The More Than Words® parent-delivered program for autistic children and those with social communication challenges: a single-arm pragmatic feasibility trial.

backgroundPediatric speech-language pathologists (SLPs) frequently use parent coaching interventions such as the More Than Words® (MTW) program to support young autistic children and others with social communication challenges. While some promising evidence exists for MTW, outcomes from previous studies have been mixed and research to date has primarily been conducted in controlled settings, limiting generalizability to real-world practice. To support future pragmatic randomized controlled trials (RCTs), this study aimed to assess the feasibility of a MTW evaluation protocol that had been co-constructed by researchers, program developers, and expert SLPs for use in community settings.

methodsThis pragmatic, single-arm, pre-post feasibility study implemented the co-constructed evaluation protocol during MTW programs delivered by community-based SLPs as a part of standard care in a publicly funded service. We assessed the following dimensions of methodological feasibility: (a) recruitment capability; (b) feasibility, acceptability, and practicality of data collection and analysis procedures; and (c) preliminary outcome trends.

resultsOf those approached, 45% of SLPs and 57% of parent-child dyads agreed to participate. Four of the five enrolled SLPs delivered their MTW program as planned and none of the 21 enrolled parent-child dyads withdrew from the study. Outcome measure completion ranged from 48 to 81%, with 4 dyads providing little to no data. SLPs viewed study methods and measures as acceptable and feasible and researcher coding of video-recorded outcome measures was reliable and practical. Preliminary outcome trend analyses indicated post-program gains in children's early communication skills and communicative participation by parent report, and in child, parent, and dyadic interaction behaviors coded by the researchers. All parents agreed or strongly agreed that their child benefited from the MTW program and most reported increased self-efficacy in supporting their child's communication.

conclusionsThis feasibility trial offers a valuable contribution to advancing pragmatic clinical trial methods for use with MTW and other similar programs, highlighting both the challenges and benefits of moving beyond controlled experimental settings. Although findings may not fully generalize, new insights into participant recruitment, data collection, and methodological feasibility are applicable more broadly and can inform future pragmatic RCT development for evaluating effectiveness of community-based caregiver-delivered programs.

trial registrationThe trial was retrospectively registered at ClinicalTrials.gov (ID: NCT06847347).