Training Peer Models to Promote Social Skills: Considerations for Practice

Abstract

Social skills training programs have increasingly enlisted same-age typical peers as instructors in the teaching of social skills to children with high-functioning autism spectrum disorder (ASD). The inclusion of peers in the teaching process has been found to be a critical component in these programs. Despite strong support for incorporating peers in social skills programs, there are few guidelines for training peers. The present study examined a treatment package to teach typical school-aged children skills to become peer models. A multiple baseline across behaviors research design was implemented using components of behavioral skills training to teach (a) initiating verbal interactions, (b) prompting for targeted skills, and (c) delivery of praise. The peer models quickly acquired the skill of initiating verbal interactions; however, posting of data, prompting, and additional contingencies were needed to maintain and generalize prompting for targeted skills and delivery of praise with novel children.

Keywords

performance feedback autism spectrum disorders social skills socialization peer models behavioral skills training

Hallmark features of autism spectrum disorder (ASD) include markedly impaired social interactions and communication (American Psychiatric Association [APA], 2013). Children with ASD often have difficulty forming normal peer relationships and exhibiting social skills consistent with their same-aged peers. Many children with high-functioning ASD exhibit deficits in social and/or emotional reciprocity and verbal and nonverbal behaviors, which result in the absence of conventional social interactions (APA, 2013). Substantive and engaging social interactions with peers and adults contribute to positive outcomes and are essential in the treatment and social integration of children diagnosed with ASD (Haring & Breen, 1992; Krasny, Williams, Provencal, & Ozonoff, 2003; Kroeger, Schultz, & Newsom, 2007; McConnell, 2002).

Peer-mediated interventions are an empirically supported approach to teach and promote social skills in the ASD population (National Autism Center, 2009; Wong et al., 2014). These interventions have been used to both increase the initiation and overall quality of interactions between children with ASD and their neurotypical peers (Bass & Mulick, 2007; Chung et al., 2007; Kohler, Greteman, Raschke, & Highnam, 2007; McConnell, 2002). The inclusion of neurotypical peers to model, initiate, and respond with appropriate social behaviors has been shown to aide in the acquisition, maintenance, and generalization of social skills across home and community environments (Kamps et al., 2002; Kohler et al., 2007; Odom et al., 2003). However, there remains no clear consensus regarding the most effective and efficient strategies to train peers in promoting social skill development in their peers with ASD. Peer-model training is a significant issue because successful implementation of interventions (i.e., procedural integrity) is imperative to demonstrate effects on social behavior of children with ASD. Historically, peer-mediated interventions have employed instructional methods such as structured social interactions, social skills training (SST), behavioral skills training (BST), and other environmental manipulations including adult prompts or positive reinforcement to train peers to promote and teach social skills (Beaulieu, Hanley, & Santiago, 2014; Gonzalez-Lopez & Kamps, 1997; Licciardello, Harchik, & Luiselli, 2008; Odom & Strain, 1986; Strain & Timm, 1974).

A seminal study on peer-mediated social skill training focused on very young children (Strain & Timm, 1974). Following an intervention, which included adult modeling of initiations of interactions with targeted children and receiving praise for initiations, increases in appropriate social behavior were observed between a target student and their neurotypical peer(s). Further studies by Strain and colleagues subsequently focused on expansion of the approach, introducing explicit teaching procedures for the peers implementing the teaching protocol (Odom, Hoyson, Jamieson, & Strain, 1985; Odom & Strain, 1986), which consisted of prompting and role-play with feedback. Further extensions of this work also found that confederate peers, often other school-aged children, can be taught to effectively teach and improve the social interactions of children with social skill deficits (Gonzalez-Lopez & Kamps, 1997; Kohler et al., 2007).

Further investigations have examined the effects of peer-mediated social skills programs in a group format containing multiple individuals with ASD. Haring and Breen (1992) combined typically developing adolescent peers with adolescents with social delays into “social network groups” with an adult facilitator, and weekly meetings were held for both the peers and the adult facilitator. Weekly group meetings centered on strategies to engage with ASD peers, including persistence in getting a response, modeling appropriate responses, modifying conversation structure or content, and reestablishing joint attention. With adult facilitation, interaction frequency increased. Investigations conducted by Kamps and colleagues (2002) aimed to achieve a similar objective by training 51 elementary-aged peers of children with ASD to initiate and respond to peers, cooperate, and engage in positive interactions during play with ASD children in small group formats. The intervention resulted in improvements in frequency and duration of interactions, which also maintained after the intervention. A follow-up study by Kamps et al. (2002) found that students interacting with trained peers demonstrated improvements in both the amount and duration of reciprocal interactions. Despite improvements in social behavior of children with ASD, neither study included descriptions of procedures used to train peers, nor did either study include quantitative data detailing the trained peers’ acquisition and utilization of skills necessary to teach and model social skills. Moreover, although positive results were observed, these studies indicated that substantial prompting from adults was necessary to ensure that trained peers implemented teaching procedures and that, without such prompts, these skills were observed at much lower rates. Evidence-based training methods may be beneficial to teach students to independently (i.e., without prompts) demonstrate peer-model skills.

BST is an instructional package that consists of instruction, modeling, role-play, and feedback. This approach has been utilized in both the training of peer models as well as target children with ASD. Harper, Symon, and Frea (2008) effectively utilized BST to train typically developing elementary-aged peers to interact with two ASD children. Peer BST included descriptions and modeling of target behaviors (i.e., how to gain attention, offer play options, narrate play, reinforce attempts at functional play, take turns, and how to deal with aggressive behavior from target subjects). Students with ASD demonstrated increased levels of initiating and responding during intervention, and those improvements were maintained when prompts were removed. Despite improvements in the social skills of the targeted students, there was no baseline measure of peer performance of targeted skills prior to training, and it was not clear whether the peer training was the only factor involved in the improvement of peer social skills. Chung and colleagues (2007) also utilized typically developing elementary-aged peers in the teaching of social skills to children with ASD using BST strategies. The peer training included orientation to the target social skill for the day and role-playing, as well as teaching peers how to prompt and praise for the social skill use. Following BST implementation, increases in appropriate talking and decreases in inappropriate talking were observed in students with ASD. However, the researchers did not measure the trained peer model’s adherence to the teaching protocol. This was a noted limitation as verbal praise procedures were found to be delivered only intermittently.

As an adjunct to BST, performance feedback (PFB) is a methodology that can be introduced in cases where the implementation of skills taught in BST are observed at insufficient levels. PFB has been shown to be effective for improving the implementation of behavioral supports in instructional packages (Gilbertson, Witt, Singletary, & VanDerHeyden, 2007) as well as decreasing rates of undesired behavior (DiGennaro, Martens, & Kleinmann, 2007; Jones, Wickstrom, & Friman, 1997). PFB methods as described in Noell et al. (2005) consisted of providing frequent feedback regarding the specific components implemented correctly as well as the steps not implemented correctly. The available research suggests that PFB improves overall adherence to intervention protocols and is applicable to a wide range of consumers and applications (Solomon, Klein, & Polityo, 2012), though its applicability to peer-mediated SST has not yet been explored.

Although the results of several studies on peer-mediated SST suggest overall effectiveness in a variety of social outcomes for children with ASD, little emphasis has been placed on the development of optimal procedural guidelines to train peer models to consistently and correctly promote social skills with their ASD peers (Chung et al., 2007; Haring & Breen, 1992; Harper et al., 2008; Kamps et al., 2002). The objective of the current investigation was to train peer models in important behaviors necessary to promote social skills in high-functioning ASD peers (Chung et al., 2007; Kamps et al., 2002). A curriculum, titled Peer Model Education Curriculum (PMEC), consisted of didactic instruction and three target peer-model skills including initiation of peer interaction, specific instructional prompts for targeted social skills, and the delivery of praise. In addition to targeting specific peer-model skills, the curriculum employed PFB and BST as specific teaching techniques to teach peer-model skills. This study aimed to determine the efficacy of the PMEC curriculum in teaching peer-model skills in the presence of a training group and a novel group of peers.

Method

Participants and Setting

Peer-model participants

Three neurotypical peer models were recruited from Grades 4 through 6 from a local parochial school located near the research setting. Peer models were nominated by school counselors and teachers based on reported social skills, low rates of problem behaviors, and academic performance. Participant 1 was a 10-year-old Caucasian male, Participant 2 was a 10-year-old biracial male. Participant 3 was a 12-year-old Hispanic male. Criteria for participation were average social skill development and low rates of disruptive or undesired behavior, as measured on the Social Skills Improvement System (SSIS; Gresham & Elliott, 2008; see Tables 1 and 2). Informed consent was obtained from the parent(s) and teachers and assent was collected from all participants prior to beginning the study.

Table 1.

Social Skills Improvement System—Social Scores.

Participant	Peer models				Difference
	Pretraining		Posttraining
	Standard score	Classification	Standard score	Classification
Participant 1
Teacher	111	Average	112	Average	0.272
Parent	92	Average	107	Average	4.079^a
Self	109	Average	107	Average	−0.543
Participant 2
Teacher	93	Average	79	Below average	−3.807^a
Parent	91	Average	104	Average	3.535^a
Self	103	Average	103	Average	0
Participant 3
Teacher	116	Above average	114	Average	−0.543
Parent	109	Average
Self	117	Above average	121	Above average	1.088

Note. There was no parent report for Participant 3 at Time 2. RCI = reliable change index.

RCI suggests significant change at ±1.96.

Table 2.

Social Skills Improvement System—Problem Behavior Scores.

Participant	Peer models				Difference
	Pretraining		Posttraining
	Standard score	Classification	Standard score	Classification
Participant 1
Teacher	95	Average	107	Average	2.571^a
Parent	89	Average	85	Average	−0.857
Self	96	Average	96	Average	0
Participant 2
Teacher	108	Average	105	Average	−0.642
Parent	85	Average	86	Average	0.214
Self	102	Average	113	Average	2.357^a
Participant 3
Teacher	84	Below average	87	Average	0.643
Parent	87	Average
Self	79	Below average	78	Below average	−0.214

Note. There was no parent report for Student 3 at Time 2. RCI = reliable change index.

RCI suggests significant change at ±1.96.

Children with ASD

Three children, ranging from 8 to 12 years of age, with a diagnosis of ASD were recruited to assist in the PMEC training phase. For two of the children, the diagnosis of ASD was made by a clinical psychologist and a developmental pediatrician, and for one child the diagnosis of ASD was confirmed by a child psychiatrist. The Autism Diagnostic Observation Schedule was completed on two of the children. These children had previously attended each weekly 90-min session of the 8-week group SST program using The SCORE Skills: Social Skills for Cooperative Groups curriculum, an evidence-based curriculum for SST in ASD (SCORE; Mathews, Erkfritz-Gay, Knight, Lancaster, & Kupzyk, 2013; Vernon, Shumaker, & Deshler, 1996; Webb, Miller, Pierce, Strawser, & Jones, 2004). The three children acquired the skills proficiently during the training and were deemed to be cooperative to assist in the training. Consent was collected from all parents and assent was collected from all screened participants. Criteria for inclusion in the study were an IQ of at least 70, prior diagnosis of ASD, and at least 70% compliance with following instructions delivered by the researcher. Compliance with following instructions was assessed during the screening session and criteria was met if the child completed at least seven of 10 simple tasks (e.g., hand me the toy, tell me your full name, do two jumping jacks).

Following the successful training of the peer models, six novel school-aged children with ASD were recruited to participate in the generalization portion of the study. The novel children were aged 7 to 12 years and were chosen based on their “next in line” status on the wait-list to participate in an upcoming group SST program. The criteria for inclusion were identical to that of the ASD participants in the peer-model training condition.

All recruitment, screening, and treatment were conducted at an institute for children with neurodevelopmental disabilities located in a midsized city in the Midwest. All the children with ASD had previously received services at the institute and were familiar with the setting. The peer models attended a school that was within two miles of the institute, but did not have exposure to the institute prior to participating in this project. The group training was conducted by the primary investigator (PI) and two supervised predoctoral interns in a moderately sized room (5 m × 5 m). An outdoor playground was available at the institute but was not used for this project. All training sessions took place after the participants’ scheduled school day.

Procedure

Measurement

During the initial training phase, the peer-model data were collected by direct observation of the target behaviors of initiating interactions, prompting for targeted SCORE skills, and delivering praise. Peer models were observed individually for five, 2-min intervals (10 total observation minutes per session) using a 15-s partial interval recording for each target behavior. The sequence of observation of the participants was randomly determined. Data were then aggregated such that the total number of intervals with the observed target behaviors across all participants was divided by the total number of observation intervals across participants and multiplied by 100. This measurement procedure was used to represent the occurrence of each of the three behaviors during each interval across all phases and participants. During generalization phases, peer-model target behaviors were similarly measured as a group during five 2-min data collection periods using the same 15-s partial interval recording procedure described above.

Initiating verbal interactions was operationally defined as any attempt by the trained peer model to begin conversation with a peer with ASD on any topic. Prompting for skills was defined as any verbal prompt by the trained peer model toward one or more peers with ASD to engage in one of the social skills outlined in the SCORE curriculum. Praise was defined as any verbal praise, specific or nonspecific, delivered by the trained peer model following targeted social skills demonstrated, or attempted, by a peer with ASD.

Peer models, their parents, and their teachers completed pre- and postintervention measures using the SSIS. The SSIS is an assessment of an individual’s social skills, problem behavior, and academic competence (Gresham & Elliott, 2008). Trained peer models, their parents, and peers with ASD also completed consumer satisfaction rating scales.

Design

The study utilized a multiple baseline across behaviors design with a generalization phase. Baseline data were collected on the percentage of intervals in which the trained peer models initiated verbal interactions, prompted peers with ASD to demonstrate targeted skills, and delivered verbal praise to peers with ASD. Once stable responding was observed in baseline, the PMEC intervention was introduced. The PMEC interventions were then sequentially introduced for prompting social skills and delivering verbal praise once change in level, trend, and variability could be established in the preceding behavior’s intervention phase.

Procedural integrity and interobserver agreement

One of the research team members collected data to assess the fidelity of implementation to measure that the instructors reviewed all critical components of the curriculum across the three teaching sessions. Of the identified components, 91.6% were present in these sessions. Interobserver agreement was obtained on 40% of the direct observation data sessions. The calculation was obtained by agreements/agreements + disagreements and divided by 100. The percent of agreement was 89.2%.

Intervention

Phase I: Peer-model training

The PI and two predoctoral interns conducted the training using the PMEC (available upon request). The PMEC curriculum was developed by the PI and colleagues as part of a Family Service Community grant award from Autism Speaks. The curriculum consisted of didactic instruction and training of three targeted behavioral skills: (a) initiating verbal interactions, (b) prompting for targeted SCORE social skills, and (c) delivering praise. The curriculum was designed to complement an existing social skills curriculum targeted for school-aged children with ASD (i.e., SCORE Skills). The curriculum and behavioral skills were taught over three sessions that each lasted approximately 90 min.

The content taught in Session 1 included the following topics: (a) What is a peer mentor? (b) What is autism? and (c) Confidentiality. The peer-model skill taught during the first session was initiating verbal interactions. In Session 2, peer models were introduced to the social skills associated with the SCORE curriculum and the behavioral skill of prompting for the SCORE skills. The content in the third session focused on positive reinforcement and strategies to deal with inappropriate behavior. The behavioral skill taught during the final session was delivering verbal praise for targeted SCORE social skills.

The didactic content was taught through a PowerPoint presentation with a question and answer discussion. The behavioral skills were taught through direct instruction, demonstration, role-play, and corrective feedback by the researchers. The peer models were given opportunities to practice each of the skills with each other using hypothetical situations that were suitable to role-play the targeted skills. These situations were practiced a minimum of 3 times or until mastery criteria of 100% was met, which all peer models achieved by the third attempt.

Peer models were joined with the three recruited peers with ASD (who previously had completed the SCORE social skills curriculum) for 30 min prior to the introduction of the curriculum and in between each of the three didactic training sessions. During this time frame, the peer models and children with ASD played with a variety of unstructured games while the direct observation data were collected.

After each session, the authors posted and reviewed aggregated peer-model data depicting their performance in previous sessions. Only the rate of responding of previously taught skills was posted (i.e., the data that showed rates of prompting for skills and delivering praise were not shown to the peer models until after those skills had been taught).

Phase 2: Generalization to a novel social skills group

The second phase of the study began 1 week after Phase 1. In this phase of the study, the peer models joined a novel social skills group consisting of six children with high-functioning ASD (who had not previously engaged in the SCORE curriculum). All the children in the novel group were male between 7 and 10 years of age. All the participants participated in a weekly 90-min group social skills program using the SCORE curriculum over an 8-week time period. Prior to the start of each of the weekly group sessions (except for the first week), the peer models met with the researchers without the novel social skills group and were shown their aggregate data collected during the previous week’s session. During this time, the novel social skills group engaged in playing board and card games with a member of the research team.

The peer models then joined the novel social skills group for the remainder of the session, which included (a) 15 min of unstructured game time with light refreshments, (b) 30 min of didactic class introducing the SCORE skill of the week, (c) 10 min of demonstration of the skill by the instructor using role-play, (d) 30 min of practice of the skills using hypothetical role-play situations with the peer models and instructors, where peer models and the instructors delivered corrective feedback to the individuals in the novel social skills group as needed. The peers and children with ASD engaged together during the game time and the didactic course, but during the role-play and practice, the peer models assisted the researchers in demonstrating, modeling, and practicing the hypothetical situations with the members group with ASD. Each of the peer models was encouraged to engage with each of the novel social skills group members. The peer models were not assigned to interact with a particular peer during the group sessions, but rather to engage with the peers as described above in a naturalistic fashion.

After the first session, the data revealed that there were low levels of peer-model responses of delivering SCORE skill prompts and praise to the peers with ASD. Thereafter, the researchers provided the peer models with additional examples of expected prompts and praise statements, and discussed situations when the prompts could be delivered. In addition, in Weeks 2 and 3, discreet (i.e., low volume) verbal prompts by the researchers were delivered to the peer models to evoke prompting for the SCORE skills and delivery of praise during interactions with their ASD peers. Researcher prompts were delivered when opportunities to use the skills arose during the unstructured play time.

In Weeks 4 to 8, a visual prompt via PowerPoint of expected prompts for SCORE skills and examples of praise were available for the peer models to see during the unstructured play time. No additional verbal prompts by the researchers were delivered. At Week 6, there were still low levels of SCORE skill prompts delivery and praise. A contingency was implemented in which the peer model earned a vending machine credit for delivering at least 10 occurrences of praise. This reinforcer was chosen because of convenience and the ability to use the US$1.00 at the vending machine, which was readily available at the end of the teaching session. The availability of the delivery of reinforcement occurred in a randomly assigned condition over a 2-min segment. A discriminative stimulus (i.e., green PowerPoint slide) was displayed when the contingency was available, and a red PowerPoint slide was displayed when the contingency was not available.

Results

PMEC Training

Data related to the initial acquisition, training, and generalization of verbal initiations are depicted in the first panel of Figure 1. The proportions of opportunities where verbal initiation was observed were low in baseline conditions, as characterized by low mean level (12.8%). The introduction of PFB resulted in immediate increases in overall verbal initiation, as demonstrated by substantial magnitude of change and increased mean level (65.8%). The percentage of all nonoverlapping data (PAND) was 96%, suggesting that behavior observed differed substantially between baseline and PFB conditions. A Pearson phi calculation comparing baseline and PFB conditions yielded .88 (95% CI = [0.4, 0.97]), suggesting a substantial effect.

Figure 1.

Aggregated procedural fidelity across intervention components.

After being presented with training on providing prompts, the peer-model participants were again given opportunities to interact with peers with ASD. They were observed exhibiting prompting behavior in the very next period of data collection; however, there was no observed prompting behavior by the peer models in the following four observation periods. The introduction of PFB following prompt delivery training resulted in immediate changes in mean level, as demonstrated by mean levels in baseline 0% and 28.6% in PFB conditions. The PAND was 100%, suggesting a complete separation between baseline and PFB conditions. A Pearson phi calculation comparing baseline and PFB conditions yielded 1.0 (95% CI = [0.76, 1.0]), suggesting a substantial effect.

The third panel depicts peer-model praise delivery for targeted social skills. In a similar fashion to the responses of the other two initial skill acquisitions, participants showed initial praising behavior in the sessions following the teaching of this skill. However, the praising behavior decreased in subsequent observation sessions, with no observation of the praise behavior in the last two observation sessions prior to introduction of PFB for that skill. The introduction of PFB was followed by immediate increases in the overall delivery of praise, as demonstrated by increased mean level in PFB conditions (12.8%) as compared with baseline conditions (0%). The PAND was 95.56%, suggesting a near-complete separation between baseline and PFB conditions. A Pearson phi calculation comparing baseline and PFB conditions yielded .87 (95% CI = [0.55, 96]), suggesting a substantial effect.

Generalization to Novel Children With ASD

In the generalization portion of the study, there was a moderately high level of initiating verbal interaction, with some variability and an increasing trend across the observation sessions; however, there was no observed prompting or praising behavior during initial sessions of the generalization phase.

Following the initial generalization observation, when verbal prompts by the researchers were introduced to suggest prompting behavior, an increase was noted in the peer-model prompting behavior. When the researcher prompts were faded, the peer models continued to engage in the prompting behavior with some variability, ranging from 0% to close to 30% of observed intervals with the behavior. Similarly, when peer models were given prompts by the researchers to engage in the praise behavior, the level of praising increased, though it decreased when researcher prompting was removed and continued at low levels. When the contingency to deliver prompts and praise was implemented, the rates of delivering prompts increased to 15% to 20% of observed intervals, but only temporarily increased delivering praise to 10% in the subsequent session.

Social Skills Improvement System Testing

The results of the SSIS social subscales prior to and following SST are shown in Table 1. The reliable change index (RCI) was calculated with each participant’s data to determine whether changes prior to and following treatment were greater than would be expected due to random variation as well as measurement error (Jacobson & Truax, 1991). All measures were at the 95% confidence level and RCI changes exceeding 1.96 were considered to be significant (Jacobson & Truax, 1991). Measures of reliable change for Participant 1 were 0.272, 4.079, and −0.543 for teacher, parent, and self-report, respectively. Calculations of reliable change for Participant 2 were −3.807, 3.535, and 0 for teacher, parent and self-report, respectively. RCIs for Participant 3 were −0.543 and 1.088 for teacher and self-report, respectively. Parent report data for Participant 3 were unavailable due to a lack of responding.

In addition to measures of social behavior, measures of problem behavior were collected as well. The results of problem behavior measures prior to and following SST are displayed in Table 2. RCIs were completed for all participants and ratings. Measures of reliable change for Participant 1 were 2.571, −0.857, and 0 for teacher, parent, and self-report, respectively. Calculations of reliable change for Participant 2 were 0.642, 0.214, and 2.357 for teacher, parent, and self-report, respectively. RCIs for Participant 3 were 0.643 and −0.214 for teacher and self-report, respectively. Parent report data for Participant 3 were unavailable due to a lack of responding.

Social Validity—Participants and Peers With ASD

Both peer models and the participating peers with ASD responded to a rating scale regarding social validity of the process and intervention. The children with ASD answered questions related to their enjoyment and perceived benefit of the program. Questions from this survey and mean scores are shown in Table 3. The peer models answered questions related to perceived skill acquisition, time spent with the peers with ASD, and overall impressions and satisfaction with the program, as can be seen in Table 4. All responses from the peer models were generally positive. Responses from the peers with ASD were much more varied, and are reflected in mean scores that are closer to the middle of each scale.

Table 3.

Social Validity Survey Questions for Peers With ASD.

Survey question	M ^a	Range
How helpful was the SCORE skills program to talk and interact with other children?	3.4	2–5
How much did you enjoy learning the SCORE skills?	2.6	1–4
How much did you like playing games and doing activities?	3.2	2–4
How important was it to learn how to get along with children?	3.6	2–5
How helpful was it to have the peer models G, S, and I—(initials of the boys)?	3.6	3–4
Overall, how satisfied were you with the program?	2.6	1–3

Note. Items were rated on a 5-point Likert-type scale, with 1 = lowest rating, 5 = highest rating. ASD = autism spectrum disorder.

n = 4.

Table 4.

Social Validity Survey Questions for Trained Peer Models.

Survey question	M ^a	Range
1. How helpful was the training program (first three sessions) to help you feel comfortable in assisting the children with learning the SCORE skills?	4.6	4–5
2. How much did you enjoy teaching the children the SCORE skills?	4.3	4–5
3. How much did you like playing games and activities with the children with ASDs?	5
4. Amount of time participating in the program?	All reported ok
5. How helpful do you think it was for the children with ASDs to have a peer model help them learn the skills?	5

Note. Items were rated on a 5-point Likert-type scale (1 = lowest rating and 5 = highest rating). ASD = autism spectrum disorder.

n = 3.

Social Validity—Parent Survey

A representative parent of each of the three peer models answered a qualitative survey regarding their impressions of the program. All three parents noted perceived benefits from their children’s participation in the program and time spent with children with ASD. Parents reported that their child showed an increased understanding and appreciation of how children are different from one another, a demonstrated improved self-esteem, and they seemed to be more outgoing and helpful as a result of participation. Parents were asked explicitly whether they had any concerns about the program. None of the parents reported any concerns and all stated that they would allow their child to participate again, given the opportunity. All the parents also stated that they would recommend the program to other parents.

Discussion

This study is one of few that explicitly measured acquisition of prosocial skills taught to peer models. Most studies examining peer-model social skill interventions have focused on the outcomes of the children with ASD. This study is unique, in that, it focuses on outcome data of the peer models. The implications of these findings are noteworthy and extend the current literature on peer modeling in several ways. First, the use of a BST methodology was demonstrated with school-aged children in a train-the-trainer format (Stewert, Carr, & LeBlanc, 2007). Such an approach is a promising method to teach social skills to children with ASD, as peer models both demonstrate and teach the appropriate social interactions within the context of the natural environment. Although the use of a BST methodology may be an effective way to teach peer modeling skills, considerations should be made to explore additional strategies to promote the frequency of peer modeling skills and the conditions under which they should occur. The results from the current investigation are representative of such a need for additional training components. Two of the skills taught with PMEC (i.e., prompt delivery and verbal praise) resulted in an increase in targeted skills, but not frequently enough to produce a significant change during the training phase or during generalization with novel peer groups. The data suggest that peer models were able to demonstrate targeted skills, but the effects of BST may be short lived without additional intervention components designed to increase the frequency of the skills taught. In contrast with the prompting and verbal praise taught to peer models, the initiation of social interaction was a behavior that required minimal intervention beyond BST.

The additional training components, specifically PFB, in conjunction with BST were found to be highly effective in increasing the use of all skills taught to the peer models. This feedback was both immediate and specific, in that, it directly followed the session and provided specific examples of instances in which the peer models appropriately prompted and praised targeted social skills. PFB and the method in which it was implemented resulted in a sustained behavior change similar to other PFB research (Brobst & Ward, 2002). However, without ongoing support, peer models were unable to generalize skills with novel peers with ASD without continued feedback. Noteworthy is the return of these skills with the resumption of PFB. The addition of tangible reinforcers was also associated with higher levels of implementation of prompting and praising behaviors, indicating a potential benefit for the inclusion of additional contingencies when encouraging peer modeling in new contexts. There is some indication, however, that prompting and PFB can affect peer-model performance if this scaffolding is maintained across contexts. Although results suggest that PFB can increase the use of complex skills in peer models, these data indicate that some complex peer modeling skills may not maintain in novel situations with novel peers with ASD without ongoing PFB and support. There are several potential explanations. First, the visual representation of the graphic feedback provided to the peer models may have been too sophisticated for the peer models to interpret. The graphs were presented in a standard line graph format identical to the graphs depicted in Figure 1. The peer models were school-aged children who may not have had the skill repertoire to interpret the graphs in a useful manner. This can easily be addressed through simpler visual progress monitoring systems that are developmentally appropriate.

Second, the graphic representation of the data may not be an adequate representation of expected rates of responding. The situational events that cue the peer models to use their targeted skills occurred at differing rates. For example, the cues that allow the peer models to initiate verbal interactions occur more frequently than the opportunities for the peer models to prompt the use of appropriate social skills or opportunities to praise appropriate use of social skills. The prompting and praising skills, although never as frequent as initiating verbal interactions, were not expected to be as frequent. All prompting and praising required social interaction; however, not all social interactions necessitated prompting or praising of targeted social skills. Also, although these skills were seen approaching 20% or slightly fewer intervals at the end of skill acquisition phase with PFB, a figure of 20% indicated that the behavior occurred during four 15-s intervals over a 5-min period. This is a rate of almost one time per minute. When this is contrasted with a possible outcome of 100%, which would be at least once every 15 s, the figure of 20%, one could argue, is preferred for such behaviors. Meanwhile, 100% of intervals are much more likely for a behavior such as initiating verbal interaction, which can happen with greater than one time every 15 s frequency during social play activities. This argument addresses the low rates of prompt and praise skills exhibited by the peer models, but it does not address opportunities that were potentially missed by the peer models to prompt or praise social skills. This can be alleviated by measurement procedures such as percent of opportunities for each skill to accurately measure the phenomenon of interest.

Furthermore, failure of the peer models to generalize the prompting and praise skills beyond BST sessions could be a result of a skill deficit (e.g., not knowing when to use the skills) rather than a performance deficit (e.g., not wanting to use the skills). The PFB component produced increases in targeted skills, but did not increase to desired rates for both the prompting and praise skills. Anecdotally, the opportunities to prompt and/or praise social skills occurred more frequently than the rate of prompt and praise skills exhibited by the peer models. It is possible that the peer models were unable to identify the situational cues that would evoke the need to prompt social skills or praise the use of social skills. This problematic issue can also be observed in the maintenance/generalization phase of the research study. When new children were introduced during the maintenance phase, it is interesting to note that prompting and praising were entirely absent during these first observation periods. This is following consecutive sessions of level output of these behaviors during the earlier phase. These behaviors required specific prompting by the researches during unstructured play times to resume. This can be addressed by conducting brief experimental analysis methodology to examine the most effective behavior change procedure to use.

Finally, the peer models selected for the study were chosen by the general education teacher. It is possible that peer models who had volunteered rather than selected may have had a greater degree of intrinsic motivation to engage with a more robust degree of performance. The sessions were conducted after school, and at least for one peer, there was conflict with his desire to participate in alternative extracurricular activities.

Limitations

Although the focus of the study was to determine the effectiveness of the PMEC curriculum in improving skills deemed necessary to be an effective peer model, further analysis exploring the improvement in social skills in the children with ASD would improve the internal validity of this study. In addition, as we were evaluating group training and resulting behavior changes, aggregated data were used rather than individual data so there were no analysis of individual variation among the peer models. The setting was created in which all peer models and children with ASD were sitting together in a small room, which resulted in logistical challenges in determining which peer model or models engaged in the behavior during each interval. Although the large group context complicated the data collection process, it created a situation that emulated a natural setting. Future studies can situate peer models in separate environments to better evaluate individual responses to intervention.

Implications

Future research should aim to (a) examine the feasibility of using discreet visual prompts throughout the study to assist the peer models in sustaining the delivery of prompts and praise statements for social skills in the children with ASD, (b) consider revising the PMEC curriculum to fit an adolescent age group and study its effectiveness while using more sophisticated social skills, (c) conduct a component analysis to examine the effects of individualized behavior change components, and (d) address measuring the peer-model skills across participants for each behaviors. Finally, further research is needed to examine methods to promote generalization/maintenance of PMEC skills to additional environments such as school and other naturalistic settings in which peers contact children with ASD.

Footnotes

Acknowledgements

The authors would like to acknowledge Betsy Becker and Tracy Pecha who diligently assisted with the data collection in this project. We are very grateful for your generosity in time. Furthermore, we would like to acknowledge Jessica Knight who was instrumental in obtaining the Autism Speaks Grant and the development of the Peer Model Education Curriculum.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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