Friendship-Skill Interventions for Children and Adolescents with Autism
Jessica Zoe Zanuttini*
University of Sydney, Australia
Submission: July 06, 2021; Published: July 19, 2021
*Corresponding author: Jessica Zoe Zanuttini, A35 Education Building, University of Sydney, Camperdown, NSW 2006, Australia
How to cite this article: Jessica Z Z. Friendship-Skill Interventions for Children and Adolescents with Autism. Glob J Intellect Dev Disabil, 2021; 8(5): 555747. DOI:10.19080/GJIDD.2021.08.555747
Abstract
Children and adolescents with autism commonly experience social communication impairments that can make it difficult for them to establish and maintain reciprocal friendships. Difficulty making or keeping friends can have a negative impact on a young person’s academic achievements, social interactions, and emotional wellbeing. This paper aims to synthesise the available research on popular friendship-skill interventions to examine the common features of effective interventions and reveal elements that remain absent from the research. Most friendship-skill interventions for individuals with autism can be categorised as social skills training and peer-mediated instruction and interventions. Across these two intervention types, there are common features that contribute to their success, such as, the presence of peers, opportunities for skill generalisation, and the selection of target behaviours that consider the individual needs of the participant. However, research indicates an over reliance on modifying the behaviour of individuals without taking environmental supports into account. In addition, there remain some key omissions from the current body of literature that need to be addressed, including opportunities for generalisation, comparison of effects across ages and stages, and the inclusion of student voice.
Keywords: Autism; Friendship; Interventions; Social communication impairments; Children; Adolescents
Abbreviations: SST: Social Skills Training; PMII: Peer-Mediated Instruction and Intervention
Introduction
Autism is a heterogeneous condition that is characterised by social communication challenges and restricted and repetitive behaviours [1]. Social communication impairments may result in inappropriate or problem behaviour, difficulties regulating emotions, and incorrect interpretation of social cues, which can have an impact on the establishment and maintenance of friendships with peers [2]. This means that children and adolescents with autism are often isolated from their same-aged peers and are more likely to interact with their parents and other adults [3]. Having fewer reciprocal friendships than their typically developing peers leaves children and adolescents with autism at risk of increased feelings of loneliness, isolation, and anxiety [4].
Professionals, such as teachers and allied health professionals, are often looking for ways to facilitate positive peer interactions for young people with autism. Facilitating these interactions can result in improved social competence which translates to positive outcomes at later developmental stages (e.g., academic achievement, quality of life, vocational success) [5]. Although still relatively limited when compared to general social skill interventions, research and reviews on friendship-skill interventions for children and adolescents with autism have commonly involved the evaluation of social skills training (SST) and peer-mediated instruction and intervention (PMII) [6,7].
Social Skills Training
SST is an evidence-based practice that focuses on teaching specific skills to individuals or, groups of individuals, based on their unique needs [8]. SST is praised for its ability to be individualised and therefore focuses heavily on the assimilation of the individual, or changes in the behaviour or skills of the target participant [7]. Although, this type of intervention can produce favourable outcomes for individuals with autism, it requires an adult facilitator and is typically administered outside of naturalistic settings. Therefore, SST is both resource intensive and difficult to embed generalisation strategies into [9]. However, both of these limitations have been shown to be moderated through delivering SST as a group-based intervention [7]. SST as a group-based intervention, compared to individual intervention, yields only moderate intervention effects as they are less individualised and there is often variability in the age of participants, targeted skills, and the length and intensity of training sessions [10].
Peer-Mediated Instruction and Intervention
PMII is another evidence-based practice that involves training typically developing peers to act as the main interventionists to support novel behaviour or skill development in individuals with disability [11]. These interventions, used in isolation or in combination with other methods, are the most commonly used approaches to support the development and generalisation of social skills that support friendship development for young people with autism [6]. Like SST, the use of PMII also aims to achieve assimilation but some of its features support accommodation, or the modification of the physical or social environment [12].
One of these features is the use of peers. Peers can be trained or untrained and are considered to be an effective feature of friendship-skill interventions as shown through increases in social interaction during intervention implementation [6]. Providing typically developing peers with autism awareness training (i.e., characteristics of autism, advice on how to interact with peers with autism, and highlighting the strengths of their peers with autism) in preparation for PMII, has been shown to further improve their intentions to interact with their peers with autism [10,11]. In addition, the ease and popularity of embedding PMII within natural settings (e.g., classrooms, schools, community centres) has been shown to increase target behaviours, particularly generalisation of behaviours to untrained settings [6].
Common Features of Effective Friendship-Skill Interventions
The availability of empirical literature on friendship-skill interventions for children and adolescents with autism remains limited, but there are some clear illustrations of successful interventions within the field. Examination of these interventions demonstrates that there are several features that commonly contribute to their effectiveness. Specifically, the presence of peers, opportunities for generalisation, and the ability to personalise the target skills/behaviours based on individual needs. Future research and practice should make use of these effective features in order to design and implement supports for the establishment and maintenance of friendship within this group.
The vast majority of research into friendship development in children and adolescents with autism either focus on improving the social skills of individuals with autism or training educators to prevent the bullying experienced by individuals with autism. Interventions that are designed to improve the social skills of individuals with autism often promote assimilation and less often rely on accommodation, or the modification of the physical or social environment [13]. To be most successful, however, it is recommended that friendship-skill interventions aim to concurrently enhance both assimilation and accommodation by moving away from only expecting individuals to modify their behaviour to setting up the environment to support the development of their skills [14].
Of the friendship-skill interventions explored here, SST remains popular for its success in improving individualised behaviours and skills, but the generalisation and embedding of SST within natural settings is limited by the resources it requires. PMII provides an alternative that is even more widely used and overcomes some of the key limitations of SST while promoting opportunities for both assimilation and accommodation.
Evaluation of Existing Research
There are several limitations within the existing body of literature on friendship-skill interventions for children and adolescents with autism. First, a key indicator of quality research into the education of students with autism is the opportunity to demonstrate generalisation. The use of structured and deliberate generalisation strategies, however, are often missing from research into friendship-skill interventions. Through carefully designing the research, such strategies should be embedded within interventions as they have been shown to enhance sustained positive outcomes for children and adolescents with autism [15].
Secondly, there has been little comparison between the effects of friendship-skill intervention features for students of different ages and stages. One demonstrated difference between successful intervention features for children and adolescents is that children with autism can be supported to develop and maintain friendships with peers within their interest-based groups or schools [16]. However, the establishment of friendships involving adolescents with developmental disabilities, including autism, have been shown to require joint experiences that go beyond the context in which the friendship was initiated [12]. Investigation into additional similarities or differences is warranted.
Finally, and perhaps most importantly, a key omission from the research into friendship-skill interventions for young people with autism is the absence of their perspective. While some progress towards this has been made in recent years, researchers must listen to the perspectives of young people with autism to accurately determine the supports they need at various life stages to effectively support them in establishing lasting and meaningful friendships [7].
Acknowledgement
I wish to thank Emeritus Professor Barbara Kamler for the constructive and valuable suggestions that she provided during the drafting of this manuscript.
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