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Milieu Teaching and Autism Ranking: Insufficient/Mixed evidence

Status Research

There are a number of limitations to all of the research studies published to date. For example

  • The studies identified included many different forms of milieu teaching including enhanced milieu teaching (Hancock and Kaiser, 2002; Kaiser and Roberts, 2013; Kaiser et al, 2000) and various forms of prelinguistic milieu teaching (Franco et al, 2013; Yoder and Stone, 2006a). This makes it difficult to be sure which aspect of the different forms of milieu teaching, if any, was responsible for any of the reported benefits.
  • Some of the studies (such as Mancil et al, 2007; Olive et al, 2007) combined milieu teaching with another intervention (such as functional communication training or a voice output communication aid) or used milieu teaching as one component within a multi-component intervention (Wetherby and Woods, 2006). This makes it difficult to be sure which of these interventions, if any, was responsible for any of the reported benefits.
  • Most of the studies (such as such as Ogletree et al, 2012; Ingersoll , 2011; Mancil et al, 2007) had a small number of participants (6 or less).  The study by Kaiser and Roberts, 2013 included 77 participants but it is not clear how many of those participants were on the autism spectrum and how many had Down syndrome.
  • The participants in the studies were restricted to children aged eight years or less. The parents and carers of the participants were not necessarily representative of all parents and carers of individuals on the autism spectrum in terms of gender, income, ethnicity, intellectual level etc.
  • Most of the studies (such as Christensen-Sandfort and Whinnery, epub; Hancock and Kaiser, 2002; Olive et al, 2007) used single-case design methodologies, such as case studies or multiple-baseline studies.  The study by Juneja et al, 2012 was a retrospective review.
  • The controlled study by Paul et al, 2013 was non-randomised and non-blinded.  None of the randomised controlled studies (such as McDuffie et al, 2012; Yoder and Stone, 2006a; Yoder and Stone, 2006b) was blinded and all three of these studies reported data from the same experiment on the same group of participants.
  • Some of the studies (such as McDuffie et al, 2012; Yoder and Stone, 2006a; Yoder and Stone, 2006b) were undertaken by researchers who were not independent of the intervention being studied.  Those researchers may therefore have been biased towards the intervention, however unconsciously.
  • Some of the studies (such as Hancock and Kaiser, 2002; Olive et al, 2007) had a fairly restricted set of participants and parents/carers of those participants – in terms of gender, ethnicity, income, education, intellectual ability etc.
  • Most of the studies did not examine if any benefits could be maintained over lengthy periods (several months) but most of the studies did take place in real world settings (at home or in school) with typical providers (parents and teachers).
  • None of the studies involved people on the autism spectrum to review the efficacy and ethical basis of the interventions provided.

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’

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