An adult and a child lying close together on a blanket, sharing a moment of joyful connection. The interaction reflects shared attention, warmth, and relational attunement, illustrating the principles of Intensive Interaction through presence, responsiveness, and connection.

Intensive Interaction as Neuro-Affirming Relational Practice

By, Dr Joanna Grace & Helen Edgar (April, 2026)


Intensive Interaction is not only neuro-affirming — it is humanity affirming.” — Dr Joanna Grace (2026)

With its model of mutual respect in interactions, engaging with Autistic interests, and taking into account Autistic cognition and sensory differences, I find Intensive Interaction the most favourable of current approaches for children on the autism spectrum.” — Dr Damian Milton (2014)


Introduction

This blog brings together the perspectives of myself, Helen Edgar, an Autistic educator with over twenty years’ experience working alongside children and young people with profound and multiple learning disabilities (Profound and Multiple Learning Disabilities), and Dr Joanna Grace, an Autistic international sensory engagement and inclusion specialist, doctoral researcher, trainer, author, TEDx speaker, and founder of The Sensory Projects.

Both Joanna and I are Autistic, and bring lived experience of extensive professional practice supporting individuals with Profound and Multiple Learning Disabilities, many of whom are also Autistic or otherwise neurodivergent. For many of the people we have worked with, being Autistic and having Profound and Multiple Learning Disabilities are not separate experiences layered on top of one another. They are woven together in how the world is perceived, processed, and communicated. Regardless of any neurodivergence or diagnosis a person may or may not have, for the people supporting those with Profound and Multiple Learning Disabilities, there needs to be a genuine attentiveness, responsiveness, and a willingness to look beyond neuronormative forms of communication and to recognise what is sensory, embodied, and relational (Grace, 2025; Grace et al., 2024).

This blog is rooted in neurodiversity-affirming values that emphasise autonomy, authenticity, and wellbeing, and that explicitly reject approaches aimed at normalising behaviour or enforcing compliance (Bottema-Beutel et al., 2023). Intensive Interaction is not just a communication technique or framework; it is a meaningful way of being with people. Intensive Interaction is person-led and centres safety, connection and presence. It is, we will argue, not only neuro-affirming but humanity-affirming.

Communication and Relationships

Intensive Interaction is an approach born out of a deep respect for the equality of human beings. It originated in a long-stay hospital in the early 1980s with practitioners who rejected the behaviourist approaches to the ‘treatment’ of people with learning disabilities. Instead of training people to behave in certain ways, they wanted to meet them where they were. Instead of insisting on a particular form of communication, they wanted to communicate with people in the ways they already used.

Through the decades, Intensive Interaction has been written about through the lenses of the time. It was originally developed in an educational setting and had to be framed as an educational approach, so it was written up as a way to teach communication. People skim-reading about Intensive Interaction can misunderstand it as an approach that insists on a particular format for communication, when at its foundations, there is simply a willingness to meet and recognise the person you are seeking to communicate with, how and where they are. There is learning within it, but it is often on the practitioner’s part as they try to understand and join in with the ways the person they are seeking to communicate with expresses themselves.

Some people have been alarmed by its apparent insistence on eye contact, and it is easy to appreciate how an approach that suggests eye contact could appear alarming to Autistic people, who may find it difficult or even painful. But there is a context to this which is missed when we reduce what is essentially a philosophy down to a step-by-step approach. The starting point of the philosophy of Intensive Interaction is the belief that humans are equal and valid in who and how they are. The suggestion to make eye contact in early writings is a suggestion to look, to really look at the person you are seeking to communicate with. Set against the context of the time, when people with learning disabilities and those that were neurodivergent were often locked away in institutions, when people would have turned away or stared had they seen them on the street. The invitation to make eye contact is an invitation to recognise the humanity of the other person. The originators of Intensive Interaction would never have forced eye contact on anyone, and would have been equally happy to sit alongside someone and share in a stim rather than fix eye contact.

This issue of reducing deeply thought-out approaches to step-by-step procedures or quick “ten things you need to know” summaries undermines practice in special education across the board. The philosophical foundations we build on are fundamental to the success of the approaches we use. It doesn’t matter how great the step-by-step approach is — if you build it on shaky foundations, it will slide and topple. The foundations of Intensive Interaction are a recognition of shared humanity, a belief in the equality of persons, and a willingness, even a desire, to meet people where they are, as who and how they are, to foster connection and understanding.

Rather than teaching communication as a set of skills to work through, Intensive Interaction starts from the premise that communication already exists. It is about attending to how a person moves, vocalises, breathes, or directs their attention, and responding in kind. No targets, no stages, no hierarchy. Just two people, present with each other, and open to whatever meaning grows between them.

Research has documented positive outcomes, including increased social engagement, communicative responsiveness, anticipation of interaction, and initiation (Nind, 1996; Hutchinson & Bodicoat, 2015). Systematic reviews have confirmed an encouraging direction of findings, while honestly acknowledging the challenges of conducting rigorous research with this population (Papadopoulos et al., 2023). Intensive Interaction is now the subject of a large-scale NIHR-funded randomised controlled trial, a sign that the field is taking it seriously (Bell et al., 2023). But the outcomes that matter most — belonging, trust, emotional safety, the experience of being genuinely met — are not easily captured by a trial. That is not a weakness of the approach. It is a reflection of what it is sometimes actually used for, and how institutions often need demonstrate concrete evidence.

Firth (2025) offers a really useful reframe here, suggesting that the changes we see in Intensive Interaction are almost certainly due to practitioners becoming better communication partners and more aware of the importance of relational practice. Progress lives in the relationship. It cannot be reduced to a checklist or a developmental stage or statistics, and trying to do so risks missing the point entirely.

Infographic titled “Neuro-affirming Relational Flow of Intensive Interaction to Support People with Profound and Multiple Learning Disabilities.” A soft-coloured infinity loop illustrates a continuous relational process with five stages:

Notice – observe with curiosity and respect.
Be Present – bring full attention without expectation.
Attune – tune into rhythms, signals, and ways of making meaning.
Respond – join in gently, being responsive to expressions and needs.
Pause – allow space for meaning to emerge in its own time.

At the centre of the loop is a heart labelled “Relationship and Connection.” Around the loop are supporting phrases emphasising noticing small expressions, attuning to the person’s world, pausing to allow connection, and responding through connection rather than a plan.

At the bottom are three principles: “No targets” (not about changing behaviour), “No hierarchy” (every person is equal), and “Led by the person” (their lead, their pace, their world).

The infographic ends with the quote: “Intensive Interaction is not only neuro-affirming — it is humanity-affirming.” Dr Joanna Grace and Helen Edgar

Being Together

People with Profound and Multiple Learning Disabilities have historically been positioned at the margins of communication theory, and they are largely absent from the Autistic advocacy spaces working so hard towards neuro-affirming practice. Their communicative expressions have been interpreted too often through a lens that asks what is missing rather than attending carefully to what is already there.

Nind and Grace (2025) challenge this beautifully, describing individuals with profound intellectual disabilities as “possessing and experiencing meaning and provoking and providing love.” This is not a polite reframing, it is a fundamental repositioning, from the margins to the centre of relational meaning-making. A subtle shift in breathing, a change in muscle tone, a pause in movement, these may all carry communicative significance. They become meaningful when someone is paying close enough attention to receive them. Communication emerges within relationships, not solely within individuals (de Haas et al., 2022; Grace et al., 2024), Clark and Nind,. 2026, Barnes et. al., 2026).

There is also an honest discomfort in sitting here, as most research surrounding those with Profound and Multiple Learning Disabilities has been conducted about them or on them, rather than with them. For a population whose communicative agency has historically been overlooked, this is not a small oversight; it is a significant ethical gap. Grace et al. (2024) and de Haas et al. (2022) are doing important work to change this, developing inclusive research methodologies that genuinely include people who do not use speech or neuronormative means of expression.

Intensive Interaction is grounded in genuinely being with someone, not for any measurable outcome, not to tick a curriculum target, but simply because that person deserves to be met. The values that make Intensive Interaction neuro-affirming in practice are the same values that make inclusive research possible.



Empathy, Safety & Sensory Experiences

Milton’s (2012) Double Empathy Problem reframes communication breakdown as arising from differences in perception and understanding between people with different lived experiences, rather than from deficits located within any one individual. Nind and Grace (2025) extend this to interactions involving people with Profound and Multiple Learning Disabilities, highlighting that challenges in understanding are mutual, located in the relational space between people..

This shifts where responsibility lies. It is not the person with Profound and Multiple Learning Disabilities who must adapt, perform, or bridge the gap. That responsibility rests with the practitioner, held with humility rather than wielded as expertise. Practitioners need to slow down, observe, and respond when it feels right, led by the person they are with. Meaning develops through shared engagement, not through externally imposed expectations. Communication is not a performance that the person with Profound and Multiple Learning Disabilities must give, it is something that happens between people, when the conditions are right, however that looks, sounds, or feels.

Safety is the foundation of Intensive Interaction, and it emerges when interaction is free of demands and expectations, when someone can just be, without pressure to perform or conform. A practitioner might sit alongside a child engaged in repetitive tapping and gently align their rhythm, not to change the behaviour, but to join in when it feels right, and to withdraw when it doesn’t.

Over time, moments of shared attention may emerge naturally. Or they may not, and that is fine, because connection is not a goal to be achieved but a condition to be created. Trust cannot be taught; it is built through feelings of safety, consistent, responsive presence, and it looks different in every relationship. Some practitioners will connect more easily with certain people than others, and some people with Profound and Multiple Learning Disabilities will respond more readily to certain people. This is not anyone’s fault, it is simply what it means to be human with another human being. If it doesn’t feel like it is working, it may be that more time is needed, or that someone else might be a better fit, and that is okay too.

For individuals with Profound and Multiple Learning Disabilities, communication is inherently sensory and bodily, rooted in internal states such as arousal, tension, hunger, pain, or emotional shifts (Garfinkel et al., 2015). These may be expressed through the most subtle of physiological changes: a shift in breathing, a softening or bracing of muscle tone, a reaching toward or a turning away. This is all communication, it needs to be noticed and honoured, not always acted upon, but received.

Many people with Profound and Multiple Learning Disabilities also live with complex medical and health needs, sensory impairments, including hearing or visual impairments, and other conditions that shape how they experience and express their inner world. There is no single template for what communication looks like. This is further complicated by the reality that many Autistic people experience significant difficulty accessing and interpreting their own internal interoceptive signals (Garfinkel et al., 2015). For someone who may not clearly feel or understand the signals of hunger, pain, or emotional overwhelm from the inside, being genuinely read by someone who knows them well enough to notice is not supplementary support; it can be profoundly important to their safety and wellbeing.

For those with Profound and Multiple Learning Disabilities, none of this can be put into words by them. They cannot speak for themselves using words, which makes understanding their consent, presence, and attunement not just important but everything. And yet, when you spend time with someone, really with them, something becomes clear and is felt. It is often something that cannot be written on a form or ticked off on a curriculum. You know when it is meaningful, you know when it feels right and when they are ready for you to engage or withdraw. Not because a target has been met, but because something shifts between you both, a shared presence of being truly with each other.

It might be a smile, or it might not even be that. It might be something much quieter; a softening in the body, a change in breathing, a stillness that feels different from the stillness before. Sometimes you are sitting or lying next to someone and nothing visible is happening, and yet something is, the atmosphere changes, there is a presence, a comfort, a connection that was not there a moment ago. These are not measurable outcomes, they are moments of shared humanity, and they matter more than any progress chart could capture.

This kind of connection is not about responding to everything or just copying sounds and bodily movements. It is about noticing and building enough of a relationship that you begin to really understand this particular person — when to respond, when to wait, when to mirror a vocalisation or body movement, when to stay still, and crucially, when to withdraw.

There is no single script for Intensive Interaction; it is relational knowledge, built slowly, held carefully, and grounded in a genuine desire to be with someone rather than to do something to them.

Recognising when to withdraw matters as much as knowing when to engage. For people with Profound and Multiple Learning Disabilities who cannot give verbal assent, the ethical weight rests entirely on the quality of the practitioner’s attunement, on their willingness to receive a “no” that may be communicated through a shift in breathing or a turning away rather than a spoken word. Interaction must remain consensual, non-intrusive, and responsive to withdrawal at every moment (Nind & Hewett, 2001). This kind of knowing cannot be rushed or manufactured. It doesn’t need a qualification, but a willingness to show up, to pay attention, to tune in, to be open and to really, really care and want to be there with the person.

A two-column infographic titled “Neuro-affirming Intensive Interaction: Myths vs. Reality” (Autistic Realms branding).

The left column, labelled “Myth & Misunderstanding,” lists common misconceptions:

It’s just mirroring or copying someone
It trains normative communication behaviours (e.g. eye contact, turn-taking, socially expected responses)
“Intensive” means high pressure or demand
It’s behaviourism under another name
It teaches communication skills as targets to achieve through stages

The right column, labelled “Neuro-Affirming Approach,” reframes each point:

It is relational attunement, guided by timing, emotion, and context—not imitation
Communication may emerge naturally through relationship, without being taught, required, or performed; the practitioner attunes rather than instructs
Intensity refers to quality of presence—being fully with and led by the person
It centres co-created meaning within the relationship, not changing the individual’s behaviour
Development evolves through connection, not instruction or checklists

Design includes soft neutral tones, a pink cross icon for myths, a green check mark for affirming approaches, and Autistic Realms logo.

Dispelling Myths

It is worth pausing to name a few common misunderstandings, because they matter and because they can put people off an approach that might genuinely change someone’s life for the better.

Intensive Interaction is not just mirroring or copying someone. Engagement within Intensive Interaction is contingent and relational, guided by timing, affect, and context. Where mirroring occurs, it is responsive, functioning as attunement rather than copying. The aim is to enter into a genuine shared communicative space with someone, not just to reflect them back at themselves.

Eye contact is not a goal to be achieved or worked towards. The early literature does refer to eye contact, but as we explained earlier in this piece, that was an invitation to truly look at and recognise another person at a time when people with learning disabilities were routinely looked away from, it was never about forcing eye contact. Connection can happen side by side, focused on a shared object or movement, without anyone looking directly at anyone; it is about following a person’s lead and tuning in, for some eye contact is really valuable, for others it may be painful.

There is also the word “intensive” itself, which deserves some attention. If your experience of intensive therapy involves being shut in a room with a practitioner who is determined to make something happen, you would be forgiven for flinching. Intensive Interaction is nothing like that, the intensity is not in the pressure or the pace or the demand. It is in the quality of the practitioner’s attention, it is the kind of presence that cannot be split — you cannot do Intensive Interaction with one hand while handing out worksheets to the rest of the class with the other. It asks you to be fully there, fully focused, and fully led by the person in front of you. That is all, and that is everything.

Within a neuro-affirming approach, the goal is never to shape, redirect, or change the way a person communicates. It is to create the conditions in which they feel safe, understood, and genuinely met. Intensive Interaction does not ask the person to perform, conform, or communicate in ways that feel unnatural or unsafe. It asks the practitioner to be present, responsive, and to follow. Safety and trust come first, and everything else grows from there.

Some practitioners trained in behavioural frameworks have questioned whether Intensive Interaction is simply behaviourism by another name. The difference goes all the way down to what the approach believes about people, about communication, and about what we are even trying to do.  A problem may arise when people translate a relational approach into behavioural evidence language, making it measurable, evidence-generating, and outcome-focused. This then potentially allows it to be misinterpreted within PBS systems and within behavioural frameworks – entirely missing the point.

Behaviourist approaches locate change within the individual through consequences, typically aiming to modify behaviour toward a normative standard — more eye contact, fewer repetitive movements, greater compliance with adult-led tasks. Intensive Interaction locates meaning within the relationship through co-construction. It does not seek to change the person. It seeks to change what becomes possible between people (Intensive Interaction Institute).

This has real consequences. Research has documented how approaches focused on normalisation can contribute to masking, distress, and poorer long-term mental health, particularly for Autistic people required to suppress their natural ways of communicating in order to appear neurotypical (Hull et al., 2017; Bottema-Beutel et al., 2023). Intensive Interaction does the opposite. By not requiring eye contact, not demanding conformity, and not targeting any behaviour for reduction, it reduces the very pressures that drive masking. For Autistic people with Profound and Multiple Learning Disabilities, who cannot easily articulate distress and whose inner world and experiences have historically been overlooked, this is a matter of wellbeing and dignity (Milton & Sims, 2016; Sandoval-Norton & Shkedy, 2019).

The Intensive Interaction Institute has been explicit that the approach has never espoused a behaviourist ethos and has always been rooted in person-centred principles (Intensive Interaction Institute, personal communication, 2026). The Intensive Interaction Institute’s own materials list certain fundamentals of communication — including eye contact, turn-taking, and vocalisation — and it is worth clarifying what this means. These are not targets to work towards or behaviours to train. They are things that may emerge naturally through genuine relational connection for some people, in some relationships, over time, they are not goals to achieve or explicitly work towards. The Institute itself frames them as possible outcomes for some, not objectives. The distinction matters: one places the expectation on the person, the other on the quality of the relationship. Quality of practice always matters — poorly attuned practice can drift from those foundations, and reflective, neuro-affirming supervision is essential. When practised with genuine care and neuro-affirming intentions, Intensive Interaction is the antithesis of behavioural interventions.

More than Neuro-Affirming: Humanity Affirming

Research shows that overwhelming sensory environments directly impact engagement and wellbeing (McGoldrick et al., 2025). Intensive Interaction does not fight this reality, it works with it, treating sensory experience not as a barrier to communication but as its very medium. Through shared rhythm, pacing, and presence, both people influence one another. This is not a technique applied to a passive recipient. It is a reciprocal, living process, a shared becoming together.

The Double Empathy Problem (Milton, 2012) and frameworks like Autistic SPACE (McGoldrick et al., 2025) help to situate Intensive Interaction within a wider relational turn in neurodiversity-affirming thinking, one that asks practitioners not to fix, train, or normalise, but to be genuinely present with another person.

Intensive Interaction should not be written into a support plan or used as an intervention on a designated day or time-tabled session. It needs to be a natural, everyday way of being with someone. It is a way of communicating and of tending a relationship together. It does not ask the person with Profound and Multiple Learning Disabilities to enter our communicative world, it asks us to enter theirs, and that can make all the difference. Meeting people where they are in that moment, no goals, no outcomes, just being with them, being responsive, and seeing what may or may not evolve over time.

Every person, regardless of how they communicate, has the right to be met, understood, and included. The UN Convention on the Rights of Persons with Disabilities establishes the right to accessible communication and supported decision-making as a fundamental right, not a privilege, not an add-on, but something that is simply due (UNCRPD Articles 9 and 12). Intensive Interaction is one of the few approaches that takes this seriously, not just in policy documents but in the quiet, unhurried moments of everyday practice.

Intensive Interaction is an act of humanity. It is about being with people with Profound and Multiple Learning Disabilities without hierarchy, without agenda, and without asking them to be anything other than exactly who they are. It is neuro-affirming, yes, but it reaches far beyond that. It is grounded in something more fundamental: the belief that every person, regardless of how they communicate, how their body moves, what they can or cannot do, is worthy of genuine connection and of being truly met, valued, and understood by another human being.

Intensive Interaction is not only neuro-affirming — it is humanity-affirming.

Signposting

Intensive Interaction Institute.
Home page and training resources.
https://www.intensiveinteraction.org/

Sense.
Intensive interaction: Ways of communicating.
https://www.sense.org.uk/information-and-advice/ways-of-communicating/intensive-interaction/

Us in a Bus.
Intensive interaction training.
https://usinabus.org.uk/

Connecting with Intensive Interaction.
Resources and practitioner Graham Frith’s blog.
https://connectingwithintensiveinteraction.com/


The Sensory Projects.
(Dr. Joanna Grace)
https://sensoryproject.org/

Neurodiverse Connection
Against ABA and PBS Campaign
https://ndconnection.co.uk/against-pbs-aba

Neurodiverse Connection
Culture of Care Programme
https://ndconnection.co.uk/culture-of-care

Therapist Neurodiversity Collective.
Harm of Social skills training.
https://therapistndc.org/therapy/social-skills-training/

Therapist Neurodiversity Collective.
Speech-language therapists contribute to Autistic trauma outcomes.
https://therapistndc.org/slps-directly-contribute-to-autistic-outcomes-of-trauma-and-suicidality-through-social-skills-training/

Stimpunks
Why behaviourism doesn’t work
https://stimpunks.org/why/behaviorism/


References & Further Reading

Barnes, J., Rushton, R. and Kossyvaki, L. (2026) Exploring the Touch Encounters of Individuals with Profound and Multiple Learning Disabilities (PMLD) at School: Comparing In-Person with Video Observation. International Journal of Disability and Social Justice, 6 (1). (TBP)

Bell, K., Hewitt, C., Bradshaw, J., & the INTERACT Trial Team. (2023). Intensive interaction for children and young people with profound and multiple learning disabilities: The INTERACT Trial (NIHR Project NIHR151428). University of York.
https://www.york.ac.uk/healthsciences/research/trials/ytutrialsandstudies/trials/interact/

Bottema-Beutel, K., Sandbank, M., & Woynaroski, T. (2023). Overview of issues in autism Intervention Research: Research design and Reporting. Perspectives of the ASHA Special Interest Groups, 8(6), 1238–1247. https://doi.org/10.1044/2023_persp-23-00104

https://pubs.asha.org/doi/abs/10.1044/2023_PERSP-23-00104?af=R

de Haas, C., Grace, J., Hope, J., & Nind, M. (2022). Doing research inclusively: Understanding what it means to do research with and alongside people with profound intellectual disabilities. Social Sciences, 11(4), 159.
https://www.mdpi.com/2076-0760/11/4/159

Clark, E. and Nind, M. (2026) ‘Inclusion matters: Learning in collaboration with students with profound intellectual and multiple disabilities’, Journal of Research in Special Education Needs.  (TBP)

Edgar, H. (2025, October 4). Why PBS is Harmful for Autistic and Neurodivergent Young People. Autistic Realms.
https://autisticrealms.com/why-pbs-is-harmful-for-autistic-and-neurodivergent-young-people/

Edgar, H., (2025). Presuming Competence: a Neuro-Affirming reframe to support Autistic people. Autistic Realms. https://autisticrealms.com/presuming-competence-a-neuro-affirming-reframe-to-support-autistic-people/

Edgar, H., (2026). Beyond “Complex Needs”: Neuro-Affirming, Relational Practice with Children with Profound and Multiple Learning Disabilities. Autistic Realms.
https://autisticrealms.com/beyond-complex-needs-neuro-affirming-relational-practice-with-children-with-profound-and-multiple-learning-disabilities/

Firth, G. (2025, April 30). The 7 stages or levels of intensive interaction: Who and/or what are we actually measuring and whose needs are we trying to meet? Connecting with Intensive Interaction.
https://connectingwithintensiveinteraction.com/2025/04/30/the-7-stages-or-levels-of-intensive-interaction-who-and-or-what-are-we-actually-measuring-and-whose-needs-are-we-trying-to-meet/

Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65–74.
https://www.sciencedirect.com/science/article/pii/S0301051114002294?via%3Dihub

Grace, J. (2025). Recognising the belonging of people with profound and multiple learning disabilities in research through a collaborative exploration of identity (Doctoral thesis, University of Southampton).
https://eprints.soton.ac.uk/497372/

Grace, J., Nind, M., de Haas, C., & Hope, J. (2024). Expanding possibilities for inclusive research: Learning from people with profound intellectual and multiple learning disabilities and decolonising research. Social Sciences, 13(1), 37.
https://www.mdpi.com/2076-0760/13/1/37

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47, 2519–2534.
https://link.springer.com/article/10.1007/s10803-017-3166-5

Hutchinson, N., & Bodicoat, A. (2015). The effectiveness of intensive interaction for people with profound intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 28(1), 72–82
https://onlinelibrary.wiley.com/doi/10.1111/jar.12138

Intensive Interaction Institute. (n.d.). What is intensive interaction? https://www.intensiveinteraction.org/what-is-intensive-interaction/

Lerner MD, Gurba AN, Gassner DL. A framework for neurodiversity-affirming interventions for autistic individuals. J Consult Clin Psychol. 2023 Sep;91(9):503-504. doi: 10.1037/ccp0000839. PMID: 37578755; PMCID: PMC10430771.
https://pubmed.ncbi.nlm.nih.gov/37578755/

McGoldrick, E., Munroe, A., Ferguson, R., Byrne, C., & Doherty, M. (2025). Autistic SPACE for inclusive education. Neurodiversity, 3.
https://journals.sagepub.com/doi/10.1177/27546330251370655

Milton, D. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883–887.
https://www.tandfonline.com/doi/abs/10.1080/09687599.2012.710008

Milton, D. (2014). So what exactly are autism interventions intervening with? Good Autism Practice, 15(2), 6–14.
https://kar.kent.ac.uk/62631/1/So%20what%20are%20autism%20interventions%20intervening%20with.pdf

Milton, D., & Sims, T. (2016). How is a sense of wellbeing and belonging constructed in the accounts of autistic adults? Disability & Society.
https://research.brighton.ac.uk/en/publications/how-is-a-sense-of-wellbeing-and-belonging-constructed-in-the-acco/

Morrison, K. E., DeBrabander, K. M., Jones, D. R., Faso, D. J., Ackerman, R. A., & Sasson, N. J. (2020). Outcomes of real-world social interaction for autistic adults paired with autistic compared to typically developing partners. Autism.
https://journals.sagepub.com/doi/10.1177/1362361319892701

Nind, M. (1996). Efficacy of intensive interaction: Developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver–infant interaction. European Journal of Special Needs Education, 11(1), 48–66.
https://www.tandfonline.com/doi/abs/10.1080/0885625960110104

Nind, M., & Grace, J. (2025). The emotional wellbeing of students with profound intellectual disabilities and those who work with them: A relational reading. Disability & Society, 40(7), 1757–1778.
https://www.tandfonline.com/doi/full/10.1080/09687599.2024.2407819

Nind, M., & Hewett, D. (2001). A practical guide to intensive interaction. BILD Publications.
https://davehewett.com/books/

Papadopoulos, A., Vogindroukas, I., Tsapara, A., Voniati, L., Tafiadis, D., & Plotas, P. (2023). Intensive Interaction as an intervention approach in children with autism spectrum disorder: a systematic review. Neuroscience Research Notes, 6(4), 276.1–276.9.
https://doi.org/10.31117/neuroscirn.v6i4.276).
https://neuroscirn.org/ojs/index.php/nrnotes/article/view/276

Sandoval-Norton, A. H., & Shkedy, G. (2019). How much compliance is too much compliance: Is long-term ABA therapy abuse? Cogent Psychology, 6(1).
https://www.tandfonline.com/doi/full/10.1080/23311908.2019.1641258

Sense. Intensive interaction: Ways of communicating.
https://www.sense.org.uk/information-and-advice/ways-of-communicating/intensive-interaction/


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    “The growing cracks in the thin veneer of our “civilised” economic and social operating model are impossible to ignore”, Jorn Bettin (2021). The double empathy problem (Milton, 2012) creates a gap of disconnect experienced between people due to misunderstood shared lived experiences. It is “a breakdown in reciprocity and mutual understanding that can happen between people…


  • Top 5 Neurodivergent-Informed Strategies

    Top 5 Neurodivergent-Informed Strategies

    Top 5 Neurodivergent-Informed Strategies By Helen Edgar, Autistic Realms, June 2024. 1. Be Kind Take time to listen and be with people in meaningful ways to help bridge the Double Empathy Problem (Milton, 2012). Be embodied and listen not only to people’s words but also to their bodies and sensory systems. Be responsive to people’s…


  • Autistic Community: Connections and Becoming

    Autistic Community: Connections and Becoming

    Everyone seeks connection in some way or another. Connections may look different for autistic people. In line with the motto from Anna Freud’s National Autism Trainer Programme (Acceptance, Belonging and Connection), creating a sense of acceptance and belonging is likely to be more meaningful for autistic people than putting pressure on them to try and…


  • Monotropism, Autism & OCD

    Monotropism, Autism & OCD

    This blog has been inspired by Dr Jeremy Shuman’s (PsyD) presentation, ‘Neurodiversity-Affirming OCD Care‘ (August 2023), available here. Exploring similarities and differences between Autistic and OCD monotropic flow states. Can attention tunnels freeze, and thoughts get stuck? Autism research is shifting; many people are moving away from the medical deficit model and seeing the value…


  • Monotropism Questionnaire & Inner Autistic/ADHD Experiences

    Monotropism Questionnaire & Inner Autistic/ADHD Experiences

     Post first published 28th July 2023 Over the past few weeks, there has been a sudden surge of interest in the Monotropism Questionnaire (MQ), pre-print released in June 2023 in the research paper ‘Development and Validation of a Novel Self-Report Measure of Monotropism in Autistic and Non-Autistic People: The Monotropism Questionnaire.‘ by Garau, V., Murray,…


  • Penguin Pebbling: An Autistic Love Language

    Penguin Pebbling: An Autistic Love Language

    Penguin Pebbling is a neurodivergent way of showing you care, like sharing a meme or twig or pretty stone to say “I’m thinking of you,” inspired by penguins who gift pebbles to those they care about.


  • Intensive Interaction as Neuro-Affirming Relational Practice

    Intensive Interaction as Neuro-Affirming Relational Practice

    Intensive Interaction isn’t about “fixing” or prompting communication. It’s about meeting someone where they are—through connection, attunement, and shared flow. A neuro-affirming, relational framing to support those with profound and multiple learning disabilities.


  • Weird Pride in a Hostile World

    Weird Pride in a Hostile World

    Weird Pride is a practice of becoming. A refusal to shrink. A quiet, feral devotion to staying alive as ourselves in a world that keeps trying to make us something else.


  • The Autistic Rhizome: Community, Liminal Spaces & Belonging

    The Autistic Rhizome: Community, Liminal Spaces & Belonging

    Autistic belonging grows through community, from liminal spaces, not conformity.


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