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ESSENCE Model

E-Executive Functioning

Student difficulties:
Working memory, task flexibility, problem-solving, planning ahead, organizational skills, inhibitory control, cognitive rigidity/lack of flexibility, goal-directed behavior.

Goals:
Set goals, plan ahead, organize, think ahead, see the whole picture, prioritize tasks, learn coping skills.

Methods:
Students will have a predictable, consistent, and reliable milieu. Students will learn to set academic, program, and clinical goals. Individual and group therapy will focus on helping students learn cognitive and behavioral skills to better plan, organize, think ahead, and solve problems. There is also a focus on staff directly working with students to learn these skills both on campus and off campus. Our psychiatric nurse practitioner, who specializes in working with ASD students, works carefully with each student to provide the most effective and evidence based care possible.

References:
1. Happé, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: Examining profiles across domains and ages. Brain and cognition, 61(1), 25-39.

http://www.sciencedirect.com/science/article/pii/S0278262606000698

2. Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2), 210-222.

http://www.psy-journal.com/article/S0165-1781%2808%2900052-8/abstract

S-Sensory

Student difficulties:
Heightened sense of smell and/or hearing, tendency to be distracted by sensory issues, feels distress with sensory overload, skin sensitivity, avoidance of certain situations or environments.

Goals:
Identify their sensory issues and clearly define them, set up a plan to learn to identify triggers associated with sensory stimulation and to put into place effective coping skills.

Methods:
We identify aspects of the academic, residential, and clinical environment that may trigger our students, and we work with each student individually on how to cope with those triggers. We also adapt the environment in certain situations to help ease certain sensory issues. Our clinicians use cognitive-behavioral techniques to help our students gain skills that will translate into real life situations.

References:
1. Myles, B. S., Hagiwara, T., Dunn, W., Rinner, L., Reese, M., Huggins, A., & Becker, S. (2004). Sensory issues in children with Asperger syndrome and autism. Education and Training in Developmental Disabilities, 39(4), 283-290.

http://daddcec.org/Portals/0/CEC/Autism_Disabilities/Research/Publications/Education_Training_Development_Disabilities/2004v39_Journals/ETDD_200412v39n4p283-290_Sensory_Issues_Children_With_Asperger_Syndrome_Autism.pdf

S-Self-Care

Student difficulties:
Lacks motivation to shower daily, put on deodorant, brush teeth, wear clean clothes, etc., low self-esteem, high stress levels.

Goals:
Increase self-awareness, do laundry on time and well, establish consistent hygiene habits, learn the cause and effect relationship associated with relationship success and personal hygiene. Improve self-esteem and lower stress and/or cope with stress more effectively.

Methods:
We coach and help students learn and apply healthy hygiene habits. We implement hygiene charts, do hygiene checks, and do one-on-one coaching with students. Students’ hygiene success is tracked and monitored by each shift. Work on self-esteem through success in school, with family, on the dorm, and in the community. CBT and DBT to learn to better manage and cope with stress.

References:
1. Bledsoe, R., Smith, B., & Simpson, R. L. (2003). Use of a social story intervention to improve mealtime skills of an adolescent with Asperger syndrome. Autism, 7(3), 289-295.

http://aut.sagepub.com/content/7/3/289.short

E-Emotion Regulation

Student difficulties:
Depression, anxiety, attention difficulties, irritability, low frustration tolerance, verbal outbursts, physical outbursts, tendency to withdraw and isolate.

Goals:
Learn cognitive-behavioral and DBT skills to help identify mood states and implement effective coping skills.

Methods:
Cognitive-behavioral therapy, adventure learning activities, medication management, individual and group therapy, skills coaching, daily exercise.

References:
1. Bachevalier, J., & Loveland, K. A. (2006). The orbitofrontal–amygdala circuit and self-regulation of social–emotional behavior in autism. Neuroscience & Biobehavioral Reviews, 30(1), 97-117.

http://www.sciencedirect.com/science/article/pii/S0149763405001193

N-Navigating Relationships

Student difficulties:
Initiating and maintaining healthy and meaningful relationships, lack of desire, lack of effective interpersonal skills, and lack of ability to read social cues.

Goals:
Learn the knowledge and practical skills necessary to initiate and maintain healthy interpersonal relationships.

Methods:
We use here-and-now interventions on the dorms, in school, and in therapy to work on the tools necessary to accomplish the goal of healthy relationships. We also use events and activities in the community to provide opportunities to practice relationship-building skills. Our students have many contexts in which to learn and practice relationship skills.

References:
1. Autism spectrum disorder and the student teacher relationship: A comparison study with peers with intellectual disability and typical development
March 2014
Jan Blacher | Erica Howell | Stacy Lauderdale-Littin | Florence D. DiGennaro Reed | Elizabeth A. Laugeson
http://www.journals.elsevier.com/research-in-autism-spectrum-disorders/recent-articles/

C-Communication

Student difficulties:
Understanding nonverbal components of language and communication, such as sarcasm, innuendo, body language, and tone, knowing how close to stand to others, how long to speak, how to have a reciprocal conversation and how to take turns in conversation.

Goals:
Learn and apply skills that may not come naturally but help to establish healthy and effective communication habits.

Methods:
We use individual and group therapy to work on specific issues related to social pragmatics. We use role play, rehearsal, and review to work on skills. We use here-and-now interventions to capture the essence of each moment.

References:
1. Koning, C., & Magill-Evans, J. (2001). Social and language skills in adolescent boys with Asperger syndrome. Autism, 5(1), 23-36.

http://aut.sagepub.com/content/5/1/23.short

2. Garfin, D. G., & Lord, C. A. T. H. E. R. I. N. E. (1986). Communication as a social problem in autism. Social behavior in autism, 237-261.

E-Empathy

Student difficulties:
Empathy, perspective, seeing the big picture, and theory of mind.

Goals:
Learn to take others’ opinions into consideration and to step back and look at different facets of the situation, learn to more effectively predict how they are being viewed by others and make needed adjustments.

Methods:
We work with students in all kinds of situations, both on campus and off campus, where these concepts naturally occur. We take frequent moments to pause where we process with students and ask them questions about what others might be feeling based on what was said or done and what others might be thinking about them. We work on helping the students see their own strengths and be patient with their imperfections.

References:
1. Lombardo, M. V., Barnes, J. L., Wheelwright, S. J., & Baron-Cohen, S. (2007). Self-referential cognition and empathy in autism. PLoS One, 2(9), e883.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000883
Evidence-based practices used with our boys on the Autism Spectrum:

  • Active listening
  • Chunking (breaking down tasks into more manageable parts)
  • Cognitive-behavior therapy (CBT)
  • Dialectical-behavior therapy (DBT)
  • Family-focused inventions
  • Family systems therapy
  • Functional communication training
  • Organizational support
  • Parent-implemented interventions
  • Predicting
  • Prompting
  • Psychopharmacology
  • Rehearsal
  • Reinforcement
  • Redirection
  • Reminding
  • Role play
  • Self-management
  • Social narratives
  • Social skills group
  • Staff mentoring and coaching
  • Task analysis
  • Time delay
  • Visual supports