Area of Investigation

This study explored the effectiveness of an online More Than Words Program among Chinese families living in Hong Kong.  Specifically, the researchers examined:

• The efficacy of an online More Than Words Program in improving parents’ responsiveness and children’s communication initiations and responses 
• Whether baseline levels of parental self-efficacy and parenting stress affected treatment outcomes 

Research Design and Subjects

Researchers used a randomized controlled trial design to evaluate outcomes following participation in an online More Than Words Program:

Subjects

Twenty-two Cantonese-speaking Chinese families of autistic children living in Hong Kong.  Children were between 36 and 72 months old.

Intervention Group

Twenty-five families were assigned to the treatment group and offered the full More Than Words Program delivered online in addition to their regular therapy, if applicable.  Nineteen families participated in the full program and twelve of these families completed the submission requirements and were included in the final analysis.

Control Group

Twenty families were assigned to the control group and continued with or without their regular therapy during the intervention phase.  These families were enrolled in More Than Words following the study period.  Ten families in the control group completed the submission requirements and were included in the final analysis.  

Prior to the intervention the families completed:

• An online demographic questionnaire
• The Chinese version of the Parenting Sense of Competence Scale (Chinese version) (PSOCC; Ngai et al., 2007)
• The Parental Stress Scale (PSS-C; Cheung, 2000)
• The Action and Gesture sections of the Cantonese version of the MacArthur-Bates Communicative Development Inventories (CDI; Tardif & Fletcher, 2008) 
• A 3-minute video of their typical daily parent-child interactions 

After the intervention the families completed:

• A second 3-minute video of their parent-child interactions (submitted within one month of program completion).

Intervention

An online More Than Words Program, including a pre-program consultation, 8 parent sessions and 3 individual video feedback sessions, was provided in Cantonese to nineteen families of autistic children.

Results

Parent outcomes

Using the 3-minute videos submitted pre- and post-intervention, researchers examined three communication variables:

1. Parent-child attention synchronization (i.e., the percentage of total child-directed attention intervals in which a parent shared the same attentional focus)
2. Parental responsiveness (i.e., the percentage of total child-directed attention intervals in which an undemanding parental verbal or nonverbal response occurred)
3. Parent’s use of linguistic facilitation strategies (including techniques of expansion, linguistic mapping, imitation, and modelling and prompting).

(Qi, Zhau & To, 2024)

Statistical analysis revealed parents who participated in an online More Than Words Program demonstrated significant improvements in parent-child attention synchronization.  In addition, researchers observed small effect sizes of parental responsiveness and an increased use of the imitation strategy in participants in the intervention group, although changes in parents’ use of linguistic facilitation strategies were not statistically significant. 

Child outcomes

Researchers coded children’s communicative acts for:

1. Vocalizations and verbalizations directed towards the parent
2. Nonverbal behaviours directed towards the parent including gestures, eye gaze and positive affect

Children whose parents participated in the online More Than Words Program showed a large effect size in their spontaneous verbal communication, although this did not reach statistical significance.  The researchers indicated these results suggest the online More Than Words Program may be effective in supporting autistic children in producing more communication initiatives (Qi, Zhau & To, 2024).

Parental factors associated with treatment outcomes

Researchers conducted hierarchical linear regression to examine how baseline levels of parental self-efficacy and parenting stress contributed to parent and child outcomes.  Only parental self-efficacy and parental education level significantly predicted parental responsiveness at post-intervention.  Parents with higher levels of self-efficacy prior to intervention were more likely to make changes to their responsiveness after participating in the online More Than Words Program.  Parenting stress reported prior to intervention did not significantly predict any treatment outcomes in this study.