Experiences Of Friendships For Autistic Individuals: A Scoping Review

Autistic individuals often face unique challenges in forming and maintaining friendships, including difficulties with social communication, navigating neurotypical social norms, and managing sensory sensitivities in social situations.

Despite these challenges, friendships are crucial for mental health and well-being. Studying this area is vital to understand autistic perspectives on friendship, challenge misconceptions about social motivation in autism, and develop effective supports to improve social outcomes and quality of life for autistic individuals.

Black, M. H., Kuzminski, R., Wang, J., Ang, J., Lee, C., Hafidzuddin, S., & McGarry, S. (2024). Experiences of friendships for individuals on the autism spectrum: A scoping review. Review Journal of Autism and Developmental Disorders, 11(1), 184-209. https://doi.org/10.1007/s40489-022-00332-8

Key Points

• Autistic individuals across the lifespan express a strong desire for friendships built on shared interests, reciprocity, respect, trust and loyalty, countering historical theories that autistic people are fundamentally less socially motivated.
• Autistic individuals define and experience friendship in ways that show commonalities with the general population, including forming friendships based on propinquity (physical proximity) and homophily (someone who is alike to you).
• Many autistic individuals struggle with loneliness and feelings of exclusion despite valuing friendships. Differences in social norms, communication styles, and social needs were commonly reported as barriers to developing friendships.
• Autistic individuals frequently reported using adaptive morphing (masking) in attempts to ‘fit in’ with non-autistic peers, but these strategies often led to feelings of distress and exhaustion.
• Coping with the demands of friendships and social interaction left many autistic participants feeling exhausted, fatigued and distressed, potentially negating the positive effects of friendship and contributing to poorer mental health.
• The study revealed some misconceptions about autistic people, finding it is not disinterest in social interactions that influence their choice to be alone, but rather social and environmental challenges they face.
• Gender differences were noted in friendship experiences, including levels of motivation to socialize, shared interests and activities, sources of conflicts, and coping strategies used to overcome social challenges.
• This research has certain limitations, such as a focus primarily on adolescents from Western cultures and underrepresentation of autistic individuals with higher support needs or who do not communicate verbally.
• Understanding autistic individuals’ lived experiences of friendship is critical for developing targeted supports and interventions to improve friendship outcomes and overall well-being for this population.

Rationale

The study aimed to explore and synthesize research examining the subjective experiences of friendships from the perspective of autistic individuals across the lifespan. This research was motivated by several key factors:

1. Friendship plays a vital role in mental health and well-being across the lifespan (Mazurek, 2014). For autistic individuals, strong friendships may serve as a protective factor against the negative impacts of social difficulties (Bauminger et al., 2004).
2. Previous research on autism and friendship has primarily focused on quantitative measures or perspectives from parents, siblings, teachers, or health professionals (e.g., Church et al., 2000; Portway & Johnson, 2003). There was a need to understand friendship from the subjective experiences of autistic individuals themselves.
3. While there is a growing number of qualitative studies exploring friendship in autism, their ability to inform a broader understanding is limited by small sample sizes, homogenous populations, and variations in topics explored. A synthesis of these studies could provide a more comprehensive understanding.
4. Understanding autistic individuals’ perspectives on friendship is crucial for developing targeted services and supports aimed at meeting their needs (Haertl et al., 2013).
5. There are historical theories suggesting autistic people are fundamentally less socially motivated (Chevallier et al., 2012). This study aimed to explore whether these theories align with autistic individuals’ reported experiences and desires regarding friendship.

The next step in advancing this field of research was to conduct a comprehensive review and synthesis of existing qualitative studies on autistic individuals’ experiences of friendship.

This approach allowed for a more robust understanding of friendship in autism across different ages, contexts, and experiences.

Method

This study employed a meta-ethnographic method developed by Noblit and Hare (1988) and refined by Atkins et al. (2008) to synthesize the results from individual qualitative studies.

The meta-ethnographic approach was chosen for its ability to maintain the voices and lived experiences of autistic participants while allowing for a higher-order level of analysis and interpretation.

Search strategy and terms:

Five electronic databases were searched for studies published from the earliest records to August 2020: MEDLINE, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Science.

Keywords were grouped into three categories:

1. autis* or “high-functioning autism” or Asperger or ASD
2. friend* or “peer relation*”
3. qualitative or “lived experience” or phenomenolog* or ethnograph* or biograph* or autobiograph* or “grounded theory” or narrative or interview

MeSH terms were exploded, truncated, and adjusted to comply with different databases. Manual searches were also conducted on Google Scholar and reference lists of retrieved articles.

Inclusion and exclusion criteria:

Studies were included if they:

1. Were full-text peer-reviewed journal articles written in English
2. Included participants with a primary diagnosis of autism
3. Used qualitative design and focused on first-hand or subjective experiences of friendship of autistic individuals
4. Examined experiences of friendship including with other autistic or neurodiverse individuals and with neurotypical individuals

Studies were excluded if they:

1. Contained only quantitative data
2. Focused on interventions or therapy

No limits were placed on the presence of co-occurring conditions, the methodological quality of the articles, or the age of participants.

Statistical measures:

As this was a qualitative meta-synthesis, traditional statistical analyses were not employed. Instead, the study used a meta-ethnographic approach for data synthesis, which involved:

1. Reading each study multiple times to identify key concepts and themes
2. Comparing concepts and themes across studies
3. Translating the findings from one study into the interpretations of another
4. Synthesizing translations through assembling and categorizing themes based on similarity in meaning

Two authors performed the final translation, engaging in extensive discussion to achieve consensus, which was then reported back to the authorship team for discussion.

Results

The meta-ethnographic analysis resulted in 14 themes arranged under two major headings:

1. Autistic meanings of friendship:

• “They would always look after me”: Friends were described as someone who offers help and support in times of need. Participants emphasized the importance of having someone to rely on for assistance and protection.
• “They actually understand”: Respect, trust, understanding, acceptance, and caring were used to describe friends. Participants valued friends who allowed them to be themselves without judgment.
• “Grow to become friendly”: Friendships were often based on proximity or developed from long-term acquaintances. Some participants described the process of slowly building trust and understanding over time.
• “Like the things I like”: Shared interests and common activities were highlighted as key requirements for friendship. Participants reported that having similar interests provided an entry point for conversation and ongoing connection.
• “People like me”: Many participants reported developing friendships with those similar to them, often other autistic individuals or those with disabilities. This similarity was seen as facilitating mutual understanding and authenticity in relationships.

2. Autistic experiences of friendship:

• “They make your life happy”: Participants reported various benefits of friendship, including emotional, social, and practical support. Friends were seen as sources of happiness, belonging, and security.
• “I don’t know if I have friends”: Some participants expressed uncertainty about whether they had friends or if others liked them. This uncertainty was reported across different age groups.
• “A small group of friends”: Many participants reported preferring to have a few close friends rather than larger social circles. This preference was often linked to the effort required to maintain multiple close relationships.
• “Some people are lonely and need friends”: Participants across age groups reported difficulties forming friendships and feelings of loneliness. Some described intense feelings of isolation despite a desire to connect with others.
• “Social disorientation”: Many participants reported difficulty navigating neurotypical relationships and forms of communication. This included challenges in understanding social cues, body language, and conversational norms.
• “I work hard to pass as normal”: Participants often reported using adaptive morphing (masking) to fit in with non-autistic peers. While this strategy was used to facilitate social interactions, it often led to feelings of exhaustion and distress.
• “They will get sick of me”: Participants expressed worries about peers not liking them or ending friendships. This anxiety about friendship stability was reported across different age groups.
• “I can count lists of people who were my friends”: Difficulties maintaining friendships and navigating conflicts were commonly reported. Participants described challenges in resolving arguments and adapting to changes in friendships.
• “It makes me tired”: Social situations and developing friendships were often described as tiring and anxiety-inducing. Many participants reported feeling exhausted after social interactions, particularly when trying to conform to neurotypical social norms.

Insight

This study provides several key insights into the experiences of friendship among autistic individuals:

1. Desire for friendship: The findings directly counter historical theories that autistic people are fundamentally less socially motivated. Autistic individuals across the lifespan expressed a strong desire for friendships, valuing qualities such as shared interests, reciprocity, trust, and loyalty.
2. Similarities with neurotypical experiences: Autistic individuals defined and experienced friendship in ways that showed commonalities with the general population, including forming friendships based on propinquity (proximity) and homophily (similarity).
3. Unique challenges: Despite similarities, autistic individuals faced unique challenges in forming and maintaining friendships. These included difficulties with social communication, navigating neurotypical social norms, and managing sensory sensitivities in social situations.
4. Impact of masking: Many autistic individuals reported using adaptive morphing (masking) to fit in with non-autistic peers. While this strategy was used to facilitate social interactions, it often led to feelings of exhaustion, distress, and inauthenticity.
5. Preference for autistic friendships: Many participants reported feeling more comfortable and understood in friendships with other autistic individuals. This aligns with the “double empathy problem” theory, suggesting that autistic individuals may have an easier time understanding and empathizing with each other compared to interactions with non-autistic individuals.
6. Gender differences: The study highlighted some gender differences in friendship experiences, including variations in socialization motivations, shared interests, conflict sources, and coping strategies.
7. Mental health implications: While friendships were highly valued, the challenges of navigating social interactions often led to feelings of anxiety, exhaustion, and distress. This suggests that interventions aimed at supporting autistic individuals in developing authentic friendships may be crucial for improving mental health outcomes.

These findings extend previous research by providing a comprehensive synthesis of autistic individuals’ subjective experiences of friendship across multiple studies.

They highlight the need for a nuanced understanding of social motivation and experiences in autism, moving beyond simplistic notions of social disinterest or deficit.

Future research could explore:

• Longitudinal studies examining how friendship experiences and needs change across the lifespan for autistic individuals
• Investigations into effective strategies for supporting authentic friendship development without relying on masking
• Exploration of friendship experiences among autistic individuals with higher support needs or who use non-verbal communication
• Cross-cultural studies to understand how cultural factors influence friendship experiences in autism

Strengths

The study had several methodological strengths:

1. Comprehensive search strategy: The review included a thorough search of multiple databases and manual searches of reference lists, ensuring a wide range of relevant studies were included.
2. Focus on autistic perspectives: By synthesizing studies that prioritized the first-hand accounts of autistic individuals, this review centered autistic voices and experiences.
3. Lifespan approach: The inclusion of studies across different age groups allowed for insights into friendship experiences throughout the lifespan.
4. Meta-ethnographic method: This approach allowed for a higher level of analysis and interpretation while still maintaining the integrity of individual participants’ experiences.
5. Multiple reviewers: The involvement of multiple reviewers in the analysis and synthesis process enhanced the rigor and reliability of the findings.
6. High-quality studies: All included studies were assessed as being of strong methodological quality, enhancing the reliability of the synthesis.

Limitations

The study had several limitations that should be considered when interpreting the results:

1. Western bias: Most studies originated from Western countries, particularly the UK and USA, limiting the cultural diversity of perspectives.
2. Age focus: The majority of studies focused on adolescents, with fewer studies exploring friendship experiences in children or adults.
3. Underrepresentation: There was limited representation of autistic individuals who do not communicate verbally or who have higher support needs.
4. Publication bias: The review only included peer-reviewed, published studies, potentially missing relevant findings from unpublished or grey literature.
5. Time limitation: The search only included studies up to August 2020, potentially missing more recent research.
6. Language limitation: Only English-language studies were included, potentially missing relevant research published in other languages.

These limitations suggest that while the findings provide valuable insights, they may not fully represent the experiences of all autistic individuals across different cultures, support needs, and communication styles.

Implications

The findings of this study have several significant implications:

1. Clinical practice: Mental health professionals working with autistic individuals should be aware of the importance of friendship and the unique challenges autistic people face in social relationships. Interventions should focus on supporting authentic friendship development rather than solely on social skills training.
2. Education: Schools and educational institutions should create more inclusive environments that foster understanding of neurodiversity and provide opportunities for autistic students to form friendships based on shared interests.
3. Public awareness: There is a need to challenge misconceptions about autism and social motivation, promoting understanding that many autistic individuals deeply desire and value friendships.
4. Support services: Services for autistic individuals should include support for developing and maintaining friendships, recognizing this as a crucial aspect of well-being.
5. Research focus: Future research should prioritize the perspectives and experiences of autistic individuals, particularly those who have been underrepresented in existing literature.
6. Intervention development: There is a need for interventions that support autistic individuals in developing authentic friendships without relying on exhausting masking strategies.
7. Mental health support: Given the potential negative impacts of social challenges on mental health, mental health support for autistic individuals should address friendship-related stressors and anxieties.
8. Neurodiversity-affirming approaches: The findings support the use of neurodiversity-affirming approaches that value autistic ways of relating and communicating rather than focusing solely on conforming to neurotypical social norms.

Variables that may influence these results include individual differences in autistic traits, co-occurring conditions, level of support needs, access to inclusive environments, and cultural context.

The intersectionality of autism with other aspects of identity (e.g., gender, race, socioeconomic status) may also play a role in shaping friendship experiences and should be considered in applying these findings.

References

Primary reference

Black, M. H., Kuzminski, R., Wang, J., Ang, J., Lee, C., Hafidzuddin, S., & McGarry, S. (2024). Experiences of friendships for individuals on the autism spectrum: A scoping review. Review Journal of Autism and Developmental Disorders, 11(1), 184-209. https://doi.org/10.1007/s40489-022-00332-8

Other references

Atkins, S., Lewin, S., Smith, H., Engel, M., Fretheim, A., & Volmink, J. (2008). Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Medical Research Methodology, 8(1), 21. https://doi.org/10.1186/1471-2288-8-21

Bauminger, N., Shulman, C., & Agam, G. (2004). The link between perceptions of self and of social relationships in high-functioning children with autism. Journal of Developmental and Physical Disabilities, 16(2), 193–214. https://doi.org/10.1023/b:jodd.0000026616.24896.c8

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Sciences, 16(4), 231–239. https://doi.org/10.1016/j.tics.2012.02.007

Church, C., Alisanski, S., & Amanullah, S. (2000). The social, behavioral, and academic experiences of children with Asperger syndrome. Focus on Autism and Other Developmental Disabilities, 15(1), 12–20. https://doi.org/10.1177/108835760001500102

Haertl, K., Callahan, D., Markovics, J., & Sheppard, S. S. (2013). Perspectives of adults living with autism spectrum disorder: Psychosocial and occupational implications. Occupational Therapy in Mental Health, 29(1), 27–41. https://doi.org/10.1080/0164212X.2012.760303

Mazurek, M. O. (2014). Loneliness, friendship, and well-being in adults with autism spectrum disorders. Autism, 18(3), 223–232. https://doi.org/10.1177/1362361312474121

Noblit, G. W., & Hare, R. D. (1988). Meta-ethnography: Synthesizing qualitative studies. Sage Publications.

Portway, S., & Johnson, B. (2003). Asperger syndrome and the children who ‘don’t quite fit’. Early Child Development and Care, 173(4), 435–443. https://doi.org/10.1080/0300443032000079113

Keep Learning

Here are some Socratic questions for a college class to discuss this paper:

1. How might the findings of this study challenge or reinforce your preexisting notions about autism and social relationships?
2. In what ways might the experience of friendship differ for autistic individuals compared to neurotypical individuals? In what ways might they be similar?
3. How could the concept of the “double empathy problem” inform approaches to supporting social inclusion for autistic individuals?
4. What ethical considerations should be taken into account when researching or discussing masking behaviors in autistic individuals?
5. How might cultural factors influence the experience and expression of friendship for autistic individuals? How could future research address this?
6. In what ways might support for friendship development need to differ for autistic children, adolescents, and adults?
7. How could the insights from this study be applied to create more inclusive educational or workplace environments?
8. What are the potential long-term implications of chronic loneliness or social exclusion for autistic individuals? How might these be addressed?
9. How might the findings of this study inform the development of mental health interventions for autistic individuals?
10. In what ways does this research support or challenge the neurodiversity paradigm in understanding autism?