More Than Words® Study 7
Using the More Than Words Program with Chinese families: A case-control study
(Lok, Qi &To, 2021)
Area of Investigation
This study investigated the effectiveness of the More Than Words Program on children with ASD and their parents in Hong Kong. Specifically, the study examined whether:
- Participation in the More Than Words Program had an impact on children’s social communication skills
- Parenting self-efficacy and socio-economic status contributed to the effectiveness of the program
Research Design and Subjects
A prospective cohort study design was used to evaluate outcomes following participation in the More Than Words program.
Subjects: 31 Cantonese-speaking children with a diagnosis of ASD and their parents. The children ranged in age from 2-7 years.
Intervention group: 26 of the families completed one of seven More Than Words Programs provided within a local rehabilitation organization.
Control group: 5 parent-child dyads served as controls. These children remained in special childcare centres and received ongoing speech therapy.
Intervention
A More Than Words Program that included a pre-program consultation, 8 parent training sessions and 3 individual video feedback sessions, was provided in Chinese to the 26 families in the intervention group.
Results
Child Outcomes
Potential gains in the children’s communication skills were evaluated following participation in a More Than Words Program and results were compared with those of the control group. All of the children’s social, communication and symbolic abilities were measured prior to the start of the program and one month following completion of the program using the Communication and Symbolic Behavior Scales (CSBS). Following the intervention, children in the More Than Words group demonstrated significant growth in their social communication skills when compared to children in the control group. This finding differs from those in the Carter et al. (2011) study, which found significant gains in communication applied only to the children who demonstrated minimal interest in toys prior to their parents' attendance at the More Than Words Program. The authors speculated that this may be due to their use of the CSBS to measure outcomes. The CSBS measures social-affective signaling and symbolic behaviour – capacities which are directly related to goals of the More Than Words Program.
Parent Variables
Prior to the program, parents provided demographic information, completed the Chinese version of the Parenting Sense of Competence (C-PSOC) and the Chinese Parental Stress Scale (PSS-C). A hierarchical linear regression was conducted to determine the impact of parenting stress and parenting self-efficacy on child outcomes following the More Than Words Program.
Parents with lower perceived self-efficacy made greater gains than those with higher self-efficacy. This finding was in contrast to other studies that found that lower perceived self-efficacy can negatively impact treatment outcomes (Shumow and Lomax, 2002). The authors suggested that the social support parents received as a part of the More Than Words Program could have been a factor that helped the parents with lower self-efficacy persevere in more challenging circumstances (i.e. circumstances where parents with higher self-efficacy would continue to persevere). Socio-economic status and parenting stress did not predict child social communication changes.
Summary
This study demonstrated the effectiveness of the More Than Words Program for parents of children in Hong Kong, indicating that this may be a viable intervention for Cantonese-speaking families. The authors note that there is an SLP shortage in Hong Kong, making More Than Words a good option for providing an effective intervention to groups of families.
The study also added to the research in identifying parental predictors of success in the More Than Words program and identified that the children of parents with lower self-efficacy had made greater gains in the Parenting Sense of Competence Scale.
Limitations to this study include the fact that group allocation was not randomized. Although the coders and raters were blinded, the assessor was not blinded to the type of intervention children received. Finally, as the research design did not include a maintenance phase, only short-term outcomes could be measured.