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02nd May 2014

You’re Not Hearing What I’m Not Saying

You're not hearing what im not sayingOne of my friends recently became a mother to a baby girl and last week brought her new daughter in to work to meet the staff team. Cue a gaggle of cooing, fawning women all huddled around the pram, remarking on how beautiful, how adorable, etc etc…….  The new mum took the chance to pop by the office and we asked her how it was all going. She was of course exhausted and overwhelmed, but the thing she described that resonated was how all-consuming her relationship with Baby had become.

“I can spend hours just looking at her, smiling when she smiles, copying her little noises…… I look a proper clown!” she laughed, “How sad am I?”

The Fundamentals of Communication

Well actually, not sad at all. This new mum was describing a method of teaching that is age old, yet still being developed as a means of connecting with people who have never learned the ropes of human communication. This method is Intensive Interaction, the activity of teaching the fundamental concepts that precede the development of communication.

Before we are able to engage in a two way dialogue, humans need to develop the basics of connecting with others.  A mother engaging in this mimicking behaviour with her baby is reinforcing the baby’s use of noises and expressions. Baby is rewarded for this with increased and repeated attention from the mother, and so it develops.

Where a child has sensory or learning disabilities, there may be challenges to overcome in building this relationship. In babies with sight loss, the reward of seeing mother’s face is absent, and sounds and touch will be used in place of visual stimulus. For children with profound learning disabilities, there may be an absence of response, which in turn might discourage parents from continuing with the communication.

As children grow and learn more about the use of communication they become confident and adept at how to engage in a variety of ways with the people around them. However, if the learning process is halted due to a lack of progress on the part of the child, they may never fully enter the world of social congress and could well become withdrawn and isolated.

The Growth of Intensive Interaction

In the 1980s a group of people working in long-stay hospitals in the south of England identified that some profoundly disabled people had not developed these fundamentals of communication and as a consequence had become almost social outsiders. They chose not to connect, engaged in self-stimulatory activity such as rocking and twirling and could not even share eye contact with others.

By slowly encouraging these people to participate in a range of activities seen as the basics of human communications, a gradual opening up took place that led to radical improvements in their life experience.

The activities used in Intensive Interaction include;

  • Being close to another person, tolerating that shared space
  • Learning to attend to another person

For many profoundly disabled people who have never experienced closeness, the sense of being in near proximity to others can be extremely threatening and bring about behaviours where they might push others away or withdraw physically. Gentle positive reinforcement for being in the company of another person, quiet time, slow acceptance; these can encourage greater tolerance of other people.

  • Developing concentration and attention span
  • learning to do sequences of activity with the other person
  • taking turns in exchanges of behaviour

Once a person is able to tolerate sharing space, it can be possible to participate in shared activities. Passing an object from person to person, activating a toy or switch in turn, or copying sounds and gestures can lead to turn-taking activities which are a basis for conversations.

  • using and understanding eye contacts
  • using and understanding facial expressions
  • using and understanding physical contacts
  • using and understanding non-verbal communication

Most of us would admit to finding eye contact occasionally very threatening, so the introduction of this can take patience and time to achieve. Learning how a person shows their emotion through expressions and movements can help us to know when to withdraw and when to engage. Often the things we would see as negative responses are really just responses – it takes time to learn each individual’s body language.

  • using vocalisations with meaning (for some, speech development)
  • learning to regulate and control arousal levels

Often we take our sophisticated social skills for granted and find it surprising when something we see as ordinary can cause a dramatic and extreme response in others. Learning to regulate our emotional responses is something we achieve as children, but if this has not been learned at that early stage, it is not unusual to find that either pleasure or fear can escalate into a crisis for a Service User. Intensive Interaction can help people to manage their emotions without such extremes.

No Equipment Required

All of these activities can be undertaken in gradual and opportunistic settings. You do not need to have a special place or time, or even any equipment to participate in these techniques. You can also learn the real value of silences between your and a Service User – communication does not always mean sound or gesture and sometimes it’s the spaces in between the words and sounds that are of real importance.

The next time you are with a person who does not use speech, who does not seek out human contact, don’t dismiss this as an inability to communicate. Think more about the way you can help them to join your world by entering theirs, on their terms. Consider the speed, volume and intensity of your contact with them. Give them time to process your words and allow space for them to respond. Then watch, listen and respect the way they do.

For an idea of what this is all about, check out the wide collection of clips on You Tube, such as this one, ‘Contact’  where you can see Intensive Interaction in practice.

For more information and the chance to access training, see

Ginny Tyler – QCS Learning Disability " href="" target="_new" data-tooltip="Learning disabilities have an impact on a service user’s everyday life, which in turns places specific demands on providers of care who specialise in services that offer support to those with learning disabilities.  Everything from arranging a visit to a shop, to going on a bus, to meeting someone new, can for some be a profoundly difficult undertaking, so appropriately qualified care providers are on hand to offer their expertise and guidance to make the lives of their service users that much more simpler and enjoyable.<br /><br />Learning disabilities are a broad spectrum and include Down’s Syndrome, Autism, Aspergers Syndrome, Fragile X Syndrome and many more.  It is distinct from learning difficulties, such as dyslexia, which do not impact upon intellect.  With the right care and management people with learning disabilities can still lead normal lives. Profound and Multiple Learning Disabilities (PMLD) present even greater challenges to the care service, but there are many services throughout the UK equipped to deal with even the most significant of learning disabilities.">Learning Disability Expert Contributor

Sarah Riley

Senior Customer Care Executive

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