Enhanced Milieu Teaching for Language Disorders
Recruiting in Palo Alto (17 mi)
+1 other location
Age: Any Age
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Wisconsin, Madison
Disqualifiers: Hearing loss, Down Syndrome, others
No Placebo Group
Approved in 2 Jurisdictions
Trial Summary
What is the purpose of this trial?Children with poor early language skills are at risk for academic, social, vocational, and health difficulties across the lifespan. Parent training-as part of early language intervention-is a cost-effective option to address this public health issue, but these interventions demonstrate large individual differences in outcomes and barriers to scalability. The purpose of this research is to examine parent-level predictors of early language interaction quality and modifiability during training, which will help increase intervention effectiveness.
Will I have to stop taking my current medications?
The trial information does not specify whether participants need to stop taking their current medications.
What data supports the effectiveness of the treatment Enhanced Milieu Teaching for Language Disorders?
Research on milieu therapy, which is part of Enhanced Milieu Teaching, shows that it can create a supportive environment that helps patients learn new skills. This approach has been used successfully in various settings, suggesting it might also be effective for language disorders.
12345How is Enhanced Milieu Teaching different from other treatments for language disorders?
Enhanced Milieu Teaching (EMT) is unique because it involves teaching caregivers specific language support strategies to use with children, which can be delivered through a mix of in-person and telepractice sessions. This approach empowers caregivers to actively participate in the child's language development, making it different from traditional therapist-only interventions.
678910Eligibility Criteria
This trial is for children with Autism Spectrum Disorder or Language Disorder, and typically developing peers. Participants must be English dominant, have no diagnosed hearing loss, and live near Temple University in Pennsylvania or in Wisconsin. Parents need internet access for videoconferencing and must be able to consent.Inclusion Criteria
I am a parent and I am 18 years old or older.
Families without an adequate digital device may be lent one for videoconferencing and testing
Parents must have access to the internet and be willing to videoconference (STUDY 1 AND 2)
+18 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Baseline Data Collection
Baseline data collection for all groups, including demographic questionnaires and language assessments
1 week
1 visit (remote)
Parent Training
Three parent training sessions using the Teach-Model-Coach-Review framework to train Enhanced Milieu Teaching strategies
3 weeks
3 visits (remote)
Follow-up Data Collection
Follow-up data collection to assess the use of language stimulation strategies and conversational turns
1 week
1 visit (remote)
Participant Groups
The study tests Enhanced Milieu Teaching (EMT), a parent training intervention aimed at improving early language skills in children at risk due to developmental disorders. It compares outcomes between those receiving EMT and a group without intervention.
5Treatment groups
Experimental Treatment
Group I: Typically Developing Children Study 2 (TD2)Experimental Treatment1 Intervention
No-intervention comparison group measured over time.
Group II: Typically Developing Children Study 1 (TD1)Experimental Treatment1 Intervention
No-intervention group for observational data comparison.
Group III: Children with Dev Language Disorder Study 2 (DLD2)Experimental Treatment1 Intervention
Enhanced Milieu Teaching
Group IV: Children with Dev Language Disorder Study 1 (DLD1)Experimental Treatment1 Intervention
No-intervention group for observational data comparison.
Group V: Children with Autism Spectrum Disorders Study 2 (ASD+DLD 2)Experimental Treatment1 Intervention
Enhanced Milieu Teaching
Enhanced Milieu Teaching is already approved in United States, European Union for the following indications:
🇺🇸 Approved in United States as Enhanced Milieu Teaching for:
- Language development in children with language impairments
🇪🇺 Approved in European Union as Enhanced Milieu Teaching for:
- Language development in children with developmental language disorders
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Temple UniversityPhiladelphia, PA
University of WisconsinMadison, WI
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Who Is Running the Clinical Trial?
University of Wisconsin, MadisonLead Sponsor
Temple UniversityLead Sponsor
National Institute on Deafness and Other Communication Disorders (NIDCD)Collaborator
References
Coordinated treatment for long-term psychiatric inpatients. [2004]Attempts to implement and maintain effective treatment of long-term psychiatric inpatients are difficult. In this article the authors describe a treatment program in which behavior modification, milieu therapy, and education strategies directed at teaching specific skills are combined in a coordinated system of steps.
The therapeutic milieu: changing themes and theories. [2019]Since its development close to 40 years ago in England, the therapeutic milieu, or therapeutic community, has undergone significant alteration and corruption by the emphasis on community care, increased use of pharmacotherapy, quick staff turnover, and lack of psychoanalytically trained staff. The hallmarks of milieu therapy, however, such as patients' participation in decision-making, collective responsibility for ward events, a multidisciplinary staff, and a belief in the rehabilitative potential of the environment, remain a part of many modern inpatient settings. The author believes that milieu therapy remains a viable treatment modality, and he offers guidelines for optimizing its potential.
Milieu therapy: a therapeutic loophole. [2019]The confusion over, and ultimate demise of, milieu therapy.
Adapting milieu approaches to acute inpatient care for schizophrenic patients. [2019]Classic therapeutic community or milieu therapy techniques are not applicable in many contemporary acute-treatment settings, which emphasize crisis intervention, short stays, psychotropic medication, and cost containment. However, milieu techniques can be integrated with an understanding of biological and psychosocial factors to provide a framework for the acute, short-term treatment of schizophrenic patients. After reviewing recent biological and psychosocial research, the authors outline three principles for incorporating such research with milieu techniques: creating a holding environment, developing a graduated therapeutic program, and focusing on common patient needs. Application of these principles in a short-stay setting will provide an intensely supportive treatment environment that allows the use of many different therapies and modulates stresses on staff.
Assertion training and human relations training in the treatment of chronic alcoholics. [2019]The effects of milieu therapy plus assertion training were compared to those of milieu therapy plus human relations training in reducing drinking behavior and increasing interpersonal skills, of skill-deficient, chronic alcoholics in an alcoholic rehabilitation center. Although both treatments led to comparable sobriety rates at a 6-week follow-up, the treatment group which contained assertion training demonstrated significant gains in interpersonal skills as compared to the treatment group which contained human relations training. A 2-year sobriety significantly longer than the human relations training group.
Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication. [2022]Purpose This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice service delivery model. Method Four caregivers and children with language delays aged 18-27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver-child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach-Model-Coach-Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words. Results There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children. Conclusion Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies. Supplemental Material https://doi.org/10.23641/asha.14977605.
Enhanced milieu teaching for children with autism spectrum disorder in South Africa. [2022]Purpose: Efficient and effective interventions are required to meet the communication needs of children with autism spectrum disorders (ASDs). However, most children with ASD living in South Africa do not receive individualised interventions.Method: This multiple baseline study examined the effects of therapist-implemented enhanced milieu teaching (EMT) on the diversity and frequency of spoken language of three children with ASD in South Africa.Result: A moderate functional relation was demonstrated between the introduction of EMT and increases in (1) the number of different words and (2) the number of spontaneous utterances used by each participant. Some evidence of generalisation to novel partners and contexts was observed.Conclusion: Results indicated that EMT may be effective for improving communication in South African children with ASD. Implications for clinical practice and cultural and linguistic adaptations are discussed.
Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. [2022]The purpose of this study was to compare the effects of enhanced milieu teaching (EMT) implemented by parents and therapists versus therapists only on the language skills of preschool children with intellectual disabilities (IDs), including children with Down syndrome and children with autism spectrum disorders.
[Application of the enhanced milieu teaching model in language intervention of children with language developmental delay in outpatient child healthcare clinic]. [2021]Objective: To explore the role of the enhanced milieu teaching (EMT) model in early intervention of children with language developmental delay (LDD) in outpatient child healthcare clinic. Methods: Case-control study design was adopted. Twenty-eight children aged 2.5 to 4.0 years who were diagnosed with LDD from June 2019 to June 2020 at the Division of Child Healthcare, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were recruited as the intervention group, and participated in one-on-one EMT model language rehabilitation sessions for 3 months (12 sessions). Another 27 children with LDD who attended the Division of Child Healthcare around the same period of time were recruited as control group, all of whom did not attend any types of language intervention in the subsequent three months. Both groups were followed up three months later. Gesell developmental scale (GDS) and diagnostic receptive and expressive assessment of Mandarin-comprehensive (DREAM-C) standardized language test were used to evaluate and compare children's development level at the first and follow-up visit, with the treatment effect of the EMT model being evaluated with independent sample t-test. Results: The language development quotient of GDS of the intervention group (22 boys and 6 girls) at the follow-up visit was significantly higher than that of at the first visit (64±21 vs. 52±17,t=4.960, P<0.01). The Dream-C test scores of total language (89±16 vs. 77±14, t=5.061, P<0.01), receptive language (90±16 vs. 77±15, t=5.301, P<0.01), semantics (93±20 vs. 79±19, t=5.06, P<0.01), and syntax after training (84±14 vs. 76±11, t=3.209, P<0.01) were significantly higher than those at the first visit. In the control group (19 boys and 8 girls), the only improvement was found in the Dream-C semantics score (82±26 vs. 71±18, t=2.330, P<0.05). There was no significant difference in any domains in GDS at the first and follow-up visit (all P>0.05). Conclusions: Early language rehabilitation training based on the EMT model has a significant effect on all domains of language development for children with LDD. Therefore, EMT model is a language intervention model compatible in the child healthcare outpatient clinic settings.
A Comparison of High and Low Dosages of a Component of Milieu Teaching Strategies for Two Preschool-Age Learners With Autism Spectrum Disorder. [2019]The intersection of treatment intensity and communication intervention is an emerging area of investigation. Milieu teaching (MT) approaches for teaching communication skills to children with autism spectrum disorder (ASD) have a substantial evidence base (see Goldstein, 2002). However, a relatively small percentage (37.8%) of MT studies have fully detailed the parameters that are required to determine treatment intensity (Parker-McGowan et al., 2014). This study compared the effect of two dosages of the modeling component of milieu teaching on acquisition and maintenance of new vocabulary for two preschoolers with ASD.