More Than Words® 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)
Area of Investigation
The aim of this study was to investigate the impact of the More Than Words Program on parental self-efficacy, anxiety, depression, perceived social support and interactive behaviours. The study also examined changes in the interactive behaviours and language development of the children whose parent/s attended the program.
Research Design and Subjects
A single case experimental design was used to determine rate of change with respect to the outlined parent and child factors. Formal and informal parent and child assessments were conducted at five different time intervals. Statistical analyses were used to determine the rate of change within the pre-intervention time frame as compared to the post-intervention and follow up periods.
Subjects: 14 children (ages 2-4) with a diagnosis of ASD and their parents, who had not had a parent education program prior to the study.
The 14 children and their families were randomly assigned to one of the two More Than Words Programs offered as a part of the study.
Intervention
A More Than Words Program, including a pre-program consultation, 8 parent sessions and 3 individual video feedback sessions, was provided in Turkish to 14 families of children with ASD.
Results
Measures
The following standardized assessment tools were used to measure parents' emotional states:
- The Self-Efficacy for Parenting Tasks Index – Toddler Scale (Turkish version)
- The Multidimensional Scale of Perceived Social Support (Turkish version)
- The Parenting Stress Index – Short Form (Turkish version)
- The State-Trait Anxiety Inventory
- The Beck Depression Inventory
Statistical analyses revealed that there was a significant decrease in parents’ state of anxiety during and following the More Than Words Program. Likewise, parents’ stress levels decreased significantly from pre- to post-intervention. Analyses also revealed a statistically significant change in the parents’ perceived self-efficacy from pre-intervention to post-intervention.
No significant change was noted in terms of parents’ perceived levels of social support, trait anxiety and depression between the pre-intervention and post-intervention time frames. The authors point out that the levels of depression were relatively low for parents from the start of the study. The authors also suggested that the lack of change noted in parents’ perceived levels of social support may be more of a reflection of the assessment tool, which looks at social support in a more generalized way, as opposed to the specific context in More Than Words, which involved receipt of support from other parents who were experiencing similar challenges.
In addition to parent self-report measures, parent interaction was measured using the Maternal Behavior Rating Scale. Ten- to fifteen-minute segments of parent-child interaction were filmed and coded by two speech-language pathologists using this rating scale. Statistical analyses of the scores revealed that there was a significant difference in parents’ sensitivity, responsivity, effectiveness, inventiveness, acceptance, enjoyment, praise, warmth and directiveness from the pre-intervention to the post-intervention period.
Children's Results
At the same five designated time points, the following measures were used to assess child change:
- The Test of Early Language Development (Turkish version)
- The Language Development Survey - a measure of children’s vocabulary acquisition
Overall, the children’s receptive language scores increased significantly in the post-intervention period, along with their overall language scores. Examined on their own, no significant difference was detected in the rate of increase of expressive language scores from the pre-to post-intervention periods.
The children demonstrated significant change in their vocabulary acquisition from the pre- to post-intervention periods. A statistically significant difference in children’s vocabulary size was also noted at follow-up, indicating generalization in this area.
Child interaction was also measured using the Child Behavior Rating Scale (Turkish version). Two speech-language pathologists coded ten- to fifteen-minute segments of parent-child interaction using this rating scale. Statistical analyses of the scores at each time point revealed that there was a significant change in the children’s overall attention to activity, involvement, initiations of activities and initiations with the adult from the pre-intervention to post-intervention period.
Summary
This study revealed positive changes in parents' perceptions of their competence and emotional states following a More Than Words Program, in addition to an increased rate of change in the children’s vocabulary, receptive language development and interactive behaviours. Prior to enrolling in the study, the children were receiving special education programming, with a focus on individual, clinician-directed services. As an increased rate of child change was noted following the More Than Words Program, the authors suggest that the parent-implemented intervention may have been a factor driving this progression. These findings validate the important role of parents in their child’s intervention and the fact that supporting parents’ interactions with their child, in turn, supports their child’s development.
This study contributes to the existing literature on the More Than Words program as the first study to examine the impact of the More Than Words Program on parental self-efficacy and social support. Limitations of this study relate to the experimental design in that the study did not include randomization or a control group.