Investigators:
Mitch Prinstein,Ph.D.
University of North Carolina-Chapel Hill

Julie Wargo Aikins,Ph.D.
University of Connecticut

Study Goals
This study was designed to examine associations among friendship contact/quality, social-psychological adjustment, and adaptive functioning among adolescents with mental retardation (MR).

Specifically, this investigation examined both adolescents’ “spontaneously occurring” friendship with a community peer (i.e., typically an adolescent also with mental retardation) and adolescents’ relationship with a Best Buddy.

It was hypothesized that Best Buddy relationships would be similar to spontaneously occurring friendships (referred to as ‘friendships’ hereafter) in many ways. Both relationships would offer adolescents opportunities to interact with a peer on a regular basis, and to establish interactions characterized by high levels of intimacy, emotional disclosure, companionship and support.

However, it also was hypothesized that the form and function of adolescents’ Best Buddy relationships would differ from adolescents’ friendships in meaningful ways.

Best Buddy relationships are likely characterized by greater levels of scaffolding (i.e., guided, supportive instruction), unilateral provision of support, and opportunities for Best Buddies to model appropriate skills and behaviors to adolescents with mental retardation.


Procedure
With the assistance of Best Buddy chapters in Connecticut and Massachusetts, thirty adolescents with mental retardation (MR) were included in the study. Adolescents were eligible to participate in the study only if they reported a best friendship in addition to their Best Buddy relationship.

This yielded a unique sample of adolescents with MR; notably, most adolescents who were contacted reported that they did not have a best friend other than their Best Buddy. Adolescents and their parents also had to be willing/able to participate in two lab-based visits.

Efforts were made to ensure that all participating adolescents were within the mild to moderate range of mental retardation, and did not have a concurrent diagnosis within the Pervasive Developmental Disorder spectrum.

The final sample included adolescents between the ages of 14 and 21 years, M = 17.5; SD = 1.9. Approximately 46% of the sample was female. Using a multi-method, longitudinal design, several aspects of adolescents’ friendships, Best Buddy relationships, and social-psychological functioning were examined.

During two lab-based assessments, adolescents and their parents completed measures assessing adolescents’ relationship quality (with their best friend, Best Buddy, mother, and father), self-esteem, anxiety, loneliness, and peer victimization.

Parents also completed measures regarding adolescents’ psychological internalizing and externalizing symptoms, and adaptive functioning. These measures were completed at an initial time point (Time 1) and again six months later (Time 2).

During the lab visits, adolescents’ best friends and Best Buddies also completed measures designed to assess their perspective of the quality of their relationship with the target adolescent as well as to examine their own and the target adolescent’s social functioning.

The lab visits also provided an opportunity to conduct an observational assessment of adolescents’ interactions with their best friends and their Best Buddies. A series of structured and unstructured interactions were designed to examine aspects of friendship quality, including positive affect, negative affect, emotional intimacy, dominance, responsiveness, scaffolding, and competition.

In addition to the data reported above, teacher-reported and school record data (e.g., individualized educational plan, results of psychological evaluations) also were requested for each participating adolescent at both Time 1 and Time 2.

Recruitment of adolescents for this project was completed in December 2003. All lab visits were completed by March 2004. Time 2 assessments were completed by the end of December 2004.


Results
Findings examining associations among adolescents’ friendship contact/quality, psychological adjustment, and adaptive functioning are reported below. These results are based on 1) results from the Time 1 and 2 assessments reported by adolescents, their best friends, Best Buddies, and parents and 2) results from coding of observational data collected during adolescents’ lab visits with their best friends and Best Buddies.


Initial Analyses
Because so little research has been conducted to examine relationship quality among adolescents with mental retardation, an initial step in data analysis was to ensure that our adapted measures had sound psychometric properties (i.e., reliability, internal consistency) within this sample. Results indeed confirmed adequate internal consistency for all measures reported by parents, friends, Best Buddies, and by adolescents themselves; all alpha’s exceeded .75 with two expected exceptions.


Comparisons between Friendships and Best Buddy Relationships
Questionnaire Assessment. Analyses first were conducted to examine whether there were differences in adolescents’ frequency of contact with best friends compared to Best Buddies.

Using results from a friendship contact checklist designed to capture typical friendship interactions (e.g., seeing each other on weekends, in school, emailing one another, etc.), adolescents reported comparable levels of interaction with their best friends and their Best Buddies; there were no statistically significant differences.

Analyses also were conducted to examine the same question using adolescents friends’ and Best Buddies’ reports of contact. Again, results revealed no significant difference in the frequency of interaction within these two relationships.

Given the high potential for frequency of contact with best friends, many of whom are within the same school or community setting, these results may seem surprising. However, because many of these friends also were adolescents with MR, the results suggest that adolescents who do develop friendships spontaneously do not necessarily have a high frequency of contact with these friends.

Average scores based on all reporters ranged between 5-7 events out of 16 assessed on this measure. Next, analyses were conducted to compare friendship quality between adolescents’ friendships and Best Buddy relationships.

Again, results revealed that based on adolescents’ report of the quality of these relationships, no statistically significant differences emerged; adolescents reported that Best Buddy relationships and best friendships had comparable levels of both positive and negative relationship qualities.

However, when based on the responses of adolescents’ friends and adolescents’ Best Buddies, significant differences were revealed. Specifically, Best Buddies reported lower levels of friendship quality with MR adolescents than did adolescents’ best friends.

Further analysis of this effect suggested that Best Buddies reported that the level of intimacy and emotional support they received from their relationships with adolescents with MR were lower than the level of intimacy and emotional support that adolescents’ reported they had received.

Given that many Best Buddies likely have friendship with other non-MR peers that are characterized by high levels of emotional support and intimacy, this finding is not entirely surprising.


Observational Assessment
As revealed above, questionnaire assessments often are limited based on the reporter (i.e., which person is completing the assessment) and the unique perspective each person might have with regard to the friendship.

Questionnaire assessments of friendships also can be limited due to different contexts or reference groups that are used by each rater to evaluate their friendship quality. A main goal of this study therefore was to examine friendships and best buddy relationships using a structured observational paradigm.

Each adolescent was asked to participate in a series of structured and unstructured interaction tasks (i.e., jointly complete a puzzle, engage in discussion tasks regarding their friendship, engage in joint decision making tasks such as deciding how to spend hypothetical lottery winnings, play competitive games of a skills-oriented task such as “Perfectionism”).

Because adolescents are not aware that the true purpose of these tasks is to obtain a “sample” of their relationship behavior, it is possible to obtain an assessment of behavior that is free of reporter-bias, and offers greater ecological validity than a questionnaire assessment.

A coding manual was developed to analyze each videotaped assessment. The manual offered a detailed operationalization, examples, and descriptions for seven dimensions of relationship quality (positive affect, negative affect, emotional intimacy, dominance, responsiveness, scaffolding, and competition).

An anchoring system was developed to indicate the types of behavior that would qualify for each point on a five point rating scale within each of these dimensions. Advanced research assistants with special expertise in adolescent relationships, but blind to the specific purposes of this study, were then trained on the coding system.

Coders were each assigned to one of the observational tasks, and provided ratings for each of the seven relationship dimensions for each videotape. Results are presented below. Reliability training currently is ongoing to offer a second rating of each videotape and examine coding concordance.

For several relationship dimensions, results revealed no significant differences in the overall quality of friendships and best buddy relationships. These dimensions included the degree of negative affect, emotional intimacy, and competition.

This finding is qualified by the fact that dyads generally scored very low in competitiveness and emotional intimacy in both friendships and Best Buddy relationships (i.e., floor effects) overall. Statistically significant effects were revealed for positive affect, scaffolding, responsiveness, and dominance.

Specifically, results suggested that best buddy relationships are characterized by higher levels of positive affect (in one task only), responsiveness and attentiveness to social cues, dominance (by the best buddy) and scaffolding. This is a very important finding with important implications for the Best Buddy program!

As hypothesized, it appears that Best Buddy relationships possess many of the qualities that are known to be important components of adolescent friendships, as well as some additional relationship dynamics that may have important consequences for social-psychological development of adolescents with mental retardation.

Friendships in adolescence serve important development functions by offering youth a context in which to develop new social roles and to experience positive feedback and social reinforcement.

Findings suggest that MR adolescents’ friendships – even within this highly selective sample of adolescents who already were able to identify a best friend – may be lacking somewhat in qualities (positive affect, responsiveness to social cues) that are thought to be instrumental in achieving these developmental aims.

Results suggesting that adolescents’ Best Buddy relationship context is characterized by greater levels of these relationship qualities therefore may offer important compensatory benefits.

In addition, Best Buddy relationships appear to be characterized by higher levels of scaffolding (guided instruction, skill building, learning), and perhaps accordingly, greater levels of dominance exhibited by the Best Buddy.

This finding suggests that the Best Buddy environment is a unique context in which adolescents with mental retardation have the potential to learn new skills and safely experiment with new social roles and experiences. Associations among Friendships, Best Buddy Relationships, and Adolescents’ Social-Psychological Adjustment.


Questionnaire Assessment
Analyses were conducted to examine potential associations between the frequency of adolescents’ contact with best friends/Best Buddies and adolescents’ social-psychological adjustment.

Results revealed that greater frequencies of contact with Best Buddies, as reported by Best Buddies themselves, were associated with adolescents’ own report of lower levels of adolescents’ peer victimization, and with parents’ report of adolescents’ lower somatic psychological symptoms, and higher levels of adolescents’ adaptive functioning in the areas of adaptive behavior, communication, and living skills.

By adolescents’ report, higher frequencies of contact with their Best Buddy were associated with higher levels of self-esteem. Interestingly, no significant associations between the frequency of adolescents’ contact with their best friend and adolescents’ social-psychological adjustment were revealed.

A second set of analyses examined associations between relationship quality and adolescents’ social-psychological adjustment. Results indicated that adolescents who reported higher levels of positive relationship qualities with their Best Buddy also reported higher levels of self-esteem.

Higher levels of negative relationship quality with either a best friend or a Best Buddy were generally associated with lower levels of adaptive behavior. Based on Best Buddies’ reports, higher levels of positive relationship quality were associated with higher levels of adolescents’ parent-reported adaptive behavior.


Observational Assessment
Analyses also were conducted to examine associations among adolescents observed friendships, best buddy relationships, self-reported friendship quality, internalizing distress (i.e., self esteem, social anxiety, loneliness), psychological symptoms (reported by parents and teachers), and adaptive functioning (reported by parents and teachers).

Analyses revealed several interesting interrelationships within and between each of these assessed domains. Associations among the relationship qualities revealed in observational assessment indicated that higher levels of scaffolding in Best Buddy relationships were associated with higher levels of positive affect and social responsiveness.

Together, the co-occurrence of these three domains might provide a model of an optimal Best Buddy relationship. There also was some evidence that observed aspects of adolescents’ relationships were associated with their own reports of friendship quality. Adolescents with higher levels of emotional intimacy in their observed friendships were associated with their higher reports of positive quality with best friends.

With regard to social-psychological adjustment correlates, results revealed that higher levels of adolescents’ parent-reported attentional problems were associated with the presence of more negative affect in interactions with adolescents’ Best Buddies.

Note that this finding does not suggest that the Best Buddy interaction is negative or detrimental in any way, but rather that adolescents’ with high levels of psychological symptom difficulties in the attention domain (i.e., similar to ADHD), likely require more structure and behavioral regulation by the Best Buddy.

Results also suggested that adolescents with high levels of parent-reported depressive/anxious psychological symptoms had interactions with their best friends that were lower in emotional responsiveness. It is likely that these adolescents are particularly difficult to engage and may possess unique social skill difficulties that require more attentiveness than can be offered in a relationship with another adolescent with mental retardation.

There also was some evidence to suggest that relationship qualities were associated with adaptive functioning. Adolescents with higher levels of communication, daily living skills, socialization skills, and an overall high adaptive behavior composite scores had relationships with their Best Buddies that were characterized by a more balanced distribution of power (i.e., low dominance) and lower scaffolding.

The consistency of this result across all major domains of adaptive functioning suggests that adolescents with greater intellectual impairment likely possess different needs from their Best Buddies (i.e., more structure) and elicit more structured guidance.

Adolescents with less intellectual impairment are better able to form relationships with Best Buddies that are characterized with greater reciprocity.


Longitudinal Results
Because data on social-psychological adjustment (including internalizing distress, psychological symptoms, and adaptive functioning) also were collected at Time2, it was possible to examine whether aspects of adolescents’ relationships with their Best Buddies were associated with changes in social-psychological functioning over time.

Analyses of adaptive behavior were conducted by examining each adaptive behavior domain (daily living skills, communication, socialization, and the adaptive behavior composite) in four separate hierarchical linear regression analyses, while controlling for initial levels of the corresponding domain of adaptive functioning at Time 1 on an initial step.

This procedure allows for an examination of scores at Time 2 while controlling for the level of adaptive behavior already achieved by the start of the study. Next, aspects of the Best Buddy friendship, both observed and self-reported by adolescents themselves at Time 1, were entered as possible predictors.

Several significant effects emerged. Results indicated that higher levels of scaffolding between adolescents at their Best Buddies at Time 1 were associated with significant increases in adolescents’ daily living skills and marginally with adolescents’ adaptive behavior composite over time.

Results also suggested that adolescents’ reports of positive relationship quality with their Best Buddies (and marginally higher frequencies of contact with Best Buddies) were associated with significant increases in communication skills over time.

In contrast, no significant effects emerged for the longitudinal prediction of adaptive functioning from relationship quality in adolescents’ friendships (i.e., with a best friend). This suggests that there may be something unique regarding the Best Buddy context that is associated with gains in adaptive behavior over time.

Although these findings are promising, it is important to regard these results with some caution. As with all observational data, it is necessary to establish high levels of reliability in observational codes to be certain that findings are not biased by a single reporter. This training is currently ongoing.


Conclusions and Recommendations
The study used a rigorous multi-method, multi-informant, and longitudinal methodological design. To our knowledge, these procedures represent the best methods currently available to examine social relationships, friendship quality, and psychological adjustment.

Findings offer a stringent test of the associations among adolescents’ Best Buddy relationship quality and psychological adjustment. Results are correlational, therefore it is not possible to determine whether engagement in Best Buddy friendships is causally related to adolescents’ adjustment.

It also is important to recognize that these findings may be applicable only to the highly specific group of adolescents who currently are involved in the Best Buddy program and also have a best friendship. This likely oversamples adolescents who already have specific familial (psychological) resources (i.e., sufficient to learn about and become actively involved in the Best Buddy program) and individual social skill to establish and maintain a friendship with a peer.

However, we believe that these sampling effects, if anything, would likely attenuate the associations between the qualities of Best Buddy relationships and adolescents’ adjustment. Thus, it is possible that with a more representative sample, findings might be stronger.

With these study strengths and limitations in mind, the following recommendations are offered.

1. Best Buddy relationships appear to offer unique benefits to the psychological adjustment of adolescents with mental retardation. The frequency of contact with adolescents’ Best Buddies was concurrently associated with lower frequencies of peer victimization, better adaptive behavior, higher levels of self-esteem, and fewer psychological symptoms. These associations were not observed with regard to adolescents’ best friendships, suggesting unique effects of the Best Buddies program. It is recommended that adolescents enrolled in the Best Buddies program maintain consistent and frequent social contact with their Best Buddy throughout the duration of their involvement.

2. Best Buddy relationship appear to be distinct from other friendships by offering higher levels of scaffolding, particularly among adolescents with lower levels of intellectual functioning. It appears that these scaffolding behaviors may be uniquely important (concurrent and longitudinal) predictors of adolescents’ functioning. Scaffolding was associated with higher levels of positive affect and emotional responsiveness in Best Buddy dyads, as well as increases in adaptive behavior over time. It is recommended that Best Buddies be advised or trained to offer scaffolding and emotional responsive behavior during their interactions with MR adolescents to maximize the benefits of this program.

3. Results also offered some evidence to suggest that MR adolescents likely have different needs within the Best Buddy program. Adolescents experiencing elevated levels of psychological symptoms, such as attention difficulties or anxious/depressive symptoms likely require greater structure within their Best Buddy relationships. Best Buddies who may be particularly adept at offering structure and emotionally sensitive support may be best matched to MR adolescents who are experiencing psychological difficulties.