The Miller Method

1. The Miller Method Arianna Scattone Caldwell College  Post- Baccalaureate Certification in Applied Behavior Analysis Megan Marinello Caldwell College Masters in Applied Behavior Analysis Allison Erwine Caldwell College  Post- Baccalaureate Certification in Applied Behavior Analysis

2. The Miller Method • The Miller Method is a cognitive developmental system with links to works of Piaget, Von Bertanfly, Vygotsky, Werner and Kaplan. • Theory: “typical development depends on the ability of the children to form systems that are initially repetitive and circular but which expand as the child develops”

3. The Miller Method • The Miller Method addresses: • Children’s body organization • Social interaction • Communication

4. The Miller Method • Founders • Arnold Miller PHD, • Eileen Eller-Miller, M.A.,CCC-SLP Founded the Language and Cognitive Developmental Center (LCDC) in Boston, in 1965. • Treatment Cost: the typical fee is $150.00 per one hour session • Video Conferencing and phone calls: $250.00 of week.

5. The Miller Method • Miller’s Goals: • Assesses interaction, adapt to the change and learn from others • Build’s child’s awareness of own body with cognitive play forms • Enable children to be functional, social and communicative • Use more abstract symbolic functioning rather than concrete

6. The Miller Method • Two Major strategies to transform development: 1. Aberrant system transformed into more functional behaviors 2. Introduction to relevant activities involving people and objects - elevated on 2.5 ft. squares - therapist guides child creating a connection between signs and words

7. The Miller Method • Elevated Board Structures: • Eye contact improves: the child’s eye level to therapist • Toe walkers become more grounded walking • Children that did not follow directions on the ground were found to be more compliant once elevated

8. The Miller Method • Elevated Square: Two Types 1. Elevated Square A:18 months-5years old -the square rests on 4 lightly made cross shaped pedestals 2. Elevated Square B: 18 months-10 years old - the square rests on 4 sturdy cubes Both come with: - velcro stairs - “swiss cheese” and parallel boards - slide - detours: alternate routes

9. The Miller Method Interaction Devices: promotes spontaneous play 1. Interaction Ramps: 2- 5 children can play on this at one time 2. Interactive See Saw: creates awareness 3. Flower Table Stool: design of table creates relationship with others • Helps therapist work behind child without child escaping from task • Stools are made without backs; prevents leaning, making them less withdrawn

10. The Miller Method • Sign and Spoken Language Program: Training films that allow children who are non- verbal to understand meaning though signs Goals of training films: • Food situations( 11 minutes): signs that help children function better in food related events ( e.g., fork, cookie, egg) • Action meanings( 11 minutes): usage of signs and spoken words in a appropriate manner (e.g., stop, go, walk,jump) http://www.cognitivedesigns.com/quicktime/JUMPSEQ.mov • Two- sign/ Two word combinations( 15 minutes): understanding of verb + noun( eat apple), noun + verb( egg breaks), adjective + noun ( big ball), noun + adverb( chair down) • Familiar objects and events(6 minutes long): understanding of familiar objects in the surroundings ( e.g., sleep, wash, awake, hot)

11. The Miller Method • The Symbol Accentuation Program • Teaches function of words • Teaches children to read in big and small text • Letter sound relationships • 3 Phases of the program • Sight reading: words are illustrated in an animated sequence and followed up with flash cards http://www.cognitivedesigns.com/quicktime/SITSEQ.mov • Transition to Phonetic: makes children more aware of words they already know http://www.cognitivedesigns.com/quicktime/MOPSEQ.mov • Phonetic Reading and Writing: consonants combine with shorts vowels( a,e,i,o,u) and long vowels( ooo) http://www.cognitivedesigns.com/quicktime/FOOSEQ.mov

12. The Miller Method • Assessment • Miller Umwelt Assessment Scale( MUSAC) • Umwelt: “world around one” • The assessment sorts out the history of the child’s reality and spatial issues and provide interventions to solve it • The MUSAC kit provides manuals, forms, videotape • 16 tasks for assessment

13. The Miller Method • Training • 4 day workshop at LCDC • 50 weeks of supervision • Cases: 3 children (two nonverbal and one verbal) • Written exam

14. Let’s Watch!! • http://www.millermethod.org/

15. Does the Miller Method Work? • The Miller Method has shown to: • Improve human contact • Decrease perseverative tendencies • Develop receptive and expressive language • Engage a child in symbolic function • Success is defined by clear and significant gains in a child’s ability to deliver speech, intervention, over-stimulation, and other social skills.

16. Will it Work for Your Child? • The younger the better. • Your child must have a good neurological status (no cortical insult or seizure disorders). • If there is bond between your child with at least 1 parent. • Those with closed-system disorders progress better. • Parents must have a high support/demand stance.

17. Outcome Research • The Miller Diagnostic Survey (MDS): • How well is a particular special child progressing in his/her school program? • How well do comparable children progress in school programs with other approaches?

18. The Miller Diagnostic Survey(The Miller Method Newsletter) • After this survey is completed it is sent to the Language and Cognitive Development Center. • Responses are reviewed. • Summary of Developmental Profile is sent back to parents. • At the end of the school year the same survey is filled out. • A statistical analysis comparing the two developmental profiles will determine changes.

19. What the Survey Entails…. • Medical issues • Sensory Reactivity • Body Organization • Social Contact • Communication • Symbolic Functioning • Abberant Behavior • System Functioning

20. Examples of Questions • When the child has a nasty fall, touches something hot or is hit by someone, does he/she cry? • Does the child seek out things to climb (monkey bars, trees etc.) as if “the higher the better?” • When the child has an object in his/her hand and someone takes it, the child is distressed. Never Rarely Sometimes Often Always

21. MDS • The second issue addressed concerns the relative effectiveness of different approaches. • Because the survey has a space to indicate the approach being used there is a clear basis for comparing one program with another with regard to gains achieved.

22. Testimonials • “After the first month Jonny learned how to ‘sign’. This was the first time in his short life he could communicate.” • “Approximately, four months after Jonny started the school year, he started to speak. What a feeling it was to hear my child’s voice!!!” • Janet (mother of an autistic child)

23. Testimonials • “There is not enough I can say about these wonderful people that have virtually saved my son from a life of mere existence to one of meaning and purpose.” • “It works. It is not a behavior modification program. It is a way of life.” • Shirley (mother of an autistic child)

24. Testimonials “I have observed many different programs, and I have never seen results like this. When you see these children on the Square, it’s hard to believe they are autistic. We’re really excited about what the kids can do.” Dr. Ruth Rivera Ed. D. Director of Special Services for the Bloomfield School District Del Pizzo (2003)

25. Success StoryKyle Westphal Fountation (2005) • Angela: Student at LCDC • Non-verbal with tantrums • Four months dramatic progress • Used new signs everyday (come, give, go, plate, etc.) • 3 months 3 weeks requests in words using simple sentences • Much happier • Tolerated change • Able to wait

26. Follow Up • Seven years later, at age 13, Angela reads, writes, and is in a regular classroom without any support. She has friends and responds to connection.

27. Independent StudyThe Miller Method Newsletter (1997) • Genese Warr-Lepper, Ph.D., University of Western Ontario • Susan Henry, M.Cl. Sc., Robarts School for the Deaf • Tracy Versteegh, B.A. (Hons.), University of Western Ontario

28. Purpose • The study was done to determine the effects of the Miller Method intervention on children with pervasive developmental disorders are severe receptive and expressive communication disorders and an identified hearing loss. • The effects were measured by standardized linguistic and behavioral tests as well as by data from checklists, scales and teacher and parent questionnaires.

29. Participants • 5 students enrolled at the Robarts School for the Deaf, London, Ontario. • Diagnosed with pervasive developmental disorder or severe receptive and expressive communication disorder related to neurological issues or syndromes. • All had hearing loss. • 2 males and 3 females • Ages from 4 years 11 months to 7 years 5 months • 4 participants had a Closed System, Type B disorder • 1 had a System-Forming, Type B disorder

30. Design • Two 45 minute individual sessions per week over 8 months • Therapy provided by Sue Henry (LCDC-trained speech-language therapist) • Participants received between 26-33 sessions • 4 out of 5 parents participated and carried procedures into the home • During the last two months Miller Method materials were brought to the school to help carry effects over to the classroom

31. Results • All 5 children made progress in their communication, cognition, and social-emotional development. (2.4 domain increase) • Proportional Change Index showed significant rates of development. (2.68)

32. Trends in Participants • Increased ability to attend and follow instructions in the class room • Increase desire to interact and communicate with others • Improved eye contact with more positive affect when communicating • Decrease in undesirable and socially inappropriate behavior

33. Parent’s Comments • Parents and teacher reports for all subjects were greatly consistent and congruent. • All parents had positive feedback toward the program.

34. Summary of Experiment • Children demonstrated more purposefully social and appropriate behavior at home and in school following Miller Method therapy • “Achievements of this nature cold be considered to have a meaningful impact on the quality of life for these children and their significant others.”

35. Does this Research Prove Anything? • The Miller Diagnostic Survey • The questions are subjective. They are from the opinions of the parents. • Independent Study • Weakly controlled and did not evaluate the direct effects of the intervention. • Based on subjective evidence. • Testimonials and Success Stories • No objective evidence

36. Does the Miller Method hold up Scientifically?MADSEC (2000)

37. Does the Miller Method hold up Scientifically?MADSEC (2000) • “Shows promise, but is not yet objectively substantiated as effective for individuals with autism using controlled studies and subject to the rigors of good science.”

38. Summary • The Miller Method challenges children to organize their perceptions and understandings of their surroundings and create new, more functional systems.

39. Summary • Addresses the three major areas of impairment found in children with autism • Social Interaction – child awareness of self and relationship with others is strengthened by using special equipment • Communications Skills – technique developed specifically to teach children with autism • Stereotyped behaviors – perseverative and ritualistic patterns and behaviors challenged to create flexibility

40. Summary • Effective? • Numerous studies and testimonials claim success • None of these show objective evidence

41. Conclusion • The Miller Method allows a child with autism to be more successful, comfortable and flexible in the surrounding environment. • Empirical research must be done

42. References • Cognitive Designs Products.(1997-2002). Retrieved September 29, 2007, from http://www.cognitivedesigns.com/playthings.html. • Del Pizzo, N. (2003). Not just the square deal: cutting edge method welcomes autistic kids to life. Kidmasters, Spring, 2-3. • Kyle Westphal Foundation. (2005). The Miller Method. Retrieve October 15, 2007, from http://kylestreehouse.org/The_Miller_Method.cfm • Maine Administrations of Services for Children with Disabilities. (2000). Report of the MADSEC Autism Task Force. Retrieved on October 3, 2007, from http://www.madsec.org/docs/ATFReport.pdf • Miller, Arnold & Eileen.(nd). The Miller Method: A Cognitive- Developmental Approach for Children with Body Organization, Social, and Communication Issues. In ICDL Clinical Practice Guidelines( pp 489-515). Retrieved September 29, 2007, from http://www.millermethod.org/pdf/chapter19.pdf • The Miller Method for Children with Autism Spectrum and Severe Learning Disorders. 1996-2004). Retrieved September 29, 2007, from http://www.millermethod.org/index.html. • The Miller Method newsletter. (1997, Spring Quarter). Language Cognitive Development Center of Boston, 2, 1-2. • The Miller Method newsletter. (2002, Spring-Summer). Language and Cognitive Development Center of Boston, 7, 1-2. • Zaks, Z. (n.d.). Information for Parents of Autistic Children. Retrieved October 5, 2007, from http://www.zaksfamily.com/autismparents.html#prosconschart