Many parents and their children with disabilities such as Autism, ADHD, and FASD are scrambling to cope amid the drastic changes that have essentially halted the regular routine of the whole world. While for most of us, this change of routine is very hard, on those with disabilities it can be completely destabilizing. This means you may be seeing more oppositional behaviour and possibly many more tantrums or problem behaviours.
The good news is, it may take a few days but you can change the course of the next few months for the better by establishing a routine supported by a visual schedule.
First, let’s address the importance of a routine. Without meaningful work (or school) or socialization, all of us and especially those with disabilities can feel lost and hopeless. While the rest of us can hopefully process these feelings and do something about them, those with disabilities can feel trapped and possibly not have the tools, cognitive level, or freedom to make choices to help themselves. They need help from their parents in the short term.
In this post I will talk about two things:
- Routines (or also known as meaningful activity or work)
- Visual Schedules (used to support establishing a new routine)
If you are like many of us, you are probably juggling a job working from home and the kids, putting these two steps into your child’s day will greatly help them become more independent and decrease their problem behaviours.
Establishing a routine for your child will be key in helping them get through this time.
Below is a picture of a routine I put in place last week for my 3 children who are 10,12 and 14.
As you can see the routine is very broad. However, just by putting this in place consistently with them over a weekend, they were able to be independent for my work week. Now, depending on the skill level of your child with a disability, you may need to put in place a few things in setting up the transition from one activity to another.
For parents of young children or if you have a child with a disability that has a really hard time transitioning, you will really want to be present with a timer going off at these transitions.
The key thing to keep in mind is that the first 2-5 days may be hard, but stand strong and insist they move on to the next activity planned…even if they yell or scream. Give them a few minutes or some calm downtime, and then re-point to the picture. Don’t give up….this hard work now will ensure that your child is following the routine for weeks to come!
The positive effects should improve their mood, and lift their spirits and give them predictability in this new situation. In turn, it will give you as a parent some much needed time to either work or take some important time to yourself.
You may be asking your self….why did she post a visual schedule for kids as old as 14? The research behind this is strong, that pictures are easier to follow and to remember. My 10-year old and 12-year old are both diagnosed with ADHD. For people with ADHD, Autism and FASD, words are harder for them to remember. It is not impossible for them to follow a word routine, but it is harder. If my goal is to make them independent, I want to make sure that I have everything put in place to give them the best chance at success. In this case, it’s following the routine, with minimal parent involvement. So yes, visuals are essential for those with disabilities no matter what their language and communication level is and will make it easier for you and them.
Before I go on about visuals, I wanted to give you some basic information about visuals:
1. Visuals and visual schedules are especially helpful in getting clients to follow rules or to follow routines better, or more independently. Talk to the client and/or family to find out what situations are the hardest for them. Start by supporting the client in using visuals targeting one or two specific challenges only.
2. For some clients, a hand-drawn picture is enough to support them. Other clients might need a real picture of the actual object (for example, a picture of their own bed). The higher the level of cognitive functioning of the client, the less specific to the client’s life the photos need to be. The hierarchy of visuals, from easiest to hardest to understand is as follows: picture of an actual object from the client’s life (i.e. real picture of their own bed), real picture of an object (i.e. real picture of any bed), cartoon picture, hand-drawn picture. If a client is struggling to successfully use visuals, you may need to change the type of visual presented.
3. For many clients, the exact picture used doesn’t matter as much as the words you will choose to say to describe the picture. For instance, a picture of a raincoat can be used to mean “raincoat” if you choose to name the picture using these words when you speak to the client. Or it could be chosen to represent any coat or even “hang your coat up” if you choose. What is important is to always pair the same picture with the same words, so that the client can easily learn what the picture represents.
4. Cognitively, it is easier for clients to understand visual schedules where pictures are placed from top to bottom than ones where pictures are placed from left to right. If a client is struggling with a visual schedule that has been placed horizontally, try reorganizing the pictures vertically.
5. For most clients, it is important that there be a way for the client to mark that he/she has finished each step of the visual schedule. This could be by using Velcro on the visual schedule and having the client place each picture into an envelope when completed. It could be done by using an erasable marker and having the client draw an X over each picture, as the steps are completed. Alternatively, it could be done by placing an “all done” visual (with sticky tack) onto each picture, as the task is done.
6. If the visual schedule you are using has empty spots, use a “no” picture (an X) to fill the empty spots. This can otherwise be confusing to clients.
7. Blank laminated visuals and an erasable marker can be used to draw a picture in a situation where you don’t have a picture to represent the challenging you are experiencing with a client. In a pinch, plain paper and a pencil can also work for many clients.
8. Use “uh-oh” pictures (could be a picture of someone scratching their head, a question mark, etc.) to show when something unexpected has happened. Take this picture and put it on top of the picture of the activity that has to change. For example, if the client was supposed to go to the park, but it has now started to rain, placing an “uh oh” picture on top of the park picture will help the client adapt to this change more easily.
9. A lanyard with a key ring can be used to keep the most frequently used pictures on it, for on-the-go situations. This is ideal for when families will be leaving the home or for a change of caregivers.
10. When using a first/then board, be sure the first item is always a task and that the second is always a reward. Get a list of things that are highly motivating to the client, either from the client or his/her family. Using first/then boards will not work if the reward is not something the client would really want to work towards earning.
11. Clients may likely need ongoing support to help troubleshoot the challenges they run into when trying to implement visuals. It is important to assign someone to directly support the family and to reach out to the family regularly to help talk through the challenges they are running into so that their use of visuals can be successful.
12. All sorts of different challenges can be supported by using visuals and visual schedules. Be imaginative in your use of them! Try to see things from the client’s perspective to help guide you on what might be needed to help the client’s functioning.
Important to keep in mind when implementing a visual schedule routine:
- Don’t Give Up!
- On the first day you introduce it, make sure to have some free time. If you are working, consider waiting until the weekend or if you can take a day off work, I suggest it.
- Show them the visual schedule and then direct them to the first activity on the list. Show them what that activity is and set the timer for the length of time you would like your child to do the activity.
- Always insist that they do the next activity (even if you have to take their hand and help them do it). By not giving in at the beginning, you will set this visual routine up to last for a long time.
- You don’t have to get too fancy….a hand-drawn stick figure drawing like the one I posted above is more than good enough. Kids are amazingly resilient and great at figuring out our poor quality adult pictures! So no excuses that you are a poor drawer!
- It works for older kids and adults too with disabilities….go ahead and try it!
- You can use it for your children without disabilities, pictures are often easier for all children to use and remember. So use it for your children with and without disabilities.
- Have on hand a clock or timer (for those that can’t tell time).+
6. Your child may need sub-visual schedules for each activity you have set out for the day. For example….when it is creative time some children will need a visual schedule just for that. Here is an example:
. Research shows that after you read something, or learn something new if you don’t put it in place within the next 24-48 hours…you will never do it. So go grab a blank sheet of paper and draw a first attempt at a visual schedule for your child!
Good luck and I wish you fewer behaviours and more independent time for both you and your child with disabilities.
Below are some useful links to get more visual material
- Victories’n Autism (provides examples of schedules and activity cards that are downloadable.
- A Day in Our Shoes (provides printable routine schedules)
- Lester B. Pearson School Board Autism Centre of Excellence: Visual Starter Kit (printable materials and instructions)
- Lester B. Pearson School Board Autism Centre of Excellence: Downloadable Visual Schedules. *Unfortunately, these images require the Boardmaker Sofware
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Cynthia Miller-Lautman – Disability Programs Specialized Services