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Randomized Controlled Trial
. 2011 Jul;52(7):741-52.
doi: 10.1111/j.1469-7610.2011.02395.x. Epub 2011 Mar 22.

A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms

Alice S Carter  1 , Daniel S Messinger, Wendy L Stone, Seniz Celimli, Allison S Nahmias, Paul Yoder
Affiliations
Randomized Controlled Trial

A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms

Alice S Carter et al. J Child Psychol Psychiatry. 2011 Jul.

Abstract

Background: This randomized controlled trial compared Hanen's 'More than Words' (HMTW), a parent-implemented intervention, to a 'business as usual' control group.

Methods: Sixty-two children (51 boys and 11 girls; M age = 20 months; SD = 2.6) who met criteria for autism spectrum disorders (ASD) and their parents participated in the study. The HMTW intervention was provided over 3.5 months. There were three measurement periods: prior to randomization (Time 1) and at 5 and 9 months post enrollment (Times 2 and 3). Children's communication and parental responsivity were measured at each time point. Children's object interest, a putative moderator, was measured at Time 1.

Results: There were no main effects of the HMTW intervention on either parental responsivity or children's communication. However, the effects on residualized gains in parental responsivity from Time 1 to both Times 2 and 3 yielded noteworthy effect sizes (Glass's Δ = .71, .50 respectively). In contrast, there were treatment effects on child communication gains to Time 3 that were moderated by children's Time 1 object interest. Children with lower levels of Time 1 object interest exhibited facilitated growth in communication; children with higher levels of object interest exhibited growth attenuation.

Conclusions: The HMTW intervention showed differential effects on child communication depending on a baseline child factor. HMTW facilitated communication in children with lower levels of Time 1 object interest. Parents of children who evidence higher object interest may require greater support to implement the HMTW strategies, or may require different strategies than those provided by the HMTW curriculum.

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Conflict of interest statement

Conflict of interest statement: Stone receives the author share of royalties from sales of the Screening Tool for Autism in Two-Year-Olds (STAT).

Figures

Figure 1
Figure 1
Participant recruitment, enrollment, randomization, and retention
Figure 2
Figure 2
Graphs depicting treatment moderation by DPA number of toys predicting the residualized gains of (a) initiating joint attention; (b) initiating behavioral requests; (c) PCFP weighted frequency of intentional communication; (d) PIA-CV nonverbal communication. DPA = Developmental Play Assessment; PIA-CV = Parent Interview for Autism – Clinical Version; PCFP = Parent–Child Free Play; T1 = 1st time point; Max = maximum value of T1 moderator variable; Min = minimum value of T1 moderator variable; Higher RoS = higher region of significance; Lower RoS = lower region of significance
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Comment in

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