Sex differences in friendships and loneliness in autistic and non-autistic children across development

Abstract

Background Autistic children have been shown to have less complete definitions of friendships and higher levels of loneliness than their non-autistic peers. However, no known studies have explored sex differences in autistic children’s understanding of friendships and reported loneliness across development. Autistic girls demonstrate higher levels of social motivation than autistic boys and appear to “fit in” with their peers, but they often have difficulty recognizing reciprocal friendships during middle childhood. As autistic girls develop a more complex understanding of friendship during adolescence, they may begin to redefine their friendships and experience heightened loneliness. Here, we explored how autistic and non-autistic boys and girls define the meaning of friendship and report feelings of loneliness across development. We also examined their perceptions of friendships and loneliness. Methods This mixed-methods study analyzed the transcribed clinical evaluations of 58 autistic children (29 girls) matched to 42 non-autistic children (21 girls) on age and IQ. Transcripts were coded for four categories that children used to define friendships—personality, companionship, dependability, and intimacy—and for reported loneliness. We then compared these codes across diagnosis, sex, and age. Content analyses were further implemented to gain a more holistic understanding of children’s perceptions of friendships and loneliness. Results Girls, regardless of diagnosis, were more likely than boys to refer to personality when defining the meaning of friendship, and the likelihood of referring to dependability and intimacy increased with age. Most children reported having at least one friend, though some autistic adolescents reported not having friends or were uncertain whether they had friends. While autistic and non-autistic boys and girls were equally likely to report feeling lonely at times, several autistic girls and boys reported being frequently lonely. Limitations This study was a secondary data analysis. The standardized set of questions on the ADOS limited the amount of information that children provided about their friendships and perceptions of loneliness. Conclusion As with non-autistic children, autistic children acquire a more complex understanding of friendship throughout development. However, as children begin to prioritize dependability and intimacy in friendships, autistic adolescents may have difficulty developing friendships characterized by these constructs. Furthermore, the quantity and/or quality of autistic children’s friendships may not be sufficient to alleviate loneliness.

Social engagement and loneliness in school-age autistic girls and boys

“… 3 – 6 These social differences begin in early childhood and persist into adolescence and adulthood. 7 – 9 However, many autistic children are able to connect to peers, and report to having at least one friend. 10 – 12 Having a mutual friendship has been associated with greater school satisfaction.…”

“… 38 Alternatively, loneliness may occur later for autistic students due to an accumulation of many negative social interactions. 9 , 38 For example, child age affects whether children report loneliness at school. In separate studies, 7- to 9-year-old autistic students did not endorse loneliness at school, 2 whereas autistic adolescents reported more loneliness than classmates of the same age.…”

“…Autistic adolescent girls were more likely to engage in active social activities, like talking with friends. As female friendships become more intimate in adolescence, 9 autistic girls may be particularly impacted relative to autistic boys because the central tenets of female friendship map onto the core challenges of autism. Autistic adolescent girls have reported difficulty fitting into female groups due to subtle non-verbal communication styles and relational aggression among non-autistic peers.…”