Modified Milieu Therapy in the Natural Environment with Young Children with Autism

Background: There is concern about the generalizability and maintenance of traditional FCT procedures. Objectives: Determine the effectiveness and efficiency of FCT with milieu procedures on decreasing aberrant behaviors, increasing communication mands, and increasing spontaneous communication with children with ASD. Methods: The subjects were referred by a local autism center that provides services for children with autism spectrum disorder and their parents. The subjects' diagnosis of ASD was confirmed by a review of records and the completion of the ADI-R. A functional analysis was completed to identify the function of each subject's aberrant behavior. The subjects were then taught picture communication using milieu therapy procedures in play routines in their homes. The researcher trained the parents who then provided training to their children. Sessions were videotaped, coded, and then graphed using a multiple baseline format. Results: The subjects' FAs indicated a tangible function. The subjects obtained efficient use of three picture communication cards within 30 five-minute session blocks. Aberrant behavior decreased to zero and latency to respond to an opportunity leveled at 2 seconds. Further, two of the three subjects' verbal vocabulary increased on average from two words to 56 words. The complexity (i.e., number of words paired together) of their verbal speech also increased from one to four on average. In addition, these results maintained over time and generalized to the classroom for each subject. Conclusions: Findings of this study show the utility of milieu procedures in FCT to simultaneously decrease aberrant behaviors, increase communication mands, increase the diversity and complexity of verbalizations, and increase levels of maintenance and generalization.