The study took place in Davidson County, Tennessee. The language sessions were administered
in the children’s classrooms or a nearby therapy room.
Forty students with developmental delays participated in this study. The students were from
two schools, a university-based preschool and a public school. The students from the university-
based preschool had developmental delays of at least 20% of their chronological age in at
least one developmental area on the Denver Developmental Screening Test. The students from
the public school had scores more than one and one half standard deviations below the mean
on four out of seven developmental areas. The 40 students were randomly assigned to two
conditions: 20 received instruction with the milieu teaching method, and 20 received instruction
with the communication training program.
Milieu teaching is a naturalistic instruction method whereby the trainer follows the lead of the
child in determining when to teach and what language form to elicit. In milieu teaching, the
environment is arranged to include objects and activities that interest the child. Instructional
strategies including incidental teaching and time-delay are utilized to encourage child communication.
The goal of the milieu teaching method is that children learn to comprehend
language structures from natural and informal adult modeling and active communication about
the object or activity that is of interest to the child. When a child produces targeted language
behavior during the activities, those utterances are consequated according to the child’s interest.
For example, if a child requests a toy, giving the toy to the child serves as a functional
consequence of the behavior. For students in both conditions, developmentally appropriate
language targets were selected from the communication training program as the goals for the
intervention. Children were separated into groups of two or three, and the sessions lasted 10
minutes per child. The treatment lasted for 60 sessions. The first half of each session consisted
of a group activity (games, making collages, etc.); in the second half of the session,
children could choose toys of interest to them from the variety of toys available.
The comparison condition consisted of another treatment, called communication training.
Communication training involves a more structured drill-and-practice approach than the naturalistic
approach espoused by milieu teaching and uses a predetermined set of rules to select
the trials and language targets. Comprehension of language targets was taught explicitly in
this condition rather than implicitly in milieu teaching. The communication training group used
consequences that included verbal feedback and tangible rewards to increase the likelihood of
child response. For children with more significant disabilities, the rewards sometimes were not
tied directly to a child’s utterance. The sessions were conducted for similar amounts of time
and with the same numbers of students in both the intervention and comparison conditions.
Nine eligible outcomes were assessed in this study, and all fall within the communication/
language competencies domain. For a more detailed description of these outcome measures,
see Appendix B.
Support for implementation
All language teachers received 12 hours of group training. They also received individual and
small-group training (ranging from two to ten hours depending on their entry skills, abilities in
executing their assigned method, and the children’s specific needs). During the intervention
period, the language teachers were observed on a weekly basis, and weekly group meetings
were held to support teachers and solve training and behavioral management problems.