Friendship and Emotional Function Among Children and Adolescents with ASD

Background: Given the high rates of comorbid anxiety and other internalizing problems among children with ASD, identifying factors that protect against those symptoms is important.  Although social impairment is a hallmark feature of autism spectrum disorders (ASD), little is known about the relations between dyadic friendships and emotional outcomes among children with ASD.  Among typically developing children, friendships serve a protective function.  Specifically, having at least one friend is associated with better emotional outcomes among typically developing children (e.g., lower levels of anxiety, improved self-esteem).  The results of such research could have implications for understanding social and emotional development among children with ASD, as well as informing the design of future interventions.

Objectives: The purpose of this study was to examine the relations among friendship, autistic symptomatology, and internalizing symptoms among children with ASD.  First, the study examined whether symptoms of anxiety and depression were higher among children with ASD and whether ASD symptom severity was associated with higher levels of internalizing symptoms.  Secondly, the study examined the relationship between ASD symptom severity and friendships.  A final aim was to determine whether having friends was associated with lower levels of anxiety/depression among children with ASD.

Methods: The sample included 933 children between the ages of 6 and 19 who participated in the Simons Simplex Collection (SSC), a North American multiple site, university-based research study that includes families with only one child with an ASD. The following child measures were included:  the Autism Diagnostic Interview-Revised (ADI-R), Autism Diagnostic Observation Schedule (ADOS), and Child Behavior Checklist (CBCL).

Results: Results indicated the level of anxiety/depression among the current sample was not in the clinically significantly range based on the CBCL normative sample.  Results also demonstrated that higher levels of ASD severity did not predict greater symptoms of anxiety/depression.  Regarding friendships, correlations between ASD severity and friendship were positive (r = .178**), indicating that increased severity of autism was associated with poorer friendships.  However, counter to expectations, better quality friendships were associated with increased levels of anxiety/depression among the current sample (r = -.157**).  Secondary analyses further examined the relations among these variables, taking into account additional factors (including IQ, gender, and severity of ASD), with some indication that the rated quality of the friendship had a nonlinear relationship to the degree of reported anxiety.

Conclusions: The relations among ASD symptoms, internalizing symptoms, and dyadic friendship appear to be complex.  Having friends, at least as measured in the current study, does not appear to protect against internalizing symptoms for children with ASD.  However, the current study has a number of limitations that will be discussed more fully.  In brief, future research is warranted in this area.  More comprehensive assessment of dyadic friendships among children with ASD will be necessary to fully examine these issues.  In particular, future studies should include specific measures that address number of friends as well as friendship quality (using parent-, child-, and peer-report whenever possible).