Milieu Teaching and Autism Ranking: Insufficient/Mixed evidence

Key Features

Milieu teaching is a behavioural intervention in which individuals are taught language skills and behaviours within the natural environment (the milieu). The teaching is delivered in places (such as the living room or the kitchen) and in situations (such as when a child wants a snack) in which individuals are most likely to want to communicate with other people.

Milieu teaching is also known as milieu training, milieu therapy and milieu communication training.


According to Choi and Kim (2005) milieu teaching has several characteristics.

1. “Teaching episodes are embedded within typical or routine activities in an individual's natural communicative environments (e.g. kitchen area, living room, child's bedroom, classroom, snack area, playground).”

2. “Teaching begins when an individual shows interest in activities or materials (e.g. standing by swing, sitting at a snack table) or initiates communicative interactions (e.g. pointing to an item, requesting an item verbally). Thus, a variety of stimuli items, like books, snacks, paper, pictures of trains, all commonly available in an individual's natural environment are used to teach language skills.”

3. “The student is taught to use his language skills for a number of communicative purposes, such as making requests, asking questions, commenting, and rejecting, and providing information.”

4. “Explicit prompts, including models, mands (i.e. questions or requests), and time delay, are used to elicit target language responses.”

5. “Natural consequences (e.g. access to requested items) are provided contingent upon appropriate communicative responses. For instance, a child's use of the correct target language response, "Drink juice", is followed by a cup of juice. Because language responses are taught and practiced under naturally occurring conditions, generalization is likely to be enhanced.”

6. “Milieu teaching incorporates only a few trials at a time. If a correct language response does not occur with prompting after only a few attempts, the desired consequence is nonetheless provided in order to preserve the motivation to under similar circumstances in the future.”

Teaching Procedures

According to Choi and Kim (2005) milieu teaching has three specific teaching procedures 1) model, 2) mand and 3) time delay, although other authors such as Goldstein et al (2002) report that incidental teaching techniques are also a key procedure in milieu teaching.

1. “The model procedure refers to demonstrating the desired language response so that a student can imitate it, for example, to repeat a particular word, phrase, or sentence, in relation to the focus of the child's interest. The model procedure is used primarily to teach verbal or signal imitation skills, and it is used for individuals who need to learn new or difficult target responses.”

2. “Mand refers to asking questions (e.g. ‘What do you want?’ or providing verbal instructions (e.g., ‘Tell me what you want’), to a student to elicit a specific response in relation to the focus of his interest (e.g. ‘Say, tie shoes’ when wanting to go outside to play). The mand procedure is used after a student is able to imitate the target language but lacks conversational or intraverbal skills.”

3. 'Time delay refers to the act of waiting for a short period of time after obtaining joint attention in order to prompt a response. For example, giving a questioning look for 5 seconds until a child produces the target language in response. The time delay procedure is used to increase the spontaneous use of the target language in situations where the child is likely to need material or assistance.'

Incidental teaching:  refers to teaching in which a teacher takes advantage of naturally occurring 'incidents' or situations to provide learning opportunities for the student.

Specific forms of milieu teaching

There are several variations of milieu teaching such as prelinguistic milieu teaching (where the focus is on teaching pre-verbal skills to very young children) and enhanced milieu teaching (where the focus is on responding to and interacting with the child).

The individual elements which make up milieu teaching (modelling, manding and time delay) can be delivered as standalone techniques, can be used together in specific milieu teaching programmes (such as the Responsive Education and Prelinguistic Milieu Teaching programme) or can be used together as part of multi-component social communication programmes (such as the Comprehensive Communication Intervention for Minimally Verbal Children With Autism).

19 Dec 2017
Last Review
01 Jan 2017
Next Review
01 Jan 2020