Many researchers will agree that selecting the most appropriate technology for individuals with learning disabilities, requires a careful and systematic plan. It is important to stress that not all assistive technologies are appropriate for all individuals in all situations. People with learning disabilities have their own unique set of strengths, weaknesses, special abilities, interests, and experiences.
For years, different modes of technology have been used to improve the quality of life of people who have various developmental disabilities. The following will discuss how Boardmaker can be implemented and used for children with autism to increase or improve their:


·
Overall understanding of their environment;
· Expressive communication skills;
· Social interaction skills;
· Attention skills;
· Motivation skills;
· Organization skills;
· Academic skills;
· Self help skills;
· Overall independent daily functioning skills.


Visual Representation Systems
It is important to determine which visual representation system is best understood by the child, and in what contexts. Various visual systems, such as objects, photographs, realistic drawings, line drawings, and written words, can be used with assorted modes of technology, as long as the child can readily comprehend the visual representation.

Example: A child may use real objects for his visual schedule, as the objects appear to give him more information as to where he's going and what's coming up next, as well as to help him remain more focused during the transition. However, this same child may use photographs or line drawings in a picture exchange in order to communicate expressively.
Some children may need different visual representation systems in different situations. This may be dependent upon numerous factors, such as the skill being taught, as well as the unique characteristics of autism: attending, organization, distractibility.

Some researchers suggest that, for most children, it is best to start with a visual representation system of line drawings, and move to a more concrete representation system of photographs or objects needed (18). See the line drawings in Mayer-Johnson "Picture Communication Symbols".
The Mayer-Johnson software program, Boardmaker, is a user-friendly program for both adults and children (18). The program offers a 3,000 Picture Communication Symbol (PCS) library in either black/white or color, and can be accompanied by any written word/message. The symbols can be made in any size, and tend to be universally understood. They present a relatively clear, 'uncluttered' representation and remove any ambiguity, which can sometimes arise when using photographs, especially personally-made photographs, as in the following example
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Example: A teacher took photographs of the various teachers that a child with autism encountered at school, in order to help him learn the names of his teachers. When reviewing the names of the teachers in the photographs, the child referred to the photograph of a particular teacher as "Mexico". Upon further review of this photo, the teacher realized that in the background, barely visible, was the corner of a map of Mexico. Although the teacher's face was the prominent feature in the photo, the child processed the minimally visible map as the most prominent feature and thus labeled the photograph according to this feature.


When using line drawings such as Boardmaker, caution should also be taken in determining whether to use black/white or color picture communication symbols, as some children with autism may prefer or dislike specific colors. They may focus only on the color instead of processing the entire picture. This will render the Picture Communication Symbol (PCS) virtually meaningless to the children as they are not processing the entire picture. Black and white picture communication symbols tend to remove any ambiguity which might arise.


Example: If a child prefers the color red, and the Picture Communication Symbol (PCS) for "lunch" has a red apple as well as a brown sandwich and orange juice, the child may only process the apple, as it contains his preferred color. The child may not even process the image, but attend only to the color red. Therefore, the PCS becomes non-meaningful to the child.

If the child has difficulty understanding the Picture Communication Symbol (PCS) line drawings and needs a more concrete representation, a good software program to use is Picture This (20). This program allows for the presentation of real photos, without risking ambiguous background clutter, which can be a part of personal photographs. Picture This contains over 2,700 photos from numerous categories which are ideal for:
·
Creating schedules;
· Augmentative communication systems;
· Games;
· Reading activities;
· Sequence activities for following directions;
· Various academic activities.

Comprehension Skills:

Increasing comprehension of tasks/activities/situations is essential in addressing skill areas such as organization, attending, self help, following directions, following rules and modifying behaviour. As a result, the child becomes more independent. The following "low" tech visual support strategies can be created and used to assist the child in increasing his comprehension skills and thus decreasing the occurrence of challenging behaviors:
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"Visual Schedule"

Schedules: Consistent daily use of an individualized visual schedule will increase a child's organization skills and independent functioning throughout all aspects of his life and will ease transition through adulthood. There are numerous ways to present visual schedules. Example: object schedule, 3-ring binder schedule, clipboard schedule, manila file folder schedules, dry erase board schedules, etc.

Each child's individual needs should be considered in designing his personal visual schedule. It should be noted that visual schedules are as important for the child to use at school as at home. The information given to the child through a visual mode is extremely critical in helping him to understand the day's events and their sequence

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"Object Schedule"

A visual schedule will give the child the following information:
· What is currently happening;
· What is coming up next (the sequence of events);
· When they are "all done" with something;
· Any changes that might occur.
A visual schedule is a "first-then" strategy, that is, "first you do _, then you do _", rather than an "if-then" approach (i.e., "if you do _, then you can do_"). The "first" activity can be modified as needed to accommodate the child's changing ability to process in-coming information. Once this is done, then he can move on to his next visually scheduled task/activity. It is important for the child to indicate that he is "all done" with a scheduled activity. For example he can cross out/check off the scheduled item, or place the scheduled activity object/photo/Picture Communication Symbol (PCS) in an "all done" envelope.
Various social interactions can be included in the child's daily schedule as well as building in a balance of "high stress" (non-preferred) and "low stress"(preferred) activities. Each child's "break time" or "quiet time" can also be visually scheduled at various times throughout the day as needed.

Example. Showing completed work to a teacher for social interaction and reinforcement, or saying "hello" to the teacher and students when entering the classroom.
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"Visual Schedule"

Mini schedules/routines can also be incorporated as needed into the child's day.
Example. A visual routine checklist titled "Before Kindergarten" was developed for a child who was having difficulty establishing a routine while waiting to go to kindergarten following lunch. As he did not readily comprehend what was expected of him during this time period, challenging behaviours typically occurred. The "routine" was laminated and posted on the refrigerator with magnets glued to the back. The child would then check off each completed routine activity (e.g., eat lunch; wash face and hands; brush teeth; read 2 books; put on shoes and socks; put on coat and back pack; wait by the door for the bus).
· Activity Schedules:
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"Activity Schedule"


Example 1: On the first page of a photo album a photograph of a puzzle is depicted. On the next page, a photo of a shape sorter is depicted. On the third page, there is a photo of the child being thrown up in the air by Daddy.
Independently engaging in appropriate tasks/activities for a certain period of time is an important life skill for children with autism. An activity schedule teaches this skill through a set of pictures (photo or PCS) or written words, which are used to visually cue the child to engage in a sequence of activities for independent recreation/leisure time (19). The number of activities and sequence of steps per activity need to be individualized for each child. For some children, activities will need to be broken down and depicted step-by-step in order for the child to complete the activity independently. For other children a more general, single photo/PCS/written word can be used to cue the child to perform an entire task or activity. Any type of binder, photo album, etc., can be used as the child's activity schedule book, or simple written lists may suffice for the child who is able to read and comprehend. The activity schedule book should contain the various tasks/activities (and steps if needed) depicted in whatever visual representation system the child best comprehends (e.g., photos, line drawings, etc.). Upon completion, a social reinforcer can be "built in" as the last page in the activity schedule book.

Calendars (home/school):
Use of a weekly/monthly calendar at both home and school can provide the child with important information regarding up-coming events/activities, rather than relying on auditory information. When the child asks when a particular event will occur, he can easily be referred to the visual calendar. For example, class field trips, "bath night", McDonald's, etc.
Use of a visual calendar can also be helpful in assisting the child to understand when regularly scheduled events may not occur.

Example: If the child has swim lessons every Friday after school, but this Friday the pool is closed, draw an international "no" - circle with a slashed line through it on the scheduled swim lesson.
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"Visual Calendar"



In this example, acknowledgement is made that the child has a scheduled activity that is not occurring on a particular day.
Calendars can also be used to give the child important information regarding school attendance, which is particularly helpful for "days off" from school during the typical school week. A visually depicted monthly calendar is used with each day that the child will be at home or at school . Many parents put these monthly calendars on the refrigerator and reference them daily with their child by crossing off a completed day, and noting where the child will be going (or staying) tomorrow.
In addition to schedules, comprehension skills can be increased by the following strategies:

International "No":
Use of the international "no" symbol (red circle with a line drawn through it) has proven very effective in visually communicating the very abstract concept of "no" for children with autism.
Use of the international "no" symbol can assist the child in visually comprehending the following "Stop - don't do what you are doing":


Example: For behavior management cards such as the Picture Communication Symbol (PCS) of "no hitting" with an international "no" over it.
"That is not a choice right now":

"You are not permitted":

Example: Placement of a tag board-size international "no" on doors has stopped children from running out of the door.

Directions:
Low tech strategies can be used in numerous ways to give the child visual information for following directions. Visual information greatly increases the child's comprehension of what is expected of him and is far more effective than auditory directions only. Visual directions help gain, maintain and refocus a child's attention as well as ensuring that he gets complete instructions, thereby reducing the amount of support needed and increasing independent skills.
Sequential step directions for specific tasks/activities.
Example: Brushing teeth, making lunch, vacuuming, folding towels, setting the table, checking out books from the library, cooking, "homework directions", "school morning directions" etc.
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"Visual Directions"



"Visual Directions"- Sequential step directionsfor specific tasks/activities

"School morning directions"



Example: Upon arrival at school a child is given a "morning directions" card to assist him in completing a visual list of instructions before sitting at his desk and beginning the day. The card is laminated with a dry erase marker attached by a string and is located near the child's coat hook. After hanging up his coat and backpack, he can take the card and begin the "morning directions", checking off each item upon completion (e.g., Put reading book in tub; Put attendance stick in box; Put lunch ticket in hot/cold box; Put "Morning Directions" card away; Sit at desk).

"Brushing teeth"

Example: Picture Communication Symbols (PCS) representing each sequential step in this task, are placed on a Velcro strip positioned directly above the sink (in front of the child). As the child completes each step of the task, he pulls off the PCS representing the step which he has completed, and puts it in an "all done" envelope.

Forewarning
For children who need very explicit forewarning regarding when something is going to "stop/end" or be "all done", use of "go", "almost done" and "stop" cards have proven very effective in giving children this important information to assist them in making this sometimes difficult transition (to stop).
Strategy: These cards are particularly useful for activities which do not have clear cut endings, such as some computer games, video games, drawing, etc.
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"Stop" Card

Each card is a large colored circle with "go" as green, "almost done" as yellow, and "stop" as red, with the word written in large letters in the center of the colored circle. When the child starts an activity, the "go" card is placed on his desk, computer table etc., accompanied by a verbal message to "go" or "start" the task. When there are approximately 1-2 minutes left for the child to continue the activity, the "almost done" yellow circle is placed in front of the child again, accompanied by a verbal message. When it is time to stop the activity, the "stop" circle is placed in front of the child with the verbal message that it is time to stop.

Rules/Alternative Behaviors:
Putting rules in a visual form allows the child to understand the expectations, as well as what actions or alternatives are acceptable. This strategy results in more consistent behaviour (12). In addition, visual representation of rules and alternative behaviours allows the child to improve his self-regulation and self-management skills without needing the support of an adult.

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"Individual Rules"

· Class rules or individualized personal rules taped to desk: These rules should be provided through a visual representation system which the child can understand (written words, line drawings, etc.). If the child is engaging in an inappropriate behavior, he can be directed to look at a specific rule, e.g., "Read rule number 3".
· "Good Choices That I Can Make" list: This visual support strategy assists the child in understanding and making appropriate choices when he has "broken" rules or engaged in inappropriate behaviors. This list should be posted so that the child has easy visual access to it, and should initially be referenced by an adult in the environment to teach the child the importance of this visual support strategy.

Example: The child is making silly noises at the beginning of a math assignment, with math typically being a difficult subject for the child. An adult can direct the child to the appropriate rule that is visually represented on his desk, by either pointing to the rule or stating "look at rule number___", which states "sit quietly and do my work" . The adult should then reference the child's "Good Choices That I Can Make" list. The adult may initially need to point out which specific choice the child should make in this circumstance.

This strategy will greatly assist the child in developing behavioral self-management skills. The following "Good Choices That I Can Make" list is an example:

1. I can raise my hand to ask questions or get help.
2. I can ask more questions if I still don't understand.
3. If I don't understand what someone is saying or doing, I can ask them.
4. I know that my own words and actions can make people feel differently than I do.
5. I can use "I" messages to tell people how I feel. ("I feel bad when you tell me it's inside recess")
6. I can write down the problem and then think of appropriate things that I could do.
7. I could use relaxation strategies. "Take a deep breath, count to 10, breathe out slowly"
8. I could ask for time-out (break) all by myself.
9. I can make good choices.
· Individual rule/behavior cards: These visual representation cards can be kept on a metal ring and used when needed either singly or in succession. Use of the international "no" should be drawn in red on top of the Picture Communication Symbol (PCS) or photo when appropriate to clearly indicate that a specific behavior should not occur. Behavior management cards can also be "color coded". This gives the child additional visual information to better understand desired and undesired behaviors. The following colors are used:
Red:behaviors you don't want the child to do (e.g., "no throwing").
Yellow: behaviors you request the child to demonstrate (e.g., "shhh, quiet", "quiet hands").
Green: appropriate alternative choices (e.g., "give a hug", "take a walk").




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"Individual Rule / Behavior" Cards



Example: Picture Communication Symbol (PCS) laminated on large index cards to communicate the following:
"Look at Mrs. Jones" - PCS of eyes;
"Sit on chair" - PCS of a child sitting in a chair;
"Shhh, be quiet" - PCS of a face with its finger to lips indicating "Shh";
"Don't hit" - international "no" drawn on top of PCS of a child hitting another child; etc.



Example: Going to McDonald's: A photograph of McDonald's is laminated to an index card. On the back of the card, specific "rules" for McDonald's are visually represented.
Transition rule cards: These cards can be used to help the child understand (visually) where he is going and what is expected of him in this environment.


If something is bothering me I can...: This strategy visually helps the child choose appropriate alternative behaviours when he is anxious or stressed. This card can be taped to his desk with the above heading and the following examples, or placed in a small photo, album which may also contain other visual support strategies:
oraise my hand for help
oclose my eyes and count to 10
otake 5 big breaths
oask for a break
Expressive Communication Skills:
"Low-tech" strategies designed to focus on a child's expressive communication skills include the following:
· Picture point communication board system: In order to communicate the child points to various visual representations (e.g., photos, PCS, objects, etc.) located on a "communication board" . Numerous communication boards can be created that are child, task, or environmentally specific.
Example: Placemat communication board to be used during snacks and meals with PCS around the edge of the placemat; communication board created for the "play" area.
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"PECS"

· Picture Exchange Communication System (PECS):The child approaches and gives a picture of a desired item (photo, PCS, object, etc.) to a communicative partner in exchange for that item (7). The use of this type of communication system provides the child with a way to communicate and most importantly, teaches the child to spontaneously initiate a functional communicative exchange (7).
Numerous adaptations can be made when using a PECS program to meet the individual needs of a child. For example, placing the visual representation system on frozen juice can lids or other hard discs or squares (counter top samples) allows the visual representation system to become more prominent to the child by giving him more tactile input (weight and hardness). He may tend to "crumple" up lightweight paper type items (pictures on plain paper) as a possible sensory need.





· Break cards: This is to help the child communicate that he needs some "down time" or a "break". Break cards should be easily accessible to the child and could be located in a consistent spot in the classroom, such as on the child's communication board or book, on the child's desk, etc. The purpose of the break card is for the child to communicate the message that he needs a break by using an appropriate communicative mode (visual representation system) rather than having to become increasingly anxious and frustrated, which may result in the occurrence of challenging behaviors.
· Choice cards: Choice cards (again using any type of visual representation system) allow the child a degree of independence by indicating a choice from a pre-determined set of possibilities. (e.g. a "work time" choice card could be presented to the child with several choices of activities for the child to choose from). When presented in this manner, the child is less likely to act out because he is allowed to make a "choice" of what he wants to do.
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"All Done" Card

· "All done" cards: Many non-verbal children exhibit challenging behaviors to indicate that they are "all done" with something, as they typically have no other way to communicate this concept. Therefore, teaching a more appropriate way to indicate "all done" through a visual representation system will lessen both the child's and adult's stress and frustration. "All done" cards can be taped to the child's work area and taught to the child by stopping an activity prior to reaching the child's attention/frustration level, then pointing to the "all done" card. The child's hand can be physically prompted to point to the "all done" card if needed. "All done" cards can also be placed on the child's communication board, or book, for him to use.

Example: The following topics are illustrated individually on small 3" by 3" laminated cards using both PCS and written words. They are either attached by a metal ring in the corner (for the child to hook on a belt loop) or placed in a small "communication wallet" to be kept in his pocket. The topics include "What did you do over the weekend"? "What is your favorite movie?" "Do you have any pets?" "What books do you like to read?"
Topic ring/topic wallet: These are designed for children who are verbal, yet have difficulty initiating a topic with others or, have difficulty initiating various topics with others, particularly when these topics are not related to their high interest areas. The "topic wallet/ring" can have various topics visually illustrated (e.g., written words, PCS) to prompt the child to initiate a topic.

· Relating past events: Many children with autism, both verbal and non-verbal, have significant difficulty relating past events. Using a visual representation system, which the child readily understands, can help to bridge this gap, at least between home and school. General templates are developed, which can be easily circled or filled out each day and sent to the respective location (home or school), to aid the child in relating past information through this visual representation system. Please click to see the samples "Last Night at Home" and "Today At School".

Social Skills:
Children with autism need to be directly taught various social skills in one-to-one and/or small group settings. Numerous low-tech strategies can be used for this purpose. Social skills training will also be needed to consider the child's possible difficulties in generalizing this information different social situations, which may be supported through the following visual strategies:

· Social Stories:The use of Social Stories, developed by Carol Gray, provides the child with the use of visual information/strategies that will improve his understanding of various social situations and teach him specific behaviours to use when interacting with others (9). Social Stories are written in first person and are individually written for each child for various difficult social situations (for example, staying in assigned seat on the bus). The Social Story should be visually represented in a mode which the child can most readily understand (such as written words, line drawings and written words, photos and written words).
The repetitious "reading" of the Social Story, when the child is calm, is what leads to the success of this strategy. Two 3-ring binders of identical Social Stories, kept in page protectors, could be made, one for home and one for school, so the child can read them at his leisure. This strategy has proven to be very successful for many students in learning to recognize, interpret and interact appropriately in different social situations.
A software program from Slater Software Company (23) which converts text to a graphic symbol, is called "Picture It",. This software program is ideal for adding line drawing graphics above written words to increase the child's understanding of Social Stories.

· Social Scripts: Social scripts are similar to Social Stories; however, an actual script is developed for a specific social situation (it is specific to the child and the social situation).
Example:A child has difficulty asking peers if he can join in their "ball-tag" game at recess. He typically runs in the midst of the game, takes the ball and then runs away. The script would read: Joey - "Hi guys. Can I play 'ball-tag' with you?" Guys - "Sure you can, Joey, but you will have to wait over there until it's your turn to throw the ball." Joey - "O.K. I'll wait until you tell me it's my turn."
Use of social scripts also readily helps in role playing these various social situations with peers, puppets, etc. Social scripts can also be used to visually, and thus clearly indicate what went "wrong" in a social situation.


· Comic Strip Conversations: The use of simple drawings to visually clarify the elements of social interactions and emotional relations. Comic Strip Conversations are used to visually "work through" a problem situation and identify solutions (8).
· Turn-taking cards: Turn taking cards are used to visually represent and mark whose turn it is. This use of turn-taking cards through a visual representation mode (PCS, object, written word, etc) is very effective in teaching this social skills concept.
· "Wait" cards: Wait cards visually represent the abstract concept of "waiting" through the use of a large orange colored oval card printed with the word "wait". These cards can be used at any time to teach the abstract concept of "waiting".
Example: Place the "wait" card on the computer monitor while waiting for the computer or a program to boot up; have the child hold the "wait" card while waiting in line.
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"Wait" Card

· "Help" cards: "Help" cards are used to teach the child the abstract concept of raising his hand in order to indicate that he needs help. Initially it is necessary to provide a concrete reason for the child to raise his hand by using the "help" card. An "I need help" visual representation (PCS, photograph, written word - taped to a Popsicle stick, or object) is used for the child to raise up in the air to indicate that he needs help. The item that he raises in the air can gradually be eliminated until the child is readily raising only his hand to seek assistance.
· "Waiting hands" card: An outline of a person's open hands on colored paper is used as a guideline as to where the child should place his hands while waiting (either for his turn, or for a chance to perform an action, etc.).
·
Example: Library social rules cards: "I will sit at a table with at least one other student". "I will discuss my book with one other student". "I will discuss another student's book".
Social "rule" cards:These cards are taped to the child's desk in the classroom (e.g., "I will raise my hand and wait for the teacher to call on me"). Social "rule" cards can be made for other environments than just the classroom. A "rule" card per environment can be written on an index card, laminated, and then given to the child to carry along as a visual reminder of the social "rules" for that particular situation.

Attending skills:
The visual symbols "go", "almost done" and "stop" can also be used to increase a child's attending skills. Data will need to be initially obtained to get a general idea of how long a child attends to a particular task.
Example: The child attends to a particular task for approximately 45 seconds and then throws all of his materials to indicate that he is "all done". To teach the significance of the "go" , "almost done" and "stop" cards, the "go" card is given at the start of the activity, the "almost done" card is given after approximately 30 seconds (as we already know the child will throw the materials after 45 seconds) and the "stop" card is given at approximately 40 seconds, with the activity immediately ceasing. It is critical to initially use the cards to "stop" the activity prior to the child throwing the materials, so that the child realizes the significance of the cards in relaying the messages of being "almost done" and "stopping". Gradually, the length of time for giving the child the "almost done" card and the "stop" card is increased, thus increasing the child's attending skills. It is important to note that the "almost done" card is always given to the child within a short time frame of giving him the "stop" card. Consistency is important in using these cards to increase the child's attention.


Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. "