University of Central Florida Undergraduate Research Journal - Multiple Complications from a Finger Fracture in a Basketball Player
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Literature Review

Children with Asperger's Disorder

Asperger's Disorder (AD) is a disorder in which individuals show impairment in social skills and nonverbal communication. Persons affected with AD are characterized as engaging in repetitive behaviors and of lacking social reciprocity, which often leads to social isolation (DSM-IV: American Psychiatric Association [APA] 1994; Pierson & Glaeser 2007). At first, it was thought that all children on the autism spectrum preferred to be alone and were indifferent to peer interaction (Kanner 1943). However, recent studies show that children on the higher end of the spectrum desire friendship and express frustration for their lack of opportunities for social interaction (Bauminger & Kasari 2000; Pierson & Glaeser 2007). As a result, they report intense feelings of loneliness that last longer than for their typical peers (Bauminger & Kasari 2000).

In studying loneliness in children with AD, there has been speculation as to whether these children understand the concept of loneliness. Studies have revealed that children with AD have interpersonal awareness and are capable of experiencing feelings of empathy when presented with various emotional scenarios (Bauminger & Kasari 2000; Yirmiya, Sigman, Kasari, & Mundy 1992). One study (Pierson & Glaeser 2007) used verbal assertions by children (e.g., "no one will play with me") to confirm their feelings of loneliness. Statements collected from the sample indicate that children with AD have the capacity to understand abstract emotions such as loneliness and to care about establishing friendships with others. In another study (Bauminger & Kasari 2000), children with AD happily reported having at least one friend. Results of this study also confirm that children with AD desire to be involved in friendships with others. However, this is not true of all individuals on the autism spectrum. There seems to be a direct relationship between cognitive ability or level of functioning and an understanding of abstract emotions, and these children report feelings of loneliness (Yirmiya et al. 1992).

Children with AD appear to understand both the social and emotional aspects of loneliness, but fail to ascribe feelings such as emptiness and sadness to their feelings of loneliness. They seem to only evaluate their loneliness on a social level, and endorse feelings of loneliness in the absence of a friend or a social network. It is hypothesized that this self-evaluation and social comparison to their typical peers on friendship quantity causes children with AD to feel lonely more frequently and more intensely than the average child (Bauminger & Kasari 2000).

One interesting finding was that children with AD do not always report greater feelings of loneliness than TD children. In a study assessing the social networks of children with AD in regular classrooms (Chamberlain et al. 2007), researchers took sociometric ratings (i.e., the degree of peer acceptance and friendship reciprocity) from each child in the classroom. To assess peer acceptance, researchers had children sort photos of their classmates into three piles: liking, disliking, and neutrality. To assess friendship reciprocity, researchers had the children complete a questionnaire in which they were asked to list their best friends in the classroom. In comparing ratings and friend lists between children with AD and their typical peers, results indicated that children with AD were rated lower by their peers in peer acceptance and experienced less reciprocity in their friendship nominations. Despite being rated lower, children with AD did not differ significantly from their typical peers in ratings of loneliness. This finding suggests peer popularity may be only one factor contributing to feelings of loneliness.

Children with Social Phobia

Social Phobia (SP) is a "marked and persistent fear of one or more social performances in which the person is exposed to unfamiliar people or to possible scrutiny by others" (APA 1994). Such individuals fear that they may humiliate themselves in front of other people or show symptoms of anxiety. A diagnosis of SP in children requires a "capacity for social relationships with familiar people and the anxiety must occur in peer settings, not just in interaction with adults" (APA 1994). Parents of children with SP often recount that their children isolate themselves from social activities, such as recess at school, and feel more comfortable engaging in solitary activities (Beidel, Turner, & Morris 1999). It seems that children with SP engage in avoidance behaviors to ease overwhelming feelings of anxiety in social situations.

Similar to children with AD, children with SP report feelings of social isolation and loneliness (Beidel et al. 1999). Their inability to effectively engage in social interactions can lead to feelings of loneliness. Selfreports of social acceptance by high socially-anxious children in comparison to low socially anxious children reveal that children high in anxiety rate their social acceptance as lower, and perceive their interactions with peers more negatively (e.g., being bullied and teased at school) (Ginsburg, La Greca, & Silverman 1998). In addition to rejection, these children are also neglected by peers (Beidel & Turner 2007). Like children with AD, these children desire to develop friendships with peers and convey frustration over their lack of friendships (e.g., "all I want is one friend") (Beidel et al. 1999). Conversely, as a result of typical development and no cognitive developmental delays in children with SP, there is no question as to whether they understand the concept of loneliness as in children with AD (see Figure 1).

In summary, both children with AD and children with SP express loneliness, although it is unclear if they experience equivalent levels of loneliness, and for the same reasons. Because children in both groups experience social isolation, it is important to understand what factors may influence that loneliness, as those factors may offer an important target of intervention.

Figure 1: DSM-IV Criteria

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