An Overview of Prelinguistic Milieu Teaching: Theoretical Foundations, Strategies, and Findings

Abstract

This review article examines the theoretical foundations, implementation principles, effectiveness, and research trends of Prelinguistic Milieu Teaching (PMT) as an evidence-based method that can be effectively used by teachers in classroom settings. PMT is a naturalistic and child-centered intervention shown to support the communication skills of children with autism spectrum disorder, developmental delays, Down syndrome, and deafblindness. Studies demonstrate that PMT strategies can be implemented with high fidelity even by parents with limited educational backgrounds. These findings suggest that teachers, with their professional expertise and structured classroom routines, can apply PMT strategies even more systematically and sustainably. Accordingly, PMT can be considered both a powerful tool for fostering children’s communication skills and a practice-friendly approach for teachers. This review aims to provide teachers with empirical evidence and practical strategies, serving as a scientific source and classroom guide for implementing PMT as an evidence-based practice.

Keywords

• Early intervention
• Communication skills
• Evidence based practices
• Prelinguistic communication
• Prelinguistic milieu teaching (PMT)
• Teacher education.

Söz Öncesi Milieu Öğretimine Genel Bir Bakış: Kuramsal Temeller, Stratejiler ve Bulgular

Abstract

Bu derleme çalışması, öğretmenlerin sınıf içi uygulamalarında kullanabilecekleri kanıta dayalı bir yöntem olarak Söz Öncesi Milieu Öğretimi’nin (SÖMÖ) kuramsal temellerini, uygulama ilkelerini, etkililiğine ilişkin bulguları ve alan yazındaki eğilimleri incelemektedir. Doğal etkileşim rutinlerine dayalı ve çocuk merkezli bir yaklaşım olan SÖMÖ; otizm spektrum bozukluğu, gelişimsel gecikmeler, Down sendromu ve kör-sağır gibi farklı yetersizlik gruplarındaki çocukların iletişim becerilerini desteklemede etkili bulunmuştur. Araştırmalar, SÖMÖ stratejilerinin farklı eğitim düzeyindeki ebeveynler tarafından dahi yüksek uygulama güvenirliği ile uygulanabildiğini ortaya koymuştur. Bu bulgular, öğretmenlerin sınıf ortamında SÖMÖ stratejilerini çok daha kolay, sistematik ve sürdürülebilir biçimde uygulayabileceğine işaret etmektedir. Bu yönüyle SÖMÖ, öğretmenler için hem çocukların iletişim becerilerini geliştirmeye yönelik güçlü bir araç hem de uygulamacı dostu bir yöntem olarak değerlendirilebilir. Çalışma, öğretmenlere SÖMÖ stratejilerini ve SÖMÖ’ye ilişkin araştırma sonuçlarını sunarak, öğretmenlerin sınıf içinde kanıta dayalı bir uygulamayı hayata geçirmelerine katkı sağlamayı hedeflemektedir.

Keywords

• Erken müdahale
• İletişim becerileri
• Kanıt temelli uygulamalar
• Öğretmen eğitimi
• Söz öncesi iletişim
• Söz öncesi milieu öğretimi (SÖMÖ)

References

1. Arıkel, Ö. (2022). Web tabanlı ebeveyn koçluk programının otizm spektrum bozukluğu olan çocukların ebeveynlerinin söz öncesi milieu stratejilerini uygulamalarında etkililiği (Tez No. 772569) [Yüksek lisans tezi, Gazi Üniversitesi- Ankara]. Yükseköğretim Kurulu Başkanlığı Tez Merkezi.
2. Arslan Armutçu, O. (2017). BİT-KOÇ öğretmen eğitim programının öğretmenlerin söz öncesi dönem milieu öğretim yöntemini uygulamalarında ve Down sendromlu çocukların amaçlı iletişim davranışlarını arttırmada etkisinin belirlenmesi (Tez No. 461547) [Doktora tezi, Gazi Üniversitesi- Ankara]. Yükseköğretim Kurulu Başkanlığı Tez Merkezi.
3. Ayyıldız, E., Akçin, N., & Güven, Y. (2016). Development of preverbal communication skills scale for children with multiple disabilities and visual ımpairment. Journal of Human Sciences, 13(2), 2668-2681. https://doi.org/10.14687/jhs.v13i2.3718
4. Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews. Review of General Psychology, 1(3), 311–320. https://doi.org/10.1037/1089-2680.1.3.311
5. Bondy, A., & Frost, L. (1998). The picture exchange communication system. Behavior Modification, 22(4), 527–554. https://doi.org/10.1177/01454455980224004
6. Brady, N. C., Marquis, J., Fleming, K., & McLean, L. (2004). Prelinguistic predictors of language growth in children with developmental disabilities. Journal of Speech, Language, and Hearing Research, 47(3), 663–677. https://doi.org/10.1044/1092-4388(2004/051)
7. Brady, N., & Bashinski, S. (2008). Increasing communication in children with concurrent vision and hearing loss. American Journal of Speech and Language Pathology, 33, 59–71.
8. Calandrella, A. M., & Wilcox, M. J. (2000). Predicting language outcomes for young prelinguistic children with developmental delay. Journal of Speech, Language, and Hearing Research, 43(5), 1061–1071. https://doi.org/10.1044/jslhr.4305.1061

9. Capone Singleton, N., & Shulman, B. B. (2018). Language development: Foundations, processes, and clinical applications (3rd ed.). Jones & Bartlett Learning.
10. Carter, M., & Iacono, T. (2002). Professional judgments of the intentionality of communicative acts. Augmentative and Alternative Communication, 18(3), 177–191. https://doi.org/10.1080/07434610212331281330
11. Crais, E., & Ogletree, B. T. (2016). Prelinguistic communication development. In D. Keen, H. Meadan, N. C. Brady, & J. W. Halle (Eds.), Prelinguistic and minimally verbal communicators on the autism spectrum (pp. 9–32).Springer. https://doi.org/10.1007/978-981-10-0713-2_2
12. Cress, C. J., & Marvin, C. A. (2003). Common questions about AAC services in early intervention. Augmentative and Alternative Communication, 19(4), 254–272. https://doi.org/10.1080/07434610310001598229
13. Diken, Ö., & Kalaycı Ö. (2019). Söz öncesi dil gelişimi. F. Acarlar & Ö. Diken (Eds.), Yetersizliği olan bireylerin dil ve iletişim becerilerinin desteklenmesi (pp. 29-50) içinde. Pegem Akademi.
14. Dubin, A. H., Lieberman-Betz, R. G., Ayres, K. M., & Zawoyski, A. (2020). The effects of prelinguistic milieu teaching ımplemented in classrooms for preschoolers with or at risk for autism spectrum disorder. Focus on Autism and Other Developmental Disabilities, 35(2), 79-89. https://doi.org/10.1177/1088357619888917
15. Feldman, R. (2003). Infant–mother and infant–father synchrony: The coregulation of positive arousal. Infant Mental Health Journal, 24(1), 1–23. https://doi.org/10.1002/imhj.10041
16. Fey, M. E., Warren, S. F., & Yoder, P. J. (2003). The efficacy of prelinguistic milieu teaching and parent responsivity education for children with developmental delays. Journal of Speech, Language, and Hearing Research, 46(3), 600–623. https://doi.org/10.1044/1092-4388(2003/047)
17. Fey, M. E., Warren, S. F., Brady, N., Finestack, L. H., Bredin‑Oja, S. L., Fairchild, M., Shari S., & Yoder, P. J. (2006). Early effects of responsivity education/prelinguistic milieu teaching for children with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 49(3), 526–547. https://doi.org/10.1044/1092-4388(2006/039)
18. Fey, M. E., Yoder, P. J., Warren, S. F., & Bredin‑Oja, S. L. (2013). Is more better? Milieu communication teaching in toddlers with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56(2), 679–693. https://doi.org/10.1044/1092-4388(2012/12-0061)
19. Fey, M., Warren, S., Bredin-Oja, S., & Yoder, P. (2017). Responsivity education/prelinguistic milieu teaching. In R. McCauley, M. Fey, & R. Gillam (Eds.), Treatment of language disorders in children (2nd ed., pp. 57–85). Brookes.
20. Franco, J. H. (2008). Teaching prelinguistic communication skills to school age children with autism. The University of Texas at Austin.
21. Green, B. N., Johnson, C. D., & Adams, A. (2006). Writing narrative literature reviews for peer-reviewed journals: Secrets of the trade. Journal of Chiropractic Medicine, 5(3), 101–117. https://doi.org/10.1016/S0899-3467(07)60142-6
22. Howard, J., & Dawson, G. (2021). The Early Start Denver Model (ESDM): Promoting social communication in young children with ASD. In P. A. Prelock & R. J. McCauley (Eds.), Treatment of autism spectrum disorder: Evidence-based intervention strategies for communication & social interactions-second edition (pp. 109–131). Paul H. Brookes Publishing Co.
23. iu, M., Brady, N. C., Boorom, O., Fleming, K., Yue, J., & Liu, Q. (2024). Prelinguistic communication complexity predicts expressive language in initial minimally verbal autistic children. International Journal of Language & Communication Disorders, 59(1), 413–425. https://doi.org/10.1111/1460-6984.12956
24. Kaiser, A., Fuller, E. A., & Heidlage, J. K. (2021). Enhanced milieu teaching. In P. A. Prelock & R. J. McCauley (Eds.), Treatment of autism spectrum disorders: Evidence-based strategies for communication and social interactions (pp. 255–286). Brookes Publishing.
25. Kasari, C., & Sterrett, K. (2021). The JASPER model for children with autism: Improving play, social communication and engagement. In P. A. Prelock & R. J. McCauley (Eds.), Treatment of autism spectrum disorders: Evidence-based strategies for communication and social interactions (pp. 229–254). Brookes Publishing.
26. Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554–563. https://psycnet.apa.org/doi/10.1037/a0039080
27. Kasari, C., Gulsrud, A., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver-mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056. https://doi.org/10.1007/s10803-010-0955-5
28. Kazee, A., Wilczynski, S. M., Martino, M., Sundberg, S., Quinn, M., & Mundell, N. L. (2021). Discreet trial instruction. In P. A. Prelock & R. J. McCauley (Eds.), Treatment of autism spectrum disorders: Evidence- based strategies for communication and social interactions (pp. 133–161). Brookes Publishing.
29. Klintwall, L., & Eikeseth, S. (2014). Early and intensive behavioral intervention (EIBI) in autism. In V. B. Patel, V. R. Preedy, & C. R. Martin (Eds.), Comprehensive guide to autism (pp. 117–137). Springer.
30. Markfeld, J. E., Feldman, J. I., Bordman, S. L., Daly, C., Santapuram, P., Humphreys, K. L., Keceli-Kaysili, B., & Woynaroski, T. G. (2023). Associations between caregiver stress and language outcomes in infants with autistic and nonautistic siblings: An exploratory study. Journal of Speech, Language, and Hearing Research, 66(1), 190–205. https://doi.org/10.1044/2022_JSLHR-22-00154
31. McCathren, R. B. (2000). Teacher-implemented prelinguistic communication intervention. Focus on Autism and Other Developmental Disabilities, 15(1), 21–29. https://doi.org/10.1177/108835760001500103
32. McCathren, R. B. (2010). Case Study: Parent-Implemented Prelinguistic Milieu Teaching With a High Risk Dyad. Communication Disorders Quarterly, 31(4), 243-252. https://doi.org/10.1177/1525740109337733
33. McCauley, R. J., & Fey, M. E. (2006). Treatment of language disorders in children. Brookes Publishing.
34. Mcduffie, A. S., Lieberman, R. G., & Yoder, P. J. (2011). Object interest in autism spectrum disorder: A treatment comparison. Autism, 16(4), 398-405. https://doi.org/10.1177/1362361309360983
35. McDuffie, A., & Yoder, P. J. (2010). Types of parent verbal responsiveness that predict language in young children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 53(4), 1026–1039. https://doi.org/10.1044/1092-4388
36. Mundy, P., & Willoughby, J. (1998). Nonverbal communication, affective sharing, and intersubjectivity. Infant Behavior and Development, 21(3), 451–467. https://doi.org/10.1016/S0163-6383(98)90023-8
37. Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 60-69. https://doi.org/10.1016/j.rasd.2010.03.011
38. Prelock, P. A., Brien, A. R., & McCadden, E. R. (2025). Evidence based treatments in communication for children with autism spectrum disorders. In B. Reichow, P. Doehring, & F. R. Volkmar (Eds.), Handbook of evidence based practices in autism spectrum disorder (pp. 123–194). Springer. https://doi.org/10.1007/978 3 031 78143 8
39. Rowland, C., & Schweigert, P. (2000). Tangibles: Systematic instruction for learners with severe disabilities. Oregon Health Sciences University.
40. Sandbank, M., Bottema‑Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S.A., Raj, S., Mahbub, & P.Woynaroski, T. (2017). Project AIM: Autism intervention meta‑analysis for studies of young children. Psychological Bulletin, 146(1), 1–29. https://doi.org/10.1037/bul0000215
41. Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll, B., Kaiser, A. P., Bruinsma, Y., Wetherby, A., & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8
42. Sigafoos, J., Woodyatt, G., Keen, D., Tait, K., Tucker, M., Roberts, J., & Pittendreigh, N. (2000). Identifying potential communicative acts in children with developmental and physical disabilities. Communication Disorders Quarterly, 21(2), 77–86.
43. Tamis‑LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767. https://doi.org/10.1111/1467-8624.00313
44. Teymouri Sangani, M., Nakhostin Ansari, N., Mohamadi, R., & Soleymani, Z. (2022). A preliminary study of telepractice Prelinguistic Milieu Teaching for children with autism spectrum disorders. Journal of Iranian Medical Council, 5(3), 471-477. https://doi.org/10.18502/jimc.v5i3.10943
45. Tomasello, M. (1995). Joint attention as social cognition. In C. Moore & P. J. Dunham (Eds.), Joint attention: Its origins and role in development (pp. 103–130). Lawrence Erlbaum Associates.
46. Tomasello, M. (1999). The cultural origins of human cognition. Harvard University Press.
47. Tomasello, M., Carpenter, M., & Liszkowski, U. (2007). A new look at infant pointing. Child Development, 78(3), 705–722. https://doi.org/10.1111/j.1467-8624.2007.01025.x
48. Warren, S. F., & Yoder, P. J. (1998). Facilitating prelinguistic communication skills. In A. M. Wetherby, S. F. Warren, & J. Reichle (Eds.), Transitions in prelinguistic communication (pp. 365–384). Brookes Publishing.
49. Warren, S. F., Bredin-Oja, S. L., Fairchild, M., Finestack, L. H., Fey, M. E., & Brady, N. C. (2006). Responsivity education/prelinguistic milieu teaching. In R. J. McCauley & M. E. Fey (Eds.), Treatment of language disorders in children (pp. 47–75). Paul H. Brookes.
50. Warren, S. F., Fey, M. E., Finestack, L. H., Brady, N. C., Bredin-Oja, S. L., & Fleming, K. K. (2008). A randomized trial of longitudinal effects of low-intensity responsivity education/Prelinguistic milieu teaching. Journal of Speech, Language, and Hearing Research, 51 , 451–470. https://doi.org/10.1044/1092-4388(2008/033)
51. Warren, S. F., Yoder, P. J., Gazdag, G. E., Kim, K., & Jones, H. A. (1993). Facilitating prelinguistic communication skills in young children with developmental delay. Journal of Speech and Hearing Research, 36, 83–97. https://doi.org/10.1044/jshr.3601.83
52. Wetherby, A. M., Yonclas, D. G., & Bryan, A. A. (1988). Communicative profiles of preschool children with handicaps: Implications for early identification. Journal of Speech and Hearing Disorders, 53(2), 148–158. https://doi.org/10.1044/jshd.5302.148
53. Yale, M. E., Messinger, D. S., Cobo-Lewis, A. B., Oller, D. K., & Eilers, R. E. (2003). The development of vocal interaction in the first six months of life. Clinical Linguistics & Phonetics, 17(3), 247–264. https://doi.org/10.1080/0269920031000061833
54. Yoder, P. J., & Lieberman, R. G. (2010). Brief report: Randomized test of the effi cacy of picture exchange communication system on highly generalized picture exchanges in children with ASD. Journal of Autism and Developmental Disorders, 40, 629–632. https://doi.org/10.1007/s10803-009-0897-y
55. Yoder, P. J., & Stone, W. L. (2006a). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing 49(4), 698-71. https://doi.org/10.1044/1092-4388(2006/051)
56. Yoder, P. J., & Warren, S. F. (1998). Maternal responsivity predicts the prelinguistic communication intervention that facilitates generalized intentional communication. Journal of Speech, Language, and Hearing Research, 41(5), 1207–1219. https://doi.org/10.1044/jslhr.4105.1207
57. Yoder, P. J., & Warren, S. F. (1999a). Maternal responsivity mediates the relationship between prelinguistic intentional communication and later language. Journal of Early Intervention, 22, 126–136. https://doi.org/10.1177/105381519902200205
58. Yoder, P. J., & Warren, S. F. (1999b). Facilitating self-initiated proto-declaratives and proto- imperatives in prelinguistic children with developmental disabilities. Journal of Early Intervention, 22, 337–354. https://doi.org/10.1177/105381519902200408
59. Yoder, P. J., & Warren, S. F. (2001a). Intentional communication elicits language-facilitating maternal responses in dyads with children who have developmental disabilities. American Journal on Mental Retardation, 106, 327–335. https://doi.org/10.1352/1944-7558-119.1.17 Yoder, P. J., & Warren, S. F. (2001b). Relative treatment effects of two prelinguistic communication interventions on language development in toddlers with developmental delays vary by maternal characteristics. Journal of Speech, Language, and Hearing Research, 44, 224–237. https://doi.org/10.1044/1092-4388(2001/019)
60. Yoder, P. J., & Warren, S. F. (2002). Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 45(6), 1158–1174. https://doi.org/10.1044/1092-4388(2002/094)
61. Yoder, P. J., Warren, S. F., & Hull, L. (1995). Predicting children’s response to prelinguistic communication intervention. Journal of Early Intervention, 19, 74–84.
62. Yoder, P., & Stone, W. L. (2006b). Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 74, 426–435. https://doi.org/10.1037/0022-006X.74.3.426
63. Yoder, P., Woynaroski, T., Fey, M., & Warren, S. (2014). Effects of dose frequency of early communication intervention in young children with and without Down syndrome. American Journal on Intellectual and Developmental Disabilities, 119, 17–32.