The method of prelinguistic milieu teaching, or PMT, includes the use of environmental arrangement, following the child’s lead, building social routines and using specific consequences based on the child’s engagement (Paul & Norbury, 2012). These are used to elicit communication from the child that is functional before the use of spoken language. This is done by facilitating the skills necessary to engage in spoken communication – most importantly, using intentional communication. The following is a detailed explanation of the four methods discussed by Paul & Norbury, (2012) which are used during PMT, as well as some examples of each method.
Prelinguistic Teaching Methods (Paul & Norbury, 2012)
· Arrange the environment by:
o Placing items that the child prefers out of their reach
o Placing desired materials in child-proof containers, or other types of containers that require adult assistance
o Providing the child with items in an incorrect order (i.e., giving them their pants before their diaper/pull-up/underwear during changings, giving them toothpaste before their toothbrush, etc.)
§ By arranging the environment so that something is unexpected or inaccessible, the child is provided with an opportunity to initiate communication with the adult in order to continue with the task, whether it is craft time, snack time, or getting dressed.
· Follow the child’s attention, gaze, and lead by:
o Talking about and focusing on the toy the child chooses
o Decreasing the amount of adult speech to match that of the child’s (i.e., if the child waits 50 seconds to begin communication, do the same)
o Imitate their motor movements, either exactly or closely, to promote and model turn-taking
o Imitating their vocalizations, either exactly or closely to promote and model turn-taking and interaction
§ By focusing explicitly on the child’s choice of toy, rate of initiation, and motor movements or vocalizations the adult is more closely matching the communicative level of the child. This shows the child that you share their interest; encouraging both joint attention and turn taking.
· Build social routines by:
o Using repetitive, predictable games and finger-plays with the child (i.e., peek-a-boo, patty-cake, “Little Bunny Foo-Foo”, etc.) and play or sing them frequently
o Changing the repetitive or predictable game in a minor way once the child has learned the typical way (i.e., change “Little Bunny Foo-Foo hopping through the forest…” to “Little Bunny Foo-Foo rolling/running/flying” through the water/snowstorm/mud pit.”
§ When children hear the same games and finger-plays repetitively they learn to predict what comes next. This can engage the child in turn taking by allowing them to initiate the next portion, or by building anticipation as they wait for the next portion. By changing the game or finger-play slightly, the disruption of routine provides them with an opportunity to react and attempt to communicate that something is not how they expect it to be.
· Use specific consequences consistently and without pausing during interactions with the child by incorporating the following:
o Prompts
§ Time delay prompting: By nonverbally interrupting a turn-taking opportunity (i.e., while blowing bubbles, the adult pauses and holds the bubble wand in front of their mouth without blowing), the adult provides an opportunity for the child to intentionally communicate the desire for continuation of the activity.
§ Gaze intersection: The adult helps facilitate eye contact by moving their eyes or face into the line of focus of the child. The adult should decrease this act as the child begins to establish more regular eye contact.
§ Verbal prompting: The adult asks the child open ended questions (i.e., “what”, “where”, “who”, etc.) or ask them directly to do something (i.e., “Look here.”).
o Models
§ Vocal modeling: The adult produces vocalizations the child is known to use in an attempt to elicit a response from the child (i.e., the child is known to use “da”, so the adult says “da” at a time the child did not immediately say it prior.
§ Gestural modeling: The adult models appropriate gestures for the child to encourage their use (i.e., the phone rings and the parent points to it as a way of calling attention to it while nonverbally communicating that it is ringing).
o Provide Natural Consequences
§ When the child communicates, the adult should follow through with the child’s intended message (i.e., if the child indicates desire for their drink, provide it to them as a signal that their intent was understood). In addition, if the child shows the adult an object with intent the adult should focus on it as well. This encourages joint attention.
§ Respond to the child each time they attempt communication, whether it is verbal, nonverbal, or gestural.
§ Provide a verbal model for the child’s nonverbal intentions (i.e., if the child reaches out to be picked up, respond to them by saying “You want up! I’ll pick you up!”
Using even one PMT teaching model during interaction with a child can encourage the child’s increase of intentional communication; however, it may work best to incorporate numerous strategies.