Clinical implications of this research

7.1. Third party understanding:

Probably the most significant finding o f this research is that a large majority o f the AS group think that it is important to have friends but that managing the nuts and bolts o f friendship can be difficult for them. It is important for those close to a person with AS to be aware they may sometimes behave in ways that suggest that they have no interest in or concern for their friends and to have some understanding o f why. An associated point is that, although many people with AS can give a very good definition o f friendship, there is a sense in which it is learnt and it does not follow that they necessarily have a conceptual understanding o f friendship. Because they sound as if they know what they are talking about, people who do not understand the implications o f AS are likely to believe that they are highly competent at friendship. Then, when they make a characteristically simple mistake, those people are likely to think that their behaviour was volitional and to react accordingly.

7 .2 Style o f communication

As noted above, it may be helpfiil for carers and friends to make some accommodations in their interactions with the person with AS. It is helpful to bear in mind, for example, that they find it hard to process simultaneous inputs. This is something that friends and teachers new to AS could usefully be told. It may help to keep speech simple and unelaborated and to rein in any spontaneous emotional response. I f someone is cross with the person with AS and perhaps shouting angrily at them, the executive hypothesis might predict that they would find it hard to decode both the words and the tone simultaneously - especially if they do not understand that they have done anything to give rise to anger.

One o f the AS teachers observed how, without conscious thought, he had developed a style o f talking to his AS pupils that was very measured and emotionally neutral. This was, he said, quite unlike the way in which he responded to his own children or, for that matter, to past pupils who did not have AS. This is perhaps the sort of style that Williams (1992, p i 96) terms "an indirect or detached manner" and observes may be very helpful (It is interesting to reflect whether this sort o f social response may be one o f the reasons why refrigerator parenting was supposed to be associated with ASDs - effect, rather than cause.)

7.3, Adult support:

The friendships o f people with AS seem to need a lot o f adult input. The person with AS may need help in thinking o f ways in which they can spend their time with a peer, in order to progress that relationship towards friendship. They may need help

in knowing how their friend is thinking or feeling and advice on how to offer appropriate support. Should conflict arise, they may need help with their own feelings as well as in understanding the nature o f the dispute, generating solutions, implementing them and monitoring the impact.

In considering the friendships o f people with AS, the errorless learning paradigm comes to mind. People with ASDs are often highly perseverative and, having once behaved in a particular way, may find it hard thereafter to generate alternatives. This suggests that maximising their chances o f a successful friendship interaction through adult intervention is important, not just for their emotional well-being but also because negative interactions could rapidly lead to a spiral o f inappropriate repetition and social withdrawal.

7.4 Skills teaching

Friendship rests, to some extent, upon a set o f social skills (like how to greet people or carry on a conversation, both issues mentioned in the staff and parent questionnaires). Whilst it may be hard for children with AS to generalise what they learn in one setting to other situations (perhaps as a function o f their executive skills deficit) there is some evidence that teaching from a social skills group may be beneficial (Howlin & Yates, 1995). Indeed, as noted in the Results, one member o f staff reported finding an AS pupil trying to learn these skills from a book. In a non­ specialist setting, he active involvement o f willing neurotypcial peers in a "circle of friends" may help in the application o f rote learned skills.

In addition, people with AS may find it hard to decipher and label emotions - a skills deficit that may become particularly apparent in adolescent friendships when mutual disclosure becomes more important. Here, too there is evidence that a taught approach may be beneficial (Hadwin, Baron-Cohen, Howlin & Hill, 1996).

7.5. Cognitive teaching

It has also been suggested that people with ASDs may need to learn in an intellectual way how to do things that non-AS people may achieve easily and intuitively (Carrington & Graham, 2001). This is particularly true in friendship and, as noted in the Results section, some participants described heuristics that they had devised themselves, in order to manage particular situations, such as conflict resolution. Marc Segar's (1997) work is a good example o f this sort o f thinking. Whilst such prosthetic solutions are unlikely to generalise to every situation, they are almost certainly better than nothing and may do much to reduce the anxiety that the person with AS is known to experience (Gillott et al., 2001) about particular social situations.