Milieu Teaching and Autism Ranking: Insufficient/Mixed evidence


Craft lesson for student with autism

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 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.

Teaching begins when an individual shows an interest in activities or materials (for example, by standing next to a table with snacks on) or begins to communicate (for example by pointing to a snack).

The teacher responds by using one or more specific techniques including

- Modelling: demonstrating the desired behaviour so that the individual can imitate it, for example, by saying “Snack”

- Manding: asking questions or providing verbal instructions to encourage the individual to provide the desired response, for example, by saying “What do you want?”

- Time delay: waiting for a short period of time in order to prompt the desired response, for example, waiting ten seconds for the individual to say “Snack”

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).

Our Opinion

There is insufficient high quality research to determine if specific forms of milieu teaching (such as prelinguistic milieu teaching or enhanced milieu teaching) provide any benefits to children on the autism spectrum.

There is no high quality evidence to suggest that specific forms of milieu teaching (such as prelinguistic milieu teaching or enhanced milieu teaching) provide any benefits to young people or adults on the autism spectrum.

However we believe that the key elements of milieu teaching (such as modelling, manding and time delay) may help to improve the communication and social skills of some young children on the autism spectrum when combined within much larger multi-component programmes, such as those which follow the NICE guidance on psychosocial interventions for children and young people on the autism spectrum.

There is a need for more research studies which use more rigorous and robust research methods; which compare milieu teaching with other, similar interventions; and which identify the specific components of milieu teaching, if any, that are most effective.


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20 Jan 2017
Last Review
01 Jan 2017
Next Review
01 Jan 2020