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Hanen Approach

The Hanen philosophy as stated by the executive director of The Hanen Centre, Elaine Weitzman (2002), is that the best practices for young children who have limited or no verbal skills consists of professionals working consistently with and through parents.Children who are older and have more verbal skills benefit from direct therapy, but the Hanen Program also asserts that parents should still have an integral part in the intervention process.There is evidence that supports the effectiveness of intervention approaches adopted by parents and used in naturally occurring contexts (Dodd et al., 1994).

Hanen claims that therapy is more effective when language learning takes place in more naturalistic settings. According to Rosetti (1996), children who learn to communicate in real-life situations are more apt to generalize learned language skills to other settings. Unlike direct therapy that is setting-specific and limited to certain times, Hanen Programs offer intervention strategies that incorporate language into everyday situations so language learning becomes an ongoing and progressive process (Rosetti, 1996).

There are several Hanen Programs for parents and early childcare providers including the It Takes Two to Talk - The Hanen Program for Parents (Manolson, 1992), More Than Words - The Hanen Program for Parents of Children with Autism Spectrum Disorder (Sussman, 1999)and Learning Language and Loving It -The Hanen Program for Early Childhood Educators (Weitzman, 1992) which all target slightly different intervention strategies.

It Takes Two to Talk (Manolson, 1992)is a Hanen Program for parents focused on training them to foster their child's communication skills and encourage increased language development. According to Manolson (1992), this program is most appropriate for parents with children who are nonverbal or only have a few words and are just beginning to use these words in one to two word combinations. It Takes Two to Talk is taught by a Hanen-certified speech pathologist generally over a period of 11 weeks. Through this program, parents learn how to observe, wait, and listen to the child and be less directive. They also are taught to follow their childs lead during play and other day-to-day activities. In addition, they learn strategies to facilitate interaction and communication. Additionally, parents become more aware of their childs needs and learn how to highlight when they communicate so the child can more easily understand and respond (Manolson, 1992). 

Tannock, Girolametto, and Siegel (1992) studied 32 preschool children with developmental disorders and the quality of their mothers interactions with them. They compared data from the interactive behavior of the experimental group (mothers and children who participated in the Hanen Program) and the control group (mothers with children who had not yet participated in Hanen).  Results showed that children in the experimental group increased turn-taking.   They also found that interactions were more frequent and lasted longer between the mother and child than prior to the program, while the control group showed no change in the amount or duration of interactions (Girolametto, Verbey, & Tannock, 1995). There is limited research on mothers interactions and the Hanen Program, thus these findings are not supported by any other studies. 

Girolametto, Pearce and Weitzman (1996) also investigated the efficacy of It Takes Two to Talk with 32 preschool children aged two to three years, six months who had severe expressive language delays and their mothers.  The group was split up into an experimental and control group. Improvement was measured with a pre-test post-test group design. The experimental group was randomly assigned.  Only mothers data was used. In the experimental group, parents were taught strategies to repetitively incorporate 10 target words in everyday activities.  The control group did not receive treatment.  The authors found that compared with mothers in the control group, the mothers who participated in the It Takes Two to Talk program implemented more target words in their vocabulary and used fewer, shorter sentences per minute.  Children with mothers who participated in the Hanen Program displayed significant improvement in communication abilities (Girolametto, Pearce and Weitzman, 1996).   The sample size of the study is limited and there is no other evidence beyond this study to back up these findings.  There needs to be more replications of these studies to support the stated evidence, and data should be taken to find if the childrens language is improving as a result of the It Takes Two to Talk program.

More Than Words (Sussman, 1999), The Hanen Program for Children with Autism Spectrum Disorders gives parents facilitative tools to use with their children to help them communicate.  Parents learn how to use everyday activities, visual supports, and the four stages of communication, including Own Agenda Stage, Requester Stage, Early Communicator, and The Partner (Sussman, 1999).  It is typically an 11 week program designed to help parents with children under six who have difficulty with language and social interactions.  Parents learn strategies to target communication difficulties associated with Autism Spectrum Disorders (ASD) as well as other disorders that affect social interaction.  The program is set up to support parents understanding of their childs behavior and how to modify or act towards these behaviors such as giving the child a chew-safe toy to bite on so the child does not chew or bite people or hazardous objects.  They also are taught techniques to encourage and develop their childs play skills like expanding manipulative or symbolic play and create increased communicative opportunities through techniques such as putting desired foods or toys just out of reach.  Parents are also shown how to set up predictable routines that make it easy for the child to learn and understand and how to implement pictures and writing into these routines for increased communication and interactions attempts (Sussman, 1999) These techniques have not been validated by data based research. 

These techniques are taught through five basic strategies.  The first strategy is for the parent to give the child a motivation to communicate and then wait.  The parent sets up a motivating object just out of the childs reach and waits for any mode of communication in response (Sussman, 1999).  Children with ASD in effective intervention programs become more aware of their environment and learn to attend to the people and surroundings in them (Educating Children with Autism, The National Research Council, 2002). 

The second strategy is to follow the childs lead.  (Sussman, 1999).  Joint attention is considered to be a fundamental aspect of early social development that may be related to later cognitive competence (Carpenter, Nagell, & Tomasello, 1998). Joint attention is when infants' begin to have the capacity to attend simultaneously to a person and a shared object (Mundy & Gomes, 1998).  Parents provide joint attention cues while communicating which infants can learn from.  Also, infants may have increased vocabulary acquisition when parents follow the infants focus of attention.

Another strategy is to make the connection with the child through People Games like peek-a-boo, where the pre-verbal child learns what the communicative role is and can initiate and respond.  Parents are encouraged to choose games appropriate for their childs level which are highly structured, repetitive, and promote communicative interaction (Sussman, 1999).  The focus during the game is on creating a routine that has concise beginnings and endings, planning opportunities for turn-taking, and being interactive for as long as possible. 

The fourth strategy is to help the child comprehend what is being said.  Most children with Autism Spectrum Disorder have comprehension difficulties (Lord, 1985). Parents in the More Than Words program are given tools on how to set up familiar daily routines like getting dressed, eating meals, and playing games to facilitate increase in comprehension.  These routines have intrinsic repetitive organization due to their everyday nature.  Furthermore, these routines promote joint attention when the parent and child are both focused on the same activity, for example when playing a game or putting shoes on. 

The fifth strategy is to use visual cues to aid comprehension (Sussman, 1999). Visual supports help the child understand what is going to happen, what is being said, and when it is time to switch activities.  Often children with ASD have difficulty changing activities or following directions so visual supports utilize their strong visual skills and help the understand the message (Quill, 1995).  Parents are instructed how to set up mini-schedules and picture boards to help facilitate communication. 

Learning Language and Loving It (Weitzman, 1992) is another Hanen program targeted at teaching childcare providers how to increase childrens verbal productivity and peer interaction through in-service training.  The program is designed to help educators foster childrens social, language, and early language development.  It also gives childcare providers a greater understanding of how to meet the needs of children with language disorders or delays (Weitzman and Greenberg, 2002).  There are very few research studies that evaluate the effectiveness of Learning Language and Loving It. 

There is a growing population of young children in day care. As a result, there is an increasing need for training educators of young children how to engage children in interactions and model appropriate simplified sentences (Girolametto et. al, 2003).  Child care providers with specialized training in language development are more likely to create interactions that promote language learning opportunities, whereas the providers whom are untrained tend to be more directive in their communication with the children (Doherty et al, 2000).   According to Girolametto et al (2000), there is a need for childcare provider in-service training.  It is found through clinical evidence that instead of providing responsive language, educators are taking most of the turns and not giving the children the opportunity to interact (Girolametto et al, 2000). 

Girolametto et al (2003) studied 16 early childcare educators who worked in four different licensed day cares in Toronto. All of the participants were females with at least two years experience in the childcare setting.  The group was divided into an experimental group with eight participants and the control group with eight participants.  The study implemented a pre-test, post-test design for both the control and experimental group.  Each participant was videotaped during interactions with four typically developing children before and after being trained in the Hanen Program, Learning Language and Loving It.  The training was divided into a 14-week program with 14 sessions.  Results indicated that the early childcare educators in the experimental group were able to provide more language stimulation and turn-taking, increased verbal communication, and more child-initiated interactions than the control group.  The experimental group was able to maintain these facilitative techniques over the nine-month follow-up period without any additional assistance (Girolametto et al., 2003). The results of this study suggest that the context of the interaction plays a large part in the childs language development.  Despite the positive outcomes, limitations of the study must be noted.  All childcare providers in the study had formal education and only worked with a restricted number of children.  Childcare providers with larger groups of children and less formal education may not reflect the same gains.  Also, more research is needed with larger, more varied cultural groups.  This first study of Learning Language and Loving It showed favorable outcomes, but more replication studies are needed in the future.

According to Bohannon & Bonvillian (1997) children with increased verbal interactions have more opportunity for language growth due to more practice in producing different language forms and receive response on their communicative attempts.