Examining the peer relationships and conflict experiences of adolescent girls and women on the autism spectrum Felicity Sedgewick UCL Institute of Education Thesis submitted for the degree of Doctor of Philosophy in Psychology October 2017 1 Declaration I, Felicity Sedgewick, confirm that, apart from where explicitly stated below, all the work presented in this thesis is entirely my own. Occasional assistance with data collection was provided by the Brain Detectives team, comprised of researchers from the Centre for Research in Autism and Education (CRAE), at the UCL Institute of Education. Eilish Roy, an undergraduate placement student at CRAE (2016-2017), also provided some assistance with data collection for the study described in Chapters Two and Three. Word count (excluding references) = 74, 075 Signature: _______________________________________ Date: ___________________________________________ 2 Abstract Despite a wealth of interest in, and research on, gender differences in the friendships and social relationships of neurotypical children and adults, there is a paucity of research on such differences in individuals on the autism spectrum. Only three published papers focus specifically on the friendships of autistic individuals in the same age range as the work of this PhD, and these have included predominantly male participants, who do not represent the range of female experiences. This PhD therefore sought to redress this imbalance by focussing on the peer relationship, friendships, and conflict experiences of adolescent girls, as well as women on the autism spectrum, in comparison to their autistic male and neurotypical female peers. Parental views on the relationships of autistic girls were also sought. In Chapter One, I review the literature investigating peer relationships amongst autistic adolescents, neurotypical adolescents, and autistic adults, focussing on their experiences of conflict within those relationships and their potential impact. Chapters Two and Three focus on data from adolescents. In Chapter Two, I present data from a mixed-methods study showing that autistic adolescents rate their best-friendships as like those of neurotypical adolescents, but that autistic adolescents experience far more peer conflict, and these experiences are qualitatively different for autistic girls compared to all other groups. In Chapter Three, I examine the factors that potentially underpin friendship strength and victimisation for male and female adolescents, following the results of Chapter Two and using data from the same participants. In Chapter Four, which focuses specifically on adult women, I report data from autistic and neurotypical adult women, examining similar constructs and questions to the adolescent study (Chapter Two). In Chapter Five, I directly compare the qualitative data from autistic girls, autistic women, and the girls’ parents. I take a developmental perspective, examining which factors might lead to the potential vulnerability described in Chapter Four, to 3 understand which preventative measures might be used to support autistic girls as they grow up. In Chapter Six, I discuss the significance of these findings in the context of the extant literature on both autism in girls and women, and of the peer relationships of autistic adolescents. I conclude by suggesting that the relationships and social experiences of autistic girls and women are qualitatively different to those of both autistic boys and neurotypical girls and women. These findings suggest that autistic girls and women require specialised and targeted support to enable them to successfully and safely engage with their peers in adolescence and beyond. 4 Acknowledgements The work in this thesis was supported by an Economic and Social Research Council PhD Studentship. Research at the Centre for Research in Autism and Education (CRAE) is supported by The Clothworkers’ Foundation and Pears Foundation. First, I would like to thank my supervisors, Liz Pellicano and Vivian Hill, for their wonderful guidance and support over the past three years. I have learned invaluable lessons about research integrity, professionalism, and the joys of academic work from them, and appreciate the knowledge they have shared with me. I would also like to thank Laura Crane, for her exceptional input in terms of reading work and providing feedback through the final stages of this process. I have also been fortunate to work with the wonderful team at CRAE, who have helped to make my PhD experience what it has been. The work presented in this thesis could not have happened without the young people, their families, and my adult participants being incredibly generous with their time and with their honesty. I would like to take this opportunity to thank them. It has been an honour to be allowed into their lives, and I have sought to do their stories justice. On a personal level, I cannot adequately express my gratitude to some of the people who have helped me through my PhD. Teremun, who gave me the experience of living with the Doctor, along with a lot of calm support and pizza. Jess, who provided advice, wine, and far more giggling than I’d anticipated in an academic life. My Cambridge girls, Emma, Ellen, and Claire, for weekends together reminding me that there are other things in life besides work. Alyssa, for taking me to the ballet and telling me exactly what I needed to hear at times. Finally, I want to thank my family. Their unwavering support and belief in me, in every way, has guided me from application to completion, and I owe them more than I can say. 5 Table of Contents Declaration................................................................................................................................2 Abstract.....................................................................................................................................3 Acknowledgements ..................................................................................................................5 List of Publications ................................................................................................................14 List of Tables ..........................................................................................................................15 List of Figures.........................................................................................................................18 List of Abbreviations .............................................................................................................19 Chapter One: Literature review...........................................................................................21 1.1 What is autism? ..................................................................................................21 1.2 Gender differences in friendships ......................................................................27 1.3 Friendship in autism...........................................................................................28 1.3.1 Autism and inclusion...................................................................................30 1.4 Gender differences in autism..............................................................................31 1.4.1. Presentations of autism across gender. .......................................................31 1.4.2. Gender differences in friendships in autism...............................................33 1.7 Friendship and conflict.......................................................................................39 1.7.1 Bullying in autism. ......................................................................................40 1.7.2 Conflict with friends/relational aggression..................................................42 1.8 Mechanisms potentially underlying conflict......................................................44 1.8.1 Social awareness..........................................................................................44 1.8.2 Self-regulation. ............................................................................................48 6 1.8.3 Anxiety. .......................................................................................................49 1.9 Development into adulthood ..............................................................................51 1.9.1 Adult outcomes in autism............................................................................51 1.9.2 Autistic women in adulthood.......................................................................54 1.9.3 Gender differences in relationships in adulthood........................................57 1.10 Conclusion........................................................................................................60 Chapter Two: Friendships and conflict experiences of autistic and neurotypical adolescents ..............................................................................................................................62 2.1 The current study................................................................................................64 2.1.2 Ethics. ..........................................................................................................66 2.2 Method ...............................................................................................................66 2.2.1 Participants. .................................................................................................66 2.2.2 Measures......................................................................................................71