Visual Supports
Visual supports (VS) are objects or pictures/symbols that can be seen and/or held, which are used to provide information visually to enhance an individual’s understanding of: the physical environment; people and the social environment (communication, words, actions, rules and expectations, and spoken or unspoken intentions or expectations) and more abstract concepts, such as the passage time, a sequence of events, or socially abstract concepts such as emotions or reasons to do something in a particular way. They are either ‘low-tech’ – objects, photos, pictures, symbols, or written words, or ‘high tech’ – on electronic devices.
VS have the potential to increase an individual’s understanding of expectations, reduce anxiety, facilitate participation, support communication, and increase independence, thereby reducing the risk of challenging behavior and supporting inclusion. Find examples from literature here.
Intervention type
Visual supports can include pictures, written lists, or timers that can serve as a reminder of a pending transition or a certain activity in the daily routine. The use of these cues can prevent behavioral problems and promote the individual’s independence and acquisition of daily living skills. For example, VS can help the individual’s ability to process information about the sequence of events, which can provide a sense of predictability and promote flexibility.
Visual supports can be used to set up choices (e.g., a choice board), time passage and sequencing (e.g., timers, first-then board), and step-by-step presentation of daily routines (e.g., visual schedules, social stories). To illustrate, developing a set of pictures showing the steps of the morning routine can remind the individual what needs to be done before going to school, avoiding confusion, and promoting compliance. Setting a timer that signals the end of 20 minutes of computer time may be more effective than abruptly telling the individual to turn off the computer.
Behavioral mechanism(s)
Visual supports are preventive strategies designed to avert the occurrence of behavioral problems by modifying the antecedents of the behavior problems. In research on VS, “on-schedule” behaviors (engagement with tasks or activities that corresponded with the current page of the VS or correctly completing steps of a task analysis for correct use of the VS) and “on-task behaviors” (visually attending to or appropriately manipulating scheduled materials, visually attending to, or manipulating the VS, and transitioning between scheduled tasks or activities) have served as dependent variables.
VS interventions usually include systematic prompting procedures to teach correct use of the materials, as well as graduated guidance procedures. VS can also provide structure, routine, and sequence that many autistic individuals need to engage in daily activities, thus supporting individuals in unpredictable and changing environments.
Severity and behavioral function considerations
Although individuals may need personal motivation to engage with them, to be taught their meaning and how to use them, VS which match the individual’s developmental stage are tools designed to help acquire a myriad of skills. Clear information does not exist regarding the severity of challenging behavior for which this intervention would be appropriate. However, there is data to support the appropriateness of VS for mild to moderate challenging behavior, as well as published studies related to VS for challenging behavior applied the intervention to behavior maintained by escape (task avoidance).
However, in these implementations it should be noted that the extinction component is not possible, given that the challenging behavior directly produces access to the maintaining reinforcer. Thus, when arranged for treatment of automatically maintained challenging behavior, DRA/I/O establish two competing reinforcement schedules in an attempt to shift responding away from challenging behavior.
Caregiver, context and practical considerations
