ephraim’s (1979) theories on ‘augmented mothering’ they moved towards a more flexible, interactive and reflective approach. Water voles are fully protected under Section 9 of the Wildlife and Countryside Act 1981 (as amended). This legal protection means that due care must be paid to the presence of water voles. [7]