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Research Summary for More Than Words®

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More Than Words® – The Hanen Program® for Parents of Autistic Children or Children Who May Benefit from Social Communication Support is a family-focused, social-pragmatic intervention program. The goal of More Than Words is to empower parents to become the primary facilitator of their child’s social communication development, thereby maximizing the child’s opportunities to develop social communication skills in everyday situations.


The More Than Words Program has the following features:

  • It is led by a Hanen Certified speech-language pathologist (SLP) who has received specialized training at a Hanen More Than Words  Certification workshop
  • It is offered to groups of parents (up to eight families per program)
  • It has three major components:
    • an orientation session, followed by a pre-program assessment and baseline video recording of parent-child interaction 
    • eight sessions of group training for parents; and
    • three individual video feedback sessions for each parent attending the program (parent-child interaction is video recorded by and reviewed with the SLP)
  • It is supported by user-friendly resources for both parents and SLPs, including: parent guidebook, detailed Leader’s Guide and power point slides with video examples for use by the SLP group leader

More Than Words has three objectives: 

1. Parent education – Parents learn about their child's unique interests and sensory preferences so they can understand their child's strengths and what is most motivating for them.  They also learn basic concepts about social communication and language – e.g., the power of following their child's lead, and how to encourage communication by including their child's interests and sensory preferences to promote joyful back and forth interactions in play. Parents become familiar with the child’s stage of communication, enabling them to set meaningful social communication goals collaboratively with the SLP and be more responsive to the child's communicative attempts.

2. Early social communication – parents learn to apply responsive interaction strategies to everyday interactions with their child. Strategies highlighted by the SLP for each parent are tied to the child’s social communication goals, which are modified over the course of the program. Effective intervention depends upon the parent learning to apply the strategies flexibly across contexts so intervention becomes a natural part of parent-child interactions. Video feedback sessions play a major role in helping parents modify their interactive behaviour and apply strategies consistently, thereby maximizing the child’s opportunities to expand their communication skills while engaging in joyful back and forth interactions.

Video feedback sessions include the following components:

  • The parent interacts with their child during an everyday activity, while applying newly learned strategies. The SLP videorecords the interaction;  
  • The SLP coaches the parent as needed, to help them apply strategies successfully; and 
  • Parent and SLP view the video recorded interaction together — the SLP encourages the parent to reflect on the interaction and guides the discussion in order to increase the parent’s awareness of their interactive behaviour and its impact on the child, as well as increasing awareness of the child’s communication. The SLP provides feedback to the parent and helps them identify metacognitive techniques that  facilitate consistent strategy use.

3. Social support for parents – In More Than Words, parents gain both formal and informal social support. The SLP, whose multi-faceted role includes that of group leader, interventionist and coach provides more formal support. The parent group itself provides informal support through the sharing of experiences with other parents within the group.

Philosophical Foundation
More Than Words reflects a family-centered model of intervention, recognizing the child as part of a dynamic social system and the family as the most important element in a child’s life. This philosophical orientation recognizes the interrelatedness of the family system in that any action or event affecting one member of the family unit affects them all (Brown, Thurman, & Pearl, 1993; Donahue-Kilburg, 1992). The family is considered to be the client in a More Than Words Program since it is widely recognized that successful treatment depends on family involvement and intensive intervention (National Research Council, 2001). Empowering parents to participate in their child’s early intervention involves supporting and strengthening their capacity to access knowledge and gain practical skills, which in turn, bolsters their sense of self-efficacy in relation to fostering their child’s development (Dempsey & Dunst, 2004).

Theoretical Foundation 
More Than Words is based on a social-pragmatic theory of language acquisition, which views the development of communication as occurring in the context of interaction between the child and their social environment (i.e., the important adults in their life). This theoretical approach is also known as social-interactionist intervention (Girolametto, Sussman & Weitzman,2007).

Strategies taught in the More Than Words program focus on enhancing the child’s social communication skills through everyday, naturally-occurring interactions with their caregivers. Within this social-pragmatic intervention program, parents and other caregivers are viewed as the primary facilitators of the child’s social communication and language development. With the support of the Speech-Pathologist, parents facilitate the child's social communication development by applying responsive interaction strategies within a structured environment (Prizant & Wetherby, 1998)

The More Than Words program enables parents to make intervention a continual and evolving process (Rosetti, 2001). The program accomplishes this by encouraging parents to take advantage of naturally occurring opportunities for communication with their child, and to use the practical strategies they learn in the program during their everyday activities. Parents learn to identify their child's communication attempts and provide prompt, positive and sensitive contingent input (Stock, 2002). Parents learn to connect with their child in a way that creates the intrinsic motivation for the child to learn and communicate.

The following responsive strategies are taught in the More Than Words program:

  • Follow the Child's Lead
    • Face to Face
    • Observe, Wait and Listen™
  • The 4 I's of Interaction
    • Include the Child's Interest
    • Interpret
    • Imitate
    • Introduce more fun
  • R.O.C.K.™
    • R.O.C.K. in People Play
    • R.O.C.K. in Routines

  

Empirical Evidence of Efficacy of More Than Words®

To date, there are 11 published studies examining the efficacy of More Than Words® – The Hanen Program® for Parents of Autistic Children or Children Who May Benefit from Social Communication Support:  

Studies #1 and #2

“We were the best people to do the job”: Caregivers’ reported outcomes of a virtual caregiver-delivered program for autistic preschoolers 
(Denusik, Glista, Servais, Friesen, Oram & Cunninham, 2024)

Families’ Experiences in the Virtual Hanen More Than Words Program 
During the COVID-19 Pandemic 
(Denusik, Servais, Glista, Hatherly, Moodie, Oram Cardy, Weitzman & Cunningham, 2023)

Read more
Study #3

Empowering Hong Kong Chinese families with autism: A preliminary study of the online Hanen More Than Words Program 
(Qi, Zhao & To, 2024)

Read more
Studies #4 and #5

Telepractice delivery of an Autism communication intervention program to parent groups
(Garnett, Davidson & Eadie, 2022a)

Parent perceptions of a group telepractice communication intervention for autism 
(Garnett, Davidson & Eadie, 2022b)

Read more
Study #6

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
(Erbas, Ozcebe & Esen, 2020)

Read more
Study #7

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

Read more
Study #8

The Impact of Hanen More Than Words Programme on Parents of Children with ASD in Malaysia
(Sokmum, Singh & Vandort, 2017)

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Study #9

A Randomized Controlled Trial Comparing the Effects of the More Than Words Program with a “Business as Usual” Control Group
(Carter, Messinger, Stone, Celimli, Nahmias, & Yoder, 2011)

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Study #10

Investigation of the effects of interactive intervention for children with ASD using case study methods
(Girolametto, Sussman, & Weitzman, 2007)

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Study #11

A Controlled Trial Comparing the Outcomes for Parents and Children Resulting from Parents’ Participation in a More Than Words® Program
(McConachie , Randle, & Le Couteur, 2005)

Read more

References

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