The diagnostic criteria for Asperger’s includes a description of some of the deficits in social interaction, for example, (a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction; (b) lack of social or emotional reciprocity; and (c) failure to develop peer relationships appropriate to developmental level.
Children with Asperger’s and High-Functioning Autism (HFA) have considerable difficulty with the understanding and expression of social reciprocity and nonverbal behaviors. With respect to peer relationships, when a parent or teacher observes the social play and friendship skills of these young people, he or she often notices a delay in the conceptualization of friendship. Also, these children may have an overall intellectual ability within the normal range, but their understanding of friendship skills resembles much younger kids.
We can only guess what the consequences may be for Asperger’s and HFA children who fail to develop peer relationships that are appropriate for their developmental level. But without a doubt, there will be lasting effects in several aspects of social, cognitive, and emotional development. When interacting with their peers, “typical” (i.e., non-autistic) kids naturally acquire increasingly sophisticated strategies to resolve conflict, as well as interpersonal and team skills. Also, they learn the value of alternative perspectives and solutions in problem solving. Many of the traits valued in a close friend become the traits associated with lasting personal relationships. However, with Asperger’s and HFA children, these skills are not intuitive – they must be taught!
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
The social isolation of an Asperger’s or HFA student in the lunch room or on the school playground can increase his or her vulnerability to being bullied and teased. Also, a lack of close friendships can be a contributory factor in the development of childhood depression. Furthermore, a delay in social knowledge can lead to anxiety in social situations that may develop into school refusal, social phobia, and even agoraphobia. “Typical” children achieve cognitive and affective growth within their circle of friends. So, it is not surprising that impaired peer relationship skills often result in significant emotional and social problems for the “outcast” (i.e., the child who doesn’t fit in).
Before considering strategies to improve specific friendship skills, it is important to determine the Asperger’s or HFA youngster's stage of friendship development. Unfortunately, there are no standardized tests to measure friendship skills as there are for cognitive abilities, language skills, and motor development. However, assessments can be made by analysis of the child’s answers to specific questions and observation of his or her interactions with peers. Questions might include: What makes you a good friend? Who are your friends at school? Why do we have friends? Why is (name) your friend? How do you make friends? What do friends do? What makes a good friend?
How parents and teachers can foster the development of friendship skills in children and teens on the autism spectrum:
3 to 6 years of age—
In this age group, the Asperger’s or HFA youngster needs to identify relevant social cues and appropriate responses to those cues. For instance, the youngster can learn the cues to join a group of peers without causing disruption or annoyance. An activity can be to brainstorm with the youngster the “entry cues” (e.g., someone giving a welcoming gesture or facial expression, or a pause in the activity or conversation). These “acts of the social play” can be rehearsed by identifying a few kids who are willing to help with the friendship skills of the Asperger’s or HFA youngster. They can be informed that he or she is learning the rules for joining in their play.
The procedure of identifying the cues in planned settings and practicing appropriate responses can be used for many friendship skills. The parent or teacher can act as a mentor or stage director, giving guidance and encouragement. It is important that the attitude from the adult is one of discovery and guidance so that the Asperger’s or HFA youngster does not perceive the activity as being critical of his or her ability and a public recognition of his or her social errors.
Due to their developmental delay, kids on the autism spectrum often demonstrate more mature interaction skills with grown-ups than with their same-age peers. It is important that parents and teachers observe the natural play of the Asperger’s or HFA youngster's peers (e.g., noting the games, equipment, rules, language, etc.). They can then practice the same play with the youngster, but with the adult “acting” as a peer. This includes “child speak” (i.e., using the speech of kids rather than adults), role-playing examples of being a good friend, and role-playing situations that illustrate unfriendly acts (e.g., disagreements and teasing). Appropriate and inappropriate responses can be performed to provide the youngster with a range of responses.
Parents and teachers can borrow (or buy) duplicate equipment that is used at school or is popular with the Asperger’s or HFA youngster’s peers. Once the youngster has rehearsed with grown-ups who can easily modify the pace of play and amount of instruction, he can have a “dress rehearsal” with another youngster (e.g., an older sibling or mature student in his class) who can act as a friend to provide further practice before the skills are used openly with the youngster’s peer group.
Another strategy to learn the relevant cues, thoughts, and behavioral script is to write Social Stories that can be used by the youngster to improve her social understanding and abilities.
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
6 to 9 years or age—
In this age group, “typical” kids develop greater cooperation skills when playing with their peers and develop more constructive means of dealing with conflict. It is important that young people with Asperger’s and HFA experience more cooperative than competitive games. In competitive games, there are winners and losers and strict rules. Kids on the autism spectrum often require considerable instruction using Social Stories to understand the concepts of being fair and gracious in defeat. Specific aspects of cooperative play that need to be recognized are (a) accepting suggestions rather than being autocratic or indifferent, (b) giving guidance and encouragement, and (c) identifying and contributing to the common goal.
Kids of the spectrum can learn that, when functioning as a cooperative and cohesive group, many activities and goals are easier and quicker to achieve. Parents and teachers can use role play games to illustrate appropriate and inappropriate actions with some time taken to explain why (in a logical and empathic sense) certain actions are considered friendly or not friendly. The unfriendly actions that are particularly relevant for kids with Asperger’s and HFA are (a) coping with mistakes, (b) failure to recognize personal body space, (c) inappropriate touch, and (d) interruptions.
Children on the spectrum can benefit greatly from published training programs designed to improve “Theory of Mind” skills. Programs on Theory of Mind skills also can help these children distinguish between accidental and intentional acts. They may consider only the act from their perspective and not consider the cues that would indicate it was not deliberate. In addition, educational programs on emotions can help them identify the cues that indicate the emotional state of their friends and themselves. The intention is to develop their empathy skills so that they can be recognized as caring friends.
On a side note, there can be different coping mechanisms used by girls with Asperger’s and HFA in comparison with boys. Girls on the autism spectrum are more likely to be interested observers of the social play of their peers and to imitate their play at home using dolls, imaginary friends, and by adopting the persona of a socially adept girl. This solitary practice of the social play of their friends can be a valuable opportunity to analyze and rehearse friendship skills. Some girls on the spectrum can develop a special interest in reading classic literature or fiction that is age-appropriate. This also provides an insight into thoughts, emotions, and social relationships. Girls tend to be more maternal than boys and can facilitate the inclusion of a girl with Asperger’s or HFA within an established peer group. The autistic girl’s social difficulties can be accommodated and guided by peers who value the role of mother or educator. The girl also may be popular because she is honest and consistent and less likely to be spiteful.
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
9 to 13 years of age—
In this age group, there is usually a clear gender preference in the choice of friends. The activities and interests of boys (who may be playing team games or sports) may be considered of little value to the boy with Asperger’s or HFA. Also, he is likely to be less capable than his peers in team games and ball skills, which may lead to teasing and bullying by boys who can be notoriously intolerant of someone who is different. When the boy on the autism spectrum approaches girls, he can be more readily included in their activities, because girls can be more patient, maternal and supportive. However, one of the consequences of being more welcomed by girls than by boys – and spending more time playing with girls than boys – is that the boy on the spectrum can imitate the prosody and body language of his female friends. This can result in further isolation and torment from male peers. The youngster needs a balance of same and opposite gender friends. Some social engineering may be necessary to ensure acceptance by both groups.
During this stage, there is a strong desire for companionship rather than functional play. The youngster with Asperger’s or HFA can feel lonely and sad if her attempts at friendship are unsuccessful. She needs instruction and guidance, and this may be achieved by discussion with supportive friends and grown-ups. Individual peers who have a natural rapport with a youngster on the spectrum can be guided and encouraged to be mentors in the classroom, playground, and in social situations. Their advice may be accepted as having greater value than that of parents and teachers. It is also important to encourage the “special needs” child’s peers to help her regulate her mood, stepping in and helping her calm down if she is becoming agitated or tormented. Peers may need to provide reassurance if she is anxious and to cheer her up when sad. The youngster on the spectrum also needs advice and encouragement to be reciprocal with regard to emotional support, and must be taught how to recognize the signs of distress or agitation in her friends and how to respond.
At this stage, existing remedial programs use strategies to develop teamwork rather than friendship skills. Attending a program on teamwork skills (e.g., sports or employment) may be considered more acceptable to the Asperger’s or HFA teen who may be sensitive to any suggestion that she needs remedial programs to have friends. Another strategy to help the teenager who is sensitive to being publicly identified as having few friends is to adapt speech and drama classes.
The teen on the autism spectrum can learn and practice tone of voice for particular situations, self-disclosure, facial expression, conversational scripts, body language, as well as role-play people she knows who are socially successful. The “special needs” teen sometimes uses this strategy naturally, but it is important to ensure that she chooses good role models to portray.
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
13 years of age to adulthood—
When the individual with Asperger’s or HFA reaches this stage, he usually seeks friends through recreational pursuits and work. Attempts to change a relationship from friend to work mate can present some challenges to the young adult on the autism spectrum. A mentor at work who understands his unusual profile of friendship skills can provide guidance and act as a confidante and advocate. The mentor also can help determine the degree of genuine interest in friendships from the coworkers.
Sometimes adults on the spectrum assume that a friendly smile, act or gesture has greater implications than was intended. There can be a tendency to develop an intense interest or infatuation with a particular person. This “special interest” may dominate their time and conversation and can lead to inappropriate behavior (e.g., stalking). On the other hand, the individual with Asperger’s or HFA can be desperate to have a friend and may become the recipient of abuse (e.g., physical, financial, sexual) through failing to recognize that the other person's intentions are dishonorable. The two-way misinterpretation of signals and intentions can lead to mutual confusion.
Relationship counseling is helpful, but most counselors today have limited knowledge and experience with Autism Spectrum Disorders. An interesting development in recent years is young adults on the spectrum providing guidance through group counseling sessions organized by support groups. These groups are often formed by people with Asperger’s and HFA who want to meet like-minded people. They meet on a regular basis to discuss topics that range from personal relationships to employment issues.
The Internet has become the modern equivalent of the dance hall in terms of an opportunity for young adults to meet. The great advantage of this form of communication to the individual on the spectrum is that she often has a greater eloquence to disclose and express her inner self and feelings through typing rather than conversation. In face-to-face social gatherings, she is expected to be able to listen to and process the other person's speech (often against a background of other conversations), to immediately reply, and simultaneously analyze nonverbal cues (e.g., gestures, facial expression, tone of voice, etc.). However, when using the computer, the individual on the spectrum can concentrate on social exchange using a visual rather than auditory medium.
As in many other situations, people with Asperger’s and HFA may be vulnerable to others taking advantage of their social naivety and desire to have a friend. Young adults on the autism spectrum need to be taught caution and to not provide personal information until they have discussed the Internet friendship with someone they trust. Genuine and long-lasting friendships can develop over the Internet based on shared experiences, interests, and mutual support. It is an opportunity to meet like-minded people who accept individuals on the spectrum because of their knowledge rather than their social persona. People on the spectrum can be somewhat self-centered and peculiar – but can prove to be honest, loyal, and knowledgeable friends.
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
Conclusion—
At any age, having friends provides support and promotes mental health and well-being. Friendships are also very important for social and emotional development. Through friendships, kids learn how to relate to others. They develop social skills as they teach each other how to be good friends. Most kids with Asperger’s and HFA want to have friends, but don’t have the skills to acquire them. Kids on the spectrum who have friends are more likely to be self-confident and perform better academically at school. When these “special needs” kids have difficulty in making friends or in keeping them, it often leads to feeling lonely and unhappy with themselves. Feeling rejected by others often leads to significant distress, too.
Parents and teachers have important roles to play in helping the Asperger’s or HFA youngster develop friendship skills. They set examples for how the youngster can manage relationships. They can also act as coaches, teaching the child helpful social skills and talking through friendship issues to help with problem solving.
Just as youngsters with Asperger’s and High-Functioning Autism need food throughout the day, their need for sensory input must also be met. A “sensory diet” is a personalized activity plan that provides the sensory input “special needs” children must have in order to stay focused and organized throughout the day. Children and teens with mild to severe sensory issues can all benefit from a personalized sensory diet.
