Enhanced milieu teaching for children with autism spectrum disorder in South Africa.

Only three boys were studied, all minimally verbal, in a public special school in South Africa, so the results cannot be applied broadly. The design was a single-case multiple baseline across participants, and the intervention was delivered by one trained speech-language pathologist. Intervention was delivered in a school playroom, not in the children's classrooms or homes, and the paper says play may not be a common home context for many South African children with autism. Generalisation was measured only before and after treatment, so natural language growth or other school experiences could not be ruled out. A 5-week school holiday break occurred during intervention, and one child missed more than 40% of planned sessions after the break due to inconsistent transportation. For one child, extra behaviour supports were added during intervention, and the children also participated in regular speech therapy, so the contribution of enhanced milieu teaching alone cannot be separated. Transcription was verified rather than independently coded with full reliability because native South African transcribers were limited, which may affect how child speech was counted. The study did not measure social validity with parents or teachers, or language use in routine classroom and home interactions.

Do not conclude that enhanced milieu teaching alone caused the language gains in all three children. The study had only three participants, the children also participated in regular speech therapy, one child's data became variable after attendance problems and extra behaviour supports were added, and generalisation changes were measured only before and after treatment without a control for natural language growth.