Using Parents' and Children's Input to Inform a Peer-Mediated Intervention for Young School-Aged Children with Autism Spectrum Disorder

Background: There is growing awareness of the research-to-practice gap in evidence-based interventions (EBI) for children with autism spectrum disorder (ASD) at school. The dearth of school-based EBIs targeting social skills for children with ASD is particularly concerning, as successful peer interactions are among parents’ most valued outcomes for their children with ASD. Peer-mediated interventions (PMI) have shown initial efficacy for targeting social-communication impairments of children with ASD. Moreover, PMI is a practical approach for resource-limited schools. A peer-training approach based on Pivotal Response Treatment (PRT) holds high heuristic value for implementation in schools, given its emphasis on embedding learning opportunities into everyday contexts and routines. However, little is known about how acceptable this approach would be for individuals with ASD, parents of children with ASD, or parents of typically developing (TD) peers. Given families’ roles in decisions regarding interventions for their children with ASD, it is imperative to seek their input to improve the feasibility and acceptability of school-based interventions. The views of individuals with ASD have only recently been elicited in the design of interventions.

Objectives: The current study aimed to fill a void in the literature by considering families’ perspectives alongside the development of a peer-mediated, play-based PRT intervention for children with ASD in the first year of school. The goals of the study were to broadly inform peer-mediated and social skills interventions for children with ASD at school, and to inform the development of the specific proposed peer-mediated PRT intervention. Acceptability and feasibility of the proposed intervention in the school setting, as well as families’ recommended modifications were examined.

Methods: Semi-structured interviews were conducted with 6 parents of children with ASD (5-10 years), 6 parents of TD children (5-10 years), and 10 youths with ASD (10-12 years; N = 22). The interviews examined respondents’ perspectives of EBIs and PRT in general, and the overall acceptability and feasibility of the proposed intervention. Interview data were analyzed using descriptive content analysis.

Results: Overall, peer-mediated PRT was considered to be acceptable and feasible. Parents and youths agreed that communication and peer interaction skills (i.e., skills addressed in the proposed intervention) are important intervention targets, and that the first year of school (i.e., age 4-6 years) is an ideal time to facilitate peer interaction skills for children with ASD (i.e., as in the proposed play-based intervention). Some specific challenges with respect to peers as intervention implementers were identified; these differed by participant group. Parents and youths also provided specific advice regarding components of PMI and social skills interventions broadly (e.g., concerning the acceptability of older TD children as intervention implementers).

Conclusions: Key findings provided important direction with regard to the implementation of the proposed peer-mediated PRT intervention within schools, including recommendations that informed how to frame the intervention to parents and their children with and without ASD. The current study contributes to the literature by considering family perspectives on a proposed intervention during its design. The result of this collaboration is the development of an intervention with a higher probability of uptake in the school context.