Randomized Controlled Trial of Hanen’s ‘More Than Words’ in Toddlers with Early Autism Symptoms
Carter, A.S., Messinger, D.S., Stone, W.L., Celimli, S., Nahmias, A.S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52, 741-752.
Reviewed by Kathleen Moran,
Why study this topic?
There is increasing evidence that early intervention (EI) programs that are implemented by service providers and that occur in a child’s natural environment improve outcomes for children with autism. However, there is little research on parent facilitated EI programs, in which parents are taught strategies to take advantage of naturally occurring opportunities to help their children learn language. One such program is known as ‘Hanen’s More Than Words’ (HMTW), which is designed to increase parent-child interactions and child communication skills by encouraging the child to initiate or respond during everyday routines. The goal of the current study was to see if participation in a HMTW program would enhance a parent’s responsivity to the child or the parent’s teaching of communication skills, and thereby increase the child’s communication skills. Another goal was to see if these skills would be maintained.
What did the researchers do?
Participants included 62 children meeting criteria for autism and their parents. Parents and children were randomly assigned to either an intervention (HMTW training) or a control group (no HMTW training). HMTW intervention was provided for three and a half months. Parents attended eight weekly group sessions and three individual family sessions. A speech and language therapist certified by a Hanen Centre administered all sessions. Children’s communication and parental responsivity were assessed at the beginning and at five- and nine-month follow up periods. To increase a parent’s responsivity, the therapist taught parents to respond to child’s communicative attempts, follow the child’s lead, build and participate in joint action routines in play, enhance interaction during caring routines, and use books and play as content for communication. Parents were also taught to evoke language using visual supports and to support peer interactions. The authors defined the control group as parents continuing with “business as usual.”
What did the researchers find?
The researchers found that parents’ exhibited responsivity increased between the initial and five-month follow up evaluations but decreased to pre-treatment levels at the nine-month follow up. No major effects on children’s communication outcomes were observed immediately after parent-implemented treatment, but an increase was found between the initial evaluation and nine-month follow up. Researchers also looked at each child’s interest in objects during an initial play assessment. Results showed that children with limited interest in objects as indicated by this play assessment showed a greater increase in communication than a child with an initial greater interest in objects. Parents of children with greater interest in objects may require more support or different strategies to implement the HMTW.
What are the strengths and limitations of the study? What do the results mean?
Overall, researchers expressed concern about the general use of this intervention with very young children, given that parents’ and children’s gains were quite limited. The study also showed that there were different effects on a child’s communication based on the child’s interest in objects, as determined by the play assessment. Limitations of the study include a greater focus on parents’ group experience than individual family sessions, little feedback support, and some assessments used were not based on children of typical development. Strengths include the use of multiple evaluations of the child’s communication skills and parent’s responsivity, which allowed the researcher to detect an increase in initiating joint attention and requests, as well as consumer satisfaction, in the intervention group compared to the control group. Future research should include an increase in family session training, analysis of mechanisms associated with the decrease in communication for children with greater interest in objects, and comparison to another active intervention.