Five weeks into home schooling and the main focus is still on Intensive Interaction. I’m aware, however, that our version of II may offend the purists. We tend to start the day with pure II, simply mirroring Henry’s body language and sounds, in order to engage him. But then, as the day goes on and his engagement increases we begin to introduce more demands, while still allowing him to lead the play. Most of these demands involve the prompting of speech. Henry is good at using language to get what he wants, but he has always used single words. He has been able to do this since he was four and in the six years since, although his vocabulary has widened, he hasn’t really moved on, apart from learning the phrase ‘ I want X please’ by rote, which he will gabble, often with the words in the wrong order, if pressed.
Although some of this is autistic pragmatism – why use four words when you can get what you want with one – much of it is bound up with Henry’s difficulties with sequencing. He has always had huge problems with motor planning, or executive function as it is sometimes called: the ability to organise actions or speech into logical order to achieve a desired end. It affects every area of his life, from playing with a train set to articulating a sentence. Using a prompting method, something we learnt when following an ABA programme, seems to help. In brief, you start with a full prompt (ie. helping him to do an action hand-over-hand) and then gradually fade the prompt, giving less and less help until he is able to accomplish the task independently. With speech, the full word or phrase is given, then gradually faded to an initial sound, a sign, a raised eyebrow and eventually, just a pause.
So, what we have ended up doing in some sessions is a kind of ABA-meets-Intensive Interaction hybrid, which will no doubt horrify some of the proponents of both approaches. How much of each approach we use in a session depends on how engaged and relaxed Henry is. There is no doubt that pure II gets him ‘in the right place’ for speech. But I feel that he also needs the prompting structure to help him to organise and articulate what he wants to say.
The short clip below shows Ellie, Henry’s new tutor, using this approach. It seems to be working, in that Henry is trying to string words together in a way he has never done before. Best of all, a number of people who’ve met him over the last week or so have commented that they find him easier to understand. I feel hopeful about his speech in a way I haven’t done for years. Exciting times.