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Kathleen Yopp, MOT, OTR/LPediatric Occupational TherapistVISUAL SCHEDULES AND TOOLS An Introductory Guide to Creating Visual Schedules forTherapists, Educators, and Parents637 Kingsborough Square Unit A | Chesapeake, VA 23320 (757) 698-4681 | www.helpinghandstherapyservices.com

DISCLAIMERThe information in this training is provided as a public service for informational and educationalpurposes only. This information should not be construed as medical advice. Each child’s medical,sensory, and emotional needs are different, and therefore, consulting with a licensed health careprofessional is recommended before starting a any home program. Although every effort is made to ensure that this material is accurate and up-to-date, it isprovided for the convenience of the user and should not be considered definitive.Strategies need to be individualized for each child; results will vary.Improvements in behavior are not guaranteed and will not happen overnight.Terms and ConditionsThe materials and information contained on this training cannot be edited, altered, or used inany other format.(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320

Kathleen Yopp, MOT, OTR/LPediatric Occupational TherapistWhat is A Visual Schedule?Research shows that we are more productive when we use organizational strategies. Forexample, most adults manage time better when if they use a planner to organize their day orwrite notes or a checklist to keep track of what they need to do. This is no different for children.Children need structure and most children thrive with some sort of visual tool. A visual schedule is any type of visual tool that uses pictures, drawings, words, or numbers, thathelps an individual to understand what will be happening when. The most common uses for avisual schedule provide an overview of the activities for the day or the steps within an activity. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320

Reinforces Verbal Instructions For many children, especially those withsensory processing difficulties, auditoryprocessing deficits, attention issues, andchildren with autism, following verbalinstructions can be difficult and veryoverwhelming. A visual schedule pairs theverbal instruction with a picture (or object)which gives them a visual cue. This gives thechild a better understanding of theexpectations. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Benefits of a Visual Schedule Helps With Transitions Visual Schedules help the child to transitionfrom one activity to the next. The best way todo this is to have a system showing beginningto end. This might be that the pictures areremoved one the steps or tasks arecompleted, or that a star or a check mark isplaced next to the activity once they are done.For older children, this can be graded bydrawing a line or erasing the task if they arehandwritten schedules. This is similar towhen an adult has a checklist and goesthrough each item on their checklist. This isalso a great way to teach sequencing of steps. Reduces Stress and AnxietyPictures and visual schedules can reduceanxiety regarding trying new things orchanges to a child’s routine (Having thesequence of events clearly depicted visuallyhelps individuals to anticipate changes and asa result reduces, and sometimes eliminates,anxiety and difficulty with transitions.)Teaches Sequential Order Abstract concepts such as first, next, after, etccan be confusing and difficult to explain orteach. Using pictures helps the child tounderstand these concepts and the sequenceof events.

(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Benefits of a Visual Schedule Teaches Life Skills Learning how to follow a scheduleindependently to complete tasks can carryover to other daily living tasks such asattending and completing homework,following directions for daily living tasks(cooking, laundry, playing game, chores).Schedules are graded and modified based ontheir age, grade and cognitive level. Startingto use a schedule at a young age teachesorganizational skills that they will continue todevelop as their skills develop. It can be easilymodified by using things such as a writtenplanner or checklist or google calendar versusa picture schedule.Supports Literacy DevelopmentParing pictures with the associatedwords/text can facilitate teaching themeaning of those words and reinforcesprecursor skills needed for reading.Fosters Self-Esteem,Development, and IndependenceVisual schedules can help develop and finetune skills such as motor planning andsequencing, organization, as well as self-monitoring. This in turn helps a child becomemore independent and confident in his or herskills. This helps to develop their executivefunctioning which is a higher level skills thatinvolves organizing and planning.

False BeliefsRegarding VisualSchedules(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Making a visual schedule is overwhelming and time consuming. Keep it simple; eliminate bells and whistles.Choose options that work best for your family: Use real life pictures, laminated pictures, or pictures drawnon post-its. Amazon sells pre-made visual schedules and magnets and magnetic boards that are easy to use teachers-pay-teachers sells pre-made templates.Once the pictures are done, the work is done. The pictures prepare children for change and helps them transition better and know what to expect. Thisresults in less meltdowns. Everyone is less overwhelmed.THE TRUTH: It does not have to be this way. There are many strategies to make this easy. Some ways to do thisinclude: "My child will not understand a schedule" or "My child cannot follow directions" THE TRUTH: If your child is non-verbal, or has a hard time following directions, your child can still benefitfrom a visual schedule. In fact, auditory processing may improve when paired with pictures because you are using a child’s strength(vision) to improve weaker areas (auditory processing). If your child struggles in this area, then a visualschedule is EXACTLY where you need to start. Using a visual schedule is beneath my child's ability.THE TRUTH: Excellent that your child can follow directions! However, that does not mean that your child willnot benefit from a schedule. This is the perfect opportunity to work on higher level organizational skills andother skills such as transitions, organization, and sequencing. If your child has a hard time staying on task, loses focus, or has difficulty with transitions, visual schedules can behelpful. Even adults uses schedules (planners, schedules, check lists) to help them stay organized and focused.

Creates independence and fosters learning (they can learn steps of an activity, or the routine of the day, expectations)Helps the child know the routine of a day.Helps prepare the child for changes to a routine.Helps ease the transition from one activity to another (if a child has a hard time stopping an activity and moving onto the next thing).Tells sequence of events.(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 What Can A Visual Schedule Be Used to Do?

Types 0f Visual SchedulesObject CommunicationSystem This type of schedule uses realobjects to represent an activity. It isideal for children who aredeveloping language skills and maynot have many words tocommunicate. For example, a spooncan be used to indicate eating, a cupfor drinking, a ball for outsideplaying. When teaching a child howto use objects to communicate,start by handing the child the objectbefore they complete the activity.Once they have an understanding ofwhat the objects represent, thechild will exchange or select anobject in order to participate in thechosen activity (cup for a cup). Byusing real objects, children start tolearn about making choices andcommunicating their wants andneeds. Once the child understands that anobject represents another object oran activity, you can usually thenmove on to using pictures orphotographs of the object.For more info on how to make an object communicationschedule, visit the TECH ACCESS website at thefollowing link. http://www.techaccess-ri.org/how-to-constructing-object-communication-symbols/Picture Schedule usingReal ObjectsOnce the child understands that anobject represents another objectyou can usually move on to placinga photograph of the object.Depending on their understanding,it may need to be an exactphotograph of the object or ageneral photograph. You may needto teach the child that photographrepresents the toy or activitydesired. Picture Schedule usingSymbolsDepending on the child’s level ofunderstanding, it is usually easier tostart with pictures of real objectfirst. Once they understand usingphotographs of real objects, you canmove onto pictures that symbolizean activity. This may be a cartooncharacter or a general picture offood to represent snacks or eatingor toys to represent playing versus aspecific food or toy. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320

Types 0f Visual SchedulesObject Communication System This type of schedule uses real objects torepresent an activity. It is ideal for childrenwho are developing language skills and maynot have many words to communicate. Forexample, a spoon can be used to indicateeating, a cup for drinking, a ball for outsideplaying. When teaching a child how to useobjects to communicate, start by handing thechild the object before they complete theactivity. Once they have an understanding ofwhat the objects represent, the child willexchange or select an object in order toparticipate in the chosen activity (cup for acup). By using real objects, children start tolearn about making choices andcommunicating their wants and needs. Once the child understands that an objectrepresents another object or an activity, youcan usually then move on to using pictures orphotographs of the object.For more info on how to make an object communication schedule,visit the TECH ACCESS website at the following link.http://www.techaccess-ri.org/how-to-constructing-object-communication-symbols/Written SchedulesWritten schedules are good for children thatare able to read or are beginning to read.Using written schedules help children to stayorganized, manage their time, and helpsthem learn to follow sequences. Written schedules can be done by using asimilar method as the picture schedule andremoving Velcro words. Or you can use a dryerase board or even a list with a pencil or pen.Once the child completes the activity, theycan erase the task or draw a line through it. You can build on this as the child gets older byusing planners, calendars, or other organizerssuch as google calendar or another app ontheir phone. This is a similar to what adultsuse to keep themselves organized and is askills that helps to develop their executivefunctioning and organizational skills as theyget older. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320

Types 0f Visual SchedulesPicture Schedule using Real ObjectsOnce the child understands that an objectrepresents another object you can usuallymove on to placing a photograph of theobject. Depending on their understanding, it mayneed to be an exact photograph of the objector a general photograph. You may need toteach the child that photograph representsthe toy or activity desired. Picture Schedule using SymbolsDepending on the child’s level ofunderstanding, it is usually easier to start withpictures of real object first. Once they understand using photographs ofreal objects, you can move onto pictures thatsymbolize an activity. This may be a cartooncharacter or a general picture of food torepresent snacks or eating or toys to representplaying versus a specific food or toy. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Choosing a Visual ScheduleWhen choosing what type of schedule to use, remember the goal is to help the child besuccessful. It is ok to start with an easier schedule and then adjust it as they develop a betterunderstanding. Modify as needed. You want your child to be successful and not frustrated. The moreindependent your child is with using the schedule, the more you are empowering them and helping them to learn a skill.

When teaching a child how to use a picture schedule, start by having the child pulloff the first picture and then go to the activity that it represents. If your child understands the pictures and is using the pictures to help with transitions, show them the schedule, and then remove the picture once the activity is done. The picture that was taken off is put away to indicate that the activity is done.Children get excited about pulling the picture off the velcro board and they are many times motivated to get to pull another one off. The get a sense of completion once being able to take the picture off.With younger children or children that have more difficulty staying on task, start with limiting to only 3-4 pictures at a time until they have mastered it. For example, set up the morning routine with 3-4 pictures and then they set up another one for theafternoon with 3-4 pictures, and then again for the nighttime routine with 3 of 4 pictures. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Making the Visual Schedule usingSymbolic Pictures Always encourage the child to participate in making the schedule!

Other Types of Visual Tools(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Rewards SchedulesSimilar to a visual schedule, but it includes a reward as the laststep as incentive for following the schedule.Token BoardsLike a reward schedule, but the rewards are given after set expectations aremet. (i.e., not necessarily the last step of a sequence). Tokens can be earnedafter a set number of tasks are completed, a set period of time in which theindividual is engaged in a task, a number of correct responses, etc. Behavior ChartsA behavior chart is a is used to encourage certainbehaviors or responsibilities. This might be remindersof rules for home or school (no hitting, no fighting,nice manners) or remembering what certainresponsibilities are (make your bed, feed the dog,etc). They earn a token (sticker, etc) to indicate whenthe specific behavior is observed. Once a specificnumber of stars is earned, they earn a reward.

(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Visual ToolsYou can also combine token boards with visual schedules. For example, in my therapy practice, Iuse a Token Board as part of my visual schedule when I want my clients to practice a skill anumber of times before going onto the next step. For example, I have a visual schedule for kidswhen introducing a new food. I use a touch, smell, kiss, lick picture schedule. If the childstruggles in one of steps, I may have them repeat each step 3 or 4 times. In this example, thepictures on the schedule stay on the board. But I would have laminated stars next to the picture.The child would then either remove a star every time they competed the activity (or put back onevery time they did it). You can also behavior charts to help with establishing and following rules. When there is abehavior expectation (i.e. using the potty, sitting to complete an activity, no fighting) the childearns a “token” to put on the chart. The token charts can be simple such as getting a number ofstarts for demonstrating the desired behaviors, or having a pictures where they earn tokens tocomplete the picture (i.e. laminate picture of a tree and let them earn leaves or apples to Velcroon the tree).

(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Using the VisualSchedule: ImportantFactors Decide on the Length of the Schedule How many items to place on a visual schedule isgoing to be based on your child’s needs andabilities. When starting with a visual schedule, Fora younger child, or when first implementing, startwith 3 or 4 items at a time so that the child canlearn the routine and not be overwhelmed. Witholder children, or children that have goodattention but poor organization, a whole dayschedule may be appropriate. It is better to start with less items, and then as thechild becomes successful and learns the routine,begin to add more items to the schedule. Minimize verbal prompts if the child hasdifficulty following verbal directions oroverstimulated/overwhelmed.Using words and giving directions to achild who is becoming overwhelmed andtrying to get them to comply can causethe child to escalate as they are not ableto process the verbal direction. Pair a simple word with a visual cue suchas a sign, or show the actual pictures onthe schedule.Use Appropriate Cues whenTeaching or Using the Visual Tools

(757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Using the Visual Schedule: Important Factors Behavior or Reward Charts: Use the pictures of certain behaviors to helpcue the child to what behaviors you are tryingto elicit. Examples include a “stop sign”, “Sitdown”, no hitting, no biting, etc. Show thechild the picture of the behavior you aretrying to elicit an pair it with simple words. Picture ScheduleGiving one of the pictures from the scheduleas a cue.Object ScheduleVisual cue is to hand the actual object pairedwith a word. Visual Tools: Modifying for Older ChildrenVisual Schedules can be easily modified based on the child's needs or as they get older. They canadvance to a written schedule once they no longer need pictures. A template can be created for written schedules wither on a dry erase board, or laminated paper,or something similar to google docs in a “checklist” type format or a time format, depending ontheir needs or what they are using it form. The child can either use a checkbox to "check off" oncethe task is completed, strike through the task, or erase it. There are several apps available suchas Structured-Daily Planner, or Google Integrated Calendar that can help with organizationalskills and color code by topic or time. Using alarms on watch or phone can help with remindersregarding tasks that need to be completed at specific times.

Monitor and ModifySet Up, Then Provide Less PromptsOnce your child is using the schedule, encourage independence anddecrease the amount of cues or assistance you provideModifications may include less activities on the schedule, less wordsand more meaningful pictures, or using objects versus pictures. Over time, your child should need less prompts to follow thesequence of activities. If your child continues to need help followingthe sequence, and there is no change in how much assistance isneeded, try to modify the schedule. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320

Be consistent with using a visual schedule, especially if you are using it to help your child follow a routine or tolerate changes to the routine. If you are using a schedule to help with transitions, completely remove all the activities from the schedule each day and then reconstruct it each day so that the childunderstands that the schedule dictates theactivities of the day. If it is never taken completely down and set back up, the child will not understand that the schedule changes and could “get stuck” in the routineChanging the activity order each day may help your the child learn to be more flexible and tolerant of changes to the daily routine. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320 Other Things to Remember

Kathleen Yopp, MOT, OTR/LPediatric Occupational TherapistIn ConclusionVisual schedules have many advantages both to children as well as their families and caregivers.While it may take time and effort in the beginning to develop a visual schedule and then to teacha child to use it, the benefits have been shown to save time in the long run. Using visualschedules help decrease behaviors and anxiety associated with changes to routine as well asfoster the developing of independent living skills.When choosing what type of schedule to use, remember the goal is to help the child besuccessful. It is ok to start with an easier schedule and then adjust it as they develop a betterunderstanding. Modify as needed. You want your child to be successful and not frustrated. Themore independent your child is with using the schedule, the more you are empowering themand helping them to learn a skill. (757) 698-4681 | www.helpinghandstherapyservices.com637 Kingsborough Square Unit A | Chesapeake, VA 23320