Tips For Using Visual Support For People With Communication Difficulties
Many people use visual support in their everyday life without thinking about it. For example we:
- Write what we are going to do on a calendar
- Create to do lists to help us organise ourselves and remember what we have to do
- Keep a diary, which can be paper based or on a phone, tablet or computer
- Put labels on drawers and boxes so that we know what is in them.
Visual processing is often easier than auditory processing for people on the spectrum, or those with communication difficulties such as attention and listening difficulties, global delay, learning difficulties and dyslexia, to name but a few. The National Autistic Society says:
“All people with an ASD can potentially benefit from using visual support, regardless of their age or ability. It’s an opportunity to communicate without complications.” (National Autistic Society, 2013)
Visual support can help children and young people in many different ways, for example it can help them to:
- Remember information
- Follow instructions
- Ask for things that they want, e.g. a drink
- Cope with change
- Have a predictable routine – they know what they are going to do
- Finish tasks and develop independent learning skills
- Make choices
- Increase understanding of social situations and implement strategies
It might feel unnatural or extra work in a busy household, but remember we already use visual support systems. We use them without thinking, whereas when you use them to support a child’s communication skills, you have to think more consciously about them. Here are some tips for using visual supports:
Think About Why You Are Using Visual Support
What do you want visual support to enable your child to do? For example, do you want him to ask for things that he wants? Do you want him to be able to get dressed independently? Do you want to make your child’s routine predictable? Etc.
Decide What Kinds Of Visual Support You Are Going To Use
Are you going to use objects, photographs, pictures, symbols, Makaton signs? You need to find the support that works for your child, e.g. your child might need objects and not be able to understand photos or pictures yet. There is a developmental hierarchy of visual support, but this has been called in to question recently as there is evidence that children do not follow this hierarchy. The National Autistic Society states the importance of finding what works for your child, this is very personal and what works for one child might not work for another. So you need to find the support that helps your child, and then use this consistently.
Start With Small Steps
I always tell families to start with small steps forward. It is not easy to implement a system through family life and it takes time, so I always advise starting off with one or two strategies, e.g. a Now and Next Board (see previous post add link) used at a specific time. For example, one child I worked with did not like having his nappy changed and would get very distressed when his mum tried to change it. We introduced a Now and Next Board with a picture of a nappy (now) and an item he likes, e.g. a biscuit or a toy car (next). When families feel more confident and comfortable, we can add another visual support. They need to see the benefit too, as this motivates them to want to use more visual support.
Plan How Often And Where You Are Going To Use Visual Support
For example, are there set times you are going to use visual support, as in the example above (when the child has to do something they do not want to do), or at mealtimes, or before you go out, etc? Are you going to use it at school, nursery, at other people’s homes – grandparents’, child minder’s, etc?
One child that I work with uses visual support to help him cope with change, e.g. where he is going, who he will see, what he will do, etc. His nursery uses a choice board with him to help him choose what he wants to do.
It does take planning, but speech and language therapy goals can help you with this, and it is an effective strategy with a large evidence base that can really help children with a range of speech, language and communication difficulties.
Case Study For Using Visual Supports
NB names have been changed
Anna is seven years old. She is at a small, one-form entry mainstream primary school. She finds it hard to stay on task and to complete work. She has attention and listening difficulties and finds it hard to follow an adult agenda. Classroom staff said that the main impacts of Anna’s difficulties are:
- Difficulty accessing curriculum tasks
- Reduced independent learning skills
- Some behavioural issues
We used a visual timetable to show Anna what she was going to do, and to divide the tasks into manageable chunks with a short break in between. For example, carpet time, counting, write sums. When each activity was finished, she took it off the Velcro strip and posted it in a box (you can use an envelope, a bag or a box). The act of doing this gives her a break between each task, so it is a subtle brain break.
When I work with Anna, I say, “1, 2, 3, finished!” and make the sign for ‘finished.’ This gives her a warning it is coming to an end and closes the activity. She then posts it. Anna knows this routine and says it and signs it with me. Some children use this routine to let people know they don’t want to do this anymore!! One boy I work with tells his mother, “1, 2, 3 finished!” when he does not want to do what she wants him to do!
If a child finds this hard, start with a Now And Next Timetable and build up to a longer timetable gradually when he is ready and able to cope with more pictures.
We don’t always use symbols with Anna. It is not always possible to have symbols for everything that you need, or to predict what you might need. When this happens, we go over what we are going to do and I draw it, e.g. I draw an ear for listening, eyes for looking, a book for story, etc. Anna crosses off the picture when the task is finished. In an ideal world of course we would all use beautiful symbols all the time, but this is not an ideal world and there are times that we need to be flexible – and that is ok!
We used visual steps to help her complete tasks and work independently. In an ideal world, it would be lovely to have beautiful visuals as shown above, but as we have discussed this is not an ideal world and there is often not time to make these wonderful resources. When that happens, I go over the steps with Anna (we never use many steps, as she would not be able to cope with this). Then I draw the first step, check it with her, and draw the second. I ask her to do the first, and to come and tell me when she has done it. I move away (not too far away). Anna comes to tell me and show me when she has completed the first step, we go over the second step and then she does this on her own and comes and tells me when she has finished it. From this we will build up to Anna doing two steps on her own and then showing me. You can build and build on this.
This approach is also helping her to learn that having lists of the steps helps, and when she is older, if she needs this support, we can teach her to make her own lists.
This is a structured approach that helps develop independent learning. You can find out more about the TEACHH approach here.
We started off with one task in a tray/box on the left side of the table that Anna completed with adult support to help her get used to this way of working. We put the task in a folder/bag/box with a picture/symbol on it to show what it is. The same picture/symbol was also on a Velcro strip. Anna looked at the Velcro strip with the adult to see what the activity was. Then she got the activity out of the tray/box and completed it. When she finished, she took the picture/symbol off the Velcro strip and put it in a finished pot/box to show she had done it, she put the activity back in the folder and put it in a finished box/tray on her right. As Anna becomes more used to this way of working, the adult can move away and we can add another picture/symbol, which is to tell an adult that she has finished. We plan to gradually increase the number of tasks and reduce adult support so that she is working more independently.
Ideas for tasks to go in TEACHH trays:
Occupational Therapy fine motor activities: for example: handwriting activities, threading, peg boards, lacing, etc. Pinterest have lots of lovely ideas.
Numeracy: For example: Matching numbers; matching amount to number; developing one to one correspondence. Pinterest have some great ideas.
Literacy: For example: sorting pictures/objects by the first speech sound, e.g. sock, soap, baby, bee; match pictures to words; match pairs of letters; sequence three pictures; make sentences using Language for Thinking resources; sort vocabulary into categories, e.g. animals and food, letters and numbers.
Using Social Stories
The behaviours are complex, so I won’t go into detail here, but Anna sometimes pinches her friends when she gets frustrated. I am attaching a social story we wrote to try to give her another strategy, which you can also view as a PDF:
I would like to end this post with a fantastic quote by Temple Grandin:
“I think in pictures. Words are like a second language to me…when somebody speaks to me, his words are instantly translated into pictures… One of the most profound mysteries of autism has been the remarkable ability of most autistic people to excel at visual spatial skills while performing so poorly at verbal skills.” (Grandin, 1995.)