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Teaching Friendship Skills to Adolescents with Autism Spectrum Disorder: Current Situation and Lessons

Nguyen Hoai Thuong*, Do Thi Thao, Nguyen Thi Hoa, Le Thi Hien

Faculty of Special Education- Hanoi National University of Education, 136 Xuan Thuy Road, Cau Giay District, Hanoi, Vietnam

Abstract: Difficulty in communication and social interaction has certain impacts on the skills of making friends and building friendships among adolescents with autistic spectrum disorder (ASD). This study focusing on the current status of teaching friendship skills to adolescents with ASD among 125 teachers and 101 parents found that (i) adolescents with ASD mostly struggle with making new friends, participating in group activities, and helping others; (ii) teachers and parents encounter difficulties in selecting the contents, approaches and methods to teach adolescents with ASD to make friends; and (iii) there is a lack of resources that provide teachers and parents with teaching activities and methodology to effectively support adolescents with ASD to make friends.

Keywords: adolescents with ASD, friendship skills, teaching friendship skills

Received March 15, 2021; Revised April 27, 2021; Accepted April 30, 2021

Citation: Nguyen Hoai Thuong, Do Thi Thao, Nguyen Thi Hoa, Le Thi Hien, Teaching Friendship Skills to Adolescents with Autism Spectrum Disorder: Current Situation and Lessons. American Journal of Educational Research, 9 (4). 235-242. January 2021. doi:10.12691/education-9-4-13

1. Introduction

Adolescents with ASD face a lot of difficulties in social interaction, communication and stereotyped behavior disorder. Many studies have pointed out that lack of social skills is a typical problem of children with ASD, among which are those by Angelika Anderson, Dennis W. Moore, Rebecca Godfrey (2004) [1], Connie Kasari, Erin Rotheram ‐ Fuller, Jill Locke, Amanda Gulsrud (2012) [2], Scott Bellini, Jessica K. Peters, Lauren Benner (2007) [3], Susan Williams White, Kathleen Keonig & Lawrence Scahill (2007) [4], DSM-5 (2013) [5].

In order to teaching social skills for children with ASD in an effective manner, researchers and educators have introduced a variety of approaches, methods and intervention programs. Among those is the study Improving social skills and disruptive behavior in children with autism through self-management [6] by Lynn Kern, Koegel, Robert L. Koegel, Christine Hurley and William D. Frea. Such difficulties have serious impact on children's friendship skills. Especially for adolescents, "developing friendship skills for adolescents with ASD becomes a great challenge for children and their families" (Shattuck et al., 2018, p320) [7]. At this stage, making friends plays a very important role, helping teenagers establish social relationships, enhance communication and interaction with people around them, and integrate in the community. Therefore, the introduction of approaches and activities to develop friendship skills in adolescents with ASD is a key factor. To make friends, children need to have the ability to communicate, interact with others and control their own emotions. Such skills are a big challenge to most adolescents with ASD, making it difficult for them to make friends, maintain friendships and work in groups. This lack of basic social skills might lead to rejection, isolation or bullying by friends and such condition may continue to their adult lives (Elizabeth A. Laugeson) [8].

There has been a high quantity of international studies on proposed approaches for developing friendships skills for children with ASD, one of which is the article The nature of friendship in children with autism spectrum disorders: A systematic review by Petrina, N (2014) [9] which outlined the level of performance and nature of practicing friendship skills in children with ASD. C.Kasari (2012), in the study Making the connection: Randomized controlled trial of social skills at school for children with ASD, demonstrated advantages and challenges in the practice of teaching friendship skills for children [10]. The research Methods for teaching social relationships for children with ASD in inclusive preschools by Thao Do (2015) described key practical approaches and activities to support preschool children to form and develop integration skills. The research also affirmed such skills for children with ASD “are the fundamental skills to help children integrate in the community” (Thao Do, 2015, p62) [11]. In 2021, Thao Do et al. published the article Methods for teaching collaborative skills for adolescents with ASD in inclusive schools which focused on the current practice of collaborative skills in adolescents with ASD at inclusive schools and proposed potential measures for collaborative skills education. The study also asserted that it is required to have a synchronous coordination among educational forces and it “needs a strong agreement in the application of objectives, teaching methods and activities to achieve the highest efficiency” (Thao Do, 2021, p141) [12].

Thus, the above studies have affirmed the significance of social skills while the studies mainly revolved around the problem of the current teaching of social skills for adolescents with ASD. There remains a lack of research on the current teaching of friendship skills to learn lessons and propose specific activities to help teachers and parents support children with ASD.

2. Content

2.1. Major Issues in Teaching Friendship Skills to Adolescents with ASD

Adolescence is perceived as a developmental stage between childhood and adulthood of human life. Adolescents in this study are referred to children aging from 11 to 15 years old, which is the age group of junior high school students [13]. Adolescents with ASD are individuals of 11-15 years of age with disorders in communication, social interaction, imagination and stereotyped behaviors. Such defects are recorded since childhood and experience changes in level, severity, symptoms and disorders over time, greatly affecting the ability of communication, interaction and establishment of social relationships.

Friendship skills are purposeful behaviors that help individuals develop friendships, communicate and interact with others, and integrate in the community of friends. In addition, friendships skills are also expressions and actions that people use to build new relationships, solve simple and complex life problems in order to easily adapt to social life (Kern, P, 2004) [14]. Friendship skills play a key role in the development of adolescents. They need to have friendship skills in daily life at school, family, and community, to build friendships, communicate, play, integrate with others, enhance their confidence and develop their communication skills.

Main stages of friendship skills development:

- Acquisition stage: This stage focuses on helping individuals learn about the main ideas of friendship skills (purpose, content, method and conditions for taking actions) (Myles, 2003) [15].

- Retention stage: Following the acquisition stage, adolescents already possess certain understanding of how to implement a specific skill, so they are able to apply the learned skills in certain situations (Myles, 2003) [15].

- Proficiency stage: Learners can perform a skill independently and stably in a familiar situation (at school or at home) (Myles, 2003) [15].

- Generalization stage: Friendship skills are maintained and implemented independently on a regular basis, through different contexts, timelines and situations (Myles, 2003) [15].

The goal of teaching friendship skills for adolescents with ASD is to: help children to develop the attitude and motivation for enhancing their confidence; build friendships and improve their communication and interaction skills; develop receptive and expressive communication skills; and improve understanding about free-play and social interaction in the most effective manner (Myles, B.S, 2003) [15].

The teaching content of friendship skills for adolescents with ASD includes (i) actively greet people, (ii) make new friends, (iii) participate in group activities and (iv) help others.

Proactively making greetings means being proactive in greeting and interacting with others in the most effective manner, making appropriate greetings in social situations, building relationships with confidence and communicating with others effectively.

Making new friends is interpreted as giving specific, clear steps in getting to know others. Adolescents can follow the steps and use the right sentence patterns.

Participating in group activities is the ability to show positive attitude and confidence when working with others to solve problems, develop positive feelings and interactions to build relationships and communicate more easily with peers.

Helping others is the skill that requires adolescents to have a positive attitude and confidence in socializing with people and willingness to share work and help others. Based on that, they can easily build and establish social relationships in the most effective manner.

Stages of teaching friendship skills to adolescents with ASD:

- Stage 1: Learning skills: Use of Social Stories, Video Modeling, Pivotal Response Treatment, Social Scripting and Pretend Play (Myles, B.S, 2003) [15].

- Stage 2: Practice of existing skills: Priming, Prompting, Self-Monitoring, Social skill Group Training; Peer Mediated Interventions (Myles, B.S, 2003) [15].

- Stage 3: Generalization of skills is the stage of learning skills with different subject groups in different contexts, practicing skills in real-life situations and planning regular reviews of skills (Myles, B.S, 2003) [15].

Teaching methods of friendship skills for adolescents with ASD include (i) Organize and integrate social skills development into daily activities; (ii) Organize fun and role-play activities in groups; (iii) Organize individual lessons; (iv) Organize lessons in small groups (3-4 students per group); (v) Organize lessons in large groups (whole class); and (vi) Combine different methods (Myles, B.S, 2003) [15].

Assessment of friendship skills among adolescents with ASD: Assessment of social skills among adolescents with ASD is a systematic process of collecting information about the basic skills in learning and daily life to propose appropriate teaching approaches for social skills development and help adolescents integrate in the community in most effective way”. The assessment should include the combination of results from different methods, environments, situations and target groups. “The purpose of the assessment is to identify behaviors beyond acceptable limits among adolescents with ASD and the responses of peers to inadequate behaviors so as to propose effective supporting measures". The assessment requires reliable data inputs since social skills are an open matter to human perception rather than based on actual factors. The assessment can be conducted through such activities as observing, interviewing, using questionnaires and gathering raw data obtained from observing behaviors.

In particular, there are three basic deficiencies in the friendship skills of teenagers that need to be evaluated, including (i) Acquiring, (2) Demonstrating and (3) Mastering (Koegel, L, 1992) [16].

Acquiring - lack of knowledge about using and applying skills in daily life.

Demonstrating – knowing the skills but not able to practice them in real situations.

Mastering – knowing and having desire to apply skills but unable or fail to use them effectively in real situations.

Driving factors affecting friendship skills teaching for adolescents with ASD: The expertise of teachers, the objectives and contents of the friendship skills teaching curriculum, the facilities and environment and family's participation and coordination in developing friendship skills for adolescents with ASD are factors that influence the process of teaching friendship skills to adolescents with ASD.

2.2. Current Situation of Teaching Friendship Skills to Adolescents with ASD

2.2.1. Organization of Surveys

- Surveying objective: To conduct a research on the current situation of teaching friendship skills to adolescents with ASD, then compare with the results of theoretical research to draw lessons learned in teaching friendship skills to adolescents with ASD.

- Surveying area: (1) Perception of teachers and parents about teaching friendship skills to adolescents with ASD: Study and evaluate the perception of teachers and parents about the objective, teaching content, approaches and methods in friendship skills development among adolescents with ASD; (2) Driving factors affecting the development and appplication of friendship skills teaching activities for adolescents with ASD.

- Surveying tool: The survey uses two questionnaires for parents and teachers of adolescents with ASD. Each one includes closed and open questions for the purpose of learning, collecting and evaluating information related to friendship skills among adolescents with ASD. The questionnaires are also aimed to learn about the awareness, skills and experience in the organization of guiding activities on friendship skills for adolescents with ASD. The surveys include questions on teachers’ and parents' awareness about teaching friendship skills to adolescents with ASD, current situation of teaching friendship skills to adolescents with ASD (objectives, contents, methods, formats and assessments) and the degree of effectiveness in using friendship skills development activities for adolescents with ASD.

- Surveying method: Survey was conducted through questionnaires, observation, interview, data processing by mathematical statistics

- Surveying geographic location and target groups: Surveyed geographic location includes Hanoi, Quang Ninh and Vinh Phuc. Respondents compose of 125 teachers, 101 parents and 33 adolescents with ASD.

2.2.2. Major Findings about the Current Situation of Teaching Friendship Skills to Adolescents with ASD (Objectives, Contents, Methods, Formats and Assessments)

Table 1. Perception of teachers and parents about the objectives of teaching friendship skills for adolescents with ASD (1 ≤ M ≤ 3)

It can be seen from the table above that most teachers and students agree with the four goals set out for teaching friendship skills to adolescents with ASD. Specifically, "Helping children to have attitudes and motivation to increase their confidence" ranks as the top goal, with an average score of M = 243. This is followed by the goal of "Helping children to build friendships and enhance communication and interaction skills” with an average score of M = 2.39. The third ranking belongs to the goal of "Improve knowledge of free-play and integration skills in the most effective manner" with an average score of M = 2.38. "Developing receptive and expressive communication" is in the fourth place, with the average score of 2.24.

In general, teachers and parents share similar understanding. Particularly, both agree that saying thank you in certain situations plays a very important role. Generally speaking, teachers and parents know how to evaluate and select suitable goals with the abilities and needs of the adolescents with ASD. However, it takes dual efforts and support of both forces to achieve this goal. In addition, it is pivotal to establish a relationship circle to help adolescents with ASD communicate and interact effectively in diverse environments.

Table 2. Perception of teachers and parents about the development of teaching content for friendship skills development for adolescents with ASD (1 ≤ M ≤ 3)

Among four items, “Helping others” is in the first place with an M of 2.90 points, followed by “Making new friends” with an M of 2.88. “Proactively greeting people” ranks the third with an M of 2.82. Proactively greeting people shows an active role in the process of making friends among adolescents with ASD, helping them create a joyful and comfortable enviroment and enhance their confidence and proactiveness in communication. The last ranked item is "Participating in group activities" with an M of 2.60. The participation in group activities should be promoted and comprehensively implemented so that adolescents with ASD have an environment where they feel confident to interact and make friends in the most effective way. In the opinion of parents, “The skills of making new friends should be implemented on a regular basis, enhanced and expanded in order to help adolescents with ASD develop friendship skills so they can build relationships and develop their skills”.

It can be observed from the table above that the training contents of friendship skills development for adolescents with ASD closely correlate with each other. "Making new friends" is closely correlated with "Helping others" r = 0.441, p = 0.000 <0.01 while remaining closely correlated with "Actively greeting people” r = 0.441, p = 0.000 <0.01. Besides, this is also correlated with "Participating in group activities" with r = - 0.134, p = 0.045 <0.05. Therefore, it can be concluded that "Making new friends" has a high degree of correlation with the other activities, since greeting and helping others is also an opportunity for adolescents to make friends. In addition, participating in group activities also enable children to meet and interact with other peers and enhance their friendship skills.

Also, "Helping others" is closely correlated with "Making new friends" and "Actively greeting people" with r = 0.239, p = 0.000 <0.01. Therefore, in the process of helping others, adolescents with ASD can offer greetings, introduce about themselves and create favorable conditions to make friends.

In summary, the variables in the friendship skills development process of adolescents with ASD are closely related to each other. Thus, teachers and parents need to combine and integrate different teaching contents in the learning process and daily activities to achieve the highest efficiency in achieving the goals.

Table 3. Pearson correlation between training content for friendship skills development for adolescents for ASD

Table 4. Current use of teaching methods for friendship skills development for adolescents with ASD (1 ≤ M ≤ 3)

Most frequently used method is "Video Modeling" with M = 2.94. In the second place is the use of "Social Stories" with an average score M of 2.67. “Pivotal Response Treatment” ranks as the third with an average score of M = 2.57 while use of "Pretend Play" comes in the fourth place with M = 2.38. In teaching friendship skills to adolescents with ASD, the use of games helps to improve generalization and problem-solving skills for children while creating fun and comfortable environment for them. "Social scripting" ranks as the fifth with an M of 2.31. As clearly seen, the majority of teachers and parents are able to use flexible and diverse methods in their teaching process.

Table 5. Organizing methods of friendship skills development for adolescents with ASD (1 ≤ M ≤ 3)

Among the six teaching methods mentioned, most parents and teachers agree that “Organizing social skills lessons in large groups" is the most frequently seen activities in schools (M = 2.96). "Organizing and integrating social skills development into daily activities" ranks second in terms of importance, with an average score of M = 2.88. "Organizing social skills lessons in small groups (3-4 children per group)" comes in the third place in terms of frequency with an average score of M = 2.87. "Combining different methods" is in the final place in terms of effectiveness with the average score M of 2.85. "Organizing individual lessons" ranks fifth when it comes to efficiency, with an M of 2.84, followed by "Organizing fun, role play activities in groups" with an average score of M = 2.83.

Table 6. Use of assessment method in teachers and parents’ teaching of friendship skills for adolescents with ASD (1 ≤ M ≤ 3)

The assessment most frequently used by teachers and parents is “Observe the practice of skills” with an average score of M = 2.80. “Interview with parents” ranks second with an average M of 2.79. "Use questionnaires to survey the practice of skills" stands in the third place with an average score of M = 2.70. "Develop assessment tools by scale" ranks fourth with M = 2.32. Most teachers and parents face challenges in assessing and developing a set of tools for the assessment of friendship skills due to the lack of sufficient professional knowledge and functional characteristics of adolescents with ASD.

Thus, a consistent perception can be observed between parents and teachers in identifying advantages in the process of developing friendship skills development activities. The educational forces claim that it is best that "Parents and teachers work closely with each other in teaching friendship skills for children" with the average score of teachers being 2.94 and that of parent being 2.92. “Educational establishments support the development and organization of skills development activities” has an average score of 2.89 and 2.88 for teacher and parents, respectively. It can be said that one of the fundamental advantages for development of activities is that educational institutions actively support teachers to design such activities, which plays the most significant role in skills development. The third advantage in teaching friendship skills to adolescents with ASD is that “Teachers and parents have understanding and experience in teaching skills to adolescents with ASD", with an average score of 2.85 for teachers and 2.81 for parents. Ranking fourth is "Students in the class actively cooperate with the development of teaching activities" with M = 2.80 and 2.76 for teachers and parents, respectively. The teaching and learning of friendship skills requires a lot of cooperation of students in class so as to create a favorable and positive learning for students to practice their skills in the most productive manner. "Equipment and facilities are suffiently equipped for skills development teaching” is the fifth advantage, with the average scores of 2.74 for teachers and 2.67 for parents. This can be seen as an extremely favorable condition that aids the effective development of friendship skills development activities for adolesecents with ASD. New facilities and those of good quality ensure the supply of basic and essential conditions for highly effective education. The sixth advantage is “Have in place friendship skills teaching programs with specific objectives and details." There is currently a limited number of skills training programs, resulting in a lack of specific goasl and training contents. This is also one of the issues requiring improvement.

Table 7. Advantages of teachers and parents in teaching friendship skills for adolescents with ASD (1 ≤ M ≤ 3)

Table 8. Challenges faced by teachers and parents in the teaching of friendship skills for adolescents with ASD (1 ≤ M ≤3)

Teachers and parents share similar challenges in the process of developing friendship skills development activities for adolescents with ASD. The biggest difficulty for both parents and teachers in the teaching process is "Challenge in identifying the objectives and prioritized activities in skills development", with an average score of 2.90 and 2.84 for teachers and parents, respectively. This can be seen as one of the major difficulties in the development of teaching activities, as identifying teaching objectives and contents play a key role in designing activities with practical benefits, right direction and high efficiency. The second challenge in teaching friendship skills is “Challenge in the development of suitable activities for personal characteristics, interests, emotions and needs of adolescents with ASD” with average scores of 2.87 for teachers and 2.83 for parents. Each adolescent with ASD has their own characteristics and interests, so it is extremely difficult to develop activities to meet most of the needs of adolescents with ASD. This requires a lot of research and understanding by educational forces. The third difficulty is "Challenge in introducing activities that are motivational, bring joy and positive feelings for adolescents with ASD" with the average scores of teachers and parents being 2.87 and 2.77, respectively. A distinctive feature of adolescents with ASD is their short attention span, tendency to get distracted and bored while participating in learning activities. This requires teachers and parents to develop activities that can attract their attention and participation in order to achieve high efficiency in the teaching process. Ranked as the fourth difficulty is "Lack of synchronous understanding between parents and teachers in the development of activities" with the average score of 2.6 and 2.74. The fifth challenge is "Challenge in allocating human resources for the development and organization of skills development activities" with the average scores of 2.82 and 2.74 for teachers and parents, respectively.

Table 9. Evaluating driving factors affecting friendship skills development for adolescents with ASD (1 ≤ M ≤ 3)

The development of friendship skills training activities for adolescents with ASD is influenced by a number of subjective factors (teachers, educational establishments and the implementation of teaching programs). Besides, it is also affected by objective factors (children themselves, training materials and coordination of educational forces). In addition, it can be seen that the impact of subjective factors is greater than that of objective factors (M = 2.77> M = 2.57).

Impact of subjective factors: The development of teaching programs show the greatest impact on the teaching process of friendship skills for adolescents with ASD (M = 2.78), followed by educational establishments and teachers, both of which share an average score of 2.77.

Teachers: "Being creative-minded and able to organize effective activities" has the greatest impact with M = 2.81. Ms. P.T.M shared that "In order to improve the quality and efficiency of education, teachers need to show commitment, dedication to the job, proactivity and creativity in the educational process". In the second place is the factor "Have high expertise in friendship skills teaching" with an M of 2.76. Improving professional expertise plays a vital role in skills development for adolescents. It is required to focus on promoting expertise development and teaching effectiveness for teachers to achieve high efficiency in skills teaching. "Being committed and eager to learn" (M = 2.7) is also a major factor. Specifically, teachers need to improve their attitudes, skills and dedication to enhance professional quality and efficiency in teaching.

Educational establishments: “Have adequate facilities and learning environment for the education of adolescents with ASD” has more influence than most (M = 2.74). Educational facilities and equipment aim to provide basic conditions to ensure the effective implementation of educational goals for adolescents with ASD.

Implementation of educational programs: “Frequency and intensity of skills review and practice” (M = 2.83) has a great influence on the skills development process for adolescents with ASD. Once skills are performed with a high frequency and intensity, they are more likely to be proficiently and effectively applied to real life.

Impact of objective factors: "Individual child" has the most impact with an M of 2.53, followed by the factors "Materials" (M = 2.30) and "Coordination" (M = 2.28).

Individual child: The most influential factor is “Level of disability” (M = 2.70). The level of disability (serious, moderate, mild) plays a pivotal role and drives the development of teaching activities that are most appropriate for each individual. For children with mild disabilities, skills education tends to be easier, and children have more opportunities to learn and apply acquired skills in real life. The factor "Personal characteristics, strengths and weaknesses" (M = 2.37) also affects the process of setting goals, activities, and implementation plans in the most effective way.

Materials: There is no available general skills education program for all adolescents with ASD; as a result, each institution develops their own teaching program. This greatly affects the educational process and the quality of education. This factor has an average score of M = 2.35. Therefore, one of the urgent tasks is to develop a general skills education program in a holistic manner, which can be applied on a large scale and shows high effectiveness.

Coordination: “Families’ engagement and coordination in skills development for adolescents with ASD” is of great importance to the teaching process for adolescents with ASD with an M of 2.35. A skill can only be acquired when used in a wide variety of circumstances. Therefore, reviewing, improving and applying skills in family-, social and community-based environments are the key. It is advisable to enable adolescents with ASD to apply acquired skills in real-life situations, improve their problem solving ability and strengthen their skills.

2.3. Lessons Learned

Based on the review of current status in the teaching and learning of friendships skills for adolescents with ASD in specific environments, a number of lessons have been drawn to improve the effectiveness of friendship skills development for adolescents with ASD. Specifically:

(1) Teachers and parents need to be trained about the selection of teaching objectives, contents and how to use methods and organize the teaching of friendship skills for adolescents with ASD. Parents and teachers need to help children know how to join a group of friends and be able to act in ways that are acceptable to their peers. Besides, regular professional training and knowledge exchanges between teachers and parents is also an important issue that needs to be addressed;

(2) The process of organizing friendship skills development activities needs to have consistency in each step of implementation to avoid confusion among children. Each child needs an individual learning plan but also a group plan to help them learn how to apply knowledge in new situations and contexts. Consequently, it is essential to teach adolescents with ASD to make friends, which synchronizes the application of steps between teachers and parents.

(3) It is necessary to ensure facilities are suffiently provided, classrooms are suitably arranged with enough trays and shelves for students to practice their skills by themselves. Social stories need to be developed to show children how to make friends, maintain friendships and help others. Video modeling should also be used to help children remember, imitate and apply skills to real life situations. Self-help groups are also advised to be put in place where appropriate. There should be space for organizing group activities and for students to review knowledge by individual corner;

3. Conclusion

Equipping adolescents with ASD with friendship skills plays a key role in helping them communicate, interact, and establishing relationships with others. As a result, teaching friendship skills becomes an urgent matter in the education of adolescents with ASD. Friendship skills development for adolescents with ASD should focus on four basic areas: (i) skills to actively greet others, (ii) skills to make new friends, (iii) skills to participate in group activities, and (iv) skills to help others. It is advisable to develop specific contents and methods of training activities to facilitate friendship skills development among adolescents with ASD.

References

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