Peer interactions in children and adolescents with autism : a systematic review

Peer interaction plays a central role in social, emotional, and cognitive development across childhood and adolescence. For autistic individuals, difficulties in peer interaction are a defining feature and are associated with reduced social participation, limited social learning opportunities, and adverse outcomes such as loneliness, social rejection, and isolation. Despite its importance, the literature on peer interactions in autism remains fragmented, employing diverse measures, age groups, and study designs, with inconsistent attention to individual and environmental factors. The aim of this systematic review was to examine the quantity and quality of peer interactions among autistic children and adolescents, and to explore how peer interactions are associated with individual and contextual characteristics, including age, sex, autism severity, social skills, cognitive abilities, partner type, and emotional and behavioral factors. Electronic searches (2014–2024), supplemented by manual journal searches, identified 22 quantitative and mixed-methods studies focusing on peer interactions (excluding interventions) among school-age autistic participants. Through inductive thematic analysis, four central themes emerged: peer participation and social network centrality, interaction quality, partner type, and individual differences. Overall, autistic children and adolescents demonstrated lower peer engagement, more peripheral or isolated social positions, and lower peer acceptance compared to neurotypical peers. Importantly, findings showed substantial heterogeneity: some autistic individuals demonstrated meaningful joint engagement and higher social status, with variability influenced by age, autism severity, social skills, cognitive abilities, emotional factors, and partner type. These findings highlight the need for developmentally sustained, peer-based interventions that promote complex social engagement, reduce social isolation, and acknowledge the value of both mixed and autistic–autistic peer interactions. Future research should employ consistent, naturalistic measures and include more diverse samples to better capture individual variability in peer experiences.