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Enhanced Milieu Teaching: A Naturalistic Developmental Behavior Intervention for Promoting Language

Young children who have deficits in communication and language skills are not only at risk for academic failure but are also at risk for experiencing “failure” socially, for developing dysfunctional relationships with peers and family members, and for developing behavioral problems. There is evidence that naturalistic teaching, such as milieu teaching, supports both the acquisition and generalization of communication and language skills in young children (Kaiser & Hester, 1994).

Naturalistic Developmental Behavior Interventions (NDBI) are research-based therapies that have been found effective for increasing skills of children who have delays in their development of communication skills. Enhanced Milieu Teaching is an NDBI and is a widely studied intervention with consistently positive effects on various language forms and structures (Kaiser & Hampton, 2016), and uses a child’s interests and initiations as opportunities to model and prompt language in everyday contexts.

Enhanced Milieu Teaching uses a specific set of strategies through play and everyday routines to help create a context for language learning. These strategies include:

Mirroring & Mapping

Mirroring allows the adult to join the interaction with the child by encouraging the adult to be responsive to the child when the child is not yet communicating. Mapping on the other hand provides the child with a language-rich description of the activity. Combining mirroring and mapping allows the adult and the child to have balanced turns.

Example: Child pushes car. Adult pushes car and says, “Push car.”

When the adult mirrors or imitates the child, the child is more likely to notice the adult since the adult is doing something that interests the child. What the adults says, is more meaningful to the child since the adult and child are both engaging in the same activity and the language is “mapped” to what the child is doing.

Some things to remember when using mirroring and mapping include:

  • Mirroring comes before mapping

  • First imitate the child and then label the action with words

  • Avoid mirroring behaviors that are unacceptable (hitting, throwing toys)

  • Balance mapping and playing – try not to over map

Environmental Arrangement to Promote Communication

When children have easy access to their toys, snacks, or other desired items they are left without a reason to communicate. We can, however, create communication opportunities by making simple arrangements in our environment. Here are a few things that you can do:

  • Offer items bit-by-bit. By being the keeper of the goods, you help to provide your child with a reason to communicate. Here are some simple ways to use this strategy during everyday routines and play time.

  • Keeping items visible, but out of reach. When toys are up on a shelf or in a hard to open container, you create the natural need for your child to gain your attention, to point, ask for help or open.

Responsive Interactions

It can be easy to miss your child’s communication attempts. When you take the opportunity to sit back and really watch, you will start to notice the messages that they are sending. When you notice your child’s communication attempts, you can respond which will encourage them to initiate more. You can respond by imitating or mirroring what your child says and does. If your child is not yet using words, you can model simple words that correspond with their gestures or actions.

Modeling and Expanding Play

Simply put, children learn through play. The longer they engage in play the more opportunities there are for learning, especially language. When your child easily engages in play, you can help expand their play by helping them learn how to play with a wider variety of toys as well as how to play with the same toy in a variety of ways by simply modeling. When your child is independently doing the same action with the same toy, it is then time to expand. You can help your little one expand their play by doing what they do (imitating them) and then modeling something new.

Modeling Language

Children learn new skills by imitating others, and learning language is no different. Therefore, modeling language at your child’s level can prove to be a powerful tool in facilitating language. It can be exceptionally powerful when models contingent on the child’s communication. For example, when a child reaches for a cookie, and you model the word “cookie” as this helps him to learn language more quickly. Model language when:

  • Your child communicates by expanding on to what was said. If your child points to a dog and says, “dog” you can say, “Yes, it is a big dog.”

  • Responding to what your child says or does. If your child throws a ball, you can say, “Throw the ball.

  • When you are doing the same action as your child. If you and your child are taking turns banging on the table, you can model the word, “bang.”

  • While taking communications turns. While playing a game like Peek-a-Boo, you can model, “Peek-a” and wait for your child to say “boo.” If your child does not take a verbal turn, simply model the word “boo,” and try again. As your child becomes familiar with the routine, they will begin to fill in the words that you have modeled.

Sometimes modeling language is not enough to elicit language from your child. In that case, you may need to provide prompts to help elicit requests or initiations of language.

Prompting to Elicit Requests or Initiations

You can signal your child to do or say something by using a prompt. There are four effective prompts that vary by the degree of adult support offered. These prompts include:

  • Time Delay. Use an expectant look and wait for 5 seconds for the child to verbalize or perform the desired action. This is an overt non-verbal cue that can be effective in cueing your child to take their turn. For example, if you model the phrase, “Ready, set, go” and you want your child to fill in the word “go,” you will say, “Ready, set” and then wait with an expectant look to cue them to say the word “go.”

  • Open Prompt. An open prompt provides a verbal cue to the child to verbalize his or her request. An open prompt is an open-ended question, such as “What do you want?” This strategy can work well for children that have words, but struggle with initiation of their language use. However, for children that do not have the words yet to express what they want a model prompt would be more effective.

  • Choice Prompt. A choice prompt works well when there is not a correct answer. This offers a great deal of support in that it provides the answer to the question. For example, you can ask, “Do you want a big bubble or a little bubble?” or “What size bubble do you want, big or little?” By offering a choice you are providing a direct model for the child to imitate.

  • Model Prompt. With a model prompt, you are telling the child what to say. For example, if the child is reaching towards the ball indicating that they want the ball, you could say, “Tell me ball,” or you could simply say “ball” and wait for the child to imitate the word.

Regardless of the type of prompt that you offer, the point is to provide the child with the opportunity to practice using their words during highly motivating activities. This allows the child to receive reinforcement for their communication.

When prompting your child to use language, you should aim to do so at a rate of approximately 1 time per minute as more frequent prompts could lead to frustration and cause challenging behaviors.

Whatever strategies you choose to use, remember that you are your child’s first language teacher. In fact, the amount of time that you talk directly to your child is associated with more positive language development (A. Weisleder & A. Fernald, 2013).


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