Social Peer Interactions in Persons with Profound Intellectual and Multiple Disabilities: A Literature Review

Social interactions may positively influence developmental and quality of life outcomes. Research in persons with profound intellectual and multiple disabilities (PIMD) mostly investigated interactions with caregivers. This literature review focuses on peer interactions of persons with PIMD. A computerized literature search of three databases was conducted. Based on specific inclusion criteria eight articles were selected. In these studies, social peer interaction was not clearly operationalized. More interactions with typically developing peers were observed compared to interactions with peers with PIMD. Both groups of peers can be trained to interact or to use technological support systems during peer interactions. After training, interactions with peers increased and interactions with professionals during peer interactions decreased. Interactions with normally developing peers positively influenced specific behaviours of persons with PIMD. Not much research is available on peer interactions of persons with PIMD, especially peer interactions between persons with PIMD remain unclear. Individuals with PIMD are characterized by profound cognitive disabilities (IQ 20–25), profound neuromotor dysfunctions (such as spastic quadriplegia) and often sensory impairments and medical problems (such as seizures, respiratory problems and/or feeding problems) (Nakken & Vlaskamp, 2007). They communicate on a preor protosymbolic level, using body movements, muscle tension, vocalisations and other subtle signals which are context bound and idiosyncratic (Hostyn & Maes, 2009). Because of their physical, cognitive, and communicative limitations they do not often show behaviours such as waving, smiling or pointing that draw attention from other people and initiate social interactions. Additionally visual and/or hearing impairments and the delay of the reactions form difficulties during social interactions (Vlaskamp, 2011). Despite these difficulties, social interactions are of high importance. Parents and direct support staff indicated social interactions and relationships as a core dimension of the quality of life of persons with PIMD (Petry, Maes, & Vlaskamp, 2005). Long-lasting and high quality relationships are highly necessary to be able to understand the person’s idiosyncratic expressions and to offer him/her a basic security. The most important bond persons with PIMD have, is the bond with their parents, family, and support staff. Hostyn & Maes (2009) conducted a literature review on social interactions of persons with PIMD with support staff and they suggested the importance of sensitive responsiveness, co-regulation, joint attention, and an emotional component in the interactions. Not only parents, family, and support staff are interaction partners of persons with PIMD. Most of the time they go to special day care centers, special schools, or residential facilities. In these contexts persons with PIMD get in contact with their peers (Lancioni, O’Reilly, & Oliva, 2002). These peer interactions may also have an influence on their quality of life (Petry et al., 2005). Against the background of the general literature on social interactions, peer interactions are important and critical in everyone’s life (e.g. Hay, Payne, & Chadwick, 2004; Rubin, Bukowski, & Parker, 1998). We preCorrespondence concerning this article should be addressed to Sara Nijs, Parenting and Special Ed Research Unit, KU Leuven, PO Box 3765, Leopold Vanderkelenstraat 32, 3000 Leuven, BELGIUM. E-mail: [email protected]. Education and Training in Autism and Developmental Disabilities, 2014, 49(1), 153–165 © Division on Autism and Developmental Disabilities Social Peer Interactions / 153 sume that this general assumption is also applicable for persons with PIMD. This makes it interesting to start from definitions and concepts related to social interactions based on the general literature (see Figure 1). Beauchamp and Anderson (2010, p. 40) define social interactions as “events in which people attach meaning to a situation, interpret what others are meaning and respond accordingly”. According to Gleasson (1989), who focuses on social interactions in persons with PIMD, ‘social’ refers to what persons do with one another when they are left to themselves. Successful social interactions form the foundation for long lasting supportive social relationships (Beauchamp & Anderson, 2010). These social relationships can positively influence different outcomes: they benefit subjective well-being (e.g. Karelina & De Vries, 2011; Rook, 1984), they facilitate stress coping of both interaction partners (e.g. Hartup & Stevens, 1997), they have a positive effect on mental and physical health (e.g. Cohen, 2004; Cacioppo, Bernston, Sheridan, & McClintock, 2000; Karelina & De Vries, 2011; Lincoln, 2000; Umberson & Montez, 2010), and they benefit cognitive and language development (e.g. Canevello & Crocker, 2010; Hartup, 1989). Social interactions can only be understood in light of the social task which must match with the demands of the social context (Dodge, Pettit, McClaskey, Brown, & Gottman, 1986). Someone is social competent when the person is able to solve a personal social task while taking the social environment into account (Rubin & Rose-Krasnor, 1992). And only by considering the context, the message within the behaviour can be understood (Gleason, 1989). When a person is social competent successful and harmonic social interactions can arise (Dodge et al., 1986). In children social interactions support the development of social competence. Social competence is developed through the combination of experiences in child-adult and peer interactions (Hartup, 2009; Rubin et al., 1998; Williams, Ontai, & Mastergeorge, 2010). Childadult interactions and interactions with a peer with a higher developmental level are hierarchical, the interaction partner has greater knowledge and social power (Hartup & Moore, 1990; Mueller & Silverman, 1989). During these social interactions children learn more advanced interactive skills (Berk, 2003). To describe this learning process, Vygotsky (1978) introduced the concept of ‘the zone of proximal development’, Bruner (1990) called it ‘scaffolding’. Social interactions with peers with the same developmental level are horizontal, equivalent and egalitarian as they are built with persons with the same social power and the same social developmental level (Hartup, 2009; Hartup & Moore, 1990; Mueller & Silverman, 1989). It is in this social context that children learn skills, needed to develop social competence that cannot be attributed to the adult-child interactions. They learn for example to resolve conflicts, initiate as well as maintain social interactions and relationships, and built the social confidence (Hartup & Moore, 1990). Looking at social interactions and friendships in persons with PIMD a qualitative in depth description (Gleasson, 1989) of the living together of persons with PIMD showed that they demonstrate the whole range of human contact during social interactions with other persons with PIMD and with staff, limited by their disabilities and the environment. Friendship in persons with PIMD has been studied by use of qualitative methods, however, it is not yet clear how friendship is talked about and how it compares with other kinds of relationships of persons with PIMD (Hughes, 2010). However, speaking of inclusion these Figure 1. Social Interactions. 154 / Education and Training in Autism and Developmental Disabilities-March 2014 friendships and the participation in other people’s lives are emphasised instead of citizenship (Reinders, 2002; Reinders, 2008). The main focus of this paper is to review recent empirical studies that focus on peer interactions of persons with PIMD. Firstly, it will be described how the concepts of ‘peers’ and ‘social interactions’ are operationalized in those studies. Who participated in these studies as peers? How are social peer interactions and relations defined and measured? Secondly, it will be investigated what is already known about social relationships and social interactions of persons with PIMD and their peers. Finally, the gaps in this research domain will be identified. What are opportunities for future research? To answer these questions a systematic literature review on this topic was conducted.