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For people with Down syndrome, family members, caregivers and professionals.

Using First/Then Boards

July 2022 | Katie Frank, PhD, OTR/L - Occupational Therapist, Adult Down Syndrome Center

We like to use visual supports to set or manage expectations. One type of visual support that can be helpful is a first/then board. When using a visual support, there can be words, pictures, or a combination of words and pictures. We can also forego the visual all together and still use the first/then concept. For instance, you can just say “first X and then Y.” You can also use physical objects to demonstrate the concept. For instance, “first snack (and show actual snack) and then brush teeth (and show toothbrush).”

First/then can be used to help someone transition away from a preferred activity. For instance, for someone who really likes their screen time, but also wants to play basketball outside before dinner, you could say, “First screen time and then basketball.”

First then board with first screen time and then basketball

It can be used to complete a non-preferred activity. For that same person who likes their screen time, but does not like to shower, you could use screen time as the reward for completing a non-preferred activity. “First shower, and then screen time.”

First then board with first shower and then screen time

First/then can also be used to help someone move more quickly between two activities because they know what is coming next, especially around morning or evening routines. “First use the toilet, and then get into bed.”

First then board with first go to the bathroom and then go to bed


First/Then Template The preceding link opens in a new tab or window.

Visual Supports Article

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