1

Citation/Rating Participants Design/Experimental

Conditions
IV DV
Hancock, T. B., &
Kaiser, A. P. (2002).
The effects of trainer-
implemented enhanced
milieu teaching on the
social communication of
children with autism.
Topics in Early
Childhood Special
Education, 22(1), 39-54.














Four preschool children
and their mothers.
Child A- male, 50
months, diagnosed with
Autism
Child B- female, 38
months, diagnosed with
PDD
Child C- male, 35
months, diagnosed with
PDD
Child D- male, 54
months, diagnosed with
Autism
Three interventionists
Single-subject, multiple
baseline design across
children.
Trainer-implemented
enhanced milieu
teaching.
Interventions sessions
twice a week in clinic
playroom. Milieu
teaching procedures
were used during the
sessions. Milieu
teaching episodes begin
with child
verbal/nonverbal
requests, follow a
specific sequence of
prompts (models,
mands, or time delay
procedures), include
corrective prompts as
needed, and end with
positive feedback,
expansion of the childs
utterance, and access to
the childs requested
object. These sessions
are child lead, meaning
the adults verbal
behavior relates directly
to the childs topic or
ongoing behavior.
Expansions are adult
utterances that follow
child utterances, embed
childs utterance in a
more complete form,
and maintain or extend
Childrens social
communication skills
consisting of the
frequency of total child
utterances, spontaneous
child utterances, total
use of targets (prompted
plus spontaneous), and
frequency of targets
used spontaneously.
Also the diversity
(number of different
word roots) and
complexity (MLU) of
the childrens language
were measured.

Frequency of
utterances= number of
utterances child made in
each session

Spontaneous
utterances= non-
prompted utterances

Diversity= mean
number of different
word roots in each
session.

MLU= mean length of
utterance

Each child had
2

Citation/Rating Participants Design/Experimental
Conditions
IV DV
the childs meaning.
The responsive
feedback the
interventionists
provided followed child
utterances, were
meaningful to the child,
and directly related to
the childs topic.


individual language
targets.
Child A
-agent-action (dog runs)
-action-object (bounce
ball)
-attribute-object (red
ball)
-2-word request
Child B
-agent-action-object
(mommy throws the
ball)
-attribute-object
-preposition-object (in
cup)
-3-word request
Child C
-agent-action
-action-object
-attribute-object
-2-word request
Child D
-agent-action-object
-attribute-object
-3-word request
Hemmeter, M. L., &
Kaiser, A. P. (1994).
Enhanced milieu
teaching: Effects of
parent-implemented
language intervention.
Journal of Early
Intervention, (3), 269-
289.
Four parent-child dyads.
Dyad A- male, 25
months, diagnosed with
down syndrome, father
Dyad B- female, 25
months, diagnosed with
language delay and
behavior problems,
mother
Multiple baseline design
across 3 intervention
strategies
Multiple-probe design
across 2 families,
replicated across 2
additional families
Parent-implemented
enhanced milieu
teaching.
During each session
there was a practice
session where the
trainer coached the
parent while working
with the child.
Childrens social-
communicative skills
consisted of frequency
of spontaneous child
utterances, total use of
targets (prompted plus
spontaneous), and
frequency of targets
used spontaneously.
3

Citation/Rating Participants Design/Experimental
Conditions
IV DV





Dyad C- male, 45
months, diagnosed with
PDD, mother
Dyad D- male, 49
months, diagnosed with
cerebral palsy and
seizure disorder, mother
Coaching involved
prompting parents
either verbally or
nonverbally to complete
teaching episodes
correctly. Coaching
involved praising the
parent periodically and
feedback after the
practice session was
complete. The
intervention consisted of
training on
environmental
arrangement,
responsive interaction,
and milieu teaching.
Environmental
arrangement (putting
items out of childs
reach to require
requests) was trained
first. Then two
responsive interaction
strategies (feedback and
modeling the childs
targets), then incidental
teaching was
introduced.
Incidental teaching
involves the use of
naturally occurring
situations and the
childs interests to
facilitate language
Also the diversity
(number of different
word roots) and
complexity (MLU) of
the childrens language
were measured.

Frequency of
utterances= number of
utterances child made in
each session

Spontaneous
utterances= non-
prompted utterances

Diversity= mean
number of different
word roots in each
session.

MLU= mean length of
utterance

Each child had
individual language
targets.

Child A
-more
-help
-verbs
Child B
-want + noun
-more + noun
4

Citation/Rating Participants Design/Experimental
Conditions
IV DV
learning (Talking to the
child about the toys they
are playing withcar,
car goes vroom, etc.).

-verbs
Child C
-nouns
-verbs
-more
Child D
-more
-want
-verbs
Kaiser, A. P., Hancock,
T. B., & Nietfeld, J. P.
(2000). The effects of
parent-implemented
enhanced milieu
teaching on the social
communication of
children who have
autism. Early Education
& Development, 11(4),
423-446.








Six preschool children
and their mothers
participated.
Child A- male, 54
months, diagnosed with
Autism
Child B- male, 35
months, Aspergers
Child C- male, 37
months, PDD
Child D- male, 40
months, Autism
Child E- male, 53
months, Autism
Child F- male, 32
months, PDD

Two individuals serving
as parent educators also
participated.
Modified single subject
design
Parent-implemented
enhanced milieu
teaching.
During each session
there was a practice
session where the
trainer coached the
parent while working
with the child.
Coaching involved
prompting parents
either verbally or
nonverbally to complete
teaching episodes
correctly. Coaching
involved praising the
parent periodically and
feedback after the
practice session was
complete. The
intervention consisted of
training on
environmental
arrangement,
responsive interaction,
and milieu teaching.
Child social-
communication skills
consisted of the
frequency of
spontaneous child
utterances, total use of
targets (prompted plus
spontaneous), and
frequency of targets
used spontaneously.
Also, the diversity
(number of different
word roots) and the
complexity (Mean
Length of Utterance,
[MLU]) of the
childrens language.

Frequency of
utterances= number of
utterances child made in
each session

Spontaneous
utterances= non-
prompted utterances
5

Citation/Rating Participants Design/Experimental
Conditions
IV DV
Environmental
arrangement (putting
items out of childs
reach to require
requests) was trained
first. Then two
responsive interaction
strategies (feedback and
modeling the childs
targets), then incidental
teaching was
introduced.
Incidental teaching
involves the use of
naturally occurring
situations and the
childs interests to
facilitate language
learning (talking about
what the child is doing
during bath time (wash,
rinse, bubble on your
head, playing with toys,
etc).


Diversity= mean
number of different
word roots in each
session.

MLU= mean length of
utterance


Olive, M. L., Cruz, B.,
Davis, T. N., Chan, J.
M., Lang, R. B.,
O'Reilly, M. F., &
Dickson, S. M. (2007).
The effects of enhanced
milieu teaching and a
voice output
communication aid on
the requesting of three
Three children and their
teacher or teaching
assistant.
Child A- male, 45
months, diagnosed with
PDD-NOS
Child B- male, 66
months, diagnosed with
Autism
Child C- male, 48
Multiple probe design
across participants
Voice Output
Communication Aid
(VOCA)

The adult followed the
childs lead. The adult
imitated child motor and
play behaviors, spoke in
shortened sentences,
and used
Use of the VOCA,
independent gestures,
and vocalizations.
Researchers wanted to
see an increased use of
the VOCA and an
increase in spontaneous
(unprompted) gestures
and vocalizations.
6

Citation/Rating Participants Design/Experimental
Conditions
IV DV
children with autism. J
Autism Dev Disord, 37,
1505-1513.




months, diagnosed with
Autism
environmental
arrangement strategies
such as in sight and out
of reach to promote
requesting. When the
child made a request
using an informal
gesture, the adult used
the least amount of
prompting possible to
elicit a correct request
with the VOCA.
Children were taught to
use the VOCA using
incidental or
naturalistic teaching
following an informal
gestural request.
Incidental/naturalistic
teaching involves the
use of naturally
occurring situations and
the childs interests to
facilitate language
learning.
Children were taught to
press the button on the
VOCA which activated
the pre-recorded
message. After a
VOCA request, the
adult provided the child
with the desired
outcome/object
(reinforcement).
7

Citation/Rating Participants Design/Experimental
Conditions
IV DV

Peterson, P., Carta, J. J.,
& Greenwood, C.
(2005). Teaching
enhanced milieu
language teaching skills
to parents in multiple
risk families. Journal of
Early Intervention,
27(2), 94-109.







Three mother-child
dyads in families with
multiple risk factors (4
or more).
Child A- female, 43
months,
receptive/expressive
language delay, 4 risk
factors
Child B- female, 27
months,
receptive/expressive
language delay, 4 risk
factors
Child C- male, 24
months,
receptive/expressive
language delay, 7 risk
factors
*None of the families
receiving Part C
services
Multiple baseline design Parent-implemented
enhanced milieu
teaching.
Parents were taught to
use milieu language
teaching skills. The
trainer modeled the
skills with the child for
the parents. The parents
then practiced and
received coaching.
Environmental
arrangement was
taught first to make the
environment conducive
to milieu teaching
(adequate selection of
toys available, toys out
of childs reach to
require requests). Then
parents were taught
Responsive Interaction
(RI) skills to form a
conversational
interaction style with
their child. RI
techniques included
making descriptive
statements, imitation
(verbally and
nonverbally), and
expansions.
Expansions are adult
utterances that follow
Childs communication
skills including;
receptive
communication age,
expressive
communication age, and
mean length of
utterance.

Receptive and
expressive
communication age tests
were used (pre and post)
to figure out where the
child was at
developmentally.
Receptive
communication= what
the child hears and
understands

Expressive
communication= what
the child says
8

Citation/Rating Participants Design/Experimental
Conditions
IV DV
child utterances, embed
childs utterance in a
more complete form,
and maintain or extend
the childs meaning.
Incidental teaching
(IT) techniques were
also taught including
model, mand, mand-
model, and time-delay.
Mand-model= request
verbal response from
child, correct response
receives praise.
Time-delay= Adult
identifies that a child
wants an object and
waits for child to make
a response.


Citation Results Instruments Fidelity Strengths/Weaknesses Usability
Hancock, T. B., &
Kaiser, A. P.
(2002). The effects
of trainer-
implemented
enhanced milieu
teaching on the
social
communication of
children with
autism. Topics in
After intervention
was introduced, all
four children
showed increases in
their total use of
targets. Three of
the four children
showed clear
changes in
spontaneous use of
targets. All
-Systematic
Analysis of
Language
Transcript program
(SALT)
-Combined
Milieu/Responsive
Interaction Code
-SICD
-Peabody Picture
Vocabulary Test-
Parents satisfied
with childrens
improvement.
Primary and
secondary
observers
independently
coded data.
Comparison of data
made on point-by-
point basis. A
Strengths:
-Intervention proved to
be effective
-High parent
satisfaction
-Children maintained
progress or progressed
even more at follow-up
Weaknesses:
-Change on
developmental
I believe this is
usable, but the
research did note
that the
interventionists
used were highly
educated and had a
lot of experience. It
may not be as
effective for less
experienced
9

Citation Results Instruments Fidelity Strengths/Weaknesses Usability
Early Childhood
Special Education,
22(1), 39-54.

children increased
in their frequency
of total utterances.
Two children
increased in their
spontaneous
utterances.
Changes in MLU
occurred for three
children and
changes in diversity
observed for all
four children.
Overall, positive
changes in
developmental
measures.
Revised
-Expressive One-
Word Picture
Vocabulary Test-
Revised

licensed
psychologist
verified all testing
data and scoring.
measures is difficult to
interpret in the absence
of a control group.
-Parents wanted more
sessions for longer
periods of time.
interventionists.
Also, a childs
initial skills could
have an effect on
results, the children
in this study had to
meet certain criteria
before
participating.
Hemmeter, M. L.,
& Kaiser, A. P.
(1994). Enhanced
milieu teaching:
Effects of parent-
implemented
language
intervention.
Journal of Early
Intervention, (3),
269-289.

All four children
had increased
spontaneous
utterances and total
use of targets after
the intervention.
Three of the four
children had
increased
spontaneous use of
targets. None of
the children showed
increases in MLU
greater than what
would have been
predicted at the
beginning of the
study.
-Combined
Milieu/Responsive
Interaction Code
-Environmental
Rating Scale
-Affective Rating
Scale
-Sequenced
Inventory of
Communication
Development
(SICD)
-Systematic
Analysis of
Language
Transcripts
program (SALT)
Primary and
secondary observer
individually coded
the videotapes.
Comparison of data
made on a point-by-
point basis.
High parent
satisfaction with
intervention.
Strengths:
-Positive effects were
observed on childrens
spontaneous
communication and
target use and on
parent-child affect.
-Positive effects on
child language
development
-High parent
satisfaction with the
intervention
Weaknesses:
-Parents commented
that they would want
both parents involved
-Intervention sessions
were short
I do think this is
usable, however I
think experience is
necessary in
coaching in order to
effectively teach
the parents how to
implement the
strategies and to get
these kind of
results.
10

Citation Results Instruments Fidelity Strengths/Weaknesses Usability
-Study did not assess
maintenance of
parents use of the
intervention procedures
Kaiser, A. P.,
Hancock, T. B., &
Nietfeld, J. P.
(2000). The effects
of parent-
implemented
enhanced milieu
teaching on the
social
communication of
children who have
autism. Early
Education &
Development,
11(4), 423-446.

Parents showed an
increase in correct
use of milieu
teaching. All six
children showed
increases in their
total use of targets
(prompted plus
unprompted) and
number of different
target classes.
Changes in
spontaneous target
use were less
noticeable.
-Systematic
Analysis of
Language
Transcript program
(SALT)
-Combined
Milieu/Responsive
Interaction Code
-SICD
-Peabody Picture
Vocabulary Test-
Revised
-Expressive One-
Word Picture
Vocabulary Test-
Revised

A primary and
secondary observer
each coded the data
and compared the
data on a point-by-
point basis. A
licensed
psychologist
verified all testing
data and scoring.
Strengths:
-High parent
satisfaction
-Positive effects were
observed on the use of
communication targets
for all children and on
the complexity and
diversity of productive
language for most
children.
-Children demonstrated
positive changes in
social communication
Weaknesses:
-Parents would have
liked more training
sessions
-No training was done
at homes
-Some changes in the
quality of
communicative
interactions between
parents and children
are not well
represented by the
quantitative data
I do think this is
usable, however
again I think
experience is
necessary in
coaching in order to
effectively teach
the parents how to
implement the
strategies and to get
these kind of
results.

Olive, M. L., Cruz,
B., Davis, T. N.,
Chan, J. M., Lang,
R. B., O'Reilly, M.
All three children
showed an increase
in VOCA use and
spontaneous
-Preferred items
from each childs
classroom (cars,
puzzles, etc.)
Intervention
competency
checklist was used
by the independent
Strengths:
-Children showed
increase in use of
VOCA and
I do think this is
usable, but not as
accessible as many
other interventions.
11

Citation Results Instruments Fidelity Strengths/Weaknesses Usability
F., & Dickson, S.
M. (2007). The
effects of enhanced
milieu teaching and
a voice output
communication aid
on the requesting of
three children with
autism. J Autism
Dev Disord, 37,
1505-1513.
independent
communication.
Only one child
began vocalizing
during the study.
-Voice Output
Communication
Aids (VOCA)

observer to score
the percentage of
intervention steps
implemented
correctly.




communication
-Relevant to children
with Autism because
many do not develop
functional speech

Weaknesses:
-Might not be as
effective with younger
children
-Children were
exposed to a variety of
other interventions
during the study
The VOCA device
is required and
everyone might not
have access to that
tool. Also, the
intervention might
not be as effective
with younger
children.
Peterson, P., Carta,
J. J., & Greenwood,
C. (2005). Teaching
enhanced milieu
language teaching
skills to parents in
multiple risk
families. Journal of
Early Intervention,
27(2), 94-109.

The three children
showed gains on
the SICD and in
their MLU, their
expressive and
receptive
communication age
scores increased
also.
-Sequenced
Intervention of
Communication
development
(SICD)
-MOOSES shell
program
-Proportional
change index (PCI)
A trained observer
not involved in the
parent training
aspect of the study
collected data.
Primary and
secondary
observers coded
data.
Strengths:
-Positive outcomes on
childrens language
-Parents were
dedicated to the study
-Strong relationships
between parents and
the parent trainer

Weaknesses:
-Parents had difficulty
completing the
homework assignments
-Parents had difficulty
being available for
sessions
I think this study
and intervention is
usable. It is very
important to know
how to teach EMT
skills to parents in
multiple risk
families. It is
evident that it is
possible and has a
positive effect on
childrens
communication.
The article itself
was not very clear
with results, but the
intervention is
usable.