Cited by 446Autism Spectrum Disorder ResearchLanguage Development and DisordersChild Nutrition and Feeding Issues

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index; none of the 30 sources its claims cite is checked for support yet.

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

Open access
Carter, Alice S., Messinger, Daniel S., Stone, Wendy L., Celimli, Seniz, Nahmias, Allison S., Yoder, Paul·2011·Journal of Child Psychology and Psychiatry

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.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This randomized controlled trial found no main effects of Hanen’s ‘More Than Words’ (HMTW) on parental responsivity or toddler communication compared with a ‘business as usual’ control group. However, child communication gains were moderated by baseline object interest: children with lower object interest showed facilitated growth, while those with higher object interest showed attenuated growth.

Key findings

  • In 62 toddlers with ASD symptoms (51 boys, 11 girls; mean age 20 months, SD = 2.6), HMTW did not produce statistically significant main effects on parental responsivity or child communication.
  • Parental responsivity residualized gains from Time 1 to Time 2 and Time 1 to Time 3 had noteworthy effect sizes (Glass’s Δ = .71 and .50, respectively), though these did not reach conventional significance (p = .08 and p = .09).
  • Time 1 object interest moderated treatment effects on child communication from Time 1 to Time 3: children who played with fewer than three toys at Time 1 showed greater gains in initiating joint attention, initiating behavior requests, and weighted intentional communication if randomized to HMTW; children who played with more than five or six toys (depending on outcome) showed lower gains if randomized to HMTW.
  • For parent-reported nonverbal communication, only the higher region of significance was interpretable: parents of children who played with at least six toys at Time 1 reported more limited growth if randomized to HMTW rather than control.
  • Consumer satisfaction was high: mean ratings of 5.48 out of 6 on the group experience questionnaire and 3.46 out of 4 on the group leader experience questionnaire.

Methods

  • Randomized controlled trial comparing HMTW, a parent-implemented intervention delivered over 3.5 months (eight group sessions and three individual family sessions), to a ‘business as usual’ control group. Sixty-two children were randomized (32 HMTW, 30 control); 55 had follow-up data (89% retention), analyzed as ‘partial’ intent to treat.
  • Measurements occurred at Time 1 (pre-randomization), Time 2 (approximately 5.3 months after Time 1), and Time 3 (approximately 9.3 months after Time 1). Outcomes included parental responsivity from the Parent–Child Free Play procedure; child communication from the Early Social Communication Scales (initiating joint attention, initiating behavior requests), Parent–Child Free Play weighted intentional communication, and Parent Interview for Autism–Clinical Version nonverbal communication.
  • Object interest was measured at Time 1 using the Developmental Play Assessment (number of toys with differentiated play). Main analyses used residualized gain scores, independent-sample t-tests, hierarchical linear regression, and empirically derived regions of significance.

Limitations

  • The paper states that group size was not commensurate with Hanen recommendations (mean 3.57 families per session; range 1–10; standard minimum of 8), which may have compromised learning opportunities and social support.
  • Statistical power was constrained for several outcome measures due to child non-compliance, technical problems, and experimenter error; a full intent-to-treat design with imputation was not pursued.
  • The paper notes that conditional effects were exploratory, regions of significance varied by outcome, and replication is essential before using results to select treatments for individual children.
  • The text also makes evident that the Time 1 parental responsivity ICC was relatively low (.46), and the sample was small, limiting precision.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/j.1469-7610.2011.02395.x

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

5 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Verification

Claims the paper makes

46 Own result · 29 Own method · 24 Not checked yet · 15 Own interpretation · 2 No basis given

Verify all 30 references — free account
  • It may state two separate claims as one. 33
  • Probably not a substantial claim. 24
  • The quote only partly states this claim. 5
54 of 54
  • The paper relies on this without support.

    Parent involvement can capitalize on teachable moments as they occur, provide learning opportunities during naturally occurring routines, and facilitate the generalization of child learning across contexts.

    “Specifically, there is recognition that parent involvement can capitalize on teachable moments as they occur, provide learning opportunities during naturally occurring routines, and facilitate the generalization of child learning across contexts.”
  • The paper relies on this without support.

    Parent-mediated intervention has the potential to be relatively inexpensive and to increase parents' sense of efficacy and empowerment.

    “Additionally, parent-mediated intervention has the potential to be relatively inexpensive and to increase parents’ sense of efficacy and empowerment.”
  • The paper relies on this without support.

    Children with ASD are unlikely to benefit unless maintenance of enhanced parenting practices occurs.

    “In addition, measuring the endurance of such effects several months after treatment ends is important because children with ASD are unlikely to benefit unless such maintenance of enhanced parenting practices occurs.”
  • The paper relies on this without support.

    The HMTW intervention is relatively low intensity.

    “The lack of overall treatment effects on child outcomes may be due to the relatively low intensity of the HMTW intervention, or to the non-optimal implementation due to smaller than recommended group size.”
4 of 4

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Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upt(29) = -3.39reported p = .003 · recomputed p = .002

    “t(29) = −3.39, p = .003”

  • Consistentt(32) = 2.88reported p = .007 · recomputed p = .007

    “t(32) = 2.88, p = .007”

  • Consistentt(45) = -3.38reported p = .002 · recomputed p = .002

    “t(45) = −3.38, p = .002”

  • Consistentt(45) = -3.41reported p < .01 · recomputed p = .001

    “t(45) = −3.41, p < .01”

  • Consistentt(42) = -2.39reported p = .02 · recomputed p = .021

    “t(42) = −2.39, p = .02”

5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

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Citations

Cites

Show all 43 references

Research works printed but not linked: 3

  1. McDuffie A., Object interest in young children with autism spectrum disorders. A randomized treatment comparison, Autism
  2. Mundy P., 2003, A manual for the abridged Early Social Communication Scales (ESCS)
  3. Sparrow S., 2005, Vineland‐II: Vineland Adaptive Behavior Scales, Survey forms manual

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Metadata

Authors
Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P.
Affiliations
  • University of Massachusetts Boston (US)
  • University of Miami (US)
  • University of Washington (US)
  • Vanderbilt University (US)
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2011-03-22
Volume
52
Issue
7
Pages
741-752
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
OpenAlex
W2112804906
Cited by
446
References
43
Citations by year
2026: 16 · 2025: 14 · 2024: 17 · 2023: 15 · 2022: 32 · 2021: 25 · 2020: 34 · 2019: 33 · 2018: 68 · 2017: 16 · 2016: 46 · 2015: 33 · 2014: 39 · 2013: 25 · 2012: 21
FWCI
15.26
Type
journal article
Language
en
Open access
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Autism Speaks (AS1718)
  • Autism Research Institute
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
autism spectrum disorder, toddlers, parent-mediated intervention, children's communication, parental responsiveness, moderation, early intervention
MeSH terms
Attention, Child Development Disorders, Pervasive, Child, Preschool, Combined Modality Therapy, Communication, Education, Family Therapy, Female, Humans, Infant, Language Development Disorders, Male, Parent-Child Relations, Play and Playthings, Psychotherapy, Group, Early Intervention, Educational

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