Conversation skills are an important intervention focus for verbally fluent school-aged children and adolescents with autism spectrum disorder (ASD). Three sets of approaches for supporting conversation skills are reviewed. Pragmatic language approaches focus on teaching the verbal and nonverbal skills needed to initiate and maintain conversations including strategies for recognizing and repairing communication breakdowns. Social skill approaches focus on similar conversation behaviors, but these behaviors are usually taught for use within specific social tasks such as entering peer groups, maintaining interactions, and resolving conflicts. Peer-focused approaches enlist the support of peers through direct teaching of strategies to engage and maintain conversations with students with ASD (i.e., peer-mediated interventions) or through environmental arrangement strategies to promote interactions between students with and without ASD (i.e., peer networks). Conversation interventions that incorporate strategies from all three sets of approaches are most likely to promote optimal outcomes. These outcomes include opportunities for students with ASD to develop and refine conversation skills with classmates who are more open to interactions with peers of differing abilities.