Experience together. Peer interactions in persons with profound intellectual and multiple disabilities

Social interactions are important in everyone’s life since they may positively influence various developmental and quality of life outcomes. Up till now research about interactions of persons with profound intellectual and multiple disabilities (PIMD) mainly focussed on interactions with direct support workers or parents. However, peers may also be important interaction partners in their social network. It can be assumed that the complex disabilities of persons with PIMD and various environmental factors substantially affect the amount and nature of peer directed behaviours. The aims of this doctoral dissertation were (1) to give a state of the art of the research on peer interactions in persons with PIMD, (2) to describe the frequency and nature of peer directed behaviours of persons with PIMD and to investigate influencing environmental factors, and (3) to develop and evaluate an intervention to promote social scaffolding behaviours of direct support workers and peer directed behaviours of persons with PIMD.

First, the research on peer interactions in persons with PIMD was  systematically reviewed (manuscript 1). The concepts peers and social interactions were operationalised in different ways. The literature review delivered insight in the different categories of peers, the effects of peer interactions on engagement and well-being of persons with PIMD, the effects of training and technological support systems on peer interactions, and the influence of the adult on peer interactions.

Secondly, the frequency and nature of peer directed behaviours of persons with PIMD and influencing environmental factors were investigated. In the first study group activities for children with PIMD organised by a direct support worker were observed (manuscript 2). Children with PIMD only rarely presented peer directed behaviours, mostly singular peer directed behaviours were observed. Direct support workers did not often present social scaffolding behaviours and the positioning of the children with PIMD was not facilitative for peer interactions. In the second study dyads of children with PIMD in presence and in absence of a direct support worker were observed  (manuscript 3). More peer directed behaviours were observed in absence of a direct support worker. The direct support workers did not often use social scaffolding strategies. The relation with the peer directed behaviours of the children with PIMD was not clear. In the third study interactions of a child with PIMD with a peer with PIMD or with a sibling were compared (manuscript 4). Interactions with the sibling seemed to be the most motivating for persons with PIMD. The siblings presented various attention directing behaviours, but mostly used nonverbal behaviours. Combining verbal and nonverbal attention directing behaviours was most effective in eliciting peer directed behaviours in the children with PIMD.

Thirdly, based on the gathered knowledge an intervention to promote social scaffolding behaviours of direct support workers and peer directed behaviours of persons with PIMD was developed and evaluated (manuscript 5). The direct support workers participated in a training and feedback session and a peer interaction supportive activity was designed. An increase in the social scaffolding behaviours of the direct support workers and an increase in the peer directed behaviours of the persons with PIMD was observed.

This doctoral dissertation contributes to the knowledge needed in research and practice to recognise and support peer directed behaviours in persons with PIMD.