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