Use of Visual Supports

When I was trying to figure out how I was going to share information about visual supports, I came across someone who used the following poem (author unknown) to describe what it feels like when visual supports are utilized. I think this may help us understand what individuals with Down syndrome may sometimes feel as well. 

 

“When I see…I understand

When I hear, I forget

In one ear, and out the next.

But it makes more sense to me

When there’s something I can see

Whether I’m young, or if I’m old

It helps to see what I am told

A written word, a picture card

Can simplify what might be hard. 

A visual aid describes it best

And gives the voice and ears a rest

From making friends to handling fear 

Showing me how makes it more clear

There’s not much left to explain

When a picture shows my brain

Who or where or what you mean

On a clear computer screen

To recall what you heard

A picture paints a thousand words.” 

 

Visual supports are pictures, words, or other images utilized to help communicate, share or manage expectations/rules, provide reminders, or teach new skills. Visual supports can provide structure and are another way for us to process information. Visual supports are also commonly used with individuals with Autism Spectrum Disorder; however, using and benefitting from a visual support does not imply your loved one also has Autism. We all use visual supports, whether it is a to-do list, our grocery list, or even our calendar. Look at your smart phone! The apps are an image with verbiage. How many of you use emojis to express information in texts and social media? 

Visual supports allow for greater independence by providing memory and comprehension strategies. When used properly, visual supports can lessen the battle between the caregiver and the individual with Down syndrome. The visual becomes the “bad guy,” not the person asking for something to be done.

We know and understand that many individuals with Down syndrome are better visual learners than they are auditory learners. When they were young, teachers or therapists probably used a visual schedule in the classroom or a visual reward system. There may have been a stop sign on the door or labels around the classroom.

We never grow out of using visual supports, but the supports may grow and change with us. For instance, some individuals will want or need photos either of themselves or the actual item and not a cartoon image while others will only want words, and some will want a picture and the word to help them understand.

A final advantage of visual supports is to provide consistency among caregivers. For a bedtime routine, it won’t be dad does it one way, mom does it another way, and then, when there is a sibling or babysitter, a totally different routine is followed. No matter who is supporting the individual with Down syndrome, the routine is identified on the visual and should be completed that way with everyone!

 

There are different types/purposes of visual support: 

 

1. First/then boards: These can be used to help manage expectations and offer rewards. For instance, a person can “first” do a non-preferred task and "then" a preferred task. They can also help with transitions. For more information, see this article on use of first/then boards in our Resource Library.

 

          

 

 

2. Visual schedules: These can be a list of activities for the entire day, only the morning or evening routine, or even the chores that need to be done. This can be presented as a list of words or as a series of pictures. The use of a calendar naturally provides a visual schedule. Perhaps you already use this for an individual’s extra-curricular activities, but you can also do this with self-care tasks. Maybe they don’t love to bathe, but you have decided that they need to take a shower every Tuesday, Thursday, and Saturday. There could be a picture of a bathtub or shower or the word “shower” on their calendar for those days. As a parent/caregiver, you can instruct the person to check their calendar/schedule. The person can be responsible for completing the task and you don’t have to keep providing verbal prompts to bathe that day. For more information, see this article on creating individualized visual schedules in our Resource Library.

 

 

 

  

 

3. Stories: Stories can be used to teach new skills, ease anxiety about activities like going for a blood draw, or even help change a negative behavior. They can also be used to support positive behavior. How many of you have turned to YouTube or looked at Pinterest to learn how to do something new or ease anxiety about an upcoming event? These stories can be pictures only, a combination of pictures and words, words only, or even videos.

 

 

 

 

4. Communication: Visual supports can be used to help facilitate communication. Sometimes, when people are not able to vocalize their wants and needs, they can use pictures to communicate with others. Our Resource Library has an example of a communication board .

 

 

 

 

5. Setting parameters: Visual supports can be used to help set boundaries. You may already use a timer, but have you thought to use pictures as well? For instance, pop/soda is a huge vice for many individuals with Down syndrome. Do you have a limit of how many your loved one can have in a day or week? What if you placed a photo for each one they are allowed by the refrigerator and they either can put an “x” through it when they take one or remove the photo all together? This can serve as a reminder for them and a way for you to not always have to be the bad guy.

We can also offer choices as a way to set parameters. Using a visual you can offer to do a task now or later. Perhaps it is time to do chores, do you want to vacuum or wash the dishes? There can also be a visual to share what needs to happen once the individual gets home from school/work such as they hang up their coat and backpack, take off their shoes, and then change into comfy clothes.

 

 

 

 

Below are some websites that are available so you can become more familiar with different types of visual supports and even create your own! At the Adult Down Syndrome Center, we use Boardmaker Online. It is important to remember that visual supports should be individualized so even using Microsoft Word with actual photos or having photos available on a cell phone can be helpful. Visual supports can also be words without photos.

 

 

 

 

General visuals on a variety of health and wellness topics can be found in our collection of resources for people with Down syndrome.  

 

For any questions about the use of visual supports, you can contact me, Katie Frank, PhD, OTR/L, occupational therapist at the Adult Down Syndrome Center, at 847-318-2303. I am happy to help!