طبیعت دوستی در کودکان مبتلا به اختلالات طیف اوتیسم: یک مرور نظام مند

This paper provides a systematic review of 24 studies that addressed the characteristics of friendship in school-age children with a diagnosis of autism spectrum disorder (ASD). The following questions were addressed: who are the participants, what methodologies have been employed, and what is our understanding of friendship in children with ASD. The results of this review indicate important differences in the manifestation of friendships in individuals with ASD as compared to typical children. While there is consistent evidence for several topographical differences in friendship characteristics, a number of gaps in our knowledge are evident. These include limited data on children who have intellectual disability, and on the perspective of nominated friends as well as circumscribed data on satisfaction with friendship relationships. In addition, there are a number of methodological limitations that restrict interpretation of extant research. Implications for future studies are discussed.

The social milieu of children grows in complexity as they develop, starting from parent-child and sibling relationships and expanding outside the family to include peer relationships. As early as infancy, children have been shown to display a preference for a specific social partner within their peer group (Howes, 1987 and Ross and Lollis, 1989). The amount of time spent interacting with friends as compared to non-friends (Rubin, Bukowski, Parker, & Bowker, 1998) and families (Larson, Richards, Moneta, Holmbeck, & Duckett, 1996) continues to increase as children reach middle childhood. Hence, as children mature, peer relationships become increasingly important and are of interest in the study of child development. A distinction can be made between two types of peer relationships. One involves interactions between non-friends and the other involves interactions with peers that are friends. Analysis of the interactions between friends, as compared to non-friends, has indicated that friendship relations are marked by a higher level of positive engagement, greater effectiveness of task performance, and better resolution of conflict (Newcomb & Bagwell, 1995). Friendship is a specific form of dyadic peer relationship that involves a complex set of skills incorporating knowledge in the area of social cognition, language, and emotions. It is characterised by a bond that is dynamic, stable, voluntary, and reciprocal in nature, involving a degree of mutual affection and preference, which results in the facilitation of socially related functions such as intimacy, companionship, and closeness (Freeman and Kasari, 1998, Howes, 1983 and Webster and Carter, 2007). In typically developing children, friendship has been shown to promote positive social, cognitive, and emotional development, all of which are influential in the overall sense of wellbeing (Hartup & Stevens, 1999). Children who have high quality friendships have also been shown to have a high sense of belonging at school (Hamm & Faircloth, 2005), positive perceptions of school (Ladd, 1990), a lower level of peer victimisation (Hodges, Boivin, Vitaro, & Bukowski, 1999), and better academic performance (Wentzel & Caldwell, 1997). The components of friendship and its functions continually evolve across the lifespan and are distinct within different age groups (Gilfford-Smith & Brownell, 2003). For example, younger children define their friendship mostly in terms of companionship, whereas older children often emphasise the importance of self-disclosure, loyalty, and intimacy in their friendships (Rose & Asher, 2000). The failure to develop successful peer relationships in the early years, on the other hand, has been shown to predict emotional and behavioural problems in children without developmental disabilities (Bagwell et al., 1998 and Hartup and Stevens, 1999). This may be because the opportunity to engage in peer interactions during the early years of life contributes to the development of fundamental skills such as communication, emotional regulation, conflict resolution, and co-operation skills, which are fundamental for successful future social relations (Hartup and Laursen, 1993 and Newcomb and Bagwell, 1995). Typical children usually acquire the basic skills necessary for social interaction simply through exposure to social situations, in which the process of implicit learning through imitation, modelling, and trial and error, take place (Meltzoff, Kuhl, Movellan, & Sejnowski, 2009). In typical children, therefore, mastery of the skills to socialise is often accomplished without many difficulties. Persistent impairments in social interaction and communication are typical of ASD diagnosis (American Psychiatric Association, 2000 and American Psychiatric Association, 2013). It is well documented that the majority of children with ASD experience great difficulties in developing friendships and peer relationships appropriate to their age (Fuentes et al., 2012, Hill and Frith, 2003, Sigman and Ruskin, 1999 and Travis and Sigman, 1998). In comparison with typical peers, children with ASD find acquisition of basic social interactional skills a challenging process, and often these skills need to be taught explicitly (Klinger, Klinger, & Pohlig, 2007). The study of friendship relations in children with ASD as compared to typical children is complicated by the presence of large variations in cognitive, linguistic, and social development, consistent with the continuum nature of the disorder (Witwer & Lecavalier, 2008). Researchers have identified a number of core impairments in children with autism that may affect social relationships. These impairments have been hypothesised to be both cognitive and emotional (Twachtman-Cullen, 2000). One aspect of cognitive impairment in ASD is apparent difficulty in understanding the mental states of others and hence, to some extent, in predicting their actions (Baron-Cohen, 1989). There are also impairments in executive functioning (Hill, 2006, Ozonoff et al., 1991 and Pennington and Ozonoff, 1996), which might influence problem solving ability and the abilities related to planning, remaining flexible, orienting, and attention shifting (Pascualvaca et al., 1998 and Townsend et al., 1996). In addition, children with autism may also show weak central coherence. That is, they may lack the ability to focus on the ‘bigger picture’ and may often only focus on specific parts of the situation (Frith and Happe, 1994 and Happe and Frith, 2006). Thus, the cognitive impairments in children with ASD may impact on their social ability to consider other's perspectives, to perceive and understand social and emotional cues (Lord, 1990), and to be flexible in their social encounters. There have been a limited number of studies reviewing the nature of relationships in children with disabilities, including ASD. Travis and Sigman (1998) reviewed the impact of social deficits on interpersonal relationships in children with ASD, but they did not specifically consider the concept of friendship. Webster and Carter (2007) provided a narrative systematic review that considered the nature of friendships in children with developmental disorders but did not specifically address children with ASD, where the nature of the social deficit is distinctive. The current paper provides a systematic review of studies that addressed the characteristics of friendship in the population of school-age children with a diagnosis of ASD. The following questions will be addressed: (a) who are the participants, (b) what methodologies have been employed, and (c) what is our understanding of friendship in children with ASD?

This systematic review has provided a summary of the current state of knowledge on the characteristics of friendship in children and adolescents with ASD. A clearer picture of the nature of friendship in children with ASD is emerging, but several gaps are evident in our knowledge. These include limited data on children who have intellectual disability, restricted information on the perspective of nominated friends, and circumscribed data on statisfaction with friendship relationships. A number of methodological limitations are evident in extant research including issues with verification of friendship nomination and extensive reliance on report measures. Future research should include confirmation from the nominated friend that a friendship exists and should also make more use of observational measures.