More than words - It takes two to Talk

Everyone has good days and bad days and your child is no different. It's hard when you have speech therapy once or twice a week and your child is tired and wants to nap, perhaps even coming down with a cold, or just plain not in the mood and not willing to work with the therapist. The hour comes and goes - with maybe ten minutes of productive therapy.

But what if someone could teach you, the parent, how to be an effective therapist for your child?

When my son was 17 months old he entered an early language intervention program called Hanen

The Hanen approach to early language intervention was developed In the 1960s and 70s, when there was little or no parental involvement in children's speech therapy. In the 1970s, research showed that parents involvement in their child's early intervention was critical and that the earlier parents were involved in their child's intervention program, the better were the outcomes for the child.

The Hanen program is quite simple in its belief - parents are their child's first and best teachers! After all, it is parents who have the strongest bond with their children and who can help their children learn in real-life situations, where the best learning takes place. I can say from experience that my child would give me a lot more than he would give his therapist.

Hanen's approach is that it helps parents use everyday situations such as eating meals or having a bath as opportunities for the child to learn to communicate. Once parents know how to do this, "therapy" occurs throughout the child's day - and not only with the speech-language pathologist. I found bath time especially good for developing language, My son was a lot calmer in the bath and I used this opportunity to my full advantage singing various songs and playing with various bath toys and it was also extremely helpful in teaching him self help skills such as brushing his teeth and washing his hair.

We did the More than words program. My husband and I did a parent workshop and learnt a variety of tools that would help our soon to develop language and communicate with us. I must admit, At first after hearing so much positive feedback about ABA therapy, I had my doubts about hanen, However my son loved the Hanen program as it was more of a natural way of learning. Below is an outline of the more than words program.

Program Summary

More than Words - The Hanen Program® for Parents of Children with Autism Spectrum Disorder (ASD) is a family-focused, social pragmatic

Intervention program for young Children with ASD. More Than Words was adapted from It Takes Two to Talk^TM - The Hanen Program® for Parents in order to meet the needs of children on the autism spectrum and their parents. The goal of More Than Words, like that of It Takes Two to Talk, is to empower parents to become the primary facilitator of their child's communication and language development, thereby maximizing the child's opportunities to develop communication skills in everyday situations. More than Words addresses the needs of both non-verbal and verbal children with ASD under the age of five.

Program Features

The More Than Words Program has the following features:

• It is led by a Hanen Certified speech language pathologist (SLP) who has received specialized training at a Hanen certification workshop
• It is offered to groups of parents (up to eight families per program)
• It has three major components:
• a pre-program assessment and baseline videotaping of parent child interaction
• A minimum of 17.5 hours (seven sessions) of group training for parents; and
• Three individual video feedback sessions for each parent attending the program (parent-child interaction is videotaped by and reviewed with the SLP)
• It is supported by user-friendly resources for both parents and SLP, including: parent guidebook, a DVD,detailed Leader's Guide and powerpoint slides with video examples for use by the SLP group leader

Program Objectives

More Than Words has three objectives:

i) Parent education

ii) Early language intervention; and

iii) Social support for parents

Parent education - parents learn about their child's unique learning style and sensory preferences so they understand his strengths and challenges. They also learn basic concepts about communication and language - e.g., the significance of joint attention and its impact on communication development; the need to manipulate the environment to motivate the child to communicate; the importance of the child's active participation in frequent, extended turn-taking episodes. Parents become familiar with the child's stage of communication, enabling them to set realistic communication goals and be more responsive to his communicative attempts.

Early communication/language intervention

- parents learn to apply responsive interaction strategies to everyday interactions with their child. Strategies highlighted by the SLP for each parent are tied to the child's communication goals, which are developed collaboratively with the parents and modified over the course of the program. Effective intervention depends upon the parent learning to apply the strategies flexibly across contexts so intervention becomes a natural part of parent child interactions. Video feedback sessions play a major role in helping parents modify their interactive behavior and apply strategies consistently, thereby maximizing the child's opportunities to develop more effective communication skills. Video feedback sessions include the following components:

■ The parent tries out newly learned strategies in an everyday activity with his or her child;

■ The SLP coaches the parent "online", as needed, to help him/her apply strategies successfully; and

■ Parent and SLP view the videotaped interaction together - the SLP provides feedback to the parent, guiding the discussion in order to increase the parent's awareness of his/her interactive behavior and its impact on the child, as well as increasing awareness of the child's communication. The SLP also helps the parent identify Meta cognitive techniques that will facilitate consistent strategy use.

Social support for parents - In comparison with parents of children with other types of disabilities, parents of children with autism appear to be at greater risk for depression, anxiety, social isolation, fatigue and frustration particularly with respect to obtaining accurate diagnoses and services.This increases their need for social support, which has been shown to have a positive impact on the well-being of the child and the family when the child has a disability However, there is some evidence that, for parents of children with autism, this support is most helpful when it comes from those who have aknowledge and understanding of the child's unique challenges In More Th an Words, parents gain both formal and informal social support. The SLP,whose multi-faceted role includes that of group leader, interventionist, coach and counselor provides more formal support. The parent group itself provides informal support through the sharing of experiences with individuals in similar situations who can genuinely empathize.

The following three clusters of responsive strategies are taught in a More Than Words Program:

1. Child-oriented strategies - observe,wait and listen; follow the child's leadby including his interests - comment or join in; be face to face.

2. Interaction-promoting strategies -encourage turn-taking within routines;cue or prompt your child to take a turn;intrude to get an interaction going and then follow your child's lead.

3. Language-modelling strategies -interpret your child's actions; say less(simplify, shorten sentences), stress (highlight important words), go slow and show (use visual aids); repeat;expand

Summary of Efficacy Studies of Social-Interactionist Intervention for children with ASD Using relationship-focused intervention to enhancethe social-emotional functioning of children with autism spectrum disorder

Pretest-posttest design used to investigate the outcomes of 20 mothers and their preschool children with ASD

Families participated in a yearlong study in which mothers received one-hour intervention sessions on a weekly basis

Mothers were trained to use strategies associated with five different components of responsive interactive behaviour: reciprocity, contingency, shared control, affect and match

Results:

◆ 80% of the mothers were reported to have increased their level of responsiveness following intervention

◆ Changes in the mothers were associated with improvements in ratings of children's attention, persistence,initiation, and joint attention.

◆ The data suggest that children who made the greatest improvement had mothers who made the most changes in their responsiveness. Despite these positive fi ndings, the lack of a control group did not permit the authors to attribute the observed gains to the intervention. Nonetheless, this study suggests that increased responsive interaction may play an important role in facilitating social interactive behaviour in children with ASD Conducted a randomised controlled trial, in which a parent-administered social-interactionist intervention model was used

■ Subjects were 28 children with ASD and their parents,randomly assigned to experimental and control groups

■ 12-month program, included parents attending an initial series of workshops to learn facilitation strategies (children did not attend), then received monthly treatment sessions (parent and child together) for six months with a further six months of monthly maintenance sessions

■ Parents were trained to respond sensitively and to interpret the child's actions as having meaning.

■ Once joint attention and reciprocity were achieved, parents learned to use action routines, repeated scripts, and pauses to elicit interaction and communication from the child

■ Following intervention, the following results were reported:

◆ Mothers in the experimental group displayed significantly more responsiveness relative to the control group

◆ The children in the experimental group demonstrated increases in reciprocal social interaction,social engagement, social responses, and spontaneous initiation of social interaction as measured by the ADOS.

◆ The children in the experimental group demonstrated significant increases in expressive vocabulary as measured by the CDI more synchronous parent-child interaction, and more child communication acts during a videotaped play sample.

This study confirmed that a social interactionist model of intervention implemented by parents can infl uence gains in joint interaction and communication skills in children with ASD.

Siller and Sigman (2002): Longitudinal follow up study examining the behaviours of parents of children with autism and their relationship to the development of their children's communication.

■ Conducted a longitudinal follow up study on a group of 25 children with ASD (mean age 50.3 months).

■ Study tested the following hypothesis: "caregivers of children with autism who spend a higher proportion of the play engagement targeting objects that are already the focus of the child's attention, trying to maintain the child's on going activity, will have children with superior communication skills at later ages" This is referred to as caregiver synchronization.

■ The children were assessed initially using the Early Social Communication Scale the Reynell Developmental Language and by videotaping an episodeof caregiver-child interaction. They were also assessed at three points in time after the initial assessment (one year after the initial assessment, 10 years after the initial assessment and 16 years after the initial assessment).

■ Results:

◆ caregivers of children with autism who demonstrated higher levels of synchronization during early play interactions had children with superior communication and language skills over a period of one, 10 and 16 years when compared with children of caregivers who demonstrated lower levels of synchronization

◆ the strongest predictor of the child's future gain inlanguage skills was caregiver utterances that were both synchronized with the child's focus of attention as well as being undemanding (i.e., the caregiver maintained the child's ongoing activity by offering reinforcement or making a comment, making no demands on the child to change the activity)

■ The authors suggest that the importance of caregivers'behaviours matching the child's focus of attention and ongoing activity may have three causal links to the child's development of future language skills. First allowing a child to pursue his focus may reduce the impact of any attentional defi cits. In addition, a shared intentional state might help the child develop an understanding of others' internal states, a basic prerequisite for the development of joint attention and language.

Finally, a sensitive interaction partner might provide the child with motivating and confi rming interactive experiences, which support the development of functional communication, thereby increasing the child's motivation to communicate.

My son also suffers from Apraxia so I found the hanen program effiective in helping him to communicate with us.

Source - http://www.hanen.org