PEER-MEDIATED PIVOTAL RESPONSE TREATMENT FOR SCHOOL-AGED CHILDREN WITH AUTISM SPECTRUM DISORDERS
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Despite dramatic progress in behavioral treatment of preschoolers with autism spectrum disorder (ASD), the gap in effective intervention models for children once they transition to school is striking. This dissertation examined an adaptation of the most common Pivotal Response Treatment (PRT) model (parent delivery) in which typically developing (TD) peers are taught to coach classmates with ASD. Specifically, peer coaches were taught to facilitate the social skills of children with ASD in natural settings (at school). This research had three aims, to: (1) systematically review evidence of the efficacy of peer-mediated PRT (PM-PRT) to increase social-communication skills for school-aged children with ASD (Study 1), (2) evaluate the acceptability and feasibility of PM-PRT for school use for young children with ASD, using content analysis of stakeholder interviews (Study 2), and (3) evaluate the efficacy of PM-PRT for children with ASD in their first year of school, targeting social engagement and initiations, using a case series of four single-subject design studies (Study 3). Study 1 results revealed that whereas most PM-PRT studies observed positive outcomes, the existing research base did not meet criteria for classification as promising or established EBP. In Study 2, stakeholders (educators and early intervention providers) had some knowledge of PRT, found the peer-mediated approach to be acceptable and feasible, but expressed several potential challenges with respect to TD peers as intervention agents. In Study 3, TD peers implemented PRT techniques with fidelity. Relatively brief training in PRT for peer coaches produced immediate and short-term (6 to 9 weeks following training) sustained increases in social-communication skills of children with ASD when playing with trained coaches, as well as with untrained TD classmates. Taken together, the three studies contribute to the evidence base of a promising school-based social skills intervention for children with ASD. This work advances the PM-PRT evidence base to the ‘promising EBP’ designation, promoting its use with the aim of stimulating additional research. This dissertation also highlights the relevance of research-education partnerships in the successful implementation of EBPs in school settings.