Peer-Mediated Pivotal Response Treatment for Young Children with Autism Spectrum Disorder at School

Background:   The gap in effective intervention models for children with autism spectrum disorder (ASD) at school is striking. School-based interventions must not only be evidence-based but also feasible and acceptable to school stakeholders. 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). Approaches in which typically developing (TD) peers are trained to implement an intervention directed toward children with a disability offer a face-valid and cost-effective means of promoting social skill development for children with ASD. A 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). Peer-implemented PRT has been shown to enhance the communication skills of children with autism in five published studies to date. This intervention is typically provided among 7- to 10-year-olds, although peer-implemented PRT may also be effective in the first year of school.

Objectives: The main objective of the present single-subject design case series was to evaluate the efficacy of peer training in PRT for improving social skills of children with ASD in the first year of school.

Methods: Four children with ASD, eight TD kindergarten peers (social skill coaches), and their parents and teachers participated. A non-concurrent multiple-probe (across participants) baseline design was used, in which TD peers were individually trained in PRT with a classmate with ASD using the Kids Helping Kids Manual (Pierce & Schriebman, 1997). Outcomes for children with ASD and peer coaches were assessed before, immediately after, and 6 to 9 weeks following training using behaviour coded from video recordings as well as questionnaires. Data were analyzed using visual inspection and percentage of non-overlapping data (PND).

Results:  Overall, for children with ASD, social-communication skills (rate of social initiations and peer engagement) increased following training and were maintained at 6-9 week follow-up (M = 81.25 % PND). Peer coaches’ fidelity in implementing PRT varied more, but generally increased following training. Enhanced social-communication skills of children with ASD were demonstrated in non-training locations for all children, and generalized to non-trained same-aged peers for two of the four children.

Conclusions: Few effective interventions targeting social-communication skills for students with ASD have been implemented at school. In the present study, relatively brief training of TD peers in PRT produced gains in the social-communication skills of children with ASD in the first year of school. Our findings add to the body of literature on peer-mediated PRT and suggest that this may be an effective, feasible and cost-effective approach for children with ASD at school.