CHRISTINE BUCKLEY ALEXIS HERSHKOWITZ NICOLE MOINHOS CALDWELL COLLEGE GRADUATE PROGRAMS IN APPLIED...
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Transcript of CHRISTINE BUCKLEY ALEXIS HERSHKOWITZ NICOLE MOINHOS CALDWELL COLLEGE GRADUATE PROGRAMS IN APPLIED...
CHRISTINE BUCKLEYALEXIS HERSHKOWITZ
NICOLE MOINHOS
CALDWELL COLLEGEGRADUATE PROGRAMS IN
APPLIED BEHAVIOR ANALYSIS
A Review of The Miller Method for Autism
Treatment
The Miller Method® Philosophy
“We maintain that each child--no matter how withdrawn or disorganized--is trying to find a way to cope with the world. Our task is to help that child use every capacity or fragment of capacity to achieve this.”
(www.millermethod.org)
History of The Miller Method®
Founded by Arnold Miller and wife Eileen Eller-Miller in 1965 Language and Cognitive Development Center (LCDC) in
Boston With the help of research and demonstration grants from the
U.S. Department of Education, the Millers have created a wide variety of strategies to help developmentally challenged children
Currently, center is being headed by Dr. Arnold Miller and his senior staff
Affiliate in Los Angeles, California called the Los Angeles Miller Method Resource Center (LAMMRC), directed by Rebecca Sperber (a parent)
LCDC is internationally known
Who are Dr. Arnold Miller & Eileen Eller-Miller?
Married for 45 years, together created The Miller Method® and founded the LCDC
Dr. Arnold Miller1. Director of the LCDC of Boston2. Affiliate Professor of Psychology at Clark University where he
received his doctorate in clinical psychology3. Research appointments at Boston University & Harvard Medical
School4. Was a faculty member of the University of Montana5. Directed the Language Development Laboratory at Wrentham State
School, Massachusetts Eileen Eller-Miller
1. Education Director of the LCDC2. M.A. in speech and language pathology from Columbia University3. B.A. in psychology from City University of New York4. Worked at Flower Fifth Avenue Hospital, Beth Abraham and Hunter
College in New York City
(www.millermethod.org)
The Millers (cont’d)
Eileen Eller-Miller passed away on June 18, 2004 from colon cancer
Her obituary read: “Eileen Eller-Miller, wife and colleague of Arnold Miller for 45 years, died on June 18, 2004 after a long and courageous battle with colon cancer. She died at home as she wished. Throughout her devastating illness she maintained her optimism and wish to help children with autism achieve a meaningful life. Just weeks before she died -- with barely enough strength to sit up -- she participated in a videoconference with Dr. Miller to help an autistic child and his family. Over the years she partnered with Arnold Miller in founding the Language and Cognitive Development Center and in developing the Miller Method. Before she died, she urged that her husband continue the mission of the Center. “
(www.millermethod.org)
Cost, Time, Location & Certification
Length of treatment varies
Fee: $150 per one hour session.
50% scholarships are available
Takes place in private and public schools in Massachusetts, New York, New Jersey, Ohio, Pennsylvania, California, Canada, Israel, and secondarily in the homes of families equipped for videoconferencing
Authorized Miller Method® School Programa. Certified Miller Method specialist or therapist on
staffb. Ongoing consultative relationship with a senior
staff member from LCDC
Certification (cont’d)
Appropriate candidates for certification1. Clinical/Developmental Psychologists2. Psychiatrists3. Social Workers4. Pediatric nurses5. Occupational therapists6. Physical therapists7. Special educators8. Speech and Language Pathologists
Several ways to train 1. 4-Day Workshops at LCDC2. Videoconference Workshops
Qualifications for certification1. 4-day training workshops at LCDC2. 50 weeks (1 hour per week) of supervised training3. Cases covered4. Written examination
Goals of The Miller Method®
Assess the adaptive significance of the children's disordered behavior
Transform disordered behavior into functional activity
Expand and guide the children from closed ways of being into social and communicative exchanges
Teach professionals and parents how to guide the children toward reading, writing, number concepts, symbolic play and meaningful inclusion within typical classrooms
(www.millermethod.org)
Problems with ABA according to The Miller Method®
ABA makes no assumptions about the sources of autism or the inner life of the child
Addresses the atypical behavior using the tools of the learning theory Reinforcing with rewards for desired behaviors (Ex. Food or
praise) Extinguish “unacceptable” behaviors with “time-out,” “turning
away,” or aversive procedures
Emphasis on compliance
Children seem to be acting appropriately but without any clue as to what they are doing.
Assume that if they can get a disordered child to behave like a typical child, then the child will be typical.
ABA vs. The Miller Method®
ABAChild remains seated
to learnTurning away from
acting out childrenDivert or extinguish
unacceptable behaviorEstablish compliance
with the help of rewards
The Miller Method®Learn best through
actionTurning towards and
engaging the acting out child
Transform unacceptable behavior into functional, interactive exchanges
Establishes repetitive rituals (systems) to elicit spontaneous initiatives from the children
Ritual Systems
Based on cognitive-developmental systems theory
MM works with systems
a. System: any organized behavior with an object or even that the child produces
b. Are directed, are organized, and lead to some outcome c. Viewed as organized “chunks” of behavior, perception, or thought d. Rituals are systems
a. Developed properly, can help a child move from atypical to more typical functioning
(Miller, A. & Chretien, K., 2007)
4 Types of Systems
1. Body systems: Coordinate sensory capacities with motor capacities in the service of a particular function.
2. Social systems: How two people interact with each other, whether by working together, turn-taking, competing, or bonding
3. Communication systems: The integration of words and actions around objects in relation to another person
4. Symbolic systems: The way in which a child organizes the relation between symbols and what they represent
(Miller, A. & Chretien, K., 2007)
Order and Disorder
Order: Predictable systems Disorder: Disruption of systems Two types of Disorder in children with autism
1. System-forming disorder: Children with autism who are quite scattered and have trouble ordering (systematizing) and making sense of their immediate surroundings and the people in it.
2. Closed system disorders: Children with autism who become over-preoccupied with routines (systems) and objects to the exclusion of people
Develop daily routines (ritual systems) in therapy and in school sessions
By developing ritual systems, the child can cope with disorder and change and is open to explore environment
Three Types of Disorder
1. Mild disorder: Evident when the teacher or therapist expands a system by changing the location of the object, the person involved in the system, the objects used in the system, or the position with which the child deals with the object.
2. Moderate disorder: The interruption of systems in a way in which induces a compensatory reaction on the child’s part to maintain the system
3. Dramatic disruptions: A strategy used in which the teacher messes up or dramatically changes something in a child daily routine
(Miller, A. & Chretien, K., 2007)
Characteristics of Systems
Once a system has been constructed, each system tends to maintain its reason
Differ from each other1. Rigidity: How urgent the child’s need is to
maintain a system unchanged 2. Complexity: Whether the system is simple (a
minisystem) or more complex (an integrative system)
3. Distance reality: Extent to which children substitute symbols for direct physical contact with a person, object, or event
(Miller, A. & Chretien, K., 2007)
Capacity
A search for the kinds of systems a child brings to a situation
Need to know to what extent a child is dominated by his/her systems
Need to know about the relative rigidity of these systems, their complexity, and the extent to which they can be altered
Assess the child’s relative emphasis on whether the child is engaged exclusively with action-object systems, with people systems, or with both
Assessment Test/Questionnaires1. Miller Diagnostics Survey (MDS)2. Miller Umwelt Assessment Scale
Miller Diagnostics Survey (MDS)
Questionnaire filled out by parents Assesses the child’s atypical functioning Establishes a ratio between a child’s overall
performance and his/her atypical functioning Produces a coping score which reflects the
extent to which a child’s performance is adversely affected by atypical functioning
Area covered by the MDS questionnaire1. Sensory reactivity2. Body organization3. Problem solving and tool use4. Communication5. Symbolic functioning
MDS: Unique Instrument
1. Organized developmentally in that each category includes specific questions about behaviors from both earlier and later stages of development, ranging from 18 months to about 7 yrs of age
2. Parents’ responses to MDS questions provide an estimate of the child’s functional capacities as well as an estimate of how atypical the child’s behavior is
3. Presents 107 questions which cover a broad range of functioning. To be completed by parents at the beginning and end of the academic year (gap between responses of 10 to 12 months)
MDS: Unique Instrument(cont’d)
4. Parents or caregivers who live with the child are continuously more fully aware of the child’s capacities and challenges
5. When gains which are first generated in school or clinic become apparent at home, this demonstrates that new learning has been generalized by the child beyond the confines of school and clinic
6. Probing questions which are part of the MDS may have positive effect of helping parents look more closely at exactly what the child can or cannot do
More about the MDS
Once a parent transmits her/his responses to the questions, a senior staff member at the LCDC will review them, construct a profile of your child, and send a report with recommendations.
Fee: $100
(www.millermethod.org)
Miller Umwelt Assessment Scale
Assessment of the child in which the child’s behavior is examined in unstructured, interactive, and structured situations
“Umwelt” coined by Uexküll (1957) - “world around the child” or world perceived through the child’s eyes
During the assessment, therapist is interested in determining how close a child is to achieving the next step in development which is determined by the additional cues a child might require for success
Seek to determine the child’s emotional resourcefulness in initiating and maintaining ongoing interactive systems with adults in the manner described by Greenspan. (Miller, A. & Chretien, K.,
2007)
Miller Umwelt Assessment Scale(cont’d)
At the end of the 2-hour session, the parent receives an oral summary of findings and a videotaped copy of the assessment.
A detailed report with recommendations is sent within 2-3 weeks.
Fee: $1,000
(www.millermethod.org)
Assessment
Miller Umwelt Assessment ScaleMiller Diagnostic Survey
Parent Survey Teacher/Instructor Survey
Umwelt Assessment
Coined by von Uexkull (1957) meaning “world around the child”
Components Parent Examiner Step slide Climbing equipment A soccer ball Large plastic container Large red ball suspended on a rope from the ceiling to
the child’s eye level Box of wooden blocks under the slide
Umwelt Assessment (cont’d)
Test measures 16 different tasksLooking for child’s capacity in:
Interation with people and objects Adapting to change Learn from experience “Testing the limits” to see their “zone of proximal
development.” Child’s emotional resourcefulness initiating and
maintaining ongoing interactive systems with adults.
Umwelt Assessment (cont’d)
First unstructured section to see what the child will interact with on his/her own Normal development: play with everything Autistic: run in circles, back and forth, etc.
16 tasks are all targeted for different components and to assess for closed or system forming disorders
Major Components
Suspended Ball Task Type A- child-object-adult Type B- child object = closed systems Type C- No object = system forming Goal: Interaction with person and object
Cups and bowls activity Stacking cups and bowls in different ways Goal: Adapting to change
Major Components (cont’d)
“Swiss Cheese” Board Avoidance of holes on Elevated Board 2.5 feet in air Goal: Awareness of space and body and ability to learn
from experience
“Croupier” Task Rake- Obstacle Goal: Problem solving ability and to learn from
experience
Contrasting Children with Closed-System and System-Forming Disorders
Disorder Type A Type B
Closed System •Minimal executivefunctioning and few systems•Poor shifting/scanning•People excluded fromsystems
•Executive functioning with many object systems•Ability to shift from one to another system•People excluded fromsystems
System Forming •Minimal executivefunctioning•Poor sensory-motorcoordination •limits system forming
• Little executive functioning•Salient properties of many sources induce repeated orienting, but not engagement
Use of Systems
Each system is a set of behaviors that accomplishes something (whether social or for self)
Interruption of Systems= language opportunity
3 Steps to Restore Typical Developmental Progressions
First Set of Interventions Systematic Body Work
Second Set of Interventions Transformation of aberrent systems
Third Set of Interventions Systematic and repetitive introduction of
developmentally relevant activities
Strategies for Applying The Miller Method
Elevated SquareTransforming Systems
Take pre-existing abberent systems and transform to more functional systems
Creating Systems Fill in developmental gaps
Inclusion PrincipleExtension Principle
Orienting, Engaging, and System Formation
Having child look at stimuliChildren may have aberrant behaviors that
distract from orienting Child then must have contact--physical or
emotional--with the person or object to create systems
Repetitive engagements are needed to create systems
Then, interruption of the newly acquired system creates language opportunities
The Elevated Square
2 ½ feet above ground and a 5 foot by 8 foot structure
Colorful and main focus of the room
Purpose of Elevated Squares
“Word Deafness” Spoken words not relevant to what is engaging them
at the moment
Solution: Enhanced reality by elevating children on the
Elevated Square so they can hear the words and focus on the manual gestures
Components
SquareWork stations in each cornerRemovable piece to make U-shaped structure
and be able to have instructor in the middleObstaclesSlide that can be removable
Reasons for the Elevated Square
Undefined reality to highly definedBody awarenessConstraint on child’s actions“Edge Experience”Eye contact leveled
Purpose for system disorders for the Elevated Square
Systems-Forming disorders External organization
Closed Systems disorders Framework taught to expand their systems
Andrew on the Elevated Square
www.millermethod.org
Transforming Systems
Find ways to channel energy used by children with autism to maintain their rituals into systems that are flexible and interactive
Autistic Systems e.g. Rocking, flapping, dropping things
1. Assess the casual dynamic that captures the child 2. Find a way to cast that dynamic as part of an
interactive and flexible system
But How?
Rocking Have child sit facing you Imitate rocking with child and maintain eye contact When child starts to anticipate, STOP! When child tries to communicate that they want to
rock again using direct eye contact and some rocking, begin again
Repeat game 10-12 times
But How? (cont’d)
Flapping Give child symbols for a more functional system Extend the system using other objects like sand blocks
Repetitive Dropping or Throwing things Have child throw things in different directions and
into different containers to “finish the experiment” Extend the system with different objects or containers
Goals: Get into what the child is doing Make it interactive Then, extend to a better functional skill
Creating Systems
Filling in developmental gaps or lagsAcceptable to use Hand over Hand (H.O.H.)
to first teach skillSpheres or Spheric ActivityBlock examples
Closed System Disorder System-Forming Disorder
Repetition and a gradual “taking over” or conversation of sphere into a system by child
The Inclusion Principle
Introducing new parts to the system Object/ Person Word Gesture
Assimilating new parts to the system Verbal prompt= child searches for other aspects
Extension Principle
Child learns a new property or aspect of a system Incorporates the newly extended system into the
original system
Plays an important role in the language system of spoken words to written words in the Symbol Accentuation Reading Program
Extending to Social Capacity
Play Games e.g. I’m going to get you, Peek a Boo, and Hide and
Seek
Mother-Child BondGrand Central Station4 interaction skills
Turn-taking Cooperating Competing Shifting to the other’s perspective
Communication
Extending System principles Uses Hand over Hand with words and a reinforcer
Come Example
Education
Building self/body awareness will lead to education
Uses same creating systems strategy
Support Systems
Parent/Instructor relationship to childFour different kinds:
High Support/Low Demand High Demand/Low Support Low Demand/Low Support High Support/High Demand ***
Angela
One of a few known “successful” casesBeautiful, blonde 5 year old from Toronto Umwelt Informal Assessment
2 parts of systematic behavior done while she was in Toronto Putting discs in a slit and was able to adapt to change Balloon blowing up and she made a social interaction by
pursing lips and moving forward
Parents decided to enroll Angela in Boston
Angela (cont’d)
Umwelt Assessment Ball Task- Level B Step-Slide Task (Step-Slide System)
Climb up the steps, sit down, hitch forward, go down, and return to steps
Created system quickly but would stomp feet at the top and threw blocks down the slide
Spontaneous expansion!! “Croupier” Task
Did an excellent job of adapting Cup-Bowl Task
Reverted halfway through putting cup into bowls Angela put her head down and turned toward the wall
But she showed social intention when Dr. Miller turned her head (she had an “impish” smile which showed she had a lot of promise!)
Angela (cont’d)
Umwelt Assessment (cont’d) Symbolic doll task
Imitate the instructor by feeding a baby doll a bottle then putting to bed
Angela added taking off all the doll’s clothes and inspecting the doll, then imitating the instructor
Mother-Child Bond Mother leaves room by saying, “Bye, Bye” and examiner
observes child’s reaction Angela ran over to mom when as she was leaving and
pulled her back into the room exhibiting a great mother daughter bond – High demand/High Support
Angela’s Progress according to Mother
First Week- screamed and tantrumedSecond Week- first sign
After this, signs and communication efforts were progressing quickly. Angela signed come, go, plate, give, and cup.
1 month- spoke come, give, plate, and cup3 months and 3 weeks- requested and made
simple sentences1 year later- returned to learn how to read Able to sustain herself in a typical classroom…able
to read and write better than typical 6 year olds!
Research Relevant to the Miller Method
• Cook, C.E. (1998) The Miller Method: A case study illustrating use of the approach with children with autism in an interdisciplinary setting. Journal of Developmental and Learning Disorders, 2, 2, 231-264.
• Messier, L.P. (1970) Effects of Reading Instruction by Symbol Accentuation on Disadvantaged Children. Unpublished doctoral dissertation, Boston University.
• Miller, A. (1968) Symbol Accentuation: Outgrowth of Theory and Experiment. In Proceedings of the First International Congress for the Scientific Study of Mental Deficiency, Montpelier, France, 766-772, Surrey, England: Michael Jackson.
• Miller, A. (1991) Cognitive-developmental systems theory in pervasive developmental disorder. Psychiatric Clinics of North America, 14, 1, 141-161.
• Miller, A. & Miller, E.E. (1968) Symbol Accentuation: The perceptual transfer of meaning from spoken to written words. American Journal of Mental Deficiency, 73, 1, 200-208.
More Research
Miller, A. & Miller, E. E. (1971) Symbol Accentuation, single-track functioning, and early reading. American Journal of Mental Deficiency, 76, 1, 110-117.
Miller, A. & Miller, E. E. (1973) Cognitive-developmental training with elevated boards and sign language. Journal of Autism and Childhood Schizophrenia, 3, 1, 65-85.
Warr-Leeper, G., Henry, S., Versteegh, T. Outcome Study: (1997) The Effect of the Miller Method on Five Severely Disordered Children with Pervasive Developmental or Communication Disorders. Unpublished Honors Study, University of Western Ontario.
Problems with References
Some references are unpublished dissertations/honors studies
Much of the “research” is dated (i.e. most is from the 1960s-1970s)
Not readily accessible to the public (i.e. consumers of treatments for autism)
Few references are empirical in nature
Why Study Cognitive-Developmental Systems?
• The Miller Method is based on a “cognitive-developmental systems” approach
• Helps us better understand typical versus atypical patterns of growth, change, and stability across the life spans of people with and without autism
(www.millermethod.org)
More about Cognitive-Developmental Systems
Assumes that typical development depends on formation of systems
Becoming aware of the distinction between themselves and their surroundings, systems (previously triggered only by salient properties of environment) gradually come under their control
Systems are then combined in new ways leading to problem solving, social exchanges, and communication with themselves and others about the world
(www.millermethod.org)
Cognitive-Developmental Systems Theory in Pervasive Developmental Disorders (Abstract)
• The concept of reality systems is introduced in context of cognitive-developmental systems theory. Examination of the parallels between the reality systems of normal infants and those of children with pervasive developmental disorders supports the view that the latter are stalled at an early stage of development. Evaluation of pervasively disordered children with closed-system and system-forming disorders indicates the aberrant manner in which such children orient toward and engage objects and events, a manner that precludes flexible adaptation to people or surroundings. Attention is given the role of interruption as it triggers a compensatory reaction to maintain systems and the contribution of such reactions in developing the intentional behavior so lacking in children with pervasive developmental disorders. Finally, the author discusses theory-driven strategies to correct deficits in the body schema, coping with surroundings, social development, and communication and representation.
Cognitive-Developmental Systems Theory in Pervasive Developmental Disorders
This is an information-only article; no experiment was performed
Author’s terms are subjectiveRestates previously stated information
Cognitive-Developmental Training with Elevated Boards and Sign Language
• “To test the relevance of this approach, elevated board-sign language procedures were applied with 19 intransigent, nonverbal, autistic children in several institutions at which we were consulting. Children who previously could not follow spoken language directions could do so when signs were paired with spoken words, and particularly when these signs and words were taught in the context of elevated board structures.”
(Miller, A. & Chretien, K., 2007)
Cognitive-Developmental Training with Elevated Boards and Sign Language
Is experimental in natureBut, article is difficult to obtain…Replication?
Significance of Elevated Boards
Miller observed a “dramatic change in behavior” when children stepped on planks between tables
“Edge experience:” Heightened awareness and increase in attention
Words paired with obstacles , generalization to other settings
However, Miller also says…
Range of concepts to be taught was limited Children seemed to turn vital involvement
into rituals (stereotypy)Continued to perform tasks, but
automatically and without alertnessWas it worth it, then?
Symbol Accentuation
Miller developed this technique as a reading program and has written 2 articles on it
Teaches symbolic function of printed words via object-word pairing
Eventually helps children understand that words can be meaningful without resembling their objects
(www.millermethod.org)
Symbol Accentuation (cont’d)
Helps children learn how to sight-read sentences in both large and small type (generalization)
Helps children shift from sight-reading to phonetic reading
Helps children develop letter-sounds relationships and blending and sequencing of letter sounds into meaningful words
Encourages active participation by both students and teachers
(www.millermethod.org)
Symbol Accentuation, Single-Track Functioning, and Early Reading
(Abstract)
“Accentuated conditions, during which animated motion pictures of objects blended into their customary printed words, was found more effective than the conventional look-say presentation of objects and words in teaching retarded persons to read.”
Looks (and sounds) a lot like stimulus shaping!
More on Symbol Accenuation
• “In a series of experiments, it was demonstrated that transfers could be made with children and adults who were able to speak but could not identify printed words. If pictures and printed words were fused on one side of a flash card, and that flash card was flipped to the other side revealing the word in its conventional form, children could transfer picture properties to printed words. Then, subsequently, they could identify the printed words without needing further transfers.”
(Miller, A. & Chretien, K., 2007)
Miller’s Research
More publications on symbol accentuation and signing than elevated boards (unique to Miller Method)
Earlier publications about other topicsField of interest is a bit broad for an “expert”
Conclusions
Dr. Miller is a clinical psychologist who did some post doctoral work in language development, but does that make him qualified?
Assessments are very subjective and no empirical data are used
Further research is needed: Elevated Square Methodology
Conclusions (cont’d)
The Miller Method is pseudoscience! Lots of subjectivity (no objectives defined) Poor research techniques Correlation does not equal causation! Did experimenters control for variables in
empirical studies? Claims to be effective for a wide variety of
disorders Area of expertise?
Lastly…
“The ‘innovative’ Miller Method has been around for 35 years, yet according to this report, it is not well-known outside their local area. Given that there are so few effective treatments for autism, one would think that this Miller Method would be quite well-known outside of their community if it demonstrates effectiveness. Effective treatments for autism don't stay hidden for very long, let alone 35 years. Also, according to this report, Miller assets that the Miller Method is not a behavioral-oriented program. But by the description given, it can only be just that. Like Stanley Greenspan's DIR Model and Barry Kaufman's Options Therapy, the Miller Method, while denying it, appears to indeed use behavioral principles, but intuitively (rather than consciously and scientifically as in Applied Behavior Analysis). Science and intuition have their respective places in evaluating program consistency and effectiveness. Choose carefully.”
(www.best-pals.org/a_med_miller1.html)
Questions?
References
Cook, C.E. (1998) The Miller Method: A case study illustrating use of the approach with children with autism in an interdisciplinary setting. Journal of Developmental and Learning Disorders, 2, 2, 231-264.
Kyle Westphal Foundation (2005). The miller method. Retrieved June 2, 2008, from Kyle’s TreehouseWebsite: http://www.kylestreehouse.org/The_Miller_Method.cfm?dp=1.
Messier, L.P. (1970) Effects of Reading Instruction by Symbol Accentuation on Disadvantaged Children. Unpublished doctoral dissertation, Boston University.
Miller, A. (1968) Symbol Accentuation: Outgrowth of Theory and Experiment. In Proceedings of the First International Congress for the Scientific Study of Mental Deficiency, Montpelier, France, 766-772, Surrey, England: Michael Jackson.
Miller, A. (1991) Cognitive-developmental systems theory in pervasive developmental disorder. Psychiatric Clinics of North America, 14, 1, 141-161.
Miller, A. (1996). The miller method. Retrieved June 2, 2008, from The Language and Cognitive Development Center (LCDC). Website: www.millermethod.org.
Miller, A., & Chretien, K., (2007). The Miller Method: Developing the capacities of children on the autism spectrum. Philadelphia, Pa: Jessica Kingsley Publishers.
Miller, A. & Miller, E.E. (1968) Symbol Accentuation: The perceptual transfer of meaning from spoken to written words. American Journal of Mental Deficiency, 73, 1, 200-208.
Miller, A. & Miller, E. E. (1971) Symbol Accentuation, single-track functioning, and early reading. American Journal of Mental Deficiency, 76, 1, 110-117.
References
Miller, A. & Miller, E. E. (1973) Cognitive-developmental training with elevated boards and sign language. Journal of Autism and Childhood Schizophrenia, 3, 1, 65-85.
Miller, A., & Eller-Miller, E. (1989). From Ritual to Repertoire: A cognitive-developmental systems approach with behavior-disordered children. New York: Wiley and Sons.
Pediatric Services (2008). A Look at the Miller Method: A Cognitive-Developmental Systems Approach to Therapy for Children on the Autism Spectrum. Retrieved June 7, 2008, from B.E.S.T. P.A.L.S. website: http://www.best-pals.org/a_med_miller1.html.
Warr-Leeper, G., Henry, S., Versteegh, T. Outcome Study: (1997) The Effect of the Miller Method on Five Severely Disordered Children with Pervasive Developmental or Communication Disorders. Unpublished Honors Study, University of Western Ontario.