The Merriam-Webster dictionary defines milieu as “the physical or social setting in which something occurs or develops: environment.”
Sometimes referred to as incidental teaching, milieu communication training (MCT) is an evidence based intervention that has been effective with language disorders related to developmental disabilities such as autism spectrum disorders and late-talkers. It has also been shown to be effective with children who have Down syndrome (Windsor, Roberts, Kaiser). For pediatric speech therapy, Murphy residents may want to visit www.speechandot.com to learn more about child development and nearby available services.
Milieu training methods takes advantage of a child’s interests within their current environment to build communication skills. A speech pathologist (also referred to as a speech therapist) arranges an environment with, or brings into an environment, communication temptations. These temptations are preferred toys or routines that attract the child’s attention thus setting the stage for interaction and reinforcement. An experienced speech therapist uses skills such as “expectant waiting” to encourage a child’s initiation (commenting, requesting). The therapist can then provide prompts to expand on the initiation or strengthen the connection between meaning and expression through repetition.
For example, if the child hands the communication partner (therapist) a jar of bubbles, it would be good to wait and see if the child signs, motions or vocalizes a desire for the bubbles to be opened before opening the jar. After opening the jar, the therapist could put the wand to her lips and say “blow?”. Wait before blowing to encourage any communication. Then blow. This kind of play sequence can be repeated or expanded, depending on the ability and interest of the child. Key to milieu training is the intrinsic reinforcement that the activity provides. In other words, the bubbles, in our example. This is a natural positive outcome for this high-interest activity.
In a Vanderbilt University study, the following strategies are identified for Enhanced Milieu Teaching (Windsor, Roberts, Kaiser).
- Create a context for communication
- Match communication turns with the child’s
- Notice and respond to all the child’s communication
- Model language at the child’s “target level”
- Expand child’s communication by repeating and adding only 1-2 words
- Teach in response to the child’s requests using milieu teaching procedures: time delay, open questions, choice questions, and “say” prompt.
An experienced speech pathologist will often use these strategies with a child who exhibits developmental delays with language. The therapist will also train family members to use these strategies in the home and community to increase carryover of communication progress.
For more information about speech therapy Murphy families can contact Speech & Occupational Therapy of North Texas, 972-424-0148.