Theresa Smith - 101 Tips for Parents of Children with Autism: Effective Solutions for Everyday Challenges

Extract

The Miller Method

Developing the Capacities of Children on the Autism Spectrum

Arnold Miller

Kristina Chrtien

ISBN 978 1 84310 722 4

eISBN 978 1 84642 583 7

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 behaviorssuch as throwing or dropping things, opening and closing doors, or lining things upare 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 outcomeall 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 childs development. For children who show little or no organized systemseven maladaptive onesour 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 childs 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 childs 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 childs life. In this chapter I will describe systems as they appear in all areas of human functioningincluding social and communicationas well as their relevance for meltdowns. But first, lets 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 disorderwith 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 autismthose we refer to as having system-forming disordersare quite scattered and have trouble ordering (systematizing) and making sense of their immediate surroundings and the people in it. Another group of childrenreferred to as having closed system disordersbecome 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 importantbut 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 childrens 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 childrens 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 therapists 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