Happy Holidays!

I will be refraining from writing a blog entry this week and next to celebrate the season with my family.

If you have enjoyed or benefited from reading these posts, what a lovely reciprocal gift!  Many of you have sent encouraging remarks over the past year, telling me of the ways you're promoting Good Friend's Awareness-Acceptance-Empathy message.  From posting entries on your office door to using specific pieces as discussion platforms during staff meetings, you are putting words into action.  For that I thank you!

Photograph: Andreas Kuehn/Getty

During this final week of 2012, I encourage you to help us promote our mission through your charitable gift.  Donations postmarked by December 31st can be mailed to Good Friend, Inc., 808 Cavalier Dr., Waukesha WI 53186.  Online donations (click on the Donate button) will be accepted through midnight EST.

Warmest wishes to you and yours for a holiday filled with understanding and friendship!

A Spectrum of Friends

First, to honor the lives of the students and staff lost in the Sandy Hook community in Connecticut ...  There is no amount of explanation that will heal hearts, but we hope our prayers for the survivors and tears for the slain will resound across miles and time.

This week's topic was to be based on friendship in elementary school -- a follow-up to last week's thoughts regarding peer relationships in early childhood.  It seems now, with these budding first grade friendships forever frozen, a respectful tribute of sorts.

There are three main considerations of peer relationships in elementary school as they apply to students with autism spectrum disorder (ASD).  First, that they are a necessary part of social-emotional development and mental health.  Second, that they will exist, but perhaps to a differing depth and breadth than their neurotypical (NT) peers will experience.  And finally, that they should be specifically developed and nurtured for mutual benefit.

As we look at the determinants of quality of life for adults living with autism, we notice that connections in the community are key.  Jobs, recreational opportunities, and social/familial relationships help us, whether we have typically-wired brains or not.  Learning to form and derive enjoyment from these connections starts in elementary school.  Tony Attwood, author of The Complete Guide to Asperger's Syndrome and a world-renowned clinical psychologist specializing in the treatment of individuals with ASD, notes that the ages of 4 to 6 years are critical for motivating these early friendship skills.  While social impairment is a diagnostic criteria for an ASD diagnosis, it doesn't mean that relationships are less important to the development of someone with autism.  It helps to understand, however, that these relationships may look different than those between NT peers.

Many individuals with autism prefer to interact with people either younger or much older than they.  In the case of elementary school students, the 3rd grader may gravitate toward 1st graders on the playground; or the 2nd grader may bond with his speech-language pathologist versus his classmate.  In the case of the former, delayed social maturity may play a role, as well as a sense of competence around less-complicated unwritten social rules.  For the student who prefers to socialize with adults, contributing factors could include a penchant for specialized conversational topics (i.e., migratory patterns of birds or dinosaurs of the Mesozoic Era), an acceptance or level of patience not experienced among peers, or a gravitation to the familiar (in the instance of children receiving many hours per week of adult-driven therapies and interventions).

Whatever those early connections are, channel them into platforms for generalizing positive social behaviors.  Speech therapists can use the foundations of these friendships to seed new social skills, such as turn taking in conversation or noticing tone of voice and body language.  Since words only account for (at best) a third of our communication, "speech" skills are inextricably tied to these social nuances so elusive to our friends with autism.

So maybe elementary school-aged children with autism might not have the quantity of friends their NT classmates have, but the quality of their early friendships is immeasurable.  They are the building blocks of critical social development, eventually contributing toward peer acceptance and positive self-image.

And we should not ignore the benefit that students with typical brain development derive from these opportunities to learn, relate, and grow.  One of my son's very first friends was able to decrease his own school-related anxiety by focusing on the help he provided to my boy.  Studies on Peer-Mediated Instruction and Intervention programs have demonstrated that specifically-trained mentors achieve better academically and feel more fulfilled because of their engagement in these relationships.  They become less self-absorbed and more empathetic.  They develop leadership skills and flexibility -- traits which will eventually make them more employable, as well.

Ultimately, children with autism should have a spectrum of friends: ones they can share their special interests with, ones who help them be the best social being they can be by gently pushing development of new skills, ones they can feel competent with at their social-emotional level, and ones who accept them right where they're at, regardless of outward manifestations of their autism.  Are we as NTs any different in our need for a diverse friend base?

Autism and Peer Relationships in Early Childhood

In the state of Wisconsin, the average age for receiving an autism spectrum diagnosis is 4-1/2 years old (CDC, 2012).  By this time, while most parents report that their child later diagnosed with ASD exhibited symptoms before seeking a medical diagnosis, children should already have been receiving services through Birth to 3.  That being the case, many of these children transition into their school district's Early Childhood program (age 3-5, or kindergarten), where, hopefully, they have access to typically-developing peers.

In the case of my now adolescent children with autism, we are fortunate enough to live in a resource-rich area where my intentions to maximize their social and educational experiences were realized without extraordinary effort.  Sure, I had to serve as my daughter's "educational assistant" in a private day care when she was 3 years old because she wasn't yet toilet trained and required additional social support, but it provided opportunities for me as a mother to recognize what developmental areas required extra attention and focus on those in- and outside the day care setting.

One of those areas for both of my children was their relationship development.  When I was asked by neuropsychologists during their diagnostic interviews how many "friends" my children had, I guess I wasn't so sure of the definition.  It was loosely described to me during the evaluation process as particular same-aged peers whose company they sought out or enjoyed.  Having no "normal" baseline before I observed my children with their classmates, I assumed the parallel play my 4-year-olds engaged in was age-appropriate.  But by the definition of friendship in a recent textbook I was reviewing in preparation for a guest lecture, my children with ASD had no friends.

However, I think we need to measure and define friendship a little differently for our students with ASD.  If we can base friendships on shared interests, mutual admiration, and general good will (versus willingness to share, the ability to enter play situations, and solve conflicts, for example), then it will be easier to pair typically-developing students with their classmates with autism.  Students with ASD may be unskilled at initiating social interactions, but that proclivity my 3-year-old daughter had to pet her classmate's long, silky hair both satisfied a sensory input desire and served as a greeting.  My 4-year-old son's proximal babbling with eye contact demonstrated to his classmate that he wanted to communicate with him.  These, in my opinion, are the seeds of relationships and should be celebrated as such.

So the next time you see a 3- to 5-year-old with autism in the vicinity of neurotypical peers, encourage the budding healthy interactions without concern about the quality or duration.  Keep rewarding efforts to engage peers while teaching social understanding and motivating students with ASD.  The baby steps you take in these early years are the training exercises for the races they'll run as they get into intermediate elementary education and beyond.

What precious "friendship skills" have you noticed in your young students with autism?