Shaw, E., Meredith, K., & Hume, K. (2009). Visual Supports. Chapel Hill: National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, The University of North Carolina. Visual Supports

Learning Objectives for Visual Supports As a result of this presentation, practitioners will: 1. describe the evidence that supports the use of visual supports. 2. identify skills that can be promoted through the use of visual supports. 3. explain the different types of visual supports and when they might be used. 4. implement the steps of visual supports as intended. 5. discuss importance of fidelity of implementation and progress monitoring when using visual supports.

Overview of Visual Supports Definition: Any tool presented visually that supports an individual as he/she moves through the day Includes: Pictures, written words, objects, arrangement of the environment (visual boundaries), schedules, maps, labels, organization systems, timelines, and scripts

Visual Supports in Our Everyday Lives

What do we know about visual supports? Meets our EBP criteria with 13 single-subject studies Can be effectively implemented with learners from early childhood through middle school with autism and high functioning autism  Early childhood settings: visual schedules to increase task engagement, visual scripts to encourage social interaction, and picture cues to support play skill development  Elementary and middles school: visual schedules and pictures cues to reduce transition time, increase on- task behavior, and complete self-help in the home

What do we know about visual supports? Skills and intervention goals that can be addressed by visual supports include:  Targeting adaptive behavior (e.g., task engagement, independent performance, transitions across activities, and increasing response chain length) Increasing skills across curriculum areas: play skills, social interaction skills, and social initiation  Reducing self-injurious behavior May be used in classroom and home settings as one component of comprehensive programming

Why are visual supports useful for learners with ASD? Complete more tasks by themselves therefore increasing their independence Learn more rapidly Demonstrate decreased levels of frustration, anxiety, and aggression related to task completion Adjust more readily to changes in their environments (Savner & Myles, 2000)

Types of Visual Supports Visual Schedules Visual Boundaries

Step 1. Developing Visual Supports for Individual Learners Determine what information should be presented visually. What activity, event, or concept  causes frustration and or anxiety,  requires a great deal of adult support for success, or  is difficult for the learner to understand when information verbally presented?

Step 1. Developing Visual Supports for Individual Learners (cont.) Conduct an individual assessment of the learner’s comprehension skills in order to determine which form of visual representation will work.  Objects, photographs, drawings or picture symbols, words, phrases/sentences, or combination of the above

Step 2. Organizing Visual Supports for Individual Learners Ensure that the selected visual support is arranged, organized and in place prior to the activity or event.

Step 3. Implementing Visual Supports for Individual Learners Show learner the visual support

Step 3. Implementing Visual Supports for Individual Learners (cont.) Teach learner to use the visual support:  stand behind the learner when prompting the use of the support  use only relevant language (as few words as necessary)  assist learner in participating in activity/event  fade prompts as soon as possible

Step 3. Implementing Visual Supports for Individual Learners (cont.) Once student has learned how to use visual support, use minimal prompts Use visual supports throughout the day Prepare the learner for changes in activity or event that requires the use of the visual support Visual supports move with the learner across settings or are located across settings Collect data on how learner uses visual supports (i.e., level of prompts, independence, types of visual prompts used)

Overview of Visual Boundaries Definition: A type of visual support that includes furniture arrangement, labeling, and color coding to make the use of a particular space more obvious

Visual Boundaries in Our Everyday Life

Why are visual boundaries useful for learners with ASD? Helps define for learner where things begin and end. Helps define for learner areas that are accessible without supervision. Provides meaning and context to an area or environment.

Steps for Implementation of Visual Boundaries

Step 1. Define/Prioritize the Need Is there a safety concern? Does the learner have difficulty staying in one place? Does the learner know what she/he is to be working on in an area? Does she/he leave a location because of frustration? Does the learner have difficulty with entering others’ work spaces and/or making use of others’ work or personal materials?

Think about your student… Select a location your student visits throughout the day and describe some of elements of visual boundaries that are in place or that you would like to put in place.  Consider what visual or physical boundaries are needed

Step 2. Define the Boundary Establish where the visual boundary should be Use natural physical boundaries, objects, and furniture

Step 3. Teach the Boundary Introduce learner to the boundary Use modeling to teach the learner to stay within the boundary Model and use reinforcement when learner stays within the boundary Model and use corrective feedback when learners do not stay within the boundary Be consistent!

Step 4. Evaluate Success Collect data on learner’s use of boundaries Collect data on learners’ related target behaviors Make data-based decisions regarding the effectiveness of the intervention Monitor on-going effectiveness and impact of intervention on learner behaviors

Process for Determining the Best Evidence- based Practice

Let’s suppose this is our goal… Goal: John will improve his ability to independently transition from one activity to another throughout the school day. Related Objective: John will increase his engagement in the task during an activity.

How do we decide which EBP to use? Let’s say we know this… John is in a self-contained preschool setting. John is handed an object to transition between all activities. John has shown that he is able to match objects to pictures.

How do we decide which EBP to use? Ask: What is our objective targeting? Transition, adaptive behavior (independence) Ask: What are our options?

How do we decide which EBP to use? Next, make a decision based on: your professional wisdom, the learner’s learning style, the learner’s temperament, the learner’s interests and motivators, supports already in place, and history of what has and hasn’t worked.

How do we decide which EBP to use? So, let’s say we decide to try… Visual Schedules What does this look like for John?

Steps for Implementation of Visual Schedules

Step 1. Overall Classroom/ Environment Schedules Display an overall classroom/environment schedule with staff and learner assignments  Location of displayed schedule  Format of the schedule (e.g. pictures, words, combination)  How/when will overall schedule be used

Step 2. Developing Individual Schedules Conduct an individualized assessment of learner’s (1) comprehension level, (2) attention span, and (3) sequencing abilities in order to select the appropriate:  form of representation,  schedule length and presentation format,  method of manipulating the schedule,  location of the schedule, and  method to initiate schedule use.

Forms Functional objects used in activities Object that is symbolic of activity Photograph Photograph with words

Forms Drawing or picture symbol with words Word Phrase or sentence

Schedule Length/Presentation One item – signifies upcoming transition Two items (left to right or top to bottom) Three to four items (left to right or top to bottom)

Schedule Length/Presentation Half day (left to right or top to bottom) Full day (left to right or top-to-bottom) Teacher Art Lunch Computer Library

Method of Manipulating Schedule Learner carries an object to be used in upcoming activity Learner caries an object/visual cue and it is matched in the corresponding location Learner turns over visual schedule cue/puts cue in a finished location when activity completed Learner marks off visual cue on schedule as completed

Location of Schedule Schedule information is brought to the learner. Schedule is stationary at a central location. Portable schedule.

Initiating Use of Visual Schedules Schedule information is brought to the learner Learner moves to the schedule using a visual transition cue

Step 2. Developing the Visual Schedule Additional elements may be added to visual schedules as necessary such as:  Color coding  Times  Alignment with school bells  Motivational components (e.g., pictures of favorite characters) or  Behavior cues (reminders about specific expectations)

Step 3. Organize Visual Schedule for Learners Arrange the learner’s daily schedule and related elements for the learner either prior to the learner’s arrival or with the learner Ensure that visual transition cues are in place, if appropriate Ensure that the classroom/school areas are visually labeled with matching schedule components

Step 4. Implement Visual Schedules Give learner a visual cue to transition to the schedule or bring schedule information to learner Teach the learner how to transition to the schedule with a visual cue and/or how to transition to location with schedule information Minimize prompts once learner has learned how to use the schedule Have learner use schedule consistently throughout the day

Step 4. Implement Visual Schedules Visual transition cue use is consistent throughout the day Prepare the learner for changes in scheduled activities Individual schedules move with learner across settings or elements of visual schedules are located across settings Use a data collection system to record learners use of visual schedules

Visual Schedules: Examples

Visual Supports: Take Home Points Visual supports must be age appropriate and individualized. Visual supports will have different forms, lengths, presentations, locations, and methods of manipulation based on individual needs. Visual supports may be used in all settings and across environments. Visual supports should be used consistently, implemented with fidelity, and monitored through data collection to determine effectiveness.