Enhanced Milieu Teaching for Language Disorders

Recruiting at 1 trial location

Overseen By Rebecca M Alper, Ph.D., CCC-SLP

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Hearing loss, Down Syndrome, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 5

300 Participants Needed

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. ^{1 2 3 4 5}

How 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. ^{6 7 8 9 10}

Research Team

Rebecca M Alper, Ph.D., CCC-SLP

Principal Investigator

University of Wisconsin, Madison

Eligibility 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)

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)

Treatment Details

Interventions

• Enhanced Milieu Teaching
• No Intervention

Trial Overview 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.

Participant Groups

Group I: Typically Developing Children Study 2 (TD2) Experimental Treatment 1 Intervention

No-intervention comparison group measured over time.

Group II: Typically Developing Children Study 1 (TD1) Experimental Treatment 1 Intervention

No-intervention group for observational data comparison.

Group III: Children with Dev Language Disorder Study 2 (DLD2) Experimental Treatment 1 Intervention

Enhanced Milieu Teaching

Group IV: Children with Dev Language Disorder Study 1 (DLD1) Experimental Treatment 1 Intervention

No-intervention group for observational data comparison.

Group V: Children with Autism Spectrum Disorders Study 2 (ASD+DLD 2) Experimental Treatment 1 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

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Temple University

Lead Sponsor

Trials

321

Recruited

89,100+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Findings from Research

The treatment program for long-term psychiatric inpatients combines behavior modification, milieu therapy, and educational strategies to create a structured approach for effective care.

This coordinated system aims to teach specific skills to patients, addressing the challenges of implementing and maintaining effective treatment in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coordinated treatment for long-term psychiatric inpatients. Stone, ME., Nelson, GL.[2004]

Milieu therapy, developed nearly 40 years ago, still retains key principles like patient participation and a multidisciplinary approach, despite changes in community care and increased reliance on medication.

The author argues that milieu therapy is still a valuable treatment option and provides guidelines to enhance its effectiveness in modern inpatient settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The therapeutic milieu: changing themes and theories. Gutheil, TG.[2019]

Milieu therapy has faced significant conceptual challenges that have contributed to its decline in use within inpatient settings.

Inpatient nurses are encouraged to move away from milieu therapy and instead concentrate on clearly defining and implementing specific nursing interventions that directly impact patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Milieu therapy: a therapeutic loophole. Delaney, KR.[2019]

Integrating classic milieu therapy techniques with modern acute treatment approaches can enhance the care of schizophrenic patients, even in settings focused on crisis intervention and short stays.

The authors propose three key principles—creating a supportive environment, developing a structured therapeutic program, and addressing common patient needs—to improve treatment outcomes and reduce stress for both patients and staff.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting milieu approaches to acute inpatient care for schizophrenic patients. Kahn, EM., White, EM.[2019]

In a study involving chronic alcoholics at a rehabilitation center, both milieu therapy with assertion training and milieu therapy with human relations training resulted in similar sobriety rates after 6 weeks.

However, the group receiving assertion training showed significantly improved interpersonal skills and maintained sobriety for a longer duration of 2 years compared to the human relations training group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assertion training and human relations training in the treatment of chronic alcoholics. Ferrell, WL., Galassi, JP.[2019]

The study showed that enhanced milieu teaching (EMT) significantly improved caregivers' ability to implement language support strategies, with results maintained for 6 weeks after the intervention.

Children of caregivers who learned EMT strategies exhibited increases in communication acts and vocabulary, indicating that the hybrid telepractice model effectively supports language development in young children with delays.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication. Quinn, ED., Kaiser, AP., Ledford, J.[2022]

A study involving three children with autism spectrum disorders in South Africa showed that enhanced milieu teaching (EMT) significantly increased both the diversity of words and the frequency of spontaneous speech.

The positive effects of EMT suggest it could be an effective communication intervention for children with ASD, with some evidence that improvements generalized to new social situations and partners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced milieu teaching for children with autism spectrum disorder in South Africa. Hampton, LH., Harty, M., Fuller, EA., et al.[2022]

Training parents to use enhanced milieu teaching (EMT) strategies alongside therapists significantly improved language skills in preschool children with intellectual disabilities, with the most substantial benefits observed 12 months after the intervention.

Children whose parents were trained in EMT showed greater and more sustained use of these strategies at home compared to those who received therapy only, indicating that parental involvement is crucial for long-term language development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. Kaiser, AP., Roberts, MY.[2022]

The enhanced milieu teaching (EMT) model significantly improved language development in children with language developmental delay (LDD), as shown by substantial increases in scores on standardized tests after 3 months of intervention.

In contrast, the control group, which did not receive any language intervention, showed minimal improvement, highlighting the effectiveness of the EMT model in outpatient child healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Application of the enhanced milieu teaching model in language intervention of children with language developmental delay in outpatient child healthcare clinic]. Tang, LN., Yan, T., Xu, L., et al.[2021]

The study found that the dosage of milieu teaching (MT) models significantly affects vocabulary acquisition in preschoolers with autism spectrum disorder (ASD), with one child benefiting more from high dosage and the other from low dosage.

These results emphasize the importance of individual differences in response to treatment, suggesting that personalized approaches to dosage in communication interventions for children with ASD could enhance learning outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Comparison of High and Low Dosages of a Component of Milieu Teaching Strategies for Two Preschool-Age Learners With Autism Spectrum Disorder. Julien, HM., Reichle, J.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Coordinated treatment for long-term psychiatric inpatients. [2004]

2. United States pubmed.ncbi.nlm.nih.gov

The therapeutic milieu: changing themes and theories. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Milieu therapy: a therapeutic loophole. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Adapting milieu approaches to acute inpatient care for schizophrenic patients. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Assertion training and human relations training in the treatment of chronic alcoholics. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Enhanced milieu teaching for children with autism spectrum disorder in South Africa. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. [2022]

9. China pubmed.ncbi.nlm.nih.gov

[Application of the enhanced milieu teaching model in language intervention of children with language developmental delay in outpatient child healthcare clinic]. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

A Comparison of High and Low Dosages of a Component of Milieu Teaching Strategies for Two Preschool-Age Learners With Autism Spectrum Disorder. [2019]