Enhanced Milieu Teaching During Play

Enhanced Milieu Teaching During Play

Barton et al. (2020) state that “play is a critical intervention goal and should be intentionally taught using evidence-based practices” (pg.15). There is a large body of research supporting the direct teaching of play skills in children. Research has shown strong evidence to support the use of adult modeling of play skills with children who have speech and language impairments as an effective intervention strategy to facilitate language learning.

Enhanced Milieu Teaching (EMT) is a natural play-based intervention approach that follows child initiations and interests to create interactive opportunities to model and prompt language in familiar contexts. It is an effective evidence-based practice supported by over 20 years of clinical research that can be used to target receptive and expressive language goals. 

One of the main focuses of EMT is teaching and coaching parents and families to promote adult-child communication interactions and facilitate children’s communication growth and development through modeling and expansion techniques during natural play. Because parents are children’s first language teachers and primary communication partners, coaching them on effective language facilitation strategies can increase children’s generalization of communication skills. The purpose of EMT is to increase the rate, diversity, and complexity of communication. With the overall goal of increasing spontaneous language and generalization of their independent communication skills.

To implement EMT during natural play, you first start with setting up the environment to promote communicative interactions.

EMT Steps to engage in play and communication include: 

•  Following the child’s lead in play and activities

•  Responding to the child’s communication 

•  Modeling language in context

•  Expanding on the child’s communication

•  Using pauses to prompt the child to make requests or communication attempts

•  Teach and practice across varied settings, activities, and with different communication partners

Hierarchical Prompts

With EMT, the adult utilizes prompts to signal the child to communicate.

There are four types of EMT prompts that can be used with varying levels of adult support.

A time delay prompt is where the adult pauses for 5 seconds.

This is a nonverbal cue used to prompt the child to communicate.

The adult can give an anticipatory look and wait for the child to communicate before performing the expected action or giving the child a desired object. This prompt provides the least amount of language support.

An open prompt utilizes open-ended questioning.  

This offers more support than pausing, as it utilizes verbal cueing to encourage the child to communicate his or her  

response.

A choice prompt can be given by asking the child a question with two choices provided. 

  For example, “Should the cat eat or sleep?” 

This offers even more support by including the answer to the question.

The SAY prompt is used by the adult telling the child exactly what to say. 

For example, the adult tells the child to “say cat”. 

This prompt offers the most amount of adult support as it instructs the child exactly what to say.

Data can be collected on number of communication turns taken by the child, amount of utterances used, MLU, vocabulary usage etc.

References

Barton, E. E., Murray, R., O'Flaherty, C., Sweeney, E. M., & Gossett, S. (2020). Teaching object play to young children with disabilities: A systematic review of methods and Rigor. American Journal on Intellectual and Developmental Disabilities, 125(1), 14–36. https://doi.org/10.1352/1944-7558-125.1.14 

Kaiser, A.P., & Trent, J. A. (2007). Communication intervention for young children with disabilities: Naturalistic approaches to promoting development. In S. Odom, R. Horner, M. Snell & J. Blacher, Handbook of Developmental Disabilities. New York: Guilford Press.

Hancock, T. B., & Kaiser, A. P. (2006). Enhanced Milieu Teaching. In R. McCauley & M. Fey, Treatment of Language Disorders in Children, Baltimore: Paul Brookes.