Autism Spectrum Disorders

Dr. Avril V. Brereton

Helping young children to communicate using visual supportsAll children who receive a diagnosis of autism have problems with communication. This fact sheet discusses the use of visual support systems and offers some ideas about their introduction and use.

Children with autism have difficulty using speech and language and also have difficulty understanding the spoken language of others and even the simplest sentences and instructions can be difficult for young children with autism to follow. Because of these problems in understanding, young children may be confused about:

what is or isn’t happening in their day why their routine has been changed being expected to shift from one activity to another being allowed to do some things but not others not always being allowed to do what they want to

when they want to

Slow processing of verbal information also means that an instruction may come and go too quickly so that the child doesn’t have time to understand the instruction and then respond to it. For young children with autism, problems communicating with others may lead to:

difficulty getting their message across frustration because their attempts to communicate

are not understood by others giving up because it’s simply too hard

We do know that for most children with autism the area of visual perception is a relative strength. How many children with autism do you know who can work the control for the TV and VCR or know how to unlock the front door yet you have never taught them to do these things? Little children with autism learn by looking and watching. Because of this, visual supports can help us to communicate with them and them to communicate with us.

What are visual supports?Some examples of visual supports or visual communication tools are:

real objects miniature objects

photographs line drawings

picture symbols choice boards

activity schedules daily schedules

How and when to use visual supportsPlanning for the introduction of visual supports requires a thorough understanding of the child’s abilities. Consultation with a Speech Pathologist and members of a multi-disciplinary team of professionals working with the child is highly recommended. Each child’s abilities and communication needs must be carefully assessed before a visual support system is introduced. Importantly, communication needs will vary according to the setting the child is in. For example how and what a child needs to communicate and with whom will be very different at home, Early Intervention, childcare or pre-school.

In order for the child to effectively use the visual support system, it should be introduced across different environments and with a range of people. It is vital that everyone interacting with the child consistently uses the same approach.

For successful introduction and effective use of visual supports, the child needs to understand what the object/picture/word represents, and how to use it to communicate a need or understand a request.

The child also has to have the following pre requisite skills: 1. the ability to attend to the visual stimuli (object,

picture etc)2. the ability to interpret the meaning of the stimulus3. the desire to communicate with others!

There is a hierarchy of complexity in visual supports. The most easy to understand and use are real objects,

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followed by miniatures of real objects, photographs of the real objects, line drawings, symbols and finally the written word.

See below an example of the communication skill – Choosing an activity.

Bubble Play is the activity of choice and the visual support hierarchy from easiest to most difficult/abstract is described.

Making choices: using the visual support hierarchy – Bubbles

Real object:The child selects the bubble wand as an indication they would like to play with the bubbles.

requires very little interpretation, is useful for a very young child, can be used with a child with significant

development delay

Photo of the real objectThe child selects the photo of the bubble jar if they would like to play with the bubbles.

requires a child to understand that 3D objects can be represented in 2D form.

does not require the child to understand that bubble jars can look different from each other.

does not require skills of generalization

Generic line drawing of the objectThe child selects the generic line drawing if they would like to play with the bubbles.

Generic line drawings require a child to understand:

3D objects can be represented in 2D form, an object can come in many different forms (size,

colour, shape), one picture can be used to represent each of these

different forms of an object; skills of generalization. Line drawings are accompanied with the written

word, to encourage the child to develop a bank of sight words that can be read in order to introduce the next phase of the hierarchy.

The written wordThe child selects the written word “bubbles” to play with the bubbles.

This is a visual support in its most abstract form. There is no picture involved for the child to refer to. The child needs to be able to read

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Choosing activities using the visual support hierarchy –

Real objects to written wordAn activity choice board using Real Objects

Steps: One piece of each activity is placed on the choice

board The child chooses an object from the board The child is then directed to the activity the piece

matches Most effectively introduced when activity is close to

the choice board and is immediately given to the child when they select a piece from the board

Available choicesThomas cards, blocks, circle puzzle or play dough

Child removes a real object from the board to make her choice. 1. Child gives you the block:

“I want to play with the blocks”

2. Child plays with the blocks

An activity choice board using Photographs

Steps:

Photos of the activities are placed on the choice board

The child chooses a photo from the choice board The child is then directed to the activity the photo

matches Most effectively introduced when activity is close to

the choice board and is immediately given to the child when they select a photo from the board

Available Choices:The choices are cards, blocks or circle puzzle

“I want to play with the circle puzzle”

An activity choice board using Generic line drawings

Steps: Generic line drawings of activities are placed on the

choice board The child chooses a drawing from the choice board

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The child is then directed to the activity the drawing matches

Available Choices:The choices are threading, dress-ups or painting

“I want to play with the dress-ups!”

An activity choice board using written words

Steps: Words of activities are placed on the choice board The child chooses a word from the choice board and

is directed to the chosen activity

First – thenUnderstanding the concept of first – then or to get across the message to a young child with autism that they can have something later rather than immediately is difficult! The use of first – then pictures can help.

Used to motivate the child

Used to motivate a child to participate in an activity they would otherwise avoido First: play lotto (undesired activity but goal for

the child), o Then: play Mr. Potato Head (child’s favourite

activity)

Used as a 2-step schedule For a child learning to complete a sequence of

activities, a first-then card can be used as a 2-step schedule

The consistent presentation assist the child to learn the skill

Used to assist a child to move on to the next activity For a child who demonstrates difficulty finishing a

current activity and moving on to the next activity

For a child who demonstrates anxiety when unsure of the routine; finishing an activity can be anxiety-provoking because the child does not know what to expect next. A first-then visual can ease the child’s anxiety by showing them the next activity.

Try a play ideas mat!

Why use a play ideas mat? To provide the child with a range of different

options to choose from in open-ended activities To use in open-ended activities with children who

lack play ideas and become stressed and/or anxious as a result

To increase the amount of time a child spends in open-ended activities, as a range of different ideas are presented to extend the child’s play

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To reduce the child’s anxiety about not knowing what to do

To assist in the social inclusion of the child.

How to use a play ideas mat Initially use each of the picture prompts individually,

showing the child step-by-step how to create the image in the photo

Once the child can copy several different images, place them on to a mat (laminated A4 or A3 sheet)

Position the mat at the activity (on the wall near the block corner or at the painting easel, for example) for all children to see and use if they wish.

Useful websites and books

http://card.ufl.edu/visual.htm

http://www.scopevic.org.au/therapy_crc.html

http://www.do2learn.com

Teaching Children with Autism: Strategies to Enhance Communication and Socialization by Kathleen Quill, New York: Delmar Publishers Inc., 1995.

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