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Posts Tagged ‘visual supports’

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is in response to multiple requests and questions about social stories and visual supports. Common questions include:

  1. I thought the story had to be written in first person? (e.g., “I like” versus “Charlie likes”)
  2. I thought the story had to be just like Dr. Gray says (A specifically defined style and format: sharing accurate social information and affirming something positive about the child)
  3. Is there any research to support social stories or visual supports?
  4. We do ABA.  Social stories aren’t behavioral.
  5. My child cannot read so why should we have a story?

Overview

Social stories and visual supports serve a specific purpose of providing visual information to individuals so that they can be successful in difficult situations. Some examples of difficult situations include:

  • Non-preferred but required activities (e.g., shopping, haircuts, blood draws)
  • Changes to routine (schedule is disrupted, substitute teacher, different bus route, school cancellations)
  • Novel situations (first time to hospital, first time on an airplane, first time to a play or show, storms)
  • Special but routine situations (dr. appointments, dentist appointments, hair cuts)

 

Individualized

Social stories and visual supports should be individualized to the user. While it may  not be convenient for a teacher to create 12-15 stories/visual supports, what works for one person may not be appropriate for another. When developing stories and visual supports keep the following considerations in mind:

  • age of the individual (resources must be age appropriate for the user)
  • reading ability (adjust the text of the visual depending on the reading level)
  • visual acuity (content should be selected based on the individual’s vision and ability, 3D versus 2D, color versus black and white)
  • attention span (the length and detail of the story or visual support)

Content

While Dr. Gray has created a trademark, there are many options beyond what she describes. Because social stories and visual supports should be individualized, the content should be determined based on the individual’s needs. For example, a mom here in CT created a social story for her child regarding Hurricane Sandy. The story included information about the storm, how it would affect trees and power, and how power could be restored. The story was developed for her son because the issue of losing power is important for him. He becomes upset if he cannot turn on lights or play on computers. However, another child may be scared of the wind or scared of the heavy rain. That child would need a story that focuses on the wind and the rain and how to make the noise go away. And then another child may not fully understand why she cannot go to school. Because she cannot read, her story may show a picture of wind and rain and a picture saying “no school”. The story would end with a picture of the little girl at home working with her ABA therapist.

Research

We have written about visual supports before: here, here, and here. We recommend only evidence-based strategies for our readers. So obviously there is ample research to support social stories and visual supports. A research group has developed a list of evidence-based practices for individuals with autism. Social narratives and visual supports are both on the list. For additional information on those practices and to read the research visit here.

ABA and Social Stories and Visual Supports

ABA, applied behavioral analysis, is simply the application of behavioral principles, to everyday situations, that will, over time, increase or decrease targeted behaviors. For additional information on ABA, visit our website. Thus, the use of visual supports and social stories does not preclude someone from doing ABA. Similarly, implementing ABA does not preclude someone from using visual supports and social stories.

I hope this helps to answer the many questions about social stories and visual supports. If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

 

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Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files.Today’s success story is a follow up to a previous clinical case. Do you remember Little Cherub? She first came to us over a year ago. Little Cherub’s dad attended a presentation we did in Atlanta. He desperately wanted help because she had very restricted eating. After listening to dad talk about her symptoms, we suggested that Little Cherub be seen by a specialist to determine if she had celiac, an autoimmune condition that leaves the body unable to digest gluten, a type of protein found in bread, pasta, and cakes.

Sure enough, Little Cherub had celiac. After putting her on a gluten-free (GF) diet, she further restricted her eating. After 5 of the toughest days imaginable, we finally helped Little Cherub learn that new foods are not scary and that, in fact, new foods can actually taste good. Little Cherub’s parents were amazed to see her chasing them down to get more cantaloupe!

In addition to her eating behaviors, Little Cherub has a fear of many new things. Take toileting for example. Little Cherub wanted to continue using her pull up for toileting. Urinating on the toilet was not painful for her. But from the look on her face and the behaviors she exhibited, one would think she felt extreme pain on the toilet. In the same week we taught her to eat, we taught her to use the toilet for urinating and defecating. We made a simple visual schedule to show her that “pee” goes in the toilet.

Within 2 days, Little Cherub overcame her fears of using the toilet. We reserved her very favorite jalapeno corn chips as a treat and she learned to associate positive things with the toilet.

Less than 10 months after overcoming her fears of new foods and toilets, Little Cherub began showing fear-like behaviors in public places such as Target and grocery stores. Little Cherub’s dad reached out to us again for assistance.

Public places can be very scary for children on the spectrum. Public places are loud, they have strange lighting, and things are not always predictable. However, once you teach children the routine, and associate the public place with something positive, children learn that public places are not scary after all.

Little Cherub’s parents used the same intensive model we used with feeding. They began taking her to public places two times per day, every day, for a week. Little Cherub’s dad writes,

She went from cowering to smiling when we went twice a day for a week and explained to her what everything was she was seeing and hearing.

Congrats again to Little Cherub and her parents for working so hard on overcoming these fears. The work parents do is never easy but with success stories like this, it makes all the work worthwhile!

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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior.

It’s the start of winter break for many families in New England. For those of you who are unfamiliar with the tradition, many families in the north-east plan trips to much warmer locations. This means that the stress level for many families is high right now due to packing, planning, and other cortisol-raising activities. All of this is exacerbated for families who have children with disabilities. Traveling with children is difficult but traveling with children with disabilities is even more so.

One question we receive often is “How can we travel with our child with disabilities? What can we do to make travel easier for him/her? What strategies do you recommend to help?”

One of our first recommendations is to help prepare your child for the trip using visual schedules. We have written about visual schedules previously (and we just recently learned it continues to be our most visited post).

So, we have created a sample schedule that may be used to support your child if you are traveling by plane.

Even if your child does not have a disability, preparing them for safe travel by reviewing the steps involved will help alleviate some of the stress associated with travel.

Safe travels to our New England Readers. To those of you in warmer locations, some of us are headed your way!

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Each week we try to review a research article. Though not intentional, several of our posts this week related to visual supports for students with autism and other disabilities. Thus, we thought it would be helpful to review a research study on the use of visual supports.

Today’s research article was published by researchers at the University of Kansas. However, the article is now over 10 years old and several of the authors have moved to other institutions. You are probably wondering why we would review an article that is over 10 years old. We have 2 reasons for doing so. First, while the article is old, many teachers and parents do not even know about visual supports. Sadly, research does not always result in translation to practice. Second, the authors completed a cool study with results that we found compelling to share with you. Finally, if it worked 10 years ago, it most likely will work today–especially if we augment the practice with a little technology.

The authors of this study included Sarah Dettmer, Richard Simpson, Brenda Smith Myles, and Jennifer Ganz. The study appeared in Focus on Autism and Other Developmental Disabilities in 2000 under the title, The Use of Visual Supports to Facilitate Transitions of Students with Autism. You may find a copy of the study (and many others) here.

Participants in the study included 5- and 7-year-old boys with autism. Both boys experienced difficulties transitioning between activities. The researchers used a withdrawal research design. Specifically, researchers observed behaviors and collected data in baseline. This was followed by intervention procedures and additional observations. The researchers then withdrew the treatment and continued observations. Finally, the treatment was reinstated while observations continued. A design such as this demonstrates experimental control and shows the effectiveness of an intervention if observed behaviors change as a result of treatment and treatment withdrawal.

For this study, baseline (or pretreatment) observations demonstrated the difficulty of transitions for each child. One mother physically removed her child from community settings due to challenging behaviors and refusals to leave. Both boys required 2-5 minutes of transition time combined with multiple verbal and physical prompts.

The intervention consisted of the use of visual supports. Researchers taught parents how to use visual schedules to communicate to their children upcoming events. If the intervention sounds simplistic to you, it is. The simplicity of the intervention adds to the quality of the study.

Both boys experienced decreases in total transition time. Specifically, one boy decreased from 5 minute transitions to 1.5 minute transitions. The other boy decreased from 2 and 3 minute transitions to transitions lasting 30 seconds.

The most surprising finding in this study (and the reason we still want to talk about it 10 years later) is the fact that one student verbally requested his picture book when it was removed. The other student went looking for the visual support materials. The students wanted their visual schedules.

So why 10 years later aren’t we all using visual supports for children who need them?

If you have a child or a student with autism who experiences difficulties with transitions. Consider using visual supports as a strategy to reduce transition difficulty. If the student has an iPad consider purchasing iPrompts so a visual schedule may be made in seconds.

Happy transitions everyone!

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