The Effectiveness of Intensive Interaction, A Systematic Literature Review

A systematic review of research on staff training as an intervention to develop communication in children and adults with profound intellectual and multiple disabilities

INTRODUCTION

This paper aims to identify to what extent staff training interventions are successful in enhancing the development of communication skills in people with profound intellectual and multiple disabilities.

METHODS

A systematic review was undertaken, conforming to PRISMA guidelines. English language, peer reviewed, empirical studies of staff training interventions to enhance the communication of people with profound intellectual and multiple disabilities were included. Databases Scopus, Web of Science, Proquest, Linguistics and Language Behaviour Abstracts (LLBA) and Medline were searched in July 2015 and updated in December 2022. Quality appraisal was conducted on 13 studies using Crowe's Critical Appraisal Tool (CCAT).

RESULTS

Few good quality evaluations of interventions were found. Challenges to research rigour included the diversity of people with profound intellectual and multiple disabilities, small sample sizes, intervention intensity and the management of fidelity.

CONCLUSIONS

Manualised and bespoke interventions showed promise in improving staff communication and responsiveness.

Valuing relationships: The impact of a sensory program on the interactions of adolescents with severe-to-profound intellectual disabilities

BACKGROUND

People with severe-to-profound intellectual disabilities often lack meaningful interactions with others. Communication partners need to be skilled in identifying and responding to often-subtle behaviours. One method of facilitating interaction is the use of sensory-based stimuli.

METHOD

This study measured the impact of sensory-based stimuli paired with behaviour chain interruptions for three participants in an alternating treatment design using a novel intervention, SensEngage. Measurements included behaviours previously identified as indicating person engagement, self-engagement, happiness as well as participants' use of potential communicative acts (PCAs).

RESULTS

The results showed increased person engagement and happiness in the SensEngage condition compared to the non-sensory condition for all three participants. An increased use of PCAs and decrease in self-engagement were observed for two participants.

CONCLUSIONS

SensEngage appears to positively impact person engagement, happiness, PCAs and self-engagement for people with severe-to-profound intellectual disabilities.

gga-miR-142-3p negatively regulates Mycoplasma gallisepticum (HS strain)-induced inflammatory cytokine production via the NF-κB and MAPK signaling by targeting TAB2

OBJECTIVE

Mycoplasma gallisepticum (MG), a notorious avian pathogen, leads to considerable economic losses in the poultry industry. MG infection is characterized by severe, uncontrollable inflammation and host DNA damage. Micro ribonucleic acids (miRNAs) have emerged as important regulators in microbial pathogenesis. However, the role of miRNAs in MG infection is poorly characterized. In this study, we validated the functional roles of gga-miR-142-3p.

METHODS

The relative expression of gga-miR-142-3p in the lungs of the MG-infected chicken embryos and the MG-infected chicken embryonic fibroblast cell line (DF-1) was determined by reverse transcription quantitative real-time PCR analysis. Bioinformatics database was used to analysis the target gene of gga-miR-142-3p. The luciferase reporter assay as well as gene expression analysis were conducted to validate the target gene. To further explore the biological functions of gga-miR-142-3p upon MG infection, the cell proliferation was quantified using Cell Counting Kit-8 (CCK-8). Meanwhile, cell cycle analysis and apoptosis were measured using a flow cytometer.

RESULTS

gga-miR-142-3p was significantly upregulated in both MG-infected chicken-embryo lungs and the DF-1 cells. gga-miR-142-3p over expression significantly downregulated the expression of pro-inflammatory cytokines, including interleukin-1β, interleukin-6 and tumor necrosis factor alpha after MG infection. Meanwhile, gga-miR-142-3p enhanced the host defense against MG infection by facilitating cell proliferation, promoting cell progression and inhibiting cell apoptosis. Interestingly, TAB2 knockdown groups show similar results, whereas, TAB2 over-expression groups and gga-miR-142-3p inhibitor groups had thoroughly opposite results. The expression of p-p65 in nuclear factor kappa B (NF-κB) and p-p38 in the mitogen-activated protein kinase (MAPK) pathway was decreased when gga-miR-142-3p was over-expressed.

CONCLUSION

Upon MG infection, upregulation of gga-miR-142-3p alleviates inflammation by negatively regulating the signaling pathways of NF-κB and MAPKs by targeting TAB2 and facilitates cell proliferation by inhibiting cell apoptosis and promoting cell cycle progression to defend against MG infection.

Mothers' experience of Intensive Interaction

There is limited research into parents' experiences of Intensive Interaction. Despite this, there are parents who use it and may hold unique experiences. Exploring this could provide insight into how to support parents using Intensive Interaction. Six mothers, who used Intensive Interaction with their children with intellectual disabilities and/or autism, were interviewed. Results were analysed using interpretative phenomenological analysis. The analysis yielded 10 subordinate themes which were organised into 4 superordinate themes: 'The Connection', 'Bittersweet', 'Fighting for Support' and 'Challenging Underlying Low Expectations & Stigma'. Intensive Interaction was found to help some mothers feel connected with their child; they appeared to indicate that accessing timely support with Intensive Interaction was beneficial. Intensive Interaction was also perceived to challenge assumptions and stigma, but these factors were also perceived to be potential barriers to using the approach.

Is speech and language therapy effective at improving the communication of adults with intellectual disabilities?: A systematic review

BACKGROUND

A significant proportion of adults with intellectual disabilities (ID) experience speech, language and communication difficulties which are associated with poor physical and mental health outcomes. Speech and language therapy (SLT) interventions are an important way to address these communication difficulties, yet there is limited available evidence to provide information about the effectiveness of the different approaches used for this heterogeneous group.

AIMS

To review the evidence available for the effectiveness of SLT interventions aimed at improving communication for adults with ID.

METHODS & PROCEDURES

A systematic search across relevant databases was performed. Information on methodological details of each relevant study, along with descriptions of the SLT interventions employed, were extracted and the Crowe Critical Appraisal Tool (CCAT) was used to assess quality. Findings were discussed in a narrative synthesis grouped by target communication skill.

OUTCOMES & RESULTS

A total of 10 relevant studies met the inclusion criteria. These were predominantly interventions aimed directly at adults with ID to improve speech, increase augmentative and alternative communication (AAC) use and develop interaction skills, with one study addressing work with carers. The included studies were all rated as low quality. There is weak preliminary evidence that SLT input can improve the communication skills of adults with ID.

CONCLUSIONS & IMPLICATIONS

There is insufficient evidence to draw strong conclusions about the effectiveness of SLT in this population. Further high-level evidence across speech, language and communication domains is urgently needed. What this paper adds What is already known on the subject There is limited evidence for community health interventions used with adults with ID. Previous reviews of SLT interventions found a lack of evidence base for this population. Some areas of SLT practice such as AAC have demonstrated potential benefits and other areas including speech work, social communication skills and training for communication partners have some evidence base for children with ID but there is currently insufficient evidence for adults with ID. What this paper adds to existing knowledge The study systematically reviews the current evidence base available when considering the effectiveness of SLT intervention for adults with ID. It provides weak evidence to suggest SLT intervention can improve communication in this population and highlights the need for clinically relevant, robustly designed studies to be undertaken in this field. What are the potential or actual clinical implications of this work? The lack of high-quality studies with sufficient power to draw conclusions about effectiveness means SLTs are not able to base their intervention choices on firm evidence. There is an urgent need to conduct robust research into the effectiveness of SLT interventions for adults with ID.

Staff experience of the implementation of intensive interaction within their places of work with people with learning disabilities and/or autism

BACKGROUND

Intensive interaction is an approach used to develop the communication and social inclusion of those who are pre-verbal. It is used in a variety of settings by healthcare and educational staff.

METHOD

A systematic search was conducted to identify and review the literature which explores staff experiences of intensive interaction being implemented within their places of work. Thematic synthesis was utilized to synthesize the findings.

RESULTS

Nine papers were included. Three higher-order themes were generated: "Personal Doubt, Discordance & Discomfort," "A Turning Point" and "Needing Implementation at All Levels."

CONCLUSIONS

There were consistent findings across a range of settings. Findings suggest that intensive interaction is rewarding for staff and beneficial to those that they work with. Implementation was sometimes perceived to be challenging and this review attempts to highlight solutions with guidance of the literature. Limitations largely relate to heterogeneity of the papers and methodological limitations are discussed.

Internet use for family carers of people with intellectual disabilities: A literature review and thematic synthesis

Being a family carer can be rewarding but can also lead to mental and physical exhaustion as well as feelings of social exclusion and isolation. Research has shown that the use of the Internet and online forums can provide an immediate place to find information and reassurance and that forum use can be an empathetic place to share experiences and seek emotional support. This article details a systematic literature search of research on carers of people with intellectual disabilities and/or autism using the Internet. A thematic synthesis of the resulting papers identified that online forums give carers a sense of agency by providing a place to go for informational support that may not be elsewhere. Carers also enjoyed the safe community of solidarity and emotional support that online forums provide. An important finding is the lack of published papers in this area with the inclusion of just eight papers.

Listening to mothers: experiences of mental health support and insights into adapting therapy for people with severe or profound intellectual disabilities

Individuals with severe or profound intellectual disabilities may be at a greater risk of developing mental health problems. Despite this, evidence suggests individuals can face difficulties in getting mental health support, and little is known about effective psychological therapies for this population. Hence, this study explored mothers' experiences of seeking mental health support for their offspring. Semi-structured interviews were conducted with six mothers of adults with severe or profound intellectual disabilities, who had sought mental health support for their offspring. Interviews were audio-recorded and analysed using Interpretative Phenomenological Analysis. The three main themes were 'A struggle to understand, Challenges to getting mental health support, and A mother's approach to adapting therapy.' Mothers found it difficult to recognise signs of emotional difficulties in their offspring. However, they thought that their offspring faced discrimination when accessing services, and that professionals often lacked the knowledge and skills to work with people with severe impairments. The mothers also stressed the importance of the therapeutic relationship and the need to involve carers in therapy. This study highlights the need for more appropriate mental health support for individuals with severe and profound intellectual disabilities. The findings also suggest further research is needed about adapting psychological therapies for this population.

Examining the impact of a city-wide intensive interaction staff training program for adults with profound and multiple learning disability: a mixed methods evaluation

Purpose: Intensive interaction is used to increase communication in people at a pre-verbal stage of communication development. The aim of the study was to evaluate a city-wide implementation of intensive interaction training to care staff by investigating how staff use intensive interaction with adults with profound and multiple learning disability, and their perceived impact of intensive interaction on these service users.Method: In phase 1, a survey investigated the outcomes of intensive interaction training on the work practices of staff supporting people with profound and multiple learning disability. In phase 2, individual interviews were conducted with staff to further investigate these experiences and perceptions. Interviews were analyzed using thematic analysis.Results: Almost all of the participants (96%) reported using intensive interaction at work with 76% wanting to use intensive interaction with more people. Factors preventing staff from using Intensive Interaction were highlighted. Three over-arching themes were identified from the interviews; the impact of Intensive Interaction; facilitating the implementation of Intensive Interaction and; the organizational support and barriers to the implementation of Intensive Interaction.Conclusions: Training in intensive interaction at a city-wide level enables staff to develop their knowledge of the approach and to engage in intensive interaction to promote the social inclusion of adults with profound and multiple learning disability. The barriers preventing staff from engaging in Intensive Interaction with adults with profound and multiple learning disability should be addressed.Implications for RehabilitationTraining care staff in intensive interaction promotes social inclusion for adults with profound and multiple learning disability.Care staff are able to identify changes in the interactive and communicative behaviors of adults with profound and multiple learning disability.Care staff perceive they are able to facilitate changes in the interactive and communicative behaviors of adults with profound and multiple learning disability.Care staff need continued support and training to sustain their use of Intensive Interaction with adults with profound and multiple learning disability.Services need to reduce the barriers of staffing, management and organizational structure to enable care staff to sustain their use of Intensive Interaction for adults with profound and multiple learning disability.

Intensive Interaction Training for Paid Carers: 'Looking, Looking and Find Out When They Want to Relate to You'

BACKGROUND

Intensive interaction (II) is a communication approach useful for working with people with severe intellectual disabilities. Health and social care providers offer II training courses to paid carers working in local services with the goal of improving social communication for their clients.

MATERIALS AND METHODS

Eight paid carers who had been trained in II were interviewed 2-3 years after training, to explore how their practice had changed, and whether any changes were sustainable. Interviews were analysed using interpretative phenomenological analysis.

RESULTS

Analysis revealed a master theme of emotional and practical endurance, with empowerment, better understanding and perceived barriers to implementation comprising subthemes.

CONCLUSIONS

Despite actual and perceived barriers to the enduring use of II, all participants spoke positively of the approach and were continuing to use II in practice.