Study Explores How Children With Disabilities Make Friends: How Can Parents and School Personnel Help?

by Pamela Thomas, Sunny Roller, Ann Scharnhorst, Sean Cunningham, and Seth Warschausky

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Research has shown that children who do well socially in their elementary school years will perform better academically and have better social skills as adults. For children with physical disabilities, the challenge of developing friendships can be significant, especially if there is limited access to a range of social activities. In addition, there is evidence that children with disabilities are at risk for social isolation as a result of the stigma that society attaches to a disability and the lack of peer understanding about disabilities.

Aware of these issues, researchers are asking, “What can parents and educators do to help produce sociable children who, in the midst of long-term disability, will enjoy committed companionships?” The Adult Facilitation of Social Integration Study (AFSIS), conducted by the University of Michigan and led by Pamela Thomas, Ph.D., is one of the first studies of its kind in the United States. In particular, the study explores how families and schools can help improve the social lives of children with disabilities. The study was conducted in partnership with the Washtenaw Intermediate School District (ISD), and funded by the U.S. Department of Education, Office of Special Education Programs.

This FOCUS on Results document provides the following information drawn from this study:

• Preliminary data regarding the social integration of children.
• Data relating to the impact of gender factors in the friendship-making behavior of children.
• Information about what parents can do to boost the social integration of their children.
• How cognitive skills and abilities relate to social interaction and friendship-making.
• Information about how a child’s quality of life affects his or her friendship-making skills.
• Indicators of positive social integration in children with disabilities.

In the final year of the three-year study, investigators recruited 140 sets of parents, teachers, and children from hospitals, clinics, summer camps, and nonprofit organizations throughout Michigan to participate in the study. Our goal was to investigate what contributes to full integration and inclusion of children with and without disabilities. Specifically, the AFSIS study team examined the social lives of four groups totaling 70 children:

1. Children who were born with a neurodevelopmental condition, such as cerebral palsy, that includes physical and often cognitive impairments.
2. Children who have an acquired disability from traumatic brain injury or stroke.
3. Children who have a physical impairment, such as an upper extremity amputation, but their condition does not include risk for cognitive impairment.
4. Typically developing peers.

Our early findings are intriguing and continue to drive more in-depth data analysis. We are seeing results in four particular areas of interest: gender differences, parenting practices related to social integration, neuropsychological factors in social integration, and key predictors in a child’s quality of life. These initial findings have implications for parents and school personnel regarding key issues in facilitating the friendship-making process in children who have disabilities.

Gender Makes a Difference in Friendship-Making Behavior

“Gender is perhaps the most significant factor in explaining the meaning, content, and variations of friendships,” says Rannveig Traustadottir (1993), a researcher from the University of Iceland. Researchers have stated that the friendship characteristics of boys and girls differ in such unique ways that they could be referred to as different “cultures.” However, little research has been conducted that investigates the friendship qualities of boys and girls with disabilities—especially the influences that gender may have on social networks and the quality of interpersonal relationships in children with disabilities. Research on the development of children without disabilities indicates that children generally have social networks comprised of children of their own gender (Maccoby, 1998 and Maccoby & Jacklin, 1987). However, individuals with a disability are more likely to have a social network largely comprised of female friends. This may be due to the fact that, in general, girls with and without disabilities show a higher preference than boys do to be friends with a child who has a disability (Maccoby, 1998 and Maccoby & Jacklin, 1987).

Data from the AFSIS suggest that parents tend to socialize their children differently depending on the gender and disability status of the child. Parents of girls with disabilities report having more restrictive parenting practices than parents of typically developing male and female peers. Parents of girls with disabilities also report planning fewer family activities than parents of female peers without disabilities do. Parents of girls with disabilities also report arranging for and allowing their child to go to a friend’s home less often than parents of female peers without disabilities do. Similarly, parents of boys with disabilities report arranging for and allowing their child to go to a friend’s home less often than parents of male and female peers without disabilities do.

In light of this information, it is important for parents to be involved in the socialization of their children—e.g., to set up play dates. Also, teachers should take steps to ensure that socialization is happening in the classroom.

Parents Can Help Children Socialize in Other Ways

Four findings have surfaced about what parents can do to help their children with disabilities become more socially integrated:

• Involve children in social organizations.
• View medical therapies as opportunities to socialize children.
• Arrange outings for children to play with each other.
• Be cautious when intervening during children’s social time.

Parents in this study reported involving their children in community organizations, religious institutions, and sporting events as social outlets. Christine Kleimola, mother of a child who participated in the research study, relates, “I take my son to recreational activities such as martial arts, horseback riding, or swimming classes, as well as to church youth group activities, hoping he will meet kids to make friends with. He has learned to get along very well in groups of people, which is a great first step, but it’s tough for him to build one-on-one friendships in these settings.”

Parents of children with disabilities see their child’s therapies—such as physical therapy and occupational therapy—as contexts in which their children can develop friendships. Kleimola comments, “Some parents encourage clinic waiting room friendships; they keep their eyes open for potential friends for their child.” She goes on to say, “In light of this research finding, I think therapists should work harder to pair similar children in therapies, like bike-riding, to promote the important development of friendships.”

Children with disabilities report less conflict in their friendships when parents arrange outings with other children. This is a finding that is unique to children with disabilities and is not present in children developing without disabilities. “It’s important that both families are willing to help make new friendships happen,” adds Kleimola. “Right now, my young teenage son interacts mostly with people older than he is, perhaps because they can drive to our house and other places. He loves to play the guitar or go to the movies with them. He makes friends on his own with adults, not his peer group. He needs friendships with his peers too. It takes a lot of trial and error and effort on my part to help him find friends his own age! It would be helpful to know other parents who have children my son’s age who live nearby who are willing to mutually arrange social outings for our children.”

Parent behaviors have been linked to the friendship quality for children with disabilities. Parents of children with disabilities, who have a tendency to step in during play, have children who report more conflict in their friendships. The practice of stepping in is related to lower amounts of friend-to-friend caring such as helping and praising each other. This finding is also unique to children with disabilities. “There will always be some conflict in children’s friendships,” Kleimola realizes. “There are healthy ways parents can intervene. If two children want the same toy, for example, I tend to wait for a resolution between them. If it doesn’t happen, then I step in to model good conflict resolution for both kids—showing them choices and warding off inappropriately abusive or passive behaviors in the children.”

Cognitive Factors Contribute to Social Integration

Recent research from a study titled, Neuropsychological Status and Social Problem Solving in Children with Congenital or Acquired Brain Dysfunction (Warschausky, Argento, Hurvitz, & Berg, 2003), has shown that specific types of cognitive impairment adversely affect social problem solving (SPS) in children with neurodevelopmental conditions at birth, including cerebral palsy and spina bifida (Warschausky, Dixon, & Cunningham, 2005). The AFSIS team is examining the ways cognitive skills and abilities are associated with specific aspects of social adjustment, including social contact and quality of friendships. The team recently gathered data from 70 children, ages 6-12. The group included a developmental condition (DC) subgroup comprised of 18 children diagnosed with cerebral palsy, 12 with other congenital conditions, and a typical development (TD) subgroup comprised of 40 children without disabilities. Controlling for level of intellect, the DC group exhibited less social contact than the TD group.

A child’s flexibility in problem-solving, or “executive functioning,” is a key predictor of friendship quality. Children with neurodevelopmental conditions who had weaker problem solving skills had friendships characterized by more conflict and less positive validation and caring. These findings highlight two key assessment and intervention issues:

• Executive functions are not assessed as part of traditional psycho-educational evaluations and may remain under identified. Findings highlight the potential value of professional development opportunities for school psychologists who may not be familiar with the assessment of executive functions.
• Children with cognitive impairments are at risk for difficulty generalizing and maintaining social skills. In part, this may reflect critical difficulties in flexible social problem solving. To the extent that social skills are taught in “pull-out” settings, it is critical to include strategies for generalization and maintenance in other school settings, including the regular class-room. In other words, there will need to be ways in which the student is then cued to use the new skills in other settings.

A Child’s Quality of Life (QoL) Can Relate to Friendship-Building Skills

Children and parents have clear, if somewhat different, ideas about what types of activities are important in sustaining satisfaction with life. Research questions in this work included: Do children with disabilities perceive themselves as having a different QoL than their peers? Do parents see things similarly? Do children with disabilities have very different needs related to QoL?

The children participating in the study ranged in age from 6-13 and were in grades 1-6. Three different QoL questionnaires were used: one with pre-set questions that the parent answered about the child (parent report), one with pre-set questions that the children answered about themselves (self report), and one where the children identified the factors they felt were most important to their own QoL (participant defined report).

Children with and without disabilities reported similar levels of quality of life, but the parents of children without disabilities reported that their children had better QoL than parents of children with disabilities. When children were asked to list “What makes your life good?” regardless of disability, they listed factors involving family, friends, and physical play most frequently. The children also stated that family was the most important factor in quality of life. It is no surprise, then, that the function of the family has an influence on the QoL of the children in those families. Our data showed that better family functioning is related to better quality of life in children with and without disabilities.

Though some commonalities arose between the children with and without disabilities, children differed on other important factors affecting their QoL. Children with disabilities listed factors involving physical play, friends, then pets as most important, while children without disabilities listed physical health/physical needs, friends, and electronics/entertain-ment as most important after family. Friendships are important to all of these children. The quality of a child’s friendships is related to that child’s quality of life. Study results indicate that children with disabilities experience more conflict and less enjoyment in their friendships than their peers without disabilities.

One implication of these findings indicates that socialization and friendship are positively related to a better quality of life. it is important for children to be in settings where they can socialize. Here are some suggestions to help children socialize:

• Find out the factors important to your individual child’s quality of life and let the child have a reasonable amount of input—don’t buy video games for a child who wants to play soccer, but if all a child wants to do is play video games (as many are prone to do), don’t over-indulge. Try to steer children toward more social activities with family or friends.
• Children with disabilities find that they need physical play to improve their quality of life. Search for adapted sports in your area. Find ways for your child to be active and to play. Therapy sessions can provide opportunities for play and interaction. Therapists can make exercises into games that feel like play. Bring friends to therapy sessions.
• In the school setting, it is important that a child with disabilities not be isolated. It is important for teachers to discourage any behavior in class that can lead a child to feel isolated. Aides need to be especially aware of the need to integrate the child socially, asking other children to help with school work, when possible.
• Work on socialization in the home as well. Arrange play dates whenever possible—even once a month. Promote social interactions by enrolling children in activities they enjoy.

For more information on this study, contact Seth Warschausky, sethaw@umich.edu, or visit the AFSIS Web site at www.med.umich.edu/pmr/afsis/index.htm.

Authors

Pamela Thomas, Ph.D., Principal Investigator, thomaspj@mail.paine.edu; Sunny Roller, M.A., Research Associate, elsol@umich.edu; Ann Scharnhorst, B.A., Research Assistant, ascharnh@yahoo.com; Sean Cunningham, M.A., Research Associate, Sean.Cunningham@mail.wvu.edu; Seth Warschausky, Ph.D., Co-Investigator, sethaw@umich.edu; University of Michigan Health System, Physical Medicine and Rehabilitation,
325 East Eisenhower Suite 100, Ann Arbor, MI 48108, Phone: (734) 936-7051, Fax: (734) 936-7048.

References

Maccoby, E. E. (1998). The Two Sexes: Growing Up Apart, Coming Together. Cambridge, MA, Belknap Press/Harvard University Press.

Maccoby, E. E., & Jacklin, C. N. (1987). Advances in Child Development and Behavior, Vol. 20. (pp. 239-287) Gender segregation in childhood. H.W. Reese (Eds.). San Diego, CA, Academic Press, Inc.

Traustadottir, R. (1993). Friendships and Community Connections Between People With and Without Developmental Disabilities. (pp. 109-127). The gendered context of friendships. A.N. Amado (Eds.), Baltimore, MD. Paul H. Brookes Publishing Co.

Warschausky, S. A., Argento, A. G., Hurvitz, E., & Berg, M. (2003). Neuropsychological Status and Social Problem Solving in Children with Congenital or Acquired Brain Dysfunction. Rehabilitation Psychology, 48, 250-254.

Warschausky, S.A., Dixon, P., & Cunningham, S. (February, 2005). Neuropsychological Correlates of Social Adjustment in Children with Congenital Neurodevelopmental Conditions. Paper presented at the Annual meeting of the International Neuropsychological Society, St. Louis, MO.

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