Hugh is a gentleman in his 60’s, who has a learning disability and autism. He lives in a home which provides him with 24-hour support. Hugh’s communication skills are non-verbal, and he largely avoids contact with others. For a variety of reasons, Hugh rarely leaves his home and can appear to be very isolated.
Today’s brief visit to see Hugh was a joyful example of his ability to explore connection. We think it is also a notable example of successfully finding the balance between ‘support’ and ‘challenge’. For all of us, our best learning happens when there is a balance between the two; the conundrum with Hugh is finding out quite just where the balance lies on any particular occasion. Today, in a few minutes together, we seemed to get it ‘right’! This is what happened:
Today when I visited Hugh, I took with me a large, red, plastic, extendible tube (Hugh loves the colour red). After singing hello, to the tune we always use, I repeated the tune using only Hugh’s name rather than the usual words, offering the sound through the extended tube close to Hugh’s ear. Initially, Hugh froze in place as I started – visibly stiffening. At that point it wasn’t completely clear if his response was interest or anxiety. But then Hugh moved away a little and then back in, leaning his head directly against the plastic tube. I changed the song to one that is deeper and more enunciated to enhance the sound and Hugh laughed – a real, relaxed, uninhibited expression of joy. We often see Hugh grin widely, but he rarely laughs out loud. I continued in the same tune, varying the words between verses, and Hugh laughed four more times. These were substantial bouts of laughing on 4 separate moments.
I then deliberately changed position, sitting on the floor, with Hugh standing over me and placed the tube to my face speaking through it. Hugh showed interest and looked at me through the tube making full eye contact. Having re-made the connection, knowing that Hugh was still interested in the interaction, I wanted to offer an opportunity for Hugh to know that he was in control of what I was doing. So, I only sang when Hugh was looking through the tube at me. When he looked away, I stopped. This was to let him know he was in control of our ‘conversation’. Hugh seemed to grasp this quickly, testing me out and smiling when I sang in response to his eye contact.
I wish we’d had a longer opportunity to explore this, but in a way, it felt like a complete and satisfying conversation.
It would be easy to think this was simply an act of entertaining Hugh or happily occupying him. Of course, it was clear that Hugh found the interaction entertaining. But there was a lot more going on at the same time. In their book “Access to Communication” (2005, David Fulton Publishing), which explores the theory and practice of Intensive Interaction, Dave Hewett and Melanie Nind list the ‘Fundamentals of communication’. These include:
- To emotionally engage with another person.
- To take turns in exchanges of behaviour with another person.
- To exchange meaningful signals with another person.
- To develop extended communicative engagements with another person.
We think that in the brief exchange this morning, Hugh was successfully and enjoyably exploring all of these. The purpose of singing down the tube only when he looked at me was to ‘Foster a sense of intentionality’ (Nind and Hewett, ibid) without which, none of those fundamentals can be achieved. It involves us noticing something that Hugh does (making eye contact) and something he enjoys (the sound of my voice reverberating in the tube) and encouraging him to notice that the two are not randomly connected – but that he can be intentionally and positively in control what I’m doing. This leads naturally to turn-taking (he looks, I sing) which is an essential component of every successful conversation. A successful conversation involves the wonderful sense of being listened to and understood – and that is what leads to the experience of increased emotional wellbeing and reduced isolation.
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