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Challenges in social communication and interactions are common and persistent for children with autism spectrum disorder (ASD). These social difficulties are especially challenging at school where children with ASD report feeling lonely and less connected to their peers (Bauminger & Kasari, 2000; Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011). Despite the need for studies addressing peer interventions in school, most social skills studies are conducted in outpatient clinic settings. The benefits of clinical interventions rarely generalize to the school setting (Bellini, Peters, Benner, & Hopf, 2007). To effect change at school, interventions are likely needed directly within the school setting.
Two approaches to delivering peer social interventions in school settings have been reported. One involves research staff who deliver the intervention on the school's campus. Our research team has engineered two studies in which research staff conducted one-on-one or small-group interventions at school with children with ASD and their neurotypical peers (Kasari et al., 2016; Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012). Both interventions yielded change on a measure of peer social involvement, one involving peer-reported classroom social networks and the other direct observations of engagement between peers on the playground. The second approach to working in schools is to train the school personnel (teachers and paraprofessionals) to carry out an intervention during the school day to improve peer interactions between children with ASD and their classmates. Most studies that train school personnel to deliver an intervention focus on outcomes of staff fidelity of implementation and improvements in both social initiations and responses of the child with ASD (Brock & Carter, 2013; Koegel, Kim, & Koegel, 2014).
While these studies have demonstrated benefits to children with ASD whether the interventions were delivered by researchers or school personnel, there are a number of important next steps in this line of research. First, in terms of school-based peer interventions, there are very few randomized trials and virtually none that involve school personnel delivering the intervention. To effect long-term and sustainable gains for children with ASD, it will likely be necessary that rigorous group studies are carried out with school personnel delivering the intervention.
Studies find that paraprofessionals in particular have the greatest ability to effect change in peer relationships during unstructured school times (Azad, Locke, Downey, Xie, & Mandell,...