Psychology in the Schools, Vol. 44(7), 2007 © 2007 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.20261

SOCIAL PLAY SKILL ENHANCEMENT OF CHILDREN WITH

AUTISM USING PEERS AND SIBLINGS AS THERAPISTS
JENNIFER D. BASS AND JAMES A. MULICK
Helping Hands Center for Special Needs and Columbus Children’s Hospital

Peer-mediated approaches represent the largest and most empirically supported type of social
intervention for children with autism. In this article, we discuss peer-initiation strategies, the
peer-mediated intervention that has been most used to teach typically developing peers or sib-
lings to improve the social play skills of children with autism. Also discussed are additional
intervention strategies that have preliminary research support including: integrated play groups,
peer buddy systems, and group oriented contingencies. Practical information regarding how to
apply peer-initiation strategies and peer buddy systems in the school setting is also
provided. © 2007 Wiley Periodicals, Inc.

Children with autism are increasingly being integrated into classrooms with typically devel-
oping peers. Although one of the aims of integration is to provide children with autism opportu-
nities to interact with typically developing peers, it is possible that they are actually subject to
further social isolation in these settings unless specific supports are also provided. Typically devel-
oping children tend to play with each other rather than play with children with autism. Children
with autism tend to remain isolated due to their inability to understand social cues (Strain, 1984).
Without appropriate interventions, children with autism fail to exhibit appropriate eye contact,
demonstrate less spontaneous communication, and engage in frequent eccentric behaviors when
interacting with others. Peers misinterpret the incompetent social behaviors of children with autism,
often resulting in their social exclusion.
Young children with autism have difficulties with joint attention, imitation, and responding to
social stimuli, resulting in an atypical and delayed progression of social play skills. Normally, the
development of play in children progresses through several developmental stages including sen-
sory motor play, manipulative play, physical play, social play, and pretend play (Boucher, 1999).
Children with autism show abnormalities in the first phase of play development, simple manipu-
lation, in that they display little variability in object manipulation and they play with a limited
number of objects in a restricted manner. These differences in manipulative play may have detri-
mental consequences on subsequent phases of play development such as social play (Van Berckelaer-
Onnes, 2003).
Social play consists of play behaviors that involve social interaction with at least one other
individual and typically involves three phases: (1) Orientation: being aware of another child as
indicated by looking at them, at their play materials, or what they are doing but not entering into
play; (2) Parallel/proximity play: playing independently beside or near another child rather than
interacting with them, but simultaneously using the same play space or materials, or engaging in
a similar activity; (3) Common focus: engaging in activities directly involving one or more peers,
including informal turn-taking, active sharing of materials, giving and requesting items to and
from someone else, showing something to someone else, commenting on what someone else is
doing, appropriately rebuffing someone else’s request, and asking someone to play (Power, 2000;
Yang, Wolfberg, Wu, & Hwu, 2003). Social play is a merger of two areas of development: socio-
emotional and cognitive (Jordan, 2003), both of which are often significantly deficient in children
with autism.

Correspondence to: Jennifer D. Bass, Helping Hands Center for Special Needs, P.O. Box 1223, Worthington, OH
43085. E-mail: jenniferdbass@gmail.com

727
728 Bass and Mulick

The social play of children with autism is generally ineffective. Compared to typically devel-
oping children, children with autism demonstrate much less peer-related social behavior, neither
serving as the recipient nor initiator of many social bids (McGee, Feldman, & Morrier, 1997). In
play settings, they demonstrate less joint attention and remain further away from other children.
Children with autism also exhibit higher rates of inappropriate and inflexible toy use, restricted
interests, and self-stimulatory behavior (Sigman & Ruskin, 1999).
Social play is critical for the development of cognitive, social, and cultural competence. It
teaches children about social relationships and the consequences of social choices they make.
Active peer engagement and social competence are “cornerstone” skills that lead to the acquisition
of skills in many other domains (Strain & Danko, 1995). Social play deficits may lead to impair-
ments in reciprocal social interaction, communication, and imagination. Social deficits in the early
years of a child’s life tend to become more pronounced later without successful intervention
(Strain, 1981).
Due to the aforementioned deficits, researchers recognized the importance of designing inter-
ventions to motivate typically developing children to interact with their classmates with autism. It
was an obvious strategy to utilize typically developing peers to improve the social play skills of
children with autism in addition to their own ability to interact more effectively with such chil-
dren. In this article, we discuss some of the interventions that have been designed, empirically
studied, and published that focus on improving peer or sibling skills to facilitate the social play
activities of children with autism.

Brief Research Review

Interest in using peers as intervention agents originated from the limitations associated with
adult-mediated and highly structured interventions, especially the resulting dependency on adult
prompting and poor skill generalization (Strain, Kohler, & Goldstein, 1996). Children with autism
often fail to generalize skills across settings, individuals, and stimuli. Using peers to teach social
play skills improves the possibility of generalizing skills by teaching skills in more natural “loose”
training environments where children typically function (Stokes & Baer, 1977) and does not
require the additional phase of transferring learning to interacting with peers (Rogers, 2000). In
addition, generalization is promoted by the availability of peers that creates more frequent and
natural opportunities for children to learn from multiple and varied play activities. This review
will be broken into two sections: (a) intervention approaches that enjoy significant empirical
support and (b) interventions with encouraging preliminary findings.

Approaches With Significant Empirical Support

Peer-mediated approaches. Peer-mediated approaches represent the largest and most empir-
ically supported type of social intervention for children with autism. Peer-mediated interventions
assume that training typically developing peers to initiate, prompt, and reinforce social inter-
actions will result in greater improvements in the social play behaviors of children with autism
than simply having such children in close physical proximity to typically developing peers.

Strain and colleagues. The work of Strain, Odom, Goldstein, and their associates, focusing
on peer initiation strategies, has been a major influence on progress in peer-mediated techniques.
Following the model developed by Strain and his colleagues, a standard training protocol is used
to teach typically developing peers (“confederates”) to deliver specific social offers to their class-
mates with autism, assuring uniformity and quality instruction (Strain & Odom, 1986). Peers
role-play with adults until they have learned the strategies successfully and are then prompted to

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 Social Play Skill Enhancement 729

interact with the target children around designated play materials and activities. External reinforce-
ments are systematically and carefully faded as the peer confederates acquire the necessary skills.
A withdrawal of treatment design using multiple baselines is commonly utilized. Confederate
peers are instructed to “do as they would usually do” during baseline phases and instructed to
teach their “friends” to play during intervention phases. Confederate peers learn several specific
skills to engage the target children with autism in positive interactions including “play organiz-
ers,” sharing, assistance, giving affection, and compliments. Direct observational data are used to
demonstrate acquisition of the skills and determine how typically developing peer confederates
implement the intervention strategies, as well as determine the responses from the target children
with autism (Strain, 1987).
Observations of preschool children’s social interactions suggested that social exchanges were
initiated and sustained by particular social overtures exchanged on a reciprocal basis. As such, the
initial peer-initiation interventions aimed to increase these particular social overtures to determine
their effects on the social behavior of withdrawn children. The first study of peer social initiations
(Strain, Shores, & Timm, 1977) involved conducting training sessions to teach typically develop-
ing preschool-aged boys a number of verbal (i.e., “Let’s play ball.”) and motoric (i.e., rolling ball
to child) social initiations to engage six children with autism in social play. Instructing peers to
increase their social initiations resulted in increases in all target children’s responses to initiations
and increases in positive initiations in all but one child. However, generalization of results was
questionable due to data collection being limited to 20-min training sessions in a restricted setting.
All but one participant exhibited generalized and maintained increases in positive social behavior
when confederate peers increased their amounts of social initiations in a systematic replication
study (Strain, 1977). Participant responsiveness to intervention was variable. The children’s initial
baseline performances were directly related to their immediate and generalized outcomes of treat-
ment. Those children who displayed lower baseline levels of positive social behavior were some-
what less responsive to treatment compared to those children who exhibited higher amounts of
positive social behavior during baseline (Strain, 1977; Strain et al., 1977).
Ragland, Kerr, and Strain (1978) modified the original peer social initiation training approach
to account for the possible maladaptive behaviors demonstrated by children with autism. During
training, the adults practicing with peers exhibited self-stimulatory and avoidance behaviors char-
acteristic of children with autism. Each target child with autism demonstrated immediate increases
in positive social behavior following intervention, leading to the hypothesis that children with
autism may not have an actual aversion to peer contact but rather a preference for engaging in
stereotyped behavior that may compete with social behavior. Researchers also speculated that the
isolated behavior of children with autism may be developed and maintained by the socially unrespon-
sive environments in which they are often placed. Due to the controversy regarding utilizing peer
social initiation tactics with low-functioning children with autism at that time, Strain, Kerr, and
Ragland (1979) undertook a systematic replication with four low-functioning elementary-aged
kids with autism. Half of the peer training was identical to that of Ragland et al., with the remain-
ing training teaching a prompting and reinforcement strategy to peers. Both training procedures
resulted in immediate and substantial increases in the levels of positive social behaviors demon-
strated by each child, as well as brief, slight increases in negative interactions that returned to
baseline levels. Neither training procedures resulted in generalization of changes in behavior.
Highly trained staff conducted initial peer-mediated procedures in highly structured clinical set-
tings. As such, Storey, Smith, and Strain (1993) taught classroom assistants to implement the
procedures during regular classroom play activities. Modifications were made to intervention
strategies of Odom and Strain (1986). These modifications included showing students five posters
of pictures depicting each skill, with the researcher cueing the classroom assistant to point to the

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730 Bass and Mulick

appropriate poster and prompting students to use a specific strategy during the play period. An
enhanced prompting and reinforcement technique was also added in which assistants rang a bell,
provided verbal praise, and put a happy face on the child’s chart each time the child used an
appropriate strategy. Happy faces were then traded for a tangible reinforcer at the end of each
training session. Results demonstrated that classroom assistants were able to implement effective
peer-mediated interventions, and higher rates of social interactions were found when enhanced
prompting and reinforcement was provided (Storey et al.).
Despite the success of peer-initiation approaches, several criticisms can be made: Implemen-
tation of such approaches is complex, they require socially skilled typical peers, and they neces-
sitate adults to train peers, control rates of reinforcement, and record data. These requirements
may be difficult to obtain in some school and clinic settings. In addition, these approaches have
been criticized due to their reliance on teacher prompting that may lead to prompt dependency,
inconsistent results of generalization, and an inability to increase more advanced social behavior
(Pierce & Schreibman, 1997). To date, peer-mediated approaches appear to influence social responses
more than social initiations of children with autism (Rogers, 2000), both of which are required for
reciprocity in social play interactions. Although peer-mediated interventions have been used with
children of various levels of functioning, preschool-aged children have been the most commonly
involved age group, with the exception of a few studies that have focused on school-age children
(Strain, 1983; Strain et al., 1979). To date, no studies have been conducted using children younger
than preschool age. In addition, no replication studies have been conducted recently to demon-
strate the continued efficacy of such an intervention within today’s schools.
Although peer-mediated approaches enjoy the greatest level of empirical support in improv-
ing social play interactions of children with autism, it is clear additional scholarly work is neces-
sary before an approach that yields the most effective, generalized, and maintained results is
identified. It remains clear, however, that educators interested in facilitating social play inter-
actions of children with autism will want to utilize the research-supported strategies already iden-
tified in the work of Strain and colleagues.

Research With Preliminary Support

Researchers continue to explore additional options for improving the social play skills of
children with autism. The intervention approaches described below represent a sample of inter-
ventions that have been submitted to very limited empirical investigation. Although the initial
findings are promising, a great deal more research will need to be conducted before they are
widely endorsed in school and clinical settings.
Integrated play group (IPG). Other interventions have been designed to teach typically
developing peers to improve the social play skills of children with autism. One such approach, the
Integrated Play Group (IPG) model, can be described as “adult-facilitated peer mediation” due to
its use of typically developing peers and adult guidance. The IPG model attempts to physically
arrange the environment in order to foster mutually enjoyable social interaction, communication,
play, and imagination experiences between children with autism and typical peers or siblings
(Wolfberg & Schuler, 1993, 1999). It proposes that children with autism maximize their develop-
mental potential by participating in play activities with more capable peers. The IPG model places
emphasis on increasing the motivation of a child with autism to socialize and play with peers.
These peers are, in turn, taught to accept and include children with autism who may relate and play
differently. Small groups (3 to 5 per group) comprised of children of various ages (ages 3 to 11),
developmental statuses, and play interaction styles regularly play together (generally twice a week
for 30– 60-min sessions over a 6–12-month period) under the guidance of an adult facilitator (play

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 Social Play Skill Enhancement 731

guide). The play guide encourages the target child to engage in and maintain interaction with peers
who are taught to use a variety of skills, including getting a friend’s attention, sharing, requesting,
play organizers, and compliments. Skills are introduced, described, and modeled before the chil-
dren practice and are given feedback. Adult guided supports, such as posters and prompts, are
faded as the children begin to independently use the strategies.
The IPG model has been found to double the amount of interaction with peers involving
“common focus” on an activity, resulting in decreases in manipulative repetitive and isolate play,
gains in functional object use, and collateral gains in more social forms of play (Wolfberg &
Schuler, 1993). Initial behavior gains failed to be maintained following the withdrawal of inter-
vention, indicating that the treatment results were dependent upon adult support and that guided
participation should not be prematurely withdrawn.

Peer buddy. The “peer buddy” approach, an active peer tutor training program, focuses on
assigning a child with autism to a typically developing peer “buddy” who is instructed to stay
with, play with, and talk to the child with autism (English, Goldstein, Shafer, & Kaczmarek, 1997;
English, Goldstein, Kaczmarak, & Shafer 1996; Laushey & Heflin, 2000). Refer to Table 1 for a
description of these instructions. The peer buddy approach has resulted in increased social inter-
actions between children with and without disabilities (English et al., 1997). When compared to a
passive proximity approach in which children were integrated but not assigned a buddy, peer
buddy programs elicited more appropriate social play skills (i.e., asking for an object, getting
someone’s attention, waiting for a turn, and looking at or in the direction of the speaker) in
children with autism. Increases in the amount of time spent in social interaction have also been
exhibited and generalized across multiple peers when dyad pairs have been rotated during training
(Laushey & Heflin).

Group oriented contingencies. Group-oriented reinforcement contingency interventions

require all children in a classroom to exhibit a specified behavior before reinforcement is offered
to any child. They attempt to encourage untrained supportive behaviors so that each child influ-
ences one another’s performance. Kohler et al. (1995) added a class-wide supportive skills train-
ing program to the social skills training package developed by Odom, Kohler, & Strain (1987) in

Table 1
Buddy Skills Script (Laushey & Heflin, 2000, p. 187)

Three things to do to be a good buddy:

1. Stay with your buddy—“This means that you and your buddy will play in the same area. Sometimes you and your
buddy may not want to play the same thing. In order to be a good buddy, you will both have to take turns playing with
what each other wants to play with. This means that you and your buddy play for a little while with what you want to
play with and then you and your buddy play for a little while with what he wants to play with. But no matter what, you
stay together.”
2. Play with your buddy—“Not only do you and your buddy stay in the same area but you also share the same type of toys
and games. You play with one another. To play with your buddy means to join in on an activity that your buddy is
playing, to bring a toy to your buddy, or to ask your buddy if he would like to participate in an activity.”
3. Talk to your buddy—“While you and your buddy are staying together and playing together, you should talk to each
other. You will probably want to talk about what you are playing with or you may want to play pretend-type games and
talk to each other while playing pretend. Even if your buddy does not always talk back with you, try to talk to them.
They may just be a bit more shy and quiet and you may be able to help them talk more.”

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732 Bass and Mulick

order to train preschool-aged children with autism and their typical peers to remind one another to
use the skills they had previously learned (i.e., play organizer suggestions, share offers and requests,
and assistance offers and requests). Some increases were shown in the amount of time children
with autism and peers engaged in social interaction. However, the rates of interaction across
children remained variable and children did not continue to offer reminder prompts when treat-
ment was withdrawn (Lefebvre & Strain, 1989).
The majority of literature published in the area of IPG, peer buddy programs, and group
oriented contingencies has involved exploratory studies and practical guidelines regarding how to
implement the models in various settings. Although exploratory experimental studies have shown
somewhat promising results regarding initial behavior gains, more extensive research is necessary
to determine the true efficacy of these approaches for improving social play skills in children with
autism and their peers.
Siblings as change agents. Results of the few studies using caregivers and typically devel-
oping siblings in the home setting have demonstrated that they can be effective as trainers and
change agents in improving the social interactions between children with autism and their siblings
(Strain & Danko, 1995; Strain, Kohler, Storey, & Danko, 1994). Such improvements have been
demonstrated in both school and home settings following an intervention that provided adult
prompting, edible reinforcement, and self-monitoring of social behaviors without adult reinforce-
ment (Strain et al., 1994). Family members have trained typically developing siblings to persis-
tently engage in social overtures toward their sibling with autism using a previously validated,
classroom-based social skills intervention package adapted for home use. This home-based inter-
vention has resulted in increases in positive initiations and responses, as well as concurrent social
behaviors (Strain & Danko, 1995).
Typically developing siblings have been taught to promote play and play-related speech, to
praise play behaviors, and to prompt their siblings with autism to respond to initiations, with skills
being generalized and maintained after withdrawing intervention (Celiberti & Harris, 1993). Inte-
grating the ritualistic behaviors of children with autism into games has increased joint attention
and social play interactions with siblings (Baker, 2000). Belchic and Harris (1994) focused on
teaching social interaction skills to target children with autism in order to improve their social play
skills with multiple peers and siblings in generalized settings including the home. Cooperative
play has been enhanced and prolonged by providing verbal and least-to-most intrusive physical
prompting to children with autism to encourage them to initiate play with confederate peers.
Generalization was evidenced by each child with autism initiating and maintaining interactions to
each new peer, a new playground, and with their sibling at home.

Table 2
Steps to Conduct Peer-Mediated Training Lessons (Strain & Odom, 1986)

Daily lessons, lasting 20–25 min, incorporate a number of standard features:

• Group (one target child and at least one confederate) is brought to intervention setting.
• Lessons begin with a review of targeted social initiation behaviors.
• Teacher models social initiation or ways to use play materials with an accompanying adult, with adult responding
50% of time and being nonresponsive 50% of time.
• Confederate practices social initiation with role-playing adult. Teacher gives verbal feedback.
• Teacher sends all but confederate to play activity, reminding confederate to play with child.
• Teacher observes confederate closely and gives verbal prompt if not initiating after 15 seconds, with length of time
between prompts increased and prompts faded gradually.
• Teacher gives verbal reinforcement or implements reward system.

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 Social Play Skill Enhancement 733

Future Directions
There is strong empirical evidence that typically developing peers and siblings can help
improve the social play skills of children with autism. Children with autism can learn to make
social initiations and respond to initiations from peers. In addition, the described interventions can
motivate typically developing peers to interact with children with autism. The majority of studies
using peer-mediated interventions have involved preschool children. It is unclear whether such
interventions can be used effectively with children younger or older than preschool age. In addi-
tion, questions remain regarding how to improve upon the most effective interventions already
identified so that they will consistently lead to generalized and prompt-free maintained results.
Further studies are necessary involving multiple peers as change agents, multiple settings to increase
generalization, and structural changes required to promote maintenance of skills. This research
will need to be extended to include siblings as intervention agents.

Applications
To use peer-initiation strategies most effectively, teachers and other professionals must give
special consideration to selecting specific targets to teach and arranging the physical space to
encourage social interaction (Strain & Odom, 1986). It is recommended that, at a minimum, peers
be taught to initiate the following: play organizers, shares, physical assists, and affection. Play
materials that require children to share in order to engage in the same activity should be provided
and the children should be confined within a designated area to promote interaction. Teachers
should choose compliant peer models in the same class as the target child with autism who have
expressed a willingness to participate. These peers should have regular school attendance, age-
appropriate play skills, and no or a positive social history with the child with autism. The peers
should be trained to execute the intervention during daily intervention sessions and may require
four or five sessions in order to reliably learn the initiation strategies (Strain & Odom, 1986).
Refer to Table 2 for steps to conduct peer-mediated training lessons and Table 3 for the observa-
tional system designed by Strain (1987) to assess dyadic interactions. An external reward system

Table 3
Observational System to Assess Dyadic Interactions (Strain, 1987)

• Play organizer—verbalizations that specify an activity, role, or other play for peers; indicate that the child will engage
in play or is physically engaged in play
• Share—offering, giving, or accepting a play material to/from another child
• Assistance—helping another child: get up from the floor, complete a task, get on play equipment, or respond to
requests for assistance
• Assistance request—asking another child to help complete a task or activity that is difficult
• Complimentary statement—orienting toward another child’s face or head, giving a compliment, praise statement, or
expression of reassurance
• Affection—hugging, putting arms around, kissing, patting, holding hands, shaking hands
• Negative Motor-Gestural—hitting, pinching, kicking, head-butting, pushing, destroying toys
• Negative Vocal-Verbal—verbalizations indicating criticism, rejection, threats, disapproval, insults, quarreling, and so
forth
• Initiation—any social behavior listed above directed to a peer that is not preceded by another behavior from the same
peer within the previous 3 s
• Response—any social behavior in the above list directed to a peer that was preceded by a socially directed behavior
from the same peer

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734 Bass and Mulick

(i.e., sticker chart, happy face chart, etc.) may be helpful in initially motivating the children to
interact with each other. A small reinforcer may be provided each time a child performs a target
behavior initially, with the schedule of reinforcement adjusted depending on the specific needs of
each child. Children should be observed during free play periods in order to determine general-
ization of skills.

Suggested Resources

Peer-Mediated Interventions in the Classroom

Strain, P.S. (2002). Nurturing Social Skills in the Inclusive Classroom (workbook). Tualatin, OR: Teacher’s Toolbox,
1-866-811-8665 or http://www.ttoolbox.com/teacher_training.htm.
Strain, P.S., & Cordisco, L. (1993). The LEAP preschool model: Description and outcomes. In S. Harris & J. Handelman
(Eds.), Preschool education programs for children with autism. Austin: PRO-ED, 1-800-897-3202 or http://
www.proedinc.com/store/index.php?mode⫽product_detail&id⫽9156.

Integrated Play Group Model

The Autism Institute on Peer Relations and Play-Center for Integrated Play Groups, http://www.autisminstitute.com/
IPGModel.htm.
Wolfberg, P.J. (1999). Play and imagination in children with autism. New York: Teachers College Press, Columbia Uni-
versity. TCP, 1-800-575-6566 or http://store.tcpress.com/080773814X.shtml.
Wolfberg, P.J. (2003). Peer play and the autism spectrum: The art of guiding children’s socialization and imagination.
Shawnee Mission, KS: Autism Asperger Publishing Company, 1-877-277-8254 or http://www.asperger.net /
bookstore_index_P_R.htm

Peer Buddy System

English, K., Shafer, K., Goldstein, H., & Kaczmarek, L. (1997). Teaching Buddy Skills to Preschoolers. Washington, DC:
American Association on Mental Retardation. AAMR, 1-800-424-3688 or http://www.aamr.org.

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Psychology in the Schools DOI: 10.1002/pits