Perspectives of the ASHA Special Interest Groups

SIG 1, Vol. 1(Part 1), 2016, Copyright © 2016 American Speech-Language-Hearing Association

Effective Peer-Mediated Strategies for Improving the Conversational Skills

of Adolescents With Autism
Linda M. Bambara
College of Education, Lehigh
University Bethlehem, PA

Jacquelyn Chovanes
College of Education, Lehigh
University Bethlehem, PA

Amanda Thomas
College of Education, Lehigh
University Bethlehem, PA

Christine L. Cole
College of Education, Lehigh
University Bethlehem, PA
Financial Disclosure: Linda M. Bambara is a professor of Special Education at Lehigh University.
Jacquelyn Chovanes is a doctoral student in Special Education at Lehigh University. Amanda
Thomas is a doctoral student in Special Education at Lehigh University. Christine L. Cole is a
professor of School Psychology at Lehigh University.
Nonfinancial Disclosure: The authors have no nonfinancial interests related to the content of
this article.

Abstract
Deficits in social-communication skills can leave high school students with autism
spectrum disorders (ASD) socially marginalized where conversation is the primary
medium for social interaction. Interventions are needed to improve conversational skills and
facilitate interactions with peers while students with ASD are still in school, yet few
research-based strategies exist for high school settings. In this article, we describe three
peer-mediated conversational strategies documented to be effective through our research:
strategies to (a) support overall conversational engagement, (b) increase initiations to start
conversations, and (c) increase follow-up questions to sustain conversations. The peer-
mediated strategies are combined with teaching students with ASD to use visual supports to
strengthen intervention effectiveness. We highlight methods for peer training, outcomes of
our research, and implications for speech-language pathologists (SLPs).
Autism spectrum disorder (ASD) is characterized by impairments in social functioning,
language, and communication (American Psychiatric Association [APA], 2013). Consequently,
many children with ASD have difficulties with reciprocal social communication, which includes
initiating, responding appropriately, and maintaining conversational topics (Paul, 2008). Social
communication deficits can be detrimental to quality of life, negatively affecting all areas of
social- emotional development, as well as academic learning and functional independence (Bellini,
Peters, Benner, & Hopf, 2007). Without systematic intervention, social communication deficits
become exacerbated as the individual with ASD enters high school, where conversation is the
primary medium for social interaction and peer relationships (Carter et al., 2014). Social
communication difficulties and idiosyncratic interaction patterns can lead to social isolation even
when individuals with ASD are physically included in integrated high school activities. At a time
when social

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conversation skills are needed the most, intervention should be a priority, not only to
improve social and academic outcomes while in high school, but also to prepare adolescents
with ASD for the social demands of adult life.
Unfortunately, few studies are available to practitioners documenting effective, practical
strategies that can be implemented in high school settings. Most social communication intervention
studies target young children, perhaps due the inherent logistical challenges posed by the high
school setting. In this paper, we share effective peer-mediated intervention (PMI) strategies designed
to improve the conversational skills of high school students with ASD based upon our pilot
research. Our target population included students with ASD of average intelligence to moderate
intellectual disabilities, who possess expressive language abilities (i.e., can comment and ask
questions), but who would be considered passive or reluctant conversationalists (Fey, 1986). That
is during social opportunities, these individuals exhibited low rates of initiation (i.e., rarely started
a conversation or introduced a new topic), were reluctant to respond or avoided social interaction
(e.g., frequently gave one word responses to partner questions, turned or looked away), and
exhibited poor topic maintenance skills (i.e., rarely asked follow-up questions or offered related,
non-obligatory comments).
First, we will illustrate three specific peer-mediated conversational strategies documented
to be effective through our research. Then, we highlight procedures for training peers to be
effective conversational partners, describe the supports that facilitated peer implementation of
the strategies taught, and focus student progress. Finally, we describe our research outcomes and
make recommendations for practice.

Why Peer Mediation?

Peer-mediated intervention (PMI) for social communication involves teaching typical
peers strategies to support conversational engagement and to prompt specific conversational
acts (Strain & Odom, 1986). More broadly, PMI has been used to impact a range of social and
instructional outcomes, and it is considered an evidence-based practice primarily for young children
with ASD by both the National Autism Center (2015) and the National Professional Development
Center on Autism Spectrum Disorder Center (Wong et al., 2014). When PMI has been applied to
improve reciprocal communication skills, research has shown improved outcomes when specific
conversational acts are targeted, direct instruction is provided to peers and focus students, and
visual supports are provided to the focus students to aid their use of targeted skills (e.g., Kamps
et al., 2014; Thiemann & Goldstein, 2004).
Few PMI studies of any kind have been conducted in high school settings, yet PMI for
improving conversational skills is potentially an excellent fit. First, peers are the natural
“experts” for adolescent conversations. They serve as models for age-appropriate language and
social skills (Chan et al., 2009), and are more likely than adults to share common interests with
schoolmates with ASD. Second, by encouraging reciprocal conversations between students with ASD
and typical peers, the development of genuine social relationships is fostered. And third, once
peers are trained, they can provide opportunities for practice throughout the school environment
and across the school day, thus encouraging generalization of newly learned skills.

Setting It Up
Due to general education peers’ discrepant and often changing schedules, a major logistical
challenge in high school is to find natural opportunities during the day for intervention and peer
training. Some possibilities include: extra-curricular activities held before and after school, talking
study halls, inclusive classes, and after school clubs. We found lunchtime to be most feasible, as
peers and focus students could sit together for a social conversational lunch an average of three days
per week, with structured peer trainings scheduled on days peers did not have lunch with the focus
student. To increase opportunities for consistently available peers, to promote fresh conversations,

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and to facilitate generalization, we found it best to create peer networks, which included four
trained peers per focus student with ASD. Different pairs of peers in each peer network rotated
having lunch with the focus student across school days.
When selecting peers, look for service-oriented students, with good language skills,
who are interested and motivated to participate in training and have lunch conversations with
fellow students with ASD. Ideally, peers should share mutual interests with the focus
student. Peer recruitment can be facilitated by using teacher nominations, focus student
preferences and recommendations, and by approaching members of service oriented clubs or
activities.
Our model of PMI at the high school level is unlike many PMIs with younger students in
that no adult intervention or direct instruction occurred during the intervention sessions. Instead,
the peers were responsible for using the conversational strategies taught at a different time
with the focus student during lunch without adult facilitation. In order for peers to serve as
interventionists, peer training and focus student training are essential steps in the implementation
of the intervention. Peer training took place outside of the cafeteria in an available classroom and
consisted of two components: (a) peer network training sessions where peers were introduced to and
practiced the conversational strategies, and (b) brief feedback and coaching sessions in the cafeteria
just prior to the students sitting down for lunch with the focus student. Focus student training
consisted of individualized direct instruction and practice in the conversational strategies, which
occurred separate from (usually during scheduled class time), but concurrent with peer training.

Moving From Passive or Reluctant to Assertive and

Engaged Communicators
Our PMI focused on three goals: (a) improving conversational engagement and sustained
verbal turn-taking, (b) increasing initiations, and (c) increasing follow-up questions to maintain
topics of conversation. We addressed the goals sequentially by first training peers and focus
students in strategies designed to improve conversational engagement and increase initiations. Once
consistent progress in these skills was observed during the focus students’ lunch conversations,
we then trained peers and focus students in strategies to support asking related follow-up questions.
Improving Conversational Engagement
Our first goal of improving conversational engagement and sustained turn-taking
involved teaching peers responsive partnering strategies to support and facilitate reciprocal
exchanges between them and the focus student. During baseline, when we told peers to do
what they naturally would do to make friends during lunch, we observed that peers do not
know how to interpret or respond to the poor conversational skills of students with ASD.
Conversational engagement actually worsened over time under baseline conditions. When focus
students rarely initiated, gave short or no responses to peer questions, or did not ask questions
about what the peers had said, peers believed that the focus student was not interested in
talking, and worse, felt that the focus student did not like them.
Our first set of strategies involved teaching peers how to engage the focus student in
conversation, and facilitate sustained conversation over longer turns. This strategy served as
the foundation for the goals of increasing initiations and follow-up questions. After providing
some ASD awareness and sensitivity training to help peers understand some of the characteristics
of ASD, we then taught peers four basic strategies, or “conversation helpers,” to support
conversation as shown in Table 1. The conversation helpers are based upon Thiemann and
Goldstein’s (2001, 2004) peer facilitation strategies for getting students with ASD to talk, which
we adapted for high school conversation.

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Table 1. Conversation Helpers

Strategy Rationale Description Example

Show Interest Encourage and • Look at your friend, smile, and Look and face student.
motivate your show enthusiasm. P: “I went to the
friend to talk with • Talk about shared interests. movies last night.”
you. • Acknowledge what your friend P: What did you do
says with positive comments. over the weekend?
FS: Played video
games. P: That’s cool.
What did you play?
Keep the Encourage your • Share information yourself to “I like to play
Conversation friend to talk avoid interviewing. video games too.”
Going: longer about a • Ask open-ended questions. “Tell me more about …”
topic. • Keep taking turns. “What else do you
play?” “Who is your
favorite character?”

Help Your When conversation • Gain your friend’s attention if Call your friend’s name.
Friend breaks down, distracted. Repeat question if
Respond: help. • Ask again if your friend necessary.
doesn’t respond. P: What’s your favorite
• Rephrase or break down the food?
question for easier understanding.
• Ask your friend to clarify or explain, FS: Favorite food?
if you don’t understand. P: Yes, what do you
like to eat?
FS: I think it is
interesting to talk about
where foods come from.
P: What kind of food?
FS: Well like a loaf of
bread.
P: What do you find
interesting about that?
Move On/ Help your • Stop and redirect-if your friend FS: Who was the evil
Redirect: partner stay on repeats a topic/question, changes bug from A Bug’s Life?
topic. topics before answering your question, P: We talked about
or is inappropriate. this before. Let’s talk
about something else.

Note. FS= Focus student with ASD; P= peer

Once trained, peers were instructed to use the conversation helper strategies during
lunch to sustain each conversational episode for as long as there was shared interest about a
topic. Consistent with previous research (Thiemann & Goldstein, 2004), our pilot data revealed
that these strategies alone can increase overall engagement and result in longer conversations
or turns per episode, and thus is an important foundational strategy. However, it had no effect
on focus student initiations and follow-up questions; essentially, because the peers did all the
work of carrying the conversation. We learned that increasing specific conversational acts
would require specific and direct instruction.
Increasing Initiations
In order to increase initiations, we provided the focus student with direct instruction
and written text cues as a visual support for generating conversation starters (see Figure 1).
Prior to each lunch session, the trainer asked the focus student to, “Think of something that
you would
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like to talk to your friends about” and wrote the topic starter verbatim on the card as either a
question or statement. This process was repeated until five topics had been written. Focus
students were individually taught how to use the written text and visual support card during a
single session with the trainer. During the training session, the trainer played the role of “peer,”
and provided the focus student several opportunities to practice initiating conversations using
the items on the card. All participants caught on quickly. Once they learned to initiate or
respond to prompts to initiate during the training session, focus students were encouraged to
use their cards during lunch conversations with their peers.

Figure 1. Written Text and Visual Support Card for Initiations.

Peers were also trained. To create opportunities for focus students to initiate, peers
were taught to pause, wait, and look expectantly at the focus student for 10 seconds between
conversational episodes. If the focus student failed to initiate within that time, the peers were
taught to use simple prompting strategies such as pointing to the written text and visual
support card and saying, “Your turn to start” or asking, “What do you want to talk about?”
Peers were encouraged to continue using the prompting strategy even when the focus student
had used all items on the visual support card to encourage spontaneous initiations. Once the
focus student initiated, the peers used their engagement strategies to keep the conversation
going for as long as the focus student seemed interested, and then peers repeated the “pause,
wait, and look expectantly” strategy to encourage a new initiation.
Across two single case experimental studies, we observed that focus students used the
written text cues on the visual support cards differently. Some followed a tight sequence,
reading items from the card in order, while others used the cards flexibly, sometimes reading
items and other times generating spontaneous conversation starters not written down.
However, regardless of how the card was used, all participants generated unscripted and novel
initiations during lunch conversations, suggesting that the visual support aided, rather than
hindered spontaneity.
Increasing Follow-up Questions
To increase focus student follow-up questions, we taught peers to create opportunities
and prompt the focus student to ask a question related to the ongoing topic of conversation. We
also provided the focus student with direct instruction in question asking, and a written text
and visual support card to remind them to ask follow-up questions. We tested several versions
of visual support cards for follow-up questions, deciding to use a simple card with the written
phrase, “Listen to what your friend is saying, then, ask about it” (see Figure 2). The question
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words “Who,” “What,” “Where,” “When,” “Why,” and “How” were also listed to encourage
variety in question types. Each focus student was trained individually using role-play with the
trainer acting as “peer” to ask follow-up questions about conversational topics. Trainers used the
strategy of making a leading statement, such as, “I saw a good movie last night.” If the focus
student did not ask a follow-up question related to the topic, the trainer prompted, “Ask me about
it.” All focus students successfully learned to generate appropriate follow-up questions (e.g., “What
movie did you see last night?”) in one or two training sessions.

Figure 2. Written Text and Visual Support Card for Follow-Up Questions.

Peers were trained to create opportunities for follow-up questions during lunch by
making leading statements and by prompting, “Ask me about it” if the focus student failed to ask a
question related to the conversational topic. Peers were taught that a leading statement is a simple
comment, that does not provide too much information, and which serves to “bait” the focus
student into asking a follow-up question. Examples of successful leading statements are: “I did
something fun last night,” or “I like to go on vacations, too.”

A Closer Look at Peer Training

We recommend training each of the three components to peers sequentially, giving them
time to practice, receive feedback, and observe the impact on the focus student’s conversation
skills before introducing a new component. However, in our third study currently in progress,
we were able to successfully combine the first two components, conversational engagement and
initiations, with positive results. Each component was introduced and practiced by peers
during group network meetings before peers used the strategies during lunch sessions. Two peer
network meetings, lasting approximately 20 minutes each, were scheduled for training each
component.
Training sessions always included (a) a rationale for using the strategy, (b) scripted examples and
non-examples, and (c) opportunities for role-play and feedback.
During the training phase of the study, trainers met briefly with the peers for about five
minutes just before lunch to review the strategies and provide feedback based on observed
lunch sessions. When the peers had learned and implemented all the strategies, and once we
observed an impact on focus student conversational behavior, we withdrew daily feedback to
peers but continued to meet with peer groups once per week for ongoing feedback and support
in the post-training phase. During these peer network meetings, the focus shifted from
learning and

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practicing new strategies to refining and applying the strategies to continually improve the
focus student’s conversational skills. The trainers reviewed focus student progress, provided
feedback on peers’ use of the strategies, and solicited input from the peers on how to improve
lunch conversations. A central goal during post-training was to continue using the strategies,
while making conversation as natural as possible.
Throughout the intervention (training and post-training phases), the trainers continued
to meet with the focus students to generate topics for starting conversation. Written text and
visual supports were maintained throughout the training and post-training intervention
sessions. In our study currently in progress, scripted initiations were completely faded.

Outcomes
Focusing on one of our studies that implemented all three peer-mediated strategies
(Bambara, Cole, Kunsch, Tsai, & Ayad, in press), we evaluated the effects of our PMI model on
the conversational outcomes of three high school students with ASD using a multiple baseline
across participants design. We took 10-minute video recorded samples of the focus students’
lunch conversations with their peers across baseline, training (involving all three strategies),
and post- training conditions. Five group training sessions were used to train peers in all three
components. Daily feedback to peers, implemented just prior to lunch ranged from 14–18
sessions, with an average of 15 sessions across the three students. First, results indicated
substantial increases
in overall conversational engagement. The frequency of conversational acts across focus students
increased from an average of 22 per session during baseline to 64 acts during post-training. The
average length of each conversation (a measure of sustained engagement) increased as well, from
a mere 3.5 acts per conversation during baseline to 7.4 during post-training sessions. Second,
substantial improvements were noted for the two targeted conversational skills. During baseline,
students averaged only .96 initiations and .5 follow-up questions per session; however during
post-training unprompted initiations averaged 5.2 per session and unprompted follow-up
questions averaged 8.56 per session. Third, and perhaps most encouraging, focus student
commenting used to maintain conversation, which was not targeted for intervention, rose
substantially for each student. When combining commenting with initiations and follow-up
questions, the focus students’ average non-obligatory acts per session increased from 2.9 during
baseline to 36.6 during post-training. These are impressive gains for passive communicators
whose conversational acts during baseline mostly consisted of obligatory responses. Finally, in
terms of social validation, high school teachers who were “naïve” to the study rated before and
after video clips, and judged the post-training conversations as “natural” and “typical” of high
school interactions. Our current study in progress is replicating these positive outcomes, with
evidence of generalization across novel peers.

Summary and Recommendations

Our research documents that high school peers without disabilities can learn a
relatively complex intervention in a few training sessions, producing dramatic effects for passive
communicators with ASD. Speech-language pathologists (SLPs) can play a vital role in
implementing PMI in high school settings by targeting critical conversational skills,
individualizing interventions, and providing direct instruction and practice opportunities to
students with ASD in therapy sessions. Collaborating with special educators, SLPs can also
assist with peer training either directly or indirectly through consultation. The SLPs can train
teachers to implement the PMI conversational strategies during inclusive classroom instruction
and social support programs. For example, many high schools implement peer buddy programs
for social interaction. Why not infuse effective strategies such as written text and visual supports
for improving conversation in these social programs? Efforts to enhance the conversational
skills of high school students with ASD are needed while they are still in school, not only to
address their conversational difficulties but also to

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foster positive peer relationships and the experiences needed for a satisfying adult life. We hope
that these relatively simple, but effective strategies provide a good place to start.

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History:
Received August 30, 2015
Revised October 12, 2015
Accepted November 19,
2015
doi:10.1044/persp1.SIG1.29

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