Updated on
January 23, 2026
|
January 16, 2026
Learn Intensive Interaction for pre-speech communication. This guide covers the six fundamentals, practical techniques, and how to support learners with PMLD and autism.
Intensive Interaction is an approach for teaching the fundamentals of communication to children and adults with severe learning difficulties, autism, or communication difficulties. Developed by Dave Hewett and Melanie Nind at Harperbury Hospital School in the 1980s, this child-led approach draws on the natural communication patterns between caregivers and infants to help individuals develop the building blocks of social interaction.
���
Intensive Interaction is a teaching approach developed by Dave Hewett and Melanie Nind in the 1980s for individuals with severe learning difficulties and autism. The method mirrors natural caregiver-infant communication patterns to develop fundamental social interaction skills before speech development begins.
Intensive Interaction is a practical approach for developing communication with people who are at early stages of communication development. The approach is particularly effective for individuals with profound and multiple learning difficulties (PMLD), severe autism, and those who are pre-verbal or have very limited communication.
The approach is based on a simple observation: typically developing infants learn the foundations of communication through playful, responsive interactions with their caregivers. These early exchanges, often called "proto-conversations," teach babies to take turns, share attention, read facial expressions, and enjoy being with another person. For various reasons, some individuals miss or do not fully develop these foundational skills.
Intensive Interaction recreates the conditions of these early learning experiences, regardless of the person's chronological age. A 15-year-old or a 40-year-old can benefit from this approach just as much as a young child.
The approach was developed during the 1980s by Dave Hewett and Melanie Nind while working at Harperbury Hospital School in Hertfordshire. They observed that existing behavioural approaches were not meeting the communication needs of their students, and sought an alternative grounded in developmental psychology.
Pre-speech communication development follows six fundamental stages: enjoying being with others, developing joint attention, learning turn-taking, using eye contact, understanding facial expressions and body language, and regulating emotions. These stages form the essential foundation before any language development can occur successfully.
Intensive Interaction focuses on developing six foundational communication abilities. These "fundamentals" must typically be in place before formal language can develop:
Before any communication can happen, a person must find being with another person rewarding rather than stressful or neutral. Many individuals with severe autism or learning difficulties find social contact overwhelming or simply not interesting.
What this looks like:
Joint attention means sharing focus with another person on the same thing, whether that is an object, an activity, or simply each other. This triangular relationship (you, me, and something we both attend to) is fundamental to all communication.
What this looks like:
All conversation is essentially sophisticated turn-taking. Before verbal exchanges can develop, the basic concept of "my turn, your turn" must be understood and enjoyed.
What this looks like:
Eye contact serves multiple communication functions: gaining attention, showing interest, signalling turns, and reading emotional states. Learning to use and interpret eye contact appropriately is crucial for social communication.
What this looks like:
The majority of human communication is non-verbal. Understanding and using facial expressions, gestures, posture, and proximity are essential communication skills.
What this looks like:
Being able to manage emotional arousal during social interaction is necessary for sustained engagement. Without some ability to regulate emotions, interactions become overwhelming or impossible.
What this looks like:
Intensive Interaction operates on four core principles: mirroring the learner's existing behaviours, removing all performance pressure and goals, following the learner's lead rather than directing, and allowing sessions to develop organically. These principles create anxiety-free environments that promote natural communication growth.
This is the defining characteristic of Intensive Interaction. The practitioner does not set an agenda, direct activities, or work towards predetermined goals. Instead, they observe what the learner is already doing and join in.
If the learner is rocking, the practitioner rocks alongside them. If the learner is making sounds, the practitioner echoes those sounds. If the learner is tapping a surface, the practitioner taps too. The learner's existing behaviours become the shared activity.
This approach honours the learner's communication where it currently exists and builds from that foundation, rather than trying to impose external communication forms.
Interactions must be enjoyable for both parties. This is not a chore or a task to be completed. When both the learner and practitioner are genuinely having fun, communication develops naturally.
Signs of mutual enjoyment include:
Intensive Interaction is "taskless." There is no worksheet to complete, no target to achieve, no skill to demonstrate. The interaction itself is the purpose.
This can feel uncomfortable for educators trained to work towards measurable outcomes. However, removing the pressure of goals creates space for genuine connection and natural communication development.
Good Intensive Interaction involves careful attention to timing. The practitioner must:
The pace is always set by the learner, not the practitioner.
Copy what the learner does. If they clap, you clap. If they vocalise "ah-ah-ah," you respond "ah-ah-ah." This demonstrates that their actions have an effect on another person and creates a shared experience.
Mirroring should be:
Go where the learner goes, both literally and figuratively. If they move, move with them. If they change activity, change with them. Resist the urge to redirect or maintain your preferred activity.
Create space for the learner to respond. Many practitioners fill silences too quickly. A pause that feels long to you may be exactly what the learner needs to process and formulate a response.
Use brief, simple language to narrate what is happening. Keep words to a minimum (one or two words at a time) and match them to actions. "Clap!" "Jump!" "Again!"
Create rhythmic patterns of activity followed by pauses. This helps establish turn-taking as the learner begins to anticipate the next burst and may start to initiate.
Example pattern:
Successful Intensive Interaction sessions require a quiet, distraction-free environment where practitioners position themselves at the learner's eye level. Sessions begin with brief interactions lasting seconds to minutes, focusing entirely on mirroring the learner's behaviours without predetermined goals or time limits.
Create conditions that support focused interaction:
There is no prescribed session length. Sessions should:
Position yourself to enable interaction:
While there are no session goals, recording what happens is valuable:
Something is always happening. The learner may be processing, observing, becoming comfortable with your presence, or simply not ready. Periods of apparent inactivity are part of the process. Stay present, stay available, and trust the approach.
Look for subtle changes over time:
Progress may be slow and non-linear. Small changes are significant.
Absolutely. Intensive Interaction is not "childish" or only for young children. The fundamentals of communication are the same regardless of age. Adaptations may be needed (such as using age-appropriate positioning), but the core approach works across the lifespan.
Intensive Interaction often reduces challenging behaviours by:
If behaviours escalate during sessions, end the session calmly and try again later.
Intensive Interaction is primarily designed for pre-verbal or minimally verbal individuals. However, elements of the approach (following the lead, mutual enjoyment, responsive timing) can enhance interactions with verbal learners too.
Students with profound and multiple learning difficulties often have limited access to communication approaches designed for more able learners. Intensive Interaction provides a genuine pathway to social connection and communication development.
Key considerations:
Many autistic students benefit from Intensive Interaction, particularly those who are pre-verbal or have significant communication difficulties. The approach:
Even students with some language may have gaps in the fundamentals of communication. Intensive Interaction can address these underlying skills alongside other approaches.
Timetabled sessions with trained staff in appropriate environments:
The principles of Intensive Interaction can be applied throughout the day:
The most effective implementation involves:
The Intensive Interaction Institute offers:
Resources for developing skills:
New practitioners often feel uncertain. Confidence builds through:
Research evidence demonstrates that Intensive Interaction significantly improves social engagement, communication skills, and emotional regulation in individuals with severe learning difficulties and autism. Studies show measurable progress in pre-speech foundations including attention span, eye contact, and turn-taking abilities.
Intensive Interaction has a growing evidence base supporting its effectiveness:
While large-scale randomised controlled trials are limited (as with many individualised interventions), the accumulated evidence from practise and research supports the approach's effectiveness for developing pre-speech communication skills.
This varies enormously between individuals. Some learners show responses within sessions; others may take weeks or months of consistent practise. Trust the process and look for small changes.
Yes. Parents are often natural Intensive Interaction practitioners already. Formal training can help them understand and refine what they do. The approach works well across home and school settings.
Intensive Interaction may look like play, and it should be playful. The difference is the intentional focus on communication fundamentals and the careful, responsive approach of the practitioner. It is structured informality.
None. Intensive Interaction requires no special equipment, toys, or technology. The interaction between two people is everything needed. This accessibility is one of the approach's strengths.
Progress can be documented through:
Avoid the temptation to create artificial metrics. Qualitative documentation often captures progress better than quantitative measures.
These peer-reviewed studies provide deeper insights into the research behind this topic:
Podcasts’ effects on the EFL classroom: a socially relevant intervention
35 citations
Beatriz Chaves-Yuste & Cristina de-la Peña (2023)
This study demonstrates that podcasts significantly enhance EFL classroom engagement by promoting meaningful student interaction and developing digital competence. The research shows podcasts serve as effective ICT tools for encouraging opinion exchange and meaning negotiation amongst language learners. Teachers can integrate podcasts to create more socially relevant and interactive English language learning experiences. [Read the full study]
SENSORY AND PLAY-BASED LEARNING: HOW New METHODS HELP CHILDREN WITH SPECIAL NEEDS LEARN ENGLISH
2 citations
Viktoriia Kachur (2025)
Research reveals that sensory and play-based approaches significantly improve English language acquisition for children with special educational needs in inclusive classrooms. The study validates new gamified teaching methods that engage multiple senses to support diverse learning requirements. Teachers can implement these strategies to create more accessible and effective English lessons for all pupils. [Read the full study]
A Speech Emotion Recognition System for Improved Communication and Enhancing Human-Machine Interaction
1 citations
Manasi Deshpande & Priyanka Savadekar (2024)
This research explores speech emotion recognition technology that could revolutionise classroom communication by analysing emotional context beyond spoken words. The system demonstrates potential for enhancing human-machine interaction in educational settings through emotion detection. Teachers may benefit from understanding how emotional analysis technology could support remote learning and student engagement assessment.
Speech and language therapy service provision to UK intensive care units: A national survey
1 citations
Claire S. Mills et al. (2023)
A national survey reveals insufficient speech and language therapy provision in UK intensive care units, highlighting gaps in specialised communication support services. The research benchmarks current SLT service levels and identifies areas requiring improvement in critical care settings. This study provides valuable insights for healthcare educators and communication specialists working in intensive care environments. [Read the full study]
RELATIONSHIP BETWEEN VERBAL AND NON-VERBAL COMMUNICATION OF NURSES WITH COMMUNICATION BARRIERS TO FAMILIES OF PRE-SURGERY PATIENTS IN THE INTENSIVE CARE ROOM AT THE ACEH GENERAL HOSPITAL IN 2020
1 citations
Wirda Hayati et al. (2022)
Research examines how nurses' verbal and non-verbal communication affects patient families' pre-surgery readiness, identifying key communication barriers in intensive care settings. The study reveals that unclear communication creates misperceptions and interaction difficulties between healthcare staff and families. Healthcare educators can use these findings to improve communication training programmes for nursing staff. [Read the full study]
Intensive Interaction offers a respectful, evidence-informed approach to developing communication with individuals who are at early stages of communication development. By following the learner's lead, creating mutual enjoyment, and focusing on the fundamentals of communication, practitioners can help individuals develop the foundation skills necessary for social connection and, potentially, further communication development.
The approach requires no special equipment, can be implemented throughout the day, and works across age groups. While it demands patience and a willingness to abandon traditional notions of teaching, the rewards for both learners and practitioners can be profound.
As Dave Hewett emphasises, Intensive Interaction is about learning and using the language that has meaning for an individual to build a relationship with them. It is not a quick fix or a cure, but a long-term commitment to genuine communication and connection.
Intensive Interaction is an approach for teaching the fundamentals of communication to children and adults with severe learning difficulties, autism, or communication difficulties. Developed by Dave Hewett and Melanie Nind at Harperbury Hospital School in the 1980s, this child-led approach draws on the natural communication patterns between caregivers and infants to help individuals develop the building blocks of social interaction.
���
Intensive Interaction is a teaching approach developed by Dave Hewett and Melanie Nind in the 1980s for individuals with severe learning difficulties and autism. The method mirrors natural caregiver-infant communication patterns to develop fundamental social interaction skills before speech development begins.
Intensive Interaction is a practical approach for developing communication with people who are at early stages of communication development. The approach is particularly effective for individuals with profound and multiple learning difficulties (PMLD), severe autism, and those who are pre-verbal or have very limited communication.
The approach is based on a simple observation: typically developing infants learn the foundations of communication through playful, responsive interactions with their caregivers. These early exchanges, often called "proto-conversations," teach babies to take turns, share attention, read facial expressions, and enjoy being with another person. For various reasons, some individuals miss or do not fully develop these foundational skills.
Intensive Interaction recreates the conditions of these early learning experiences, regardless of the person's chronological age. A 15-year-old or a 40-year-old can benefit from this approach just as much as a young child.
The approach was developed during the 1980s by Dave Hewett and Melanie Nind while working at Harperbury Hospital School in Hertfordshire. They observed that existing behavioural approaches were not meeting the communication needs of their students, and sought an alternative grounded in developmental psychology.
Pre-speech communication development follows six fundamental stages: enjoying being with others, developing joint attention, learning turn-taking, using eye contact, understanding facial expressions and body language, and regulating emotions. These stages form the essential foundation before any language development can occur successfully.
Intensive Interaction focuses on developing six foundational communication abilities. These "fundamentals" must typically be in place before formal language can develop:
Before any communication can happen, a person must find being with another person rewarding rather than stressful or neutral. Many individuals with severe autism or learning difficulties find social contact overwhelming or simply not interesting.
What this looks like:
Joint attention means sharing focus with another person on the same thing, whether that is an object, an activity, or simply each other. This triangular relationship (you, me, and something we both attend to) is fundamental to all communication.
What this looks like:
All conversation is essentially sophisticated turn-taking. Before verbal exchanges can develop, the basic concept of "my turn, your turn" must be understood and enjoyed.
What this looks like:
Eye contact serves multiple communication functions: gaining attention, showing interest, signalling turns, and reading emotional states. Learning to use and interpret eye contact appropriately is crucial for social communication.
What this looks like:
The majority of human communication is non-verbal. Understanding and using facial expressions, gestures, posture, and proximity are essential communication skills.
What this looks like:
Being able to manage emotional arousal during social interaction is necessary for sustained engagement. Without some ability to regulate emotions, interactions become overwhelming or impossible.
What this looks like:
Intensive Interaction operates on four core principles: mirroring the learner's existing behaviours, removing all performance pressure and goals, following the learner's lead rather than directing, and allowing sessions to develop organically. These principles create anxiety-free environments that promote natural communication growth.
This is the defining characteristic of Intensive Interaction. The practitioner does not set an agenda, direct activities, or work towards predetermined goals. Instead, they observe what the learner is already doing and join in.
If the learner is rocking, the practitioner rocks alongside them. If the learner is making sounds, the practitioner echoes those sounds. If the learner is tapping a surface, the practitioner taps too. The learner's existing behaviours become the shared activity.
This approach honours the learner's communication where it currently exists and builds from that foundation, rather than trying to impose external communication forms.
Interactions must be enjoyable for both parties. This is not a chore or a task to be completed. When both the learner and practitioner are genuinely having fun, communication develops naturally.
Signs of mutual enjoyment include:
Intensive Interaction is "taskless." There is no worksheet to complete, no target to achieve, no skill to demonstrate. The interaction itself is the purpose.
This can feel uncomfortable for educators trained to work towards measurable outcomes. However, removing the pressure of goals creates space for genuine connection and natural communication development.
Good Intensive Interaction involves careful attention to timing. The practitioner must:
The pace is always set by the learner, not the practitioner.
Copy what the learner does. If they clap, you clap. If they vocalise "ah-ah-ah," you respond "ah-ah-ah." This demonstrates that their actions have an effect on another person and creates a shared experience.
Mirroring should be:
Go where the learner goes, both literally and figuratively. If they move, move with them. If they change activity, change with them. Resist the urge to redirect or maintain your preferred activity.
Create space for the learner to respond. Many practitioners fill silences too quickly. A pause that feels long to you may be exactly what the learner needs to process and formulate a response.
Use brief, simple language to narrate what is happening. Keep words to a minimum (one or two words at a time) and match them to actions. "Clap!" "Jump!" "Again!"
Create rhythmic patterns of activity followed by pauses. This helps establish turn-taking as the learner begins to anticipate the next burst and may start to initiate.
Example pattern:
Successful Intensive Interaction sessions require a quiet, distraction-free environment where practitioners position themselves at the learner's eye level. Sessions begin with brief interactions lasting seconds to minutes, focusing entirely on mirroring the learner's behaviours without predetermined goals or time limits.
Create conditions that support focused interaction:
There is no prescribed session length. Sessions should:
Position yourself to enable interaction:
While there are no session goals, recording what happens is valuable:
Something is always happening. The learner may be processing, observing, becoming comfortable with your presence, or simply not ready. Periods of apparent inactivity are part of the process. Stay present, stay available, and trust the approach.
Look for subtle changes over time:
Progress may be slow and non-linear. Small changes are significant.
Absolutely. Intensive Interaction is not "childish" or only for young children. The fundamentals of communication are the same regardless of age. Adaptations may be needed (such as using age-appropriate positioning), but the core approach works across the lifespan.
Intensive Interaction often reduces challenging behaviours by:
If behaviours escalate during sessions, end the session calmly and try again later.
Intensive Interaction is primarily designed for pre-verbal or minimally verbal individuals. However, elements of the approach (following the lead, mutual enjoyment, responsive timing) can enhance interactions with verbal learners too.
Students with profound and multiple learning difficulties often have limited access to communication approaches designed for more able learners. Intensive Interaction provides a genuine pathway to social connection and communication development.
Key considerations:
Many autistic students benefit from Intensive Interaction, particularly those who are pre-verbal or have significant communication difficulties. The approach:
Even students with some language may have gaps in the fundamentals of communication. Intensive Interaction can address these underlying skills alongside other approaches.
Timetabled sessions with trained staff in appropriate environments:
The principles of Intensive Interaction can be applied throughout the day:
The most effective implementation involves:
The Intensive Interaction Institute offers:
Resources for developing skills:
New practitioners often feel uncertain. Confidence builds through:
Research evidence demonstrates that Intensive Interaction significantly improves social engagement, communication skills, and emotional regulation in individuals with severe learning difficulties and autism. Studies show measurable progress in pre-speech foundations including attention span, eye contact, and turn-taking abilities.
Intensive Interaction has a growing evidence base supporting its effectiveness:
While large-scale randomised controlled trials are limited (as with many individualised interventions), the accumulated evidence from practise and research supports the approach's effectiveness for developing pre-speech communication skills.
This varies enormously between individuals. Some learners show responses within sessions; others may take weeks or months of consistent practise. Trust the process and look for small changes.
Yes. Parents are often natural Intensive Interaction practitioners already. Formal training can help them understand and refine what they do. The approach works well across home and school settings.
Intensive Interaction may look like play, and it should be playful. The difference is the intentional focus on communication fundamentals and the careful, responsive approach of the practitioner. It is structured informality.
None. Intensive Interaction requires no special equipment, toys, or technology. The interaction between two people is everything needed. This accessibility is one of the approach's strengths.
Progress can be documented through:
Avoid the temptation to create artificial metrics. Qualitative documentation often captures progress better than quantitative measures.
These peer-reviewed studies provide deeper insights into the research behind this topic:
Podcasts’ effects on the EFL classroom: a socially relevant intervention
35 citations
Beatriz Chaves-Yuste & Cristina de-la Peña (2023)
This study demonstrates that podcasts significantly enhance EFL classroom engagement by promoting meaningful student interaction and developing digital competence. The research shows podcasts serve as effective ICT tools for encouraging opinion exchange and meaning negotiation amongst language learners. Teachers can integrate podcasts to create more socially relevant and interactive English language learning experiences. [Read the full study]
SENSORY AND PLAY-BASED LEARNING: HOW New METHODS HELP CHILDREN WITH SPECIAL NEEDS LEARN ENGLISH
2 citations
Viktoriia Kachur (2025)
Research reveals that sensory and play-based approaches significantly improve English language acquisition for children with special educational needs in inclusive classrooms. The study validates new gamified teaching methods that engage multiple senses to support diverse learning requirements. Teachers can implement these strategies to create more accessible and effective English lessons for all pupils. [Read the full study]
A Speech Emotion Recognition System for Improved Communication and Enhancing Human-Machine Interaction
1 citations
Manasi Deshpande & Priyanka Savadekar (2024)
This research explores speech emotion recognition technology that could revolutionise classroom communication by analysing emotional context beyond spoken words. The system demonstrates potential for enhancing human-machine interaction in educational settings through emotion detection. Teachers may benefit from understanding how emotional analysis technology could support remote learning and student engagement assessment.
Speech and language therapy service provision to UK intensive care units: A national survey
1 citations
Claire S. Mills et al. (2023)
A national survey reveals insufficient speech and language therapy provision in UK intensive care units, highlighting gaps in specialised communication support services. The research benchmarks current SLT service levels and identifies areas requiring improvement in critical care settings. This study provides valuable insights for healthcare educators and communication specialists working in intensive care environments. [Read the full study]
RELATIONSHIP BETWEEN VERBAL AND NON-VERBAL COMMUNICATION OF NURSES WITH COMMUNICATION BARRIERS TO FAMILIES OF PRE-SURGERY PATIENTS IN THE INTENSIVE CARE ROOM AT THE ACEH GENERAL HOSPITAL IN 2020
1 citations
Wirda Hayati et al. (2022)
Research examines how nurses' verbal and non-verbal communication affects patient families' pre-surgery readiness, identifying key communication barriers in intensive care settings. The study reveals that unclear communication creates misperceptions and interaction difficulties between healthcare staff and families. Healthcare educators can use these findings to improve communication training programmes for nursing staff. [Read the full study]
Intensive Interaction offers a respectful, evidence-informed approach to developing communication with individuals who are at early stages of communication development. By following the learner's lead, creating mutual enjoyment, and focusing on the fundamentals of communication, practitioners can help individuals develop the foundation skills necessary for social connection and, potentially, further communication development.
The approach requires no special equipment, can be implemented throughout the day, and works across age groups. While it demands patience and a willingness to abandon traditional notions of teaching, the rewards for both learners and practitioners can be profound.
As Dave Hewett emphasises, Intensive Interaction is about learning and using the language that has meaning for an individual to build a relationship with them. It is not a quick fix or a cure, but a long-term commitment to genuine communication and connection.
