A couple of months ago I had a "date" on a Friday night at a wonderful Italian restaurant—not with my husband (much to his dismay), but with a 14-year-old young man who is a poet, black diamond skier and "culinary critic." He also happens to have Asperger syndrome. Four years earlier, this young person—I will call him Daniel—came to my office on a Saturday morning and for two hours asked repeated questions about restaurants and music, with little interest in my responses. I hadn't intended to take on Daniel's inability to have a meaningful conversation but, as his parents had predicted, Daniel's charm and potential convinced me this was a learning opportunity for me, my students and, most important, for him. So, as I sat across from this amazing teenager four years later, we reflected on how hard he had worked with me and other providers to achieve the social capacity he now possessed. When I asked what was most important to him now as he transitioned to high school and beyond, he said without hesitation—having friends!
As my experience with Daniel shows, youths with autism spectrum disorders present a unique challenge to providers—but also opportunities to capitalize on their strengths and engage them in their community. For almost two years, I spent a couple of hours a month with Daniel to help build his capacity to carry on a reciprocal conversation. But I was only one small part of a larger effort, including his parents, teachers, tutors and community SLPs, to ensure his success as a student, a peer, a family member and a member of his community. For me, intervention had to consist of a framework for function that would lead Daniel to be a successful participant in his community [PDF].
So Daniel and I worked with social stories, video modeling and other established interventions described in the literature and in the 2009 report of the National Standards Project. These interventions are specifically designed to increase interpersonal, self-regulatory, social communication and cognitive skills, while decreasing problem behaviors and emotional dysregulation. Daniel and I started by focusing on how to tell an interesting story. He learned how to use key narrative components to construct meaningful stories that connect to the listener.
He then learned to write his own social stories, highlighting the elements of conversation he wanted to bring to his interactions with others. He began to understand the role of perspective taking in social conflicts and the magic of knowing how someone else might feel about what you are saying or doing. He also learned that others don't always share his feelings, prompting him to request video models to help him "see" what a positive social interaction with peers could look like. He would say, "Patty, I need a comic strip conversation to figure out what happened today."
The ongoing challenge for Daniel, however, is sustained, personal relationships with peers. Daniel's strengths and opportunities—his intellect, his exposure to a global world through travel with his parents, his deeply emotional poetry, his access to skiing ventures beyond those of his peers, his ability to detect the best culinary experiences, his skill at conversing with adults—put him at risk for having very little in common with his peers. Small talk with adults is effective, but social banter with peers is less so. I did teach him some magic tricks in hopes that this would help his social relations, but his exposure to peers remains limited. His parents struggle to balance the most appropriate and individualized learning environment for their son—characterized by private schooling, tutors and even home schooling—with his need for positive peer connections.
So, I sit across from this amazingly talented young person who has so much to offer the world, but struggles just to make one same-age friend. I should not be surprised, as the research tells us that friendship bolsters well-being and is especially important in early adolescence. As a clinician, I want to find a way to help Daniel make those friends he so desperately wants. As a researcher, I ask: Are we sufficiently investigating and evaluating treatment that fosters friendship development? As a leader, I wonder if my advocacy for change in how we educate and support our children and youth with ASDs is sufficient to ensure a balanced view of the role of friendship and education to achieve quality of life.