Autism and Relationships in Adolescence

In December, I chose to share some thoughts about friendship skills of students with ASD in preschool and elementary school.  As students move into secondary school (grades 6 through 12), the nature of their relationships change.  Puberty becomes a factor not only in physical development, but in social-emotional development as well.  And just as physical maturity varies wildly in this life phase, so does social-emotional maturity.

Most neurotypical (NT) tweens will form strong bonds with a select few peers.  This may be a nuclear group they retain from elementary school during the transition to middle school, or it may be a mix of peers: some from the "old" school, some from the "new" school, and others from extracurriculars (sports, faith-based groups, etc.).  Some may venture into "romantic" relationships, and even that will be a spectrum.  As they near the end of middle school, there will be those who fall "head over heels in love", forsaking their friend base to explore this new relationship category.  Others may dabble, but (appropriately) don't take these early romantic entanglements too seriously.

While parental engagement in an adolescent's social life is still necessary, children may begin to rely more on peer guidance for relationship management.  And for students on the autism spectrum, they may have precious few friends in middle and high school.  This may be by design; decoding unwritten social rules is exhausting.  Perhaps maintaining a couple key connections taps the available social resources for your student with autism.

Zachary Riggins, The University of Alabama

Just as parents of NT children seek to influence relationships in their adolescent's peer groups, those who care for students with ASD should also continue to guide and explain social relationships.  People with autism often miss the nonverbal communication styles that become increasingly important in secondary school.  Consequently, they may not respond appropriately.  Their inadvertently inappropriate response may offend a peer without proper understanding of autistic neurology.  And, in extreme cases, may draw the attention of authorities.

Besides the popular approaches to socializing such as video modeling or Comic Strip Conversations, you might consider laying down some ground rules.  Quantitative guidelines such as "2 text messages per day, per friend", or "1 phone call every 3 days" might help your teen establish boundaries that are healthy both for him or her and the friend.  Don't be afraid to use visual reminders of guidelines, such as sticky notes or checklists.  And be very careful about allowing adolescents with autism onto social media outlets where their social understanding (or lack thereof) can be exploited.  Squag is a great website for tweens and teens with autism (and their siblings) to start learning about personalizing a place on the Web using a safe, secure platform.

While it is important to encourage some independence in socialization for adolescents, it is imperative, for the well-being of our children, to remain actively involved in the development of healthy social-emotional skills.  Thank you to the speech language pathologists who are are purposefully working with students to be sure these skills -- which we know to be pre-employment qualities -- are nurtured!

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?

The Right Tools

Last week, I had four enormous spruce trees removed from my yard.  The work crew arrived at 9 a.m. and by 2 p.m., all that remained were four piles of fragrant, shredded mulch.  Even if my husband and I possessed the skill and knowledge these gentlemen had, there's no way we could have done the same job.  We didn't have the right tools.  These guys had enormous chainsaws and bow saws and stump grinders and cranes.  They had cherry pickers and wood chippers and hand trucks.  And muscles -- big ones.

Anyone who works with tools, whether in a kitchen or a garage or at a desk in front of a computer, will tell you how important it is to have the right tool for the right job.  Wrong tools for the right job and vice versa will be useless.  Why do we think this is any different for our children?

Our children need tools for their social-emotional toolbox.  Noticing the social impairments in children on the autism spectrum, caregivers developed social skills training.  We were equipping students with autism with tools we assumed they could use with their typically-developing peers.  In some cases, it was a case of right tool, wrong job; we were equipping students for the job that comes after social understanding.  It was kind of like handing over the chisel before we gave them the mallet.  And they looked at the block of stone, glanced at the chisel and thought, "Why do I need this again?"

Somehow, we missed the importance of putting the tools of awareness and acceptance in our typically-developing kids' toolboxes also.  We sent them to school with their pencils and paper and crayons in the backpack without explaining the differences between learners, and how important it was to accept each of their classmates regardless of those differences.  It didn't seem to matter much when the kindergarteners walked away wide-eyed and turtle-shelled with their big backpacks.  Even in first grade, they interacted mostly with whomever they were near.  And we assumed they just understood their classmates with differently-wired brains.

Boy, were we wrong.

They have all sorts of problems to solve, but no tools to get the job done.  Without the right tools, they'll chip away at the block of stone without much skill or finesse, and we'll wonder why they've been unable to produce a masterpiece.  They did the best they had with the tools we provided.  Had we put the right tools in their toolboxes and showed them what each was for (think Peer-Mediated Instruction and Intervention), imagine what the finished result might have been!

I think it would have looked like meaningful inclusion.  Let Good Friend help you equip your students for an inclusive classroom in the 2012-'13 school year by scheduling staff and student services to take place immediately in the fall.  Contact me or Denise before school's out for the summer!

Teachable moments

Since my son was four years old, we've made a point of returning to his pediatric neuropsychologist every two to three years for an evaluation.  It's not for the purpose of diagnostics (his primary diagnosis of PDD-NOS has remained unchanged since 2003), but to assess his visual-spatial reasoning, cognitive and social abilities, expressive and receptive speech, and fine and gross motor skills.  The best part about the comprehensive report written after all the tests are compiled and analyzed is the page of recommendations the evaluating team develops.  These suggestions are specific to home and school teams, lending themselves to better parenting and incorporation into the IEP (Individualized Education Plan).

When we were facing the transition to middle school for our firstborn, one of the best recommendations seems now to be the most obvious to me: Explain everything.  When you're watching a story on the news about the aftermath of a tsunami, talk about why the person being interviewed is crying.  When a commercial makes you laugh, explain that the play on words is what makes that funny.  If you ask him to put deodorant on before he leaves for school, tell him it's because his hormones are starting to prepare him for being an adult, and that means sweat in places like armpits gets smelly.

I remember reading in a book when I was expecting this same child that I should speak to him while pregnant and while he's an infant, well before his own verbal abilities formed.  It seemed unnatural at first, but came more easily as practiced.  I have found the same to be true with explaining the "hidden curriculum" we take for granted.

It's just as important (if not more) for my daughter with Asperger's Syndrome.  She seems more aware of these daily vagaries and therefore more confounded.  She will often come to me explaining a social situation that she felt she handled awkwardly.  We do a little debrief.  She starts to tell me who was involved and what occurred by her perception, and I begin to ask questions.  "When you laughed at her, were other kids laughing, too?  What did her face do when you laughed?  Did she smile or hang her head?"  And, since she's been taught to notice these things, she recalls.  While we're talking through it, she might come up with a response on her own that might have been more appropriate.  Sometimes it warrants an apology to her friend; but it always results in a better understanding of the scenario.

And while the brain wiring associated with autism spectrum disorders makes the hidden curriculum piece more difficult to grasp, it doesn't mean that these teachable moments should be relegated to the population of individuals with ASD. If you observe a situation in the classroom, on the playground, or in your home that presents an opportunity for a social-emotional lesson, capitalize on it!  Perhaps you saw a student stand up for another when group behavior was starting to deteriorate.  Be sure to point out how you appreciated the UPstander quality the model student displayed.  Maybe your own child made an unnecessary judgment about a child nearby who responded in an unexpected way to environmental stimuli.  Remind him that we don't all process information in the same way.

In being mindful of the value of these teachable moments, we will contribute positively to the mental well-being of the children in our care.

The Gift of Friendship

I had the kind of conversation last week with a mom that throws me into fits of hate and hope. She told me a sad but familiar story of a misunderstood boy who spends his recess pacing the playground perimeter because he and his peers just haven't figured out how to have successful social interactions. And without intervention, they won't.

No one "just knows" how to interact appropriately with someone with autism. Certainly, there are those with a sensitivity and compassion that encourage them to continue trying in spite of pratfalls, but unless you have an understanding of that differently-wired brain and how it impacts the way that person experiences the world around them, you will struggle.

And children with autism can't be expected to be socially graceful.  A hallmark of their disability is lack of social understanding, so how can we as parents and teachers expect them to generalize to the playground skills taught in a speech therapist's office without coaching?

And this mom told me about how this boy was trying to initiate social interaction by hugging, which he was told specifically was unacceptable.  The poor child.  So while I hate that this downtrodden boy is despairing of his young life because he can't find a way to fit in, I have hope.  My hope springs from the results we've seen from our staff and student services.  I know that we can go into that school and work with its community to create a culture of acceptance, where glimmers of understanding and empathy shine more brightly than the darkness of despair.

But we can't do that without your help.  Please consider giving a year-end gift to Good Friend, Inc.  Your donation of $10 pays for us to send a Presentation Kit loaded with helpful resources for educators and families to the school that invites us.  A $25 donation pays for gel bracelets and personalized certificates for a classroom of students who learn to be good friends.  Only $50 covers the expenses associated with a guest lecture, where upwards of 100 college students at a time learn about best practices associated with interacting with people with autism.  And a $100 donation allows us to go to a school and provide an hour-long staff in-service. 

You can donate online through our website (right-click on the Donate button to open a new PayPal checkout window) or Cause.  Checks can be made payable to Good Friend, Inc. and mailed to 808 Cavalier Dr., Waukesha WI 53186.  Donations are tax-deductible to the extent provided by law, and should be postmarked by December 31st for this year's application.

Thank you for your generous support of our mission!