DESCRIPTION OF THE STRATEGY

Clinicians have increasingly recognized the potential of peers as effective agents of behavioral
change in children. A considerable body of research conducted over the past three decades has
convincingly demonstrated that the peer group exerts strong influences on the acquisition and
refinement of a wide range of skills, most notably social skills and academic competencies.
Given their important role as teachers across a wide range of skills and settings, peers are a
natural choice for treatment agents and can be equally or more effective than adults. Peer
intervention strategies focus on using children's interactions with age mates as a means of
teaching new skills through modeling, providing opportunities for skill usage, and improving
upon already established competencies. Targets have been wide-ranging. Teaching social
skills, increasing rates of peer interaction, decreasing disruptive classroom behavior, and
remediating academic deficiencies are some examples.
Peer intervention can be split into two broad categories: indirect and direct peer approaches.
Indirect approaches capitalize on naturally occurring contingencies to increase appropriate
social and academic behaviors. Particular strategies falling in this category include the use of
group reinforcement and peer modeling. Group reinforcement involves using the responses of
the peer group as naturally occurring reinforcement for socially appropriate behaviors. Peer
attention is an often-used example. A child who is behaving in a socially competent way will
receive attention and acceptance from the peer group. For example, a student who is sharing
toys with the other children in the classroom will receive praise and attention from the peers
around him or her. This positive attention, in turn, will increase the likelihood of using
socially appropriate behavior in the future. In contrast, if a child is behaving in an
unacceptable manner, the group might ignore the child and the behavior, resulting in
behavioral change. For example, children who react with a tantrum when they do not get what
they want might be ignored by the peer group. Peer modeling is another indirect strategy that
entails using competent peers as exemplars of adept behavior. With a strong empirical basis in
the work of Bandura, the rationale for using peers as prototypes is that after target children are
exposed to models of skilled behavior, they are likely to acquire new competencies, altering
their own behavior to match that which they have observed. Children are more likely to
imitate a peer they perceive as receiving reinforcement and less likely to emulate behavior of
a peer who has been punished for a behavioral transgression. In somewhat more direct
variations, sometimes using prompts and reinforcement, peers have served as coping models
in treatments addressing a whole range of presenting concerns from specific phobias to
compliance with painful medical procedures. Overall, indirect peer intervention strategies use
peers in a subtle way to increase or decrease particular behavior patterns.
The direct peer approach, in contrast, utilizes peers in a more immediate manner to enhance
children's social competence and academic behaviors. Direct peer interventions include peer
proximity techniques, direct peer prompting and reinforcement, and peer initiation strategies.
The peer proximity approach is based on the premise that placing skilled peers with target
children will allow for the natural transmission of skills from one child to another.
Furthermore, these children are more likely to use newly acquired skills when surrounded by
a peer group that facilitates and reinforces their use. Accordingly, children with behavioral
problems are simply placed with more socially competent peers. The socially skilled
companions are often instructed to play with the target child, engage the child in play, and
teach the child how to play. Peer prompting and reinforcement involve, as the name implies,
teaching peers to prompt and reinforce the responses of target children. A prompt is defined as
a directive to engage in an activity (e.g., Why don't you get on the swing and I'll push you),

and reinforcement comes subsequently during the interaction (e.g., I like to play with you).
Peer initiation, however, is the most frequently used intervention for promoting social
interaction among target children. Using this approach, socially competent peers are
instructed to both initiate social interactions and to respond to initiations from children with
behavioral problems. Social initiation may include asking a child to play, suggesting an idea
for an activity, or providing assistance with something. Direct peer intervention techniques
can be used with either a single peer or within the context of multiple peers.

RESEARCH BASIS
The research shows immediate and substantial treatment effects for the use of peer
intervention, but with some differential efficacy across treatment strategies. Specifically,
large-scale reviews of the treatment literature suggest that peer initiation and
prompt/reinforcement interventions have comparatively stronger effects on positive behavior
changes than do proximity interventions. In terms of the indirect strategies, empirical work
demonstrates significant effects of both peer modeling and reinforcement strategies. As
suggested, researchers have demonstrated that children are likely to imitate peers whom they
perceive as the recipients of reinforcement from fellow classmates. Similarly, in terms of
reinforcement interventions, peer attention has empirical support as a useful tool for
modifying disruptive classroom behavior. Specifically, the withdrawal of peer attention has
been demonstrated to reduce disruptive and inappropriate behavior in the classroom.
Interestingly, several studies report concurrent social gains by the competent children who
serve as peer-intervention agents.
Despite such short-term success and the fact that these types of intervention are often touted
for their hypothesized ability to enhance generalization, the generalization and long-term
stability of these effects are less clear. In terms of generalization of new skills to
nonintervention settings, the findings are inconsistent. Regardless of the strategy that is
employed, some researchers find cross-setting generalization, whereas others do not. Overall,
it seems that socially competent and responsive peers must be present in order for skills to
generalize to new settings. The same kind of mixed evidence exists regarding the maintenance
of treatment effects across time. It should be noted that ambiguities regarding generalization
and maintenance of effect exist not only for peer intervention techniques but for most social
skills training approaches in general.

RELEVANT TARGET POPULATIONS

Children benefiting from peer interventions generally suffer from social skills deficits, social
withdrawal, behavioral disorders, or academic deficiencies.
These kinds of interventions are shown to be useful with populations of children ranging in
age from early preschool through adolescence. Moreover, peer intervention techniques are
demonstrated to be effective with special populations, including autistic and mentally retarded
children. Although peer interventions have been used almost entirely with children, there is
some evidence to suggest that these kinds of strategies may also be useful with alternative
populations, including developmentally mentally disabled adults and the elderly.

COMPLICATIONS

Practically speaking, peer-mediated intervention, particularly in its more direct forms, seems
best suited for clinicians working in settings, such as school and treatment programs, in which
they can more readily recruit and utilize groups of children. For the individual clinician in a
private practice, the practical obstacles are many. For example, identifying and recruiting
more competent peers while balancing needs for client confidentiality may not be possible.
Likewise, gaining the consent of larger groups of peers without bringing unwanted attention
to the target child is difficult if not impossible. Furthermore, the clinician must obtain consent
from the other child(ren)'s parents to be included as part of the intervention. As is easy to
imagine, it may be difficult for a clinician to provide incentive to parents of a normally
adjusted, socially competent student to have their child participate in the psychological
treatment of another child in the classroom.
An issue of particular concern to participating parents, schools, and Institutional Review
Boards is the possibility of negative consequences for the more socially and academically
skilled peer. Past research on group therapies with behaviorally disordered adolescents has
demonstrated that peers often can reinforce negative behavior in other children. In other
words, it is possible that the direction of influence will not simply flow from the socially
competent peer to the target child. Instead, it may be that the target child negatively impacts
the behavior of the skilled peer. To shield against these kinds of negative outcomes, peer
interventions must be closely monitored both by the clinician and the other adults in the
children's environment. Indeed, when these kinds of interventions are executed appropriately,
it is often found to be beneficial to the participating peer.

CASE ILLUSTRATION
Bobby was a 9-year-old boy enrolled in the third grade who lived with both parents, an
older brother, and a younger sister. After beginning elementary school, Bobby became
increasingly socially withdrawn in the classroom. He spent most of his free time at school
playing alone, removing himself from group activities, and physically placing himself in the
corner or in remote regions of the playground. Most notably, Bobby did not speak and would
only respond softly when questions were posed directly to him. As a result, Bobby's
classmates did not befriend him and did not include him in class activities either at recess or
after school. At that time, Bobby did not identify any children as friends and spent most of his
time either playing alone or occasionally with his siblings.
At the time of intake, a thorough behavioral assessment was performed to determine the
nature of Bobby's problems in the school setting. A classroom observation was done in which
rates of interaction with both peers and teachers were noted and his withdrawing behaviors
were identified. Furthermore, both Bobby's teachers and parents completed behavioral rating
scales. These procedures converged with interview findings to suggest significant social
withdrawal and skills deficits. Assessment results further suggested that Bobby's social
problems were becoming worse over time and that neglect by his classmates was leading to
increased levels of social withdrawal in the classroom.
In addition to social skills training, treatment involved a combination of peer-mediated
interventions. First, a socially skilled peer was identified by Bobby's teacher. Consent was
obtained from that student's parents, and Bobby was paired with the peer in the classroom.
This classmate was instructed to teach and model ways that Bobby could both join, as well as
initiate, group activities. Furthermore, Bobby's peer teacher provided instruction to Bobby on
starting conversations with other children and reinforced Bobby with praise and attention

when he successfully initiated conversations on his own. Moreover, the selected peer was
instructed to engage Bobby in activities frequently throughout the day (e.g., How about we
play kickball at recess?) and to provide Bobby with reinforcement (e.g., Sure, it will be fun
to play a game together later) when he asked the child to engage in social activities.
Spending increased amounts of time with a socially skilled peer allowed Bobby to practice
some of the social skills he was simultaneously learning in the context of skills training and
thereby generalize these skills from the therapy to the class setting.
After 2 months, a follow-up classroom observation was conducted, and behavioral rating
scales were readministered to Bobby's parents and teachers to determine the effectiveness of
the intervention. These assessments indicated that Bobby began initiating interactions with
other children in the classroom, played and talked more frequently with other children
throughout the school day, isolated himself less often, and joined in group activities. As
Bobby's repertoire of social skills increased, his social withdrawal began to decrease and,
accordingly, his social acceptance within the classroom improved.
Douglas W. Nangle, Karen R. Zeff, and Michelle S. Rivera
Further Reading

Entry Citation:
Nangle, Douglas W., Karen R. Zeff, and Michelle S. Rivera. "Peer Intervention."
Encyclopedia of Behavior Modification and Cognitive Behavior Therapy. 2007. SAGE
Publications. 15 Apr. 2008. <http://sage-ereference.com/cbt/Article_n2089.html>.