Enhanced Milieu Teaching (EMT)

for Children with Autism

Spectrum Disorder
Stephanie Schafer
Significance
● Personal connection
● Efficient and effective
● Evidence-based
Key concepts

● Naturalistic developmental behavioral intervention

● Natural environment
● Individualized
● Child-lead, interest-based
● Embedding strategies
● Therapist-implemented AND/OR Caregiver-implemented

The strategies:
● Prompting
● Feedback
● Environmental arrangement
Methods
Hampton et al., 2019
Participants: 3 boys with ASD (ages
5-7) and minimal verbal output
Setting: Small playroom at the boys’
school
Materials: Consistent age-appropriate
toys
Documentation: video recording, SALT
Procedures
● Baseline 2x/wk for 30 minutes
● Intervention 2-3x/wk, 30 minutes
● Interventionist-implemented
● Strategies: child-lead, responding,
modeling, mirroring play,
mapping/narrating, expansion,
time delay, milieu prompting,
environmental arrangement
Kaiser & Roberts, 2012
Participants: 77 children (30-54
months) with intellectual
disabilities/minimal verbal output &
their caregivers
Measures: both norm-referenced,
observational (parent and child), SALT,
two transcribers, parent-report
Materials: age-appropriate toys
Procedures:
● Language samples during 20
minute play sessions
● 2- five-minute child/parent
untrained play sessions
● 2- five-minute trained play
sessions
● Therapist-implemented group
vs. therapist & parent
implemented
● 12 home-based intervention
sessions, 24 clinic-based
● Assessed before, 6 months after,
12 month after
Olive et al., 2006
Participants: 3 boys with ASD (45-66
months old) and minimal verbal
output/pointing response with their
teacher/ teaching assistants
Materials: preferred items, four-button
VOCAs
Measures: coding sheet and operational
definitions, data taken by teachers
during the session (verified by a second
coder)
Procedures:
● Baseline for each participant
began when the previous
participant was stable
● 5 min play sessions for baselines
and interventions
● Adult-implemented EMT:
child-lead, shortened sentences,
environmental arrangement,
prompt hierarchy, time delays,
reinforcement
Findings and conclusions
Hampton et al., 2019 Kaiser & Roberts, 2012
● Overall increase: ● Parents in hybrid group
○ # of different words used the strategies at home
○ # of spontaneous & maintained these skills
utterances
● Increase:
● EMT may be effective to ○ Child target use
increase language for ○ MLU
children with ASD ○ # of different words
● EMT may be maximized
when parents and
therapists work together
Olive et al., 2006
● All 3 children learned to
use the voice output aid to
request
● Increase in total requesting
● EMT may be used to
increase requesting and
teach children to use a
voice output aid
Additional research
Hampton et al.
● Underdeveloped countries
● Culturally appropriate coaching strategies & adaptations
● EMT in the school setting- necessary frequent feedback
● Multilingual environments

Kaiser & Roberts

● Replication
● Parameters of treatment (dosage, setting, interventionists)

Olive et. al
● Training teachers to implement
● Appropriate technologies for young children
Usability & validity

Research in the US has shown EMT can be taught to

parents, teachers, professionals, etc.
References
Hampton, L.H., Harty, M., Fuller, E.A., & Kaiser, A.P. (2019). Enhanced milieu teaching for children with autism spectrum disorder in

aaaaSouth Africa. International Journal of Speech-Language Pathology, 1-11. doi: 10.1080/17549507.2018.1559357

Kaiser, A.P. & Roberts, M.Y. (2012). Parent-implemented enhanced milieu teaching with preschool children who have intellectual

aaaadisabilities. Journal of Speech, Language, and Hearing Research, 56, 295-309. doi: 10.1044/1092-4388(2012/11-0231)

Olive, M.L., de la Cruz, B., Davis, T.N., Chan, J.M., Lang, R.B., O’Reilly, M.F., & Dickson, S.M. (2006). The effects of enhanced

aaaamilieu teaching and a voice output communication aid on the requesting of three children with autism. Journal of Autism &

aaaaDevelopmental Disorders, 37, 1505-1513. doi: 10.1007/s10803-006-0243-6