Greenspan's
Floor Time approach is unstructured in that the therapist waits for the
child's lead before attempting to build on it with "circles of
communication." While also exploiting the child's leads, the Miller
Method, in addition , introduces a specific program to directly address
developmental lags. For example, if a child has never gone through the
9-11 month old stage of "experimentally" dropping things to learn how
they fall, a Miller Method therapist may deliberately introduce a
dropping system by showing the child how to drop things so that they
land with a satisfying "clunk" in a pan and will then shift that pan so
that the child learns to drop in different locations and with different
people...The Miller Method also structures the children's behavior with
the help of elevated structures such as the Elevated Square in a way
that helps "scattered" children focus more effectively. For other
differences see our book From Ritual to Repertoire or our chapter in
the ICDL Guide to Clinical Practice edited by Greenspan and Weider and
available next month (November, 2000). We
have seen far too many children with autism utter spoken words
perfectly or even seem to "read" complex sentences and yet totally lack
understanding of what they are saying or reading, to accept the "duck"
analogy. In other words, like the walking and quacking ducks that turn
out to be decoys, these children may seem to be communicating or
getting meaning from printed words, but really are not. Being
able to say the words correctly is one part of the job. But, only when
the child truly understands everything that he or she says or reads --
and can demonstrate that understanding -- does the child have a
foundation on which to advance cognitively and academically. Such
progress is a major goal of the Miller Method. First,
there is no certainty that the child associates the time out with his
or her previous unacceptable behavior. Second, given the fact that a
major aspect of autism is the child's difficulty making human contact,
it is difficult to see how placing a child in a time out room does
anything but support the child's disposition toward autistic withdrawl. When
one tells a child that he or she is climbing, jumping, peddling his or
her bike, and so forth, those narrated words provide the child with a
chance to relate the words he or she hears to what he or she is doing.
This develops receptive language and can lead to the child learning to
talk to himself or herself - a necessary prelude to being able to
communicate with others. Perhaps
the only good thing about saying "Good job!" is the positive feeling
conveyed by teacher or therapist through the voice. However, this same
positive feeling can easily be conveyed while narrating with pleasure
the behavior the child is performing. So I would recommend trying the following:
Get
all kinds of balls - big ones, little ones, red, green and yellow,
soft, hard, heavy, light - then set up different locations so the
little balls go in one place, the big ones in another place. Then
-- before he gets bored with this sorting task -- start pelting him
with the light (nerf) balls to start a ball interaction (like a snow
ball fight). where you pelt him, he pelts you. Perhaps you get his
father or another sibling to help him pelt you with the balls.
Periodically duck behind some furniture so he can't see you then
suddenly reappear and pelt him again. If he ducks down wait until he
pops up then get him again. See if he will try to get you as you
move from one hiding place to another.. After
a time (when you judge he's had enough excitement) tell him its time to
put the balls away. Then, sing the "Clean up!" song as you point
to the different balls all over the room and guide him toward dropping
them in their proper location. If, at that point, he wants to
take a couple of balls with him as he prepares for bed, that's
fine. I'm
sure that as you follow this line of thinking you'll find other
productive ways of turning his "obsession" into important interactive
play that will prepare him for playing with other children. A.M.
We
are also able to vary the child's rituals (or systems as we call them)
so that they become less and less like rituals and more like typical
functioning. We expand them bit by bit, involve different people in
them so they are no longer solitary and we can interrupt them in a way
which induces the child to produce words, signs or actions indicating
his or her need to maintain the ritual. So, far from adding to the
child's autism, the systematic use of rituals (systems) turns out to be
a powerful way of helping children on the spectrum begin to move beyond
rituals to function more appropriately with people. For
further information on how the Miller Method works with rituals, read
our book "From Ritual to Repertoire" published by John Wiley and Sons
and available from www.cognitivedesigns.com In
other words, the meaning of the signs had transferred to the spoken
words in a way that made heard spoken words meaningful. Also, for a
certain number of children, the use of manual signs seems to "pull"
spoken language. For these children - as for typical children - the
manual signs are an important transition to functional spoken language. Further,
we have found that a number of children who toe-walk on the ground walk
completely flat-footed when elevated. We are gratified to find that
there are now dozens of Centers using elevation around the country and
in other countries. Currently,
a comprehensive controlled study contrasting the effect of functioning
while elevated with comparable functioning on the ground is under way
at the Language and Cognitive Development Center in Boston.
One
way to do this is to set up a picture sequence showing him going on the
bus, going to school on the bus, getting off to go to school, being in
preschool with his teacher, then leaving teacher and school to go on
the bus, getting off the bus to be happily greeted by you. You should
have one of these sequences and his teacher the other so you can work
the going to school on the bus while the teacher can workgoing home to
you on the bus. Another
thing that might help is giving him some item that he associates with
you to take with him on the bus ( a kerchief, a pin, etc) . At
school the teacher can give him something from school to take
home. To further help him connect these two parts of his life it
would help to have a large picture of his teacher at home (so you can
call his attention to it) and a large picture of you at school so
that his teacher can refer to your picture (and your continued
existence) even when you are not physically present. A.M.
If she
doesn't understand letter-sounds it is possible that she can be taught
to write her name in a rote manner if she can repeatedly copy a model
or trace a template of her name. Then, if you place a picture of her
next to her tracing and keep telling her that both the picture and the
written name refer to her, she may eventually relate the written form
of her name to herself and recognize it. To further strengthen the
relationship between her writing her name and herself, each time she
writes her name, say it and help her pat her chest.
If she has
trouble with the forming of the letters you might first try having her
make the letters in a clay pan with a stylus. The resistance from the
clay may make it easier for her to form the letters. You might recall my comment during the videoconference to the effect that to
communicate intentionally (and not just under emotional stress) the child
must become consistently more aware of him or herself and the other person.
When your child's usual way of being is interrupted (he is led away from his
mom, he suffers a very painful injury) the emotional impact may help your
chld become more aware of himself and others and may, therefore, allow him to
express himself under these conditions while he cannot do so under ordinary
circumstances.
This suggests that if we can help children like your son develop greater
ongoing awareness of himself in relation to others then he might well reach a
point where he can communicate without first having to be emotionally
stressed.
The Miller Method includes a variety of strategies -- such as the Elevated
Square, "rough and tumble" activity, narration of the child's behavior,
setting-up"Can Do!" Picture Boards -- that are designed to help the special
child build the better defined self-other relationships which favor
spontaneous communication. We
also recommend pushing the swing in such a way that it makes different
trajectories which provide the child with a varied body experience.
Then, unexpectedly, we recommend interrupting the swinging (holding the
swing) to determine if the child can in some way indicate a need for
the swinging to continue. Swinging
the child in a blanket or parachute is also part of the "rough and
tumble" activity (carefully adjusted to each child's sensitivities) we
recommend prior to involving the child in more structured activity. Our
clinical experience is that the experience of swinging helps "ground"
the child but I am not aware of specific research related to the effect
of swinging per se.
1.
Videoconferencing... This allows senior staff at the Language and
Cognitive Development Center (LCDC) in Boston to see, hear, answer
questions and guide the work done with a special child hundreds or even
thousands of miles away.
2. Phone
consultation... This method supplemented by videotapes of work being
done with a special child and sent to LCDC for review and
recommendations is also effective.
3. Internet
consultation... This newest method allows a regular exchange of
questions and answers between parent and senior staff in a private
Interactive Chat Room on the Center's website
If you are interested in any of these methods contact Drs. Arnold Miller or Paul Callahan at 1-800-218-5232. The Miller Method has developed interventions -- involving pairing spoken
words with directed body action and gesture -- to cope with "word deafness."
The Method also introduces strategies to enhance self-other awareness.
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