Building Blocks of Childhood: Prelinguistic Milieu Teaching - A Boost for Children Age 2

Prelinguistic Milieu Teaching (PMT) is an early intervention method that has been studied for 10 years. It involves one-on-one services for the child and a program of parent education. Its purpose is not to make the child talk, but to build the first stage of communication. This will lead to developmental milestones, including language. PMT builds the child's motivation and awareness of a communication partner.

"To be able to tell someone - even in gestures - that you are hungry is empowering," says Nancy Brady, associate research professor with the Life Span Institute at the University of Kansas. "In our clinical experience, we've found that young children are much less frustrated when they learn to communicate."

Brady is fine-tuning the effectiveness of PMT in a 5-year research project with Steven Warren, senior scientist at the Life Span Institute, and Marc Fey, professor in the Communication Disorders Program at the University of Kansas Medical Center.

The PMT philosophy holds that children show progress if given specific kinds of supports in an environment that brings out their interests and abilities. The goals are to help a child make frequent, clear requests and comments with gestures and/or sounds, and to look at the person they are communicating with.

PMT can fill the gap between infancy and age 3 when more intensive early intervention often begins.

"Doctors and educators are reluctant to offer a child augmentative devices when they see delays at age 2. They often tell parents to wait and see if their child will develop spoken language on his own," says Brady.

Sign language and picture pointing are two kinds of augmentative communication. With PMT, a therapist can work with children as young as 18 months and establish the first stage of communication that is prelinguistic.

"If a child hasn't learned what communication is, he will have a hard time knowing how to carry on a conversation with sign language or other techniques," says Brady. She has seen children with autism repeatedly point at a picture card, unaware they must show it to someone if they hope to make their request known.

Here are three basic principles of PMT. The first is -- follow the child's lead. Children focus best on things that interest them. The PMT therapist spends time observing the child when they are together and waits to begin a session until he sees what the child is looking at or playing with. Face to face, at eye level with the child, he talks about it.

Another principle is - set the stage for communication. By putting a favorite toy in the room, but out of reach, the PMT therapist encourages the child to come ask for it. When a therapist puts things out of order in the room, this may elicit a comment from the child.

The third principle is - use social games like Pat-a-Cake strategically. Children learn how the game ritual goes and when the adult interrupts or changes it, the child will communicate to be able to keep playing. Pat-a-Cake and Peek-a-Boo also reinforce face-to-face contact with give and take, like a conversation.

PMT has proven helpful in building the child's capacity to initiate communication with clear, frequent acts.

"The technique is most effective when parents notice the changes in their child and reinforce this growth and development at home," says Warren. Several researchers are validating its effectiveness with specific clinical populations.

Paul Yoder has a project like KU's underway at Vanderbilt University. He is working specifically with autistic children, whereas Warren, Brady and Fey have focused their study on children with Down's syndrome and other disabilities resulting in language delays.

Progress between the ages of 0 to 3 years may affect how well a person uses the tools of communication throughout his whole life. This can include vocabulary, reading comprehension, and fluent self-expression. For a child with developmental delays, early intervention is considered best practice. "The earlier the better," says Steven Warren. Research shows that parents may be able to stave off behavioral problems and school failure, if they can build support for their child's prelinguistic development in the early stages of life.

This is fourth in a four-part series, The Building Blocks of Childhood, with Steven Warren and Nancy Brady, scientists at the Schiefelbusch Life Span Institute, and written by Joy Simpson. The series includes:

Part 1: What we know about communication between infants and parents

Part 2: Signposts of Disability: What Parents Can Observe

Part 3: The Value of an Interactive Environment

Part 4: Prelinguistic Milieu Teaching: A Boost for Children Age 2


Brady, Nancy C.., and Warren, Steven F. (2003). Language interventions for children with mental retardation. In L. Masters-Glidden and L. Abbeduto (volume editors). Language and communication in mental retardation: A volume in international review of research in mental retardation, 27 (pp. 231-250). Boston: Academic Press.

Calandrella, Amy M. and Wilcox, M. Jeanne (October 2000). Predicting language outcomes for young prelinguistic children with developmental delay. Journal of Speech, Language, and Hearing Research, 43, 1061-1071.

Leew, Shirley V., Warren, Steven F., and Yoder, Paul J. (2002). Infants and Toddlers: putting Research into Practice. In H. Goldstein, L.A. Kaczmarek, and K.M. English (Editors). Communication and language intervention series: Volume 10. Promoting social communication: Children with developmental disabilities from birth to adolescence. Baltimore, Maryland: Paul Brookes Publishing Company.

Warren, Steven F., and Yoder, Paul J. (1998). Facilitating the transition from preintentional to intentional communication. In A.M. Wetherby, SF Warren, and J. Reichle (Editors). Communication and language intervention series: Volume 7. Transitions in prelinguistic communication. Baltimore: Paul Brookes Publishing Company.

Yoder, P.J. and Warren, S.F (2001). 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.