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Peer-Based Instruction and Intervention (PBII)

Intervention in which peers directly promote autistic children’s social interactions and/or other individual learning goals, or the teacher/ other adult organizes the social context (e.g. play groups, social network groups, recess) and when necessary provides support (e.g., prompts, reinforcement) to the autistic children and their peer to engage in social interactions

*PBII is a reconceptualized category that now includes adult-mediated interventions with peers in addition to peer-mediated interventions.

Evidence Based
Ages: Skip to Evidence

Steps for Implementation

Step 1. Selecting Peers

The first step in implementing peer initiation training is to select the peer or peers who will be involved in the interactions with the focal child. Selected peers should:

  • exhibit good social skills, language, and age-appropriate play skills;
  • be well-liked by other peers;
  • have a positive social interaction history with the focal child;
  • be generally compliant with adult directives;
  • be able to attend to an interesting task or activity for 10 minutes;
  • be willing to participate; and
  • attend school on a regular basis (Strain & Odom, 1986; Sasso et al., 1998).

Step 2. Training and Supporting Peers

Peer training typically takes place in a quiet area of the classroom where all of the needed materials are organized and close at hand; it involves a series of phases. The first phase (Step 2a) of the training process is to teach the pre-selected peers to recognize and appreciate individual differences. For example, practitioners talk to peers about similarities and differences (e.g., how we are the same and different in appearance, likes/dislikes, needs, abilities) and explain how we often learn from each other in the classroom (e.g., games, songs, movements). During this initial phase, peers also are given a brief overview of the similarities and differences of children with autism.

This discussion will vary in content based upon the ages of the peers. For instance, in preschool, the discussion will be very concrete and will focus on observable behaviors (e.g., “Taylor needs help learning how to play with other kids, so we are going to teach him how.”). For school-age children, more detail about the specific characteristics of children with autism can be given; however, the discussion should continue to focus on providing examples and observable behaviors.

The second phase (Step 2b) focuses on training and supporting peers by introducing specific strategies one at a time and then practicing them with the adult trainer. Peers are taught to take part in the intervention during daily training sessions and may require four or five sessions to reliably learn the initiation strategies (Strain & Odom, 1986). Peers learn specific behaviors that are used to facilitate play and social interaction during learning activities. These behaviors include:

  • organizing play (making suggestions for play activity, role, or other play for peers);
  • sharing (offering, giving, or accepting a play material to/from focal child);
  • providing assistance (helping focal child to complete a task, get on play equipment, or respond to requests for assistance); and
  • providing affection and praise through hugging, putting arms around, patting, holding hands, shaking hands (Odom et al., 1993; Strain & Odom, 1986).
  • Stay with your buddy. Peers learn that they must stay with their buddy in the same area, playing and taking turns. However, they do not need to continually play with the same toys.
  • Play with your buddy. Peers are taught to stay in the same area with their buddy and play with the same materials by joining in their buddy’s activity, offering toys, and asking their buddy if they would like to play.
  • Talk to your buddy. Peers are taught to (1) talk to their buddy about what they are playing with, (2) play pretend games, and (3) talk to each other while engaging in pretend play activities.

After the teachers describe the skills, they demonstrate the skill in a role play with one of the peers. Other peers watch and identify when the teacher uses the skill in the demonstration. The adult then has the child use the skill in a role play with one of the other peers in the group. Prompts or suggestions are provided to the peers as necessary. Adults also provide subtle reinforcements (e.g., pats on the back, thumbs up) during the practice session to encourage the peers’ use of the strategies. At the end of the practice session, adults provide more explicit reinforcement and feedback (e.g., “I liked the way you handed me the block to put on the tower you were building”) so that children are motivated to continue participation (Timler, Vogler-Elias, & McGill, 2007).

Step 3. Peer and Focal Child Interaction in a Structured Play Setting

In the initial training sessions, only peers are included. To help peers practice skills further, they then participate in structured play sessions with the focal child. In daily play sessions that last approximately five to eight minutes, the teacher introduces the play activity, provides prompts to the peer, and reinforces behavior as necessary. At the conclusion of the activity, children can then go on to another setting or remain in the activity if they wish. Once peers have become proficient, teachers implement daily activities with the focal child and peers with reduced prompting and reinforcement.

Step 4. Implementing in Classroom Settings

When planning and implementing peer-mediated interactions within classrooms, several factors should be addressed to promote the success of the activities:

  1. Classroom arrangement. Peer-initiated learning activities should be a part of the daily schedule and should take place at approximately the same time each day in a relatively quiet area of the classroom that is free from distractions. At least 15 minutes should be allowed for each play session, including the transition to and from the activity. Play activities should not take place during preferred activities such as outdoor play that could interfere with the peers’ motivation to participate. Having a consistent time and place for these activities will help children with autism transition to the activity more smoothly and will increase the likelihood that social interactions will occur because they will know what is expected of them. As children become more proficient and as interactions become more naturalistic, peer-initiation strategies can take place in all classroom routines and activities, both planned and spontaneous.
  2. Material selection. One way to increase peer interactions and social engagement is to limit the play materials to items that (1) contain a specific theme for each play session (e.g., blocks, prop box), (2) include an element of sociodramatic play, (3) may require assistance in operating, and (4) are not normally available in the classroom. Specific activities and materials that promote social interaction between peers and children with autism include the following:
  3. Identification of responsible staff. During the play sessions, one staff member in the classroom should be consistently responsible for running and supervising play. This adult will (1) train peers, (2) implement the learning activities, and (3) observe child progress.
  4. Use of prompts and reinforcement. The use of prompts and reinforcement is essential to the success of peer initiation training. When prompting social exchanges, practitioners could use the following as prompts:
  • Sand table
  • Birthday party prop box
  • Dollhouse and toy people
  • Road-building materials with cars and trucks
  • Car garage
  • Doctor
  • Farm animals and blocks
  • Grocery store
  • Play-Doh
  • Puppet show
  • Puzzles
  • Zoo animals (Odom et al., 1993)

These types of activities encourage sharing, exchanging of materials, and other social behaviors that children with ASD often need to develop.

  • Observe children to identify non-interaction. When there has been no interaction between the focal child and peers for 30 seconds, a prompt should be provided.
  • Provide a prompt to the peer or the focal child to begin an interaction or respond to an initiation.

Prompting often involves cueing the peers to use the strategies through the use of explicit instructions (e.g., suggest a game to play; “Try talking about Taylor’s animals”), more subtle verbal instructions (e.g., “It’s your turn to talk,” “Try again”), picture cues (e.g., a drawing of two children talking), or gestures such as signaling the peer to move closer to the focal child (Goldstein, Schneider, & Thiemann, 2007). If the child does not respond to the prompt within 10 seconds, repeat the prompt again and provide physical guidance (Ostrosky et al., 1990).

As peers become more proficient at engaging children with autism in play, practitioners can withdraw their use of prompts and reinforcement. If the peers and focal children are engaging in relatively few social interactions, practitioners should temporarily increase the use of prompting and reinforcement to ensure that social interactions are occurring with a high level of frequency. Gradual withdrawal of prompts and reinforcement will allow practitioners to periodically assess the progress of individual children.

Step 5. Extending Initiations Across the Day

The final phase of the implementation process is to extend initiations across the day so that the focal children can begin to generalize skills. This can be accomplished through the use of two strategies: (1) embedded intervention and (2) class-wide peer buddy system.

With an embedded intervention approach, instruction is provided within child-initiated, naturalistic, and contextualized interactions. For example, a teacher might seat a trained peer next to the focal child during a small group art activity with a limited number of materials to promote social interactions. The peer could be prompted to ask the child with autism to pass the paint or assist the child in gluing. Practitioners should plan to include peer initiation strategies within at least three classroom routines and activities per day. The use of an activity matrix may help practitioners organize the activities and provides a structure for making sure that the learning opportunities occur.

A class-wide peer buddy system also can be used to increase the number of peers who interact with the focal child. With this approach, children in the class have different play partners each day. A chart can be created that displays pairs of children’s names printed on individual cards. Each day, the cards are systematically rotated so that each child has the opportunity to buddy with a different peer. At “buddy time,” children check the chart and find their name as well as the name of their buddy. During free play, children play with their buddies. Teachers prompt interactions as needed during this time. Prior to “buddy time,” peers are taught the following skills:

To increase motivation to participate, peers are told that if they stay with their buddy, play together, and talk to one another, they will be able to put their name in a box. Every day, a pair of names is pulled out of the box. The selected pair receives a special treat (e.g., candy, sticker, treasure, prize). This reinforcement strategy is withdrawn as children become more proficient at staying with their buddies (English, Goldstein, & Shafer, 1997; Laushey & Heflin, 2000).

Research and Outcomes

Research Summary

Age Range: 3-18

Skills: Communication, social, joint attention, play, cognitive, school readiness, academic/pre-academic, challenging/interfering behavior, mental health

Settings: Home, school, community

Evidence Rating: Evidence Based

The information found in the Research Summary table is updated following a literature review of new research and these ages, skills, and settings reflects information from this review.

Outcomes Matrix

The Outcomes Matrix shows outcome areas by age for which this evidence based practice is effective
Age: 0-5 6-14 15-22
Academic/Pre-academic Yes Yes
Challenging/Interfering Behavior Yes
Cognitive Yes
Communication Yes Yes Yes
Joint Attention Yes Yes
Mental Health Yes
Play Yes Yes
School Readiness Yes Yes
Social Yes Yes Yes
More about Intervention Outcomes

In Peer-Based Instruction and Intervention (PBII) peer social interaction is the defining feature of the intervention. Most often but not always, the peer of the learner is a neurotypical child of the same general age. There are two types of PBIIs, which are characterized by the role of the peer and the teacher. In peer-mediated instruction and interventions (PMIIs), the peer receives training and perhaps coaching from an adult (e.g., teacher, clinician) to deliver social initiations or instructions in a way that supports the learning goal of the learner with autism. In a variation of this approach, a sibling of the learner may serve in the peer role (e.g., sibling-mediated intervention), but the procedures are the same. In adult-mediated instruction and interventions (AMII) the teacher or other adults arranges the social environment (e.g. brings children in proximity) and provides coaching, prompts, and/or reinforcement for both the learner and the peer to engage in social interaction (Steinbrenner, et al., 2020).

In the most recent literature review conducted in 2020 by the National Clearinghouse for Autism Evidence and Practice (NCAEP), efforts were made to combine and/or expand EBP categories that shared similar features. Structured Play Groups (SPG), which was listed as its own evidence-based practice in previous literature reviews, moved into Peer-Based Instruction and Intervention.