Within a three-tiered intervention framework, such as School-Wide Positive Behavioral Interventions and Supports, Tier 2 interventions were initially conceived as employing a standard protocol across all at-risk students. Research and practice, however, suggests advantages to adapting interventions so they are tailored to individual student needs. In this literature review, we examined adaptations to social skills training (SST). We identified 19 studies that implemented SST within a tiered framework, eight of which made adaptations. Across the studies, nine different types of adaptations were made. All studies made multiple simultaneous adaptations with the 156 participants, which resulted in uniformly favorable outcomes. Most studies made adaptations at the study onset and the rationale for making the adaptations varied. Studies varied in the number of Quality Indicators present. This review indicates that adaptations may improve the effectiveness of Tier 2 interventions; however, additional research is needed to provide further evidence of the effectiveness of individual adaptations and to identifying procedures for selecting adaptations matched to student need.