Paul et al (2017) Chapter 7

Milieu Teaching Methods

BOX 7.4 Adapted from Warren, S., & Yoder, D. (1998). Facilitating the transition
from preintentional to intentional communication. In A. Wetherny, S. Warren, & J.
Reichle (Eds.), Transitions in prelinguistic communication (pp. 365-384). Baltimore,
MD: Paul H. Brookes; Wagner, A., Wallace, K. & Rogers, S. (2014). Developmental
approaches to treatment of young children with autism spectrum disorders. In J.
Tarbox, D. Dixon, P. Sturmey, & J. Matson (Eds.). Handbook of early intervention of
autism spectrum disorders (pp. 3893-3428). New York: Springer.

Arranging the environment

• Place desired materials in view but out of reach.

• Place materials where adult assistance is necessary to obtain them

(such as, in a tightly closed, clear plastic jar).

• Violate the expected order of events (e.g., give the child a shoe to put
on before giving a sock).

Following the child’s attentional lead

• Attend to and talk about toys selected by the child from an array.

• Reduce adult behavior to child’s rate of initiation, even if this means

long periods of silence.

• Use contingent motor imitation—an exact, reduced, or slightly

expanded imitation of a child’s motor act immediately after the child’s
production to establish early turn-taking.

• Use contingent vocal imitation—following a child’s vocalization with a

partial, exact, or modified adult vocal production (e.g., if the child says
“aaah,” the adult can say, “aah” or “baa”).

Building social routines

• Engage the child in repetitive, predictable games, such as “patty-cake”

or “peek-a-boo;” encourage parents to play the game at least once a
day with the child.

• Vary the game slightly (e.g., if the child has learned “patty-cake,”
change it to “Bake me a cake as S-L-O-W as you can,” with a
corresponding change in the pace of the song).

Use specific consequences

Provide the following specific consequences in teaching episodes that are

brief, positive, and embedded within the ongoing interaction.
Prompts

• Time delay prompts: Nonverbal prompts that interrupt an ongoing turn-

taking routine (e.g., if the child and adult are rolling a ball back and
forth, the adult can hold onto the ball instead of returning it and wait
with an expectant look for the child to initiate a request to continue).

• Gaze intersection: To establish eye contact, the adult moves his or her
head into the gaze of the child. This is faded out as the child begins to
engage in eye contact more regularly.

• Verbal prompts: Attempts to elicit communication, such as an open-

ended question (“What?”) or directive statement (“Look at me.”).

Models

• Vocal models: Delayed imitations of sounds that the adult has heard
the child use. If the child is heard saying “ba,” for example, the adult
can use “ba” at another time to try to elicit a vocalization from the child.

• Gestural models: Encourage the child to use pre-symbolic gestures by

modeling them at appropriate times (e.g., if a plane passes overhead,
the adult can point up to it, as a model of nonverbal commenting).

Natural consequences

• Be sure the child achieves any intent expressed. If the child expresses
a protest, honor it by ceasing the protested action.

• Provide any object the child requests and attend to anything on which
the child is seeking joint attention.

• Provide acknowledgment of communication. Smile, look at, or

comment on any intentional behavior of the child. Make sure the child
knows the message was received.

• Provide linguistic mapping. Use simple language to “translate” a child’s

nonverbal intention to words. If the child holds up a cup, respond, “It’s a
cup! I’m glad you showed me!”