The Miller Method
Notes from conference 3/2908 - 3/30/08 J. Feder, MD
Rationale: Autism as organized behavior that does not include people. Miller's developmental approach is to turn toward the child and meet the child's needs. THen bit by bit the child can bring behavior under control. Contrast behavioral approach where the goal is compliance and the person turns away from the child to extinguish the behavior.
Miller divides people with ASDs into two main categories: System forming: distractible, disorganized behavior, without a consistent reliable pattern of behavior Closed: has a pattern of behavior but does not include people in that behavior
Hanging ball as a diagnostic tool: lets the ball swing toward the child. If it bounces off the child with no real organized reaction it is likely that the child has a system forming disorder. If the child has an organized but closed response to the ball, your job is to introduce disorder into the system (i.e. playfully get in the way of the child's intent)
Body Organization and Apraxia: Demonstration: has us clasp hands and turn arms 'inside out', points to a finger and you have try to move it. Easier when he touches the target finger. Movement is critical to developing a sense of oneself and one's body. Elevation to improve body awareness
Cognitive-Developmental Intervention: rapidly 'pacing' the child through a sequence to improve the ability to go through a sequence - this is a rapid beckoning, with use of simple signs
Elevation and edge detection creating a precise reality, demanding a survival instinct and improving focus. E.g. with tantrums, join and help person transform an unconscious sequence of crying screaming and kicking into one that is ritualized
Use of Elevated Square: Better ability to do gross motor sequences - stairs and slide Better understanding of prepositions - up, over, around More use of words/ signs Better fine motor function Location expansion Interaction Sequencing
Contagion Excitement: Repetition Narration Contagion Pacing
Social Capacity: 6 months: knows mom and 'not mom' 9 months: can attend to mom or object but not both 10 months: can pay attention to mom and object at same time; necessary for advanced social capacity
correlates with responses to swinging ball: mom pushes ball - nothing happens
recognition of ball but not person - closed looking at ball and at mom - most advanced
Management of eye aversion: restabilization - tug at shirt - has to right himself face touching blow on hands - orienting technique does not say 'look at me' makes him 'embed self in body'
Modified sign language Up, over, come, stop, sit fuse sign w/ referent command sequence use to increase child's sense of competence and ability to make things happen in the world hand over hand at frst, eg help child sign 'come' to dad and dad slowly comes to child eg w/ a wanted object
Vygotsky test - have child reach for an object that is laying beyond another object if the person is guided by the sign or word, he can go beyond the nearest object to the thing that you asked for - implies a sense of symbolic capacity
3D-2D: using cards with half 'real' 3D and other side a drawing, to teach the 2D world to kids
Tableau Calendar: Using 3D toys to represent activities, and 'predict the future' i.e., plan
Prognostic Factors: age - start earlier absence of severe neurological difficulties bonding with at least one parent capacity of family to provide both high support and high demand
Low Support/Low Expectation – e.g., unengaged, alone in room, playing videogames (can be neglectful) Low Support/High Expectation – e.g., “He needs to just be normal and he WILL be!” (can become abusive) High Support/Low Expectation – e.g., accommodations and excuses with little progress (often very frustrating) High Support/ High Expectation – e.g., continuous daily engagement, wooing into new areas of thought and function, wraparound model (this is usually best).
Important principles: Pacing Architecture Zone of Intention Balance of pacing and waiting