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Visual Schedules - December 6, 2009

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Visual Schedules

By: Lara C. Pullen, Ph.D.

CEO and Founder Healing Thresholds

What is it?

A visual schedule is a set of pictures that communicates a series of activities or the steps of a specific activity 1,2. Visual schedules are meant to help children understand and manage the daily events in their lives 3. Visual schedules may be created using photographs, pictures, written words, or physical objects. Ideally, they communicate clear expectations for the child and decrease the need for constant adult involvement in the activity 4. Most visual schedules are introduced with adult guidance that gradually decreases with time 3. They can be used in speech therapy, at school, and at home 1,4,5.

What’s it like?

Schedules may be placed into notebooks or on a schedule board, or also presented with the aid of or on computers. The figure below represents an example visual schedule for the last portion of a child’s school day.

[Image: VisualSchedules.jpg]

When designing a visual schedule, consider the following questions 2:
  • Will the child understand or recognize the pictures or words?
  • Is the activity represented by the visual schedule obvious to the child?
  • Can the schedule be made clearer by the use of words, more images, or objects?
  • Does the child know and have available the tools required to successfully complete the activity?

What is the theory behind it?

Children with autism frequently have trouble paying attention to, adapting to, and understanding auditory input. They also tend to have strengths in rote memory and the ability to understand visual information 8. Visual schedules take advantage of these strengths by efficiently communicating information that allows children to better predict and plan within their environment 2,3,6. Some children with autism benefit from the use of computers to generate and present visual schedules, and may prefer getting visual schedule information directly from a computer rather than from a person 7.

Most behavioral problems associated with children with autism seem to stem from poor communication 2. While visual schedules can be useful at home, they may be especially useful for children transitioning into a school environment 4,6. Visual schedules facilitate communication and therefore may minimize behavioral problems 3,4.

Does it work?

Many studies have demonstrated that visual schedules are effective in helping developmentally disabled, and specifically autistic, children. These studies show visual schedules to be effective in helping children to gain independence and increase on-task behavior at school, at home, and in community settings 1,2,6,8. In younger children, this can translate into improved play skills, and a decrease in disruptive and aggressive behavior 5,6 Specifically, use of visual schedules has been associated with a decrease in disruptive behavior, aggression, tantrums, and property destruction 1.

In older children, use of visual schedules can enhance learning and improve a child’s ability to perform the skills required for daily living 1,3,4,6,8. Visual schedules have also been effectively used to improve physical activity in a physical education setting 6. With time, some children are able to independently use visual schedules to achieve on-task behavior and self-management without supervision 3-6

The most effective way to use visual schedules is to have them readily available and used consistently 6. Most children seem to enjoy the use of schedules and appear to be excited to see what will be coming next 3,4. This enthusiasm has been shown to translate into increased peer-peer interactions 3,4.

Is it harmful?

There are no reports of visual schedules being harmful.


Visual schedules can be included as a component of speech therapy 1. The cost of speech therapy is covered by the government through the Individuals with Disabilities Education Act (IDEA). The amount of speech therapy provided in this setting may be suboptimal and may need to be supplemented with private therapy. Private speech therapy can be expensive (approximately $100/hour).

Activity schedules can be designed and made at home inexpensively, and are easy to transport 5. They can be made by hand on note cards by drawing or gluing cut-out pictures from magazines. They can also be made on the computer using clipart and the PowerPoint program.

When used at home, visual schedules require an initial parental investment of time. With time, the child should achieve an improved ability for self-management and should require less parental supervision.


Autism is a condition covered under the Individuals with Disabilities Education Act (IDEA). Services covered by IDEA include early identification and assessment and speech-language pathology (speech therapy). This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21 (U.S. Department of Education Web site). Pediatricians can provide contact information for the state early intervention program (for children 0 to 3 years old). School districts will coordinate special services for children 3-21 years old.

Clipart can be used to generate homemade schedules. One source of clip art is the Graphics Factory:

  1. Bopp KD, Brown KE, Mirenda P. Speech-language pathologists' roles in the delivery of positive behavior support for individuals with developmental disabilities. Am J Speech Lang Pathol. 2004;13(1):5-19.
  2. Wheeler JJ, Carter SL. Using visual cues in the classroom for learners with autism as a method for promoting positive behavior. B C Journal of Special Education. 1998 1;21(3):64.
  3. Kimball JW, Kinney EM, Taylor BA, Stromer R. Lights, Camera, Action! Using engaging computer-cued activity schedules. TEACHING Exceptional Children. 2003 1;36(1):40.
  4. Bryan LC, Gast DL. Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. J Autism Dev Disord. 2000;30(6):553-567.
  5. Morrison RS, Sainato DM, Benchaaban D, Endo S. Increasing play skills of children with autism using activity schedules and correspondence training. Journal of Early Intervention. 2002;25(1):58-72.
  6. Zimbelman M, Paschal A, Hawley SR, Molgaard CA, St RT. Addressing physical inactivity among developmentally disabled students through visual schedules and social stories. Res Dev Disabil. 2006 7.
  7. Stromer R, Kimball JW, Kinney EM, Taylor BA. Activity schedules, computer technology, and teaching children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities. 2006;21(1):14-24.
  8. Massey NG, Wheeler JJ. Acquisition and generalization of activity schedules and their effects on task engagement in a young child with autism in an inclusive pre-school classroom. Education & Training in Mental Retardation & Developmental Disabilities. 2000;35(3):326-335.

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Many Thanks to Lara Pullen, PHD, CEO for allowing us to reprint her article which appeared on the Healing Thresholds Website

Lara is a former research scientist in the field of immunology. She has been a medical writer since 1999 and has written on a wide range of topics from Alzheimer's disease to diabetes. She is the mother of three children, the youngest of whom has Prader-Willi Syndrome.

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Tags: December 2009 Newsletter Visual Supports OT PT SLP School Based Psychology Autism Article