Introduction
High functioning autism spectrum disorders (HFASDs) including high functioning autism, Asperger’s Disorder, and pervasive developmental disorder NOS (PDDNOS) are characterized by impairments in social functioning and language, and by the presence of restricted interests and repetitive behaviors. Impairments in executive functions are among the most consistently reported deficits in individuals with autism spectrum disorders (Hill
2004; Ozonoff et al.
2006; Verté et al.
2006). It has been difficult to document clear relationships between measures of impairments in executive functions and measures of autism-related behaviors (e.g. Geurts et al.
2009).
Abstract Reasoning and HFASD
Abstract reasoning, which is an element of executive functioning, requires the considerations and manipulation of information about events, objects, and concepts not in the immediate environment. Abstract reasoning is thought to involve both the ability to identify concepts (i.e. to recognize underlying category attributes so as to better understand them), and the ability to form concepts (i.e. to generate cognitive schemas to organize information) based on these discriminations.
Concept identification abilities, emerge during the first year of life in typical development, and children with autism appear to acquire simple classification abilities involving the physical world (e.g. the ability to sort objects) similarly to children with other developmental delays (Ungerer and Sigman
1987; Tager-Flusberg
1985). However, it is unclear whether individuals with autism can categorize based on more representational and abstract criteria. Some have found that lower functioning children have difficulty with sorting tasks that involve abstract categories (Shulman et al.
1995; Ropar and Peebles
2007), though older higher functioning individuals do not appear to have these difficulties (Minshew et al.
2002).
In contrast to concept identification, concept formation involves an “open field” situation in which the individual must initiate the cognitive processes required to solve a problem. The ability to generate schemas to organize social and non-social behavior is an example of concept formation. This type of initiation, or “generativity,” is recognized as a deficit area for children (Bishop and Norbury
2005), and adults (Ambery et al.
2006; Minshew et al.
2002; Turner
1999) with HFASD. Concept formation, but not concept identification, as assessed by the Goldstein-Scheerer object sorting task, has been found to differentiate children with HFASD from others, correctly identifying 89% of cases of autism in individuals aged 12 and above (mean age = 21) with HFASD in a discriminant function analysis (Minshew et al.
2002).
Preadolescent and Adolescent Development and Friendship
Social impairments, which are among the most handicapping symptoms of autism (Rogers
2000), have been conceptualized as involving deficits in affective reciprocity (Hobson
1996), in theory of mind (Saxe and Baron-Cohen
2006), and in imitating/mirroring the actions of others and thereby intuiting their intention (Hobson and Lee
1999; Rizzolatti and Fabbri-Destro
2008; Rogers
2007). While these areas have been relatively well-studied, there has been little research about cognitive and developmental aspects of friendship quality in individuals with HFASD. This represents a significant gap in the literature because the ability to achieve sustained friendship is one of the most clinically important and ecologically-valid indicators of social functioning (Bauminger and Kasari
2000).
Friendship is critical for human development. It provides a context for social, moral, and emotional growth (Bukowski et al.
1996; Bukowski and Sippola
1996; Howard et al.
2006; Rubin et al.
1998). In addition to its importance in promoting development, the quality of preadolescent and adolescent friendship is related to multiple important outcomes including self-esteem (Berndt
1996), depression and school adjustment (Hartup
1995), and loneliness and social dissatisfaction (Parker and Asher
1993). Friendship, and the social support it provides, also serves as a protective factor against the development of psychopathology (Berndt
1989; Rubin et al.
1998; Sullivan
1953), while problematic peer relationships are associated with depressed mood and loneliness (Boivin et al.
1994; Parker et al.
1999).
Despite folk wisdom to the contrary, research suggests that friendship is highly desired by individuals with HFASD (Henault and Attwood
2002; Howard et al.
2006; Jones and Meldal
2001; Stokes and Kaur
2005), although the level of social functioning of children, preadolescents, and adolescents on the autism spectrum is variable (Orsmond et al.
2004). While deep and intimate friendship is beyond the grasp of many such individuals, for others, positive, sustained, and even sexual relationships (see Stokes et al.
2007) are possible (Bauminger
2004; Orsmond et al.
2004). The friendships of individuals with HFASD may differ from those found in typically developing ones with respect to duration, frequency of meetings, activities undertaken (Bauminger and Shulman
2003), and composition of the disability status of the dyad (Bauminger and Shulman
2003; Bauminger et al.
2008a).
The achievement of intimacy, which involves the ability to integrate a partner’s needs and perspectives with one’s own, is considered the most critical milestone for typical adolescent friendship (Grotevant and Cooper
1986; Selman
1990), and intimacy of friendship in adolescence is related to adjustment and to interpersonal competence (Buhrmester
1990). The ability to attain intimacy is likely made possible by the maturation of executive functions including selective attention, behavioral control, perspective taking, organization, decision making, planning, and abstract reasoning that occur in typical preadolescent and adolescent brain development (Luna et al.
2004; Spear
2000; Yurgelun-Todd
2007). Indeed, behavioral researchers have linked the maturity of adolescent friendship to cognitive development during this period (Hartup
1996).
Linking Abstract Reasoning and Friendship Abilities
Deficits in concept formation may limit the ability of individuals with HFASD to generate cognitive schemas that promote the efficient organization of social and non-social information. Impairments in the ability to create organizing schemas for initiating new social behaviors and routines (i.e. meeting new people, entering different and unstructured social situations, and/or conducting reciprocal conversations) would greatly disrupt daily social functioning. Similarly, the inability to conceptualize, represent, and integrate multiple perspectives would produce deficits in interpersonal relationships. The replicated finding that concept formation abilities and the demonstration of cognitive generativity is predictive of play quality in younger children supports the assertion that concept formation abilities are related to real world social functioning (see Jarrold et al.
1996; Rutherford and Rogers
2003; Rutherford et al.
2007).
Goals of the Current Study
The overarching goal of the current study was to examine relationships between abstract reasoning abilities in HFASD and social functioning involved in friendship. We used an ecologically valid approach involving multi-informant and multi-method assessment consisting of trained observer (Q-sort based ratings across two semi-structured tasks) and friend reports (a self-report inventory) of friendship quality. We had three main hypotheses. Consistent with literature from older samples, we hypothesized that individuals with HFASD would have impairments in concept formation, but not in concept identification. We tested this on age, gender, and receptive vocabulary matched groups of children with and without HFASD using the DKEFS Sorting Task. Second, as shown in our previous work, we hypothesized that the relationships of participants with HFASD would be less intimate, and that friend perceptions in the dyad would be more variable, than those seen in children without ASD. To test this hypothesis, we examined relationship quality within and between dyads consisting of HFASD and TYP probands. Given their trajectory in typical development, we also hypothesized that relationship intimacy would increase with age, and we tested this exploratory hypothesis by examining correlations between observer and friend reports of relationship quality and age. Third, we hypothesized there would be links between abstract reasoning abilities in individuals with HFASDs and their social functioning as measured by the ability to form strong and reciprocal friendships. We tested this hypothesis by examining the relationship between abstract reasoning variables in individuals with HFASD, and friendship quality measures.
Data Analysis
Analyses were completed in SPSS version 16.0. Hypothesis one was test using a one-way analysis of covariance (ANCOVA) where PPVT score was used as a covariate, given that the groups differed on this variable. For hypothesis two, between group differences on friendship variables were examined by means of Mann–Whitney U tests for independent samples. Within group differences (i.e. those involved in proband/friend pairs) were examined by means of Wilcoxon Signed Rank tests. Exploratory correlational analyses that examined the relationship between age and friendship intimacy were conducted using Spearman’s rho correlations (2-tailed). To examine the fourth hypothesis about the relationship between cognitive factors (abstract reasoning) and social functioning (friendship quality), we first conducted a principal components factor analysis with varimax rotation to reduce the number of friendship quality variables. These were followed up using multiple regression analyses that examined the relationship between disability status, age, abstract reasoning abilities, and relationship quality.
Discussion
This first study of concept formation and concept identification in preadolescent and adolescent children with HFASD revealed a generalized impairment in concept formation, identification, and generation of sorting descriptions in this population. This deficit was not related to age or receptive vocabulary level, but rather to scores on the communication domain of the ADI-R, suggesting that it was pragmatic aspects of language, rather than receptive vocabulary, that were related to difficulties in abstract reasoning. Our findings of impairments in both concept identification and concept formation are at odds with the influential view that persons with ASD have specific difficulty with more complex forms of information processing (i.e. concept formation), rather than less complex forms of information processing (i.e. concept identification) (Minshew et al.
1997; Williams et al.
2006). Minshew, Meyer, and Goldstein (
2002) concluded that there was a dissociation between these two components of abstract reasoning and that concept formation impairments could correctly discriminate 89% of subjects with autism in a group whose average age was 21 years. Given that the experimental tasks used in that study were similar to the ones used in this work, it remains possible that abstract reasoning abilities, and especially concept identification abilities, continue to improve through adolescence and early adulthood in individuals with HFASD. There have, in fact, been reports of the development of executive functions during this age period in HFASD (Happé et al.
2006). Thus our findings suggest that deficits in concept identification in children and teens with HFASD represent an area of developmental delay as opposed to deviance. Another developmental finding was Q-sort ratings of the interaction of both groups showed increasing positive orientation, coordination, and responsiveness. Future studies should investigate the extent to which individuals with HFASD “catch up” to those with typical development as this information is critical for treatment planning in adulthood.
Q-sort scores suggested that differences between the functioning of the HFASD and TYP dyads in a naturalistic play scenario could be detected by outside observers. Although their assessments of friendship intimacy were lower, child reports on the FQS suggested that children with HFASD and their friends did not differ from typical dyads in the amount of companionship they reported. This unexpected finding suggests that individuals with HFASD are experienced as valued partners in the important realm of companionship. It also bears mention that this critical information about the nuances of the relationships would have been lost if we had relied solely on outside observer reports. Concordance of perception of friendship quality between the children with HFASD and their friends also validated the reporting abilities of the children with HFASD and their ability to describe friendship qualities including companionship, security-intimacy and trust, help, and conflict.
Our findings add to the growing list of studies that demonstrate similarities in many aspects of friendships of HFASD and TYP preadolescents (Bauminger et al.
2008a,
b). The current study again documented that companionship and shared perceptions of aspects of the friendship are present in these relationships. Given that companionship, in addition to intimacy, is considered an important aspect of adult relationships including marriage (Rhyne
1981) and mature friendship (Connidis and Davies
1992), this is a hopeful finding consistent with the premise that individuals with HFASD are capable of sustaining sophisticated adult interpersonal relationships. Future longitudinal research about these individuals’ marital and friendship relationships throughout the lifespan may help illuminate strategies for achieving successful relationships, and for promoting mental health.
Results of the factor analysis also illustrated how two measures of friendship quality– observer- based measures of a laboratory-based interaction, and friends’ self-reports of their relationships—captured different aspects of the friendship. The demographic variables age and disability status were related to observer-based assessments from the play scenarios, while abstract reasoning abilities explained about 20% of the variance in friends’ perceptions of relationship quality. In future research it will be important to determine how other sources of individual differences including personality, co-morbid psychopathology, and characteristics of the family system, as well as biological factors, account for the remainder of the variance in friendship quality.
Gender composition of the dyad is another factor that may relate to differences in friendship characteristics. More HFASD dyads were cross-gendered. This may reflect the fact that individuals on the spectrum were not as aware of social norms, which in middle childhood and preadolescence dictate that friendships be single sex (Maccoby
1990). The friendships of boys and girls have been noted to differ in important ways including characteristic strategies used to resolve conflict. Girls are more prosocial in their goal and strategy orientation than boys (Rose and Asher
1999), although friendship quality and relationship number are related to strategies and goals in members of both genders (Rose and Asher
2004). Given the small number of girls in our sample, it was impossible to directly examine the influence of gender composition on the functioning of dyads. However, the study of gender differences in the mechanisms underlying friendship quality could potentially illuminate the range of interpersonal relationships open to individuals on the autism spectrum. Disability status of the dyads (whether they consisted of one or two children with a disability) is another important contributor to relationship quality, which was impossible to examine in great depth in this small sample. However, friendship quality analyses in this manuscript were completed independently for the groups with and without friends with disabilities and the pattern of findings did not change. We have, however, addressed this question in the bi-national sample (Bauminger et al.
2008a).
This study had several limitations. First, we only had complete data for Israeli participants, and the overall sample size is relatively small, thus limiting possible statistical analyses. Second, our sample consisted of high functioning persons with ASD, thus our results may not generalize to lower functioning and/or cognitively impaired individuals. Third, ADI-R, a parent-report measure based largely on reports of retrospective behavior was the principal means used to qualify participants into the study. It would have been preferable to have a current day clinician report measure as well. Fourth, to qualify for the study, a participant needed to have a friend of 6 months duration, and to be able to convince that individual to attend the session. This also may have biased our sample towards persons with ASD with relatively well-developed social relationship abilities. Fifth, this study leaves open the question of whether there are systematic biases in how individuals with HFASD select friends, and not just differences in the quality of ability to interact with friends, and that this is what is driving results.
Finally, and perhaps most importantly, the current study raises important issues related to treatment. First, companionate friendships, as opposed to the more intimate relationships generally associated with typical preadolescent and adolescent development, may be a more appropriate and attainable goal for HFASD preadolescents. The common and frequently successful recommendation to help children with autism to socialize through their special interests is consistent with this result.
This study also suggests that helping individuals develop abstract reasoning abilities is a potentially important, frequently unrecognized, and as yet untested treatment goal. It was striking that performance on concept formation and concept identification measures related so closely to friends’ reports of relationship quality. In fact, existing social skills interventions for individuals with HFASD often implicitly scaffold concept formation abilities. For example, many of the social skills curricula for the HFASD population (i.e. Solomon et al.
2004) teach simple rules and/or templates for organizing social and non-social information (i.e. for identifying and explaining one’s emotions across multiple contexts, for managing stressful situations, for engaging in reciprocal conversations about appropriate topics; and for identifying and generating solutions to daily problems). Parents also can be coached to verbally mediate the social world for their HFASD children during the course of semi-structured play, thereby helping the children to develop schemas for this form of dyadic interaction (Solomon et al.
2008). Finally, the “social stories” technique, which involves using narrative templates that can ultimately be elaborated and internalized by the individual to assist in managing situations encountered in daily life, has received empirical support (Quirmbach et al.
2009). All of these approaches implicitly enhance the ability of the individual with HFASD to script the social world, and to develop a larger and more flexible repertoire of behavior. In effect, the use and effectiveness of these techniques provides additional validation for our findings.