Activity Participation, Friendship, and Internalizing Problems in Children with Autism Spectrum Disorder

Background: Social interaction difficulties in children with autism spectrum disorder (ASD) can be challenging, especially during adolescence. In addition, high rates of comorbid internalizing disorders in ASD can lead to social isolation. With limited social activity participation, social deficits and internalizing problems in ASD may be related to participation, exposure, and practice with friends.

Objectives: Children with ASD are at high risk for internalizing symptoms and social isolation. Understanding the factors that may protect against those difficulties is important for helping to promote social-emotional well-being. The purpose of this study was to evaluate the relations among friendship, activity participation, and internalizing problems (See Figure 1).

Methods: Participants included 129 children with ASD between the ages of 6 and 18. Measures of friendship, participation in sports, hobbies, and clubs, and internalizing problems were assessed using the Child Behavior Checklist (CBCL). We analyzed the relationship between 1) activity participation and friendships, 2) activity participation and internalizing problems, and 3) friendships and internalizing problems. For significant bivariate relationships, we subsequently examined the influence of covariates on the relationship between variables.

Results: See Table 1 for participant characteristics. The most popular types of hobbies were screen-based media, academic-based (e.g., reading), or toy-based. The most popular clubs were religious in nature or special-interest groups (e.g., marching band, chess club). Children with higher IQs had more internalizing problems than children with lower IQs (r = .348, p < .001). Children with at least one friend had significantly higher IQs (M = 84.58, SD = 28.15) than children with no friends (M = 70.62, SD = 26.40) [t (124) = -2.866, p = .005]. Activity participation was related to more friendships, even after controlling for IQ. Activity participation was not significantly related to internalizing problems (r = .037, p = .678), and friendships were not significantly related to internalizing problems (r_s = .010, p = .914).

Conclusions: This study sheds light on the impact of social engagement with peers in developing and maintaining friendships as well as managing internalizing problems. Extracurricular activities offer children opportunities for regular and sustained social interactions focused on shared interests, leading to development of relationships among co-participants. However, it is also possible that children are more likely to join activities if they have friends who are already involved in those groups or clubs. Similarly, children with ASD may be more likely to participate in activities if they have stronger social skills and greater social interest at the outset. Longitudinal studies examining more comprehensive assessments of friendship and activity participation over time are necessary to help understand the directionality of these relationships in children with ASD. In addition, future research should evaluate the specific contributions of physical exercise (e.g., Ströhle, 2009), typically developing peer role models (e.g., Bauminger-Zviely & Agam-Ben-Artzi, 2014; Dolan et al., 2016), and specific types of organized activities that are conducive to interpersonal skill development (Larson, Hansen, & Moneta, 2006).