Autism is a condition that is still widely misunderstood, not
just among support workers but also at management level. Since the
information processing system is like a bottleneck, the sensory
experience of those on the spectrum is grossly distorted,
overloaded and often extremely painful. A child tells us that it is
like having his head in a car-crusher. While their sensory (eyes,
nose, etc) systems may be working, the processing of incoming
information to the brain is skewed so that they do not necessarily,
see, hear or sense the world we share in the same way as those not
on the spectrum. Over-activity of the autonomic nervous system
leads to behavioural distress and sometimes severe aggression
towards self or others. We can get some idea of what it can be like
by watching a small clip made by
an unnamed woman with autism of her experience of sensory overload.
She says that her brain is like a dial-up modem instead of a cable
modem, that is, if it is fed too much data it will crash. Those who
experience this say they will do anything to stop it - hence the
Even if staff responses are not as horrific as the treatment of
vulnerable adults at Winterbourne View, attempts to control such
outbursts without addressing their origin only inflames situations.
Even trying to talk people down adds to the sensory confusion since
the speech areas in the brain are virtually always affected.
Training needs to address the construction of an autism-friendly
environment and reducing confusion by, 1) identifying and reducing
sensory triggers to sensory overload and 2) increasing signals that
do have meaning for the brain. Included in this latter approach is
the use of Sensory Integration -strong physical input, and of
Intensive Interaction - the use of body language to set up
Using Intensive Interaction can make a real difference to the
quality of life for a person with autism and those who are
interested can find information on,
and references on
One of the problems in the care of those with severe autism is
that many care homes are being run by organisations that do not
understand the nature of autism and whose managers have no
up-to-date training in the specialist care that is needed.
Even 'love is not enough'. This is because the sensory
environment that is pleasant for a non-autistic person may be
painful and stressful for an individual on the spectrum. What is
needed is not a bright cheerful environment but, visual and
auditory tranquility. Everything needs to be measured by this.
And what evidence is there that Intensive Interaction
works? Apart from a massive accumulation of anecdotal
evidence, Nind and Kellett (2002) show a significant decrease in
disturbed behaviour in adults with learning disabilities when their
support staff engage with them through corresponding actions. A
recent survey commissioned by Mencap and the Department of Health,
on communication with people with PMLD, Goldbart, J. (2010), finds
that Intensive Interaction is one of the approaches most widely
used. Over 85% of Speech Therapists in the survey were using it.
Frame by frame analyses of videos by Zeedyk, Caldwell and Davie
show that even if the time-line varies, there is always a
significant increase in eye contact, proximity and social
responsiveness when Intensive Interaction is used.
Nind, M. and Kellett, M. (2002) Responding to individuals
with severe learning difficulties and stereotyped behaviour.
Challenges for an inclusive era. European Journal of Special
Needs Education 3. 265-282
Zeedyk, S, Caldwell, P. and Davies, C (2009) 'How Rapidly
does Intensive Interaction
promote social engagement for adults with profound learning
disabilities?' European Journal of Special Needs Education,
Vol 24. 2009, p.119-137
Intensive Interaction Training
Caldwell, P. (2002b) 'Learning the Language'
Follows a three day intervention using Intensive Interaction to
get in touch with a young man with very severe autism, using his
body language, followed by discussions with Care Staff.
Caldwell, P. (2004)'Creative Conversations'
Pavilion Press. Intensive Interaction being used with people with
multiple disabilities, mainly severe Cerebral Palsy.
Caldwell P (2007) 'Reaching Ricky' Teachers TV Made
by 'Available Light' . Working with a child with autism in
Caldwell, P.(2009) Autism and
Intensive Interaction: using body
language to get in touch with children on the autistic
spectrum'. Jessica Kingsley Publishers. Includes a twenty
minute uncut Intensive Interaction intervention with an eight year
old child, whom staff cannot make contact with and whom Caldwell
has never met before. The film moves from initial rejection to
total attention. Other interventions with children aged 3-18. http://www.phoebecaldwell.co.uk/films.html