Milieu Teaching in Children with Autism Katie Dyer, B.A

Comparing Discrete Trial Training and Milieu Teaching in Children with Autism Katie Dyer, B.A. & Abbie Olszewski, Ph.D., CCC-SLP University of Nevada, Reno Introduction Results Children with autism often display expressive language deficits. Expressive language consists of spontaneous Authors (date) Participants (diagnosis, Purpose Dependent Results speech, MLU, or increased language performance. There are behavioral and naturalistic approaches used to increase Research Design gender, grade & age) Variable expressive language in children with autism. One approach stems from Applied Behavior Analysis (ABA) and is (Outcome (Experimental vs. Nonexperimental) Measures) called discrete trial training (DTT). Discrete trial training breaks down skills into manageable tasks, which are then taught through repeated trials. The other approach is more naturalistic, called milieu teaching. Milieu teaching Christensen-Sandfort & Whinnery, N = 3 Examine if teacher- Spontaneous • Nick: Used the target phrase spontaneously in both circle time & includes four strategies: model, mand-model, time delay, and incidental teaching. milieu teaching uses the child’s (2013). implemented milieu teaching occurrences of on the playground. Percent overlap from baseline to treatment was • Nick: (4;11) mild/moderate strategies in typical classroom communication 3.70%. natural environment to assist in language production. Single-Subject Study; Multiple Baseline Design autism routines in an ECSE classroom targets • Mary: 5x times spontaneously on the playground .One of these • Mary: (4;5) severe autism positively impact responses was after a mand-model prompt. Percent overlap from • Carl: (5;6) severe autism communication in children with baseline to treatment was 0%. Case Scenario autism. • Carl: Spontaneous responses was 4.33 with a range of 0 to 8. v My name is Katie and I am a graduate student at University of Nevada, Reno in my second semester. Percent overlap from baseline to treatment was 0%. v Connor, a four year old male has a primary diagnosis of autism and sensory processing disorder. v Did not produce any of the developmentally appropriate morphological endings (past tense –ing, past tense –ed, Delprato, (2001). N = 8 To review studies that Spontaneous use • All of the studies reviewed reported that normalized language plural –s) and has a low mean length of utterance (MLU) according to his chronological age. compare discrete-trial and of prepositions training was more effective than discrete trial training when Systematic Review • 29 males,12 females normalized behavioral language teaching young children with autism to spontaneously produce v Improving Connor’s expressive language will decrease the amount of defiant behavior exhibited in therapy • Between ages (3;0) – (8;0) interventions with young prepositions. sessions. • All had diagnosis of autism children with autism. v Applied Behavioral Analysis (ABA) has been proven to be an effective approach to increase expressive language of clients with autism. Ingersoll, (2011). N = 2 Compare the effect of three Spontaneous • Leon: Used more spontaneous language in the milieu teaching and v I learned about a more naturalistic approach called milieu teaching. Milieu teaching uses modeling, mand- naturalistic language teaching language combined conditions that in the responsive interaction condition. modeling, time delay, and incidental teaching to teach children language skills within a natural context. I want to Single-Subject Study, Randomized • 2 males approaches (responsive There was not a significant difference in improvement between the know which treatment approach I should use to increase my client’s expressive language. Alternating Treatment Design • Leon: (42 months) interaction, milieu teaching, milieu teaching condition and the combined condition. CDI= 56 words, communicated combined intervention) on the for protesting & requesting. expressive language behavior • Griffon: Used slightly more spontaneous language in the milieu Purpose • Griffon: (40 months) in children with autism. teaching and combined teaching conditions than in the responsive CDI=570 words, spontaneous interaction condition. Throughout the study, spontaneous responses In children with autism, (P) is milieu teaching (I) more effective at increasing expressive language (O) as measured language consisted mainly of in the responsive interaction condition improved to the point where by increased MLU or increased spontaneous speech when compared to Applied Behavioral Analysis discrete trial single words & simple phrases. there was no difference between the three conditions at the end of training (C)? • Both had diagnosis of autism treatment.

Method • Search terms: “autism AND milieu AND language,” “milieu teaching” AND “autism”, “autism AND discrete trial Jennett, Harris, & Delmolino, (2008). N = 6 Compare DTI with mand • Independent Mand Training prior to DTI: AND social communication”. training for teaching requesting requests- correct • Maggie: average of 15.3 independent requests Single-Subject Study, Two Multiple- • Inter-rater reliability: Studies were analyzed using a CATE form (14 point scale) or CASM form (6 point scale). • 1 female, 5 males in children with autism. responses/ • Marcus: average of 13.7 independent requests Probe Designs Across Participants Inter-rater reliability was achieved in all studies. Mand Training prior to DTI: approximations • Oliver: no improvement • Databases: ERIC, PsychINFO, Academic Search Premier. • Maggie without a model • CATE form: Compelling (6 points), Suggestive (5 points), Equivocal (4 points or less). • Marcus DTI followed by Mand Training: • CASM form: Compelling (14-11 points), Suggestive (10-9 points), Equivocal (8 points or less). • Oliver • Echoic requests- • Peter: average of 11 independent requests correct responses • Christian: average of 13 independent requests DTI followed by Mand Discussion Of target word • Ryan: average of 8.7 independent requests Training: within 5 seconds of • External evidence: Research indicates an increase in spontaneous speech in children with autism when provided • Peter with both milieu teaching or discrete trial training (DTT). model • Christian • Internal evidence to clinical practice: The clients included in the studies were all young children with a diagnosis • Ryan of autism, which relates to my client. Currently, my client displays temper tantrums in clinic sessions because he • All had prior diagnoses of cannot tell me his wants and needs. When attempting to introduce structure to the session, my client prefers to play with the stimulus items. For this reason, I think slowly introducing structure would be in the best interest of my autism & PDD-NOS client, which would imply using milieu teaching to increase spontaneous language. Selected References • Evidence internal to client: My client’s mother has expressed that she wanted to add structure at home to increase spontaneous language and regulate behavior. The mother also reported Connor often has difficulty following Christensen-Sandfort, R.J., & Whinnery S.B. (2013). Impact of milieu teaching on communication skills of young children with autism spectrum disorder. Topics in Early Childhood Special directions at home. He often becomes frustrated when he cannot express himself. Education, 32(4), 211–222. doi: 10.1177/0271121411404930 Delprato, D.J. (2001). Comparisons of discrete-trial and normalized behavioral language intervention for young children with autism. Journal of Autism and Developmental Disorders, 31(3), • What Treatment Am I Going To Implement? Based on the external evidence, internal evidence to clinical 315-325. doi: 10.1023/A:1010747303957 practice, and evidence internal to my client, I have chosen to implement milieu teaching to increase spontaneous Ingersoll, B. (2011). The differential effect of three naturalistic language interventions on language use in children with autism. Journal of Positive Behavior Interventions, 13(2) 109–118. doi: language in my client. 10.1177/1098300710384507 Jennett, K., Harris, S.L., & Delmolino, L. (2008). Discrete trial instruction vs. mand training for teaching children with autism to make requests. Analysis of Verbal Behavior, 24(1), 69-85. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779923/