What Does the Research Say about More Than Words® – The Hanen Program® for Parents of Children with Autism Spectrum Disorder?
An effective treatment program for young children with Autism Spectrum Disorder (ASD) should be based on sound research. The More Than Words Program is based on a large body of research that has shown that children learn to communicate within positive, meaningful interactions with their parents and caregivers and that, when parents become more responsive and sensitive to their children’s communication, the children’s communication skills improve.
Responsiveness: The key to fostering communication
The theory underlying the approach in the More Than Words program proposes two key factors:
- Learning to communicate is a very social process and that children learn to communicate from birth within everyday interactions with their parents.
- Parents foster their child's communication development by responding to it promptly and building on what the child is communicating about. This applies to all children, including those with autism. However, it has been shown that children with autism also benefit from some very specific ways of responding to them.
What does responsiveness mean?
There are three elements to being responsive:
- Responding promptly (within a few seconds of a child doing or saying something).
- Responding positively – responding in a way that shows the child the parent is really interested in what she or he is saying.
- Sticking with what the child is “talking” about and interested in – this means not trying to direct his attention to something else when he is already focused on something or someone.
Being responsive involves Following the Child’s Lead, which takes advantage of what the child is currently interested in and attending to. The parent can, therefore, can capitalize on the child’s current focus of attention. This is thought to increase the child’s ability to learn from the language he hears since his attention is already “captured”. This is in contrast to the parent directing the child’s attention away from what he is interested in to something else, which can be challenging for the child.
For example, if a child is startled by the noise of a large truck driving by and turns to look (this is now his focus of interest), his mom could say, “Ooh! That truck made a very loud noise!” (following the child’s lead) versus, “It’s okay. So, what did you do at school today?” (directing attention away from child’s interest).
The More Than Words® approach to early language intervention
The More Than Words approach to early language intervention is based on this theory of social language learning and parent responsiveness. The More Than Words program has adapted and intensified its approach to address the needs of children on the autism spectrum.
The approach used in More Than Words as well as in other interventions that are based on this social theory of communication development include the following characteristics:
- allowing the child to initiate interactions (as opposed to the adult always doing the initiating)
- following the child’s lead and basing interactions on what interests and motivates the child to communicate
- treating the child’s communication as if it is meaningful (even if it isn’t or if the parent doesn't understand what the child is "saying") and being responsive even if the child’s communication is unconventional
- using natural, everyday situations as the context for learning to communicate – so that communication is about real-life, meaningful things
- using the natural repetition, structure and predictability of everyday routines to make it easier for the child to learn
- using visual supports, such as gestures and visual aids (pictures, photos, written words) to help the child understand what others are saying as well as to express himself
- setting up the environment to encourage communication – e.g. briefly interrupting an activity in a playful way, changing a familiar routine to elicit a response from the child, putting things out of reach
Research on Interventions that are based on the Social Learning and Responsive Approach
Four studies which evaluated the effectiveness of four different interventions, all based on the Social Learning and Responsive Approach, showed positive effects on children with autism spectrum disorder as follows:
- Caregivers who demonstrated more of a responsive style of interaction had children with better communication and language skills 10 and 16 years after the beginning of the study (Siller & Sigman, 2002)
- Mothers who received training in responsiveness were able to become more responsive, and this change resulted in changes in their children, including better attention, persistence, initiation of communication, and joint attention (Mahoney & Perales, 2003).
- Parents became more responsive and, as a result, their children demonstrated increased and improved social interaction, engagement (they stayed longer in an interaction), responsiveness (to their parents), initiations, vocabulary, and communication acts (the number of times they communicated with their parents) (Aldred, Green, & Adams, 2004).
- Mothers who were more responsive to their children at 18 months (children with suspected autism, who later received the diagnosis) had children with higher expressive language between ages 2 and 3 years (Baker, Messinger, Lyons, & Grantz, 2010).
Studies on More Than Words® – The Hanen Program® for Parents of Children on the Autism Spectrum
To date, there have also been three published studies on the More Than Words Program:
1. McConachie, Randle, & Le Couteur (2005): “A Controlled Trial Comparing the Outcomes for Parents and Children Resulting from Parents’ Participation in a More Than Words Program”
51 preschool children with Autism Spectrum Disorder or suspected ASD and their parents attended the More Than Words program. Some of the families attended a More Than Words program immediately upon being referred for speech and language services and others (the control group) attended a More Than Words program later on.
The results indicated that parents who attended More Than Words used more responsive interaction strategies than parents in the control group, and their children had larger vocabularies than the children in the control group.
2. Girolametto, Weitzman, & Sussman (2007): “Using case study methods to investigate the effects of interactive intervention for children with Autism Spectrum Disorders”
This case study was comprised of 3 children with ASD and their parents who participated in a More Than Words Program.
After taking the program, the parents used more responsive interaction strategies, and the children had larger vocabularies, communicated more often, and participated in turn-taking routines more often. Two of the three children also showed increases in social initiations.
3. Carter, A., Messinger, D., Stone, W., Celimli, S., Nahmias, A., & Yoder, P. (2011) “A controlled trial of Hanen’s “More Than Words” in toddlers with early autism”
This study compared the outcomes of two groups of children with autism and their families: one group who attended a More Than Words Program and one group who participated in other interventions, but did not attend a More Than Words Program. The study showed three important results:
- The parents who attended the More Than Words Program were more responsive to their children’s communication than the parents who did not attend the program.
- Of the children who attended the More Than Words Program, those who showed little interest in toys at the start of the program experienced significant improvement in their communication skills. They initiated communication and reached and pointed to objects more frequently. They made more eye contact and showed or gave the experimenter a toy more often. All of these are important communication skills, providing a critical foundation for the development of more advanced communication. An important aspect of the child’s improvement was the ability to transfer the skills learned during interactions with their parents, who provided support as needed, to the experimenter, who was a stranger and provided no support. In addition, follow-up testing four months after the program revealed that the children maintained those improvements.
- Of the children who attended the More Than Words Program, those who played with a greater number of toys at the start of the program did not show significant improvement when compared to the children who did not attend the program. Guided by these results, The Hanen Centre made revisions to the More Than Words Program in 2013 to better meet the needs of this group of children.
These studies show that both the underlying approach on which More Than Words is based and the More Than Words Program itself can change how parents interact with their children, and that children’s communication improves as a result.
If you are interested in attending a More Than Words Program, click here to find a Hanen SLP in your area who is trained to lead the More Than Words Program and to use the More Than Words approach in the service s/he delivers to children and their families.
Aldred, C., Green, J., Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 40, 1-11.
Baker, J., Messinger, D., Lyons, K., Grantz, C. (2010). A Pilot Study of Maternal Sensitivity in the Context of Emergent Autism. Journal of Autism and Developmental Disorders, 40, 988-999.
Carter, A., Messinger, D., Stone, W., Celimli, S., Nahmias, A., & Yoder, P. (2011) A randomized controlled trial of Hanen’s “More Than Words” in toddlers with early autism. The Journal of Child Psychology and Psychiatry, 52(7), 741-752.
Girolametto, L., Sussman, F., & Weitzman, E. (2007). Using case study methods to investigate the effects of interactive intervention for children with Autism Spectrum Disorders. Journal of Communication Disorders, 40, 470-492.
Mahoney, G., & Perales, F. (2003). Using relationship-focussed intervention to enhance the social-emotional functioning of your children with autism spectrum disorders. Topics in Early Childhood Special Education, 23, 77-89.
McConachie, H., Randle, V. & Le Couteur (2005). A controlled trial of a training course for parents of children with suspected autism spectrum disorder. Journal of Pediatrics, 147, 335-340.
Siller, M., & Sigman, M. (2002). The behaviours of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32(2), 77-89.
Sussman, F. (1999). More Than Words: Helping parents promote communication and social skills in children with autism spectrum disorder. Toronto: The Hanen Centre.
University of Miami (2010, February 25). Mother’s sensitivity may help language growth in children with autism spectrum disorder. Science Daily.