Miller Method

1. Miller Method Presented by: Pranali Ifversen and Claire Hess Caldwell College

2. Founders • Arnold Miller, Ph.D. • Director of the Language and Cognitive Development Center of Boston and Affiliate Professor of Psychology • Doctorate in clinical psychology from Clark University. • Research appointments at Boston University and Harvard Medical School • Directed the Language Development Laboratory at Wrentham State School in Massachusetts.

3. Founders • Eileen Eller-Miller, M.A., CCC, Sp/L • Education Director of the Language and Cognitive Development Center • M.A. in speech and language pathology from Columbia University and a B.A. in psychology from the City University of New York. • Died June 18, 2004.

4. Cognitive-Developmental Theory • Ability to form systems • Chunks of behavior that are initially repetitive and circular • Awareness of the distinction between themselves and their surroundings • Children’s systems become more under their control • Combine systems to assist in problem solving, social exchanges and communication

5. Cognitive-Developmental Theory for Developmentally Delayed children • They become stalled a early stages of development • They progress to more advanced stages in an incomplete fashion. • An impairment in the ability to react and influence the world. • Lack of a sense of the body in relation to the world. • Salient stimuli drive them into stereotypic behavior.

6. Systems • “When children are able to indicate objects by pointing, gestures, or words, these gesture/word relations to various objects, events, or people are systems that may be regularly reactivated by the sight of particular referents.”

7. Types of Systems • Mini - systems - pick up / drop • Multi step system - more complex • Integrative systems - going up and down slides

8. Forming, Maintaining and expanding systems • Orienting - turn or orient toward the source of stimuli • Engagement - moving toward and becoming physically and emotionally involved with the stimulus properties of the object, even or person in his immediate surroundings. • Orienting plus engagement provides the precondition for the formation of systems.

9. Forming, Maintaining and Expanding systems (Cont.) • Inclusion Process - A. introducing new parts to the system. Ex: therapist says “push” while child pushes the wagon. The sound is separate from the act. B. Assimilating new parts to the system. Both the sound and the action are paired together. • Partial Interruption - only the spoken word or gesture is introduced, the child searches for the wagon.

10. Extension Principle • “Whenever a system with which the child is engaged acts upon a new property of an object or event, that property becomes an extended part of the original system. The child then maintains the integrity of the newly extended system when it is interrupted just as with the original system.” (Miller & Eller-Miller, 1989). (Miller & Eller-Miller, 1989).

11. Extension Principle • Ex: A child has established a natural sign “ch ch” to refer to a train, the parent then introduces the term “train” which extends the rhythmic “ch ch” cadence to include the new term.

12. Executive Function • The child begins to form new systems based on an inner plan, this emerging capacity is referred to as the development of executive function. • It appears that executive function is only possible when children have developed sufficient awareness of their bodies to self consciously direct them in different ways. When this occurs, they find that they have the ability to choose one system over another, to alter systems, or to combine previously developed systems in new ways.

13. Closed-System Disorder • Children with the executive functioning dysfunction are also known to have a closed-system disorder. • These are divided into Type A and Type B disorders. • Type A - minimal executive functioning and few systems. • Type B - Executive functioning with many object systems. Ability to shift from one system to another.

14. System-Forming Disorders • Different from closed - system disorders • Difficulty forming any systems. • Also divided in Type A and Type B. • Type A - minimal executive functioning. Poor sensory - motor coordination limits system forming. • Type B - little executive functioning, repeated orienting but no engagement.

15. Umwelt Assessment • Assess the nature of each child’s system functioning before intervening. • Goal of the miller method is to assess each child’s capacity to interact with people and objects, adapt to change, and learn from experience. • Umwelt (Uexkull, 1934) refers to the world around one.

16. Umwelt Assessment (Cont.) • Examines 3 kinds of interactions with a particular child: • Child’s response to unstructured situations (adult passive) • The child’s ability to maintain an interactive system with the examiner • The child’s ability to accept and participate in examiner initiated systems.

17. Umwelt Assessment (Cont.) • Figure 1a,b,c.Assessing a Childﾕs Ability to Form an Interactive System: a.Child-object-adult b.Child-object c.No object system

18. Umwelt Assessment (Cont.) • Assessing the capacity to adapt to change: stacking bowls and cups - stack cups and bowls in different ways. • Problem solving and learning from experience: The Elevated “Swiss Cheese “ Board and “Croupier” - adjust to changing circumstances but to learn from experience.

19. Overview of Miller Therapy • Symbolic playthings • Elevated board structures • Elevated square A • Elevated square B • Interaction devices • Interaction ramps • Interaction see-saw • Flower table with stools • Sign and spoken language program • Signs, sounds, and their referents (actions) • Food situations • Familiar objects and events • Two-sign/two-word combinations

20. Overview of Miller Therapy (Cont.) • Symbol accentuation reading program • Phase 1: Establishing sight reading • Phase 2: Transition to phonetic reading • Phase 3: Phonetic reading and writing

21. Symbolic Playthings: Elevated Structures • Promote improvement in eye contact • Increase “organization” (e.g. less toe-walking) • Improve responding to signs and spoken words

22. Symbolic Playthings: Interaction Devices • Promote cognitive and emotional development • Interaction ramps • Facilitate interactions between 2-5 children • Interaction see-saw • Channel with wooden ball guides eye-gaze and awareness • Flower table with stools • Facilitate interaction between easily distracted and withdrawn children

23. Sign and Spoken Language Program • Training videos are edited to present adjusted American Sign Language (ASL) signs with video footage of their associated actions and vocalizations • Target receptive and expressive language • Segment one: Signs, sounds, and their referents • Segment two: Food situations • Segment three: Familiar objects and events • Segment four: Two-sign/two-word combinations

24. Symbol Accentuation Reading Program • Phase 1: Establishing sight reading • Teaches a symbolic function of written words • Phase 2: Transition to phonetic reading • Teaches sight-reading in various sizes of type • Facilitates the shift between sight-reading and phonetic reading • Phase 3: Phonetic reading and writing • Teaches letter-sounds and their sequencing into words

25. Opening a Closed System • Identify the object of preoccupation • Collect a dozen of this object • Approach child while engaged in preoccupation with your bag of like objects and firmly remove his, replacing it immediately with one of your own • Repeat this procedure • 3-4 times on the first day • 5-6 times on the second day • 7-8 times on the third day • Gradually increase the delay before return • Begin to place object in front of your face during the delay to promote eye contact

26. “Dealing with ‘Glomming’” • Due to a child’s inability to differentiate his body from others • Implement a “rough and tumble” activity • Sit child on backless stools (i.e. flower table with stools)

27. “The Randomly Aggressive Child” “We have, on several occasions, had children with autism in our program who—without any provocation—would strike out and slap a child passing by or seated next to them at the table. Recently, a 10-year old boy with autism, new to tour Center (having been expelled because of his aggressive behavior from his previous school) behaved in this way. Firmly confronting him seemed to have no effect. Indeed, this seemed to be one of those instances where the boy seemed to seek out confrontation—perhaps because the intensity of the teacher’s response (“You do not hit other children!” helped him become more aware of himself.). Going on the assumption that he was groping for a way to experience his own existence, we sought a method that would enhance his self-experience while reducing his tendency to strike out… The technique developed entailed alternating his wearing roller skates on one day and mini-stilts that increased his height by 3-4 inches on another day. The immediate effect of wearing the skates and stilts in school was a dramatic reduction in striking out and other physical assaults. The reason for this, we felt, was three fold: First, the skates and stilts tended to make him more aware of how he used his body. With skates or stilts on, lashing out at someone could cause him to lose his balance. To avoid this, he had to become much more conscious as to how he moved and used his body. The second reason for the positive effect was that the skates and stilts conferred a certain uniqueness on him. Not only did the skates and stilts make him taller (he tended to be shorter than the other children in his class) but he was the only child in the class that wore skates or stilts throughout the day. The third reason for this method’s effectiveness was that it ‘bought time’ for him to establish relationships with both teaching staff and with the other children in his class… These relationships are now making it possible for him to sustain himself in class without striking out and without wearing the skates or stilts.” The Miller Newsletter Vol. 1, Issue No. 3

28. “Contrasting the Miller Method with the ABA Approach”(The Miller Method Newsletter, Vol. 1, Issue No. 3 and Vol. 7, Issue No.1) • “A key difference” • “The ABA approach maintains that children must learn to sit quietly at a desk or table before it is possible to teach them.” • Miller Method workers believe that children need to involve their bodies and narrate children’s actions, vocally and with sign. • “Two different mind sets” • “They cannot be mixed without confusing the child.” • “Because the behavioral approach stems mostly from animal research and the work of B.F. Skinner it does not concern itself with whether or not what a child does or says is meaningful. For behaviorists the appearance of meaningful performance is sufficient as they assert, ‘If it walks like a duck and quacks like a duck, it’s a duck!” • The Miller Method builds on the work of Vygotsky, Werner, and Piaget in developmental psychology and considers the distinction between the “duck and decoy.”

29. “Contrasting the Miller Method with the ABA Approach” (Cont.)(The Miller Method Newsletter, Vol. 1, Issue No. 3 and Vol. 7, Issue No.1) • “Valuing what the child brings” • ABA seeks to “stamp out” certain behaviors • For Miller Method workers, “even disruptive behavior such as repetitive throwing or lining things up is valued even though they serve no immediately apparent function.” These behaviors can be transformed into functional behaviors. • “Treatment of stereotypies” • “Stereotypies of disordered children… for the behaviorist are negative, abnormal-looking behaviors which need to be extinguished either by redirecting the child to other more acceptable activities or by punishing them. • For Miller Method workers, stereotypies are “valuable sources of organized, integratedbehavior which need to e transformed or expanded so that they become more functional and interactive.”

30. “Contrasting the Miller Method with the ABA Approach” (Cont.)(The Miller Method Newsletter, Vol. 1, Issue No. 3 and Vol. 7, Issue No.1) • “The role of interruption” • “Behaviorists tend not to interrupt an activity that the child is performing because in their view this will make the task ‘aversive’ for the child who will then not wish to continue with it.” • Miler Method workers see that interruptions increases a desire to continue activity and production of related words and/or signs

31. “Contrasting the Miller Method with the ABA Approach” (Cont.)(The Miller Method Newsletter, Vol. 1, Issue No. 3 and Vol. 7, Issue No.1) • “Dealing with disruptive behavior”/“Treatment of Tantrums” • “The classical response of a behaviorist with regard to tantrums is to ignore them or to place the child in a ‘time out’ place until the child is ‘ready’ to rejoin the group. The assumption here is that any ‘attention’ given the child during tantrum will inevitably lead to ‘reinforcing’ this behavior.” • Miller method workers view tantrums as a breakdown in the child’s ability to cope. “The worker may provide more nurturing and ‘special time’… or introduce a repetitive and calming ritual.” If the tantrum continues, “the child may be restrained while the worker maintains face-to-face contact and speaks quietly to the child. Under no circumstances is the child ever placed in a ‘time out’ room since this merely intensifies the child’s autistic isolation.”

32. Language and Cognitive Development Center, Boston Mission: • Language and Cognitive Development Center is a private, non-profit special needs school founded in 1965 to work with children with significant developmental disorders such as Autism and PDD. We are a developmentally oriented program (Miller Method) which is internationally known for it's innovative therapeutic and educational work with children. We provide education and therapy to children diagnosed with Autism, consultation to schools and families and professional training to persons interested in becoming Miller Method Certified Therapists.

33. Language and Cognitive Development Center, Boston • Clinic and training facility • Has affiliates in Los Angeles, Berkeley, Heights and New Jersey. • Two major demonstrations grants from US Department of Education.

34. LCDC - Programs • Miller Umwelt Assessment :- 2- 3 hour evaluation. • The assessment costs $1000. • Parent - Child Training :- 3 day session, averaging 3 to 4 hours per day. • Individual sessions - hour long sessions - one to three per week. Sign and Spoken Language Program; as well as Symbol Accentuation Reading Program. • Professional Training - workshops as well as video conferencing • Distance Consultation - telephone, internet and video conferencing.

35. Sites with Miller Therapy • All saints Catholic Church - Mississauga, Ontario, Canada • Broadmoor School -Mentor, Ohio • William Patrick Day Center, Cleveland, Ohio • Community Park School, Morris Plains, NJ • Westlake School, Westfield, NJ • Allegro School, Morris Plains, NJ • Ross Tilley School, Bowmanville, Ontario,Canada • Small Wonder Preschool. Glendale, Long Island, NY

36. Miller Certification Requirements • Participation in a one-week training at LCDC • Ability to conduct a Umwelt Assessments, compose reports and treatment plans for three children • Weekly supervision of work with at least three children, two of which are non-vocal, for the duration of one year • Successful completion of an exam covering the cognitive-developmental systems theory • Maintenance of certification by attending a one-week recertification program at LCDC biannually

37. Publications • The Miller Method Newsletters • Books • Miller, A. with Chretien, K. (2007) The Miller Method: Developing the Capacities of Children on the Autism Spectrum. Jessica Kingsley Publishers. • Miller, A. & Eller-Miller, E. (2000) The Miller Method: A Cognitive-Developmental Systems Approach for Children with Body Organization, Social and Communication Issues. Chapter 19. (pp 489-516) in (Eds.) Greenspan, S. & Weider, S. ICDL Clinical Practices Guidelines: Revising the standards of practice for infants, toddlers and children with developmental challenges. • Miller, A. & Eller-Miller, E. (1989) From Ritual to Repertoire: A Cognitive-Developmental Systems Approach with Behavior-Disordered Children. Wiley and Sons, New York (1989) 520 pages, illustrated.

38. Publications (Cont.) • Miller Umwelt Assessment Scale • Workshops (on Video) • Comparing Behavior Modification with the Developmental Systems Approach • Understanding Pervasive Developmental Disorders (PDD) from a Medical Perspective • Helping the Child with Pervasive Developmental Disorder Cope in the “Here” and “Now” • Video Documentaries • Edge of Awareness • A Small Awakening • From Ritual to Repertoire • Where is Angela? • Come Back Jack

39. Publications (Cont.) • Journal articles • Cook, C.E. (1998) The Miller Method: A case study illustrating use of the approach with children with autism in an interdisciplinary setting. Journal of Developmental and Learning Disorders, Vol 2, No 2, 231-264. • Messier, L.P. (1970) Effects of Reading Instruction by Symbol Accentuation on Disadvantaged Children. Unpublished doctoral dissertation, Boston University. • Miller, A. (1968) Symbol Accentuation: Outgrowth of theory and experiment. In Proceedings of the First International Congress for the Scientific Study of Mental Deficiency, Montpelier, France, (766-772) Surrey, England: Michael Jackson • Miller, A. (1991) Cognitive-developmental systems theory in pervasive developmental disorder. In Pervasive Developmental Disorders (Eds) J. Beitchman, M., M. Konstontareas, Psychiatric Clinics of North America, Saunders Press, Vol 14, No 1, 141-161

40. Publications (Cont.) • Journal articles (Cont.) • Miller, A. & Miller, E. E. (1968) Symbol Accentuation: The perceptual transfer of meaning from spoken to written words. American Journal of Mental Deficiency, 73, 200-208. • Miller, A. & Miller, E. E. (1971) Symbol Accentuation, single-track functioning and early reading. American Journal of Mental Deficiency, 76 (1), 110-117. • Miller, A. & Miller, E. E. (1973) Cognitive-developmental training with elevated boards and sign language. Journal of Autism and Childhood Schizophrenia, 3, 65-85 • Warr-Leeper, G., Henry, S., Versteegh, T. Outcome Study: (1997) The Effect of the Miller Method on Five Severely Disordered Children with Pervasive Developmental or Communication Disorders, Unpublished Honors Study, University of Western Ontario.

41. Strengths of The Miller Method • There is a clearly identified and detailed theory (i.e. cognitive-developmental systems theory) on which the method is based • Training and certification criteria are outlined • There is consistency to their assertions regarding their approach to intervention

42. Weaknesses of The Miller Method • Presupposes an unconfirmed origin of Pervasive Developmental Disorders • There is a heavy dependence on testimonials • Many references and publications are not peer-reviewed or even unpublished • There is considerable up-front cost in the form of necessary materials • Very impersonal, distance consultation is presented as a viable option • Oversimplified steps to success are made • Bold claims and predictions that have an emotional appeal • “By the time this boy is 6, it will take a trained professional to pick out his diagnosis of PDD.” • “Just weeks before she died—with barely enough strength to sit up—she participated in a videoconference with me to help an autistic child and his family.” • Criticisms of ABA

43. References • http://www.millermethod.org/ • http://www.best-pals.org/a_med_miller1.html • http://www.autismtoday.com/mds.htm • http://autism.wikia.com/wiki/The_Miller_Method • http://www.kylestreehouse.org/The_Miller_Method.cfm • The Miller Method Newsletters • Spring/Summer, 1996 (Vol. 1, Issue No. 2) • Fall Quarter, 1996 (Vol. 1, Issue No. 3) • Spring Quarter, 1997 (Vol. 2, Issue No. 1) • Fall/Winter Quarter, 1998 (Vol. 3, Issue No. 1) • Summer Quarter, 1999 (Vol. 5, Issue No. 1) • Winter-Spring, 2000-2001 (Vol. 6, Issue No. 1) • Spring-Summer, 2002 (Vol. 7, Issue No. 1) • Winter-Spring, 2007 (Vol. 8, Issue No. 1) • Miller, A. & Eller-Miller, E. (2000) The Miller Method: A Cognitive-Developmental Systems Approach for Children with Body Organization, Social and Communication Issues. Chapter 19. (pp 489-516) in (Eds.) Greenspan, S. & Weider, S. ICDL Clinical Practices Guidelines: Revising the standards of practice for infants, toddlers and children with developmental challenges.