What Does the Research Say about More Than Words® – The Hanen Program® for Parents of Children on the Autism Spectrum or Who Have Social Communication Difficulties?

An effective treatment program for young children on the autism spectrum should be based on sound research. The More Than Words Program is based on a large body of research that has shown that children’s social communication is best supported within responsive, meaningful interactions with their parents and caregivers.

Responsiveness: The key to fostering communication

The theory underlying the approach in the More Than Words program proposes two key factors:

  1. Learning to communicate is a very social process and that children learn to communicate from birth within everyday interactions with their parents.
  2. Parents foster their child's communication by responding to it promptly and building on what the child is communicating about.


What does responsiveness mean?

There are three elements to being responsive:

  1. Responding promptly (within a few  seconds of a child doing or saying something).
  2. Responding  positively – responding in a way that shows the child the parent is really interested in what they are saying.
  3. Sticking with what the child is “talking” about and interested in – this means not trying to direct their attention to something else when they are 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, capitalize on the child’s current focus of attention. This is thought to increase the child’s ability to learn from the language they hear since their attention is already “captured”. This is in contrast to the parent directing the child’s attention away from what they are 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 their focus of interest), their 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 social communication

The More Than Words approach to social communication intervention is based on this theory of social language learning and parent responsiveness.

The approach used in More Than Words includes 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 themself
  • Setting up the environment to encourage communication – e.g. adding structure to fun games, changing a familiar routine, adding something fun to an activity they are doing on their own


Studies on More Than Words® – The Hanen Program® for Parents of Children on the Autism Spectrum

To date, there have been eight published studies on the More Than Words Program:

1. Garnett, Davidson, & Eadie (2022a) “Telepractice delivery of an autism communication intervention program to parent groups”

The researchers investigated the impact of a telepractice delivery of the More Than Words Programs on eleven parent-child dyads, examining both parent and child behaviours.

After taking the program, parents demonstrated improved responsive communication (e.g. directing their child less, imitating their child more) and children demonstrated improved social communication (e.g. initiating and responding to communication more often, increased joint attention).

2. Garnett, Davidson, & Eadie (2022b) “Parent perceptions of a telepractice communication intervention for autism”

As an extension of study #1, the researchers examined parent perceptions after participating in an online More Than Words Program.

Parents reported increased confidence and awareness of their own interactive behaviour. All parents were satisfied with the online delivery of the program and felt that their children’s social communication skills improved.

3. Erbas, Ozcebe, & Esen (2021) “Investigation of the effect of Hanen’s “More Than Words” on parental self-efficacy, emotional states, perceived social support, and on communication skills of children with ASD”

This study evaluated parent and child outcomes following a More Than Words Program. Fourteen children and their families participated in a program.

Parents demonstrated increased self confidence, self-efficacy and decreased anxiety and stress levels. Parents also demonstrated more responsive interactions with their children. The children showed improvements in vocabulary, receptive language development and interactive behaviours.

4. Lok, Qi & To  (2021). “Using the More Than Words Program with Chinese families: A case-control study”

Twenty six children with a diagnosis of ASD and their parents participated in a More Than Words Program in Hong Kong. The outcomes of children who participated in the More than Words Program were compared to children receiving traditional speech therapy.

The children who participated in the More Than Words Program demonstrated significant growth in their social communication skills.

5. Sokmum, Singh, & Vandort (2017) “The impact of Hanen More Than Words Programme on Parents of Children with ASD in Malaysia”

This study compared the outcomes of two groups of families with children on the autism spectrum: one group of 16 children and their families attended a More Than Words Program and one group of 15 children who received traditional speech and language therapy (the control group).

The parents who participated in the More Than Words Program increased their use of responsive interaction strategies (e.g. simplified language, fun physical contact, imitations and expansions) more than the parents in the control group. Parents who participated in More Than Words reported high levels of satisfaction with the program. The children in the More Than Words group demonstrated a significant improvement in their communication, socialization, receptive and expressive language, and more improvement overall compared to the children in the control group.

6. 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 on the autism spectrum 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.

7. 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 three children with a diagnosis of 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.

8. 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”

Fifty-one preschool children with a diagnosis of 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.


In conclusion

These studies show the More Than Words Program can change how parents interact with their children, and that children’s social 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 they deliver to children and their families.


References

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.

Erbas Noyan, A., Ozcebe, E., Cak Esan, T. (2020). Investigation of the effect of Hanen’s “More Than Words” on parental self-efficacy, emotional states, perceived social support, and on communication skills of children with ASD. Logopedics Phoniatrics Vocology, 46:1, 17-27.

Garnett, R., Davidson, B & Eadie, P. (2022a). Telepractice delivery of an autism communication intervention program to parent groups. Research in Autism Spectrum Disorders, 91, https://doi.org/10.1016/j.rasd.2021.101902.

Garnett, R., Davidson, B. & Eadie, P. (2022b). Parent perceptions of a group telepractice communication intervention for autism. Autism & Developmental Language Impairments, 7, 1-23.

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.

Lok, J.S.Y., Qi, X. & To, C.K.S. (2021). Using the More Than Words Program with Chinese families: A case-control study. Frontiers in Communication, 6:792758.Doi:10.3389/fcomm.2021.792758.

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.

Sokum, S., Joginder Singh, S. & Vandort, S. (2017) Th e Impact of Hanen More Than Words Programme on Parents of Children with ASD in Malaysia. Jurnal Sains Kesihatan Malaysia, 15(2), 43-51.

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.