Addressing Social Skills in Autistic Children: Feasibility and Parental Insights on Hanen's More Than Words

Communication differences in autistic children may challenge parent-child interactions and social development. This study investigated the feasibility of implementing Hanen's More Than Words (HMTW) among Iranian families and its impact on social communication in autistic children.

A sequential explanatory mixed-methods design was employed. In the quantitative phase, 22 autistic children were assigned to a controlled trial within a pretest, posttest, and follow-up framework, divided into an intervention and a control group. Parents in the intervention group received HMTW training for three months. After the follow-up, parents from the intervention group participated in semi-structured interviews analyzed using thematic analysis.

Quantitative data demonstrated observable changes in the social communication of autistic children, characterized by an increase in mutually engaging behaviors and a decrease in behaviors that typically disrupted social interactions. Qualitative findings revealed four main themes: change in parental attitude and increased awareness, parent-perceived utility of HMTW Strategies for facilitating communication, psycho-emotional challenges of parents and personal issues, and the HMTW limitations in addressing behavior problems. These results suggest the potential usefulness of HMTW strategies in supporting social interactions, while also highlighting the gap in attention to the psychosocial needs of parents and strategies for managing challenging behaviors.

In general, following cultural adaptation, the HMTW can be utilized as a feasible and acceptable parent-mediated early intervention to change the social skills of Iranian autistic children. However, integrating psychosocial support for parents in addition to complementary behavioral interventions, may enhance the implementation and potential impact of the program.