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Intensive interaction & sensory integrationStaying in the grey when the thunderstorm threatensRebecca SecombeOccupational TherapistSt Patrick's Special School, Dulwich, SA

We are mostly engaged in what isnt happening rather than what isand missing lifeOnly been working in the disability sector for 6 years and Ive found that is easily to fall into the trap of the deficit model. It is common to develop curriculums around what we think our students need to learn to become more complete, rather than acknowledging their strengths and being in the moment. We seem to default to always predicting what the next step is to fill in the gaps in their development. With intensive interaction we need a paradigm shift in what we require of the learner-educator dynamic. II requires of us to be totally present. Present to what is happening instead of trying to fill in what we deem as missing

It is very natural for us a neurotypical adults to see the disability and want to normalise the person. However, when we used intensive interaction we are taking an inside out approach, we become like our communication partner, assimilating their behaviours and body language to create a familiar point of reference. 2Why si & II?A sensory world

Altered perceptions

Sensory overload

The Autonomic Storm (meltdown)

We live in a sensory world. We experience the world through our senses. We smell, touch, taste, hear, move and see our way through life. When our senses are processing our environment correctly, we are available to socially interact and engage with others.

People with severe learning disabilities often have sensory systems that are get blocked up in the brain and cause a bottle neck, which leads to sensory overload and eventually meltdown. 3The sensesWe all live in a sensory world

TACTILE

AUDITORY

OLFACTORY

GUSTATORY

Tactile-messages about hard, soft, warm, cold, pain, pressure, shape, size, texture, tactile defensiveness, tactile seekingAuditory- messages about the surrounding environment, impending danger, speech as communication, loud, soft, how far away something is from usOlfactory- dangerous smells (smoke), smells that wake up the nervous system such as mint or calm such as lavenderGustatory- salty, sweet, sour, bitter, strong flavours, bland flavours4We all live in a sensory world

VISUAL

VESTIBULAR

PROPRIOCEPTIVE

INTERNAL

The senses

Visual- understanding of the objects in the world, colour, shape, size, brightness, big small, fast, slow, near, farVestibular- SCC inner ear keep you upright, know up from down, back from front, coordination of vision and movement, alertness and arousal, how sleepy or awake we are, unifies visual, auditory and tactileProprioception- info from muscles, joints and tendons give body awareness, body map, how much force to exert to pick up a cup, endorphins released from activating the proprioceptors, calming effect. Deep pressure on our bodies can calm us down when we are in a highly anxious stressed, alert state but also wake us up and bring us into a better state of awareness Internal- hunger, emotions, chemical reations

They have a very different sensory reality to us. This results in atypicial behaviours.

SHOW ADRIANA VIDEO5Behaviours Flicking fingers/objectsTongue clickingScratching fingersChewing objectsLooking out of corner of eyesSmelling everythingBiting- self or othersKicking wallsBanging headRocking

WHY?Repetitive behaviours are coping strategies, they provide the person with a predictable point of reference that makes them feel safe. I know what it feels like to flicking me flingers in front of my eyes and if I do it over and over it will feel the same. These are often strategies used to stop themselves from entering meltdown. Just like you an I have coping strategies when our systems are getting stressedchewing pencils, twisting hair, drinking coffee, chewing gum, fiddling with jewellery, tapping our feet.

Look at feedback that they are seeking and what they are avoiding. If they are seeking pressure (proprioception) they are trying to calm themselves. They often dont have the resources to get what they need and biting the nearest person because there is a loud noise that their system interprets as noxious, may be the only way they can express Im really hurting here, you are the only thing I can see near me that may be causing this, make it stop!

Shut down a sense `6The eye of the storm My heads running awayMy ears are fizzyWords sound like bulletsIt began with the feeling one gets from eating lemons Donna WilliamsUp and down were suddenly in the same place and I had no idea where my feet were Gunilla GerlandSo as not to fall over or explode from inside I had to grab the fence where I was standing, pressing myself against it and holding on hard Gunilla GerlandI will do anything to stop it, Ill run in front of a car, bash my head on the wall

Electrical stormClouds have been brewing, the signs have been there, building friction and tension, electricity in the air, havent been able to get ourselves out of sensory overload using our coping strategies and all the right climatic conditions have aligned to cause a storm. Thunder, lightning, hail and all chaos breaks out. Confusion. Meltdown, shutdown, breakdown, fragmentation, collapse, distress, chaos, The coming apart of all systems

7conversationPartner respondsBrain processesBrainrecognisesBrain initiatesThe brain-body-brain feedback loopThe brain-body-brain-partner interaction spiralPeople require a lot of processing:We make noiseWe move fastWe use subtle expressionsWe talk fastWe smell

Hear so many people in my workplace say what do I do once I've copied their actions or noisesII is not about imitation or copying. Copying is merely the hello, how are you? in your conversation, your conversation starter, your icebreaker, your get to know you. Its also black and white. You do something, I do the same thing. You do something, I do the same thing. There are no social nuances, no shared joke, no mutual reciprocation, no dynamics, no flow.

8In the greyYes, Intensive Interaction does involve imitation, but it also involves developing an awareness of others, joint focus; turn taking; responding predictably; mutual anticipation; enjoyment of social time; eye gaze ; physical dialogues; patterns of touch, reciprocity, expressing emotions, having the opportunity to practice the behaviours that sustain social encounters; exploring agency, learning to remember and return to familiar games; and for practitioners, what Dave Hewett calls giving good face or maintaining your presence in the learners consciousness.

Mark Barber Staying in the GreyOur role is not teacher, entertainer or carer

Grey is messy, its murky, its unpredictable, it creates suspense, anticipation, ebbs and flows, spirals and tapers. Dynamic.

SHOW JERED VIDEO9communicationFunctional language is like looking through a window and seeing what a persons needs are, whereas emotional access opens the door and lets us in to who we are and they really are-it allows us to be with each other.

How we feel is the colourful part of our lives. It is not just that we are but who we are.

Phoebe Caldwell Finding you finding Me Pg 55-56 Be with life just the way it is & just the way it isnt. It is not only who we are, but who we are not that defines us. We need to accept ourselves and everyone we interact with just the way we are and just the way we are not.

Put aside your own agenda. Your own justifications. Be present in the interaction.

I chose to be in an interaction with you because I chose to be in an interaction with you. 11Recommended readingUsing Intensive Interaction and Sensory IntegrationPhoebe Caldwell with Jane Horwood

Finding You Finding MePhoebe Caldwell

From Isolation to intimacyPhoebe Caldwell with Jane Horwood

Autism and Intensive Interaction DVDPhoebe Caldwell