Area of Investigation

Study # 1

This study investigated the impact of a telepractice delivery of the More Than Words Program on parent and child communicative behaviours. The goals of the study were to test whether:

• Parents’ use of directive and asynchronous (does not relate to the child's previous message) communication decreased 
• Parents’ responsive communication increased
• Children’s initiating and responding behaviours increased
• Changes in parent or child communication behaviours were maintained post-intervention

Study # 2

A subsequent study investigated parent perceptions after participating in a More Than Words Program via telepractice.

Research Design and Subjects

Study # 1

A single case experimental design across multiple baselines was used to evaluate parent and child outcomes. 

Parent-child dyads were randomly assigned to one of three online More Than Words programs. Data were gathered during four study phases including pre-baseline, baseline, intervention and one, two and three months post-intervention. Baselines for each of the More Than Words groups were staggered, occurring at either three, six or nine weeks prior to the onset of each group’s corresponding program. 

Eleven children with ASD (2.7-4.7 years) and their mothers participated in the study. Parents were permitted to access other services throughout the research period and reported on any other interventions and services they received during this time.

Study # 2

A convergent mixed methods design was used to evaluate parents’ perceptions of the intervention. The Parenting Stress Index (PSI) and an online parent survey were administered one-month post-intervention. In addition, six More Than Words evaluation forms were completed by parents throughout the intervention period. 

Intervention

Parents attended an online More Than Words Program. At the time the research commenced, the telepractice version of the More Than Words Program had not yet been developed. As a consequence, the researchers obtained permission from The Hanen Centre to deliver the in-person version of the program via Zoom. The More Than Words Program included a pre-program consultation, 8 parent sessions and 3 individual video feedback sessions.

Results

Measures

Throughout the study, each parent submitted several self-recorded videos of interactions with their child. These videos were coded by the primary researcher and a trained speech-language pathologist for the following: 

• Parent communication acts

  • Directive communication: Parent-initiated communication directed at the child for the purpose of directing or controlling behaviour (e.g. “Put it on the track”)
  • Asynchronous communication: Parent communication that does not relate to the topic of the child’s previous communication
  • Responsive communication acts:
    • Imitate the child’s actions, gestures, sounds, verbalizations and/or words
    • Interpret the child’s message
    • Expand by adding semantic or grammatical information to the child’s message
    • Comment on the child’s focus of interest or communicative initiation
    • Responsive questions that relate to what the child just did or said
    • Confirming act to reinforce the child’s actions or responses (e.g. “well done”)

• Child acts

  • Respond to parents’ initiations
  • Initiate behavioural request to ask for desired objects or actions without words
  • Initiate joint attention, drawing another’s attention to self or an object without words
  • Initiate functional verbal, intentional requests or comments using words or word approximations

Parent Communication Behaviours

Analysis of the data revealed a significant and immediate decrease in parents’ directive and asynchronous communication. These changes were maintained following the intervention, with two of the parent groups continuing to decrease these communicative behaviours during the post-intervention phrase.

In addition, parents increased their responsiveness, with significant increases in imitating, commenting, responsive questioning and confirming noted. These changes were maintained between the intervention and post-intervention phases.

Child Communication Behaviour

Children increased initiating behaviours once the intervention began. Large treatment effects were observed on child initiating behaviour (i.e. initiating behavioural requests, joint attention, and functional verbal initiations) from baseline to intervention. One group demonstrated large intervention effects between intervention and post-intervention and two groups demonstrated medium intervention effects from intervention to post-intervention.  

Children also demonstrated increased responding behaviours once the intervention began, with moderate increases from baseline to intervention. 

Child vocabulary was measured by parent report on the MacArthur-Bates Communicative Development Inventory (CDI) at the pre-baseline and post-intervention stages. Children’s vocabulary increased, with children noted to produce more words one-month post-intervention. This trend towards increased vocabulary was not significant, however. 

Parent Perceptions

Analysis revealed that parents found many aspects of the online More Than Words Program to be beneficial, including the program videos, practice activities, and the social support of the parent-to-parent interactions. They rated the individual video recording, coaching and review highest. Parents increased awareness of their own interactive behaviours and reported confidence in their use of strategies to support their child’s play and communication goals. All parents felt that their child’s social communication skills improved after attending the program. In addition, all parents were satisfied with the online delivery of the program, which allowed for participation and provided them with group support.

Although the Parenting Stress Index (PSI) scores did not improve from pre-intervention to post-intervention, parents reported feeling less stressed following the intervention. The authors suggest that the lack of change in PSI scores is to be expected given the short-term intervention and that the increased confidence and insight parents gained during the intervention may have led to a perceived reduction in stress.