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
Greenwood (2005) multiple environmental risks be
taught to use milieu language
teaching procedures with their
children and will they able to
maintain the use of these
procedure over time?
Is milieu language teaching an months old
effective approach for improving
2 the language skills of children
living in families with multiple
environmental risks?
3 mother- child dyads
in families with multiple
risk factors (includes
low- income, single
parent, minority group,
low educational level)
child A was 43
child B was 27
months old
child C was 24
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)
Describe and list of intervention
"actions"
1) Matched turns: percentage of adult
turns that are in response to the child's
previous utterance; 2) Expansion:
percentage of child utterances to which
the adult adds a word;
3) Time Delays: Number and
percentage of episodes that include
correctly executed steps of the
nonverbal prompting hierarchy;
4) Prompting: Number and
percentage of episodes that include
correctly executed steps of the verbal
prompting hierarchy
Responsive interaction (RI) taught to DV1- parent and child language interaction:
parents included descriptive statements, 1) descriptive statement- when the parent
imitation, and expansion.
Incidental teaching (IT) was occurring. 2) imitation- parent imitated or
taught to parents included modeling,
manding, mand-modeling, and time-
delay.
Dependent Variable (Target Behavior)
Describe and list change
DV1- caregiver- use of EMT language
support stategies
1) Matched turns- adult
verbal or nonverbal communicative turns that
immediately followed (within 2 seconds) a
child communicative turn and were follwed to
the child communicative turn.
2) Expansions- a) adding
one or two contect words to th child's previous
utterance, b) replacing a word in the child's
previous utterance to make it grammatically
correct, or c) changing the verb tense in the
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
named an object or activity, or described what
repeated the child's vocalization; 3) expansion-
parent expand on the child's verbal behavior; 4)
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;
2)imitation: response to child motor and independently presses VOCA to request an
play behaviors;
3) environment arrangement
VOCA-1) correct VOCA- child
object, action, or respons; 2) incorrect VOCA-
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)
modeling (adult utterances contained
child language targets) , responsive
interaction (child utterances to the
adhult responed); c) expands child
communication forms by adding words
to child utterances; d) prompting (the
prompting episodes that were delivered
in response to a child request)
environmental arrangement; b) modeling,
responsive interaction; c) expands child
communication forms by adding words to child
utterances; d) prompting
DV2-children: a) norm-referenced measures-
children's nonverbal cognitive skills, EVT and
PPVT; b) observational measures : language
sample (MLUs and NDW); c) parent report
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
maintain skills after the
intervention was completed.
children- increased
their verbal behavior and mean
length of utterance.
would need to explore
implementation factors related to
parent characteristics and
environmental risks.
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
EMT strategies at home than
parents in the theraist only
group and the skills maintaintes
over time
6 months follow up:
children in the parent+ therapist
group had longer MLUs and
greater NDW
naturalistic language
intervention implemented by
parents and therapists together is
helpful and having an impact on
children's everyday use of
language at home.

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.