This review examined the effectiveness of peer-mediated pivotal response treatment (PM-PRT) to increase social-communication skills for children with autism spectrum disorders (ASD). A systematic review was conducted of all published studies examining PM-PRT in school-aged children with ASD, based on an established rubric. Five PM-PRT studies utilizing single-subject research designs were reviewed, involving 29 participants (8 with ASD and 21 peer coaches). Most studies of PM-PRT observed positive outcomes. However, the existing research base did not meet criteria for classification as promising or established evidence-based practice (EBP) for improving social skill deficits in children with ASD. More research is required for PM-PRT to be considered formally as EBP. This review may be used to guide clinical decisions for school psychologists and future research. Our aim was to highlight the rationale for, and core aspects of, this intervention and discuss school-based applications.