How to Use Visual Aids to Support Children With Autism Spectrum Disorder.

This blog explores techniques and ideas that come from the Positive Behaviour Support Framework which you can read more about here

Visual aids are a really effective way to empower children with Autism Spectrum Disorder (ASD) to communicate, learn, participate and develop independence.

When you’re supporting children with ASD, be it at home, community or a classroom it’s helpful to know how best to implement visual aids.

What is a visual aid?

A visual aid involves the use of a symbol such as an object, photograph, line drawing and written word to help the individual understand, express and interact with others.

Why are visual aids so empowering for children with ASD?

Children with ASD experience difficulties in social communication and social interaction. Visual aids are a helpful tool to support the development of these skills. To help understand how let’s define communication more clearly.

Communication is a two-way process involving an exchange and flow of information and ideas between at least two people. This two-way process can be broken down into three broad categories: 

1. Receptive communication is the process of receiving and understanding a message from a communication partner. For example, understanding words, phrases, instructions, directions, questions etc. 
2. Expressive communication refers to the way the child conveys a message that is to say, to communicate their needs, wants, information, feelings and ideas to a communication partner verbally and/or non-verbally. We use facial expressions, vocalisations, gestures, signs and body language to do this.   
3. Social communication refers to when, how and for what purpose the child uses communication. For example, making eye contact, sharing with others, or having a conversation.

When children cannot understand messages from their environment or communicate their own message across visual aids are a useful tool. Visual aids enhance, support and supplement the individual’s communication skills empowering them to interact with the world and others effectively.

Let’s look next at the different types of visual aids available to us as parents, caregivers and teachers.

What are the different types of visual aids you can use to support children with ASD?

An object, photo, line drawing and the written word can be used as a visual aid.

At the top of this table are the least abstract visual aids and at the bottom, the most abstract:

Aid	Description	Image
Objects	Objects refers to the use of an item to represent people, places, activities and things. For example, a key to represent going for a drive.
Object Symbols	Object symbols refers to using a whole or part of an item to represent an activity, person or thing. The item is attached (e.g. with Velcro, glue or string) to a board (e.g. cardboard, laminated card), which is especially useful when it is difficult to carry the whole object. An example of a part object symbol is a piece of towel to represent having a shower.
Photographs	Photos refers to the use of photographs to represent people, places and activities. This includes non-digital and digital photos, Polaroid photos, pictures cut out from magazines or catalogues. For example, a photo of a park to represent going for a play.
Line Drawings	Line drawings refers to the use of coloured or black and white line drawings (hand drawn or commercially produced) to represent people, places, activities and concepts. Examples of commercially available programs include Clipart, Boardmaker, Lessonpix and Clipart.  Example of a line drawing of school to represent going to school.
Written word	Written word refers to the use of the written words to explain concepts. For example, a list of steps the individual needs to follow when brushing their teeth.	1. Get toothbrush and toothpaste. 2. Put toothpaste on toothbrush 3. Brush teeth. 4. Spit in sink. 5. Rinse toothbrush.

What are visual systems?

It is important to embed visual aids into visual systems.  As the saying goes “A picture can say a thousand words…” in other words a visual aid (an object, photo, line drawing, written word) on its own can communicate a variety of meanings.  For example, if you saw a photo of a ‘park’ it could mean ‘this is what a park looks like’, ‘I want to go to the park’, ‘I went to the park’ or ‘I am going to a park’.  

However, if the photo of the park was embedded in a visual system it would help convey a more specific message.  

For example, to convey the message ‘I want to go to the park’ the photo of the park can be embedded in a ‘Choices visual system'.  The purpose of a choices visual system is to present all the activity options to the child so they can choose between one or another (Figure 1). 

Figure 1 - Choices visual system for: ‘I want to go to the park.’

To convey the message ‘I went to the park’ the photo of the park can be embedded in a ‘Chat Book’, the purpose of which is to help the child talk about what they have done (Figure 2).

Figure 2 - Chat book visual system for: ‘I went to the park.’

To convey the message ‘I am going to the park’ the photo can be embedded in a ‘Schedule’ system whose purpose is to help the child understand the sequence of events in their day (Figure 3).

Figure 3 - Schedule visual system for: ‘I am going to the park.’

Those are just three examples of visual systems incorporating visual aids that are helpful to children with Autism Spectrum Disorder. But of course there are many others that can be used. Some of them include:

• Calendars
• Schedules
• Mini-schedules
• Choice systems
• Cause-effect links
• Social stories
• Category books
• Circles concepts
• Activity checklists
• Chat books
• Feeling - problem - solution charts
• Behavioural rules
• Comic strip conversations
• Shopping lists
• Cue cards
• PECS (Picture exchange communication system)
• ALS boards (Aided language stimulation)
• PODD (Pragmatic Organisation Dynamic Display)

Why use these visual systems when supporting children with ASD?

Visual systems can be particularly helpful for children with ASD by addressing the following: 

1. Communication difficulties

In order for communication to take place, the child needs to understand what is being communicated to them and be able to convey their messages. It can be very frustrating for children who have difficulties with understanding and/or expressing themselves. This frustration can often lead to the child resorting to using inappropriate behaviours to get their message across. Visual systems can make communication more accessible.

2. Slow information processing  

Slow information processing means that the way the brain is processing communication is affected.  As a consequence the child requires more time to "take in" the information, process (interpret) the information and respond to the information.  The child may require multiple opportunities to practice and remember the information.  Without the additional time the information may come and go too quickly without the child understanding or responding appropriately.  

Visual systems are permanent and non-transitory whereas language is fleeting.  In other words when we present information verbally, the words are available for a brief moment and if the child did not hear the verbal information then they have missed out.  Whereas when the information is presented visually it is static and it can be there for as long as the child needs.  

3. Attention difficulties

Effective communication requires the ability to rapidly establish attention on what is being said, maintain attention and shift attention to the next topic. 

However, many children with attention difficulties experience difficulty establishing, maintaining and shifting attention at the speed necessary to participate effectively in communication interactions.  

As a consequence the verbal information may disappear before the child has had a chance to pay attention enough to take in what is being said. They may miss a lot of information and only receive fragments of the verbal information.  Visual systems can address these issues by staying there as long as the child needs to see the information, take it in and respond to it.

4. Learning style

Learning style refers to how your child approaches learning.  Researchers discuss a variety of learning styles but in this booklet we will discuss only three – visual, auditory and tactile learning styles.  Some children may have a dominant style of learning, with far less use of the other styles.  Other children may find that they use different styles in different circumstances.  There is no right mix, nor are the styles fixed. Your child can develop ability in less dominant styles with guidance and support.  

Many children are not easily able to understand verbal messages as this requires the child to have an auditory learning style. However, using visual systems can supplement the verbal information and clarify the information.  Also, promoting the child’s active physical exploration / engagement in the activity can increase understanding and learning. 

Thus, visual systems also help children develop the following skills:

Communication
Listening
Social Skills
Vocabulary	rat cat mat
Independence
Self Esteem
Life Skills
Play
Writing
Reading
Maths	1+1 = 2; 2+2 = 4; 3+3 = 6

When should you use visual systems?

Visual systems should be used throughout the day as communication is an integral part of life, so it is best learned and practiced as part of everyday routine.  You can create activity specific visual systems that can facilitate the development of your child’s receptive, expressive and social communication skills.  

Integrating Visual Systems Into the Child's Life
Sleeping
Eating
Toileting
Bathing
Getting Dressed
Playing
Cleaning Up
Visiting People
Shopping
Fun Outings

What are some of the considerations for choosing appropriate visual aids and visual systems?

Each visual system should be individualised to meet the needs of the child.  In order to create systems that will be effective tools for each child, consideration must be given to a variety of factors such as: 

1. Choice of visual aid

Deciding on the way a message should be represented – i.e. objects, photos, line drawings or written word will depend on what the child understands. The ability to understand different levels of abstraction will vary from child to child.  Begin by using visual aid that your child understands.  For example, if your child responds best to photos then photos should be used.  Remember to always use speech when using visual aid.

If you are unsure, researchers suggest that it is best to start with objects and then gradually move to photographs before moving to line drawings.  The aim is to start simple and then gradually work towards the more abstract.  

For example, consider how a child might learn to request a drink:  Starting with a photo to make a request for a real object can be too abstract.  Initially, the child might need a real cup to request juice.  You can teach that a photo of a cup and a real cup represent the same thing by first using the real cup with the photo, and then transitioning to just using the photo.  Some children may always prefer the real object.  

The goal is simply to provide whatever makes the connection for a child.  If you see confusion or frustration in the child's attempts to communicate, decrease the level of abstraction.  If you are unsure how to begin to use visual systems with your child at home, contact a speech pathologist.

It is important to label the visual aid (e.g. object, object symbol, photo, line drawing) with the written word. The text will promote an interest in letters and words, and some children may even become early readers.  By labelling the visual aid it also ensures that everyone using it with the child will use the same language when interacting with them.   

2. Number of visual aids

You will need to consider the number of objects /photos /line drawings/written words your child can use at a time.  Researchers suggest that you should gradually build the number of visual aids you have on your child’s visual system.  You may begin with one or two and as your child’s understanding develops you can keep adding more.  

3. Size of visual aid

Depending on your child’s visual skills the way you present the visual aid may need to be modified.  It is important to make sure your child can see the visual aid so you may need to change its  size for optimum viewing.  If the child needs the visuals to be distinctive, highlighting and darkening the outline of the picture may help. 

With some types of visual impairments such as colour blindness, presenting the visual aid on a contrasting background is beneficial.  For example, an object or a dark object in a photo or line drawing should be displayed on a white background or a light object on a dark background. 

4. Time

Most importantly be sure to give your child enough time to focus on the visual aid.

5. Presentation of visual aid 

Depending on your child’s visual scanning abilities (horizontal scanning – looking from left to right; vertical scanning – looking from top to bottom) present the visual aid accordingly.

6. Location of the visual system

The visual system should be easily accessible for the child.  It should be stored in the location where the child will be engaging in the activity.  For example, a food and drink choices page could be kept in the kitchen.  You could put it on the fridge or a wall or a dining table so that it’s in view.  

7. Portability of the visual system 

This is an important consideration which will determine how big/small; heavy/light or fixed/portable the system will be.  If the child has difficulty with mobility then you will have to determine ways that the child can access their visual systems as independently as possible.

8. Tips on taking photos

• Have a good camera preferably a digital camera. 
• Make sure that there is enough light so that the photograph comes out clear. Use the flash as necessary.  
• When taking photographs to use for communication, it is helpful to make the photograph as simple as possible. Include only one object in the picture or make the background blank. 
• When taking a photo focus on what's really important and try to avoid any extraneous aspects that may be distracting.
• If you do have extraneous parts you can chop them off by either cutting around the extraneous parts or using image editors to crop the important part in your picture or enhance the image.  
• Take the photo from a good distance and from the child’s perspective. 
• Get a variety of shots so that you can choose the most appropriate photo i.e. the one that conveys the information accurately.
• You can print the photos at most photo shops or online.

9. Additional cues

In conjunction with the visual system use speech and the following cues to support the indivdiual's comprehension. Examples of additional cues include:

• Routines. i.e. use them in the same way each time consistently. 
• Environmental arrangement for example, at the dining table have a drink choices chart so that the individual can select what drink they would like. 
• Body language i.e. facial expressions, proximity, body stance, movement of body, reaching, touching, pointing, eye contact, eye gaze, and gestures. 
• Key signs e.g. Makaton is a key word signing system that provides a means to communicate and encourages language development.
• Other natural cues (i.e. taste, touch, smell).

What do you need to make visual aids systems?

You will need the following:

• Velcro (rough/smooth or hook/loop)
• A4/A3 Laminator
• A4/A3 Laminating pouches
• Scissors
• White/Coloured paper
• Digital camera for photos
• Colour printer
• Magazine and catalogue pictures
• Labels from food products, toy boxes, etc.
• Line drawing picture software programs if appropriate.  

Examples of visual systems you can use at home, community or in the classroom

Calendar: Visual systems for individuals with Autism Spectrum Disorder

What? A calendar is a visual system that represents time (i.e. week, months and years) in a concrete manner. The calendar can be used to record the main outing for the day, appointments alongside holidays, trips and other important events. The calendar can be weekly, monthly or yearly, based on the individual’s understanding. 

Why? Time is an abstract concept. By using a calendar, you can associate each day and date with the main activity for that day. The main activity for each day marks the passage of time and helps the individual countdown to a particular day. 

Where? Display the calendar in an accessible area so that the individual and caregivers can refer to it as necessary to see upcoming appointments. 

How? Choose a calendar layout suitable for the individual’s abilities and understanding and add appointments. At the beginning of each day, refer to the calendar to identify the day and the main activities the individual will be participating in on this day.  

Below is an example of a calendar system that was put in place to inform Edmond of when he will be going to school.

Schedule: Visual systems for individuals with Autism Spectrum Disorder

What? A schedule is a visual system that provides information about the sequence of activities that will occur within a specific time period. A simple schedule is called a ‘Now’ schedule, which highlights the upcoming activity. The next more complex schedule is called a ‘First-Then’ schedule, which informs the individual about the sequence of events that will be occurring in a specific period of time (i.e. first… and then…). The most complex schedule presents all activities that will occur throughout the day. Schedules can be used to explain to the individual of the sequence of upcoming activities.  
 
Why? Schedules can assist the individual in transitioning from the preceding activity then to the activity that follows it, as they know what they will be doing after each activity concludes. A schedule can also motivate the individual to attend a non-preferred appointment, especially if they can see that it is followed by a motivating activity. A schedule can provide the individual with a sense of security and control because they can refer to it to see how their day is planned and structured. This can help them avoid feeling anxious about things seeming to be happening randomly to them. Schedules also provide a means to represent abstract concepts such as time (e.g. morning, afternoon and night) in a more concrete and manageable form. 

Where? Keep the schedule in an easily accessible area so that the individual and caregivers can refer to it as necessary to see each upcoming activity on the day of the appointment. You can also create a portable copy of the schedule (e.g. on a clipboard, key chain or photo album) to take with you  to review with the individual as the day progresses.

How? Refer to the schedule on a regular basis to inform the individual of the upcoming activities and review what they have done. 

Get Dressed
Eat Breakfast
Brush Teeth
Go to the Toilet
Go to School

Mini Schedule: Visual systems for individuals with Autism Spectrum Disorder

What? A mini schedule is a visual system that represents a task analysis of an activity from the schedule. It can be used to break down the activity into simple, clear and manageable steps for the individual to understand and follow. 

Why? By breaking down the visit into simple, clear and manageable steps, the individual can understand the sequence of steps they need to complete. This can help reduce confusion, anxiety and frustration caused by not understanding what is happening. 

Where? Create a portable copy of the mini schedule (e.g. on a clipboard, keychain or a photo album) so that the individual can refer to it as they complete each step. 

How? As you refer to each step you can cross out or tick off each step as it is completed, or remove the visual support and put it in a ‘finished’ envelope.  

For example, playing with sand is very general, but ‘put the spade into the sand, ‘lift some sand into the bucket ’, 'tip the sand into the truck’ and ‘push the truck' defines the precise steps within the 'play with sand' instruction.

Examples of play mini schedules

We hope this information was useful. Remember to design the visual system in accordance with the individual's level of needs, abilities and preferences in your context.