Toddlers who played with a limited number of toys showed more improvement in their communication skills following parent-guided treatment than those receiving other community-based treatments.
The report is the first to examine this autism treatment -- called Hanen's More Than Words -- for children younger than 2 showing early signs of an autism spectrum disorder. Caught early enough and treated with the right behavioral therapy, autism symptoms can improve dramatically.
The paper appears online March 22 in the Journal of Child Psychology and Psychiatry.
"This report adds to our emerging knowledge about which interventions work for which kids. It will help match children with the right intervention and not waste time enrolling them in treatments that are not well-suited for them," said co-author Wendy Stone, director of the UW Autism Center.
Stone said that parents often detect autism symptoms when their children reach about 17 to 18 months old. At this age, typical signs of autism include the child using fewer gestures and facial expressions to communicate, and being less likely to initiate social exchanges, such as pointing out something of interest, than other children the same age.
One in 110 children has autism spectrum disorders, which include autistic disorder, Asperger's syndrome and pervasive developmental disorder-not otherwise specified. More boys, one in 70, than girls are affected.
Few autism interventions focus on toddlers -- children aged 1 to 3 -- and those that do can be time-intensive and expensive. Stone and her collaborators wanted to study the effectiveness of a short-term, relatively low-cost intervention for toddlers showing warning signs.
"Our ultimate goal is to catch the symptoms early and find effective preventive interventions so that these children can attain their full potential," Stone said.
Sixty-two children (51 boys and 11 girls) younger than age 2 and meeting criteria for autism disorders, participated in the study with their parents. The researchers measured the toddlers' baseline social and communication skills during a pretest in which parents and their children played with toys and read books while a researcher observed.
Then the youngsters were randomly assigned either to the Hanen's More Than Words program or to a treatment-as-usual control condition. The program is intended to stimulate mature communication, language development and social skills.
The parents in the treatment group learned strategies to help their toddlers communicate, such as practicing taking turns, encouraging eye contact and modeling simple sentences from the child's perspective. For instance, when the child pointed to crackers, the parent wouldn't just hand over the food. Instead, the parent would get down at eye-level with the child and say, "I want crackers."
"By age 2, most kids have already learned how to interact and communicate with others," Stone said. Children showing early signs of autism spectrum disorders don't seem to learn basic social interactions without coaching, she said.
To the researchers' surprise, the intervention did not make a difference in communication skills when they compared the 32 children in the intervention group and the 30 children in the no-treatment group.
But they did find that the intervention helped a subset of the children. Kids who played with fewer toys during the pretest showed more improvement if they received the treatment than if they didn't. They showed more instances of making eye contact, pointing to or reaching for objects of interest and showing or giving the experimenter a toy.
The effect lasted for at least four months after the intervention ended. To Stone, playtime is a logical time to help children develop communication skills. "Playing with toys provides great opportunities for teaching social and communication skills," she said. "It enables children and caregivers to share a focus of attention."
The advocacy organization Autism Speaks and the Marino Autism Research Institute funded the research.
Co-authors are Alice Carter, professor of psychology at the University of Massachusetts Boston; Paul Yoder, professor of special education at Vanderbilt University; Daniel Messinger, associate professor of psychology at the University of Miami; Seniz Celimli, postdoctoral researcher at the University of Miami; and Allison Nahmias, a psychology graduate student at the University of Pennsylvania.
- Alice S. Carter, Daniel S. Messinger, Wendy L. Stone, Seniz Celimli, Allison S. Nahmias, Paul Yoder. A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 2011; DOI: 10.1111/j.1469-7610.2011.02395.x
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