Milieu teaching is a behavioural intervention in which individuals are taught language skills and behaviours within the natural environment (the milieu). The teaching is delivered in places (such as the kitchen) and in situations (such as when a child wants a snack) in which individuals are most likely to want to communicate with other people.
Teaching begins when an individual shows an interest in activities or materials (for example, by standing next to a table with snacks on) or begins to communicate (for example by pointing to a snack).
The teacher responds by using one or more specific techniques including
- Modelling: demonstrating the desired behaviour so that the individual can imitate it, for example, by saying “Snack”
- Manding: asking questions or providing verbal instructions to encourage the individual to provide the desired response, for example, by saying “What do you want?”
- Time delay: waiting for a short period of time in order to prompt the desired response, for example, waiting ten seconds for the individual to say “Snack”
There are several variations of milieu teaching such as prelinguistic milieu teaching (where the focus is on teaching pre-verbal skills to very young children) and enhanced milieu teaching (where the focus is on responding to and interacting with the child).
The individual elements which make up milieu teaching (modelling, manding and time delay) can be delivered as standalone techniques, can be used together in specific milieu teaching programmes (such as the Responsive Education and Prelinguistic Milieu Teaching programme) or can be used together as part of multi-component social communication programmes (such as the Comprehensive Communication Intervention for Minimally Verbal Children With Autism).
There is insufficient high quality research to determine if specific forms of milieu teaching (such as prelinguistic milieu teaching or enhanced milieu teaching) provide any benefits to autistic children.
There is no high quality evidence to suggest that specific forms of milieu teaching (such as prelinguistic milieu teaching or enhanced milieu teaching) provide any benefits to autistic young people or adults.
However we believe that the key elements of milieu teaching (such as modelling, manding and time delay) may help to improve the communication and social skills of some young autistic children when combined within much larger multi-component programmes, such as those which follow the NICE guidance on psychosocial interventions for autistic children and young people.
There is a need for more research studies which use more rigorous and robust research methods; which compare milieu teaching with other, similar interventions; and which identify the specific components of milieu teaching, if any, that are most effective.
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According to Choi and Kim (2005), milieu teaching is “recommended for individuals with disabilities who are at the early stage of language development” which includes autistic children.
The aim of milieu teaching is to increase and improve a range of communication skills. For example according to Goldstein (2002),
There have been various claims made for milieu teaching used with young autistic children including improved communication. For example
Milieu teaching is a behavioural intervention in which individuals are taught language skills and behaviours within the natural environment (the milieu). The teaching is delivered in places (such as the living room or the kitchen) and in situations (such as when a child wants a snack) in which individuals are most likely to want to communicate with other people.
Milieu teaching is also known as milieu training, milieu therapy and milieu communication training.
According to Choi and Kim (2005) milieu teaching has several characteristics.
1. “Teaching episodes are embedded within typical or routine activities in an individual's natural communicative environments (e.g. kitchen area, living room, child's bedroom, classroom, snack area, playground).”
2. “Teaching begins when an individual shows interest in activities or materials (e.g. standing by swing, sitting at a snack table) or initiates communicative interactions (e.g. pointing to an item, requesting an item verbally). Thus, a variety of stimuli items, like books, snacks, paper, pictures of trains, all commonly available in an individual's natural environment are used to teach language skills.”
3. “The student is taught to use his language skills for a number of communicative purposes, such as making requests, asking questions, commenting, and rejecting, and providing information.”
4. “Explicit prompts, including models, mands (i.e. questions or requests), and time delay, are used to elicit target language responses.”
5. “Natural consequences (e.g. access to requested items) are provided contingent upon appropriate communicative responses. For instance, a child's use of the correct target language response, "Drink juice", is followed by a cup of juice. Because language responses are taught and practiced under naturally occurring conditions, generalization is likely to be enhanced.”
6. “Milieu teaching incorporates only a few trials at a time. If a correct language response does not occur with prompting after only a few attempts, the desired consequence is nonetheless provided in order to preserve the motivation to under similar circumstances in the future.”
According to Choi and Kim (2005) milieu teaching has three specific teaching procedures 1) model, 2) mand and 3) time delay, although other authors such as Goldstein et al (2002) report that incidental teaching techniques are also a key procedure in milieu teaching.
1. “The model procedure refers to demonstrating the desired language response so that a student can imitate it, for example, to repeat a particular word, phrase, or sentence, in relation to the focus of the child's interest. The model procedure is used primarily to teach verbal or signal imitation skills, and it is used for individuals who need to learn new or difficult target responses.”
2. “Mand refers to asking questions (e.g. ‘What do you want?’ or providing verbal instructions (e.g., ‘Tell me what you want’), to a student to elicit a specific response in relation to the focus of his interest (e.g. ‘Say, tie shoes’ when wanting to go outside to play). The mand procedure is used after a student is able to imitate the target language but lacks conversational or intraverbal skills.”
3. 'Time delay refers to the act of waiting for a short period of time after obtaining joint attention in order to prompt a response. For example, giving a questioning look for 5 seconds until a child produces the target language in response. The time delay procedure is used to increase the spontaneous use of the target language in situations where the child is likely to need material or assistance.'
Incidental teaching: refers to teaching in which a teacher takes advantage of naturally occurring 'incidents' or situations to provide learning opportunities for the student.
There are several variations of milieu teaching such as prelinguistic milieu teaching (where the focus is on teaching pre-verbal skills to very young children) and enhanced milieu teaching (where the focus is on responding to and interacting with the child).
The individual elements which make up milieu teaching (modelling, manding and time delay) can be delivered as standalone techniques, can be used together in specific milieu teaching programmes (such as the Responsive Education and Prelinguistic Milieu Teaching programme) or can be used together as part of multi-component social communication programmes (such as the Comprehensive Communication Intervention for Minimally Verbal Children With Autism).
The costs of using milieu teaching will depend to a large extent on whether the teaching is incorporated within a larger, multi-component programme, who provides the teaching, how long it takes to implement the intervention, and whether support materials are purchased.
Like many other interventions, the length and frequency of treatment will depend to a large extent on the needs of the individual. In some cases, the intervention will require many hours of work each day and be implemented over many years.
There are no known hazards for milieu teaching.
There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for milieu teaching.
In practice, milieu teaching may actually be implemented by a variety of people, including parents and carers, as well as professionals such as teachers.
There is no internationally recognised qualification for the delivery of milieu training. In practice, milieu training may actually be implemented by a variety of people, including parents and carers, as well as professionals such as teachers.
Milieu teaching was developed by a number of researchers, including Hart and Rogers-Warren, in the late 1970s and early 1980s.
They described milieu teaching as a collection of “naturalistic” instructional procedures that built on the incidental teaching methods described by Hart and Risley.
Since the 1990’s various researchers have developed different forms of milieu teaching including
We have identified 17 scientific studies published in peer-reviewed journals in which milieu teaching was identified as the main intervention or in which milieu teaching was identified as a core component of a multi-component programme. These trials included more than 100 children, most of pre-school age, diagnosed as being autistic (including children with autistic disorder or pervasive development disorder - not otherwise specified).
Most of the studies reported positive benefits including increased language skills and improved social interaction.
The studies by Ingersoll et al (2012, 2011) reported more mixed results, suggesting that milieu teaching led to more overall language, prompted language, and requests than responsive interaction but that responsive interaction led to more comments than milieu teaching.
The study by Kaiser and Roberts (2013) reported that EMT delivered by parents and therapists was more effective than EMT delivered by therapists alone.Please note: we have not evaluated studies which included only some of the elements of milieu teaching (such as incidental teaching or manding) or where milieu teaching was not specifically identified as the main teaching technique.
There are a number of limitations to all of the research studies published to date. For example
For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’
There is insufficient high quality research to determine if specific forms of milieu teaching (such as prelinguistic milieu teaching or enhanced milieu teaching) provide any benefits to autistic children.
There is no high quality evidence to suggest that specific forms of milieu teaching (such as prelinguistic milieu teaching or enhanced milieu teaching) provide any benefits to autistic young people or adults.
Future studies should
This section provides details of scientific studies into the effectiveness of milieuteaching for autistic people which have been published in English-language, peer-reviewed journals.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
This section provides details of other publications on this topic.
You can find more publications on this topic in our publications database.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
There is some confusion over the difference between milieu teaching and similar, overlapping interventions such as incidental teaching, with different authors having different definitions for each. For example, Goldstein et al (2002) provide a very broad description of milieu language teaching which includes incidental teaching but also the natural language paradigm (the early version of pivotal response training).