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| COMPARING THE MILLER METHOD WITH OTHER APPROACHES
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| UNIQUE FEATURES OF THE MILLER METHOD
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| THE MILLER METHOD WITH TANTRUMS
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| THE MILLER METHOD APPLIED TO PARTICULAR PROBLEMS
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| COMPARING THE MILLER METHOD WITH OTHER APPROACHES
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| How does the Miller Method differ from Greenspan's Floor Time Approach? |
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While
the two approaches are similar in their emphasis on transforming
developmentally challenged children's repetitive and stereotypic
actions into functional behavior whenenver possible, there are
significant differences between the two approaches. Greenspan's
Floor Time approach is unstructured in that the therapist waits for the
child's lead before attempting to build on it with "circles of
communication." While also exploiting the child's leads, the Miller
Method, in addition , introduces a specific program to directly address
developmental lags. For example, if a child has never gone through the
9-11 month old stage of "experimentally" dropping things to learn how
they fall, a Miller Method therapist may deliberately introduce a
dropping system by showing the child how to drop things so that they
land with a satisfying "clunk" in a pan and will then shift that pan so
that the child learns to drop in different locations and with different
people...The Miller Method also structures the children's behavior with
the help of elevated structures such as the Elevated Square in a way
that helps "scattered" children focus more effectively. For other
differences see our book From Ritual to Repertoire or our chapter in
the ICDL Guide to Clinical Practice edited by Greenspan and Weider and
available next month (November, 2000). |
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| What
do behavior therapists mean when - referring to the behavior of a child
on the autism spectrum -- they say, 'If it walks like a duck and quacks
like a duck, it's a duck!'?" |
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What
they are saying, for example, is that if a child gives the outer
appearance -- by correctly enunciating words -- of knowing what he or
she is saying or reading, then, indeed, that child has this
understanding -- We have a major problem with this formulation as
applied to children on the autism spectrum -- or for that matter when
applied to any child. We
have seen far too many children with autism utter spoken words
perfectly or even seem to "read" complex sentences and yet totally lack
understanding of what they are saying or reading, to accept the "duck"
analogy. In other words, like the walking and quacking ducks that turn
out to be decoys, these children may seem to be communicating or
getting meaning from printed words, but really are not. Being
able to say the words correctly is one part of the job. But, only when
the child truly understands everything that he or she says or reads --
and can demonstrate that understanding -- does the child have a
foundation on which to advance cognitively and academically. Such
progress is a major goal of the Miller Method. |
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| Why doesn't the Miller Method use "time out" to control children's disordered behavior? |
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We
view "time out" as punishment for a child's unacceptable behavior as
both inappropriate and ineffective with children on the autism spectrum. First,
there is no certainty that the child associates the time out with his
or her previous unacceptable behavior. Second, given the fact that a
major aspect of autism is the child's difficulty making human contact,
it is difficult to see how placing a child in a time out room does
anything but support the child's disposition toward autistic withdrawl. |
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| Why
does the Miller Method discourage the use of the term "Good job!" when
a child does something desirable? What does it use in its place? |
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We
discourage the use of the term "Good job!" for several reasons: One,
it's a pretty abstract term and even if it were understood by the
nonverbal children who hear it, it's frequent repetition would soon
turn it into meaningless jargon - as happens with any term that is
frequently repeated. Instead of endlessly saying "Good job!" we find
that narrating what the child is doing (like a sports announcer) is far
more important for the child. When
one tells a child that he or she is climbing, jumping, peddling his or
her bike, and so forth, those narrated words provide the child with a
chance to relate the words he or she hears to what he or she is doing.
This develops receptive language and can lead to the child learning to
talk to himself or herself - a necessary prelude to being able to
communicate with others. Perhaps
the only good thing about saying "Good job!" is the positive feeling
conveyed by teacher or therapist through the voice. However, this same
positive feeling can easily be conveyed while narrating with pleasure
the behavior the child is performing. |
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| My
autistic son is obsessed with balls. When I take them away or
hide them he cries inconsolably. My behavioral consultant
recommends that I get rid of the balls. What would you
suggest? |
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First,
let me say that our philosophy is - whenever possible - not to take
things away from the children but to try to build on what they
have. For your "ritual-captured" child, involvement with balls is
an important system. Repetitive play with them is at this time
the very best that he can do with these intriguing objects. So I would recommend trying the following:
Get
all kinds of balls - big ones, little ones, red, green and yellow,
soft, hard, heavy, light - then set up different locations so the
little balls go in one place, the big ones in another place. Then
-- before he gets bored with this sorting task -- start pelting him
with the light (nerf) balls to start a ball interaction (like a snow
ball fight). where you pelt him, he pelts you. Perhaps you get his
father or another sibling to help him pelt you with the balls.
Periodically duck behind some furniture so he can't see you then
suddenly reappear and pelt him again. If he ducks down wait until he
pops up then get him again. See if he will try to get you as you
move from one hiding place to another.. After
a time (when you judge he's had enough excitement) tell him its time to
put the balls away. Then, sing the "Clean up!" song as you point
to the different balls all over the room and guide him toward dropping
them in their proper location. If, at that point, he wants to
take a couple of balls with him as he prepares for bed, that's
fine. I'm
sure that as you follow this line of thinking you'll find other
productive ways of turning his "obsession" into important interactive
play that will prepare him for playing with other children. A.M. |
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| UNIQUE FEATURES OF THE MILLER METHOD
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| Why
does the Miller Method develop new rituals with children on the autism
spectrum? Since these children already have plenty rituals, wouldn't
giving them more rituals make them more autistic? |
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Good
question. In answering it, let me first describe all the good things
that introducing and working with rituals does for children with autism
-- Suppose you have a tantrumming autistic child. Introducing a
repetitive ritual of some kind -- having him or her go up and down
stairs, cross back and forth over an elevated structure, repeatedly
pour water or drop objects in a can, scribble back and forth, knock
blocks off a stand, and so forth can often help calm the child and make
it possible to bring him or her back into regular classroom or therapy
activities in a relatively short period of time. We
are also able to vary the child's rituals (or systems as we call them)
so that they become less and less like rituals and more like typical
functioning. We expand them bit by bit, involve different people in
them so they are no longer solitary and we can interrupt them in a way
which induces the child to produce words, signs or actions indicating
his or her need to maintain the ritual. So, far from adding to the
child's autism, the systematic use of rituals (systems) turns out to be
a powerful way of helping children on the spectrum begin to move beyond
rituals to function more appropriately with people. For
further information on how the Miller Method works with rituals, read
our book "From Ritual to Repertoire" published by John Wiley and Sons
and available from www.cognitivedesigns.com |
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| If
I use sign language with my nonverbal child with autism will he become
so dependent on it that he will never learn to use spoken language? |
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A
number of parents have expressed this concern about sign language. The
plain answer is "No!". The use of sign language does not interfere with
the development of spoken language. Quite the contrary, our research
and that of others clearly demonstrates that children who previously
could not follow spoken directions could do so after spoken words were
paired with manual signs. In
other words, the meaning of the signs had transferred to the spoken
words in a way that made heard spoken words meaningful. Also, for a
certain number of children, the use of manual signs seems to "pull"
spoken language. For these children - as for typical children - the
manual signs are an important transition to functional spoken language. |
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| Why do you have children on the autism spectrum walk on an "Elevated Square" 2.5 feet above the ground? |
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We
have been using elevation with children on the autism spectrum for over
thirty years - ever since we discovered that children placed on
elevated structures become more aware of themselves, produce better eye
contact are more focused and able to communicate and to learn. Further,
we have found that a number of children who toe-walk on the ground walk
completely flat-footed when elevated. We are gratified to find that
there are now dozens of Centers using elevation around the country and
in other countries. Currently,
a comprehensive controlled study contrasting the effect of functioning
while elevated with comparable functioning on the ground is under way
at the Language and Cognitive Development Center in Boston. |
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| THE MILLER METHOD WITH TANTRUMS
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| My
nonverbal 4-year old son (diagnosed PDD) always has a hardtime
separating from me, his mom, to go on the bus for preschool.
Getting on that is is like torture for the poor little guy. Any
suggestions? |
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It
may be that your son feels that when he leaves you to get on the bus he
will never see you again. In other words, that he has not yet
gotten the notion that even though he leaves you he will eventually
return to you. For him, it is likely that when he is with you
that the teacher at school doesn't exist and when he is in school that
you don't exist. If this is correct, then finding ways to help
him connect his mom-at-home reality with the teacher-at-school reality,
should ease the problem. One
way to do this is to set up a picture sequence showing him going on the
bus, going to school on the bus, getting off to go to school, being in
preschool with his teacher, then leaving teacher and school to go on
the bus, getting off the bus to be happily greeted by you. You should
have one of these sequences and his teacher the other so you can work
the going to school on the bus while the teacher can workgoing home to
you on the bus. Another
thing that might help is giving him some item that he associates with
you to take with him on the bus ( a kerchief, a pin, etc) . At
school the teacher can give him something from school to take
home. To further help him connect these two parts of his life it
would help to have a large picture of his teacher at home (so you can
call his attention to it) and a large picture of you at school so
that his teacher can refer to your picture (and your continued
existence) even when you are not physically present. A.M.
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| My
little girl with special needs (26 months) screams and tantrums when
she has to leave the bathroom or kitchen to go to her room. What can I
do to help her? |
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For
your daughter the different spaces in your home are very disconnected
from each other. That means leaving the familiar space of bathroom and
kitchen must be for her like "walking off the end of the earth." You
can do several things to help guide her to other spaces in your home:
One effective strategy is to cut out foot prints the size of her feet
and lay them out from where she is to where she needs to go. then have
her simply walk on her footprints. You can also show her that she can
venture from a familiar space for a few feet and then return to it.
Then, keep expanding the distance until she has made contact with
another familiar space. Once she develops an "inner plan" for the
geography of your home, distress and tantrums at leaving one space for
another should disappear. |
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| THE MILLER METHOD APPLIED TO PARTICULAR PROBLEMS
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| How can you encourage a child to write and recognize her own name? |
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There are
two ways in which you might be able to get your child to write and
recognize her name. Each requires different capacities which your
daughter may or may not have. One way depends on her knowledge of the
sounds for each letter in her name. If she has that knowledge -- and
has the motor ability to draw the letter forms -- she may with much
repetition learn to write and recognize her name.
If she
doesn't understand letter-sounds it is possible that she can be taught
to write her name in a rote manner if she can repeatedly copy a model
or trace a template of her name. Then, if you place a picture of her
next to her tracing and keep telling her that both the picture and the
written name refer to her, she may eventually relate the written form
of her name to herself and recognize it. To further strengthen the
relationship between her writing her name and herself, each time she
writes her name, say it and help her pat her chest.
If she has
trouble with the forming of the letters you might first try having her
make the letters in a clay pan with a stylus. The resistance from the
clay may make it easier for her to form the letters. |
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| Do you ever use swings in your method? Do you know of any research done on the effectiveness of swinging for autism? |
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Swings
and swinging used in a certain way are definitely part of the Miller
Method. When swings are used we recommend that the teacher, therapist
or parent push the swing whilce standing in front of the child so that
eye contact is maintained. Then, each time the child swings close the
adult says, "I'm going to touch your nose, (hand, toe, face, etc.)
while observing to see whether or not the child is beginning to
anticipate the contact. In this way, swinging contributes to the
child's body awareness and awareness of the other. We
also recommend pushing the swing in such a way that it makes different
trajectories which provide the child with a varied body experience.
Then, unexpectedly, we recommend interrupting the swinging (holding the
swing) to determine if the child can in some way indicate a need for
the swinging to continue. Swinging
the child in a blanket or parachute is also part of the "rough and
tumble" activity (carefully adjusted to each child's sensitivities) we
recommend prior to involving the child in more structured activity. Our
clinical experience is that the experience of swinging helps "ground"
the child but I am not aware of specific research related to the effect
of swinging per se. |
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| What is Cognitive and language development? What are the different ways in which this affects the children? |
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Thank
you for your interest in the Miller Method. Most of the children we
serve have problems being with people and with the ability to use
language the way typical children do. Many -- but not all -- have
trouble solving problems such as learning to use a chair to get
something they want on a shelf out of reach. The term cognitive
development refers to where a child is in his or her capacity to solve
such problems and others more complicated. The work we do at the
Language and Cognitive Development Center of Boston is designed to help
children both learn to solve these and more complicated everyday
problems and to learn to use language to understand others and to
communicate what their needs are to them....At the earliest level, a
child might simply pull someone by the hand to get what they want. With
language and cognitive development they can communicate their wishes
through manual signs and spoken words without hand-pulling. |
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| If a parent called me and stated that the doctor said that her child has "spectrum disorder," what is it? |
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If
the doctor is referring to "autism spectrum disorder" he is referring
to a developmental condition -- involving the central nervous system --
that affects about 1 in 1000 children (mostly boys). The condition
shows itself with difficulties establishing human relationships, in
delayed or disordered language, difficulty with transitions as well as
"self stimulating" behaviors (flapping, twiddling of fingers, rocking,
toe walking, etc.). The condition is treated most effectively when
begun as early as possible. The Language and Cognitive Development
Center of Boston -- using the Miller Method -- specializes in helping
these children. |
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| There
are no Miller Method programs where I live in British Columbia. Is
there any way you can guide me in using your approach so that I can
help my 5-year old autistic son? |
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Yes. We are currently working with a number of families who live far from our Center through one of the following modalities:
1.
Videoconferencing... This allows senior staff at the Language and
Cognitive Development Center (LCDC) in Boston to see, hear, answer
questions and guide the work done with a special child hundreds or even
thousands of miles away.
2. Phone
consultation... This method supplemented by videotapes of work being
done with a special child and sent to LCDC for review and
recommendations is also effective.
3. Internet
consultation... This newest method allows a regular exchange of
questions and answers between parent and senior staff in a private
Interactive Chat Room on the Center's website
If you are interested in any of these methods contact Drs. Arnold Miller or Paul Callahan at 1-800-218-5232. |
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| How is language development affected by autism? |
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Excellent
question. Language development is affected by autism in several
important ways: One, concerns the "word deafness" often found among
children on the spectrum. This means that while there is nothing wrong
with the children's hearing, they often have great difficulty deriving
meaning from spoken words directed toward them. Another area in which
communication is affected has to do with their uncertain
differentiation of their own bodies from those of others. Without such
body-other awareness they have difficulty spontaneously initiating
communication. This poor self-other separation is also related to
echolalia -- the tendency to repeat whatever is said to them as well as
confusion between the use of the terms "I" and "you."
The Miller Method has developed interventions -- involving pairing spoken
words with directed body action and gesture -- to cope with "word deafness."
The Method also introduces strategies to enhance self-other awareness.
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