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  1. “Will you be my friend?” An integrated approach to providing friendship groups for children with developmental disorders Melissa Bryan Robyn Low Sue Wells

  2. Friendship Structure and function of friendship is RELATIONAL The Australian Concise Oxford Dictionary defines ‘relational’ as: ‘the existence or effect of a connection, correspondence, contrast, or feeling between persons or things..’ Many of the children referred to the Friendship group have been referred due to concerns about their ability to make and/or sustain meaningful relationships (friendships) with their peers. Many of the children have chronic developmental disorders such as Autistic Spectrum Disorder (ASD) or Asperger Syndrome

  3. Friendship Groups Development • Groups began in 2002 as result of Masters study. • Initially run by two therapists at Paediatric OT Clinic. “This was the best day of my life!” (Child participant) • Conjoint parent feedback/education groups. • Change of practice location and staff. • Growth and evolvement of groups. More process driven. • Differed from usual ‘social skills’ model to those focusing on relating and a sense of ‘belonging’ in the group • Parent feedback sessions & school consultations offered

  4. Evaluation • “...joining in more.” • “He is moderating his own behaviour better.” • “More of these groups during term please”

  5. Focus of attention for the groups Therapist attention in the groups is directed to several aspects stemming primarily from parent infant studies • Attachment • Attunement • Shared attention and experience in the group space • Shared affect in the group Some of the children attending the groups have had early attachment difficulties with others, and many of the children also have sensory modulation difficulties that impinge further on their ability to participate in the social world

  6. Ingredients for meaningful friendships Brazelton and Cramer describe the early relationship between parent/primary caregiver and infant having several important characteristics that enhance development of secure attachment and successful relationships. They are also important for developing successful frienships. These ingredients are: • Synchrony & Symmetry- synchronising own state of attention to that of another person • Contingency -capacity for shared interaction contingent on ability for self-regulation • Entrainment - ability to anticipate responses of others in long sequences • Play - shared activities or games that have ascribed rules that are known by each player • Autonomy & Flexibility – autonomy develops when child is assured of predictable (stable) response from the other, and flexibility required so any disturbance in the stable relationship will not be lead to disintegration of the relationship

  7. Shaping the environment for friendship • Similar developmental level (not necessarily chronological age) • Appropriate developmental level activities providing opportunity for children to come into a shared physical and attentional space. A variety of movement, sensory and communication games are done together. • Balancing education/instruction vs experience • Regulating the boundaries and provide a safe exploration space • Provide some transitional object or activity that will enable child to move as seamlessly as possible in and out of the group. • Holding space for experimentation and reinforcement • Use of specific therapeutic tools and techniques e.g Alert Program, individual therapy, activity choices • Opportunity for enjoyment!

  8. Developing the dance and flow of friendship The children’s being ‘in’ and ‘out’ of the group space must be allowed to happen. A dance develops as children move out to the edges of the group space and back. There may be moments of unified experience when children are ‘in’ the group space and if these are more than momentary, the child may then be internally have memory of this, and if this memory experience is provided for children repeatedly, the child’s mind, and relationships can be transformed. *

  9. Using Boundaries Physical and psychological/emotional boundaries must be respected Flexibility and entrainment important to allow children to experiment with involvement in the experience, and opportunity to withdraw if they become overwhelmed and are in danger of disintegrating Care taken when children rejoin the group to provide opportunity for pleasurable experience on rejoining

  10. Therapists working together Due to the complexity of the dynamics in the group, two therapists are required to manage the group space. The therapists need to be attuned to each other, the individuals in the group and also be responsive to the group dynamics. Therapists focus on process as well as content in the groups.

  11. Feeling our way together Important to pay attention to affect generated within the group as well as the behaviour occurring in the group space and at the boundaries. The connections between affect and actions in the group are often difficult to spot. Use of video can help therapists and children see the connections more clearly. It is important to be able to take an observatory as well as active role as a therapist

  12. This shared space that encourages capacity friendship building is not there constantly, but we hope that the children attending the group are offered enough of this experience to enable them to build a memory of this experience, and to generalise this outside the group.

  13. If you need a friend...... Each group develops its own individual identity over the course of the group sessions, and this identity grows from each person in the group sharing in the group experience.

  14. References • Gordon, Rob (1999) Conference Paper, Tokyo (unpublished paper) • Gordon, Rob (2008) Personal communication • The Australian Concise Oxford Dictionary. Third Edition. Oxford University Press 1997 • T.Berry Brazelton, Bertrand G Cramer. The Earliest Relationship: Parents, Infants, and the Drama of Early Attachment. Addison-Wesley Publishing Company, Inc. 1994