More Than Words® Study 10
Investigation of the effects of interactive intervention for children with ASD using case study methods
(Girolametto, Sussman, & Weitzman, 2007)
Area of Investigation
The study examined the outcomes of three children in relation to their social interaction skills following their mothers’ participation in More Than Words.
The study had three aims:
- To confirm that parents used responsive interaction strategies following participation in the More Than Words program
- To replicate findings from previous studies of increased vocabulary development for children with ASD following the parent intervention; and
- To examine the children’s social interaction skills following the intervention.
Research Design and Subjects
A multiple case study methodology was used to determine whether enhanced responsiveness, which is the underpinning of the social-interactionist model, is associated with hypothesized changes in social interaction skills (Girolametto et al., 2007).
This study attempted to improve on the procedures used in the McConachie et al. (2005) study by using microanalytic techniques to code videotapes of mother-child interaction. Using a multiple case study design, it was hypothesized that there would be a positive relationship between parental responsiveness and social interaction skills for children with ASD.
Three families of children with a confirmed diagnosis of ASD participated in the study. The children ranged in age from 2.8 – 3.2 yrs.
Intervention
Parents attended the More Than Words Program, consisting of eight group sessions and three individual videotaping and feedback sessions.
Results
Parents’ showed increased use of responsive interaction strategies
Microanalytic techniques were used to investigate mothers’ responsive comments in two contexts – when the child communicated versus when the child was unengaged. All three mothers increased their rate of responsive comments during a play interaction and their gains exceeded those in the Aldred, Green and Adams study (2004), which utilized a similar coding system. The mothers also showed increases on the JAFA rating scale from pre to posttest, which equalled or exceeded the pre-established criterion established by McConachie et al. (2005), using this scale.
Children demonstrated increases in vocabulary development
Children’s vocabulary was measured by parent report on the MacArthur-Bates Communicative Development Inventory and by using videotaped interaction. All three children made vocabulary gains as measured by the CDI. Their vocabulary gains exceeded those made by the intervention group in the McConachie et al. study (2005). The children’s posttest interaction showed that they were using an increased number of different words, which confirmed parent report on the CDI. Mothers reported subjective perceptions of increased vocabulary development on home visit surveys. Thus all three case studies replicated the posttest increases in vocabulary observed in prior studies using this approach to intervention (Aldred et al., 2004; McConachie et al., 2005).
Children demonstrated increases in social interaction
The most important aim of the study was to examine the children’s social interaction skills following their parents’ participation in More Than Words. The data analysis focused on their rate of communicative acts, participation in social turn-taking episodes and initiation of social interaction. All three children made gains in the rate of communication acts, surpassing the gains made by the experimental group in Aldred et al., (2004). The children also increased their participation in social turn-taking episodes. Two of the three children showed increases in social initiations.
This study extends the findings of McConachie at al.’s (2005) study which did not report any gains in children’s social interaction and initiation skills. It also replicates the findings of studies by Aldred et al. (2004) and Mahoney & Perales (2003), which examined similar interactive behaviours using rating scales (Girolametto et al., 2007).
Summary
The findings of this study have important implications. Social-interactionist theory suggests that the more children are engaged in social interactions, providing them with opportunities to practice their social and linguistic skills, the more responsive input they receive from which they can deduce the rules of social interaction, discourse, and language. This suggests that, due to the synergistic nature of caregiver-child interaction, the changes observed in the children’s interactive behaviour have the potential to facilitate further development gains in their communication development (Girolametto et al., 2007).
The limitations to this study include the absence of control groups or multiple data collection points. The lack of a control group prevents any conclusions from being drawn about the efficacy of this intervention approach. However, the outcomes highlight the potential of sensitive measures for detecting important changes in the social skills of this group of children.