By Amy Cooperman, OTR/L
THE MILLER METHOD
At around the time I began working with autistic children, I stumbled upon a book which was to revolutionize my approach. The Miller Method: Developing the Capacities of Children on the Autism Spectrum by Dr. Arnold Miller, PhD was featured in my OT magazine. After ordering and reading the book, I wrote to Dr. Miller stating that I would like to learn from him, since his methodology and interventions rang true on a professional as well as spiritual level.
Dr Miller was a clinical psychologist in Boston. He and his wife, Eileen, a speech therapist, worked together to create the LCDC (Language and Cognitive Development Center) for severely autistic children. For over 45 years, they developed brilliant programs and interventions, documenting their journey via reams of powerful and moving video footage.
Since Dr. Miller’s work is rooted in Cognitive Developmental Systems Theory, it has stood the test of time. In fact, many of his ingenious interventions and insights appear to be rather “cutting edge” these days. Dr. Miller was not a self-promoter, and although he conducted valid and respected research, his aim was not to market or “package” his work; rather, it was his life’s mission to “help these children come alive!”
The Miller Method is a developmental theory, recognizing three stages of development. These stages span 0 months to 5 years, and beyond. In these stages, a child is first dominated by the effect of stimuli on his body .He then begins to differentiate his body from the world as he initiates actions and utterances (0 to 18 months). He is then able to represent his body as a coherent entity with all body parts and can name the parts. He can use names to represent objects (18 months to 5 years.) Finally he is able to represent reality, using symbols, which leads to the acquisition of reading, writing, drawing, and math skills (5 years and older).
Many of the adolescents I was working with had delays in their early development. Many were functioning at the early stage of pure involvement with their body. Others had a small amount of verbal language, while others had no language at all. And others appeared to have some potential for the later stage of symbolic development, as I saw with the “pipe tree.”
THE ELEVATED SQUARE
Dr. Miller created an ingenious way to help autistic children organize their bodies in space, which is a prerequisite for an integrated transition into the next developmental level—the Elevated Square. This square is a wooden structure 5’x 8’ around and stands 2.5’ above the ground. It is painted yellow and blue for visual saliency. The square consists of interchangeable sturdy blocks and boards which serve as a newly defined “reality” for these children.
Dr. Miller and his wife observed that when they “elevated” these children, toe walking decreased, focus, language and communication increased, and they were able to address other developmentally appropriate skills, such as tool use, coloring and writing. He called the square a “prosthesis,” with the eventual goal that the child could perform all tasks on the ground in the natural setting.
I was able to procure my own square when a former student of Dr. Miller’s no longer needed his. My husband and I rented a truck and traipsed to New Jersey from Baltimore (in the rain), hauling back the pieces which we dropped off at my school.
I then began my work with my “beloved square,” as Dr. Miller often quipped. I used it with my students who were relatively small in size. One student, MC, was twelve years old, non-verbal, with no eye contact. His hands either flapped, hung limply like a rag doll’s or churned inside his mouth.
My first goal was to help him gain body awareness and functional use of his hands. Since this child was able to make eye contact only when working on his back on the floor, that’s where we started. I used an integrated approach, combining Miller Method with Sensory Integration modalities.
On the square, we worked on his ability to establish eye contact with me, with an object, and then performing a simple sequenced activity. Soon, he was throwing cans into a bucket, handing me blocks, and going up and down the steps, aided by my verbalization and sign language.
These skills soon carried over into MC’s ability to feed himself (he was being fed by classroom staff). As I sat across the desk from him at lunch, he was able to look at me, the spoon/fork, and the food. We worked on his ability to put enough pressure on his fingers and hands to spear a soft sandwich square, or push a wooden skewer into a gummy bear. He was eye tracking the gummy bear as well, a skill which had been severely undeveloped. He soon was able to turn the knob on a door to open it, to the delight of myself and his classroom staff. MC finally had a physical awareness of his hands and was using them functionally.
Dr. Miller taught that these children do not have a sense of their own bodies or body boundaries. They seek “edge experiences”; the desire for pressure, squeezing, and climbing heights can be viewed as a compensation for this lack of body awareness. Occupational Therapists trained in Sensory Integration address this powerful need for pressure/compression in children and adults. Dr. Temple Grandin’s “squeeze machine” is great example of an intervention which she designed to address this issue. It provided body boundaries, bringing with it a profound sense of calming, security and “grounding.”
There is much renewed interest in the Miller Method these days, due to the lack of other methods to address autism in such a structured, yet deeply child- centered fashion. I recently attended a conference in Boston where two speech therapists with minimal English language skills had flown in from Korea. They were desperate to help autistic children in their clinics there. Two other attendees flew in from the Philippines, wanting to set up clinics there as well. Miller Method therapists are now in the US, Canada, Israel and Bahrain.
Although I am currently located in the U.S., thanks to Skype and videoconferencing, it is possible to consult from across the world. I am looking forward to being involved in ICare4Autism’s initiative: The Global Center for Autism, to be built on Mount Scopus in the next few years.
Although the amount of physical work involved in helping these children is enormous, I have found great satisfaction in every ounce of sweat produced during a session. I believe that that those of us who work with these children see their charm, personality, and uniqueness. The fact that these qualities are often hidden is the fuel which propels us further to keep looking for ways to reach them and for them to reach us.
“We have, at times, been able to enter the realities of disordered children and guide them into our own. We offer this theory so that others can do the same- not from a great emotional distance, but from touching range”
(From Ritual to Repertoire, Dr. Arnold Miller, PhD, 1989) “