Jacob* walked onto Open Sky’s base camp with a lot of optimism. He was 18 years old, hoping to go to college soon, and determined to address his autism spectrum disorder (ASD) symptoms that he had long ignored. Like many young people with ASD, Jacob struggled to make and keep friends, had a hard time with social nuance, was often emotionally dysregulated, struggled with breaks in his routine, and wasn’t taking good physical care of himself. Over the following months, Jacob worked in a group with both neurodiverse and neurotypical peers to build social skills, improve self-care, learn to better understand his thoughts and feelings, and grow in a way that prepared him to better launch into college.
Jacob’s team at Open Sky averaged eight co-ed students of a similar age, with about one third of them having some sort of neurodevelopment disorder like his. This diversity is critical to the treatment process at Open Sky. The National Autism Center (2015) suggests that two of the most effective ways to ameliorate social deficits for people on the spectrum is to model social behaviors, and to teach and practice scripting.
Modeling is the simple act of watching, practicing, and receiving feedback on social interactions. To accomplish this, Jacob would take an occasional morning or afternoon and sit away from the team with an ASD-trained staff member with the task of watching a specific social nuance, such as spacing, tone, or nonverbal communication. While watching his neurotypical peers, Jacob would take notes, ask questions, and then spend the rest of the week practicing what he saw. This worked wonders for Jacob and, as Bellini & Akullian (2007) show, was especially effective when learning new skills.
During therapy sessions, Jacob worked on learning new social scripts that could be helpful in initiating, deepening, and transitioning out of conversations. Scripts like this have shown to be effective ways to teach social skills (Bellini & Peters, 2008) for people with ASD. Neurotypical peers who excelled in socialization provided great role models and insightful feedback for Jacob throughout his stay. This diversity also allowed growth for everyone else in his team. People who worry about the negative impact of having such diversity in a treatment environment should seek out Asmus et al. (2017)’s work that shows how neurotypical people experience significant academic, social, and emotional growth when working with a neurodiverse peer. This reciprocal therapeutic relationship allowed for both Jacob and his peers to make tremendous strides.
In addition to Jacob’s significant social growth, he also worked diligently on his difficulties with mood regulation, anxiety, and negative thinking, all of which are common for people with ASD (Kerns et al., 2016). Cognitive behavioral therapy (CBT) has long been seen as an effective treatment modality for people with ASD (Wood et al., 2015, Reaven et al, 2012), and it also happens to be the foundation for the therapeutic workbook for all students at Open Sky. Jacob worked alongside his peers to disentangle his thoughts and feelings, practice coping skills, and consistently behave in a way that aligned with his values.
Additionally, it’s been shown that people with ASD can benefit from adapting CBT to incorporate their specific interests (Keefer, White, Vasa, and Reaven, 2018). Jacob loved hockey, and would consistently reference it in conversations, so together, we worked to incorporate hockey vocabulary into his therapeutic work. Instead of “cognitive distortions,” Jacob would work on “cognitive penalties.” Instead of “taking space” to practice a coping skill, he would “go to the penalty box” to practice a coping skill. This gave him ownership over the process and made him excited to “score a goal” by reframing his thoughts or regulating an emotion.
One of the most important parts of Jacob’s work was addressing his difficulties with transitions and disruptions to his routine. Open Sky uses a basecamp model where students spend four to five days on expedition and then return to an established and consistent basecamp for two to three days. Jacob started his stay at Open Sky by making a calendar so that he could prepare for this schedule and build routines around it. He could reference this calendar and rely on this routine whenever he felt out of control, which is something he reported as providing great comfort to him. This is especially important when considering that disruptions to routine for people with ASD can often result in confusion, uncertainty, and emotional outbursts (Helbert, 2013).
As the days and weeks went on, Jacob became more and more comfortable with ever larger changes to his routine and schedule, as he could always rely on going back to base camp with his personal comforts at the end of the week. This aspect of the Open Sky model allowed for plenty of challenge with the perfect amount of comfort and consistency.
Another piece of Jacob’s growth was rooted of the most basic tenets of the Open Sky model—healthy eating. Like many people with ASD (Berding & Donovan, 2018), Jacob avoided most all fresh fruit and vegetables prior to arriving at Open Sky. As he became more comfortable with those fresh items, he began to lose weight, feel more confident, and have more consistent energy. A recent study suggested that unhealthy eating can exacerbate ASD symptoms (Iglesias-Vázquez, Van Ginkel Riba, Arija, & Canals, 2020), so it is unsurprising that he experienced such symptom improvement as he took better care of his body.
While Jacob enjoyed taking care of his body and getting back into “hockey shape,” he had a harder time adapting to another of Open Sky’s foundational pieces—mindfulness. Open Sky students have been practicing mindfulness every day since 2006, and Jacob was not going to be an exception to that rule. He avoided it at first, complained about it second, but eventually gave it a try. And it’s a good thing that he did, because mindfulness helps people with ASD to reduce anxiety, depression, and ruminative thought, while also improving social responsiveness and emotional regulation (Cachia, Anderson, & Moore, 2016). Once Jacob was better able to calm his thoughts and practice mindfulness with his peers, it was clear that he was going to “score” a lot more “goals” for regulating his feelings, reframing negative thoughts, and socializing in a way he was proud of.
Jacob had gone his entire life without learning about his autism, building skills to manage it, and practicing them in a way that fostered long-term growth. It was only once he stepped into base camp at Open Sky that he was given an opportunity to make real, lasting change. Jacob experienced a diverse peer group to learn and practice with, an effective and tailored treatment model, a safe home-away-from-home at base camp, healthy living, and evidence-based practices while at Open Sky. He took these skills, and as he would say, skated with them all the way to the goal.
*Student’s name has been changed.
Resources
Asmus, J., Carter, E. W., Moss, C. K., Biggs, E. E., Bolt, D. M., Born, T. L.,…Wier, K. (2017). Efficacy and social validity of peer network interventions for high school students with severe disabilities. American Journal on Intellectual and Developmental Disabilities, 122(2), 118–137.
Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73, 264–287.
Bellini, S., & Peters, J. K. (2008). Social skills training for youth with autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 17, 857–873.
Berding, K., & Donovan, S. M. (2018). Diet can impact microbiota composition in children with autism spectrum disorder. Frontiers in neuroscience, 12, 515.
Cachia, R. L., Anderson, A., & Moore, D. W. (2016). Mindfulness in individuals with autism spectrum disorder: A systematic review and narrative analysis. Review Journal of Autism and Developmental Disorders, 3, 165-178.
Helbert, K. (2013). Finding your own way to grieve: A creative activity workbook for kids and teens on the autism spectrum. Philadelphia, PA: Jessica Kingsley Publishers.
Iglesias-Vázquez, L., Van Ginkel Riba, G., Arija, V., & Canals, J. (2020). Composition of gut microbiota in children with autism spectrum disorder: a systematic review and meta-analysis. Nutrients, 12(3), 792.
Kasari, C., Locke, J., Gulsrud, A., & Rotheram-Fuller, E. (2011). Social networks and friendships at school: Comparing children with and without autism. Journal of Autism and Developmental Disorders, 41, 533–544
Keefer, A., White, S. W., Vasa, R. A., & Reaven, J. (2018). Psychosocial interventions for internalizing disorders in youth and adults with ASD. International Review of Psychiatry, 30(1), 62-77.
Kerns, C. M., Wood, J. J., Kendall, P. C., Renno, P., Crawford, E. A., Mercado, R. J., …Storch, E. A. (2016). The treatment of anxiety in autism spectrum disorder (TAASD) study: Rationale, design and methods. Journal of Child and Family Studies, 25, 1889–1902.
National Autism Center. (2015). Evidence-based practice and autism in the schools: An educator’s guide to providing appropriate interventions to students with autism spectrum disorder (2nd ed.). Randolph, MA: Author. Retrieved from
Reaven, J., Blakely-Smith, A., Culhane-Shelburne, K., Hepburn, S. (2012) Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and 27 anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53, 410-419.
Wood, J., Ehrenreich-May, J., Allesandri, M., Fujii, C., Renno, P., Laugeson, E., . . . Storch, E.A. (2015). Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, clinical trial. Behavior Therapy 46 (1), 7- 19.
May 2nd, 2023