Video Interaction Guidance
The most extensive work to date using VIG with autistic children has probably been carried out by the Scottish Society for Autism. VIG is carried out by the two Community Support Service Workers usually on home visits to pre-school children although some work has been done in the school setting. The pre school work has been typically focused on pre-verbal communication skills, identifying incidences of eye contact, turn taking, making and responding to initiatives, pointing anticipation and an examination of the sequence of events.
In Scotland VIG is being used with autistic children for a variety of purposes and in a variety of settings. In West Lothian a Nursery Nurse was trained in the technique. The successful contact principles were then incorporated into the child's Individual Educational Programme. Once the contact skills were made explicit, the nursery nurse was able to apply them in her interactions with a pre-school autistic girl throughout the child's 4 afternoons a week placement at the Nursery during the course of an academic year.
Although the child already used a lot of language much of it was repetitious and she seemed to lack an understanding of language and an ability to communicate her emotions. The VIG approach was able to identify the child's development level of communication and the most effective responses to child's initiatives.
VIG was also used to reinforce incidences of positive interactions in the home between the mother and child. This intervention consisted of 4 or 5 video and feedback sessions. Both her mother and her nursery nurse reported positive changes in the child's responses to them and the interactional skills. Some progress was recorded on a pre 5 development checklist that charted her progress in language skills.
VIG is currently being used in West Lothian in a special provision for primary pupils on the autistic spectrum. The aim of the project to facilitate peer communication. Since 1993 VIG has been used in Dundee in a pre school centre which caters for children with special educational needs. A collaborative approach has been adopted involving nursery nurses, nursery teachers, special educational needs teachers, educational psychologist, an occupational therapist, a speech and language therapist, parents and carers. A series of 8 parent/carer workshops covering one contact principle in turn offered a systematic approach to understanding and applying the principles. It was hoped to increase awareness of communication skills and emphasise the importance of quality communication. Between workshops, videos were taken in the carers home. A similar format was applied to a series of workshops for staff with the videos being taken in the classrooms. Final evaluative questionnaires for both groups indicated a favourable response to the approach.
There are no experimental studies of VIG designed to demonstrate significant positive changes in interactions involving children with Autism. However, there is a steady accumulation of evidence from individual case studies to support the idea that VIG may be an effective form of intervention.
Van Rees and Biemans (1986) showed in a video that a child with primary autism can make gains through a sustained regime of communication and play with a mother who has benefited from a guided interpretation of her behaviours and the child's responses.
Benefits to parents
The reported benefits to parents lie in the provision of a practical approach, which puts the parents in control. Examination of the video footage helps parents to understand how Autism impacts on their child. The process of analysis and feedback informs parental expectations so that they can set goals that are more realistic and therefore potentially achievable. Parents report that one of the main benefits for them lies in the increased responsiveness of the child.
Benefits of the Approach
The approach is a flexible one. The Society has used the technique to provide feedback to a 14 year old with Asperger Syndrome. It has also enabled a father to communicate more effectively with his pre school autistic child and a Primary One sibling. In nursery settings it can be used for individual work between nursery nurse and child to increase interactions between children.
The underlying Contact Principles are based on sound research evidence (Trevarthen 1977, 1979, 1993) Moreover, although the development of children with Autism is considered to be qualitatively different, the theoretical basis from which the Contact Principles are derived are grounded in observations of normally developing infants. The technique thus applies principles that 'normalise' the autistic child's development of communication skills.
With its emphasis on the development of pre-existing skills, helping the client to identify 'what works' and normalising problems it applies a solution focused approach to that recommended by Solution Focused Therapy (De Shazer 1985).
Benefits to the Child
The approach fulfils the requirements of the Children Scotland Act (1995) that any intervention offered should adhere to the principle of being the least intrusive. The child is videoed in a familiar context for a short period of around ten minutes over any single session. The analysis and feedback sessions do not involve the child at all.
However, the actual benefits to the child are perhaps harder to identify. There is a growing body of opinion among practitioners using the techniques that there are considerable benefits for the child that can be built on and are maintained in the long term. The videotapes themselves offer evidence that seems to have a great deal of face validity. Once cannot fail to be impressed from the tapes held by the Society of the tremendous gains in communication skills that are made over the intervention period.
Although quantifiable evidence is not available from any large scale experimental research it is possible to gather quantifiable data from individual case studies.
Evidence from a Case Study
A VIG intervention was carried out on a 7 year old child who had been diagnosed by the Scottish Centre for Autism at Yorkhill as having Childhood Autism. He had difficulties using and understanding language. His social understanding was poor. There were also behavioural difficulties, several challenging behaviours, sleep disturbance and toileting difficulties. The intervention was carried out over a period of 3 months. In that time, there were five video sessions and five feedback sessions. A micro analysis was made covering four minutes from the first tape (6.2.97) and four minutes from the last tape that was made 9 weeks later (2.4.97).
The responses were entered into a chart showing the attuned and the discordant responses and the attuned and the discordant initiations made by the adult in the interaction with the child over a four minute period. The attuned responses to the child's initiative rose from 55% to 85% while the number of child's initiatives rose from 26 to 34. VIG can thus offer both a base line measure of communication skills and a built in evaluation of the gains made.
Written by, and reprinted with the permission of, Sheila Messenger for SPIN-VIG Newsletter (June 1999).
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