The Miller Method (R)

Developing the Capacities of Children on the Autism Spectrum

Arnold Miller

• Publisher: Jessica Kingsley Publishers
• Year: 2007
• Print ISBN: 9781843107224
• eBook ISBN: 9781846425837
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

This informative and practical guide to the Miller Method® presents an entirely new and dynamic perspective on advancing the body organization, social, and communicative skills of children diagnosed with autism spectrum disorders (ASDs).

Working on the premise that children with ASDs learn more effectively when their whole bodies are involved, The Miller Method® covers major issues such as communication skills and social play, as well as day-to-day behavioral issues including tantrums, aggression and toilet training. Part of Miller's method includes guiding the child on to The Elevated Square, a device that gets the child off the floor and markedly diminishes toe-walking, hand flapping and aimless wandering. By creating a highly defined reality that requires the child's rapt attention to traverse it, the Elevated Square helps counter some of the significant challenges these children confront. Another feature of the method entails the carefully gauged disruption of everyday routines. This may include deliberately 'messing up' the classroom so that the children experience putting it together and learning that they can cope with disorder and change.

This practical resource is essential reading for parents and professionals living and working with children with ASDs.

Part I

ABOUT CHILDREN’S SYSTEMS

Chapter 1

What Makes the Miller Method^® Unique?

The single most unique and important aspect of the Miller Method^® (MM) is its work with systems. But what is a system? By system we mean any organized behavior with an object or event that the child produces. Even “upsetting” behaviors—such as throwing or dropping things, opening and closing doors, or lining things up—are systems, although they do not seem to others to serve any particular function.

We are interested in such behaviors because they are directed, are organized, and lead to some outcome—all parts of what we look for in functional behavior and in communication. If we can find a way to help the child modify or transform these repetitive action systems so that they become functional and interactive, then we have contributed to the child’s development. For children who show little or no organized systems—even maladaptive ones—our first task will be to find ways to help them form systems.

When the nonverbal or limited-verbal child is involved in an action system, the child’s reality is that action system. Nothing else exists for that child. Further, if someone interrupts or disrupts that system the child will need to restore or maintain it. Often it is the child’s drive to restore “broken” action systems that provides us with the opportunity to communicate about restoring them.

Systems are in play in various ways: Body systems coordinate sensory capacities with motor capacities in the service of a particular function such as picking up an object, climbing over a fence, walking, riding a bike, swimming, and so forth. Social systems concern how two people interact with each other, whether by working together, turn-taking, competing, or bonding. Communication systems involve the integration of words and actions around objects in relation to another person. Symbolic systems involve the way in which a child organizes the relation between symbols and what they represent.

Systems may be viewed as organized “chunks” of behavior, perception, or thought. The 15-month-old child at the beach who repeatedly fills up his pail with sand and then dumps it into the ocean only to repeat it again and again is engaged in an action system; the autistic boy who, seeing my glasses perched at the very end of my nose, must reach over to push them higher on my nose where they belong is reacting to a disrupted perceptual system; the child who engages in “make believe” play to the exclusion of all else is involved in a system, as is the Asperger child who can only talk about airplanes. All are dominated in varying degrees by particular systems.

However, before one can apply understanding of systems to intervention with special children, it is necessary first to recognize what systems look like when they are forming, when they are fully formed, and when they are disrupted. Once parents and professionals understand the dynamics of systems they gain access to a powerful tool for dealing with every aspect of a child’s life. In this chapter I will describe systems as they appear in all areas of human functioning—including social and communication—as well as their relevance for “meltdowns.” But first, let’s consider the role systems play in the order and disorder of everyday life for children with autism.

ORDER AND DISORDER

If we look at our lives we find both order and disorder—with order referring to predictable systems and disorder referring to the disruption of those systems. In fact, one might argue that an important part of living concerns coping with unpredictable disorder and trying to impose some order on it. (When I look at my desk it becomes clear that I have a way to go in this regard.) Both ordered and disordered systems have an important place in teaching children on the autism spectrum.

Used properly, the introduction of both ordered and disordered systems helps children make important progress that they would not make if only imposed order were the rule. Some children with autism—those we refer to as having system-forming disorders—are quite scattered and have trouble ordering (systematizing) and making sense of their immediate surroundings and the people in it. Another group of children—referred to as having closed system disorders—become over-preoccupied with routines (systems) and objects to the exclusion of people. They tend to live in isolated “bubbles” of repetitive activity with one or more objects.

The importance of ordered systems

For both kinds of children, developing daily routines (ritual systems) in therapy and in school sessions are important—but for different reasons. For scattered children with system-forming disorders, the repetitive and predictable routines of being greeted by therapist or teacher, putting their clothes in cubbies, knowing where everything belongs, helps to organize a safe, predictable setting. For children with closed system disorders, these predictable routines may at first be helpful because they guide them from their over-preoccupation with small “chunks” of the environment in therapy or classroom sessions to a broader experience of their surroundings. These routines also promote a bond between the children and their therapists and teachers. For these reasons it is desirable at first to establish and emphasize rituals (systems) in therapy and classroom.

Limitations of ordered systems

However, if the daily ritual systems continue unchanged for too long, they limit the children’s potential for new learning, exploration, and development. In other words, the children will not learn to cope with the changes that new places or new people bring into their worlds but will, instead, become confused or distressed by new situations. To help the children learn to cope, therapists, teachers, and parents need to introduce different amounts of change into their predictable ritual systems. Obviously, if the changes are too great, too soon, the children will “fall apart.” The challenge for therapists, teachers, and parents is to introduce small amounts of disorder within the children’s everyday systems so that the children begin to develop the toughness they need to cope with more dramatic changes in the world outside the therapy and school sessions.

Introducing system expansions as “mild” disorder

When a child is engaged with the usual way of doing things, it is important after a time to carefully vary those routine systems. In therapy sessions routine systems are systematically varied by changing various aspects of a task such as pouring water into a can. The therapist’s movement of the can to another location (location expansion) introduces a “mild” disorder which the child pouring water copes with by having to follow the new location of the can so that he or she can continue the water-pouring system. Similarly, when the therapist offers the bottle from different positions (position expansion), the child adjusts to these changes. A therapist can also offer bottles of different shapes and sizes resulting in ability to generalize (object expansion). And finally, although the child has grown accustomed to always receiving the bottle from one person, he or she can learn to tolerate the disruption produced by a new person offering the bottles (person expansion). Clearly, the child who can tolerate and eventually enjoy these mild changes is further along in development than the child who clings desperately to a fixed pattern. Additionally, the child gains a true understanding of the object by experiencing its form rather than just memorizing a single instance of a particular type of bottle.

In similar fashion, teachers, while keeping certain aspects of the daily routine stable, may systematically vary others. For example, the table at which the children sit and work may be varied in its location from day to day as can the chair in which each usually sits. Similarly, the order of events scheduled for the day may be changed. Cubbies should remain constant because they provide children with a “security station” while other things in the child’s environment change. Care should be taken that only one aspect of the child’s environment at a time is changed. If a change is too upsetting for a particular child, a lesser amount of change can be negotiated.

Interrupting task systems as “moderate” disorder

Once the child can tolerate and cope with the “mild” disorder implicit in the expansions described above, he or she is ready to cope with “moderate” disorder introduced by interrupting the various systems (tasks or activities) with which the child is engaged. “Moderate” disorder can be introduced by momentarily taking the bottle out of the child’s hand just as he or she is ready to pour from it, or dropping the slide just as the child was ready to slide down; or it may be introduced by sitting in the child’s path in a way which interferes with his or her access to a desired toy; or it may involve the teacher who is working with the child on the Elevated Square (a device to increase awareness and focus which is discussed in Chapter 5) suddenly “changing his or her mind” and requiring the child to go in the opposite direction to that to which he or she was accustomed.

If we apply the same concept in the classroom, the teacher, noting when the children are “captured” by a particular activity system such as scribbling with crayons, may suddenly interrupt the scribbling to shift the child to rolling play dough only to interrupt the play dough activity to return the child to the scribbling.

In all these situations, the child accustomed to a certain order must cope with the change induced by interposing another activity system before the child can return to the first activity system. Once the children can cope with both expansions and interruptions, they are ready to cope with more dramatic disorder.

Dramatic disruptions of familiar systems

From time to time, therapists working with children who have become completely familiar with the standard structure of the Elevated Square will completely dismantle the structure before the child’s therapy session begins. Then, the child’s need to restore that familiar structure (see Figure 1.1) results in cooperative efforts with therapist or with another child to repair it. In the classroom a similar procedure can be used.

Figure 1.1 An autistic child helping his therapist restore the disrupted Elevated Square. Photographed with permission from Crossroads School, Westfield, New Jersey

Another example is as follows: One morning, as the children walk into their familiar classroom, they find everything “topsy-turvy.” Tables and chairs are capsized, crumpled paper as well as cups, saucers, bottles, and kitchen utensils are strewn over the floor, mixed up with blocks and other toys. Everything is in complete disarray. Teachers—who created the mess after the children had gone home the day before—express dismay to the children, saying something like, “Oh my, look at this terrible mess. We have to fix it!” Then, as they “struggle” to right a table, the teachers turn to different children and say, “Help me pick up the table!” or “Help me clean up this mess!”

Some of the children (those with closed system disorders) spontaneously start to help clean up the mess while others need guidance about where to put things. Usually, the trash in the wastepaper basket is easiest for them, while helping someone move or lift something is more difficult. Still others need to put the toys and blocks on the shelves where they belong while others need to put the kitchen utensils in their proper compartments. One child may be very upset about the mess and begin to cry. A teacher needs to encourage that child to see that he or she can help put everything in its proper ord...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Acknowledgements
• Contents
• Foreword by Diane Twachtman-Cullen
• Foreword by Stuart G. Shanker
• Preface: Beyond Compliance
• Part I About Children’s Systems
• Part II Treatment
• Part III Education
• Part IV Research
• Appendix A: Theory Summary and Glossary
• Appendix B: Miller Diagnostic Survey for Children with Developmental Issues
• Appendix C: Sam and The Boys
• Appendix D: The Language and Cognitive Development Center
• References
• Subject Index
• Author Index