1. The importance of Visual Supports Rose Fletcher Speech and Language Therapist Madri Morley Occupational Therapist 18 th March 2016

2. Learning Objectives 1.Why do children with Autistic Spectrum Disorder (ASD) benefit from the use of visual supports? 2.When should you use visual supports? 3.What visual supports should you use?

3. Discussion What visual support do you rely on everyday? –Body movements (gestures, facial expression) –Environment (objects, signs) –Traditional organisational tools (calendars, diaries) How would you cope without these?

4. Body Movements

5. Environment

6. Organisational Tools

7. Understanding Autism Typically developing children are rewarded by looking at faces from 3 months of age. They follow gaze, anticipate the intentions of others and derive pleasure from initiating interactions…

8. Children with ASD have difficulty processing social stimuli such as faces and speech sounds. They therefore have difficulty predicting the actions, intentions and emotions of others. This impacts their ability to communicate, regulate their emotions and therefore causes anxiety, challenging behaviours (head butting when a toy is broken) and/or unconventional behaviours (leading an adult by the hand to a toy they want)

9. “To me the outside world is a totally incomprehensible mayhem which terrifies me” Ros Blackburn, 2005

10. Why are visual supports important? Makes life more predictable and reduces anxiety To know what to expect Gives the child time to focus Allows child to refer back Support social communication Support emotional regulation Encourage independence, ie transitions Encourage consistency and procedure, expectations and routines across all people working with the child Verbal language and gestures are often not enough Physical guidance can pose a threat.

11. Examples of visual supports for children with autism…

12. Visual schedules

13. Augmentative Supports

14. Rules/Social cues

15. Emotional Regulation

16. Activity is time related…

17. To extend and use more creative language

18. When to use visual supports and what supports to use…

19. To Support Transitions… Photos Symbols Objects of Reference Daily ScheduleNow/Next Schedule Written Schedule Encourage Independence Reduce Physical Handling Life is more Predictable Support Understanding

20. Beginning and End of an Activity… Visual Schedules Now/Next Schedule Count down strips Goodbye songs Activity Trays Motivate child and be interesting

22. Egg timersCountdown Strips Visual schedules Verbally/visually count down Define the Time

23. Will I be in this lesson forever??

24. Steps within an Activity e.g. TEACHH Steps removed Tick sheets Written/pictorial steps within tasks

25. Commenting on actions/activities Colourful semantics PODD Understanding/using more creative language Colourful semantics Forced alternatives Understanding Objects of reference Photos Symbols Written words Language Development

26. Visual Reminders e.g. Good sitting Social StoriesClass/group Rules Social Understanding and Expectations

27. Role in an Activity TEACHH Turn taking- green/red charts Tick chart Age appropriate association to activity Indicating Expectations

28. Comment and Respond to Questions PODDModellingColourful Semantics How to ask for Help Visual cue cardPODD/MAKATON When to Initiate and what to say… Objects/Photos Singing hello/goodbye e.g. Pictures/written words

29. How to regulate emotions… Visual choices of coping strategies, ie “When I am angry I can… go for a walk, throw/catch a gym ball with my TA.” Attune to students’ emotions, ie be bored with them, angry with them Reminder for how to express emotion, ie pointing to the ‘It’s too loud’ symbol Emotion Key Ring

30. Remember to… Be consistent Consider developmental level of child Use visuals all the time and don’t stop – it’s their voice you are taking away!! Monitor and make necessary changes Always use with language and gesture Infuse motivating and meaningful topics to increase engagement and motivation Allow time to process and problem solve.

31. Any questions?

33. DEAR TEACHER

34. OUR BEHAVIOUR IS AN EXTERNAL DEMONSTRATION OF OUR EMOTIONAL REGULATION. WHEN OUR BEHAVIOUR CHANGES IT IS DUE TO OUR EMOTIONAL RESPONSE/REACTION TO ENVIRONMENTAL STIMULI OUR BEHAVIOUR AND EMOTIONAL RESPONSE WORK TOGETHER FILTERING INFORMATION TO ALLOW US TO UNDERSTAND AND REACT TO THE ENVIRONMENT IN APPROPRIATE WAYS.

35. What behaviours may present in children with autism who are unable to emotionally regulate? In primary aged children with autism, anxious behaviour may include. Crying Screaming Throwing objects Absconding Self-harm Tantrums Hitting and kicking withdrawal

36. Why do children with autism lack the tools needed to be able to emotionally regulate? Central Coherence Theory of Mind Executive Function Theories of cognition Difficulty organising sensory information Unable to filter the demands of the environment Refer to Anna’s presentation Sensory processing Communication and social difficulties are evident in variant levels Confusion or lack of understanding in social situation Social/Communication difficulties

37. Theories of cognition Central Coherence A weak Central Coherence is defined as difficulties with drawing experiences, details and other such pieces of information together to access ‘the whole picture’ (gestalt). Theory of Mind Theory of mind is said to offer an explanation for understanding, appreciating and accommodating the mental and emotional state of self and others. Executive function Executive function is a term used to describe the ability to plan, organise, self reflect, self monitor, time manage and prioritise

38. Social and communication difficulties Communication Communication happens when one person sends a message to another person either verbally or non-verbally. Interaction happens when two people respond to one another – a two-way communication. Interaction Most people on the autism spectrum have difficulty interacting with others. This may be a difficulty with responding to others when they are approached by them, with initiating interactions, or with using interaction to show people things or to be sociable. Social Skills Social skills are used when communicating with other people. They involve knowing how to act in a certain social situation. Good social skills can improve and maintain relationships and help us to make friends. (NAS)

39. Is there a developmental profile of Emotional Regulation? Examples: Vocalisations Focusing attention on oneself Rocking Spinning Finger tapping Examples: Can use 7 symbols Saying or signing to them self “Don’t worry, it’s ok” Saying to a partner “one more and we are all done” Or requesting assistants from others when needed during a frustrating task Example: Able to internalise a ‘dialogue’ inhibiting behaviour based on social and moral ‘rules’ using reflective problem- solving Behavioural Strategies Language Strategies Meta-cognitive strategies Barry M. Prizant, Ph.D., CCC-SLP

40. Emotions Initiating and maintaining friendships difficulties with communicati on Social Understandi ng sensory difficulties Executive function Theory of mind Weak Central Coherence changes in routine The Emotions Bucket What Fills your Bucket?

41. The confusing world of words

42. Understandin g Emotions Ask the child to draw a picture of themselves? Use mirrors to allow the pupil to start to understand what they look like when talking about different emotions. With the pupil Mind map different emotions as you are teach them. This allows the pupil to make connections.

43. Happy Box I feel happy when I am playing with a Koosh ball I feel happy when I am watching a Thomas video. I feel happy when I am eating an Oh Henry bar or a bag of crisps. What would be in yours or your child’s? Or maybe Happy/Chil ling Music, TV or Movie Clips – all that can relax or redirect BEHAVIOUR STRATEGIES

44. Relaxation Sequence : Getting Started BEHAVIOUR STRATEGIES

45. Visual Imagery What image relaxes you ? Perhaps a Relaxing PowerPoint Presentation will help? BEHAVIOUR STRATEGIES AND LANGUAGE STRAEGIES

46. Thermometer (Tony Attwood, 2001) LANGUAGE STRATEGIES

47. Feel-o-Meter (Tony Attwood, 2001) LANGUAGE STRATEGIES

48. ‘ The Incredible 5- Point Scale’ – Baron, Curtis (2003) What Does it Look or Feel Like? Exampl e. LANGUAGE STRATEGIES / META COGNITIVE STRATEGIES

49. 1 Keep doing what you are doing 2 Take time to calm a little – read a book, ask for help, think about something you like 3 Walk away. Find an adult to talk to. Do something you know helps you feel better. Tell someone how you feel. 4 Leave what you are doing: listen to some music. Tell an adult what is wrong 1 I feel calm. Everything is ok. 2 I feel a bit upset and sad. I am unsure what to do - puzzled 3 I am starting to feel cross – I don ’ t like what is happening. 4 I am angry. I want to shout or scream, to make a noise. How do I feel? 5 LOST IT! I need you to help me now. META COGNITIVE STRATEGIES

50. Create a thought that is an Antidote to a ‘poisonous thought’ “I always make mistakes” What can you do when you make mistakes? If you make a mistake what does it teach you? Making mistakes is one way to learn. Well done for making mistakes. You learnt something new today. META COGNITIVE STRATEGIES

51. CBT FOR CHILDREN THOUG HTS FEELIN GS BEHAVI OUR

52. CBT in action

53. ANIMAL SCHOOL Strengths Self- Esteem Emotional Regulation

54. Additional reading Thank you