Enhanced Milieu Teaching for Language Disorders

No longer 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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how training parents can improve language skills in young children, particularly those with language disorders or autism. By analyzing parent interactions and adaptations during training, the study aims to enhance the effectiveness of language interventions. The trial includes various groups of children: those with typical development, developmental language disorders, and both autism and language disorders. Some participants receive a teaching method called Enhanced Milieu Teaching (EMT). Families near Temple University in Pennsylvania or in Wisconsin, with internet access for video calls, may be suitable if they have young children showing signs of language delays or disorders. As an unphased trial, this study offers families the chance to contribute to groundbreaking research that could improve language interventions for children.

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 prior data suggests that Enhanced Milieu Teaching is safe for children with language disorders?

Research has shown that Enhanced Milieu Teaching (EMT) is generally well-tolerated by children with developmental disabilities, such as autism and language delays. EMT is a proven method that helps improve communication and language skills in everyday settings.

Several studies found that children who participated in EMT did not experience significant negative effects. EMT focuses on interaction and communication, which naturally carries a low risk of harmful side effects. This method has been used successfully in different settings, demonstrating its safety for various groups.

Although direct data on side effects is limited, the design of EMT suggests it is safe for children. Prospective participants should discuss any concerns with the research team. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Enhanced Milieu Teaching (EMT) because it offers a unique, naturalistic approach to improving language skills in children with language disorders. Unlike traditional therapies that may rely on structured settings and repetitive drills, EMT integrates language learning into everyday interactions, making it more engaging and practical for children. This approach emphasizes using a child's interests and daily routines to facilitate language development, potentially leading to more meaningful and lasting improvements. By focusing on enhancing communication within natural environments, EMT has the potential to be more adaptable and accessible for families and caregivers.

What evidence suggests that Enhanced Milieu Teaching could be effective for language disorders?

Research shows that Enhanced Milieu Teaching (EMT), which participants in this trial may receive, helps children with language delays. Studies have found that EMT improves parental communication with their children and increases children's natural language use, especially for those with autism. One study found that combining EMT with joint attention strategies enhanced social and language skills in toddlers with autism. Additionally, involving parents in EMT may yield better results than relying solely on therapists. Overall, evidence supports EMT as an effective method for improving language skills in children with developmental language disorders and autism. ^{1 6 7 8 9}

Who Is on the Research Team?

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

Principal Investigator

University of Wisconsin, Madison

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

Citations

1. pubs.asha.org pubs.asha.org/doi/abs/10.1044/2024_JSLHR-24-00260

Systematic Review and Meta-Analysis of Enhanced Milieu ... Enhanced milieu teaching (EMT) is a naturalistic intervention that supports the language development of children with emerging language.

2. ies.ed.gov ies.ed.gov/use-work/awards/efficacy-trial-j-emt-enhanced-milieu-teaching-language-intervention-plus-joint-attention-engagement

An Efficacy Trial of J-EMT: Enhanced Milieu Teaching ... This project will evaluate the efficacy of an early social communication and language intervention, the J-EMT, on toddlers with autism spectrum disorders (ASD).

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3740334/

Parent-Implemented Enhanced Milieu Teaching with ... 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 ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT03525951

Parent-Level Predictors of Early Language Interaction ... These sessions will follow the Teach-Model-Coach-Review framework (TMCR; 1) to train the Enhanced Milieu Teaching (EMT) strategies of responsive interaction, ...

5. researchgate.net researchgate.net/publication/338823806_Enhanced_Milieu_Teaching

(PDF) Enhanced Milieu Teaching It was designed for children with autism spectrum disorder and has been effective in increasing both quality of parent language input and child spontaneous ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10913137/

Enhanced Milieu Teaching in resource-constrained settings Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities.

7. researchgate.net researchgate.net/publication/303323228_Enhanced_Milieu_Teaching

Enhanced Milieu Teaching | Request PDF Ten EMT studies investigating the effects of EMT with children with autism spectrum disorder and other developmental or language delays are then summarized and ...

8. withpower.com withpower.com/trial/phase-autism-spectrum-disorder-2-2021-82782

Enhanced Milieu Teaching for Language Disorders This N/A medical study run by University of Wisconsin, Madison is evaluating whether Enhanced Milieu Teaching will have tolerable side effects & efficacy ...

9. clinicaltrials.gov clinicaltrials.gov/study/NCT01013545

Developmental and Augmented Intervention for Facilitating ... Language outcome in autism ... The effects of parent-implemented enhanced milieu teaching on the social communication of children who have autism.