A peer-mediated school intervention significantly improved the social skills and playground interactions of children with autism spectrum disorder

Research: objective To compare two school‐based interventions aimed at improving the social skills of high functioning, fully included children with autism spectrum disorder (ASD).

Design/Participants: This randomised controlled trial (RCT) employed a 2 × 2 factorial design and included 60 children with ASD and their 815 typically developing classroom peers, aged 6–11 years. Children with ASD were randomised to a: (1) peer‐mediated (PEER) (n = 30) or (2) child‐assisted (CHILD) (n = 30) intervention. Within this design, 15 children received both interventions and 15 children received no treatment.

Setting: Intervention sessions took place at the school of the child with ASD; the study included 30 different schools in the United States.

Intervention: Children allocated to the CHILD intervention met with a trained therapist during lunch for 20 minutes, twice per week, for six weeks. The therapist used direct instruction and role‐playing to target skill development. In the PEER intervention, three typically developing peers from the target child's classroom met with a therapist for 20 minutes, twice per week, for six weeks. Through direct instruction, modelling and role‐playing, peers were taught how to: encourage positive social interactions, initiate play, and facilitate games for children who had difficulty making friends.

Outcome measures: Primary measures. The Social Network (SN) Survey was administered to children in classrooms to examine social network salience before, after and three‐months following the intervention. The Playground Observation of Peer Engagement was scored by blinded assessors: before, after and at the three‐month follow‐up. Secondary measures. The Teacher Perception of Social Skills and the SN Survey (measuring: received friendship nominations, nominations of friendship, rejections and reciprocal friendship nominations).

Results: There was a significant group effect on children's social network salience (P < 0.001). The PEER intervention had a significant, large effect (P < 0.001, d = 0.76), while the CHILD intervention had a non‐significant, small effect (P = 0.06, d = 0.36). Children who received the PEER intervention also had an improved number of received friendship nominations (P < 0.001) and teacher report of social skills in the classroom (P < 0.001); with gains persisting at follow‐up. By the three‐month follow‐up, playground isolation had significantly decreased (P < 0.001) and joint engagement had significantly increased (P = 0.01). There were no significant between group differences in secondary outcomes of: friendship nominations by the child, rejections or reciprocal friendships.

Author's conclusions: Peer‐mediated treatments were superior to non‐peer‐mediated treatments on several outcomes. The school setting offers unique opportunities to teach typically developing peers to become sensitive and helpful towards peers with different learning and developmental needs.