Visual Supports

Overview

Individuals with autism spectrum disorders (ASD) learn in a variety of different ways, but research has shown that they demonstrate strength in visual learning (see resource list). To play on this strength parents and professionals have developed visual supports for individuals with ASD. Put simply, visual supports make auditory information visual. Visual supports organize a sequence of events, enhancing the individual's ability to understand, anticipate, and participate in those events. Visual supports supplement verbal instruction, clarifying the information for the individual and increasing comprehension. Visual supports can be used to cue communication, providing reminders of what to do and say in a situation. When individuals with ASD are given the opportunity to learn with visual supports or cues they:

o Complete more tasks by themselves therefore increasing their independenceo Learn more rapidlyo Demonstrate decreased levels of frustration, anxiety, and aggression related to task

completiono Adjust more readily to changes in their environments (Savner & Myles, 2000).

Are there things that you hear yourself saying over and over, or questions that you hear the individual with ASD asking over and over? Visual supports provide a way to problem solve these issues and prevent communication and performance breakdowns.

When we present information verbally, the words are available for a brief moment.

When we present information visually it can be there for as long as the individual needs it.

This module will define visual supports, discuss how they might be used across settings, and provide specific examples that can be used as models as parents and professionals work to accommodate individuals with ASD.

Visual symbols utilized mainly for communication purposes will be discussed in detail in our module on communication.

Defining Visual Supports1. Do you have a calendar that you write things on to help organize your life?2. Do you have a list of things to do on your desk or refrigerator?3. Did you ever make a checklist of errands that you need to run and cross

them off as you completed them?4. Have you ever pointed to a picture in an advertisement or a menu to show

someone what you want?5. Do you make up a shopping list before you go to the store?6. Do you ever read a sign to tell you what line to stand in or what door to exit

from?

7. Have you ever followed a recipe in a cookbook to create some delicious dinner or entrée? Did you go back to that recipe each time you wanted to cook that item?

8. Do you ever write notes to your family members reminding them to do things?9. Do you scan the menu to evaluate your choices before ordering in a

restaurant?10.Have you ever made a checklist for your children to help them remember to

brush their teeth?11.Did you ever attach a note to your bathroom mirror to remind you to do

something?12.Have you had the experience of assembling a new bicycle by following the

"easy to follow-step by step" instructions? (Adapted from Hodgdon, 1996, p. 12)

All these things are examples of visual supports. The terms visual supports, visual strategies, or visual cues are used synonymously. Various definitions have been used to describe these terms. Diane Twachtman-Cullen (1995) defined visual supports as "a tool that enables the child to keep track of the day's events and activities and at the same time helps him or her to develop an understanding of time frame and an appreciation of environmental sequences" (p. 145).

A visual cue is a picture, graphic representation, or word used to prompt an individual regarding a rule, routine, task, or social response. Visual strategies include accommodations to support individuals in less structured situations, assist them as they access curriculum, or scripts for social situations. This module will utilize the term visual supports. Visual supports are any tool presented visually that supports the individual as he or she moves through the day. Visual supports might include, but are not limited to pictures, written words, gestures, objects within the environment, arrangement of the environment or visual boundaries, schedules, maps, labels, organization systems, timelines, and scripts. They are utilized across settings to support individuals with ASD (National Research Council, 2001).

Research has shown that when individuals with ASD are given the opportunity to learn with visual supports or cues they:

o Complete more tasks by themselves therefore increasing their independenceo Learn more rapidlyo Demonstrate decreased levels of frustration, anxiety, and aggression related to task

completiono Adjust more readily to changes in their environments (Savner & Myles, 2000).

For individuals with ASD, using visual supports can help them be more successful in what is often a confusing world. The individual with ASD does not necessarily intrinsically recognize and understand how to use the information provided by visual supports. Many individuals will need to be specifically taught how to use existing visual supports in their environment.

Points to remember:

o It is only by using the visual supports that individuals will attach meaning to them.

o Sometimes you will see immediate results. Sometimes it takes days, weeks, or even months before you see results. STICK WITH IT but be thinking about the possibility of making modifications. Sometimes one little change can make a big difference.

o Some visual supports may be used less over time, but it's a good idea to keep them handy for those times when the individual needs a little extra support. If supports are kept in place, they can be easily changed when the individual transitions to a new, more challenging environment.

o Visual supports should be age-appropriate. Make sure to consider the size and portability of the visual as well as the kind of visual symbols used. Be sure they "fit the environment."

o All home, school, work, and community settings should be considered when developing visual supports.

o To help individuals attach meaning to the visual support, pair its use with spoken language. Match key words and phrases to the object, picture, or action.

o Keep in mind that the more stressful the situation, or the higher the anxiety level, the more need for visual supports. When under stress and anxiety, we all go down one level in communication. Supporting an individual with ASD with visual supports is especially important in times of stress an anxiety. Using visuals allows the parent, professional, and individual with ASD to more effectively communicate without adding to their level of stress.

o Always keep in mind that independence is the ultimate goal! Visual supports promote independence by providing a means of communication and a sense of order and control for the individual with ASD.

Creating Visual BoundariesOne of the most basic ways that parents or professionals can provide visual support is to create visual boundaries for the individual with ASD. Boundaries can be created through a variety of means including furniture arrangement, labels, and color coding. This section of the module will assist parents and professionals as they work to create visual boundaries for individuals with ASD.

Some examples:

Case Study: Mrs. SmithMrs. Smith is a new teacher working with six students, ages 5-7, with autism spectrum disorders. She has so much to do to get ready for the students. One thing she wants to figure out is how to create the best environment to meet their needs. She found the kindergarten, first-grade, and second-grade classrooms in the building and observed how each room was arranged. She knew her students would be spending time in the general education classrooms and wanted to help them generalize to each room. Using the furniture, area rugs, and bookcases, Mrs. Smith defined areas of her classroom. She had one table with two functions; placemats meant snack, tablecloth meant art. She had a circle time area, an individual work area, a group area, and a leisure area. All were defined by the type and configuration of furniture, rugs, and visual labels, All resembled the general education classrooms that her students would be integrating into. Visual boundaries were defined for each area of her classroom.

As the school year began, Mrs. Smith consistently used each defined area for its designated task. She used consistent language to refer to the areas, matched her terms to the labels used on the visual schedules when students transitioned to the areas, and reinforced students with verbal praise as they correctly transitioned. Within a few months students were using their schedules and independently transitioning to the appropriate area of the classroom. They were also remaining within the designated visual boundaries for the duration of activities.

Case Study: SuzieSuzie is a first grader with Asperger Syndrome who spends her school day in her general education classroom of 20 students. When working, the students are seated four to a table. Suzie has difficulty remaining seated with her feet on the floor. At times she lies across the table, the floor, or her chair; she often leaves her seat without permission, and she frequently touches or plays with other children's belongings or materials.

To help Suzie learn where she was expected to be, her teacher used colored tape to mark off Suzie's personal space. The tape provided a visual cue of where Suzie was supposed to sit. Her teacher and her peers modeled the appropriate behavior for Suzie, and reinforced her for exhibiting the appropriate behavior. Suzie learned she could not cross these "boundaries," thereby learning to stay within her personal space or area.

Case Study: SamSam is a 5-year-old boy with autism who attends a special education classroom. Sam frequently leaves an area without permission or supervision. Staff members felt that Sam did not understand where he was required to be, and thought that defining boundaries might help Sam learn. They used colored tape on the classroom floor to visually define areas of the room for Sam. This worked within the classroom.

One day when recess was ending, Sam did not line up with the other children and ran away from the playground. When the staff tried to redirect Sam to line up, he ignored them and ran towards a nearby parking lot. The staff felt that some of the visual boundary strategies that had proven successful in the classroom might be effective on the playground as well. There were already railroad ties around all the playground equipment, forming a natural boundary. Sam was taught that once he was inside the railroad ties, he had to remain there until the bell rang. He was also instructed to wait for a staff member or a classmate to walk with him to the door of the building-never to take off on his own.

Steps for Setting up Visual Boundaries

Step 1: Define the needIt is important to take time to really define the issue that requires or supports the use of visual boundaries. In the examples provided in the introduction to this section of the module, different needs were addressed with different boundary interventions. By clearly defining the need, staff or parents can really individualize the type of visual boundary that may work best for the individual. Safety and compliance should always be at the forefront of boundary considerations.Questions considered when working to define the need might include the following.

Does the individual...

o Have difficulty staying in one place? o Have difficulty transitioning from one area to another? o Run away when frustrated, frightened, or upset? o Have trouble sitting (e.g., at the dinner table or at a desk)? o Experience problems leaving others' belongings alone?

Once these questions, and others as appropriate, are answered and safety issues have been addressed, it is time to prioritize the needs.

Step 2: Define the boundaryFor many adults, places where we live and work are clearly defined with visual boundaries. Cubicles are used within businesses, cashiers have their own stations in grocery stores, booths are used in restaurants; boundaries are well defined.

Where physical boundaries do not exist, many adults create their own spaces. For individuals with ASD, teaching them to function in those spaces becomes part of our job. To begin this process, it is important that the various areas in the classroom, home, or work environment be set up and organized for individual with ASD.

In the examples provided at the beginning of this section of the module, furniture and other physical supports were used to help establish visual boundaries. Areas within the classroom, home, or work environment that may need visual boundaries include play area, group area, break area, and work area. Within the home, boundaries may be needed for areas where toys can be used, designating spaces where food is and is not allowed (e.g., the workshop or office), places to get dressed, and areas that are accessible only with adult supervision.

Establishing a visual boundary will help individuals understand (a) where things begin and end, and (b) areas that are accessible without supervision. In addition, visual boundaries make it easier to identify the meaningful parts or aspects of the

environment. A play area or designated work environment would be a good place for setting and teaching a boundary.

Boundaries for a play area could be created by:

o Blocking off the area with tape on the floor o Physically arranging the furniture to define the area, such as setting up the shelves

that contain the toys on the border of the play areao Placing a carpet remnant in the play area

Another great place for setting and teaching a boundary is a place that is less structured such as a cafeteria or library. Boundaries within those spaces could be created by:

o Using existing features of the facility, such as floor tiles, or built-inso Physically arranging the furniture to define the area such as placement of tables or

chairso Utilizing boundaries such as where rugs end or floors begin.

Step 3: Teach the boundaryStrategies that have proven effective in teaching visual boundaries to individuals with ASD include:

a. Model the correct behaviorThe teacher/parent models the appropriate behavior for staying within the given boundary. Each adult working with the individual should be informed of the expectation for the correct behavior. For instance, if the adult is playing with LegosTM in the play

area, he leaves the LegosTM in the play area before going out of the room to get a drink of water.

Self-verbalization techniques are a useful way to reinforce boundaries. For example, while modeling the appropriate behavior, the adult says to himself, "When I want to play with LegosTM, I need to stay in the play area. If I need to go to the bathroom or get a drink, I need to leave the LegosTM in the play area. I can always come back later and I know the LegosTM will be there."

Peers can be appropriate models. A group of students wait in the cafeteria after finishing lunch. There is a designated area that they need to go to as they wait for the bell. To assist Joe, a student with autism, his peers have visually defined eight squares of tile on the floor of the cafeteria that are a different color. They direct Joe to stay within those squares after he has finished his lunch. To help him remain there, the students congregate around him.

Modeling may also occur via videotape. Teachers, parents, or peers could prepare a videotape showing the area and its defined boundary. They can indicate by actions (e.g., sitting in the area and playing, etc.) and words where the individual should remain. Some individuals with ASD may benefit by also seeing non-examples. If you have individuals who learn from this type of feedback, identify in the videotape which areas are not appropriate for LegoTM play, or which areas are not appropriate for waiting, and how the individual can distinguish appropriate from inappropriate areas.

b. Model reinforcementIn addition to modeling the expected behavior, the adult or peer should also model the reinforcement of that correct behavior. This provides another opportunity for the individual with ASD to see the expectation. A peer or adult engages in the appropriate behavior, for instance, staying in the play area with the LegosTM, and an adult or peer reinforces him or her.

Reinforcement should be specific, stating the behavior that is appropriate and a rationale for following the rule. For example, a paraeducator could reinforce a teacher who is modeling playing with the LegosTM in the play area by saying, "Mrs. Johnson, you stayed in the play area with the LegosTM. Good job!"

c. Model correctionModeling what happens when the individual does not remain within the visual boundary is also important. Peers can model corrections for the individual with ASD. For example:

a student walks out of the area in the cafeteria designated for waiting until the bell rings, another peer calls him back to the designated wait area.

When the student returns to the wait area, he is reinforced for complying. This is modeling the correct behavior. The peer should also specifically reinforce that the student needs to stay within the defined area to wait for the bell to ring.

d. Be consistent with the use boundary settings from day to dayOnce a boundary has been taught, it is very important to be as consistent as possible.

Step 4: Evaluate successVisual boundaries can be wonderful supports for individuals with ASD. Individuals can show an increased level of independence if boundaries are used consistently. Once parents, teachers, employers, or community members have defined and taught a visual boundary the next step would be to evaluate the success with the individual with ASD. Some signs of successful boundary settings are as follows.

If the individual...

o independently leaves objects where they belong o consistently transitions successfully from one area to another o eats all or most of his lunch while sitting at the lunch table o stays in the designated area when upset o leaves others' belongings alone.

Specific Interventions that use Visual BoundariesVisual boundaries are built into a variety of intervention programs, strategies, and throughout the life of individuals with ASD. Houses are built with walls that define the living room, dining room, kitchen, etc. School buildings are built with classrooms, halls, cafeterias, etc. Visual boundaries are a natural, and many times unobserved, part of our daily functioning and many times their importance is overlooked. Teaching their relevance is important for many individuals with ASD.

Other modules within AIM address specific boundary issues. Applied Behavioral Analysis (ABA) approaches define work and break areas, many time identifying those specific areas with visual boundaries. TEACCH utilizes specific visually defined areas of

the classroom or work environment as well (for further information, please view those modules).

Visual Labels and LocatorsVisual supports can range from simple to complex based on the needs of the individual with ASD. Among the simplest visual supports are labels and locators. This section of the module will provide descriptions of labels and locators and examples of how they can be utilized in the home, school, and community setting.

Labels

Labels are used in many aspects of daily life. Think about the last time you had to use a public restroom. Were the restrooms clearly labeled to identify them by gender? Probably. Did you even think twice about which one you had to go into? Probably not.

Most of us use labels in our day-to-day lives without a second thought or any effort on our part. Much of our world is already chock-full of visual supports - like signs and labels - to help make the right choices and to interact appropriately in the world around us.

Labels are used to identify important features in the environment. For an individual with ASD, labels assist in organizing environments.

Case Study: SalSal is an 8-year-old with autism. He is beginning his third-grade year in his neighborhood school. He will be in Mrs. Zegorski's room. Mrs. Zegorski is an "awesome" teacher, at least that is what everyone says. In her room she has a large cage with a rabbit named Homer, a fish tank, a cage for the guinea pig "Wilbur," and another cage that holds "Zeke," the white mouse. Plant are growing everywhere in her room and vine branches wind over the tops of the windows. Students sit at tables and

share materials from a container in the middle of the table. Mrs. Zegorski has students work in cooperative groups throughout many of the day's activities.

Sal has toured his third grade classroom and met with his teacher. He is excited about the animals in the room as he really has a special interest for animals. Although this classroom is a match for Sal in many ways, Sal has a difficult time sharing materials. Mrs. Zegorski and Sal's mom have decided he will sit at the yellow table next to the row of bookshelves under the window. His chair will be labeled with his name, and he will have a special shelf also labeled with his materials. Proactively, staff working with Sal have all made extra labels with his name on them anticipating that Sal might need a chair labeled with his name in specials and also in the cafeteria. As the first few weeks of school progress, staff find that they were right. Sal has difficulty transitioning into each new space and a chair with his name on it seems to ease that transition for him at this time.

Labels that include the individual's name are easily recognized for many individuals with ASD. Other labels need to be identified and taught so that they are noticed. A gender label on a public restroom is a label that becomes very important as a child grows to an adult. Other labels are equally important and need to be learned and recognized by individuals with ASD. Strategies to help individuals with ASD learn about labels include:

o Develop labels for items within the home, school, or work environment, for instance, label the refrigerator or the bathroom. Place these labels in prominent spots for easy viewing by the individual with ASD. Point to the label and verbalize it when using the appliance or room.

o Point out signs or labels when walking through school or community settings. Pair your pointing with a verbal cue such as "Johnny, that is an exit sign, see, E-X-I-T. It is where you go to leave the building."

o Teach the meaning of the label across a variety of settings.

Grace cannot read her name but recognizes a picture of herself. A picture of Grace on her lunchbox will help her identify which lunchbox belongs to her among all the others at school. Additionally, Grace may benefit from a picture on her desk, chair, cubbie, etc. These visual labels will help cue Grace as to where she needs to be.

These visual labels will help cue Grace as to where she needs to be. Visual labels do not need to be used in isolation to be effective. Using picture labels along with words on items can help individuals eventually associate the picture with the word.

Labeling may be used to organize the individual's entire program. For instance, on the computer have a label that shows a picture of the computer and says whatever you call that activity, such as "computer center." (Be sure you are using the same label on the individual's visual schedule as used to label the object, center, or activity!) Programs such as BoardmakerTM or Picture ItTM, and Snag ItTM are useful for customizing your own labels. Labels do not have to be anything fancy; a photograph, pictures cut from magazines, an item label or wrapper, or even a simple drawing will do.

Using labels is one of the simplest things that can be done to assist the individual in organizing his life and communicating his needs. Areas where supplies are kept may be labeled with a picture of what item belongs where. Labeling dresser drawers, shelves, closets, cabinets, etc., to show the contents is another useful way to implement labels in the home environment. Not only does this help the individual with ASD know where things belong, it can assist everyone in the household in returning items to their rightful place. No more excuses for not putting things away! The possibilities for using labels in the environment are endless.

Labeling the environment also helps teach the concept of matching. By using labels to identify what goes where, the individual learns to match items in a practical, useful way.

Suppose all the drawers in Susie's room have pictures showing where everything belongs. When Susie is finished playing with her toys, she can be taught to match the item to its picture on the appropriate shelf or in the correct drawer. Not only is she learning to match, she is learning how to pick up and put away her things, which can be a first step in teaching personal responsibility. These skills can transfer to work environments when Susie gets older. She may need to stock shelves or supplies and beginning the process of matching early with labels will help her later in life.

The same principle of labeling is easily transferred to the classroom or work environment. Keeping an entire classroom or work environment organized can be a challenging task, but the simple use of labels can help keep the search for tools and supplies to a minimum. If every individual is taught where items belong and to return items to their place, it helps foster a sense of reliability and stability for the individual who has difficulty with organizational skills. By teaching simple organizational skills, individuals will learn to

o Function more independently o Become more responsible for their belongings and needs o Become more accountable for their activities and achievements o Easily locate needed items o Have a sense of security from a predictable, organized environment

There are a few important questions to ask as the environment is visually organized for the individual. These include the following:

o Does the individual understand the labeling system being used? o Can the individual match objects or be taught to match objects so he can find what

he needs? o Is the system consistent and appropriate for the individual's functioning level? o Does everyone easily understand the system? o Is the system "user friendly" for the individual? o Do you periodically review the system to determine its effectiveness for the

individual?

Initially, it may seem like a lot of work to label everything. However, the investment of time in constructing a labeling system will be more than compensated for by the rewards a successful system will produce. Teaching the individual with ASD to use visual labels to help organize and control his environment can reduce his frustration and stress levels and increase his success in the future.

LocatorsA visual locator can help individuals with ASD process where a favorite person is more readily than if just told. It makes the information more concrete and memorable.

Case Study: JohnnyJohnny is always asking "Where's Daddy?" He asks over and over repeating the same question. His mother has tried to verbally tell him that Daddy is at work, but because Johnny has not been to work with his father, this answer does not satisfy him. To help him understand what "Daddy is at work" means, Mrs. Frank took a picture of "Daddy at work". When Johnny asked "Where's Daddy?" she showed the picture to Johnny. She talked with Johnny about Daddy sitting at his desk and working on the computer. Johnny now says, Daddy is at work at his desk on the computer. His anxiety about where Daddy is appears to be reduced.

The visual format of a locator also allows the individual with ASD to refer back to the visual support as often as needed to reassure themselves and reduce anxiety. By having this visual tool at their disposal there will be less need for verbal reassurances on the part of another person.

A visual locator does not have to be elaborate or costly to be effective. It can be a simple addition to a visual schedule that is already in use, or it can be a complete separate visual tool. Simple examples like the one provided here can help individuals become aware of visitors to the home or school.

Many teachers use locators to help students transition into the classroom. They are set up on a calendar or chart, and are used to "locate" classmates that are present or absent. Calendars such as the one provided in this example also assist students in determining what days are "school" days, and which days are "home" days. Locating where they need to be each day of the week.

Defining Visual Schedules

Visual schedules display planned activities in the order in which they will occur using symbols, words, pictures, photographs, icons, or actual objects. The mode of the schedule is determined by the needs of the individual with ASD.

Schedules can be used in the home, school, work, or community environment. Just as adults use calendars, PDAs, and other visual aids to plan daily events and organize

daily obligations, visual schedules help individuals with ASD understand and organize their world (Savner & Myles, 2000).

Visual schedules clarify expectations during a specific time period or activity, particularly if the activities are familiar. In addition, visual schedules help the individual move from one activity to the next with less frustration. The number of activities and amount of time shown on a visual schedule depend on the individual's needs. Some visual schedules list all of the activities for a particular day, while others may only present events that occur during a more limited period (i.e., morning only, after school).

Group Schedules

Group schedules display planned group activities in the order in which they will occur using symbols, words, pictures, photographs, icons, or actual objects. Educators might use schedules throughout the day to orient the students to the day's activities. These group schedules might also include mini-schedules which provide a group of students with a sequenced list of tasks to complete for an individual activity.

Group schedules designed for sequencing daily activities should be posted in a central location such as the chalkboard or a specific bulletin board within the classroom designated for the daily schedule. The teacher should refer to the schedule at each transition in order to orient students to its importance and intended use. The schedule should be free from clutter and clearly visible to all students. Some suggestions for increasing structure within the schedule include:

o Using color within the schedule. Color-coding activities that happen within the classroom and activities that happen outside of the classroom using different colors assists students with transitions throughout the day.

o Developing a symbol for unexpected activities that might occur requiring a change in the schedule. This should be something that is age appropriate depending on the student population.

o Perhaps use magnets or Velcro to make the schedule components flexible so if activities have to be rearranged during the day, they can be changed with ease.

Consider adding a "finished pocket" or place to deposit or cross-out activities as they are completed throughout the day.

Case Study: BillyBilly is 12 and in the sixth grade. He has been attending a self-contained class for students with autism this year and uses an individualized schedule system throughout his day. Billy enjoys having his own personal area in the classroom. He has his rules posted and his favorite items close by. The first part of his schedule system is a small task schedule. His tasks are attached with Velcro to a strip of paper. They are listed in the order in which they need to be completed. When he completes a task, Billy tears it off his schedule and puts it in a finished box. He appreciates knowing the beginning and end of tasks, and his individual schedule makes this concrete for him.

In addition to working in the self-contained setting, Billy leaves the classroom to participate with his same-aged peers. To help Billy navigate his day, his teacher has made a visual schedule for him to follow. This schedule is broader than his individual task schedule on his desk. Billy's whole-day schedule is on a laminated sheet of paper that he can keep in a notebook or carry on a clip board. All the things that occur consistently each day have been typed on the paper for him. Each morning, with the help of his teacher or the paraeducator, Billy "fills in the blanks" on the rest of his schedule. As he finishes events throughout the day, Billy is able to cross them off of his schedule. He has difficulty with the concept of time, and appreciates having a beginning and an ending to each activity. His schedule provides him with that.

Individual schedules are a sequential list of activities designed for specific purposes and specific individuals. The format for these schedules will vary across ages and situations, as well as the materials used to construct them. Individual schedules can be used in the home, school, work, and community environment. They can encompass an entire day or a short activity. They can be carried in a pocket, in a notebook, be on a desk, or even in a PDA or day planner.

In each of the case examples below, an individual visual schedule has provided the support needed. Some individuals with ASD require support from activity to activity, such as: a schedule for before breakfast and a schedule for breakfast. In Billy's case, he needed a schedule for the broader part of his day, and also a schedule for tasks to be

completed within each segment of his day. The needs of each individual with ASD will vary.

Case Study: AndrewAndrew is a preschool student with Asperger Syndrome. His mother has decided to carpool with Jack's mom on Tuesday and Thursday because Jack's mom works those days. On Tuesday, Andrew's mom pulls into Jack's driveway, Jack gets in the van and sits next to Andrew. Andrew immediately tells Jack to get out of that seat, that he does not belong in the car, this is not his car. He continues this behavior and it begins to escalate to a point that his mother has never seen before. She and Jack's mom decide that for this particular Tuesday, Jack's mom will drive him.

This solution will not work for the long term as Jack's mom needs to go to work. Andrew's mom is determined to find a solution that will help Andrew understand that Jack will be riding with them on Tuesday and Thursday. She consults a relative with experience with children with autism spectrum disorders. Through their discussion she realizes how much Andrew relies on the schedule she uses for his morning routine. They brainstorm how to use a schedule or other visual cues to support Andrew. They decide to make an individual schedule for the car for Andrew. Pictures will show the day of the week and when Jack will be in the car. Andrew's mom decides to hang the schedule right in front of Andrew's seat in the car. In addition, she adds a photo of Jack to the car seat where he will sit on the days he is going to ride with them. It works! Andrew knows when Jack will be in the car. It is on his schedule so he is OK with it happening.

In addition Andrew, and others, may benefit from a schedule that reflects special events or changes to the normal routine as provided in this example.

Case Study: JoeJoe is in the 11th grade and receives special education services at the local high school. He spends part of his day participating in a functional curriculum and part of his day at a local work site. Joe's individual schedule within his school and work environment consists of an ordered group of tasks. He picks up the first object for each task in his schedule area. Each task has a designated area for completion. Once he has completed the task, he moves to the next object on his individual schedule. When there are no more objects, he knows he is done for the day.

Schedules in the Home, Work or Community Environment

When developing visual schedules for individuals with ASD, certain considerations will help make the process more seamless between all environments. For example, if an individual with ASD relies on visual supports, such as a visual schedule, it is important that those supports be available across all settings and personnel. As stated previously, in order for any visual support to be useful, it has to be used. In addition, many individuals with ASD need to be taught to use the schedule so they are able to get the most benefit from the tool.

Case Study: RobbieRobbie is in the fourth grade. His parents work very closely with his teacher on all aspects of his day. Robbie's class is taking a trip to the Museum of Natural History in nearby Washington, DC. His parents and teachers have been preparing him for the trip to see the dinosaur exhibit. On the day of the trip, a new staff person filled out Robbie's schedule for the day. She did not see a picture of the museum, or field trip, and left it off his schedule. Robbie refused to line up to get on the bus for the field trip. He was not able to communicate: "It's not on my schedule, so I don't do it" which might have been what was going through his mind. The speech-language clinician quickly intervened and made a picture of the bus with the word "museum" on it. She put it on Robbie's schedule and set the schedule in front of him, then asked him to line up for the field trip. He looked at his schedule, and got up to get in line.

In our example, Robbie had been taught to use his schedule and had come to rely on it for all the transitions throughout his day. Although the team working with Robbie was planning for his trip to the museum, not all members of the team were included in the planning, so on the day of the event, Robbie had some difficulty.

To prevent issues such as those in the above scenario, teams should plan ahead for changes that might occur in a schedule, having the needed icon, or words available. If exact icons or words are not readily available, doing an on-the-spot adaptation is perfectly acceptable, as our speech/language clinician did in the example.

Remember Joe? His schedule consisted of objects that cued him to begin a task. When the task was completed he moved the object to the finished box. He knew he was done for the day when there were no more objects on his schedule. All parents and professionals working with Joe need to know that he uses an object schedule. This schedule translates easily between environments, because each environment would have the appropriate objects available for Joe. Difficulty might arise when Joe's time at a certain location is up before he has completed the tasks on his schedule.

Case Study: Joe (cont.)Joe had two items left to complete on his schedule at work when the bus came to pick him up for the day. Anticipating that this might occur at some time, the team working with him had planned proactively. Joe's schedule was assembled in segments, and the adult working with him, removed the bottom segment of his schedule, simultaneously removing the two remaining tasks. Joe was able to transition to the bus, because his schedule was then cleared for the day. All his tasks were finished.

It is important to be proactive. As with Joe, the team anticipated a difficulty and planned for it in advance with the design of the individual schedule.

Tips for Creating Visual Schedules

Some other tips for developing visual schedules across settings include making decisions about:

1. Who is the schedule being used for?

o A group of children o An individual

If the visual schedule is to be used by an individual, is he insistent that other students not be aware that he is using a visual support?

2. How will the visual schedules show a sequence of events or time?

o Does the schedule need specific times to coordinate with bells and other school functions?

o Does the sequence need to change from work, to school, to home? o Does the schedule need to be broken down for small increments of time?o Does the schedule need clock pictures on it?o Is the sequence of activities more important than specific times? o Will color coding events increase the individual's understanding of the sequence?

3. How will the visual schedule be presented?

Visual supports can be presented in a myriad ways, depending on the number of individuals who will use them, where they are located, whether the individual is sensitive to others knowing about the visual support, and age of the student.

Common ways in which visuals schedules are presented include:

o Wall charts o Books, folders, or binders o Plastic strips or pages o Paper or index cards o Clipboards o Blackboards

4. Where will it be used?

o At a center o In one classroom or in one area of the classroom o In several classrooms o Outdoors/on the playground o In a work setting

o In a less structured setting such as the cafeteriao On the bus, in a car, or on another form of transportationo Stays in one location o Goes with user

(Hodgdon, 1995)

Visual Supports for Less Structured SettingsVisual supports assist individuals with ASD in all aspects of their day. In less structured settings throughout the home and school, visual supports provide structure. Sometimes visual supports in less structured settings are even more important than those provided in a structured setting. This section of the module will focus on visual supports in less structured settings.

Case Study: PaulPaul is in the second grade and spends all of his day in the general education setting. He enjoys the academics, the time with peers, and the structure of his classroom. Paul has the most difficulty during the unstructured parts of his day. Recess, P.E., and lunch are the times when Paul really struggles. His team of teachers along with his mother met for a brainstorming session to develop supports for Paul during these unstructured times of the day. They began by identifying reasons why these times of the day were difficult for Paul. Recess usually occurred on the playground. Although the class moved through the halls to and from recess in a nice line, when they reached the playground, they all ran in different directions. The playground was noisy and chaotic, and Paul tended to walk the perimeter and talk to himself. During P.E., Paul tended to try to climb up on the bleachers that surrounded the gym floor. Again, although the gym teacher had the children line up on the lines on the gym floor, once activities began, the noise and normal chaos of 7-year-olds caused difficulties for Paul. Lunchtime provided a difficulty as well. Tables were designated as second-grade tables, but each day children sat in different seats. Paul was also unsure of what he had to pick in the lunch line, and was always getting sent back to get something else by the cafeteria worker. Both of these issues caused difficulty for Paul in the cafeteria.

The team decided to incorporate some visual supports for Paul.

o At recess, Paul was given a visual choice board similar to one he used for picking center time in the classroom. His recess board had swings, slide, catch, bike on it. When he reached the playground, he made a choice, engaged in that activity, and came back to the visual choice board to transition to a new activity.

o In P.E., Paul was given an "x" with tape on the floor to line up on. He was given a visual schedule for the tasks to complete within P.E., and he was given ear plugs to wear during certain activities.

o In the cafeteria, the lunch ladies labeled the front of the glass cases with "take 1" for each of the required food groups. This not only helped Paul, but it helped all the other students as well. Another visual support was a name tag for a chair at the second grade table.

Just as certain visual strategies were helpful for Paul, they can be helpful for other children as well. Using a line in the hallway can help children determine where they are supposed to walk, just as Paul used an "x" to detemine where he was supposed to be.

Choice Boards are simple to make and simple to use, but provide another visual option for students who need that concrete structure.

Case Study: JeffJeff is 14 and his family is working on independence in the community. They take him to local stores to help prepare him for shopping in his future. Some stores are crowded and noisy and this can be upsetting to Jeff. His parents have found that providing him with a map of the store with some detail, but not extensive detail, helps him handle the trip. In addition, they provide him with a visual list of items to purchase. He knows that

when he has obtained all the items on the list and paid for them that he may leave the store.

Transition Supports

People make many transitions throughout the day. Think of your morning routine. How many transitions did you make this morning between getting out of bed and leaving for school or work? From the bedroom to the bathroom, from the bedroom to the kitchen, to other rooms in your house; these are just a few of the possible transitions you made today. We make countless transitions throughout our day that we don't even think about. They are just a part of our routine; steps we mindlessly go through to accomplish tasks we need to get done.

For an individual with ASD, transitions can be difficult. They can seem unpredictable and random. Educators and parents can assist the individual with ASD by including visual supports that prepare for transitions. Some ideas include:

o Visual schedules, which are discussed in detail in another section of this module.o Presentation of tasks is important. Packaging tasks in a folder, or a zip lock bag,

provides a structure to the task. Individuals learn that when they have finished what is in the folder or bag, the activity is complete, and they can move on to something else.

o A transition area can also be helpful. Programs such as Project TEACCH (see module on Interventions) utilize a transition area within the classroom- a specific area that students go to when checking their schedule. Transitioning becomes a very visual process because it is within a designated boundary (see section on visual boundaries within this module).

o Transition cues can also support transitions. Cues can consist of any visual prompt that is appropriate for the individual. Examples include: index cards of different colors, stop sign, start sign, magnetic checkmark next to a finished activity on the chalkboard, a piece of clothing, or toothbrush, etc.

o Community Supports

o

o Visual supports are used in community settings all the time. Think about your last trip driving from your house. You encountered street signs, building signs, and if driving in unfamiliar territory, you probably used a map to get to your destination. Arrows pointed the way around construction and down one-way streets. When you reached your destination, labels (numbers, names, etc.) on the buildings helped you navigate where to go. Once inside, depending on where you were going, you had signs outside elevators, or signs on aisles, or names on offices to help you get to your desired place. Individuals with ASD need those visual supports to navigate their community environments. In our example, Jeff used visual supports to navigate the stores in the community. Visual supports can be used to help individuals access public transportation, go to the movies, or participate in other recreation and leisure activities. They can also assist with using a Laundromat, ordering food at a restaurant, and other tasks for independent living.

o

o Children with ASD also need support in the community. Providing a list of places that will be visited on the trip in the family van will assist the child as they transition from place to place. Providing visual cues for rules and expectations while in the community also may prove helpful as individuals with ASD learn expectations of different community settings.

o Any of the visual supports discussed throughout this module would work in a community setting. It is important to respect the dignity of the individual utilizing the visual supports, so making them portable, storing them in an age-appropriate place, such as a wallet, or day-planner is recommended.

Supports Outside the Classroom

Paul needed visual supports to help structure his day outside his classroom. These supports were designed to structure the less structured aspects of his day such as P.E., recess, and the cafeteria. Parents and educators tend to integrate individuals with ASD into more social settings whether they be with a play date, a club, a recreational activity, or a special class such as music or art. These times, although potentially great opportunities for interaction with peers, can be times when the individual with ASD really needs visual supports.

In the school setting these special classes typically are meant to have less structure. Their purpose is to provide creative outlets. Although these classes may appear to be more fun-filled than the rest of the day, many of our students with ASD find these the most challenging times of the day.

Case Study: MartyMarty, a sixth grader with Asperger Syndrome, received the majority of his special education services in a very self-contained setting. He had difficulties with transition and with changes in his routine. Marty had a keen interest in art. His parents and teachers felt that enough support could be provided within the art room for Marty to be integrated into that special activity once a week. Two paraeducators supported the art room the

period that Marty had art. Most days he was successful in that environment with one-on-one support.

One day the sixth graders were tasked with creating a head dress and neck ornament representative of King Tut. This was a fabric project. The students had to color on a paper with crayons, and then using an iron, transfer their design onto a piece of cloth. Marty was very excited about the project and wanted his fabric piece to turn out just as dark as his original piece. Unfortunately, when he did the transfer, he did not wait for the iron to get hot enough and the project did not turn out like he anticipated.

Marty engaged in some very destructive behavior. He had to leave the art room. In hindsight the team felt that if Marty had been provided more visual supports for the tasks, such as specific directions on how long to preheat the iron, that the behavioral episode may have been prevented. The team implemented visual instructions for each art activity after that. Marty was able to be successfully integrated into that less structured setting.

Supports such as a "mini-schedule" or a "schedule within a schedule" could have provided Marty with the supports he needed to be successful. These tools break tasks down into their smaller component parts, thus allowing the individual with ASD to concentrate on one aspect of the task at a time.

Although the examples provided here represent tools that might be used with younger individuals, mini schedules can be created for use with all ages, within all environments.

Special classes are not the only out-of-class activities in which individuals with ASD participate. Hallways, sports, clubs, the gym locker, etc., are all places where visual supports can provide assistance to the individual with ASD.

Visual Supports Across the Curriculum

When we present information verbally, the words are available for a brief moment.

When we present information visually, it can be there for as long as the individual needs it.

Visual supports might include, but are not limited to pictures, written words, gestures, objects within the environment, arrangement of the environment or visual boundaries, schedules, maps, labels, organization systems, timelines, and scripts. They are utilized across settings to support individuals with ASD (National Research Council, 2001).

As individuals with ASD spend more time in the general education setting, educators must focus on using and developing visual supports for them. Supports are needed that increase access to the curriculum, and also to increase successful participation in, and completion of curriculum requirements.

Tips for visually supporting individuals across the curriculum include:

o Organize the environment with the students in mind. Keep the environment free from clutter, and try to keep it visually consistent with well labeled areas.

o Provide well-labeled areas for things such as depositing homework, picking up and turning in folders, accessing materials.

o Graphic Organizers

o

o Graphic organizers are used to visually represent information for individuals from all ages, backgrounds, and academic levels. Timelines, charts, tables, and pictorial representations are all examples of graphic organizers. The goal of graphic organizers is to visually depict information. They are used to sequence information and make it more concrete. Graphic organizers assist students in planning paragraphs, pulling important information from content, sequencing ideas or information for writing or answering questions, sequencing the steps in a job or task, etc. Their strength is in their concrete visual presentation of material. Websites with sample graphic organizers are included in the resources section of this module. Software specifically available and used by many K-12 classrooms particularly designed for creating graphic organizers includes; Inspiration and Kidspiration software (http://www.inspiration.com/).

o Color-Coding

o

o Color-coding is a simple visual cue with a large impact. Think of the numerous things throughout your day that use color to assign meaning- the stop sign, the green light, holidays; the list could go on and on. Color creates a visual picture in the mind. Using color to label materials can assist individuals with ASD as they

organize various aspects of their day. Color can be used to establish boundaries and to separate or outline areas of a room. Red and green are great colors to use to label areas of the environment. Green is associated with "go" or "OK," and red is associated with "stop" or "don't touch." Simple accommodations can be made using color, such as covering the screen of the classroom computer with a red sheet of paper when it is not an option for a leisure choice. Color can be used for book covers, notebooks and folders associated with one subject. Color can be used for labeling personal possessions. Tasks that relate to each other can be color-coded. All these uses of colors assist in structuring the environment, visually, for individuals with ASD.

Technology SupportsKeep in mind the technological supports that are available to assist in the development of visual supports across the curriculum. Technology can make the creation of visual supports easier. Email and other forms of communication via technology can increase the ease of communication about visual supports being utilized at home, in school, and in the work setting. Included below are just a few technology supports available.

Mayer-Johnson BoardmakerBoardmaker (BM) is recognized as a top tool for educators and speech-language pathologists for creating printed classroom materials such as schedules, worksheets, reading and writing activities, game and song boards, communication boards, books and more. Boardmaker is a software program that uses clip art consisting of picture communication symbols (http://www.mayer-johnson.com/).

Slater Publications Picture-ItPicture-It is software designed for use by both adult and individual with ASD to adapt the written environment. This product allows the user to visually represent words for ease of reading and increasing comprehension (http://www.slatersoftware.com/pit.html).

SummaryWhen individuals with ASD are given the opportunity to learn with visual supports or cues they:

o Complete more tasks by themselves therefore increasing their independenceo Learn more rapidlyo Demonstrate decreased levels of frustration, anxiety, and aggression related to task

completiono Adjust more readily to changes in their environments (Savner & Myles, 2000).

When we present information verbally, the words are available for a brief moment.

When we present information visually it can be there for as long as the individual needs it.

Frequently Asked Questions (FAQs)Question: What is a boundary setting?

A: A boundary setting is an intervention that creates structure at home or school by defining areas that are accessible and/or are appropriate for specific activities.

Question: Who can use boundary settings?

A: Anyone who works with a child who needs increased structure can use a boundary setting; this includes parents, educators, paraprofessionals, and volunteers. Anyone can implement this intervention.

Question: Why use boundary settings?

A: The structure that is created helps children make good choices and manage their behavior in a safe and appropriate way.

Question: When should boundary settings be used?

A: If a child has trouble staying in one place, transitioning, focusing, or leaving others' belongings alone a boundary setting may be an effective intervention.

Question: At what ages can boundary settings be used?

A: The low-cost interventions can be used for individuals at any age, from toddlers to adults.

Question: What materials might be needed for boundary settings?

A: Most boundary setting materials are readily available and cheap. They include colored tape, cardboard boxes, photos, and carpet squares.

Question: Do I have to be a really organized person to implement a label system?

A: No you don't have to be the most organized person on the block for a labeling system to work. But you might discover that you will benefit as much as the child does when you incorporate a labeling system in your daily routine. It's amazing how much less picking up you will do when there is a "place for everything & everything in its place."

Question: What if I have labeled everything but my child doesn't seem to notice?

A: Be sure to draw the child's attention to the labels. Point them out at every opportunity. If you feel like you have labeled everything to the point that it is "too much," perhaps the child has "tuned out" the labels you've placed everywhere. If you think this might be the case, to start out in a small way, perhaps labeling just a few of the child's favorite items to begin with. Be sure that you have the child's attention, hold the label in one hand and the item in the other (if possible, you may have to stand by and point or touch larger items like a TV or computer!), say the name of the item ("Bobby's dinosaur") while showing it to the child, then repeat the process but show the child the picture / label that represents the item, while saying the name of the item again. Once you are sure the child has made the connection between the actual item and the label that represents the item, it won't be long before she will be ready to use more of the labels you have made.

Question: How do I decide what kinds of labels to use? Should I invest in a computer program, use photos, try to draw?

A: Use whatever works the best to help the child understand the information easily and quickly. Generally, the more realistic looking, the better. It shouldn't be too complicated

or take too much thought to figure out. If you have to think about it too much, it may be too complicated of a system. If the child has difficulty understanding your system, you may inadvertently have added one more stressor to the child's day. Try to keep it as simple as possible.

Question: What is important to keep in mind about using labels?

A: Like any tool, be sure to use it! You can have the neatest, most easily understood labeling system possible but if you don't implement it and use it, what good is it? Does the child easily understand your system? Can the child recognize or be taught to recognize what the label stands for? After you have a system in place, remember to evaluate it every so often to make sure it is still working for the child.

Question: If I use a camera to make pictures for labels, will I need to be a good photographer?

A: No. Just remember a few basics and you will be a pro in no time. a.) Be sure you know how to operate your camera correctly! Read the manual to know how your camera operates best. This seems like an unnecessary thing to point out, but the more you know about how your camera works, the better your labels will turn out. b.) Take a close-up of the object for which you are making a label. c.) Be aware of what is behind the object you intend to photograph - try to have a plain, simple background to avoid any distractions. d.) Check the film and batteries before using the camera!

Question: Do I have to have good art abilities to make a People Locator for my child?

A: No, not at all! If you can operate a camera, you can make a People Locator!

Question: What if my child continues to perseverate on where a favorite person is even after a People Locator is being utilized?

A: Be patient and continue using the People Locator. It may take time for the child to feel secure that the information on the People Locator is accurate and can be "trusted."

Question: Can a People Locator be used for all the students in my classroom?

A: Sure! It may even be used as a handy way to take roll. Each child could put his or her picture on the "Who Is Here" portion of the locator when they come into the room every morning. At a glance, you and all the students would know who is present and who is absent. A People Locator doesn't have to be limited only to the child with ASD.

Question: Is a People Locator really helpful in the home setting?

A: Yes, because it will help the child understand where family members are using a visual format that is more readily processed by the child with ASD. When the child understands where the family member is, it can help lower his/her stress and anxiety levels about the family member's absence.

Question: Should the child with ASD be included on the People Locator?

A: Including the child can help him/her transition between places when the picture of where he/she currently is located is exchanged for the picture of where he/she is going.

Question: Why do we use visual schedules?

A: Visual schedules help individuals understand what they will be doing for a certain period of time and help enhance expected behaviors.

Question: Who benefits from using a visual schedule.

A: Almost everyone can benefit from a visual schedule.

Question: What do I need to make a visual schedule?

A: Materials needed for a visual schedule depend on the number of children who will use the schedule, its placement, and need for mobility. Generally, visual schedules requires

o Some type of symbol such as a photograph, line drawing, words, or objects.o Construction paper, file folder, clipboard, or another medium on which to present

the visual schedule.o A means of adhering the symbols to the backing and something that will allow you

to post the schedule. Common items used for this purpose include: glue, Velcro, and putty.

Question: If my child can talk, can she benefit from a visual schedule?

A: Yes. Children of all abilities can benefit from a visual schedule. When deciding whether a visual schedule will benefit your child, consider the child's ability to understand rather than the ability to speak.

Question: How do I change the schedule to include an activity that is unfamiliar to my child?

A: A question mark may be used to symbolize a new or different activity

Post-AssessmentPost-AssessmentVisual Supports are used only in the school environment.

Select an answer for question 28

Visual Supports can be developed for ___________.

Select an answer for question 29

A visual support is

Select an answer for question 30

Visual supports are only used to help individuals who are having behavioral difficulty.

Select an answer for question 31

Labels and locators are only used by individuals with disabilities.

Select an answer for question 33

Visual boundaries are used primarily for preschool-aged individuals.

Select an answer for question 34

Once an individual uses a visual support independently it should be faded.

Select an answer for question 60

Discussion Questions[ Export PDF with Answers | Export PDF without Answers ]

Submit Post-Assessment

1. Why are visual supports important for individuals with autism spectrum disorders?

A correct answer should include a statement such as:

When individuals with ASD are given the opportunity to learn with visual supports or cues they:

o Complete more tasks by themselves therefore increasing their independence

o Learn more rapidlyo Demonstrate decreased levels of frustration, anxiety, and aggression

related to task completiono Adjust more readily to changes in their environments (Savner & Myles,

2000).2. When is it appropriate to use visual supports and why?

A correct answer should include a statement such as:

For children with autism spectrum disorders (ASD), using visual supports can help them be more successful in what is often a confusing world.

3. How might an educator or parent create visual supports for use with an individual with ASD?

A correct answer should include a statement such as:

Materials needed to make the visual supports are not necessarily difficult to find or expensive. Words, photographs, magazine pictures, line drawings, commercially made icons, miniature objects (check out refrigerator magnets), or simple drawings can be used. The specific choice of symbol depends on the individual's needs.

4. Various types of visual supports were presented within this module. Which do you feel would be most beneficial to the individual you know with ASD? Why?

Answer will vary to this question. Each should be supported by content taken directly from the module regarding a particular visual support.

Citation and References

If included in presentations or publications, credit should be given to the authors of this module. Please use the citation below to reference this content.

Smith, S. M. (2007). Visual supports: Online training module (Columbus: Ohio Center for Autism and Low Incidence). In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, www.autisminternetmodules.org. Columbus, OH: OCALI.

VISUAL SUPPORTS REFERENCES

Buron, K. D., & Curtis, M. (2003). The incredible 5-point scale: Assisting students with autism spectrum disorders in understanding social interactions and controlling their emotional responses. Shawnee Mission, KS: Autism Asperger Publishing Company.

Gagnon, E. (2001). Power cards: Using special interests to motivate children and youth with asperger syndrome and autism. Shawnee Mission, KS: Autism Asperger Publishing Company.

Hodgdon, L. A. (1996). Visual strategies for improving communication: Volume 1: Practical supports for school and home. Troy, MI: QuirkRoberts Publishing.

Klin, A., Volkmar, F. R., & Sparrow, S. S. (Eds.) (2000). Asperger syndrome. New York, NY: The Guilford Press.

Kluth, P. (2003). You're going to love this kid: Teaching students with autism in the inclusive classroom. Baltimore, MD: Paul H. Brookes Publishing Company.

Moore, S. T. (2002). Asperger syndrome and the elementary school experience: Practical solutions for academic & social difficulties. Shawnee Mission, KS: Autism Asperger Publishing Company.

Myles, B. S. (2005). Children and youth with asperger syndrome: Strategies for success in inclusive settings. Thousand Oaks, CA: Corwin Press.

Myles, B. S., & Adreon, D. (2001). Asperger syndrome and adolescence: Practical solutions for school success. Shawnee Mission, KS: Autism Asperger Publishing Company.

Myles, B. S., Cook, K. T., Miller, N. E., Rinner, L., & Robbins, L. A. (2000). Asperger syndrome and sensory issues: Practical solutions for making sense of the world. Shawnee Mission, KS: Autism Asperger Publishing Company.

Myles, B. S., & Simpson, R. L. (2003). Asperger syndrome: A guide for educators and parents (2nd ed.). Austin, TX: ProED.

Myles, B. S., Southwick, J. (1999). Asperger syndrome and difficult moments: Practical solutions for tantrums, rage, and meltdowns. Shawnee Mission, KS: Autism Asperger Publishing Company.

National Research Council (2001). Educating children with autism. Washington, DC: National Academy Press.

Sakai, K. (2005). Finding our way: Practical solutions for creating a supportive home and community for the asperger syndrome family. Shawnee Mission, KS: Autism Asperger Publishing Company.

Savner, J. L., & Myles, B. S. (2000). Making visual supports work in the home and community: Strategies for individuals with autism and asperger syndrome. Shawnee Mission, KS: Autism Asperger Publishing Company.

Scheuermann, B., & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA: Wadsworth/Thomson Learning.

Simpson, R. L. (2005). Autism spectrum disorders: Interventions and treatments for children and youth. Thousand Oaks, CA: Corwin Press.

Simpson, R. L., & Myles, B. S. (Eds.) (1998). Educating children and youth with autism: Strategies for effective practice. Austin, TX: ProED.

Small, M., & Kontente, L. (2003). Everyday solutions: A practical guide for families of children with autism spectrum disorders. Shawnee Mission, KS: Autism Asperger Publishing Company.

Wetherby, A. M., & Prizant, B. M. (Eds.) (2000). Autism spectrum disorders: A

transactional developmental perspective. Baltimore, MD: Paul H. Brookes Publishing Company.