This blog was kindly written for us by Evan Brown, and offers his thoughts on best practice in creating visual aids for autistic children.
For our project, this blog shows the broad variety of meanings which we associate with ‘the NHS’. The NHS is not only hospitals or GP practices, but also affects teaching, home life, and daily routine. To research and understand the meaning and contexts of medical diagnoses, historically and today, we must pay attention to this range of spaces, and to the voices of patients and members of the public telling us about their experiences of health and care. After reading this blog, if you would like to also read more about the history of autism, please do consider the excellent work of Dr Bonnie Evans, who has an open access article on this topic available here.
We welcome all contributions to our blog, as we move towards trying to write an inclusive and dynamic ‘People’s History’ of the NHS. If you would like to write a blog for us, please do email J.Crane.firstname.lastname@example.org with your idea. We also welcome thoughts on what you’d like to see on our blog, and about how we can bring historical perspectives in to conversation with contemporary ones, to better understand the NHS over time.
As this amazing poster by NHS describes, an Autism-related meltdown is often passed off as an episode of tantrum by a headstrong child. The lack of awareness on living with an Autistic individual often leads to painful and exasperating results for these children as their lack of ability to communicate their feelings and needs may lead them to become frustrated and repressed. Since the main challenges of ASD lie in exhibiting repetitive behaviors, using language aptly, displaying limited interests, and a challenge in interacting socially, this is where visual supports come in to play to enable teachers, caregivers and parents of Autistic to help them comprehend social cues while interacting with the society in daily activities. Such as this NHS Hospital Passport helps people with learning disabilities to provide essential information about them and their health if they are admitted to hospital or in emergency situations to the healthcare staff.
Visual supports for neuro-divergent students, such as mood boards or picture cards, are used outside the NHS, as well as inside it, to help us communicate with children who experience difficulty in understanding or using language. Visual supports can be in the form of objects, lists, photographs, written words, drawings, and lists. Extensive research stands witness that visual supports are one of the most viable ways of communicating with students with developmental disorders. When used for those on the spectrum, visual supports aid teachers in communicating better with their students, while helping the students interconnect with their surroundings.
In addition, Autistic children often fail to comprehend verbal instructions. Even expressing their feelings could be a paramount task for them. By helping teachers and students communicate effectively in the classroom, visual aids ward off problem behaviors that rise from a difficulty in communication, and the exasperation that follows. Visual supports can cultivate positive, appropriate ways to communicate for both the students and their teachers. Not only teachers, but designers designing for Autism must also be aware of these visual aids to help them incorporate design elements for kids on the spectrum.
1. VISUAL TIMETABLES
Visual timetables play a major role in the classroom; they impart tangible information and help alleviate anxiety by adding predictability to the daily routine, which makes it easier for Autistic students to transition between activities as the student can explicitly see beforehand what they are transitioning to. Teachers should try to depict different activities of school days in apt illustrations so that the students have enough time to prepare themselves for the daily schedules. In addition, color coding each day helps to create a pattern in the minds of the students, and separates the activities of each day for them.
2. DESIGNING FIRST-THEN BOARDS
A First-Then Board is one of the best visual strategies to help students displaying language or behavioral needs effectively complete specific tasks that they are not inclined to do otherwise. The teacher can begin by displaying two images side by side. The “First” image illustrates an undesirable activity, while the “Then” image promises as reward an activity (a possible reinforcer) the child has a penchant for. In order to do the second activity, the child must complete the first one. By knowing exactly what is expected of them, Autistic students are prone to less bouts of frustrations and episodes of tantrums. In addition, the child gleans helpful visuals from these cards that they can refer to and associate with the activity even if the word isn’t displayed anymore.
3. VISUAL POSITIVE REINFORCEMENT SYSTEM
A Visual Positive Reinforcement System explicitly depicts what a student has to do, as well as their progress so far, to earn positive reinforcement. This strategy is highly successful in refining certain behaviors and inculcating particular skills by allowing access to preferred activities, foods, and toys only after the child has completed the desired feat successfully. For instance, if you want to foster a habit of sharing toys in a student, the right motivation can move mountains. Select (or let them choose) a reward for their efforts using a choice board. Using these cards, explain to the child that they have to earn a certain number of stars before they claim their reward. The visual cards help them keep score of how many more times they have to share toys with their class mates before they would reap their desired rewards.
4. CLASSROOM BEHAVIOR CARDS
Another way to support receptive language comprehension and avoid challenging behavior, is to provide understandable, clear expectations for classroom rules. They might be student-specific, aimed for the whole classroom, or even situation-specific. This group of visuals indicate what behavior is deemed appropriate classroom behavior for students. Visual supports like stop signs are used to make students understand when things are off limits, while the “Go” sign is meant to incite them into action.
5. CONTINGENCY MAPS
Contingency maps are effective visual supports that depict explicit information about the expectations of behaviors and their consequences. In essence, a contingency map tells the students that if they engage in a particular behavior, they will be rewarded (a positive reinforcer), while if they choose to follow along an alternative behavior track, the consequence for their behavior will be different than before; in most cases, the child would be deprived of the promised reward.
Prior to giving your students a direction, these maps can make these contingencies clearer to aid students in processing the potential consequences of their actions. While a contingency map can be construed as a general proactive strategy, it can also be used as a preventive strategy, since visual supports are leveraged by students for comprehending receptive language. Since most students’ reaction to a challenging situation is to escape altogether, the contingency map helps them see that doing what they are expected to do or following a desired path will reap reward for them.
6. TAKING TURNS STICK
Episodes of unappeasable tantrums ensue when children on the Autism spectrum are denied their favorite possession or activity, for instance getting their hands painted on. Therefore, a “taking Turns Stick” can ease them into the process of waiting for their turn, while visually perceiving how long their waiting period is. In order to teach the concept of taking turns to your students in small settings, glue stick figures of the various participants on a spare ice-cream stick, and keep moving the stick figures according to changing turns, so that children can keep track of when they are up next. This simple visual support would ensure a smoother transition, while your student patiently watches how many more kids they would have to contend with before it’s their turn again.
7. CHOICE CARDS
Choice boards are one of the most essential visual supports for neurodivergent students. A choice board visually lists down the choices presented to the students at any given time. A choice board can be used to display options for a recess play activity, toys that are available to play with, or snack options for lunch. Offer no more than 3 choices until your students have grasped the mechanics of making their own choices, adding more options as they feel more comfortable with the process. Keep fueling up the complexity of the Choice Boards to include harder choices such as a classmate to partner with in an activity or choosing the color of a marker for a craft activity.
8. VISUAL PARAMETERS
Setting parameters entails leveraging visuals to establish boundaries around activities or items, and to articulate basic expected behaviors, such as waiting. Setting parameters in this manner helps in communicating limits that may seem unclear to your students even though they are part of an activity. For instance, to communicate the physical limitations of an area, a stop sign can be placed to make children know how far they are allowed to venture in a playground. Visual parameters can also be used to depict how much of an activity or item is available to the students. For instance, by putting up a “not available” sign visual on the computer screen, it can tell the students that it is not the time to play on the computer, or by placing pictures of 10 juice boxes on the carton, and removing an image each time a juice is given out, helps prepare students for the fact that the juice supply is running out. Similarly, a timer coupled with a “wait card” can depict the need to wait for something will be available in a certain time period or is delayed definitely.
9. EMOTION THERMOMETER
Since children on the Autism spectrum are not particularly apt at showing feelings, it often poses a challenge for teachers to cater to their needs. Visual supports along the lines of this emotional thermometer above, can be used by students to open up and show their teachers what they are feeling at any given moment; something words fail to do. Try to incorporate as many states and feelings as the child is prone to feeling in the visual display, and help your students associate visuals to their feelings so that they can show you how they feel.
10. KEY PHRASE SYMBOLS
Teaching these basic symbols to your students, and reinforcing them with the help of visual cards and posters, can make phrasing simple sentences a lot easier for them, and for you to comprehend.
Tips to Make Visual Supports More Effective for Neurodivergent Students
The visual supports can be made portable by:
- Installing a visual supports app on your student’s tablet
- putting schedules, pictures, and symbols in a folder for the child to carry around if they are performing an activity alone.
- storing pictures and photos on a smartphone
- Back up any pictures, photos, and apps that the students use on a computer, tablet, or smartphone.
- Laminate printed visual supports to protect them against damage.
Easy to find
Make sure that visual supports are easily findable by:
- Attaching them to an actual object
- Putting up visuals at eye level in prominent places to make them available without hassle
- Distributing them throughout a particular environment, such as areas and objects in the classroom could be labelled according to the type of visual available
- putting single symbol cards in your student’s pocket pertaining to a single instruction
- Attaching symbols to easily assessable boards in school so that your students know where to go find them. Velcro strips can be employed to attach symbols to a board, so that schedules can be easily altered and activities added or removed once completed.
- Putting a shortcut to visual symbols from a tablet home screen
- Due to the personal nature of visual supports, what works for one person may not work for another. A visual timetable can for instance be in the shape of a rocket to accommodate a student’s special interest. However, some Autistic people find it difficult to generalize, so keep that in mind when designing for the whole class.
- While it’s best to introduce visual supports gradually, it is often helpful to use more than one type of visual support simultaneously. Start off with basic symbols and introduce complexity in order.
- Once you choose a style or type, especially when using pictures and images, stick to it consistently. Also advice the family members or co-workers to use the same visual supports unswervingly with your students.
NHS has offered a treasure trove of guidelines to health care professionals when it comes to ensuring effective communication with patients who have difficulty processing speech. Whilst we can see a plethora of cases where the NHS uses these materials when caring for Neuro-divergent patients, there are also many used outside the hospital or GP surgery, such as in education, where the guiding principles and visual supports offered by NHS can be extended to help teachers. Effective care for Neuro-divergent people and other patient populations will always need these types of resources to be introduced in numerous settings, across the community, as well as in the NHS itself to provide a healthier, more secure environment for these individuals.
Given the indispensability of visual aids when it comes to establishing effective communication with students on the spectrum, teachers should strive to transform verbal communication into visual cues whenever possible to make it easier for students to process and comprehend information, and feel comfortable and safe in their environment.