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LCDC Workshop Videotapes
Edited from workshops conducted at the Language and Cognitive Development Center

Comparing Behavior Modification with the Cognitive-Developmental Systems Approach
Arnold Miller, Ph.D., Executive Director, Language and Cognitive Development Center of Boston Affiliate Professor of Psychology, Clark University

How best to help autistic and other children with pervasive developmental disorders?

How we view the unusual behaviors they show... twiddling, stereotypic actions with objects...has major implications for how we go about trying to help them. For example, if we view such aberrant behaviors as asocial or "bad" then we follow the path of the behaviorists who try to make the children look as normal as possible by having them sit quietly in their seats like typical children. But, if we view their unusual behaviors as evidence that they are stalled at an earlier stage of development, we try as do proponents of the cognitive-developmental systems approach to expand and transform these behaviors into more functional contact with reality.

Dr. Miller demonstrates, in this lively presentation, how the different assumptions made by behaviorists and developmentalists, dictate dramatically different treatment approaches. Dr. Miller stresses the importance of helping the children progress in two ways: One, by attempting to expand their disordered systems (closed system or system-forming disorders) so that they can cope with objects and people more appropriately; and by introducing spheric sequences (repetitive activity involving an object or person) which can be used to guide the children into new relations with their surroundings and with others.

As part of the C-D systems approach, Dr. Miller indicates the importance of integrating lateral development (the ability to move around and cope with everyday objects and events) with vertical development (the ability to represent the world to oneself through signs, pictures and words). He finds both these goals notably lacking in the behavior modification approach which tends to assume, for example, that when a child uses spoken words he knows what he is saying. In contrast, in Dr. Miller's terms, "If it quacks, it may be a duck... or it may be a decoy. And the task of the C-D systems approach is to discern the difference and make certain that when there is a quack it really is coming from a duck."

Understanding Pervasive Developmental Disorders (PDD) from a Medical Perspective
Kathleen M. Braden, M.D., Director, Center for Children with Special Needs, Tufts New England Medical Center

Dr. Braden divides her informative presentation into three parts: Description of the disorders, predisposing factors and issues of differential diagnosis and medication.

In describing these disorders (autism and PDD), Dr. Braden considers their incidence in the population, severity, onset and course. She also considers three factors considered indispensable in making the diagnosis- developmental delays in language, absence of reciprocal social contact and absence of imaginative play. Her talk also includes reference to autistic and PDD symptomatology such as the presence of self stimulatory behavior, difficulties with transitions and preoccupation with objects.

In the second part of her talk, Dr. Braden considers various predisposing factors for these disorders. These include viral encephalitis, untreated metabolic disorders (PKU), acquired injury around birth (including anoxia), abnormalities of brain development, retrolental fibroplasia, genetic component, chromosomal abnormalities, infantile spasms, tuberous sclerosis, profound sensory deprivation. During this part she also considers the manner in which different portions of the brain may be implicated in these disorders.

During the third part of her talk, Dr. Braden discusses and answers questions related to the differential diagnosis between autism or pdd and retardation. She also considers the manner in which other disorders such as epilepsy, anxiety or depressive disorders may be associated with autism or pdd. Dr. Braden closes with reference to the manner in which various medications as well as vitamins and magnesium may have positive impact on some children with these disorders.

Helping the Child with Pervasive Developmental Disorder Cope in the "Here" and "Now"
Arnold Miller, Ph.D. Kristina Chrétien, M.A., Language and Cognitive Development Center of Boston

In this engaging two-part presentation, Arnold Miller and Kristina Chrétien consider the manner in which the cognitive-developmental systems approach guides the children into awareness of their bodies, of objects and into the skills necessary to navigate the space in which they live.

Dr. Miller begins with a discussion of how individuation occurs in normal children and how this individuation fails to occur with autistic and pdd children. He describes the apraxia evident among the children because they lack awareness of their body parts in relation to their immediate surroundings. He then considers how various strategies-- "rough and tumble" and the use of elevated structures--brings children into better contact with their own bodies and with others. In the course of his talk he refers to the work of Mahler, Schilder, Sacks and others.

An integral part of the talk includes consideration of the distinction between children with "closed system disorders" and those with "system forming disorders." He also considers the strategies of developing body, object and people awareness through the use of "minispheres" and "integrative spheres." To cope with the children's problem of shifting from one engaging object or event to another Dr. Miller describes the use of "multispheres." He also considers the application of these procedures to help the children develop more flexible thinking patterns.

In her presentation, Ms. Chrétien demonstrates the application of the principles which Dr. Miller described. She used various treatment strategies in her work with an autistic child so fascinated with lines that he could not attend to other things in his surroundings. Ms. Chrétien's work is illustrated by video excerpts from the files of the Language and Cognitive Development Center.

Video Documentaries

Edge of Awareness
Edge of Awareness was selected for showing at annual conventions of the National Society for Autistic Children, the American Psychological Association, and the American Speech and Hearing Association. In addition, it has won commendation from the American Psychological Foundation, and an award from the National Association of Mental Health.

The autistic and aphasic children in this film live on the edge of awareness. To cross this edge, they must learn that they exist, that they have control of their bodies, and that what they do can have an impact on others. Only when they have this understanding, do they have a basis for communicating through signs and spoken language with those who care for them.

Dr. Arnold Miller, psychologist, and Eileen Eller Miller, speech therapist, have developed new procedures for helping autistic and aphasic children emerge from their isolation. The husband-wife team working in their Language and Cognitive Development Center in Boston are effectively using an intensive combination of sign language (adapted from the American Sign Language for the Deaf) body awareness courses, and language training films with many so-called "hopeless" children. The Millers have found that many mute children who are unable to either understand language or communicate can begin to do so with manual signs when these signs are used in context of carefully constructed body awareness courses.

As the film opens, the viewer meets each child and notes the aimless, repetitive behavior so characteristic of autism. The viewer then follows staff and children as they engage in orienting strategies (tickling, rough and tumble, and group games) designed to help the children relate pleasurably to the staff and to each other.

Before introducing signs, the Millers first help children develop a heightened awareness of their bodies by taking them through a demanding body awareness course. This course consists of connected wooden boards elevated from 3 to 6 feet above the ground. Situations constructed on the boards include doors that have to be opened, bridges that have to be crossed, drawbridges that have to be lowered, gaps at which the child must stop and positions from which the child must slide down , push-pull, pick-up something and jump. The Millers refer to such sequences as body awareness courses because a child cannot solve the course unless he attends to and becomes aware of his feet, hands, balance, and the accurate positioning of his body.

Background of the film:
In a published study* concerned with nineteen mute autistic children and adults ranging in age from 6 to 24 (median age 12), the Millers found that their cognitive training procedures induced marked increases in the ability to understand fifty language concepts. Equally important was their finding that some mute children who had never before initiated any kind of symbolic expression could indicate their needs for food, drink, their wish to open doors, etc. for the first time in their lives by using manual signs.

The Millers, in discussing these findings, caution that the use of signs does not necessarily imply that these children and others like them will learn to speak. However, establishing communication, whether vocal or manual, is of primary importance. Without such human contact, most mute autistic children tend to lapse into states in which they pass their days rocking back and forth and twiddling objects.

As a child solves the course, the Millers begin to introduce signs directly related to his experience of the course. For example, the spoken command, "Stop", is given with the manual sign (the edge of one palm meets the other to simulate a barrier), and both related to an obstacle the child suddenly confronts on the awareness course. Similarly, the word, "Come", and the sign (fingers beckon) are paired to help guide the child from one part of the course to another.

The varied problem situations built into the course encourage the children to initiate signs. A child poised five feet above the ground and wishing to get through a box enclosure with doors on each end must make the sign for "open" (hands part) before the teacher will open the door and let the child through. Once a child can respond to and use signs effectively above ground, the Millers teach him to generalize his understanding to lower levels and finally to everyday situations on the ground.

Training films carefully edited to accent the relationship between manual signs and their referents help extend the child's understanding of the function of signs. In these films, the manual sign is intercut with the object or event it signifies. For example, the sign for "jump" (two right fingers of the right hand jump off the left hand) is intercut with the image of a child jumping off a stool, and the sign for "break" (two hands simulate breaking something) readily blends on film with two hands actually breaking a stick. Similar film treatments of the manual signs for "eat", "drink", "fork", "knife", "spoon", "pour", "push", "pull", "drop" and many others help the child grasp the relationship between the manual sign and the object or event to which it refers. The Millers believe this film technique is so effective because many manual signs closely resemble their referent objects or actions in a way spoken words cannot.

The documentary shows all these concepts in practice, with children approaching, coping with and passing through the edge of awareness - a dramatic change in their lives- and into meaningful contact with the world around them.

Available in VHS or 3/4" U-Matic videocassette formats.

A Small Awakening
30 minutes, color

In this heartwarming videotape, the viewer follows Jack's progress over 30 months of treatment, from a profoundly disordered 2.7 year old nonverbal autistic boy unable to tolerate any change in his surroundings to a child able to play, compete and communicate both with his parents and other children.

The program opens in Jack's home; both parents describe their despair as they tried to cope with the dread diagnosis of early infantile autism and their fear of the future. Beyond this they struggle with Jack's prolonged tantrums and his inability to communicate. They describe how even moving a cup a millimeter could trigger a half-hour tantrum. The viewer sees and hears the father's pain as he talks about literally "not existing" for his son.

Jack's initial evaluation-- the first of many actual clinical session excerpts-- illustrates his total inability to cope with any demand; he collapses into screams as the examiner tries to work with him. Subsequent sessions highlight Jack's ferocious need to wrap his arms around any objects that catch his attention.

The therapist's methods to "wean" Jack from his objects-- to expand his systems-- are shown, as well as the manner in which he is taught to move from one object to another in a predictable way; how he simultaneously develops fine motor skills as he learns that he can move deliberately from one place to another. One interesting sequence shows how the therapist helps him develop problem solving skills by systematically disrupting his familiar systems of activity in a way which requires him to restore them to their former state.

The documentary also illustrates the methods used to develop JackŐs social skills. This occurs through various object exchanges (putting bracelets and necklaces on each other) and through "peekaboo" with therapist and mother. It details how Jack's father begins "to have a son" by engaging him in rough-and-tumble activities.

Jack's social development is also evident in his changing relationship with his older sister. Whereas previously she could take anything she wanted out of his hands because "he wasn't a person to her" the viewer sees him snatch paint brushes from her hands and her subsequent complaint.

The final section of the program portrays the manner in which Jack develops spoken language. The viewer notes the careful attention given to the development of prelinguistic skills such as pointing and discriminating between different objects. Finally there is the appearance of Jack's first spoken word, followed by his first sentences and his ability to communicate his wishes such as "Go for a ride in the car!"

The documentary closes with the family sitting together and reviewing all the things that Jack can now do...and their hope for a future in which Jack can take his place with other children.

From Ritual to Repertoire
30 minutes

Constructed from the clinical video files of children attending the Language and Cognitive Development Center, this videotape captures the application of cognitive-developmental (C-D) systems therapy with three children with very different problems.

Jennifer, a 3-year-old girl with PDD: her problems with body and behavior organization are so profound she routinely stumbles over furniture at home. The vignette shows how carefully planned collisions with objects placed in different locations on an elevated square finally enables her to learn how to move around them. It also shows her improved response in the course of a year's intervention mother's call "Come!", both on the elevated square, and on the ground.

John, a nonverbal 3-year-old boy with autism (closed system type): he is so heavily involved with objects that he shows little interest in people. He ignores mother's "Good-bye" as she disappears behind a door. The therapist must find a way to help John invest in his mother as much as he invests in objects. After a year of bringing mother into his object world, John's connection with her is again evaluated with dramatically different results.

Rachel, a nonverbal, autistic girl is shown from age 2.5 through 6 years at LCDC. In the beginning Rachel is unable to respond to her parents calling her and is unwilling to cope with big body tasks, such as walking across the Swiss Cheese board. In the course of 3.5 years of treatment we see Rachel begin to express feeling to anticipate outcomes, and to begin to use language. One interesting part shows how Rachel is taught to cope with her need to keep things the same by systematically interrupting her in various tasks that engage her. The segment ends with a much improved Rachel jubilantly "commanding" a class of children to clap their hands, stamp their feet and to laugh.

Where is Angela?
25 minutes
Videotaped on location at LCDC/Lynnfield

This charming and instructive video opens with voices singing "Where is Angela?...Where is Angela?" followed by a pause, then continuing, "There she is!" as Angela appears for the first time. She is a beautiful 4-year old, nonverbal girl diagnosed as having pervasive developmental disorder (PDD). The title and the song helps the viewer become aware that at first Angela does not know either where she is or who she is because she can neither understand nor use spoken words. This video documentary illustrates her dramatic progress toward achieving this understanding in the course of 4 months at the Language and Cognitive Development Center in Lynnfield, Massachusetts. First seen as a nonverbal, tantrumming child unable to tolerate change, the video shows the careful Umwelt Assessment conducted by the Millers and the manner in which the assessment leads to specific interventions both in her class and in individual therapy sessions.

After the assessment the viewer sees her classroom teacher using sign language with her on elevated structures both to teach her to respond to simple commands such as "Get up!" and "Jump!" as well as how to play symbolically with dolls. Following this, the viewer has an opportunity to see her working with tools to make a boat in a shop under the guidance of a cognitive-developmental therapist. It is delightful to watch her as she decides to quit working and begin to tease her therapist by smiling as she drops to the floor -- a vivid expression of her new capacity to assert her own individuality. Subsequently, she is seen in her class cooking a "make believe" breakfast with other children in her class. A later scene shows her laughing delightedly as she rides on mother's back and commands her with sign and word to "Go!" Mother obligingly does so but then deliberately collapses in a way which makes a giggling Angela get off and command her mother with sign and word to "Get up!" so that she can again climb on mother's back to continue her ride.

The documentary then shows Angela at home -- 3-months after leaving LCDC/Lynnfield -- mischievously letting her cat lick her ice cream cone and later asking for toys while she is in her bath. It ends with a brief report by Angela's mother as to the gains Angela made week by week during the almost 4 months she was at Lynnfield and how these gains changed not only Angela, but the lives of her entire family.

Come Back Jack
60 minutes
"Come Back Jack" is a video documentary showing the bumpy road a family went though as they sought help for their son, Jack Parish, who carries a diagnosis in the autism spectrum. The award-winning hour-long video shows Jack's early history, the Parish family's arrival at LCDC, the assessment of Jack by Dr. Arnold Miller and Jack's heart-warming progress under the guidance of Eileen Miller and her dedicated staff during his five-month stay. Through interviews with Jack's mother, Diane, the documentary also shows, in intimate detail, what his progress meant to his family.

Jack's father, Robert Parish, is a professional scriptwriter and filmmaker based in Cincinnati, Ohio. He followed his son's progress at LCDC with his camera and assembled the documentary. Recently, he reported tht "Come Back Jack" won two prestigious national awards, a Silver Telly and an "AXIEM," which stand for Aabsolute Excellence in Electronic Media...The video is of professional quality and, when purchased, may be shown to large audiences.

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