THE FRIENDS PROGRAM
A Unique Therapeutic Group for Children with Asperger’s and their Parents
Laurie Leventhal-Belfer, Ph.D.
Luisa Montaini-Klovdahl, Ph.D
Alice Locke-Chezar, MFT, ATR
The Friends Program initially was a diagnostic play program for children who were having difficulty adapting to their preschool setting. The program was designed to replicate the preschool setting so that we could capture some of the challenges that they were experiencing with their peers. Two clinicians were with the children while I stayed with the parents in the observation room. My goal was to observe the children as well as to learn the parents’ perceptions of their children. We observed that the highly active child was moving from activity to activity, inviting his friends to join him, but not waiting for them to arrive. In the center of the room was a child who tediously arranged the blocks in a circle, making a train track. When he could not find the next perfect block or when someone tried to enter his play, he had meltdowns similar to the ones his parents and his school were reporting. There was no flexibility or awareness of the other child inviting him to play, rather he worried that his peers and the staff did not move his blocks.
At the same time we were evaluating these children, the diagnosis of Asperger’s had just been accepted by the American Psychiatric Association Diagnostic and Statistical Manual of Mental Health Disorders, 4th edition, DSM-IV (1994). The diagnosis was based on the observations made by Hans Asperger’s (1991), a Viennese pediatrician who described a group of children who had difficulty adapting to social situations with their peers. The children possessed average to above average intelligence and no significant delay in language. Further the children displayed restricted, repetitive and stereotyped patterns of behavior, interests and activities. Collectively these behaviors caused clinically significant impairment in social, or other important areas of function. We gave the child who was hyper-focused on the tracks the diagnosis of Asperger’s Syndrome.
When the pilot program ended, the parents asked if we could turn it into an intervention program. Many of these parents were just beginning to understand the social challenges of their children playing with peers. It was also the first place that they did not have to worry about their child being kicked out because of his rigidity or disruptive behavior. Hearing the needs of the parents demonstrated to us that they had to be a core part of our program.
What Makes The Friends Program Unique?
The Friends Program was developed in response to the needs of children who were not succeeding in their preschool setting. Since the diagnosis of Asperger’s was new, the children were often initially misdiagnosed as having an attention disorder, anxiety disorder, or oppositional disorder. The children were often placed in social skills programs for children with ADHD or Anxiety. Regrettably they made very little progress because the programs used social, verbal interactions and games as their primary tools. This resulted in the children’s early termination from the group due to their parent’s or the clinician’s sense that they were having difficulty engaging in the group process. Finally, none of these groups provided a parent component that included observations, support and guidance.
The mission of The Friends Program is to help children develop their social interaction, play, emotional regulation, communication, and sensory regulation skills (SPECS) needed to adapt to the social world of school, play dates, home life, and community activities. The Friends Program utilizes a Transactional Model (Bronfenbrenner, 1979) and replicates the different social settings in which these children have the most difficulty adapting, due to social skills that do not come naturally or are not learned incidentally from their parents, teachers, or peers.
It is our belief, that the children cannot generalize the skills that they learn in our program without active parent participation and support.
A licensed clinician who has specialized in working with children on the Autistic Spectrum oversees each child’s group. The director of the program is the therapist of the parents group. In addition to the head therapist, there is a developmental specialist who has had experience in preschool – school settings. Lastly, the Friends Program is a teaching site that has a pre-doctorate intern in each of the children’s groups.
To be enrolled in The Friends Program, the child must have received a formal diagnosis that preferably includes a clinical observation of the child in a social setting with peers. The program begins as early as Pre-Kindergarten and includes children from four – nine years (second-third grade). The parents must be able to tolerate working in a group setting where they observe and talk about their children in their most vulnerable position: interacting with a group of peers in evolving play situations that they do not control.
SPECS – A guide to the Friends Programs Goals:
S: Social Interactions with Adults and Peers: Special attention is given to the children’s non-verbal communication, eye contact, interest in interacting with their peers, awareness of their proximity to the other person and the nonverbal cues that their peers are giving them.
P: Play: Most of the children are engaged in primarily individual or parallel play rather than social-dramatic play with a peer when they join the program. The group therapists help the children develop symbolic play skills with a peer as well as participate in a game or activity where they are not always in charge.
E: Emotional Regulation: A great deal of time is spent on helping the children increase their awareness of their own feelings and eventually their peer’s feelings across social settings. Attention is also given to helping the children regulate their feelings.
C: Communication with Peers: Many of the children have no problem talking with attentive parents, teachers, and adoring grandparents about their areas of special interests. The problem arises when either the adult or more likely a peer loses interest when the child monopolizes the conversation. These children struggle with initiating and maintaining back and forth circles of communication.
S: Sensory Regulation: Many of these children have sensory defensiveness or are hypersensitive to noise being too loud, certain smells, how things feel, taste, or look. Different strategies are taught to assist with self-calming and regulating tolerance to different sensory input and emotions.
The Young Ones and Early Explorers Groups
The children move through multiple transitions within the 90 minutes of a group session to replicate similar demands faced in their natural settings of school and playground. The process is outlined below:
The therapist begins by greeting the children. Oftentimes the children want to dart into the room, intrigued by a toy or art material arrangement. The therapist encourages the children to interact with the social world, that is, first with the teachers and peers, before the objects and things in the playroom.
Circle time teaches friendly behaviors through puppetry, pictures, stories or role-playing. The table activity facilitates imaginative social play or art related to the monthly theme. Snacks and outdoor play allows opportunities to practice sharing, staying on a topic of conversation, and listening skills. They also learn to manage the fun and frustration of playing yard games under rules that are different from the ones that they like to follow.
The closing circle with the parents is used to review the important friendship skills learned in the group, which are codified on a star for the child to take home.
The Older Group
This group is for children in first and second grades and the process is as follows:
We start with snack since they are often starved after school. This is also the time the children get a chance to practice participating in-group conversation where they discuss shared and different interests.
The table is the setting where we work intensely on the SPECS. The group has monthly themes and therapeutic goals like: creating an ideal park, symbolic play, winning and losing in games, and bullying.
The circle time provides a setting to work on a special skill i.e. using your peers names, making and maintaining eye contact, body regulation and social stories (Leventhal-Belfer, Montaini-Klovdahl, 2008). At the playground, we are very attentive to sensory stimulation and social play skills. The focus is on learning how to join group games when you are not in charge or do not excel in the activity.
At the Closing Circle with the children and their parents, we share the day’s activities, the children’s challenges, as well as celebrating their achievements. The head child therapists from both groups attend the parents group on a monthly basis so that the parents have an opportunity to ask more specific questions about their children and the group program.
The Parents Group
The parents group provides the parents with guided observations of their children in the therapeutic group in addition to participating in a parents-only group facilitated by a therapist. The group aims to enhance the parent’s understanding of the child and provide guidance and support for the daily issues the parents are grappling with. Most of the parents travel through stages in understanding themselves, their child and their family. These stages, which are not linear but closely related to their child’s current state of progress are: Denial, Anger, Bargaining, Sadness, Advocacy, and Acceptance. They may revisit those earlier stages when new issues arise. The Couples may travel as a Team, at Different Speeds, or on Separate Paths (Leventhal-Belfer & Coe, 2004).
Sam entered the group as the visiting architect. He was a tall, lanky boy whose favorite activity was building cities with his grandfather. His cities took over his playroom, a space that he forbids his friends from entering, in fear that they might destroy a building. Sam was referred following an evaluation. Mom was not sure that the diagnosis was right since most of his problems occurred at school not at home. His school insisted that the family seek help if Sam was going to stay in the preschool.
Sam’s first month was marked by meltdowns when he realized that coming to the Friends Group meant playing with other children all of the time. He had extreme difficulties with transitions. He resisted entering opening circle, and as in school he took a long time determining what he wanted to make at the table and then had a meltdown when it was time to cleanup because he was not finished. The same challenge occurred during transitions to and from the playground.
Gradually, Sam began to enjoy interacting with other children and became an active member of the group, still eager to tell the group a new fact about buildings or maps but able to incorporate a friend’s comments and additions to his plans. His journey through school has had its ups and downs with his mother always as his advocate. She learned the importance of educating both the school and his new teachers at the beginning of the school year rather than after a problem arose. She could laugh when she was reminded of how literally her son took things, and how he needed to always be prepared for changes. Most of all she glows as she discusses her son’s achievements.
Sam is currently in high school; he excels in math and science, and is a powerful member of the tennis team. He likes to spend his free time with the friends he meets playing computer games over the internet. Mom is the person the school turns to for support, when a new family is concerned about their child’s adaptation to the new school.
The parents and the children in The Friends Program continue to be our guides along the journey we travel together to help their children thrive. One of our greatest rewards is watching our children run into a room talking with their friend about a new game they have played or telling each other their favorite jokes. We treasure watching them offering a hand to a friend who just fell on the ground. We are gratified when their parents note how their child is beginning to use those same skills at home, and at school. We know the journey will be long and nonlinear but we hope that we have provided both the children and their parents the tools they need to get the support and resources they’ll require in years to come.
Dr. Leventhal-Belfer is a clinical psychologist and co-author of the book, Asperger’s Syndrome in Young Children: A Developmental Guide for Parents and Professionals. She is a member of the Adjunct Faculty in the Division of Child & Adolescent Psychiatry and Child Development, Stanford University School of Medicine.
Dr. Montaini-Klovdahl is a clinical psychologist who specializes in working with young children. She provides evaluations, interdisciplinary team testing, psychotherapy, and consultation services to parents, teachers and schools. She also provides psychological services to adolescent age children and their families.
Alice Locke-Chezar is the principal therapist at Palo Alto Parenting Solutions, a specialty practice focusing on therapeutic work with children and families who struggle with behavioral, social and emotional issues. She has an MA in Marriage and Family Therapy with a Specialty in Art Therapy.
Asperger, H. (1991), ‘Autistic Psychopathy in Childhood’, In U. Frith (Ed.), Autism and Asperger’s Syndrome, Cambridge: Cambridge University Press.
Bronfenbrenner, U. (1979), ‘Contexts of Child Rearing: Problems and Prospects’, American Psychologist, 34(10), 844-850.
Leventhal-Belfer, L. & Coe, C. (2004), ‘Asperger’s Syndrome in Young Children, A Developmental Guide for Parents and Professionals’, Jessica Kingsley, London.
Leventhal-Belfer, L & Montaini-Klovdahl, L. (2008), ‘Why Do I Have To? A book for children who find themselves frustrated by everyday rules.’ Jessica Kingsley, London.
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