Summary of “How to develop and implement visual supports”

What are visual supports and who can benefit from them?

* Visual supports can be used to provide information, to teach self-help skills, to teach independent work skills, to help students understand expectations, and many other ways.

* Visual supports can be used with all students regardless of intellectual capacities or verbal abilities.


How to create visual supports

* Whenever possible, the most age appropriate representative level should be used (object level, photograph level, drawing, icon, word, written phrase/sentences)

* Must consider the size, location of usage, and color that will be most beneficial


Types of visual supports:  Visual schedules

* Visual schedules present the abstract concept of time in a concrete and manageable form.

* Visual schedules can often reduce stress, teach the concepts of time, and assist in promoting students’ understanding of change and flexibility.

* How to construct a visual schedule:

1) Determine the activities

2) Determine the appropriate level of visual representation

3) Establish a “finished” indicator

4) Decide how much information a student can handle at one time

5) Determine if the student will be involved in the daily construction of the visual schedule

6) Allow student choice when appropriate

7) Establish a schedule routine


* Types of visual schedules

1) General visual schedule- provide students with a general overview of the day’s activities

2) Minischedules- indicates the specific activities that will occur during a designated time period (for example: reading-review sight words, read story, complete worksheet).

3) Task organizers-augments minischedules by breaking down the exact steps associated with completing each activity (for example:  for “complete reading worksheet”, the task organizer schedule would provide words or symbols representing the steps—get worksheet, get pencil, put name on paper, complete worksheet, review answers, place worksheet in finished basket.

4) Calendars-visual supports that assist students in understanding the concept of time relative to organizing their lives and understanding the sequences of activities.

5) Memory aids-in this support, the materials needed for a given situation are specified.  These often appear as checklists to improve organization skills.  Can also be used as visual reminders, for example, a picture of a flushing toilet could be placed above the toilet to remind the student to flush before exiting.


Visual strategies that support behavior

* Turn taking cards

* Waiting symbols

* Making choices

* Defining rules and teaching alternate behaviors

* Consequence maps

* Visual representation of calming supports

* Transition supports (visual timer, time limit warnings, etc)

* First/then visuals


Visual supports that structure the learning environment

* Labels-mark tubs and containers with visual representations of their contents

* Boundary settings- establish a specific physical space for activities, such as, playing, reading, or cooking


Visual supports that enhance communication

* Picture card files-graphically depict different tasks to be accomplisjed during a specific period of time, such as a transition within a given activity.

* Teacher notebook-designed for use with small groups of students rather than individuals,  As the teacher provides instruction, he/she can point to the relevant symbols

* Teacher minibooks-groupings of generic directional pictures and words that the students use throughout the day (directions for lining up, waiting in the hallway, being quiet, circle time, etc)


Facilitating communication between environments

* Visual bridges- developed to support ongoing communication between home and school.

* Remnant books-appropriate for students who require tangible, hands-on support to communicate about past events (for example-if a student completed an art project, a marker can be placed in the remnant book)

Visual strategies that support social skill development

* Topic wheels-gives students a random selection of conversation topics from which to choose.  Assists in reducing perseveration

* Power cards-example:  a student with a dominant interest in Spider Man might be provided a profile and script describing how Spider Man demonstrates acceptable behavior at school.

* Social Stories-minibook that describes a social situation along with appropriate social responses.  Written for the individual and often have pictures depicting the student completing social activities correctly.

–Rachel Lacap

Chapter 89

Summary: Christopher explained to Siobhan that his father ordered him to stop detecting which meant his book was finished. She complimented him on what he’d written and tried to comfort him but Christopher wasn’t satisfied, though, because his book did not have a proper ending and he still hadn’t figured out who’d killed Wellington.

Siobhan then explained something that is difficult for many of us to accept: That’s life. It’s not uncommon for things to happen that we don’t fully understand and our experiences don’t always get wrapped up with a definite conclusion. Of course, that did little to ease Christopher’s mind.

He was still unsettled that Wellington’s killer was free and likely in Christopher’s immediate area. He then told Siobhan that his father insisted that he never mention Mr. Shears name again and that he was an evil man which caused him to speculate again that he was the killer. Siobhan pointed out that he may have said that because he simply doesn’t like Mr. Shears and speculated that it could be that he was taking Mrs. Shears’ side.

Christopher then added that his father told him that Mrs. Shears isn’t their friend anymore. Siobhan had no more insight to offer and was saved by the school bell.

The following 2 days were rough for Christopher; he had 2 consecutive black days thanks to seeing yellow cars on the way to school. After shutting down for 2 straight days—secluding himself, groaning, not eating—he took advantage of some pre-arranged agreement that allows him to close his eyes on the way to school to avoid seeing yellow cars which would inevitably lead to another black day.


Application: It is important to walk a fine line between not overindulging all the quirks some students have, but to also be sensitive about how powerfully those aversions can interfere with basic functioning. You never want a child to have 2 straight black days, but it’s vital that we provide strategies and opportunities to work through fixed thoughts rather than trying to anticipate and clear every possible obstacle, because like Siobhan explained, life doesn’t always line up the way we think it should.

— Jennifer Johnston


Chapters 79 and 83

Chapter 79 opens in the family’s kitchen. Christopher’s father confronts him about the ongoing investigation, and forbids Christopher to continue. His father is emotional and frustrated, met by Christopher’s detached assessment of the facts. Christopher makes statements intended to appease his father and end the conversation, without the intention to compromise. As Christopher’s dad accuses him of continuing the forbidden investigation, Christopher is seemingly disconnected from his father’s emotion. This is not to say he is disengaged; however, he is over-attentive to the details of the room, his food, and his own thoughts. When working with children on the spectrum or with sensory processing needs, it is important to understand how they see the world. When the brain does not effectively filter out extraneous noise or sensory stimuli, the “meaningless details” can overwhelm and distract from the communication attempted by others. Chapter 83 begins with Christopher opining about his desire to be an astronaut. He speaks to the appealing nature of the job- the social isolation that would be terrifying to some is comforting to him. The tight spaces, the machinery, and the isolation would be predictable and routine. Navigating the depths of space is less intimidating to Christopher than navigating social interactions with others. As he mentions earlier in the book, he appreciates “prime numbers because it is what exists after you have taken all the patterns away. They are very logical but you could never work out the rules, even if you spent all your time thinking about them.” Students with social communication deficits sometimes live in a world where the patterns of communication and social interaction seem indecipherable, and as a result, are most comfortable seeking interaction with objects. It makes them feel safe and in control, in a world that may feel intimidatingly unpredictable.

–Laura Woodring

Tech Tuesday

Kristin Kelly shares:

How do I use my WHAS Crusade for Children funded iPad in speech language therapy?

  1. Ready to go (regardless of who you are serving!). I was able to begin therapy immediately for a student who has multiple needs. I had quick access to touchscreen aps to work on yes/no responses and cause/effect while her eye gaze and touchscreen devices were being ordered through her private provider and materials were obtained through the technology center.

2. Changing Levels. I was able to trial a dynamic display platform with a student who had progressed well with a picture notebook. I was able to informally assess many factors that the technology center asks about and the iPad made it much easier (less time and more convenient)

3. Pictures! The IPAD makes taking pictures easier (no more uploading from a camera or using my personal cell phone)

4. Videos! I have been video recording students working on articulation goals as they transition to using sounds in conversation. This promoted self-evaluation, self-correcting and self-monitoring as they watched and listened to themselves on video. It was also a motivator for behavior by “earning” the privilege of making a video. This has been my favorite because students as young as 4 want to “do it again” so they can fix their sounds. Awesome!

Potential future uses/personal goals:

  1. Online assessment tools and online scoring of standardized assessments.
  2. Expand my repertoire of free apps.


Summary of “How to Teach Verbal Behavior”

Verbal behavior is not what you think it is

* Verbal behavior is behavior mediated by other people, meaning that another person is in the middle of delivering reinforcement.

* Example: If your child says “puzzle, please” and you pick up the puzzle and give it to the child OR if your child drags you by the arm to the puzzle and points and cries until you give it to him, that also is verbal behavior. If your child asks, cries, signs, sings, uses PECS, writes, jumps up and down in order to request an object, and you give that object-that is also verbal behavior.

* Verbal behavior is operant behavior

* Four Common Verbal Operants

1. Mand-the request

2. Tact-naming, labeling, and commenting

3. Echoic-an imitation

4. Intraverbal-answering questions

* During verbal behavior, there is a speaker who emits the verbal behavior and a listener who cues and reinforces appropriate verbal behavior.

* Children on the Autism spectrum must be taught each verbal operant separately.

* Children on the Autism spectrum must be taught both speaker and listener behavior.

* Verbal behavior depends on special reinforcers, such as attention from other people.

* Children on the spectrum must learn that attention is a reinforce


What is a reinforcer?

* A consequence that increases the future probability of a behavior.  In everyday language, a reward.

* There are positive reinforcers (gaining access to things we want) and negative reinforcers (the removal of unpleasant things).

* Reinforcer deprivation (withholding a favored reinforcer for part of the day and then bringing it back out during a new lesson) can make your teaching more effective while reinforce satiation (using the same reinforcer over and over) can decrease the effectiveness.

* Identify reinforcers by completing a reinforcer checklist, observe approach and avoidance behavior, do preference assessments with objects, photographs, or words.


Human relationships and their role in teaching verbal behavior

* Relationships are important for the development of verbal behavior because attention from others reinforces tacts, echoics, and intraverbals.

* People can become conditioned reinforcers by being repeatedly paired with many positive reinforcers or even negative reinforcers (paired with the removal of something that the child does not like).

* When building relationships with children on the spectrum:

1. Pair yourself with many reinforcers

2. Pair your own behavior with different kinds of reinforcers (if child likes juice, frequently give the child juice)

3. Be responsive to all the child’s approach behaviors (if child points to toy, give him the toy.)

4. Do not pair yourself with averse stimuli (in the very early stages of developing rapport, do not  make requests, teach, interrupt, reprimand, etc).

5. Get others to manage difficult situations.

How to teach mands

* Pointing, leading, and requesting positive reinforcers are all types of approach mands.

* Pushing items away, turning away, or saying “no” are all types of rejecting mands

* To teach mands, you must identify the positive reinforcers

* Steps to teaching mands

1. Use effective reinforcers or aversive stimuli

2. Ensure that reinforcer deprivation has occurred and not satiation.

3. Observe child’s approach or rejection response.

4. Use wait time, and then prompt, if necessary, for the mand.

5. Reinforce the appropriate mand with the reinforcer your child requests.

* Teach new mands using physical and echoic prompts and fade these prompts as soon as possible.

* Teach mands in the natural environment by observing child’s approach and avoidance responses (for example, if student is coloring and wants a new color, you can ask her to name the color she wants).

* Contrive opportunities to mand using incidental teaching:  put a desired object within sight but out of reach and request the mand from the student in order to get desired item.


Watching other people

* Generalized imitation refers to imitating novel models without reinforcement, for example, when someone sings a new song and your child imitates the new song without specific teaching to do so.

* Generalized imitation is important for language development because without imitating new things that people do and say, a child is unlikely to learn much language.

* In order to teach generalized imitation, use discrete trial training steps:

1. Child sits with hands in laps facing the trainer

2. Trainer places an object in front of child.

3. Trainer says child’s name, pauses, and says, “Do this”

4. Trainer presents the model

5. Wait 5 seconds for correct response, if no response is given or incorrect response is given, physically prompt the correct response

6. Immediately praise prompts and unprompted correct responses.

7. Record child’s response after every trial.


Say Something: teaching vocalization

* Teaching vocalization is important because it is the most conventional form of communication understood by most people.  It may decrease behavior problems.

* Lovaas’s four steps for teaching vocalization:

1. Reinforce any vocalization or looking at the adult with food.  This should result in more vocalization and more looking at the adule.

2. Only reinforce vocalization if the vocalization follows the adult’s vocalization within a few seconds.

3. Only reinforce vocalization that occurs after the adult vocalizes and the child’s vocalization approximates what the child says.

4. Once a few simple words are taught, new words are taught using echoic prompts and fading.

* Important not to teach verbal behavior until the child is able to sit and look when his/her name is called.

* Differentially reinforce vocalization by reinforcing vocalizations and withholding reinforcement for not speaking.

* There are several alternatives to vocalization, including signing, using visual systems, and using AAC.

What’s that?

* Receptive language reflects what we observe people do, not what is in their head.

* Discrimination can be used to determine receptive language.  Example:  show the child a picture of a circle and a square.  If the child reliably points of a circle with teacher says “circle” and points to square when teacher says “square”, the child probably understands the concept.

* Using conditional discrimination training helps improve receptive language.

* Example: The therapist presents pictures of cat, dog, or cow.  The therapist says “cat” and only reinforces pointing to the picture of the cat.  If the child points to the dog or cow, the therapist does not reinforce that response.


* Intraverbal is the verbal operant that does not have 1:1 correspondence with its verbal antecedent; for example, filling in the gaps in incomplete sentences and answering some WH questions.

* You begin teaching intraverbals by using mand training (discussed above) and fading prompts.

–Rachel Lacap

Chapters 71 and 73

Chapter 71

In this chapter, Christopher explains his life plans and how’s he’ll achieve them. He has to take his exams, and do well enough to be able to go to university.


“Then, when I’ve got a degree in Maths, or Physics, or Maths and Physics, I will be able to get a job and earn lots of money and I will be able to pay someone who can look after me and cook my meals and wash my clothes, or I will get a lady to marry me and be my wife and she can look after me so I can have company and not be on my own.”


This quote can be interpreted to mean he wants a relationship – he says he wants a wife. But when he describes why he wants a wife, it gives us a greater insight into his mind. He wants someone to care for him: cook, clean, etc.  AND he wants the company, so he is not on his own.


As an SLP, I often struggle to engage my students with Autism.  Language is a social construct, and frequently my students with Autism do not socially engage with language.  Because of that, I may fall into thinking that they do not desire social interaction. The insight revealed in this quote – and really, throughout the book – is that people with Autism DO desire social interaction, but in a way that is different than neurotypicals do.


I have a 5th grade student with Autism, he’s been on my caseload since he was in Pre-K. He is FREQUENTLY difficult to engage using language – even with his dynamic device.  However, every time I see him, he initiates a hug.  And when we walk down the hall together, he may not answer questions, comment, or even look in my direction during our stroll, but he will invariably reach out to hold my hand.


Chapter 73


The topic of this chapter centers on how Christopher’s behavioral difficulties when he was younger and how they  impacted his parent’s relationship.  This is a tough chapter.  Parenting and marriage is difficult, and I imagine it would be even tougher when you are learning how to parent a child with a disability. Have any of you heard the statistic thrown around regarding the divorce rate for couples that have a child with a disability?  I heard somewhere that the rate was significantly higher. It’s irresponsible of me, but I don’t know WHERE I heard that statistic, and yet, I still shared it numerous times. I assumed that this statistic was a fact, because having a child with a disability DOES cause more stress in general and I assumed it would affect a couple’s marriage negatively. You know what happens when you asssume?  I thought I’d be more responsible during the writing of this blog post, and I looked up the statistic.  I assumed wrong. For married couples with a child with a developmental disability ( which included CP, Down Syndrome, Intellectual Disability and Unknowd), there is not a statistically significant difference in the divorce rate.

As a clinician, this chapter reminds me to support my students and their families with an empathetic ear.

–Chelsea Graham



Blog post chap 59, 61, and 67

Chap. 59 Summary: Christopher is detailing how confusing it is when people tell him what to do-for example, “Keep off the grass,” but then not telling which area of the grass exactly. He feels relieved with the way Siobhan understands him and gives very exact directions on what it is he is allowed to do. She gives him a strategy, for example, that if someone hits him, he is to move away and stand still and count from 1 to 50, then come and tell her what has happened. Next Christopher has more detective work sneaking into the backyard of his neighbor and looking in the windows of her garden shed. Mrs. Shear’s then had to threaten Christopher that she would call the police again for him to go home. Christopher returned home and didn’t tell his dad what he had been up to.

Application: Very explicit directions are comforting to our students that don’t understand abstract language or indirect messages J

Chap. 61 Summary: Christopher is imagining that because his mother was cremated, he sometimes looks up into the sky and thinks that there are molecules of his mother in clouds over Africa, or coming down as rain in Brazil, or in snow somewhere. He doesn’t understand this concept of heaven that people have tried to explain to him, but he does thoroughly understand the process of decomposition and what happens to people who are buried.

Application: Further confirmation of how easy it is to imagine the concrete and real for Christopher.   Also, in this chapter, you can see how overfocused Christopher is on what people wear and how they smell J

Chap. 67 Summary: It’s Saturday, and Christopher’s dad is watching England play Romania at football on the TV, so he decides to do more detective work to find out who killed Wellington the dog. He talks about how this is brave for him, because he doesn’t like talking to strangers. It takes him a long time to get used to new staff members at school, and he won’t talk to them for weeks and weeks until he knows they are safe. Once he learns about if they have pets, or what there favorite color is, and draws a plan of their house, and asks them what kind of car they drive, he doesn’t mind being in the same room with them.

As Christopher goes on his neighborhood investigation, he has a couple conversations, and one longer conversation with a nice older lady who wants to bring out a snack to him. She offers many different snacks to him, but he ends up rejecting several of the offered food items because of their color. When Mrs. Alexander goes into the house to get snacks, Christopher ends up leaving because he was worried she might be calling the police. As he was walking away, he had a Chain of Reasoning inside his head, which left him with the notion that Mr. Shears may be his prime suspect in the murder of Wellington.

Application: To see how difficult it was for Christopher to eat things that were a certain color was enlightening. I never had thought that the strange eating habits I see with students that have autism, could be related to color! I always just thought it was the texture and taste they didn’t like and had never even thought it may be the color, or the fact that it was touching another food item

— Holly Porter