According to best practice guidelines, including and training parents to assist their child’s communication development is considered essential for effective autism intervention and a natural step to provide consistent, daily support for development (National Research Council (NRC), 2001). Research suggests that parents can learn to be effective language facilitators (Kaiser & Hancock, 2003); however, less is known about what constitutes effective delivery of parent training programs and further, even less is known about how effective these programs are outside the constraints of controlled research settings. Many parent-training programs are implemented without careful examination of whether and how well parents are able to learn skills taught and whether and to what extent their ability to use these skills alters the language environment.
Objectives:
This study utilized multiple methods of data collection to explore growth and change in parent-child interactions, parent skill development, and child language development in the child’s natural language learning environment at multiple time points before, during and after parents’ participation in the widely used parent language education program Hanen More Than Words (MTW; Sussman, 1999).
Methods:
Fourteen male and 4 female toddlers who ranged in age from 24-39m (mean=30m) with a developmental age of 2-28m (mean=12m) and their parents participated in the study. Thirty three percent of the families spoke a language other than English and 58.3% were Caucasian. All children had a diagnosis of autism or suspected autism.
Measures: Four methods of data collection were used in this study. First, the MacArthur Communicative Development Inventory (Words and Gestures Module) (Fenson et al., 2007) was utilized to track prelingustic gestures, receptive and expressive language development. Second, in home parent-child talk audio (including adult word count, child vocalizations and conversational turns) was collected via a the Language Environment Analysis (LENA) system, a digital language processor. Third, child engagement in dyadic interaction was explored using videotape data and coded using a protocol developed by Bakeman and Adamson (1984). Last, parents and clinicians provided evaluations of the parents’ skills via a 24-item questionnaire.
Results:
Overall, these families spoke at rates lower than average demonstrated by families of typically developing toddlers (Gilkerson & Richards, 2008). Parents increased their skill mastery from 10% at baseline to approximately 50% post intervention. Children demonstrated statistically significant changes (paired sample t-tests) in their receptive language (t(10)=-2.75, p=0.020, d=.662), prelinguistic gestures (t(10)=-2.12, p=0.060, d=.440), and their frequency of coordinated joint attention in dyadic interaction (t(8)=-2.67, p=0.028, d=.957).
Conclusions:
Results indicate that parents’ response to the program was not uniform. Four patterns of change in the timing, quality and quantity of parent-child talk and child language were observed. Where, in families where both adult talk and child language increased, children demonstrated greater increases in coordinated joint attention, receptive and expressive language while parents demonstrated higher fidelity. The opposite was true in families where little to no change occurred in adult talk or child language. Discussion will include consideration of the importance of child and parent characteristics when examining the impact of parent training.