One of the central diagnostic criteria for Autistic Spectrum Disorders (ASD) is a failure to develop peer relationships and clinicians examine how the child conceptualises and demonstrates friendship skills. Normal children’s conception of friendship changes over time and it is notable that children with autism and Asperger’s Syndrome often have an immature and unusual definition of friendship. The research literature on the concept of friendship indicates there are four levels between early childhood and adolescence. The four levels are summarised as follows:
LEVEL 1: APPROXIMATELY 3 TO 6 YEARS
The child recognises that games and activities cannot happen unless there is an element of turn taking but there is an egocentric or simple conceptualisation of friendship in terms of defining a friend as someone who gives you things or someone you play with. Friendship is based on proximity and physical attributes and when asked Why is _____ your friend? The typical response is: He lives next door!
LEVEL 2 : APPROXIMATELY 6 TO 9 YEARS
There is an increasing understanding of the concepts of reciprocity and mutual rather than one-way assistance. The likes and dislikes of the other person are more likely to be considered with friendship based on how closely each friend matches their self interest, for example, in liking similar games. There is also a new awareness of the motives, thoughts and feelings of others. When asked Why is _____ your friend? the typical response is He lets me play the games I want to, Because she comes to my party and I go to hers or She’s nice to me.
LEVEL 3 : APPROXIMATELY 9 TO 13 YEARS
The child is more aware of other people’s opinions of them and how their words and actions affect the feelings of others. They are more careful in what they say and do because it may be hurtful to someone. Friendship can be based on shared experience or common interests and helping becomes more valued than simply playing together. There is a greater selectivity in choosing friends, a gender split and a greater durability in the relationship. There is increased value placed on personal attributes such as trust, loyalty and keeping rather than breaking promises. When asked Why is _____ your friend, the typical response is He sticks up for me and helps me with my maths homework, She enjoys doing the things I like to do or I can talk to them and they listen.
LEVEL 4 : ADOLESCENCE TO ADULT
Peer group acceptance becomes more important than the opinions of parents, there is a greater depth and breadth of self disclosure, desire to be understood by friends and recognition that there are different types of friendship – from acquaintances to close friends with autonomous interdependence. When asked Why is _____ your friend, the typical response is or Because we think the same way about things.
When children with an ASD are asked What makes a good friend?, clinical experience suggests that a common response is a list almost exclusively of actions that a friend should not do, e.g. bully or tease you, which indicate that the child has experienced a disproportionate level of negative experiences in their peer relationships. They know what a friend should not do but have little idea what they should do.
SOCIAL PLAY WITH FRIENDS
The social play of children with an ASD is often more immature than their peers and includes unusual characteristics such as having less motivation to seek friends, autocratic qualities and being less able to demonstrate the wide range of behaviours that we use as an index of friendship skills. The traditional school curriculum pays little attention to the development of friendship skills yet these skills are the foundation of abilities that are highly valued by adults in their professional and personal lives, namely having teamwork skills, the ability to manage conflict and having successful personal relationships. A recent study examined the perceived quality of life of high functioning adults with autism and Asperger’s Syndrome and only one variable, hours spent with friends, was able to significantly predict the scores on any of the quality of life measures . These adults valued and desired friendships more than anything in their lives, yet few had the ability to maintain acquaintances, let alone friends. As children we were never directly tutored in friendship skills, so how do we start teaching someone who appears to lack the intuitive ability we take for granted?
The starting point is an assessment of the friendship skills the child demonstrates and the skills that are conspicuously absent. We have standardised tests to measure cognitive, linguistic and movement skills but at present we do not have standardised assessment instruments for friendship skills that can be applied to children with an ASD. However, a review of the research literature on the range of social behaviours used as an index of friendship skills with ordinary children can produce a primitive checklist of friendship skills for children with Asperger’s Syndrome. The key social behaviours to be examined are as follows:
- Entry Skills: How the child joins a group of children and the welcome they provide for children who want to be included in their activity.
- Assistance: Recognising when and how to provide assistance as well as seeking assistance from others.
- Compliments: Providing compliments at appropriate times and knowing how to respond to a friend’s compliment.
- Criticism: Knowing when criticism is appropriate and inappropriate, how it is given and the ability to tolerate criticism.
- Accepting Suggestions: Incorporating the ideas of others in the activity.
- Reciprocity and Sharing: An equitable distribution of conversation, direction and resources.
- Conflict Resolution: Managing disagreement with compromise, and recognising the opinions of others. Knowing not to respond with aggression or immature mechanisms.
- Monitoring and Listening: Regularly observing the other person to monitor their contribution to the activity and body language. Their own body language indicating interest in the other person.
- Empathy: Recognising when appropriate comments and actions are required in response to the other person’s circumstances and the positive and negative feelings of others.
- Avoiding and Ending: The appropriate behaviour and comments to maintain solitude or end the interaction.
The next stage is to use behavioural and cognitive strategies to maintain and improve friendship skills. If the skills outlined above occur, then it is essential that such behaviour is recognised and rewarded. The authors would add that the praise should also be directed at the other child, as they need encouragement to maintain their friendship, especially as such children are often not among the most popular children in the class or neighbourhood. It is also essential that the child’s social play is monitored by an adult to identify when the cues for specific friendship skills occur but the child has not recognised them or is unsure how to respond. The child’s attention is drawn to a specific cue or opportunity and verbal prompts and instruction given as to what to do. This is an application of the traditional behavioural techniques of task analysis, prompting, shaping and reward. Children with an ASD are unusual in that they can be taught what to do in a given situation, but they may not understand why the action or comment is appropriate. They need to learn the theory as well as the practice. Conventional programs to encourage friendship skills with ordinary children make assumptions that may not be applicable to children with an ASD who have significant problems with Theory of Mind Skills, Affected Relatedness, Central Coherence and Executive Function. However, Social Stories can be used to assist the child to acquire the necessary cognitive mechanisms. The following is an example of a social story for a grade one child who needs to learn about the concept of assistance in friendship. It is designed to understand what ‘help’ is.
SOMETIMES CHILDREN HELP ME
Sometimes children help me. They do this to be friendly.
Yesterday, I missed three math problems. Amy put her arm around me and said, Okay, Juanita She was trying to help me feel better.
On my first day of school, Billy showed me my desk. That was helpful.
Children have helped me in other ways. Here is my list:
I will try to say, Thank you! when children help me.
HOW I CAN HELP CHILDREN IN MY CLASSROOM
My name is Juanita. Sometimes, children help me. Being helpful is a friendly thing to do. Many children like to be helped. I can learn to help other children.
Sometimes, children will ask for help. Someone may ask, “Do you know what day it is today” or “Which page are we on?” or maybe something else.
Answering that question is helpful. If I know the answer, I can answer their question. If I do not know the answer, I may try to help that child find the answer.
Sometimes, a child will move and look all around, either under their desk, in their desk, around their desk. They may be looking for something. I may help. I may say, “Can I help you find something?”
There are other ways I can help. This is my list of ways I can help other children:
Children like to be helped.
Other techniques can be used to encourage friendship skills such as a friendship diary, matching individuals and support groups. For younger children, a friendship diary can be used to record occasions when the child demonstrated friendship abilities and other children were particularly friendly towards the child. It is interesting that one of the criteria ordinary children use for defining what makes a good friend is someone who has similar interests. However, the special interests of the child with an ASD may not be interesting or popular with their peers. One option is to identify other children who have the same interest and introduce the two children to each other. An example is a child with Asperger’s Syndrome who has a special interest in ants, a solitary pursuit for him as no other of his acquaintances at school shared his enthusiasm and knowledge of this topic. However, by chance, another local child who also has Asperger’s Syndrome, was also interested in ants. When they were introduced a genuine friendship occurred with joint expeditions to observe and collect ants and the sharing of information and resources on these insects. It was notable that each child’s friendship skills with other children appeared hesitant and contrived, yet when the two met, their natural friendship skills were far more fluent and spontaneous. This technique can be facilitated by local parent support groups having a registry of children and their interests, pen pal registries, special interest clubs and Internet chat lines. An extension of personal matching is the development of local support groups run by adolescents and young adults with Asperger’s Syndrome. These groups hold regular meetings and excursions to destinations that may not be valued by their ordinary peers, such as museums and transport facilities. These groups provide a social life outside school, and the opportunity to meet someone who shares the same experiences and values, the basis of many friendships for adults
One of the issues raised during social skills workshops for young adults with an ASD is recognising when someone appears to be friendly but may actually be taking advantage of their social naivety, and how to identify and respond to the different types of personality. Tuition may be required in identifying hidden motives, seeking a second opinion and how to manage situations of potential abuse. It can also be necessary to teach the strategies of maintaining friendship, coping with grief when the friendship ends and overtures of friendship that are not reciprocated. The authors have also noted that children with Asperger’s Syndrome appear to lack an ability to perceive and describe the personality characteristics of others and themselves. When asked “What sort of a person is _____?” their responses are predominantly descriptions of physical attributes such as height or what a person does, eg. a teacher. What is missing is a wide lexicon to describe the different types of character. When personality characteristics are nominated, a common response is “nice and kind”, and synonymous words to this one characteristic. The children appear to have a one dimensional approach to characterisations. Other children can quickly “read” a person’s character and adapt their behaviour accordingly. They know which children to avoid and are more proficient in choosing who complements their own personality. To teach such skills in young children with Asperger’s Syndrome the authors advocate using the popular Mr. Men stories by Roger Hargreaves. They describe a range of personality types such as Mr. Grumpy and Mr. Nosey and Little Miss Chatterbox.. Another activity is encouraging the child to choose an animal that represents someone’s personality. Older children can use adaptations of literature studies to identify the indications of personality type and how to respond to such people. It is important to help the child understand their personality and to recognise the type of person they are likely to get along with and who might become their friend.
RESOURCES ON DEVELOPING FRIENDSHIP SKILLS
- Baby Faces (1998) . New York, NY: Dutton Children’s Books.
- Conlin, S. & Friedman, S. L. (1991, 1993) . All My Feelings At Preschool. Seattle, WA: Parenting Press, Inc.
- Funny Faces: A very first picture book (1996,1999) . New York, NY: Lorenz Books.
- Hallinan, P. K. (1999) . Heartprints. Nashville, TN: Ideal Children’s Books
- Rogers, R. (1996) . Making Friends. New York, NY: The Putnam & Grosset Group
- Offerman, L. (1999) . Little Teddy Bear’s Happy Face Sad Face. Brookfield, CT:
- The Millbrook Press, Inc.
- Brandenberg, A. (1993) . Communication. New York, NY: Greenwillow Books
- Brown, L. K. & Brown, M. (1998). How to be a Friend. USA: Little, Brown & Company
- The Care and Keeping of Friends (1996) . Middleton, WI.: American Girl Library Editor, Pleasant Company Publications.
- Conlin, S. & Friedman, S. L. (1989, 1993) . All My Feelings At Home. Seattle, WA: Parenting Press, Inc.
- Holyoke, D. (1997) . Oops!: The Manners Guide for Girls. Middleton, WI: Pleasant Company Publications
- Kipfer, B. A. (1994) . 1,400 things to be happy about. New York, NY: Workman Publishing
- Krueger, D. W. (1993). What Is A Feeling? Seattle, WA: Parenting Press, Inc
- Dimitrius, J. & Mazzarella, M. (1998, 1999) . Reading People: How to Understand People and Predict Their Behavior-Anytime, Anyplace. New York, NY: The Ballantine Publishing Group
- Gabor, D. (1983) . How to Start a Conversation and Make Friends. New York, NY: Simon & Schuster
- Gray, C. (1999, Spring) . Gray’s Guide to Compliments. The Morning News, 11-1, 1-17.
- Rubin, L. B. (1985) . Just Friends: The Role of Friendship in Our Lives. New York, NY: Harper & Row Publishers.
- Mattews,A (1990). Making friends: A guide to getting along with people. , Singapore, Media Masters.