Perhaps the area of challenge most commonly associated with an ASD diagnosis is difficulty with social interaction. Individuals with ASD often struggle to understand and respond to the perspectives of others, and demonstrate differences in their experience of pleasure from social relationships (APA, 2013). Research literature and clinical report indicate that these difficulties are readily apparent when it comes to making reciprocal (i.e., shared, two-way), lasting friendships. Here, we provide a summary of what is known about how friendships emerge in children (specifically, school-aged boys, ages 8 – 12) with and without ASD, how features of ASD may impact the development of friendships, as well as positive outcomes commonly associated with friendships (Mendelson & Lerner, under review).
Friendship and School-Aged Typically Developing Boys
Considering research from among typically developing (TD) boys aged 8-12, difficulty forming reciprocal friendships may have lasting implications for boys with ASD. The school-aged period is a time when children learn key social skills and develop a sense of self-image that can last into adulthood. TD boys use friendship as a forum for developing a sense of what is appropriate (Dunn, 2004). Moreover, in addition to learning social “rules,” friendship allows children to develop the more subtle and fluid ability to take on others’ perspectives (Hughes & Leekam, 2004), which contributes to social functioning across the life span. For TD boys, reciprocal friendship serves as a forum for development of a sense of self, with positive friend relationships associated with more positive self-image, higher self-esteem, and greater academic achievement (e.g., Vandell & Hembree, 1994). Thus, friendship plays a crucial role in overall well-being. It acts as a buffer against negative life events, including parental divorce and bullying (e.g., Hartup & Stevens, 1997), and is associated with lower rates of depression and anxiety overall.
The inexplicable nature of reciprocal friendship is a tricky thing to pin down, but research to date among TD boys aged 8-12 points to a feature called “affective sharing” as a central component of reciprocal friendship. Affective sharing is defined as the use of gestures, facial expression, vocal intonation, verbalizations, and body posture to express affect. For TD boys, affective sharing plays such a central role in reciprocal friendship that the degree of affective exchange during interaction has been found to differentiate between friends and non-friends as well as between reciprocal vs. unilateral friendships (Newcomb & Bagwell, 1995). Friend interactions have been found to be higher overall in shared laughter and silliness (Howes, 1996), as well as in the use of eye contact, touching, and verbalizations to communicate affect (Foot, Chapman, & Smith, 1997).
Friendship and Boys with ASD Aged 8-12
Taking into consideration the difficulties individuals with ASD experience in terms of the understanding and communication of their own and others’ affect, it becomes readily apparent why friendship-formation proves especially challenging. Factoring in that children with ASD also often experience elevated rates of peer exclusion and bullying (van Roekel, Scholte, & Didden, 2007), against the negative effects of which friendship can serve as an important buffer, children with ASD appear to be in the midst of a “perfect storm” for negative outcomes as the result of a lack of reciprocal friendships. Indeed, although children with ASD almost universally endorse desiring friendship, the vast majority of their friendships are unilateral (e.g., Bauminger & Kasari, 2000). Given that individuals with ASD tend to demonstrate more concrete thinking in their social relationships (Bauminger & Kasari), individuals with ASD may be more likely to rely on social “rules,” rather than the fluid, in-the-moment reciprocal exchange of affective sharing. Research on friendships among children with ASD indicates that, among those who do have friends, their friend interactions are often lower in terms of shared behaviors and reciprocated feelings (Bauminger et al., 2008), including lower rates of affective sharing. Importantly, however, affective sharing appears to play a comparable role among friendships of children with ASD, although it appears overall to a lesser degree (Bauminger-Zviely & Agam Ben-Artzi, 2014), suggesting that friendships among children with ASD are based on similar processes as among TD individuals.
If friendships among individuals with ASD operate through similar processes, where then lie the differences? Two main theories of ASD appear to map most clearly onto the abilities implicated in affective sharing; social cognition theory and social motivation theory. Per social cognition theory, individuals with ASD struggle to recognize the emotional states of others as well as to take on their perspectives, which results in difficulty with social relationships. The implications of difficulties with social cognition and with perspective taking for formation of reciprocal friendship in general, as well as for affective sharing, are readily apparent. Difficulty recognizing and comprehending the emotional states and perspective of others would hinder participation in the subtle interchange involved in affective sharing. However, findings relating to the abilities of individuals with ASD in this domain are not consistent. While some studies indicate that individuals with ASD struggle with emotion recognition tasks, others indicate that these difficulties are largely task specific and age dependent, and point to the 8-12 age range as a period of relative ability in this domain (e.g., Capps, Sigman, & Yirmiya, 1995). Similarly, while individuals with ASD have been found to struggle with perspective-taking tasks, differences are markedly more pronounced in-vivo settings, rather than laboratory-based studies (Izuma, Matsumoto, Camerer, & Adolphs 2014).
Social motivation theory posits that individuals with ASD experience social interaction as less intrinsically rewarding than do TD individuals (Chevallier, Kohls, Troiani, Brodkin, & Schultz, 2007). Some research suggests that individuals with ASD show markers of these challenges as early as infancy (Osterling & Dawson, 1994). This line of research suggests that they may simply experience social relationships as less rewarding. With regards to friendship, this would seem to indicate that individuals with ASD are less desirous of friendship and, for those who manage to form friendship, the exchange of positive affect is less rewarding than for TD individuals. This stands in contrast, however, to the fact that the vast majority of individuals with ASD do report wanting friends (Bauminger & Kasari, 2000). Additionally, the elevated rates of depression and anxiety among individuals with ASD (Strang et al., 2012) suggest that they may suffer the negative psychosocial implications when faced with a lack of reciprocal friendship, in contrast to the implications of social motivation theory.
Key Differences and Inconsistencies
So where do these inconsistencies leave us in our attempt to understand why individuals with ASD may experience difficulty forming reciprocal friendships? A consideration of the Social Information Processing Speed (SIPS) presents a potential common thread. Social Information Processing Speed is the rate at (or efficiency by) which individuals are able to perceive and comprehend social information, which can include gaze, gestures, body posture, verbalizations, and vocal intonation. Results from across both eye tracking and various types of brain imaging studies consistently suggest that individuals with ASD may simply process social information more slowly than do TD individuals (e.g., Lerner, McPartland, & Morris, 2013; McPartland et al., 2011; Senju 2013). This could explain inconsistency in performance on emotion recognition and perspective taking tasks across task-type and lab vs. “real world” settings. Relative success on lab-related tasks may be attributable to the relative straight-forwardness (or simplicity) of information presented facilitating faster processing: the difference, for example, between indicating whether a photo image represents “happy” or “sad” and running into an old friend in a coffee shop. A SIPS-based deficit suggests this difference may be due to the burden of processing the additional wealth of information provided in a “real world” setting. Thus, a slower rate of SIPS would explain the challenges implicated in social cognition theory as due not to a lack knowledge of correct emotions or others’ perspectives, but to difficulty doing so with sufficient speed or efficiency. This would also seem to explain why individuals with ASD may appear to find social relationships less rewarding; they may not process social information with sufficient speed or efficiency to “catch” the subtle, rewarding moments as they occur. For example, a SIPS-based deficit would indicate that infants with ASD often appear far more oblivious to the positive social overtures of adults because they simply do not process the information with sufficient speed to react.
Implications
A consideration of SIPS as a potential underlying point of deficit for individuals with ASD opens up a range of new avenues for both understanding and treatment. This SIPS-based model suggests how the challenges involved in perceiving the social world among children with ASD “scale up” to yield some of the difficulties they experience in making the transition from acquaintance, to casual friend, to deep connection. More excitingly, it suggests that individuals with ASD who have relatively “faster” SIPS may more easily achieve such connections, and provides a potential avenue for impacting basic processes to help them to do so. If SIPS does prove to play the central role we hypothesize, social interventions may be well served to consider focusing on helping individuals with ASD increase basic processes such as SIPS (e.g. Lerner et al., 2011; 2012) rather than (or in addition to) teaching social rules. Doing so may increase the benefits of these interventions not only for friendship-making, but for ability to access social relationships more broadly. Current and recent research we are conducting is designed to explore precisely these implications, thereby enriching understanding of friendship development in ASD.
Summary and Conclusions
Friendship serves a wide range of important functions among TD boys aged 8-12, and appears largely contingent on the ability to engage in affective sharing (Newcomb & Bagwell, 1995). Individuals with ASD may reasonably be expected to struggle with affective sharing due to difficulty with both social motivation and social cognition that may be driven by a slower rate of SIPS. Research studies and interventions that focus on SIPS may present an exciting new avenue for understanding, encouraging, and fostering reciprocal friendship among boys with ASD, and helping them to derive the benefits thereof.
Jenna L. Mendelson, MA, LPA, HSP-A, is a Graduate Student at the University of North Carolina – Greensboro and can be reached at (336)-256-0061 or jmbarnwe@uncg.edu. Matthew D. Lerner, PhD, is Assistant Professor of Psychology, Psychiatry, and Pediatrics at Stony Brook University and can be reached at (631) 632-7660, matthew.lerner@stonybrook.edu or by visiting http://www.lernerlab.com.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bauminger-Zviely, N., & Agam-Ben-Artzi, G. (2014). Young friendship in hfasd and typical development: Friend versus non-friend comparisons. Journal Of Autism And Developmental Disorders, doi:10.1007/s10803-014-2052-7
Bauminger, N. & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71, 447–456. doi:10.1111/14678624.00156
Bauminger, N.; Solomon, M.; Aviezer, A.; Heung, K.; Gazit, L.; Brown, J. & Rogers, S. (2008). Children with autism and their friends: A multidimensional study of friendship in high functioning autism spectrum disorder. Journal of Abnormal Child Psychology, 36, 135 150. doi: 10.1007/s10802-007-9156-x
Capps, L., Sigman, M., & Yirmiya, N. (1995). Self-competence and emotional understanding in high-functioning children with autism. Development And Psychopathology, 7(1), 137-149. doi:10.1017/S0954579400006386
Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends In Cognitive Sciences, 16(4), 231-239. doi:10.1016/j.tics.2012.02.007
Dunn, J. (2004). Children’s friendships: The beginnings of intimacy. London, England: Malden Blackwell Publishing.
Foot, H. C., Chapman, A. J., & Smith, J. R. (1977). Friendship and social responsiveness in boys and girls. Journal of Personality and Social Psychology, 35(6), 401–411. doi:10.1037//0022-3514.35.6.401
Hartup, W. W., & Stevens, N. (1997). Friendships and adaptation in the life course. Psychological Bulletin, 121(3), 355-370. doi:10.1037/0033-2909.121.3.355
Howes, C. (1996). The earliest friendships. In Bukowski,W. M., Newcomb, A. F., and Hartup, W. W. (eds.), The company They Keep: Friendships in Childhood and Adolescence, Cambridge University Press, Cambridge, UK, pp. 86–66.
Hughes, C. & Leekam, S. (2004). What are the links between theory of mind and social relations? Review, reflections and new directions for studies of typical and atypical development. Social Development, 13, 590-610. doi:10.1111/j.1467-9507.2004.00285.x
Izuma, K., Matsumoto, K., Camerer, C. F., & Adolphs, R. (2011). Insensitivity to social reputation in autism. PNAS Proceedings Of The National Academy Of Sciences Of The United States Of America, 108(42), 17302-17307. doi:10.1073/pnas.1107038108
Lerner, M. D., Mikami, A. Y., & Levine, K. (2011). Socio-dramatic affective-relational intervention for adolescents with asperger syndrome & high functioning autism: pilot study. Autism, 15, 21-42.
Lerner, M. D., White, S. W., & McPartland, J. C. (2012). Mechanisms of change in psychosocial interventions for autism spectrum disorders. Dialogues in Clinical Neuroscience, 14, 307.
Lerner, M. D., McPartland, J. C., & Morris, J. P. (2013). Multimodal emotion processing in autism spectrum disorders: An event-related potential study. Developmental Cognitive Neuroscience, 3(1), 11-21. doi:10.1016/j.dcn.2012.08.005
Mendelson, J.L., Lerner, M.D. (under review). A developmental, process-based model of friendship among school aged boys with autism spectrum disorder.
McPartland, J. C., Wu, J., Bailey, C. A., Mayes, L. C., Schultz, R. T., & Klin, A. (2011). Atypical neural specialization for social percepts in autism spectrum disorder. Social Neuroscience, 6, 436-451.
Newcomb, A. F., & Bagwell, C. L. (1995). Children’s friendship relations: A meta-analytic review. Psychological Bulletin, 117(2), 306-347. doi:10.1037/0033-2909.117.2.306
Osterling, J., & Dawson, G. (1994). Early recognition of children with autism: A study of first birthday home videotapes. Journal Of Autism And Developmental Disorders, 24(3), 247-257. doi:10.1007/BF02172225
Senju, A. (2013). Atypical development of spontaneous Social Cognition in autism spectrum disorders. Brain & Development, 35(2), 96-101. doi:10.1016/j.braindev.2012.08.002
Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., & Wallace, G. L. (2012). Depression and Anxiety Symptoms in Children and Adolescents with Autism Spectrum Disorders without Intellectual Disability. Research in autism spectrum disorders, 6(1), 406–412. doi:10.1016/j.rasd.2011.06.015
van Roekel, E., Scholte, R. J., & Didden, R. (2010). Bullying among adolescents with autism spectrum disorders: Prevalence and perception. Journal Of Autism And Developmental Disorders, 40(1), 63-73. doi:10.1007/s10803-009-0832-2
Vandell, D., & Hembree, S. E. (1994). Peer social status and friendship: Independent contributors to children’s social and academic adjustment. Merrill-Palmer Quarterly, 40(4), 461-477.
