Use of visual schedules in autism treatment - Essay Example

Introduction The word autism first appeared in the professional literature when Leo Kanner, a child psychiatrist at Johns Hopkins in Baltimore, MD, wrote a description of 11 children from his psychiatric unit in 1943. These children were different from the others in his unit who were diagnosed with Childhood Schizophrenia. The children Kanner wrote about in his original paper had little interest in other people, peculiar language, and insistence on routines, and they displayed unusual body movements and repetitive behaviors. Kanner's original description emphasized three areas of difficulty: social isolation, abnormal communication and an insistence on repetitive, narrow routines. These major areas of impairment have continued to be the foundation of autism diagnosis in the major diagnostic systems used throughout the world. Although this 'triad of impairments' (Cafiero, 2005) has always been central to the diagnosis of autism, it has also been acknowledged that it is possible to have more subtle deficits or peculiarities in these three areas without having the full autism syndrome. For this reason, the Pervasive developmental Disorder (PDD) was created as the umbrella category of all people showing impairments or peculiarities in these three areas, including more subtle ones. More recently, the term Autistic Spectrum Disorders (ASD) is replacing PDD as the umbrella term for the triad of impairments. This term is preferred by most professionals who believe that autism is the central and most widely known disability among this group and for this reason this term (autism) should be part of any phrase describing the broader syndrome. Current diagnostic systems, DSM-IV (American Psychiatric Association 1994) and ICD-10, usually define autism based on a series of specific social, communication and restricted behaviors. In order to qualify for the autism diagnosis, a person must demonstrate deficits in each of these three areas and the requirement is that the social deficit or peculiarity will be especially marked. Many individuals with ASD will also have additional learning difficulties. Although autism is the best-known and most widely used diagnostic category within the autistic spectrum, there are several other specific diagnostic classifications as well. These other classifications are distinguishable from classical autism because of their characteristics, but most of the needs of this group and the intervention techniques that have proven effective are similar to those used for children and adults classified with the autism diagnosis. What are visual schedules "Visual schedules help children and youth with autism, Asperger Syndrome, and other special needs understand their world better" (Greenspan, 2006). Older individuals would prefer to use calendars, planners, PDAs or simple lists to be reminded of the responsibilities that they need to accomplish on a specific timeframe. People with ASD would need visual schedules to be able to understand the events or tasks that they need to complete in a specific time. Aside from helping the children to recall their assigned tasks, visual schedules also assist in facilitating the transition from a certain activity until the next one. This way, they will not be confused as to which they should do first. The Cost of Visual Schedules Visual schedules are composed of pictures, clippings, photos, icons or miniature objects. These materials are very easy to find that we can actually locate some of these inside the house so this makes visual schedules inexpensive. Some of the materials that can also be used are photo albums, wallets, loose leaf rings, timer, storage bins, scissors, colored paper, Velcro, contact paper, camera, colored markers, clip art, binders, poster board, foam board, bulletin board, index cards, glue or adhesive, labels, stickers, picture books, magazines, magnets, calendar, post-it flags and highlighters. Materials needed to make the visual schedules are not necessarily difficult to find or expensive. Words, photographs, magazine pictures, line drawings, commercially made icons, miniature objects (check out refrigerator magnets), or simple drawings can be used. The specific choice of symbol depends on the individual's needs. Other basic materials that might be needed include: construction paper, glue, small photograph albums, tag or poster board, and a camera. Digital cameras are particularly useful when creating visual schedules. Pictures taken using this type of camera can easily be downloaded into a computer and be easily manipulated on a visual schedule. To preserve the pictures and schedules, laminating materials or clear contact paper is recommended. Laminating material or clear contact paper is often available at office or teacher supply stores (McClannahan, 1999). Tailoring Visual Schedules to the User's Needs Before investing the time and effort to create a visual schedule for a particular student, it is best to have an idea of what features will be most helpful to the student. If you do not know the student well, you may need to take some time to determine how he best responds to different types of pictures, colors, sizes and other variables. "The number of activities and amount of time shown on a visual schedule depend on the individual's needs. ... You know your child or student and can decide which is better - a schedule that covers a shorter period or one that covers a longer period" (Greenspan, 2006). When the student is initially learning to use a particular visual schedule, you should begin with one or two supports at a time and systematically increase to the desired number in order to orient the student about the meaning of the different pictures to be used for the visual schedule. For example, if you are using a picture schedule to increase independent play, start with one picture. When the child is able to respond independently, add another until he can complete both activities independently. Continue to add one picture at a time until the child is able to complete as many activities as is appropriate for his age. Types of pictures The selection of photos or drawn/commercially created pictures is another consideration. Depending on the student's age or cognitive abilities, he may respond best to: objects that represent the item photographs life-like drawings or symbolic drawings such as the Picture Communication Symbols) It is best to expose the student to each option to see which one he responds to best. Some students with autism spectrum disorders have difficulty responding to photographs or pictures. Pictures and photos are symbols of the items they represent and the person with autism spectrum disorder may not be able to respond to symbols at this time. Instead, he may respond to the use of small objects that represent the actual item. Dollhouse accessories or craft supplies are good sources of these objects. Some speech and language catalogues might also offer objects which could be used but are usually more expensive. If it is possible that the student might place these small objects in his mouth, it is necessary to secure them to a flat surface that is too large to swallow or put them in a clear container. Effectiveness of the Visual Schedules Durability. Younger children can be rough with materials so durability is a consideration. Learning to make supports durable enough may require some trial and error on the instructor's part but some general principles are to select materials that last after being bent or that are safe to make pictures, flash cards o other paper material waterproof and less resistant to tearing. Portability. When creating visual schedules, it is a good idea to determine if they will be stationary or portable. Typically, it is easier for young children and children who have weak fine motor skills to manipulate larger supports. In some case, the need to have a larger support may dictate the need for it to stay in one place. Smaller visual supports may be in order is students with Autism Spectrum Disorder are included in a regular education classroom. In this case, it will be especially important to take into account whether the support draws undue attention to the students' differences. This should be a consideration regardless of the child's placement but it is particularly critical in social situations with typically developing children. Clarity. In order to develop a casual schedule that is effective, it will be necessary to test for clarity. Develop a test sample and try it out with a child. Is the support salient enough for the child to respond in the manner expected Use colors that are unusual and right so they attract attention. If using pictures or photos, are they clear and crisp Clarity is particularly important if the visuals will be kept at a distance. Some student with autism may be over-selective and may cue into other aspects of the visual support. Age Appropriateness. This becomes a concern when the student is about eight years of age. Age appropriateness is an important consideration because instructors would want to convey the message that people with ASD are young children in large bodies. Students with ASD are more likely to be accepted of they use items that appropriate for their age. The best way to determine of the visual schedule is age appropriate is to spend time observing typically developing peers. Response effort required. Some students with ASD do not like to exert tremendous amount of energy. Consequently, you should look at how easy it would be to use the support that the instructors' are designing. Strengths of Using Visual Schedules Visual schedule systems are an easy way to provide students with consistent cues about their daily activities. They provide a structure that allows a student to anticipate what will happen next, reduce anxiety by providing the student with a vision of his/her day and promote calmness between transitions. They are especially important for students who have a profile that includes difficulties with the understanding of oral language and directions. The consistency provided by a visual schedule is crucial in establishing an atmosphere of trust and security. Visual supports can also provide motivation to work through a less favored activity knowing a favored activity is to follow. For example, using the First This /Then That strategy in visual form can provide high motivation for the student to work through one activity to get to a preferred activity. When dealing with students with behavioral difficulties, this can be a powerful strategy in maintaining appropriate classroom behavior. For non-verbal students a visual schedule can be a way to introduce symbols that the student can eventually use as an alternate form of communication. Through the consistent use of the schedule, the student can begin to pair the symbols presented with the activities that are occurring. A sure sign that this association is developing is seeing the student begin to rearrange their schedule to include all of their favorite activities. Establishing a visual schedule can also provide a structure for the student to begin to do some choice making as they are encouraged to provide some input as to the order of some of the day's events. The student may also be introduced to choosing a specific activity from a teacher-selected group of activities. Characteristics that Make Visual Schedules an Effective Intervention The ultimate goal for all of our students is the development of independence and the enhancement of self esteem. This can be an automatic result of allowing students to participate in the design of their day. The ability to look at a schedule, find the materials for the next activity and get started with that activity without adult support is a big step toward a student's independence. Visual supports can be a way to work toward this goal. Each system developed is unique to the student and is created after a careful examination of the following factors: the student's strengths and abilities the classroom teacher's orientation toward the concept the teacher assistant's commitment to its consistent use the classroom environment (the logistics, size, location and application of the schedule) parental attitudes and home support classmates' involvement It has been experts' experience that when these factors are ignored or when any one factor does not receive adequate consideration as a system is created, the system may not succeed. Each system must be uniquely tailored to the student and the environment in which it is being used. Support personnel can be instrumental in assisting with the setup of the system but it is essential that the class has ownership of it. Providing a framework for the design and examples of several successful systems, can assist in creating a model that will work in a specific classroom. Continued support will be needed to provide the modifications in design and the development of the appropriate strategies for its implementation. As a system gets up and running it will require many adjustments as it is molded to a particular student and environment. Despite the best of designs, many systems fail because of lack of support and understanding at this crucial stage. REFERENCES: (2008, April 23). Healing Thresholds. Retrieved May 14, 2008, from Connecting Community and Science in Healing Autism Web site: http://autism.healingthresholds.com/therapy/visual-schedules Cafiero, J. M. (2005). 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