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Enhanced

Milieu
Study/ citation Research Question Participants
Teaching
(EMT)
Roberts, Kaiser, Wolfe, How does effects of the teach- 4 parent-child dyads,
Bryant, and Spidalieri model-coach-review instructional children were between 24
(2014) approach on caregivers' use of and 42 months and had
language support strategies and language impairment
on their children's use of
expressive language?

Peterson, Carta, and Can parents in families with 3 mother- child dyads
Greenwood (2005) multiple environmental risks be in families with multiple
taught to use milieu language risk factors (includes
teaching procedures with their low- income, single
children and will they able to parent, minority group,
maintain the use of these low educational level)
procedure over time? child A was 43
Is milieu language teaching an months old
effective approach for improving child B was 27
2 the language skills of children months old
living in families with multiple child C was 24
environmental risks? months old
Olive, Cruz, Davis, Evaluate the effects of enhances 3 children with autism
Chan, Lang, O'Reilly, milieu teaching when combined and the age was 45, 48,
and Dickson (2007) with a voice output and 66 month-old
communication aid on the
requesting skills of 3 children
with autism

Kaiser and Roberts The effects of enhance milieu 77 children including


(2013) teaching implemented by parents children with intellectual
and therapists versus therapists disabilities, Down
only syndrome and autism

Kaiser, Hester, The effects of the application of 4 preschool boys ragned


Solomon, and Keetz EMT with preschool children in age from 57 to 71
(1994) during interactiona with their months and they had
primary conversational partners speech and language
delay

keywords: database inclusion criterion


Enhanced milieu teaching EBSCO PsycINFO
early intervention Psychology and behavioral
ERIC
Education Full text
Education Research complete
Length of
Research Design Setting sessions Implementers
(weeks)

A single-subject, clinic sessions 12 caregivers


multiple-baseline, across-
behaviors design (match
turns, expansions, time
delays, prompting)

A multiple baseline home 4 + 10 + 18 + 12 parents


design across parent-child (baseline,
dyads (response response
interaction and incidental interaction,
teaching) incidental
teaching,
followup)
A multiple probe design classroom 12 teachers or
across participants teaching assistants
(baseline vs. EMT
procedures)

Randomized group home and clinic 24- 48 parents and


design study (parent + (intervention + therapists
therapist vs. therapist followup)
only)

Multiple baseline across 2 Small play room 105- 115 2 graduare student
children replicated across adjacent to the sessions trainers and 4
two additional children classrooms with a classroom teachers
selection of child-
prefered toys

rch complete
Independent Variable (Intervention)
Dependent Variable (Target Behavior)
Describe and list of intervention
Describe and list change
"actions"

1) Matched turns: percentage of adult DV1- caregiver- use of EMT language


turns that are in response to the child's support stategies
previous utterance; 2) Expansion: 1) Matched turns- adult
percentage of child utterances to which verbal or nonverbal communicative turns that
the adult adds a word; immediately followed (within 2 seconds) a
3) Time Delays: Number and child communicative turn and were follwed to
percentage of episodes that include the child communicative turn.
correctly executed steps of the 2) Expansions- a) adding
nonverbal prompting hierarchy; one or two contect words to th child's previous
4) Prompting: Number and utterance, b) replacing a word in the child's
percentage of episodes that include previous utterance to make it grammatically
correctly executed steps of the verbal correct, or c) changing the verb tense in the
prompting hierarchy child's previous utterance to make it
grammatically correct. 3) Time
delays- parents attempts to elicit verbal and
nonverbal requests from the child and label
these requests with specific target language.
4) Prompting- adult prompts in response to a
child verbal or nonverbal request.
DV2- children- use of communication targets

Responsive interaction (RI) taught to DV1- parent and child language interaction:
parents included descriptive statements, 1) descriptive statement- when the parent
imitation, and expansion. named an object or activity, or described what
Incidental teaching (IT) was occurring. 2) imitation- parent imitated or
taught to parents included modeling, repeated the child's vocalization; 3) expansion-
manding, mand-modeling, and time- parent expand on the child's verbal behavior; 4)
delay. modeling- parent demonstrated a required
verbal behavior. 5) madning parent requests a
verbal response from the child. 6) time-delay-
parent seemed awaree of the child's interest but
waited at least 15 sec for child to make a
request.
DV2- children behaviors: 1) comment- the
child made intelligible comment; 2) correct
response- the child made a correct response
following a parent MLT behavior.
1) follow children's lead; VOCA-1) correct VOCA- child
2)imitation: response to child motor and independently presses VOCA to request an
play behaviors; object, action, or respons; 2) incorrect VOCA-
3) environment arrangement child indepedently presses VOCA to request.
Child shows displeasure in outcome by
creaming, shoutung, or refusing object; 3)
Prompted VOCA- Adult prompts child to press
VOCA, including verbal, gestural, physical,
and time delay prompts.
Gestural communicative act- child uses a sign
or gesture for a communicative purpos;
Verbal/vocal communicative act- child uses a
wor or word approximation.

therapist and parent- EMT: a) DV1- therapist and parent- EMT: a)


environmental arrangement; b) environmental arrangement; b) modeling,
modeling (adult utterances contained responsive interaction; c) expands child
child language targets) , responsive communication forms by adding words to child
interaction (child utterances to the utterances; d) prompting
adhult responed); c) expands child DV2-children: a) norm-referenced measures-
communication forms by adding words children's nonverbal cognitive skills, EVT and
to child utterances; d) prompting (the PPVT; b) observational measures : language
prompting episodes that were delivered sample (MLUs and NDW); c) parent report
in response to a child request) measures: child's behaviors; work and
sentences checklist

Trainers and teachers implemented Children- use communication of target words


EMT: 1) environmental arrangement: and their generalization of targets
facilitates child interest in the
environment, sustained attention to the
environment; 2) responsive interaction
strategies: facilitates engagement
between the child and adult, turn-
taking; 3) milliew teaching techniques:
facilitates responsiveness to adult
requests for communication,
generalized imitation skills, requesting
behaviors
Results Social Validity/Usability

Caregivers- they increased in Caregivers increase use of EMT


their use of each EMT after strategy and had positive impact
instruction but generalization on child language skills.
and maintenance of strategy at
home was limited.
Children- all children
gained in their use of
communication targets and in
their performance on norm-
referenced measures of
language.

parents- they learned the For future implications, practices


EMT skills and were able to would need to explore
maintain skills after the implementation factors related to
intervention was completed. parent characteristics and
children- increased environmental risks.
their verbal behavior and mean
length of utterance.
All 3 children learned to use First study to demonstrate the
VOCA and increased their total use of any type of AAC
requesting during play. intervention paired with EMT. It
may help children with autism
increase requesting, however, the
study lacked the data for children
over time and across settings.

Parent and therapist group Having well-designed


demonstrated greater use of naturalistic language
EMT strategies at home than intervention implemented by
parents in the theraist only parents and therapists together is
group and the skills maintaintes helpful and having an impact on
over time children's everyday use of
6 months follow up: language at home.
children in the parent+ therapist
group had longer MLUs and
greater NDW

1) the effects of the intervention The implementation of EMT by


on children's use of targets are conversational partners would
consistent across children and change in the children's
their peers; 2) the generalization communication in the context of
resulting from target language intervention. Children could
use only for one child increase the target words.
However, the data in this paper
was shown that the language
support in the classroom did not
provide enough for significant
language delays.