Acceptability and Feasibility of Peer-Mediated Pivotal Response Treatment for Children with Autistic Spectrum Disorders: An Integrated Knowledge Translation Approach

Background: The gap in effective intervention models for children with autistic spectrum disorders (ASD) at school is striking. The lack of evidence-based practices (EBPs) for children with ASD in schools may indicate inadequate translation of research into practice (Stahmer, Suhrheinrich, Reed, & Schreibman, 2012). This knowledge-to-practice gap frustrates researchers and educators alike (Dingfelder & Mandell, 2011; Stahmer et al., 2012). While researchers tend to focus on the fidelity of intervention implementation in lab settings, educators often feel that researchers do not consider the complexity of implementing interventions in the real-world school environment (Kasari & Parsons, 2013; Stahmer, Collings, & Palinka, 2005). Collaborating with knowledge users throughout the research process  in an “integrated knowledge translation” (CIHR, 2006) framework may help to bridge the gap. Approaches in which typically developing peers are trained to implement an intervention directed toward children with a disability offer a logical, face-valid and cost-effective means of promoting social skill development for children with ASD. A specific peer training approach based on Pivotal Response Treatment (PRT; Koegel & Koegel, 2006) holds high heuristic value for implementation in schools given its emphasis on embedding learning opportunities into everyday contexts and routines (Koegel et al., 2011; Stahmer et al., 2011).

 Objectives: The goal of the present study was to collaborate with a school board / school staff members and related stakeholders to develop a peer-mediated Pivotal Response Treatment (PRT) intervention targeting social skills for children with ASD in the first year of school. Feasibility of the proposed intervention in the school setting, as well as stakeholders’ recommended modifications, were examined.

Methods: Semi-structured interviews were conducted with 24 educators and 5 early intervention providers (N=29) serving children with ASD. Qualitative methodology was used to obtain respondents’ perspectives on EBP in general, components of the proposed intervention, and the overall acceptability and feasibility of implementing the intervention. Interviews were recorded, transcribed, and analyzed using grounded theory.

Results: Most participants had a rudimentary understanding of evidence-based intervention, but reported it to be important. Stakeholders’ knowledge of PRT ranged from minimal to comprehensive. Overall, peer-mediated PRT was judged to be acceptable and feasible.  Perceived strengths of the proposed intervention included: ecological validity, generalizability, potential for friendship development and greater acceptance of disabilities among classmates. Weaknesses identified included: sustainability of the model and uncertainty about how to train peers. Several challenges with respect to peers as intervention agents and location of intervention were identified. Teachers recommended specific adaptations.

Conclusions: Findings highlight the added value of building a research-to-community partnership. Overall, stakeholders perceived peer-mediated PRT at school to be acceptable and feasible. A trial of the intervention is now proceeding. This process of obtaining qualitative feedback from frontline practitioners provides a model for researchers to promote EBPs for optimal classroom use. Findings are discussed within the framework of implementation science and effective and feasible models of ASD intervention at school.