Research & Practice for Persons with Severe Disabilities
2010, Vol. 35, No. 3Y4, 63–79
Peer Interactions of Students With
Intellectual Disabilities and/or Autism:
A Map of the Intervention Literature
Erik W. Carter, Lynn G. Sisco, and Yun-Ching Chung
University of Wisconsin-Madison
Tina L. Stanton-Chapman
University of Virginia
Social interactions with peers are an important aspect
of childhood development that is closely linked to emo-
tional well-being and success in school. We conducted a
comprehensive review of recent intervention studies eval-
uating strategies to improve the peer interaction outcomes
of students with intellectual disabilities and/or autism.
The purpose of this review was to characterize the current
knowledge base, to analyze key dimensions of recent stud-
ies, and to identify important areas for future research
and synthesis. The 85 reviewed studies addressed 20 educa-
tional practices, which we categorized as (a) student-focused,
(b) peer-focused, and/or (c) support-focused. Although the
overall quality of these studies was high, considerable varia-
tion exists in the degree to which specific practices have been
adequately evaluated with students across disability cate-
gories and grade levels. Additional research is needed to
strengthen the depth of evidence for these practices across
school levels, school settings, and disability categories.
DESCRIPTORS: severe disabilities, autism, intellec-
tual disability, peer interaction, literature review, evidence-
based practices
The relationships students have with their peers can
make important contributions to social and emotional
development, promote success in school, and enhance
overall quality of life (Gifford-Smith & Brownell, 2003;
Rubin, Bukowski, & Laursen, 2009). Indeed, the quality
and quantity of interactions students have with their
peers may be among the most influential factors shaping
children’s well-being (Prinstein & Dodge, 2008). It is not
surprising, therefore, that improving peer interaction out-
comes has been such a prominent and enduring focus
of special education for students with low-incidence dis-
abilities (Brown et al., 1979; Haring, 1991). An extensive
literature addresses the array of social, behavioral, aca-
Support for this research was provided by a grant from the
Centers for Medicare and Medicaid Services, Medicaid Infra-
structure Grant to the Wisconsin Department of Health Services
(CFDA No. 93.768).
Address all correspondence and reprint requests to Erik W.
Carter, Department of Special Education, Box 328, Peabody
College, Vanderbilt University, Nashville, TN 37203. E-mail:
erik.carter@vanderbilt.edu
63
copyright 2010 by
TASH
demic, and other benefits that may accrue to these students
through interactions with their same-age classmates with-
out disabilities (Brown, Odom, & McConnell, 2007; Carter
& Hughes, 2005).
Yet, social interaction among students with low-
incidence disabilities and their peers without disabilities
can be quite limited. This is particularly true for children
with intellectual disabilities (ID) and/or autism spectrum
disorders (ASD), who comprise the primary caseload
for teachers of students with low-incidence disabilities.
Although these students are spending an increasingly
greater proportion of their school day in general edu-
cation classrooms alongside their peers without disabil-
ities (U.S. Department of Education, 2009; Williamson,
McLeskey, Hoppey, & Rentz, 2006), descriptive stud-
ies indicate that interactions among students with and
without ID and/or ASD remain infrequent apart from
targeted intervention efforts (e.g., Carter, Sisco, Brown,
Brickham, & Al-Khabbaz, 2008; Webster & Carter, 2007).
Moreover, national studies examining the peer relation-
ships of students receiving special education services sug-
gest that friendships may be more restricted for students
with ID and ASD than for students served under other
disability categories (Wagner, Cadwallader, Garza, &
Cameto, 2004; Wagner et al., 2002).
Special educators, general educators, paraprofessionals,
and related service providers responsible for addressing
the social-related needs of students with low-incidence
disabilities need access to strategies for promoting inter-
action among students with and without disabilities (Carter
& Pesko, 2008; Causton-Theoharis & Malmgren, 2005).
At the same time, recent discussions have emphasized the
necessity of identifying and implementing evidence-based
practices to improve educational outcomes for students
with disabilities (Cook, Tankersley, & Landrum, 2009;
Odom et al., 2005). These two needs underscore the im-
portance of clearly identifying the depth and quality of
the empirical base focused on enhancing social opportu-
nities for students with low-incidence disabilities. How-
ever, determining which intervention approaches have
accumulated sufficient evidence to warrant consideration
as an Bevidence-based practice[ for these students holds
some particular complexities.
64 Carter et al.
One important step in establishing the knowledge base
for promoting peer interaction among students with and
without disabilities involves identifying the specific edu-
cational practices for which some empirical evidence has
accumulated. Although previous systematic reviews have
targeted individual intervention approaches (e.g., aug-
mentative and alternative communication [AAC] use,
Hart & Banda, 2010; peer support arrangements, Carter
& Kennedy, 2006), a broader and more comprehensive
examination of the entire intervention literature would
provide information about the full range of evaluated
practices (e.g., social stories, self-management strategies,
social skills instruction, and peer interaction training)
potentially available to practitioners, as well as delineate
critical gaps in the literature, which should be addressed
within future research. Moreover, a targeted review of
practices specifically directed toward increasing social
interactions with peers without disabilities is essential,
as the approaches used to promote communicative ex-
changes with teachers, clinicians, or other adults may be
considerably different than those involving peers.
A second challenge involves clearly identifying the
students for whom each of these intervention practices
have (and have not) been evaluated. Although prior re-
views have narrowly addressed interventions involving
either students with ID (e.g., Carter & Hughes, 2005;
Webster & Carter, 2007) or ASD (e.g., Bellini, Peters,
Benner, & Hopf, 2007; Reichow & Volkmar, 2010; Wang
& Spillane, 2009), teachers of students with low-incidence
disabilities typically serve both groups of children on
their caseloads. Furthermore, there is considerable over-
lap between these two special education categories, as a
substantial proportion of individuals with ID also have
autism (and vice versa; Matson & Shoemaker, 2009).
Thus, it is important to delineate what is already known
and still needs to be learned regarding intervention op-
tions for students served under each of these labels.
Currently, there are no comprehensive reviews that as-
semble this information for practitioners, teacher educa-
tors, and researchers.
At the same time, each disability category represents
a heterogeneous group of students with diverse support
needs. Federal special education definitions (Individuals
With Disabilities Education Improvement Act, 2004)
and diagnostic manuals (American Psychiatric Associ-
ation, 2000) highlight unique needs associated with each
disability category. For example, ID (i.e., mental retar-
dation) is defined by significant limitations in intellec-
tual functioning that coexist with deficits in more than
one adaptive behavior. Social skills deficits and/or lan-
guage delays may be areas of adaptive challenges for
a particular child but are not a requirement for an ID
diagnosis. Autism, however, more specifically affects the
communication and social interactions of children. In
addition to exhibiting deficits in the areas of symbol use
and joint attention (National Research Council, 2001),
stereotypical, self-injurious, or other challenging behav-
iors are also associated with autism and may impact
students’ peer relationships (Matson & Shoemaker, 2009).
Therefore, clear and thorough descriptions of the students
with whom individual practices have and have not been
evaluated is an essential element of determining the depth
of the knowledge base.
The relevance of context to peer interactions and re-
lationships also has been widely demonstrated (Kennedy,
2001; Sheridan, Buhs, & Warnes, 2003). As students prog-
ress through elementary, middle, and high school, the
nature of their interactions with their peers evolves as
students develop physically, intellectually, and emotionally
and the broader peer culture changes (Rubin et al., 2009).
Although previous literature reviews have addressed the
social-related outcomes of young children with disabilities
(Goldstein, 2002; McConnell, 2002), less attention has fo-
cused on the interventions available to practitioners work-
ing with school-age children at key points across the grade
span. Even within a given school, the diverse settings in
which students spend their day (e.g., classrooms, cafeteria,
playground, and hallways) may provide divergent social
expectations and opportunities (Carter, Hughes, Guth,
& Copeland, 2005). Determining the extent to which
research support is available for a particular social in-
teraction intervention practice requires consideration
of both the school level and school settings in which it
is implemented.
Finally, the adoption of peer interaction interventions
is likely influenced by the extent to which specific prac-
tices are considered feasible by and acceptable to edu-
cational practitioners (Boardman, Arg[elles, Vaughn,
Hughes, & Klingner, 2005; Snell, 2003). When research-
ers are extensively or exclusively involved in imple-
menting intervention strategies within evaluations of
school-based practices, it remains unclear whether the
intervention will retain its effectiveness when those prac-
tices are implemented by practitioners in ways that more
closely resemble everyday school routines. Moreover, it
is widely held that discussions of intervention efficacy
should be accompanied by indicators of social validity
(Horner et al., 2005; Schwartz & Baer, 1991). The extent
to which the goals, procedures, and outcomes associated
with an educational practice are acceptable to key stake-
holders may influence the degree to which that practice is
adopted and implemented with fidelity by schools.
The primary purpose of this systematic review was to
provide a comprehensive map of interventions focused
on promoting social interaction among students with ID
and/or ASD and their peers without disabilities. Spe-
cifically, we focused on identifying which educational
practices have been evaluated with which students in
which school contexts. We also attended to the persons
involved in implementing these interventions. The fol-
lowing questions guided our review:
1. What educational practices for promoting social
interactions among students with ID and/or ASD
 Peer Interaction
and their peers without disabilities have been eval-
uated in the research literature?
2. With whom, in what contexts, and how have these
educational practices been evaluated?
3. What is the overall quality of the evidence base for
this intervention literature?
4. In which areas has sufficient research accumulated to
warrant closer consideration as an evidence-based
practice? Where is additional research needed?
Our review differs from traditional meta-analyses in
that our purpose was not to document the magnitude
of intervention effects or to compare the efficacy of
different intervention approaches. Instead, we sought
to delineate the extent to which specific intervention
strategies have been evaluated thus far and to charac-
terize the overall quality of the studies comprising this
literature. Such a map can provide practitioners and
teacher trainers with information about the range of
potential intervention strategies for students with low-
incidence disabilities and guide researchers in addressing
key gaps in the knowledge base. Therefore, we chose not
to calculate effect sizes for the 85 studies addressed in this
review. Indeed, considerable debate exists about whether
and how to quantitatively synthesize literature comprised
primarily of single-case research data (Parker, Hagan-
Burke, & Vannest, 2007; Scruggs & Mastropieri, 1998),
with Wolery, Busick, Reichow, and Barton (2010) con-
cluding that, Bthe field does not have a suitable method
for calculating effects for studies that would allow them to
be synthesized appropriately[ (p. 27). Furthermore, such
syntheses are particularly difficult when a literature in-
corporates multiple research methodologies (i.e., single-
case design and group experimental design) or when
interested in individual practices within multicomponent
intervention packages.
Method
Inclusion Criteria
We selected studies for review based on the follow-
ing criteria. First, the study comprised an empirical,
intervention-based investigation using group (i.e., experi-
mental and quasiexperimental) or single-case design. We
excluded case reports, observational studies, qualitative
studies, or other nonintervention studies in which the de-
sign could not document experimental control. Second, at
least one participant was identified by the study authors
as having an ID and/or ASD (e.g., autism, Asperger syn-
drome, and Rett syndrome). We relied on disability
category descriptions provided by the authors to deter-
mine whether each study participant met this criterion.
Given our interest in mapping intervention strategies
for teachers of students with low-incidence disabilities,
we chose not to expand our review to address students
with emotional disturbance or other high-incidence dis-
abilities. Third, participants meeting the second criterion
were students receiving special education services at the
65
elementary, middle, or high school level (i.e., Grades
1Y12). We excluded studies conducted exclusively with
preschoolers and kindergartners or in which it could not
be determined from the article whether any of the par-
ticipants clearly met this criterion. Fourth, at least one
of the dependent variables comprised a direct measure
of social-related interaction (e.g., initiations, responses,
social interactions, and contacts) between students with
ID and/or ASD and at least one peer without disabilities
that occurred in schools serving both students with and
without disabilities. Studies involving interactions among
students and their peers with disabilities were not ex-
cluded if interactions with peers without disabilities also
were examined. However, we excluded studies if the
social interaction outcome was not reported separately
from broader, non-social-dependent measures; inter-
actions occurred only with school staff members, family
members, or undesignated social partners; or interactions
with adults and peers were not presented separately.
We also excluded studies reporting social interactions
occurring exclusively in community-based settings, em-
ployment sites, separate special education schools, or
settings that were not clearly described. Fifth, all studies
were published in English in a peer-refereed print or on-
line journal between January 1990 and December 2008.
We focused on contemporary research published within
the last two decades during which service delivery shifts
have resulted in greater school inclusion for students
with disabilities (U.S. Department of Education, 2009;
Williamson et al., 2006). We also selected this start date
because it marked the addition of autism as a distinct
special education category within IDEA and predated
refinements to current diagnostic criteria.
Literature Search Procedures
We employed a multipronged, comprehensive approach
to identify all studies meeting our study criteria. First,
we conducted a search for studies published in print jour-
nals or available in advance online between January 1990
and December 2008 using six electronic databases (i.e.,
Academic Search, CINAHL Select, Education Full Text,
ERIC, PsycArticles, and PsycINFO). We utilized various
combinations of keywords describing the student popula-
tion (e.g., Asperger syndrome, autism, cognitive disability,
developmental disability, intellectual disabilities, mental re-
tardation, and pervasive developmental disorder), outcomes
(e.g., conversation, friendship, initiation, interaction, peer
relations, peer training, response, social contacts, social in-
teraction, social networks, and social relationships), and
settings (e.g., general education, inclusion, integration, and
mainstreaming). Additional keywords were incorporated
into our search process as new articles were identified.
Second, we examined bibliographies of related research
reviews (e.g., Bellini et al., 2007; Carter & Hughes, 2005;
National Autism Center, 2009; National Research Coun-
cil, 2001; McConnell, 2002; Reichow & Volkmar, 2010)
and each identified article (i.e., ancestral search). Third,
66
we conducted an electronic search of the Social Sciences
Citation Index to locate studies citing each of the iden-
tified articles. These articles, as well as their reference lists,
subsequently were examined for potential inclusion in
this synthesis.
Article Coding and Reliability
We developed an original coding sheet to examine
each included study according to a number of key ele-
ments (e.g., descriptions of participants, descriptions of
settings, dependent variables, experimental design, treat-
ment fidelity, and social validity; Gersten et al., 2005;
Horner et al., 2005). Each study was independently re-
viewed and coded by two graduate students (second and
third author) whose doctoral research focused on edu-
cational services for students with low-incidence disabil-
ities and who each had at least 5 years of experience in
this area. For each study, information on these elements
(described below) were coded categorically or recorded
as narrative, based on the information provided in the
written report. When sought-after information (i.e., par-
ticipant age or grade, disability, gender) was not clearly
apparent in the written report, we attempted to obtain
additional information or clarification by contacting one
or more of the study’s authors.
We coded the total number of students involved in
each intervention, as well as determined which of these
students met our inclusion criteria. For example, many
studies included a heterogeneous group of students with
and without ID and/or ASD for whom both social- and
non-social-related measures were collected. For each of
the participants meeting inclusion criteria, we recorded
their gender, disability labels, disability severity (as re-
ported by the study authors), race or ethnicity, commu-
nication modes, challenging behaviors, and school level
(i.e., elementary, middle, or high school). We coded
the school settings in which social interaction data were
gathered as (a) general education classrooms, (b) special
education classrooms, and/or (c) nonclassroom school
settings (e.g., cafeteria, hallways, and playgrounds).
Social-related outcome measures were categorized based
on their primary focus (e.g., initiations, responses, and
interactions). For each study, we recorded the interaction
partner (e.g., peers without disabilities only and peers with
and without disabilities), as well as whether and how stu-
dents may have been partnered together (e.g., no explicit
arrangement and intentionally paired together). We coded
the implementer of the intervention as one or more of the
following: researcher, teacher, peer, and other persons.
We also coded the methodological features of each study,
including the research design used to evaluate the prac-
tices; whether information about observer training was
provided; the observational approaches (i.e., live, recorded,
or both) used to document social-related outcomes; and
the extent to which evidence of adequate interobserver
agreement (IOA), intervention fidelity, social validity, and
generalization was reported.
Carter et al.
Although 99 studies initially appeared to meet the in-
clusion criteria and were independently coded by the two
reviewers, only 85 of these studies were ultimately in-
cluded after closer inspection and team discussion involv-
ing the reviewers and the first author (i.e., an associate
professor whose research focuses on peer interaction and
students with low-incidence disabilities). The excluded
studies were omitted primarily because of design issues or
their outcome measures. Each of the 19 previously dis-
cussed italicized variables was compared using the exact
agreement method (i.e., the two reviewer’s independent
ratings were dichotomously scored as either perfectly
matching or not perfectly matching). For example, a dis-
agreement would be scored if one reviewer coded a study
as having three participants with ASD, but the other re-
viewer coded the study as including two participants with
ASD and one participant with ID. Overall agreement
was calculated both for each study and for each variable
using the following formula: total number of exact
agreements divided by the total number of exact agree-
ments plus disagreements multiplied by 100%. The aver-
age agreement across all 85 studies was 89.1% (range,
68.4Y100% for individual studies) and the average agree-
ment across all 19 variables was 88.7% (range, 51.8Y
100% for individual variables). After interrater reliability
was calculated, all disagreements were discussed by the
project team, needed corrections were made, and the
finalized data were used in all subsequent analyses.
In addition to independently coding these study ele-
ments, we also sought to describe the specific educational
practices comprising these intervention packages. Al-
though educational practices have been defined in widely
diverse ways in the literature, we drew upon the defini-
tion provided by Horner and colleagues (2005) when de-
lineating these practices:
A practice refers to a curriculum, behavioral inter-
vention, systems change, or educational approach
designed for use by families, educators, or students
with the express expectation that implementation will
result in a measurable educational, social, behavioral,
or physical benefit. A practice may be a precise in-
tervention, a procedure for documenting a control-
ling mechanism, or a larger program with multiple
components (p. 175).
After reading each study, we identified the individual
practices comprising each intervention package by
consensus as a project team. Specifically, we identified
a tentative list of practice categories by drawing upon
previous research reviews (e.g., Carter & Hughes, 2005;
McConnell, 2002), as well as our own reading and sys-
tematic coding of the articles (described above). Next,
the two doctoral students independently identified which
practices were reflected in each of the studies, suggest-
ing additional practice categories when needed. Then,
all three team members met to discuss each article and
 Peer Interaction 67

finalize the practices. As each article was discussed, we our inclusion criteria and 52 participants did not (e.g.,
revised practice definitions, combined and/or dropped participants were in preschool or kindergarten and par-
practices, and revisited articles until we all agreed on which ticipants had other disabilities not emphasized in this
category(ies) of practice each study reflected. We worked review). Table 1 summarizes the demographic charac-
together to define and cluster these educational practices teristics of these 434 students, as provided by the authors
at a level at which they could be implemented alone (i.e., of these studies. Fifty-eight studies included participants
apart from other practices) yet would still remain rec- at the elementary school level (i.e., Grades 1Y5), 14 stud-
ognizable to educators as a cohesive practice and retain ies included participants at the middle school level (i.e.,
the core elements defining it as a practice (e.g., social Grades 6Y8), 15 studies included participants at the high
stories, peer support arrangements, and pivotal response school level (i.e., Grades 9Y12), and 4 studies (Bauminger,
training; see Table 2 for practices and definitions). 2002, 2007a, 2007b; LeGoff, 2004) did not provide the
We concurrently worked as a team to cluster each of the participants’ school level, although reported ages suggest
educational practices under three broad areas based on its that most participants were in elementary school. Seven
primary focus: (a) student-focused, (b) peer-focused, and studies involved students from multiple school levels.
(c) support-focused interventions. We defined student-
Interaction Settings
focused practices as interventions in which skill instruc-
Because this review focused on peer interactions within
tion was provided directly to students with disabilities to
school settings, most studies (94.1%) described interven-
increase or improve their social interactions; peer-focused
tion practices that also were implemented within schools.
practices as interventions in which instruction or training
However, three studies (LeGoff, 2004; Owens, Granader,
was provided to peers without disabilities to promote in-
Humphrey, & Baron-Cohen, 2008; Sansosti & Powell-
teractions with students with disabilities; and support-
Smith, 2006) involved interventions implemented outside
focused practices as interventions focused on the efforts
of adults to create socially supportive environments in
which peer interactions were actively prompted, promoted, Table 1
Demographics of Study Participants With Disabilities (N = 434)
and/or supported. Thus, individual studies often were
coded as comprising multiple educational practices, which n (%)
may have fallen under more than one of these three focus Gender
areas. Because educational practices were identified as a Female 284 (65.4)
group, interrater reliability was not calculated. Moreover, Male 94 (21.7)
Not specified 56 (12.9)
we acknowledge that other approaches for delineating Race ethnicity
and grouping peer interaction intervention practices could African American 21 (4.8)
be developed and the authors of these studies may have Asian American/Pacific Islander 5 (1.2)
framed their own interventions differently. European American 24 (5.5)
Hispanic/Latino 4 (0.9)
Other race/ethnicities 2 (0.5)
Results Not specified 378 (87.1)
Disabilitya
Reviewed Studies ASD 216 (49.8)
We reviewed and analyzed 83 articles from 22 jour- ID 143 (32.9)
ASD and ID 23 (5.3)
nals meeting our inclusion criteria. Of these 83 articles, Not clearly specified 52 (12.0)
two articles (Kamps, Leonard, Potucek, & Garrison- Reported severityb
Harrell, 1995; Sasso, Mundschenk, Melloy, & Casey, Mild 35 (21.1)
1998) reported findings for multiple studies, yielding Moderate 40 (24.1)
85 studies meeting our inclusion criteria. The journals Severe 46 (27.7)
Other descriptors (e.g., Bmoderate to severe[, 23 (13.9)
most frequently publishing these studies were Research Blower levelB)
and Practice for Persons With Severe Disabilities (n = Not clearly specified 22 (13.3)
13 articles), Focus on Autism and Other Developmental Verbalc
Disabilities (n = 10 articles), and Education and Training Described as being verbal 163 (37.6)
Described as not being verbal 28 (6.5)
in Mental Retardation and Developmental Disabilities Not clearly specified 243 (56.0)
(n = 7 articles). Almost half of the articles (43.9%) were Challenging behaviorsc
published since 2000, with 25 articles published between Described as having challenging behaviors 36 (8.3)
1990 and 1995, 23 articles published between 1996 and Described as not having challenging behaviors 77 (17.7)
2000, 18 articles published between 2001 and 2005, and Not clearly specified 321 (74.0)
a
17 articles published between 2006 and 2008. Categorizations are based on information reported by the
author(s). It is possible that some students with ASD also had
ID and that some students with ID also had autism.
Students With Disabilities b
Categorizations are made only for students reported as having
Four hundred eighty-six students with disabilities par- ID (n = 166).
c
ticipated in these 85 studies, of whom 434 students met Based on information provided by the author(s).
68
Table 2
Educational Practices Definitions
Educational practices
Student-focused practices
AAC use. Introducing AAC systems (e.g., pictures,
communication books, and electronic systems) to
students with disabilities and/or providing additional
training to students; peers may or may not also
receive training.
CognitiveYbehavioralYecological social skills training.
A training package consisting of (a) instruction in
prerequisite social concepts, (b) affective education
related to four basic emotions, and (c) social
interpersonal problem solving.
Collateral skills. Teaching students with disabilities
other skills (e.g., game playing and computer skills)
that are not explicitly social to enhance participation
in leisure or other activities.
Conversational turn-taking. Providing systematic
instruction and conversational structures to facilitate
balanced turn-taking by both partners in conversations.
Pivotal response training. Naturalistic strategies designed
to promote generalization by using multiple exemplars
and incorporating a target student’s preferences.
Self-management. Teaching students with disabilities to
self-manage their own social behaviors using goal
setting, self-prompting, self-monitoring, self-evaluation,
and related strategies.
Social stories. Individualized stories that describe a specific
social situation a student with disabilities may find
challenging, explain the reactions of others to the situation,
and provide examples of appropriate social responses.
Social skills. Teach students with disabilities general social
and communication skills (not addressed in the other
practices described above).
Peer-focused practices
Assigning roles. Assigning specific roles within activities
to peers and/or students with disabilities to facilitate
social interaction.
Peer awareness training. Providing activities to promote
greater awareness or understanding of disabilities
among peers.
Peer interaction training. Providing direct social skills
training to equip peers without disabilities to become
effective communication partners, interaction facilitators,
and/or social skill instructors.
Peer networks. Establishing structured social groups
around a student with disabilities to promote social
and communication outcomes within the classroom
and/or across the school day; academic-related
support is secondary or incidental.
Carter et al.
Implementation within studies
Implemented by researchers (Garrison-Harrell et al., 1997;
Hunt et al., 1990; Hunt et al., 1991a, 1991b); by teachers
(Jolly et al., 1993); by peers (Hughes, Rung, et al., 2000),
and by researchers, teachers, and/or others (Hunt et al.,
1996; Hunt et al., 1997).
Implemented by teachers (Bauminger, 2007a) and by teachers
and others (Bauminger, 2002, 2007b).
Implemented by researchers (Breen & Haring, 1991; Werts
et al., 1996; Whalon & Hanline, 2008) and peers (McMahon
et al., 1996).
Implemented by researchers (Hunt et al., 1990; Hunt et al.,
1991a, 1991b).
Implemented by researchers and peers (Harper et al., 2008;
Pierce & Schreibman, 1995, 1997a, 1997b).
Implemented by researchers (Hughes, Copeland, Agran, et al.,
2002; Hughes et al., 2004; Loftin et al., 2008; Morrison et al.,
2001), by peers (Hughes et al., 1995; Hughes et al., 1996;
Hughes et al., 2000), and by researchers and peers (Gilberts
et al., 2001).
Implemented by researchers (Delano & Snell, 2006; Thiemann
& Goldstein, 2001), by teachers (Bock, 2007a, 2007b; Scattone
et al., 2006), and by teachers and/or others (Sansosti &
Powell-Smith, 2006, 2008).
Implemented by researchers (LeGoff, 2004; Loftin et al.,
2008; Morrison et al., 2001; Owens et al., 2008; Thiemann
& Goldstein, 2004); by teachers (Gonzalez-Lopez &
Kamps, 1997); and by researchers, teachers, peers, and/or
others (Haring & Breen, 1992; Kamps et al., 1992; Kamps
et al., 1997; Kamps et al., 2002; Licciardello et al., 2008).
Implemented by teachers (Sasso et al., 1998) and by researchers,
teachers, and/or others (Hughes, Carter, et al., 2002; Kamps
et al., 1999).
Implemented by researchers (Carter & Maxwell, 1998; Fritz,
1990; Owen-DeSchryver et al., 2008; Staub & Hunt, 1993);
by teachers (McEvoy et al., 1990; Miller et al., 2003; Sasso
et al., 1998); and by researchers, teachers, and/or others
(Hunt et al., 1996; Hunt et al., 1997; Klavina & Block, 2008).
Implemented by researchers (Brady et al., 1991; Carter &
Maxwell, 1998; Garrison-Harrell et al., 1997; Hunt et al.,
1990; Hunt et al., 1991a, 1991b; Hunt et al., 1994; Loftin
et al., 2008; Mundschenk & Sasso, 1995; Ostrosky &
Kaiser, 1995; Owen-DeSchryver et al., 2008; Romer et al.,
1996; Staub & Hunt, 1993; Thiemann & Goldstein, 2001,
2004; Weiner, 2005); by teachers (Bauminger, 2007a;
Gonzalez-Lopez & Kamps, 1997; Lee & Odom, 1996;
Nientimp & Cole, 1992); and by researchers, teachers,
peers, and/or others (Haring & Breen, 1992; Harper et al.,
2008; Kamps et al., 1992; Kamps et al., 1997; Kamps et al.,
2002; Lee et al., 2007; Martella, Marchand-Martella, Young,
& Macfarlane, 1995; Pierce & Schreibman, 1997a, 1997b, 1995).
Implemented by researchers (Garrison-Harrell et al., 1997);
by teachers (Miller et al., 2003; Sasso et al., 1998); and by
researchers, teachers, peers, and/or others (Haring & Breen,
1992; Hunt et al., 1996; Hunt et al., 1997; Kamps et al., 1997).
 Peer Interaction
Table 2
(continued)
Educational practices
Peer support arrangements. Arranging one or more peer(s)
without disabilities to provide ongoing academic and
social support to a student with disabilities while
receiving ongoing feedback and assistance from adults.
Peer tutoring. Assigning a peer without disabilities to
provide academic support to a student with disabilities
within tutorYlearner pairs; social-related support is
secondary or incidental.
Support-focused practices
Direct adult facilitation. Adult-provided prompts or
facilitation strategies to promote social interactions
between students with and without disabilities; social
skill instruction is incidental.
Educational placement. Enrolling students with disabilities
in general education classes with appropriate supports
(e.g., active collaboration among educators, curricular
adaptations and classroom modifications, and individual
supports).
Environmental modifications. Modifying a classroom
environment to promote the academic and social
participation of students with disabilities without
changing educational placement.
Instructional groupings. Small-group classroom
arrangements designed to promote collaborative and
interdependent interactions among group members.
Interactive activities. Introducing interactive activities to
promote social opportunities between students with
and without disabilities.
Unified plans of support. Individualized support plans
consisting of (a) regular team meetings, (b) development
of supports to increase the student’s academic and
social participation in instructional activities, (c) built-in
accountability system, and (d) flexibility to change
ineffectual supports.
of the school (e.g., student’s home, clinic setting) and
two studies (Hunt, Alwell, & Goetz, 1991a; Hunt, Alwell,
Goetz, & Sailor, 1990) spanned multiple settings (e.g.,
school, home, and community settings). Because our pri-
mary focus was on peer interactions occurring within
school settings, we coded observational settings rather
than intervention settings. Forty-four study reports in-
cluded social outcome data collected in general education
classrooms (e.g., physical education class, health, and third-
grade classroom), 27 studies in special education class-
rooms, 7 studies in empty classrooms, and 42 studies in
nonclassroom settings (e.g., cafeteria, playground, and
hallways). Of these latter 42 studies, 19 (45.2%) focused
on multiple nonclassroom settings (e.g., playground and
cafeteria, and cafeteria and hallways), 12 (28.6%) focused
on playgrounds or other areas used for recess, 6 (14.3%)
focused on other nonschool settings (e.g., hallways, library,
and conference room), and 5 (11.9%) focused on cafe-
69
Implementation within studies
Implemented by researchers (Garrison-Harrell et al., 1997);
by teachers (Sasso et al., 1998; Shukla et al., 1998); by peers
without disabilities (Shukla et al., 1999); and by researchers,
teachers, and/or others (Carter, Cushing, et al., 2005; Carter
et al., 2007).
Implemented by teachers (Kamps et al., 1994; Sideridis et al.,
1997) and by researchers, teachers, and/or others (Kamps
et al., 1997; Klavina & Block, 2008).
Implemented by researchers (Baker et al., 1998; Hughes,
Copeland, Wehmeyer, et al., 2002; Ostrosky & Kaiser,
1995); by teachers (McEvoy et al., 1990); by others
(Causton-Theoharis & Malmgren, 2005); and by researchers,
teachers, and others (Hughes, Carter, et al., 2002; Hunt
et al., 1996; Hunt et al., 1997).
Implemented by teachers (Center & Curry, 1993; Kennedy
& Itkonen, 1994) and by teachers and others (Kennedy
et al., 1997).
Implemented by researchers and teachers (Peck et al., 1997).
Implemented by teachers (Cushing et al., 1997; Eichinger,
1990; Kamps et al., 1995 [study 2]; Piercy et al., 2002)
and by researchers, teachers, and/or others (Dugan et al.,
1995; Kamps et al., 1995 [study 1]; Kamps et al., 2002;
Peck et al., 1997).
Implemented by researchers (Baker et al., 1998); by teachers
(McEvoy et al., 1990; Miller et al., 1993); and by researchers,
teachers, and/or others (Hunt et al., 1996; Hunt et al., 1997;
Peck et al., 1997).
Implemented by teachers and others (Hunt et al., 2002; Hunt
et al., 2003).
terias. Twenty-six studies involved data collection in mul-
tiple school settings.
Educational Practices
Through a consensus process, we identified 20 distinct
educational practicesVevaluated separately or as part
of a multicomponent intervention packageVin the re-
viewed studies (see Table 2). Table 2 presents descriptions
of the 20 educational practices, the studies in which they
were evaluated, and person(s) implementing the practice
in each study. Fifty-two studies (61.1%) addressed an
intervention comprised of a single educational practice,
21 studies (24.7%) addressed two educational practices,
8 studies (9.4%) addressed three, 2 studies (2.4%) ad-
dressed four, and 2 studies (2.4%) addressed five. Table 3
organizes these educational practices by focus, school
level, and disability category. Each cell reports the total
number of students with disabilities and total number of
 70

Table 3
Evaluated Educational Practices by Disability and School Level and Focus
Elementary school Middle school High school Any school level
Focus/educational practice ID ASD All ID ASD All ID ASD All ID ASD All
Student-focused practices
AAC use 9 (4) 4 (2) 13 (5) Y Y Y 11 (3) Y 11 (3) 20 (7) 4 (2) 24 (8)4
CognitiveYbehavioralYecological social Y Y Y Y Y Y Y Y Y Y 60 (3) 60 (3)1
skills training
Collateral skills 5 (2) 3 (1) 9 (3) 3 (1) Y 3 (1) Y Y Y 8 (3) 3 (1) 12 (4)4
Conversational turn-taking 3 (1) Y 3 (1) Y Y Y 6 (2) Y 6 (2) 9 (3) Y 9 (3)1
Pivotal response training Y 8 (4) 8 (4) Y Y Y Y Y Y Y 8 (4) 8 (4)2
Self-management Y 4 (2) 4 (2) 5 (1) 3 (1) 8 (2) 20 (5) 3 (3) 20 (5) 25 (6) 10 (5) 32 (8)3
Social stories Y 16 (6) 16 (6) Y 2 (2) 2 (2) Y Y Y Y 18 (7) 18 (7)5
Social skills (not above) Y 45 (9) 45 (9) 1 (1) 4 (2) 5 (2) Y Y Y 1 (1) 96 (11) 97 (11)7
All student-focused studies 14 (6) 80 (22) 95 (27) 9 (3) 9 (4) 18 (6) 26 (7) 3 (3) 26 (7) 49 (16) 192 (31) 239 (42)20
Peer-focused practices
Assigning roles 3 (1) 5 (2) 5 (2) Y Y Y 3 (1) Y 3 (1) 6 (2) 5 (2) 8 (3)3
Peer awareness training 15 (7) 8 (3) 48 (8) Y Y Y 4 (1) Y 4 (1) 19 (8) 8 (3) 72 (10)8
Peer interaction training 18 (9) 48 (18) 63 (23) 1 (1) 4 (2) 5 (2) 11 (4) Y 11 (4) 30 (14) 78 (21) 105 (30)17
Carter et al.

Peer networks 8 (4) 10 (4) 15 (6) 1 (1) 1 (1) 2 (1) Y Y Y 9 (5) 11 (5) 17 (7)5
Peer support arrangements 3 (1) 6 (2) 6 (2) 5 (2) 4 (3) 8 (3) 5 (2) Y 5 (2) 13 (4) 10 (5) 19 (6)5
Peer tutoring 2 (1) 5 (2) 7 (3) 1 (1) Y 1 (1) Y Y Y 3 (2) 5 (2) 8 (4)2
All peer-focused studies 35 (16) 61 (23) 135 (33) 7 (3) 8 (5) 62 (6) 21 (7) 2 (1) 21 (7) 61 (26) 95 (29) 194 (46)26
Support-focused practices
Direct adult facilitation 9 (4) 5 (3) 12 (5) Y Y Y 6 (2) 1 (1) 8 (2) 15 (6) 6 (4) 68 (8)6
Educational placement 26 (1) Y 26 (1) 1 (1) Y 1 (1) 4 (2) Y 4 (2) 31 (3) Y 31 (3)2
Environmental modifications 5 (1) 2 (1) 5 (1) Y Y Y Y Y Y 5 (1) 2 (1) 5 (1)1
Instructional groupings 21 (4) 14 (6) 29 (7) 1 (1) 1 (1) 2 (1) Y Y Y 22 (5) 15 (7) 31 (8)5
Interactive activities 17 (4) 5 (3) 20 (5) Y Y Y Y Y Y 17 (4) 5 (3) 68 (6)5
Unified plans of support 4 (2) 1 (1) 5 (2) Y Y Y Y Y Y 4 (2) 1 (1) 5 (2)1
All support-focused studies 68 (12) 20 (10) 128 (17) 3 (2) 1 (1) 52 (3) 11 (4) 1 (1) 13 (4) 80 (17) 22 (12) 143 (22)13
All studies 103 (28) 118 (40) 253 (57) 19 (8) 17 (9) 83 (14) 49 (15) 6 (5) 51 (15) 166 (49) 239 (55) 434 (85)39
Note. Cells represent total number of participants (total of studies) clearly described by authors as reflecting having ID or ASD. BAll[ refers to the total number of students meeting the
inclusion criteria of this review (i.e., ID, ASD, ASD and ID, and not clearly specified). Because a given study could include students served under multiple disability categories, be
implemented at multiple school levels, and address multiple practices, row and column totals do not necessarily add up. Superscripts represent the number of research groups examining
the educational practice.
 Peer Interaction
studies with which each practice has been evaluated. For
example, at the elementary level, AAC use has been ex-
amined with nine students with ID across four studies and
with four students with ASD across two studies. Because
one study included students with ID and students with
ASD, the BAll[ column indicates the practice has been
evaluated with 13 studies across 5 studies. Due to vari-
ability in participant descriptions within studies and the
fact that some students had more than one disability (i.e.,
a particular student could be counted under both the ASD
and ID columns), the number of participants in the ID
and ASD columns does not always equal the total number
of participants with disabilities in these studies at a given
school level. Furthermore, the total number of students
and studies across educational practices or school level is
not always the sum of individual cells, as a given study
may have been implemented across multiple school levels
or included multiple educational practices. As displayed
in Table 3, student-focused practices and peer-focused
practices were examined in more studies and with more
students than support-focused practices. Overall, more
studies evaluated these practices with students with ASD
than students with ID. Moreover, most educational prac-
tices were evaluated at the elementary school level, with
substantially fewer studies conducted at the middle school
and high school levels. In the remainder of this section,
educational practices are summarized further by disability
and school level.
Student-focused practices
The most commonly evaluated student-focused educa-
tional practices were instruction addressing general social
skills, self-management of social behaviors, and AAC use;
the least frequently evaluated practices were conversa-
tional turn-taking and pivotal response training. Student-
focused practices were evaluated in almost twice as many
studies involving students with ASD as students with ID.
Three of the eight practices (i.e., cognitiveYbehavioralY
ecological social skills training, pivotal response training,
and social stories) were evaluated exclusively with stu-
dents with ASD. Conversational turn-taking instruction
was only evaluated with students with ID. Of the eight
student-focused practices, seven were evaluated with
students with disabilities at the elementary school level,
four at the middle school level, and three at the high
school level.
Peer-focused practices
The most commonly evaluated peer-focused educa-
tional practices were peer interaction training, peer aware-
ness training, and peer networks; the least often evaluated
practices were assigning roles and peer tutoring. Peer-
focused practices were represented in a similar number
of studies involving students with ASD and students with
ID. Moreover, comparable attention has been given to
each educational practice for both groups of students. All
of the peer-focused educational practices were evaluated
more commonly at the elementary school level than at
71
the middle or high school level. All but two of the practices
(i.e., assigning roles and peer tutoring) were evaluated at
the middle school level. Similarly, all but two (i.e., peer
interaction training and peer tutoring) were evaluated at
the high school level.
Support-focused practices
The most commonly evaluated support-focused edu-
cational practices were instructional groupings, interactive
activities arrangement, and direct adult facilitation; the
least commonly evaluated practices were environmental
modifications and unified plans of support. Studies ad-
dressing support-focused practices were more likely to
involve students with ID than students with ASD. All
of the educational practices received similar attention
among students with ID or ASD except for educational
placement, which was not evaluated in studies involving
students with autism. Of the six support-focused prac-
tices, all were evaluated with students with disabilities
at the elementary school level, four at the middle school
level, and two at the high school level.
Implementers
These practices were implemented by a variety of in-
dividuals including researchers, general and/or special
educators, paraprofessionals, and peers (see Table 2). In
28 (32.9%) studies, the researchers implemented the in-
tervention. In 22 (28.9%) studies, general and/or special
educators implemented the intervention. Peers were the
implementers in four studies (4.7%), and other individ-
uals (e.g., paraprofessionals and parents) implemented
the intervention in four studies (4.7%). Multiple imple-
menters (e.g., researcher and peers; educational teams)
were utilized in 27 studies (31.8%).
Social-Related Outcomes and Observations
Interactions were measured across a variety of dimen-
sions (e.g., rate, duration, frequency, and interval). Only
four studies focused on extended interactions (i.e., inter-
actions extending at least 3 s after original initiation).
Initiations by the student with ID and/or ASD were mea-
sured in 34 studies (40.0%). Fewer studies (n = 18, 21.2%)
focused on initiations from peers to participants with dis-
abilities. Less than a quarter (22.4%) of studies measured
the responses of participants with disabilities, and only
11 studies measured peers’ responses to initiations made
by participants with disabilities. Eight studies (9.4%) fo-
cused on conversation maintenance behaviors (e.g., expan-
sion and continuation). The quality of interactions between
students with ID and/or ASD and their peers was mea-
sured in six studies (7.1%).
Most studies exclusively focused on participants’ inter-
actions with peers without disabilities (69 studies, 81.2%).
In nine studies (10.6%), the researchers measured par-
ticipants’ interactions with both peers with and without
disabilities. In six studies (7.1%), the focus was on interac-
tions occurring with adults and peers without disabilities.
In one study (1.2%), researchers focused on interactions
72
occurring with adults, peers with disabilities, and peers
without disabilities. In 34 studies (40.0%), students with
disabilities were explicitly paired with peers without dis-
abilities, and both were given directions by adults (e.g.,
researcher or teacher) to interact with one another. In
22 studies (25.9%), students with disabilities and peers
were not explicitly paired together by adults. Students
with disabilities and peers were explicitly paired together
but were not provided with any instruction to interact
with one another in eight studies (9.4%). In the remaining
19 studies (22.4%), multiple peer partner arrangements
existed, wherein students with disabilities experienced a
combination of the above arrangements. Typically, this
was due to training, intervention, and generalization con-
ditions, wherein students with disabilities were explicitly
paired together and given directions by adults during
training or intervention phases and not paired together
or given directions by adults during generalization phases.
The type of partner arrangement was unclear in two stud-
ies (2.4%).
Forty-five of the studies (52.9%) provided information
about observer training. All but four studies (Bauminger,
2002, 2007a, 2007b; Owens et al., 2008) collected data
on the reliability or data collection of social-related out-
comes. Overall, every study had IOA levels meeting mini-
mal standards (e.g., IOA = 80%, Kappa = 60%; Horner
et al., 2005), although IOA levels sometimes went below
minimal standards for a single participant or measure in
a study.
Experimental Design
Single-case research methodology represented the
dominant approach for evaluating the efficacy of these
studies (n = 77 studies, 90.6%). Specifically, researchers
used multiple baseline or multiple probe designs in
53 studies (68.8%), reversal or withdrawal designs in
16 studies (20.8%), and multielement designs in 3 stud-
ies (3.9%); in 5 studies (6.5%), a combination of single-
subject designs were used. Experimental group designs
were used in 8 studies (9.4%). Per our selection criteria,
all studies employed designs in which experimental con-
trol could be demonstrated (Horner et al., 2005). How-
ever, experimental effects were not demonstrated in
one study (Fritz, 1990).
Design Features
Treatment fidelity
Information on the implementation of the indepen-
dent variable was measured (e.g., procedural checklists
and observations) and reported in 34 of the studies
(40.0%) to demonstrate that the implementation of the
intervention was systematically manipulated and under
the control of the experimenter with high levels of fidel-
ity (Horner et al., 2005). In general, these interventions
were implemented with high levels of fidelity (range,
72Y100%). In six studies (7.1%), treatment fidelity was
assessed either formally or anecdotally, but no findings
Carter et al.
were reported. In the remaining 45 studies (52.9%), there
was no mention of assessment of treatment fidelity.
Social validity
The social validity of the intervention goals, procedures,
and/or outcomes was measured and reported in 35 studies
(41.2%). In 19 of these studies (54.3%), the social impor-
tance of the dependent variable(s) was assessed, typically
by (a) asking teachers and/or parents through interviews
or surveys, (b) looking at the Individualized Education
Program (IEP) goals and objectives of student with dis-
abilities, and/or (c) conducting prebaseline observations of
the behaviors of student with disabilities. In 23 of these
studies (65.7%), the social importance of the magnitude of
change in the dependent variable(s) was assessed, typically
by (a) obtaining the perspectives of teachers and other
relevant stakeholders through interviews or surveys, (b)
conducting observations of peers’ behaviors to obtain nor-
mative comparisons for the dependent variable(s), and/
or (c) anecdotal information provided by teachers and/or
parents after the completion of the study. Of the 35 studies
in which social validity data were reported, 25 (71.4%)
addressed issues of acceptability, feasibility, effectiveness,
and/or continued use of the independent variable by ask-
ing teachers, peers, students with disabilities, and/or other
relevant stakeholders through interviews or surveys. In
most studies, relevant stakeholders were reported to have
found the outcome measures to be appropriate and so-
cially important and were pleased with the improvements
in these measures. Additionally, participants reported over-
all satisfaction with the interventions in terms of accept-
ability, feasibility, and effectiveness; however, participants
did occasionally report dissatisfaction or lower levels of
satisfaction on some components of an intervention.
Generalization
In 36 studies (42.4%), researchers measured and re-
ported generalization of treatment effects over time (n =
36 studies), across settings (n = 18 studies), and/or across
persons (n = 22 studies) to enhance the external validity
of the study’s findings (Horner et al., 2005). In general,
treatment effects were generalized across settings and
persons (e.g., untrained or novice peers) and/or main-
tained over time.
Discussion
Although current discussions of educational policies
and practices often emphasize academic performance and
accountability, the interactions children have with their
peers play a central role in promoting learning, relation-
ships, and quality of life. Although these social inter-
action opportunities certainly are no less important for
low-incidence students with disabilities than for any other
students, they may be considerably more elusive (Carter
et al., 2008; Katz, Mirenda, & Auerbach, 2002; Webster
& Carter, 2007). This review paper provides a com-
prehensive map of the intervention literature focused
on promoting social interaction among students with ID
 Peer Interaction
and/or ASD and their peers without disabilities. Findings
from this review highlight some of the considerations,
complexities, and challenges associated with identifying
evidence-based educational practices to promote social-
related outcomes.
First, a wide array of educational practices has been
evaluated within the literature, falling within three broad
categories of intervention approaches. Consistent with re-
views of interventions involving young children (Brown
et al., 2007; Goldstein, 2002; McConnell, 2002), peer-
focused and student-focused interventions were both pro-
minent within this school-based literature. Indeed, one
quarter of studies (n = 21) evaluated intervention pack-
ages combining these two approaches, intimating that in-
teractions may be enhanced when both students with and
without disabilities are equipped with the information and
skills to interact with one another confidently and effec-
tively. Support-based interventions, which involved adults
making changes to the educational environment, received
considerably less attention. Given the pervasiveness of
segregated educational services for students with signifi-
cant disabilities (Smith, 2007) and the burgeoning reliance
on individually assigned paraprofessional supports within
general education settings (Giangreco, 2010), addi-
tional attention should focus on examining how environ-
mental variables (e.g., educational setting, instructional
approaches, adult proximity and facilitation efforts) in-
fluence the interaction opportunities and outcomes of
students with disabilities. Indeed, some support-based
practices (e.g., inclusive practices) may be requisite to im-
plementing peer- and student-focused interventions.
The variety of educational practices subsumed within
these broad categories was also substantial. Among these
20 educational practices, peer interaction training, so-
cial skills instruction, and peer awareness activities were
most frequently evaluated. In nearly 40% of the reviewed
studies, however, multiple practices were combined in var-
ious ways within multiomponent intervention packages.
Such combinations may be necessitated by the complexity
of the social and communication challenges experienced
by many students with ID and/or ASD. At the same time,
the experimental designs typically used to evaluate these
intervention packages make it difficult to discern how
exactly these practices, individually or in various com-
binations, contribute to improvements in students’ social-
related outcomes. Although component and parametric
analyses could help elucidate the efficacy of individual
practices for educators, the number of intervention com-
binations required to isolate each practice or package var-
iation would not be tenable. To guide practitioners in
selecting the most appropriate practices, future researchers
should provide a stronger theoretical foundation for the
individual practices evaluated in their studies, as well as
articulate the underlying assumptions about the types of
social interaction challenges specific practices are designed
to address (e.g., social skills deficits, peer attitudes, and
limited interaction opportunities).
73
Second, discussion of evidence-based educational
practices must be accompanied by a clear description of
with whom a particular intervention has been evaluated.
Students with low-incidence disabilities represent an ex-
tremely heterogeneous segment of the grade school pop-
ulation, and many of the practices identified in this review
have not been sufficiently evaluated with students with
ID and/or students with ASD (see Table 2). Although
substantially more students receive special educational
services under the category of ID versus ASD in the
United States (567,818 vs. 166,645; U.S. Department
of Education, 2009), most participants in the reviewed
studies were described as having ASD. This heightened
attention may reflect the central place of social-related
deficits within the definitional criteria for ASD, the greater
general education participation of students with ASD,
recent increases in the identification of students with
autism, or other factors. Nevertheless, future research is
needed that focuses on (a) which specific educational
practices are most appropriate and effective for particular
students, (b) whether and how certain aspects of disability
moderate or mediate the efficacy of particular interven-
tion approaches, and (c) how practices could be adapted
to more directly align with individual student’s social-
related needs. Such research efforts must be accompanied
by more consistent and comprehensive participant infor-
mation (e.g., race or ethnicity; co-occurring disabilities;
diagnostic information; and communication, language,
and behavioral assessments) in published reports of future
studies. For example, given epidemiological data sug-
gesting that between 40% and 70% of children with ASD
may have a co-occurring ID (Matson & Shoemaker, 2009;
National Research Council, 2001), it is possible that many
more of the participants in the reviewed studies actually
had both ASD and ID.
Third, the school contexts within which these educa-
tional practices have been evaluated varied widely. This
literature reflects a heavier emphasis on intervention
efforts involving younger students, with nearly twice as
many studies conducted at the elementary compared to
secondary grades. Early efforts to promote peer inter-
action and friendships are certainly important; however,
there currently is limited evidence that the short-term
interventions identified in this review yield long-term
durable changes in the social relationships of children
with disabilities (cf., Kishi & Meyer, 1994). Changes in
the structure and focus of secondary schoolingVcoupled
with a peer culture that evolves throughout adolescenceV
highlight the importance of further deepening the knowl-
edge base at the middle and high school level. This gap
in the knowledge base is particularly apparent for high
school students with ASD. Future researchers might sys-
tematically replicate and refine those interventions found
effective at the elementary level to fit within secondary
programming and opportunities.
In addition, the appropriateness and efficacy of social-
related interventions may also be setting dependent.
74 Carter et al.
Although not directly evaluated in this literature, edu-
cational practices that facilitate interactions within the
classroom may not have the same impact within other
school settings (e.g., cafeterias, playgrounds, hallways,
and school-sponsored clubs). Collectively, this literature
reflects the diversity of contexts within which students
spend their school day. Slightly more than half of all
studies were implemented within inclusive classrooms,
mirroring current policy and legislative initiatives fo-
cused on increasing students’ access to the general edu-
cation curriculum (IDEA, 2004). Similarly, almost half
of all studies were evaluated within noninstructional
settings (e.g., lunch, recess, physical education, and tran-
sitions between classes), contexts within which social-
related conversations are more likely to be encouraged
and reinforced. Unexplored in most reviewed studies,
however, was the potentially influential role of peers
without disabilities on intervention efficacy. Little infor-
mation typically was provided about the students with
whom participants with disabilities were interacting; the
reasons they were identified for involvement in the in-
tervention; the directions and preparation they were pro-
vided by adults; or the knowledge, attitudes, and prior
contact they had (Carter, Hughes, Copeland, & Breen,
2001; Jackson & Campbell, 2009).
Fourth, in addition to identifying which practices work
with which students within which contexts, attention also
should be given to precisely who implemented these in-
terventions and how. Determining whether intervention
strategies produce promising outcomes when imple-
mented by practitioners without intensive support from
researchers or outside agents is an important element of
establishing educational practices as feasible, socially valid,
and effective (Snell, 2003). Most reviewed studies directly
involved practitioners (e.g., special educators, general edu-
cators, paraprofessionals) and/or peers in implementing
some or all of the intervention components. Moreover,
intervention fidelity (when reported) was sufficiently high
and social validity (when collected) generally affirmed
stakeholders’ satisfaction with the goals, procedures, and
outcomes associated with these practices. Future research-
ers, however, should apply the same level of rigor and
attention to documenting intervention fidelity and social
validity as they do to collecting dependent measures. Ad-
ditional research also is needed to examine the efficacy of
professional development approaches for equipping prac-
titioners to implement these practices with consistency in
everyday conditions and in ways that lead to noticeable
improvements in student outcomes.
In their presentation of quality indicators for single-case
research methodology, Horner and colleagues (2005)
proposed one benchmark for determining whether a prac-
tice can be considered an evidence-based practice, stating:
A practice may be considered evidence based when
(a) a minimum of five single-subject studies that
meet minimally acceptable methodological criteria
and document experimental control have been pub-
lished in peer-reviewed journals, (b) the studies are
conducted by at least three different researchers
across at least three different geographical locations,
and (c) the five or more studies include a total of at
least 20 participants (p. 176).
Although an adequate number of studies, participants,
and research groups have been represented for some
individual practices aggregated across all students (see
the far right column of Table 2), it is clear that when
factors such as disability and grade level are considered,
few practices have been evaluated sufficiently to warrant
consideration as an evidence-based practice. Indeed, we
were somewhat surprised by the number of unexplored
gaps identified in this map of the intervention literature
(noted by BY[ in Table 3). Additional research is needed to
explore the boundaries of these interventions by system-
atically replicating studies across disability groups, grade
levels, and other relevant factors. Moreover, focused meta-
analyses and best-evidence syntheses are needed to re-
view in greater depth those practices for which sufficient
studies have accumulated. We encourage new researchers
to draw upon this map of the literature as a starting point
for these important endeavors.
Fifth, unlike previous syntheses focused broadly on com-
munication and/or social skill outcomes for children and
adults with disabilities (e.g., Bellini et al., 2007; Reichow
& Volkmar, 2010), this review focused narrowly on studies
addressing interactions among students with disabilities
and their peers without disabilities. Although almost all
of the reviewed studies reported some increase in interac-
tion measures, very few studies documented increases in
prolonged interactions among these students. Moreover,
additional research is needed that addresses whether and
how improvements in social outcomes spill over beyond
intervention settings. Friendships are typically character-
ized by regularly occurring, lasting interactions that ex-
tend beyond the classroom or school day (Rubin et al.,
2009). To promote meaningful improvements in the
quality of life of children with low-incidence disabilities,
increased emphasis must be placed on implementing strat-
egies that create contexts for such friendships to develop
(Webster & Carter, 2007).
Limitations
Several of our search and analysis decisions place some
limits on the conclusions readers can draw from this lit-
erature review. First, this review focused only on recent
studies published since 1990, excluding studies that are
more than two decades old. As educational service delivery
and disability definitions continue to evolve, the relevance
of prior studies to the current evidence base should be
evaluated. Second, we focused narrowly on studies im-
plemented in grade school (i.e., elementary, middle, and
high schools), excluding studies involving young chil-
dren. Several prior reviews have already focused on early
 Peer Interaction
childhood, preschool, and kindergarten settings, which
may offer quite different social contexts for children with
and without disabilities. Third, we restricted our review
to interventions targeting social interactions with peers
rather than on studies examining improvements in stu-
dents’ communication, language, and social skill acquisi-
tion and use. Fourth, we included in our review studies
with as few as one or two participants with ID and/or
ASD (typically single-case studies). The external validity
of these particular studies may be more limited, as in-
tervention effects were not sufficiently replicated across
multiple students with developmental disabilities. More-
over, we were unable to discern whether some studies
may have involved the same student participants. Fifth,
although we arrived at consensus on an approach for
categorizing intervention practices in these 85 studies,
other approaches for characterizing and organizing these
practices also are appropriate (e.g., Bellini et al., 2007;
Reichow & Volkmar, 2010).
Although academic-focused interventions dominate the
special education literature (Mastropieri et al., 2009), this
review suggests that considerable interest in improving
the peer relationships of students with ASD and/or ID
remains. This body of literature is fairly impressive in terms
of its size, scope, quality, and diversity. At the same time,
it is clear that there is additional work still to be done to
ensure that educational practitioners are well equipped
with the range of strategies needed to promote meaning-
ful interaction among all students with and without dis-
abilities in their schools. We are hopeful this review of
the literature will provide valuable guidance to future re-
searchers, as they pursue this important work and continue
to develop the knowledge base addressing this domain.
Moreover, we hope this map of the current literature will
facilitate future syntheses focused more specifically on in-
dividual intervention strategies.
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Advance online publication. doi: 10.1177/0022466908328009
Received: September 29, 2009
Final Acceptance: December 10, 2009
Editor in Charge: David L. Westling