Adv Neurodev Disord (2017) 1:14–20
DOI 10.1007/s41252-016-0001-5
ORIGINAL PAPER
Adolescents with Autism Spectrum Disorder: Friendships
and Social Interactions
Laura Nabors 1 & Renee Hawkins 1 & Andrew Robert Yockey 1 & Stephanie Booker 1 &
Amanda Tipkemper 2
Published online: 3 October 2016
# Springer International Publishing 2016
Abstract Adolescents with autism spectrum disorders
(ASDs) often have difficulty with social interactions. This
study aimed to increase social interactions in adolescents with
ASD. Teachers developed friendship goals based on social
skills outlined in the teaching-family model. Teachers provid-
ed reinforcement to students for displaying positive behaviors
linked to goals throughout the school day. The current study
also examined student, parent, and teacher perceptions of ad-
olescent social interactions using interviews and surveys.
During their interviews, adolescents reported that they were
often lonely. Parents indicated that their children needed to
learn skills to improve peer interactions. Observers used a
behavioral system to quantify the types of social interactions
displayed by adolescents. After a baseline period, teachers
developed an intervention focusing on friendship goals to en-
courage students to engage in social interactions. The inter-
vention had a limited impact on improving social interactions.
The findings for the current study indicated limited improve-
ment in social interactions resulting from the teacher-directed
intervention. Parents, adolescents, and teachers highlighted
the need for adolescents with ASDs to find ways to utilize
social skills to reduce loneliness and improve peer support.
Future research investigating the impact of teaching
interaction/friendship skills around the students’ interests
(e.g., sports) may help them learn skills to interact more with
peers. Additionally, assessing the impact of individualized
* Laura Nabors
naborsla@ucmail.uc.edu
1
School of Human Services, University of Cincinnati, Mail Location
0068, Cincinnati, OH 45221-0068, USA
2
The Children’s Home, 5050 Madison Road, Cincinnati, OH 45227,
USA
planning to improve each adolescent’s skills may be more
influential in changing social behavior than a system-wide
intervention, such as the one implemented in this study.
Keywords Social interactions . Friendships . Social skills .
Adolescents with autism spectrum disorder . Teachers . Parents
Introduction
Autism spectrum disorder (ASD) is a broad diagnostic cate-
gory associated with problems in the areas of social commu-
nication, emotional intelligence, social recognition, and social
interactions (Laugeson et al. 2012). Social impairment is ar-
guably the most limiting symptom of this diagnosis, and social
interaction and communication with others are pivotal for ac-
ademic success and improved communication skills for ado-
lescents with ASD (Sansosti 2010). However, social interac-
tions may occur less frequently for adolescents with ASD than
their typically developing peers (Cappadocia et al. 2012). Due
to these social deficits, adolescents with ASD can be isolated
and bullied at school, which increases their risk for low self-
esteem and internalizing problems (e.g., depression; Tse et al.
2007). Thus, improving social involvement may boost mental
health. In addition, improving social skills also increases vo-
cational development, which will improve the future of youth
with ASD (Tse et al. 2007). Research to determine factors
influencing the interactions of and tools for measuring the
social involvement of adolescents with ASD will contribute
to literature and the growing need for interventions to improve
social skills for adolescents with ASDs.
Adolescents with ASD spend less time in social interac-
tions compared to their peers (Humphrey and Symes 2010).
Isolation and loneliness may take a toll, eventually leading
to negative and turbulent experiences in day-to-day
Adv Neurodev Disord (2017) 1:14–20
interactions (Hughes et al. 2013). Improving communica-
tion skills and abilities to engage in social exchanges with
peers reduces social isolation for youth with ASD (Koegel
et al. 2013; Stichter et al. 2007). Several factors may con-
tribute to improved interactions. For example, Koegel et al.
(2013) found that communication skills increased in ado-
lescents with ASD when their interactions with other youth
focused on activities they found interesting. Feldman and
Matos (2013) reported that adult involvement in classroom
interactions facilitated the involvement of youth with au-
tism in social exchanges. Furthermore, providing instruc-
tion about making friendship bids, speaking to, and
interacting with classmates may increase the frequency of
social interactions with peers and improve social develop-
ment and reduce the feelings of isolation for adolescents
with ASD (Tse et al. 2007). Instruction on social skills
and interpersonal communication should be pivotal educa-
tional experiences for adolescents with ASD, but planning
in this area can be under-developed in classroom settings
where busy teachers have little time to implement and as-
sess the impact of interventions to improve social
involvement.
Most adolescents with ASD report having at least one
friend (Bauminger and Kasari 2000; Locke et al. 2010).
They define their friends as a person to talk with or do things
with and as someone they can trust, who is kind (Locke et al.
2010). Adolescents with ASD may understand they have few-
er friends, poorer social skills, and that their friendships might
not be as close as their peers’ friendships (Bauminger et al.
2008; Rao et al. 2007). Establishing friendships with peers
may be difficult because adolescents with ASD lack abilities
to build relationships with others (Samuels and Stansfield
2012). These deficits reduce opportunities to build friendships
and engage in interactions. Continued research will increase
knowledge and provide information to develop interventions
to improve the social development of adolescents with ASD.
Researchers have reviewed studies examining interven-
tions to improve social the skills of adolescents with ASD,
identifying several effective intervention strategies (e.g.,
Mason et al. 2015; McDonald and Machalicek 2013).
Reinforcement and token economies have been successful
in improving social communication (Matson and Boisjoli
2009). Mason et al. (2015) found that the reinforcement of
verbal responses increased the verbal responding of a 15-
year-old and a 17-year-old male with ASD. These adoles-
cents worked one-on-one with behavioral technicians from
a university program. Koegel et al. (2014) used a rein-
forcement and token system to improve the conversation
skills of a 14-year-old boy with ASD. Points that could
lead to earning rewards, such as increased computer time,
were awarded for appropriate conversation, question ask-
ing, and interacting with a graduate student, who served as
a conversation partner. This intervention was successful in
15
increasing the levels of conversation and question asking.
Less information is available about whether reward sys-
tems are effective in the classroom, in the hands of
teachers (Parsons et al. 2013). Additionally, research ex-
amining class-wide interventions to improve the social
communication of adolescents with ASD will determine
if these types of interventions are effective when there
are several adolescents with ASD in the same classroom.
One goal of this study was to examine the parent and ado-
lescent perceptions of social skills and friendships for adoles-
cents with ASD. Parents completed surveys and adolescents
completed interviews to examine their perceptions of the ad-
olescents’ social skills and friendships. Another goal of this
study was to evaluate the outcomes of a teacher-directed in-
tervention, emphasizing Bfriendship behaviors^ to improve
adolescents’ social skills. Behavior observations and teacher
interviews were used to assess the impact of a friendship in-
tervention to improve socialization with peers. It was antici-
pated that social behaviors (i.e., interactions with others, ask-
ing questions, and expression of positive emotions) would
increase after the implementation of the intervention.
Method
Participants
Twenty youth (17 boys and 3 girls) enrolled in a private high
school for adolescents with ASD participated in this study.
Average age was 16 years, 2 months (ages ranged from 14
to 19 years). All of the youth were diagnosed with a primary
diagnosis of ASD (90 %, n = 18) or a significant cognitive
delay (10 %; one boy and one girl). The youth with cognitive
delays as a primary diagnosis also exhibited symptoms that
were consistent with a secondary diagnosis of ASD. The ma-
jority of youth were Caucasian (n = 17) and three were
African-American. The high school included three class-
rooms, and on a typical day, a class size averaged about six
or seven youth with 18 to 20 youth attending school regularly.
There was one lead teacher and at least one assistant teach-
er per classroom. There were six teachers (four males and
three females). Five teachers were Caucasian and one was
African-American. All had received special training for work-
ing with adolescents with ASD, and teachers were certified
intervention specialists. There was a certified education spe-
cialist and an educational assistant working in each classroom.
The assistant principal, a Caucasian female with a master’s
degree in special education, consulted with the teachers on a
daily basis. Two college students and a licensed psychologist
served as observers and interviewers. There was a male and
female college student and the psychologist was a female.
Observers/interviewers were Caucasian.
16
The setting for the current study was a private high school
for youth with ASD. The students at the high school were
experiencing significant conversational and social skill
deficits, which precluded their enrollment in public schools
and in inclusive classroom settings. Teachers in the school
setting were using key principles and goal setting developed
through the Teaching-Family Model (TFM). Grounded
in behavioral principles, the TFM is an evidence-based
intervention with over 30 years of research supporting its
impact on increasing grades, improving behavioral function-
ing, and reducing restrictiveness in different treatment settings
(e.g., James 2011; Kingsley 2006; Kirigin 2001; see
http://teaching-family.org/wp-content/uploads/2013/10
/tfabibliography.pdf for a bibliography). The high school was
certified as a TFM program by the Teaching-Family
Association (www.teaching-family.org; http://www.teaching-
family.org/aboutthemodel.pdf; http://teaching-family.
org/teaching-family-research-development/). Students earned
points for the attainment of their behavioral and academic
goals, which they could exchange for prizes or Bcomputer
time^ at the end of the week.
In addition to an individualized academic program
(morning program), the school offered life skills and job
readiness programming to help students prepare to be inde-
pendent and productive adults (afternoon programming).
Students also participated in other services including speech
and occupational therapy, as well as specialized music and art
programming.
Procedures
A university-based institutional review board approved this
study. Parents provided consent and children provided assent
to participate in this study.
At the outset of the project, parents completed a survey and
students completed interviews to gather information on their
perceptions of friendships and social skills. Parents returned
surveys assessing their perceptions of their child’s friendships
and social skills. Parents provided demographic information
and then responded to seven questions: (1) How does your child
make friends? (2) How many friends does your child have at
school? (3) Does your child seem to enjoy social activities? (4)
Please write down reasons for your answer about whether your
child enjoys social activities. (5) Does your child ever appear
lonely? (6) If they answered yes to question 5, they provided
information about why their child appeared lonely and (7) What
types of friendship skills are difficult for your child to engage in
and why? Adolescents participated in semi-structured inter-
views that lasted approximately 5 to 10 min. Interview ques-
tions included: (1) BHow do you make friends at school?^ (2)
BWhat do you talk about with your friends at school?^ and (3)
BDo you feel ‘O.K.’ telling your friends about personal or pri-
vate things or secrets?^
Adv Neurodev Disord (2017) 1:14–20
An A-B single-case research design was used to examine
the effects of the intervention on students’ behavior. There
was a four-week baseline period where behavior observations
were completed, followed by 7 weeks of intervention. During
baseline, class instruction and implementation of the TFM
program continued as usual. As part of the TFM program,
teachers developed two to three behavioral goals for each
student (i.e., following instructions, accepting Bno^ for an
answer, showing respect). Each student’s goals also had
specific behavioral steps to break down the behaviors for
successful goal attainment. Teachers provided corrective
feedback and reinforcement linked to each student’s goals
throughout the day and reviewed progress toward goals with
students at the end of the school day. Students received points
when they exhibited behaviors consistent with their goals.
They also received behavior-specific praise if they successful-
ly performed one of the behavioral steps for their goals or
actually successfully performed one of their goals. Teachers
recorded point totals at the end of each school day in a log and
students accumulated points throughout the week. Students
could Bspend^ their points at a point store at the end of the
week. Students could purchase either items, such as food or
games, or rewards (e.g., increased computer time) at the point
store.
Following baseline, teachers continued implementing the
TFM program but added the intervention for this study, which
consisted of three behavioral goals for all students: (1) begin-
ning a conversation with another person, (2) joining in an
interaction with others, and (3) offering to help a classmate.
The component behaviors required (component parts of each
goal) are presented in Table 1.
The behavioral goals focusing on friendship skills were
added to existing goals for each student. Teachers awarded
points for reaching friendship behavioral goals and other stu-
dent goals throughout the day. Teachers discussed progress to-
ward goals with students at the end of the day. Teachers imple-
mented this intervention on a daily basis, throughout the school
day, for 7 weeks. Observers recorded behavior observations
throughout this intervention period.
After the intervention had been completed, teachers and the
assistant principal completed interviews to discuss their per-
ceptions about the implementation of the intervention and
their views of student behavior before and during the inter-
vention period. This data provided information about social
validity and provided information about future ideas for im-
proving the intervention. Teachers and the assistant principal
also suggested ideas for improving adolescents’ social skills in
the future.
Measurement: Behavior Observations
Students’ social behaviors were observed by three of the au-
thors in the classroom using a structured direct observation
Adv Neurodev Disord (2017) 1:14–20
Table 1 Behavioral goals or
target skills for the friendship Behavioral goal or target skill
intervention designed by teachers
Beginning a conversation
Joining in
Offering to help a classmate
code. Behavioral categories were modified from those devel-
oped by Gottman (1983) to assess social behaviors. Categories
included the following: (1) positive emotional expression (to-
ward another person), (2) negative emotional expression, (3)
asking questions, (4) interaction with a peer, and (5) interaction
with a teacher. A positive emotional expression was defined as
positive feelings directed toward another person in a positive
manner or with a positive tone (i.e., making a positive verbal
statement, smiling, laughing). A negative emotional expression
was defined as negative feelings, expressions, or emotional tone
expressed toward a peer (frowning, yelling, or making a nega-
tive verbal statement). Asking a question involved asking an-
other person to answer a question. Interaction with a peer or
teacher consisted of talking with a teacher or peer. In order to
deter reliability decay, observers reviewed the observation cat-
egories on a weekly basis (Bakeman and Gottman 1986).
Observers recorded behaviors at the end of a 2-min scanning
period. One observer verbally signaled the start and end of a
scan sample of the classroom, when there were two observers
present in the classroom. If there were two observers present to
determine inter-rater reliability, they stood at the sides of the
classroom, at a distance, so they could not see what the other
observer was recording. Observers scanned the room from the
front to the back of the room and then recorded which behav-
ioral categories occurred by placing a check mark in a box on a
grid with categories for each of the five behaviors. Observers
also recorded field notes below the grid as needed. Scan sam-
pling has been used in previous research focusing on social
interactions (e.g., Buhs and Ladd 2001).
Data Analyses
Researchers entered the data from behavior observations into a
data analysis program (SPSS Version 20). Data from behavior
observations were analyzed using percentages and chi-square
analyses. Kappa coefficients were utilized to determine
17
Behaviors for obtaining goal or target skill
1) Decide on a person to speak to
2) Decide what you are going to say
3) Speak with a calm voice tone
1) Watch what the person is doing
2) Say something like, BCan I play?
3) Wait for an answer
4) If they say BNo, then say BO.K.^
5) If they say yes, say thank you
1) Look at the person
2) Say, BCan I help you?^
3) If they say BYes,^ then help them right away
4) If they say BNo,^ then say BO.K.^
interobserver agreement for behavior observations.
Descriptive analyses (frequency counts) were used to analyze
descriptive data from interviews and surveys. In addition, con-
tent coding was used to determine key themes in qualitative
data from interviews and surveys. Three of the researchers
reviewed transcripts of the interview data (provided by teachers
and students) and information recorded by parents on surveys
in six meetings to determine key themes in the data (Strauss and
Corbin 1990). Disagreements were resolved by consensus.
Results
Nine parents (eight females, one male) completed surveys; all
were Caucasian. Four were in their B40s^ and five were in
their B50s.^ Eight of the parents reported all of their adoles-
cent’s friends were Bat school.^ One parent reported her child
did not have any friends at school. One parent said her son had
eight friends at school, but the others typically reported one,
two, or three friends. Two parents reported their child had no
skills for making friends, and one parent did not provide a
response for this question. Seven parents reported their child
appeared lonely. Four parents (44 %) reported they arranged
meetings with friends for their adolescent. When asked wheth-
er their child enjoyed social activities, 33 % (n = 3) of the
parents indicated Bno,^ 33 % indicated Byes,^ and 33 % re-
ported Bsometimes.^ Parents who reported their child did not
enjoy social activities were likely to write that their child
needed a parent to go with them to support their involvement
with peers at social events. Parents reported that encouraging
social skills around adolescents’ favorite activities had the
potential to engage them in interactions. Parents wrote that
adolescents needed to work on improving empathy skills,
turn-taking in conversations, Bfitting in,^ and having patience
with others (e.g., Bhe needs things done his own way in his
own time^).
18
Table 2 Kappa coefficients for interobserver agreement
Behavioral variable Kappa p and during the intervention.
Positive emotional expression .631 .001
Negative emotional expression .707 .001
Asking questions .798 .001
Interaction with a peer .849 .001
Interaction with a teacher .769 .001
Thirteen of the twenty students at the school completed
interviews to assess their perceptions of their friendships.
There were eleven boys and two girls; three were African-
American and ten were Caucasian. Seven of the youth (1 girl
and 6 boys) were unable to explain how they made friends.
Five of the youth (1 girl and 4 boys) reported they made
friends by Btalking^ or Bintroducing myself.^ One boy said
he would make friends by Bjoining a conversation that is go-
ing on.^ The students also provided information about what
they talked about with friends. Specifically, two students, one
boy and one girl, reported, BYou speak to your friends about
Banything.^ Another boy said, BThey talk about things that are
already occurring in a conversation.^ Two boys and one girl
mentioned they speak about games, movies, or cartoons with
friends. Two boys said, BI talk about my weekend.^ One boy
said he discussed Bhistory^ with his friends. Another boy re-
ported he discussed sports with friends. Finally, another boy
stated he spoke about Bcurrent events^ with friends. Nine of
the youth reported they would discuss personal or private
things with a friend.
Two observers were present for 34 % of the observations.
Kappa coefficients are presented in Table 2. Interobserver
agreement for different behavioral categories was good.
Two hundred and three behavioral observations were re-
corded by the three observers. The frequencies for each type
of behavior, across the 203 observations, were as follows:
positive emotional expression 6.9 % (n = 14), negative emo-
tional expression 7.4 % (n = 15), asking questions 43.3 %
(n = 88), interaction with a peer 68.2 % (n = 137), and inter-
action with a teacher 60.7 % (n = 122).
Chi-square analyses were used to assess the behaviors ob-
served before the implementation of the intervention, and then
during the intervention period. Table 3 presents the
Table 3 Rates of behaviors by
categories: representing social Behavioral variable
exchanges in the classroom
Positive emotional expression*
Negative emotional expression
Asking questions*
Interaction with a peer
Interaction with a teacher
*Denotes significant difference at p < .05
Adv Neurodev Disord (2017) 1:14–20
frequencies of behavioral observations by category before
There were significant differences for positive emotional
expression, X2 = 4.596, p = .024, and for asking questions,
X2 = 4.389, p = .026. Expression of positive emotion increased
and questions decreased during the intervention. Chi-squares
for change in negative emotional expression, interactions with
peers, and interactions with teachers did not reveal significant
differences. It is noteworthy that interactions with peers in-
creased and interactions with teachers decreased after the im-
plementation of the intervention, although differences were
not statistically significant.
All of the teachers, except one, reported they believed
using the three friendship goals was helpful in reinforcing
skills that adolescents needed to be able to interact more with
others in their classrooms. For example, one female teacher
reported, BWhile the friendship goals were in effect I felt that
the adolescents were, ‘respecting’ children’s (other peers)
problems more.^ She believed teaching the adolescents to
respect each other was an important social goal. However,
one teacher stated he was not sure all of the students recalled
the friendship goals. Thus, he did not have complete confi-
dence in the goals as being helpful to all of the students.
Teachers also discussed future goals for improving social
skills. All of the teachers believed incorporating more field
trips into their routine and ensuring the students were engag-
ing in interactions during recreational activities would im-
prove socialization among students.
The assistant principal felt that the intervention improved
teachers’ focus on the development of social skills. She men-
tioned that the point store, as a reward system, might be more
important to some of the students and less important to others.
Specifically, she mentioned, BSome youth are motivated by the
point store, while others are not. Some have difficulty waiting
until the end of the week to earn a reward at the point store,
which reduces value of the system.^ She wanted to discuss the
idea of tying the point system to privileges during flexible time
(a time when adolescents could select what they wanted to do)
so that students could earn time to participate in valued activi-
ties (e.g., computer time). Moreover, she felt that iPads and
computers could detract from social opportunities. She stated
that, BThere are at least two computers at the back or corners of
the rooms and this causes distraction.^ She planned to work
Before the intervention (%) After the intervention (%)
1 9
6 8
54 38
64 70
64 59
Adv Neurodev Disord (2017) 1:14–20
with staff to move classroom computers to an unoccupied class-
room and meet with teachers to develop ideas for earning com-
puter time for accomplishing personal goals.
Discussion
Consistent with existing literature, study results indicated that
adolescents with ASD valued friendships, although parent re-
port indicated that adolescents lacked skills and would benefit
from interventions to improve social skills (Bauminger and
Kasari 2000; Locke et al. 2010). Most parents reported that
their child was lonely, which was consistent with the findings
of previous studies (Hughes et al. 2013; Locke et al. 2010).
Given that parents were providing a great deal of support for
interactions outside of the school setting, it may have been
advantageous to involve parents in the development of inter-
ventions. Social interactions with peers slightly increased and
expression of positive emotions improved after teachers im-
plemented the intervention. This may have been a precursor to
significant amounts of involvement with peers, had the inter-
vention period been longer. Interactions with adults reduced
during the intervention period, perhaps because teachers were
allowing adolescents more opportunities for interactions with
their peers. Students were asking fewer questions during the
intervention period, which may have been related to the lower
frequency of interactions with teachers. However, further re-
search is needed to confirm this idea.
However, over 50 % of the students’ interactions were with
teachers, irrespective of the application of an intervention.
Teachers’ encouragement of interactions with peers and
awareness of reducing Bone-on-one^ interactions between
themselves and youth may promote peer-to-peer interactions
(Carter et al. 2013; Feldman and Matos 2013). Teachers can
play a role in facilitating social interactions through incidental
teaching opportunities where they can include other students
in ongoing interactions. Teachers did report important areas
for intervention, including improving empathy for others, re-
ducing negative outbursts, respecting personal space of others,
and improving students’ abilities to express their emotions
with others. Developing behavioral goals in each of the afore-
mentioned areas, and rewarding adolescents for reducing neg-
ative outbursts, respecting others’ personal space, and improv-
ing their skills for positive emotional expression during con-
versations with others may improve adolescents’ social skills
in the future.
Students discussed a limited range of topics with friends,
and the topics of conversation usually were limited to their
own narrow range of interests. Developing situations in which
adolescents can Bpractice^ friendship goals may improve op-
portunities for adolescents with ASD to develop their social
skills. Practice situations may be most effective when
19
conversations revolve around an area of interest for students
with ASD.
Limitations
Several factors could have limited the generalizability of study
findings. For instance, some parents and youth did not provide
complete interview and survey data, which may have limited
the utility of our findings. In addition, observers did not record
the sequence of events during behavioral interactions, which
could have afforded data about the content and information
reviewed in successful interactions. Observers did not record
data about the number of youth involved in each interaction,
so optimal group size for facilitating interactions could not be
determined. It also may be the case that observers missed
interactions occurring in different parts of the classroom as
they were completing scan samples. However, the classrooms
were small and the number of students in each class was small,
making this unlikely. Some of the students may not have been
sufficiently motivated to perform social behaviors, because
there was a lag in receiving rewards, because they went to
the point store at the end of the week. Moreover, other stu-
dents may not have been motivated, because the rewards at the
point store were not valuable to them. It also was not possible
to determine the impact of TFM—whether components of this
model influenced the adolescents’ social behaviors during the
intervention period. However, findings still point to value
added by when teachers added general social goals as a
school-wide intervention. Findings are applicable to a special
setting, a school for children with ASD, and future research is
needed to determine the impact of goal setting in integrated
classroom settings.
The results of this study provide new information about a
teacher-directed social skills intervention that was integrated
in a token system. Parent and teacher report supported the
need for increased social skills training and provided ideas
for interventions. Teacher report revealed that a Bone size fits
all^ intervention may not be effective for many students.
Other researchers have suggested that individualized planning
using functional analyses of behavior is critical for advancing
the skills of adolescents with ASD (Sansosti 2010). Teachers
may benefit from consultation with school psychologists to
develop individualized plans to improve peer interactions for
adolescents with ASD. School psychologists can also provide
advice on how to use functional analyses of behavior, develop
goals, and assess the impact of interventions. In future studies,
more immediate tangibles might be rewarding for adolescents.
Improving social interactions should remain a high priority for
interventions for youth with ASD (Laugeson et al. 2012).
Individualized interventions that are part of the student’s edu-
cational planning may be needed to ensure social skills are
developed and then generalized to interactions with peers
(Cappadocia et al. 2012). After designing interventions,
20
teachers and other school professionals can use existing token
systems to reward social interactions. Observation of interac-
tions can provide objective data about whether changes in
social involvement occur.
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