Rising-to-new-heights-of-communication-and-learning-for-children-with-autism-the-definitive-guide-to-using-alternative-augmentative-communication-visual-strategies-and-learning-supports-at-home-and-school.pdf

Rising to New Heights of
Communication and
Learning for Children
with Autism
of related interest
Assessing and Developing Communication and Thinking Skills in
People with Autism and Communication Difficulties
A Toolkit for Parents and Professionals
Kate Silver
With Autism Initiatives
ISBN 978 1 84310 352 3
Enabling Communication in Children with Autism
Carol Potter and Chris Whittaker
ISBN 978 1 85302 956 1
Communication Issues in Autism and Asperger Syndrome
Do we speak the same language?
Olga Bogdashina
ISBN 978 1 84310 267 0
Rising to New Heights
of Communication and
Learning for Children
with Autism
The Definitive Guide to Using
Alternative-Augmentative
Communication, Visual Strategies, and
Learning Supports at Home and School
Carol L. Spears and

Vicki L. Turner
Illustrations by Pete Diaz
Jessica Kingsley Publishers

London and Philadelphia
First published in 2011
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Carol L. Spears and Vicki L. Turner 2011

Illustrations copyright © Pete Diaz 2011
All rights reserved. No part of this publication may be reproduced in any material form
(including photocopying or storing it in any medium by electronic means and whether
or not transiently or incidentally to some other use of this publication) without the
written permission of the copyright owner except in accordance with the provisions
of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued
by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London
EC1N 8TS. Applications for the copyright owner’s written permission to reproduce
any part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorized act in relation to a copyright work may result
in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data

A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data

A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84905 837 7

ISBN pdf eBook 978 0 85700 332 4
Dedication
It is to the families who have risen above the struggles and challenges
of autism, to soar and triumph like the phoenix, that we dedicate
this work. It is to educators, therapists, aides, professionals, and other
interested parties devoted to improving the lives of children with
autism and other developmental disabilities, that we offer this resource
guide. All of you have inspired us through your tireless efforts. We
hope to facilitate your endeavors.
It is with a promising vision of the future that we dedicate this
work to all children diagnosed with autism and other pervasive
disabilities. You have touched our souls, and it is in you that we
have found our lives’ work. It is our intent that this book should be
useful to those in your life, making your learning experiences, social
situations, and communication efforts more successful.
It is to our husbands, Darren and Hugh, that we dedicate this
work. We are truly thankful for the sacrifices you made in order for it
to come to fruition. You encouraged, supported, and loved us as you
kept the home fires burning to illuminate our journey to completion.
Finally, in all that we do, we acknowledge our Creator who was
in the midst of this project from conception to completion. We give
all the praise and glory to our Father-Mother-God.
Sincerely,
Carol and Vicki
Contents
Introduction 11
PART I: Alternative-Augmentative Communication

Methods 19
Chapter 1: Speech Generating Devices (SGDs) 21
Chapter 2: Picture Exchange Communication System (PECS) 38
Chapter 3: Symbolic Language Systems 46
PART II: Strategies to Support Learning 63

Chapter 4: Visual Supports 65
Chapter 5: Social Stories™ 87
Chapter 6: Structured Environments 96
PART III: Resources 107

Chapter 7: Information on Related Topics 109
Appendix 1 National Organizations 122

Appendix 2 Goals and Objectives 134
Index 142
List of Figures
Figure 1.1–1.2 SGDs for social interaction, comprising:
Figure 1.1 Greeting on arrival at school (a) 27
Figure 1.2 Greeting on arrival at school (b) 27
Figure 1.3–1.6 SGDs for requests and to information giving, comprising:
Figure 1.3 Communicating on arrival (a) 27
Figure 1.4 Communicating on arrival (b) 28
Figure 1.5 Answering questions on arrival (a) 28
Figure 1.6 Answering questions on arrival (b) 28
Figure 1.7–1.9 SGDs for structured academic activities, comprising:
Figure 1.7 Weather 30
Figure 1.8 Circle or group time 31
Figure 1.9 Interaction in the classroom 31
Figure 1.10–1.12 Overlays, comprising:
Figure 1.10 Meal or snack time 33
Figure 1.11 Free time (a) 33
Figure 1.12 Free time (b) 34
Figure 1.13 Bingo 36
Figure 1.14 Messages from school to home 36
Figure 2.1 Phase 1 Picture exchange (a) 42
Figure 2.2 Phase 2 Picture exchange (b) 43
Figure 2.3 Phase 3 Picture discrimination 44
Figure 2.4 Phase 4 “I want” 45
Figure 3.1 Fast-food menu 55
Figure 3.2 Sample pages for a communication binder, comprising:
Figure 3.2a Basic vocabulary 56
Figure 3.2b The weather 56
Figure 3.2c People at school 56
Figure 3.3 An eye gaze chart 57
Figure 3.4 A communication board 59
Figure 3.5a Personal information page 59
Figure 3.5b Calendar words 60
Figure 3.5c Dates in the month 60
Figure 3.6 I am feeling… 61
Figure 3.7 Activities 61
Figure 4.1 Mealtime, with two mini-schedules 67
Figure 4.2 “FIRST/THEN” board 68
Figure 4.3 “NOW/NEXT” board 68
Figure 4.4 “IF/THEN” board 69
Figure 4.5 “Morning routines” 71
Figure 4.5a “Getting ready for school” 71
Figure 4.5b Arrival at school 71
Figure 4.6 Calendars 71
Figure 4.6a Home 71
Figure 4.6b Classroom 71
Figure 4.7 Visual reminders for improving behaviour 72
Figure 4.7a Waiting, visual directive 72
Figure 4.7b Counting down 72
Figure 4.8 Hierarchy of visual representations comprising: 76
Figure 4.8a Real objects 76
Figure 4.8b Miniature real objects 76
Figure 4.8c Photograph 76
Figure 4.8d Container remnant 76
Figure 4.8e Detailed drawing 76
Figure 4.8f Written word 76
Figure 4.9 Four types of visual schedules 81
Figure 4.10 Checklist schedule 81
Figure 5.1 Sample Social Story for a young child for school 91
Figure 6.1 Structured TEACCH work session 103
Figure 6.2 Structured classroom 104
List of Boxes
Box 5.1 Sample Social Story for home 93
Box 5.2 Sample Social Story for home 94
Box 5.3 Sample Social Story for an older child for home 95
Introduction
Increasing knowledge
A number of words are emotionally laden, but few as much so as
the term “autism”. Kubler-Ross’s (2005) stages of mourning (shock,
denial, anger, bargaining, depression, testing, and acceptance) are
similarly experienced by families who receive the pronouncement
that their children have a pervasive developmental disorder (PDD) of
autism or other disability. Hopes, aspirations, goals, and dreams for
their children are typically replaced by a grieving process of despair
and fear. Fear of the unknown prevails due to a lack of immediately
available information, resources, and support. The primary purpose
of this introductory chapter is to provide basic information on autism
and other PDDs. Second, our aim is to assist families through the
final stages of seeking solutions and finding ways to rise above the
fear that is often inherent in a diagnosis of developmental disability,
communication deficit, or behavior disorders.
If there is any consolation to families, we reveal that some
educators, therapists, and other school staff are equally fearful of
autism and other pervasive developmental disabilities. The genesis
of the emotions may be different, but the underlying cause is the
same—fear. We have witnessed many teachers going into shock, not
unlike families, when first learning that they are to be assigned a
student who has been diagnosed with autism. There is anger and
denial that the child has been placed appropriately. This resource
guide assists educators, therapists, and other interventionists in rising
above the fear of the unknown by providing them with proven
11
Rising to New Heights of Communication and Learning for Children with Autism
effective strategies that facilitate learning, improve behavior, and

promote increased communication.
Definitions
The American Psychiatric Association (APA) has designated the
category of PDD to indicate children with delay or deviance in
their social, language, and/or cognitive development (APA 2000).
PDD is not a single disorder, but rather a range of delays of differing
magnitude, across different domains. The diagnostic terms that fall
within the broad category of PDD include:
• autism spectrum disorder (ASD)
• Asperger syndrome
• Rett’s disorder
• childhood disintegrative disorder
• pervasive developmental disorder not otherwise specified
(PDD-NOS) (Centers for Disease Control and Prevention
2007; The National Dissemination Center for Children with
Disabilities (NICHCY) 2010).
An ASD is a neurological condition affecting a child’s ability to
comprehend and express language, relate to others, and learn. A
diagnosis of PDD-NOS indicates that a child is impaired in the
development of reciprocal social interaction or communication, or
exhibits stereotyped behavior, but does not meet the criteria for a
specific PDD.
According to the APA (2000), the DSM IV-TR diagnostic criteria
for an autism disorder are as follows:
A. A total of six (or more) items from (1), (2), and (3), with at least
two from (1), and one each from (2) and (3):
1. Qualitative impairment in social interaction, as manifested by
at least two of the following:
(a) Marked impairment in the use of multiple non-verbal
behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction.
12
Introduction
(b) Failure to develop peer relationships appropriate to

developmental level.
(c) A lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g. by a
lack of showing, bringing, or pointing out objects of
interest).
(d) Lack of social or emotional reciprocity.
2. Qualitative impairments in communication as manifested by
at least one of the following:
(a) Delay in, or total lack of, the development of spoken
language (not accompanied by an attempt to compensate
through alternative modes of communication such as
gesture or mime).
(b) In individuals with adequate speech, marked impairment
in the ability to initiate or sustain a conversation with
others.
(c) Stereotyped and repetitive use of language or idiosyncratic
language.
(d) Lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level.
3. Restricted, repetitive, and stereotyped patterns of behavior,
interests, and activities, as manifested by at least one of the
following:
(a) Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that is
abnormal either in intensity or focus.
(b) Apparently inflexible adherence to specific, nonfunctional
routines or rituals.
(c) Stereotyped and repetitive motor manners (e.g. hand
or finger flapping or twisting, or complex whole-body
movements).
(d) Persistent preoccupation with parts of objects.
13
B. Delays or abnormal functioning in at least one of the following

areas, with onset prior to age three years: (1) social interaction;
(2) language as used in social communication; or (3) symbolic or
imaginative play.
C. The disturbance is not better accounted for by Rett’s disorder or
childhood disintegrative disorder.
More simply stated, autism, as defined by the CDC (2007) is one
of a group of disorders termed ASDs. ASDs are developmental
disabilities that cause significant impairment of social interaction
and communication, accompanied by unusual behavior and interests.
Although individuals with an ASD may display atypical ways of
learning, attending, and reacting to sensory information, their
cognitive and learning abilities vary, ranging from gifted to severely
challenged. Autism, PDD-NOS and Asperger syndrome, each
categorized as an ASD, share some common symptoms but differ
in onset, severity, and nature. CDC (2004) define developmental
disabilities as a diverse group of severe chronic conditions, resulting
in part from mental retardation and/or physical impairments.
Individuals affected are challenged by major life activities, such as
language, mobility, learning, self-help, and independent living.
Under federal legislation of the Individuals with Disabilities
Education Improvement Act (IDEA 2004), infants, toddlers, children,
and youth with disabilities receive early intervention, special education,
and related services, such as speech-language or occupational therapy.
IDEA defines autism as:
a developmental disability significantly affecting verbal and non-
verbal communication and social interaction, generally evident
before age three that adversely affects a child’s educational
performance. Other characteristics often associated with autism
are engagement in repetitive activities and stereotyped movements,
resistance to environmental change or change in daily routines, and
unusual responses to sensory experiences (NICHCY 2010).
What do we currently know?

The questions related to treating autism and other developmental
disabilities often appear to outweigh the answers. Research is
abundant, yet two primary concerns remain: what causes autism and
14
Introduction
what is the cure? In Rising to New Heights, we do not address either

issue. Instead, we respond to the question most frequently asked by
families and interventionists: “What do I do for my child or student?”
Of the various PDDs, the focus of this text is on autism. The
strategies introduced are not applicable solely to autism, however.
Families, educators, and interventionists responsible for the care
and treatment of children with other developmental disabilities and
exceptional needs will also find the information appropriate for home
and educational settings. The purpose in writing Rising to New Heights
was to dispel the fears frequently inherent in a diagnosis of a PDD
or other developmental disability. Our approach to accomplishing
this complex undertaking was to answer frequently asked questions
regarding the influence of autism and other developmental disabilities,
communication deficits, and behavior disorders at home and in
school.
In Part I, we assist home and school team members in treating a
child with a communication disorder due to a PDD, developmental
disability, or other condition, to rise to new communicative heights
by increasing adults’ knowledge of alternative-augmentative
communication (AAC). In Part II, we attempt to help teams understand
that there is nothing to fear when you use the right supports. The
techniques we share involve employing visual strategies to improve
communication, behavior, and learning opportunities. Information
is provided on using social stories with children with disabilities,
and on structuring the environment for their benefit. Finally, in Part
III, we further our efforts to help others overcome the fear factor
by offering introductory information on various topics including
sensory integration, applied behavior analysis (ABA), and routines.
We provide additional information on available resources such as
national organizations, as well as specific goals and objectives relating
to each chapter in this guide.
In Parts I and II, we answer the following questions:
• Who would benefit from a particular intervention or strategy?
• What does the strategy entail?
• Why use the strategy?
• How is the strategy implemented?
15
• When is the strategy best used (with examples and

illustrations)?
• Where does one turn for additional information?
The provision of resources, and goals and objectives, in Part III
further supports families and school personnel with information and
strategies for overcoming the fear factor. The outcome is success for
a child while determining and implementing solutions that work!
Improved communication, behavior, and learning come about as the
child becomes more easily integrated into home and school activities
and functions more effectively.
Expert answers
With increasingly high numbers of children diagnosed daily with
a PDD, both private and governmental entities have turned their
attention to learning more regarding the disorders. The CDC
responds to questions about who is affected by ASDs by reporting
that the condition occurs in all racial, ethnic, and socio-economic
groups (CDC 2009). ASDs occur four times more often in boys than
girls. The CDC’s recent studies indicate that in 2009 approximately
1 in 110 eight year old children in several regions of the United
States had an ASD (CDC 2009). According to the CDC, autism can
be detected in children as young as 18 months of age. Children in
high-risk groups, such as siblings of those previously diagnosed, or
children of parents with autism, should be monitored closely for
acquisition of developmental milestones or warning signs of an ASD
or other developmental disabilities. The CDC lists specific behaviors
as “possible red flags” for an ASD. These are when children:
• do not play “pretend” games (e.g. pretend to “feed” a doll)
• do not point at objects to show interest (e.g. point at an
airplane flying over)
• do not look at objects when another person points at them
• have trouble relating to others, or not have an interest in
other people at all
• avoid eye contact and want to be alone
16
Introduction
• have trouble understanding other people’s feelings or talking

about their own feelings
• prefer not to be held or cuddled, or might cuddle only when
they want to
• appear to be unaware when other people talk to them, but
respond to other sounds
• appear to be very interested in people, but not know how to
talk to, play with, or relate to them
• repeat or echo words or phrases said to them, or repeat words
or phrases in place of normal language (echolalia)
• have trouble expressing their needs using typical words or
motions
• repeat actions over and over again
• have trouble adapting to changes in routine
• have unusual reactions to the way things smell, taste, look,
feel, or sound
• lose skills once displayed (e.g. stop saying words they were
once using) (CDC 2007).
Although information exists on the prevalence and symptoms of
autism, research on causes is not as specific. According to the CDC,
scientists believe that both genetics and the environment have an
influence on ASDs. There are probably many factors that can lead
to autism. There is speculation that a child’s diet, inoculations, or
mercury may be responsible. As stated previously, our emphasis is
not on the why of developmental disabilities, but rather on what to do,
particularly in order to remove the factor of fear from the equation.
Especially for parents

As we formulated ideas for this definitive guide, our imaging of a hot
air balloon typified numerous situations that we encountered during
our decades of providing services to children with disabilities and
their home and school teams. On the one hand, the balloon represents
escalating emotions, when filled with the hot air of fear, anxiety, and
dread that often emerge when parents are given a diagnosis of autism
17
or other disability. The balloon rises at the onset of mourning and

extinguishes hopes and dreams for their children. Shock, denial,
anger, bargaining, and depression keep the emotional balloon afloat.
But we strive to rescue such wayward balloons, not by deflating them
but rather by putting families and school members in control. With
appropriate information, teams learn to release the emotional hot air
and replace it instead with new knowledge and strategies we know
work. This alternate view of the hot air balloon depicts families and
educational teams at the helm, with information, effective methods,
and resources fueling the apparatus to rise above fear. Families, in
particular, need to know they are not on a solitary flight. They are
embarking on a journey replete, certainly, with challenges; but most
significantly, with this text as a guide, they are also choosing a path
of success for their children.
Readers are encouraged to move beyond the initial mourning stages
to those of testing new solutions, and accepting and implementing
what works best for their children or students. Be mindful that all
individuals are different, with unique interests, skills, and talents. The
core strategies presented in this book, nonetheless, are intended to
guide intervention approaches at home and school. We intend that
Rising to New Heights should make the trip smoother, and that the
destination should be one of enhanced communication, learning,
behavior, and functioning for children living with developmental and
other disabilities
Further reading
American Psychiatric Association (APA) (2000) Diagnostic Criteria for 229.00 Autistic
Disorder (DSM-IV-TR). Arlington, VA: APA.
Center for Disease Control and Prevention (CDC) (2004) What Are Developmental
Disabilities? Available at www.cdc.gov/ncbddd/dd/default.htm. Accessed
August 2010.
Center for Disease Control and Prevention (CDC) (2007). www.cdc.gov/ncbdd/
autism/signs.html. Accessed 12 January 2009.
Center for Disease Control and Prevention (CDC) (2009) CDC Press Briefing
on Autism Surveillance Summary. Available at www.cdc.gov/media/
transcripts/2009/t091218.htm. Accessed 2 July 2010.
Kubler-Ross, E. and Kessler, D. (2005) On Grief and Grieving. Sribner, NY: NY.
National Dissemination Center for Children with Disablilities (NICHCY) (2010).
www.nichcy.org
18
PART I
Alternative-Augmentative
Communication
Methods
Imagine initiating an exchange with another individual, only to

discover yourself suddenly silent…wordless…voiceless. A myriad of
ideas swirl in your head. You might even hear them loud and clear;
yet, the person with whom you seek to interact has no awareness
of your meaning or your intent. In effect, you have experienced a
communication breakdown, a commonplace occurrence for a child
on the autism spectrum or with a pervasive developmental disability.
We wrote Part I of Rising to New Heights because we recognized the
frustration of children with disabilities who lack sufficient means to
communicate effectively. Also, in Part I, we offer support to adults
who deal with their own fears regarding how children with severe
disorders communicate.
Communication is the ability to relay information and thoughts
using a reliable method of expression that produces a mutually
understood message intentionally exchanged between two or more
people. Challenges arise when an educator or parent attempts to
communicate with a child who has significant limitations in expressive
communication abilities, resulting in inconsistencies in message
production and poor intelligibility. Typically, verbalizations are not
the only method of expression: gestures, intonation patterns, facial
expressions, and posturing may also relay meaning to the listener. In
Part I of Rising, we answer Who, What, Why, How, Where, and When
questions about utilizing and expanding an individual’s methods of
expression and application of alternative methods of communication
19
to relay mutually understood messages. Instruction on Alternative

Augmentative Communication (AAC) techniques to compensate for
the limitations in message generation, and to provide individualized
methods that allow a child’s ability to engage and be successful in the
communication process, is discussed.
Communication is a necessity when individuals attempt to
transfer information, have wants and needs met, create social bonds,
understand the environment, control their circumstances, and realize
their self-worth. AAC strategies are implemented to assist in bridging
the gap in social, educational, interpersonal, and professional settings
for individuals with expressive communication limitations. When one
takes on the task of working with individuals who must compensate for
limited expressive abilities, there are many variables to consider, such
as cognitive levels, physical abilities, typical communicative partners,
and communicative needs. As detailed in Part I, these variables dictate
the specific AAC strategies and communicative supports required to
address the specific communicative needs of the students.
The chapters in Part I of Rising address topics of AAC highlighting
our knowledge and experiences in effective, functional use of AAC.
As authors, our goal for all readers of these chapters is to be able to:
• utilize alternative assessment procedures to identify the
specific communicative needs of the student
• become familiar with various AAC options that compensate
for significant expressive communication delays
• tailor AAC goals, strategies, materials, and equipment for
each student addressed.
20
1 Speech
Generating
Devices
Who would benefit from the use of speech W

H
generating devices (SGDs)? O
Individuals with severe expressive communication disorders benefit
most from the use of SGDs. Included among these individuals are those
who utilize gesture, speech and/or written communication methods
that do not adequately address their expressive communication
attempts or needs. In all these individuals, the primary cause for
the limitations in expressive communication should not be due to
hearing impairment. Many individuals are capable of some verbal
output; however, their utterances are limited and inadequate to meet
their varied communication needs (START 1996). Candidates for
AAC vary in disabilities and may include individuals with autism,
cognitive or developmental delay, traumatic brain injury, cerebral
palsy, specific language disabilities, developmental apraxia, muscular
dystrophy, and sensory impairments.
What are SGDs? W

H
SGDs are communication devices that offer speech output, have A
programming capabilities, and can provide the individual with a T
broader range of communication possibilities (although this is not
necessarily the case) (START 1996).
There are two types of SGDs. Systems designed for the single
use of speech output are called dedicated systems. An example of
21
a dedicated system is the Vantage Lite (manufactured by Prentke

Romich Company). The second type of SGD is a computer system
that is used for a variety of functions including that of generating
speech. Examples of this type of SGD system is the Mercury
(manufactured by Assistive Technology Inc.) and a computer with
Speaking Dynamically software installed (START 1996).
The dedicated systems range from the one message voice output
device, such as the Big Mack (manufactured by Ablenet Inc.), to the
mid-range devices, such as the Go Talk, Communication Builder, and
Tech Talk, to the high-tech devices, such as the ECO-2 (manufactured
by Prentke Romich Company), the V (manufactured by DynaVox
Electronics Inc.), and ComLink (manufactured by Forbes Rehab
Services Inc.).
W Why are SGDs used in the classroom setting?

H
Y Over the years, new legislation addressing issues relating to special
needs students has prompted change in the educational opportunities
for such students. According to Hartsell and McIntosh (2005),
federal and state mandates dictate that students with cognitive
or developmental delay, cerebral palsy, autism, specific language
disabilities, multiple disabilities, sensory impairments, developmental
apraxia, muscular dystrophy, and traumatic brain injury, receive
free and appropriate education in the least restricted environment.
Included in the mandates is the necessity for public school systems
to provide each student with the specific materials or equipment
needed for them to successfully access the curriculum. Students
with significant communication difficulties are faced with the daily
challenge of functioning effectively in the educational environment
with the inability to relay even the simplest of messages. SGDs are
therefore used to bridge the gap that poor expressive communication
abilities create in the academic setting. When SGDs are effectively
integrated into the classroom curriculum, students have the tools that
they need to be productive, independent, and successful learners.
Technology provides the students with the tools that they need to
participate and achieve within these educational activities.
22
Speech Generating Devices
How should SGDs be integrated in the classroom? H

O
No SGD is a “cure” for an ineffective or inadequate expressive W
communication system. Rather, an SGD should be considered one
component of a communication system that allows a student to
effectively relay messages. There will certainly be occasions when
the use of just one SGD will not be appropriate in a communication
setting. It is therefore incumbent upon the educators to develop
and teach the student an arsenal of communication strategies. Once
equipped with multiple options for expressive communication, the
student can in turn pair the most effective and efficient method with
the communication situation at home and school. This allows for
faster and easier communication exchanges, more communication
opportunities, and more learning. (Downey et al. 2004).
Important factors to consider when using SGDs

Irrespective of the SGD considered for a student, it is important to
remember some basic premises (START 1996):
• SGDs enhance speech and language development.
• Communication efforts are more effective when additional
materials and techniques are used in conjunction with an
SGD.
• Formal training and support in device use fosters more
accurate use of the SGD in all communicative settings.
• Educators maintain verbal modeling when communicating
with a student using an SGD.
• Ideally, the educational team participating in the evaluation
and selection process should consist of any combination of
the following members:
ôÃ´ speech-language pathologist
ôÃ´ occupational therapist
ôÃ´ physical therapist
ôÃ´ itinerant teacher for visually impaired
ôÃ´ special education teacher
23
ôÃ´ classroom or subject teacher

ôÃ´ computer or augmentative communication specialist
ôÃ´ parent
ôÃ´ student
• Some students use negative behaviors as a form of
communication. When addressing the behaviors, it is
important that they are not immediately dismissed but
are analyzed to determine if the displayed behavior is an
inappropriate yet purposeful communication attempt.
• The SGD system should be a functional one. The content of
the system should reflect the child’s cognitive level, physical
abilities, interests, and communication needs.
• When changes and additions are needed to supplement the
child’s language needs, re-programming the SGD should be
easy.
• A viable successful communication method should not be
replaced with a more abstract time-consuming SGD. That is,
the students who are able to nod and shake their head for yes
and no should not be directed to use a device for yes and no.
• Students need frequent opportunities to use their SGD,
particularly during the early stages of learning.
• More success in learning is often achieved when a student
realizes that the SGD offers pleasurable outcomes such as
control, having desired needs met, social interaction, and fun.
• Teaching the use of a SGD should be done in interesting,
naturalistic settings rather than through memorization and
drill.
• Use of the SGD should be incorporated throughout all
communicative settings (i.e., home, school, work).
• The educational team needs to be prepared to commit the
time and energy needed for successful teaching of the use of
the SGD.
24
When should SGDs be used? W

H
An SGD may be used when: E
• there is a communicative situation and the desire to N
communicate
• the potential user has the ability to formulate a message
cognitively and to understand and use a device
• an SGD has been determined a viable alternative means of
communication by a speech-language pathologist following
an AAC evaluation
• there is a need to relay messages during academic lessons,
provide information and questions about vocational
responsibilities during social exchanges, and to relay wants
and needs when needed.
It is paramount, however, that SGDs are used following specific
training on their purpose, function, and operation. Teaching the use
of SGDs for communication takes lots of time and patience by the
user, family, teacher, and other students. When teaching the SGD,
there are multiple methods that may be used and important factors
that should be considered. (CeDIR 2003).
The educational team at the school develops a plan on when the
students are to use their communication method. Within this plan,
the team determines when and how often the communication tool is
to be used, what vocabulary is needed, who will program or fabricate
whatever is required and what the expectations of the students are.
There follows examples of how an SGD can be incorporated during
different times of the day. Keep in mind that the expectations for
expressive output are first and foremost dependent on the vocabulary
constraints of the device. After that, familiarity with the device and
cognitive level also contribute in determining the level of expectation.
Consequently, the following activities may vary depending on the
device used. For example, some students may use their SGD to label
the food items they want at mealtime, while others will use yes or no
in response to food items already labeled, in order to indicate what
they want. In both cases, however, the student is requesting food
items.
25
Burns (2005) identified classroom settings as priceless

opportunities or costly obstacles to building proficient use of SGDs,
citing student, teacher, and peer participation as pivotal factors in
helping promote the use of devices. Below, he identifies the three
levels of participation required to encourage AAC users to seek the
many opportunities for activities to develop communication skills.
W When student participation is a factor

H
E This level of participation recognizes the student as the focal point.
N There are four primary areas for student participation:
• social interaction
• curricular interaction
• communication personality
• communication technique.
These four areas of participation will certainly have an impact on the
individual user’s desire and need to use a device.
Social interaction
According to Burns (2005), opportunities for social interaction exist
in infinite quantities for verbal children at school and at home. These
interactions are generally short in duration and they are often not
school-related even though they occur in school. Social interactions
occur before, after, and during structured school, home, and
community activities. It is therefore recommended to include some
social vocabulary on an SGD unless it is not a high priority either
because of limits on the amount of vocabulary that can be included
on the SGD, or because it is not deemed important by the SGD user.
Figures 1.1–1.6 are examples of different SGDs that are
programmed with vocabulary for communication during social
situations. For example, Figures 1.1 and 1.2 show SGDs with
greetings to staff and peers on arrival at school, and Figures 1.3 and
1.4 show SGDs with messages to allow for communication regarding
arrival topics. Figures 1.5 and 1.6 demonstrate how students can be
helped to respond to possible questions on arrival such as:
26
“Good morning
Mr. Jones.”
Figure 1.1 Greeting on arrival at school (a)
“How are
“Good morning
you today?”
Mr. Jones.”
“Good to
see you.” “What’s
up?”
Figure 1.2 Greeting on arrival at school (b)
“Would you help

me take my coat
off please?”
Figure 1.3 Communicating on arrival (a)
27
“There’s a note from

my Mom in my
“Would you help book bag.”
me take my coat
off?”
“I would
“I have my like to eat
homework.” breakfast.”
Figure 1.4 Communicating on arrival (b)
“no”
“yes”
Figure 1.5 Answering questions on arrival (a)
“water”
“cheese
croissant”
“chocolate
milk”
“Peanut butter
and jelly
sandwich”
“white
milk”
“French “juice”
toast
sticks”
“cereal”
Figure 1.6 Answering questions on arrival (b)
28
Do you want breakfast?

Are you hot?
What would you like for breakfast?
When including vocabulary for social situations, it is important to
keep in mind that reasonable speed for message generation is critical.
Message generation that is so slow that it creates non-functional
communication by impeding or stopping the flow of communication
should be addressed by creating easier access. Efficiency of access to
vocabulary is critical and may require using one word, a short phrase
or, at the most, very concise sentences when communicating during
social settings.
Curricular interaction
Communication opportunities exist during structured class activities
embedded in the school day. Typical school activities such as
reading groups, circle time, show and tell, and oral reports provide
opportunities for expressive language. The level and type of
expressive opportunities are dependent upon the type of classes in
which the student is enrolled, the make-up of the classroom, and
the developmental level of the student. It is therefore important to
recognize the communication opportunities and teach the student to
use the SGD to communicate successfully in the school environment
(Burns 2005).
Figures 1.7–1.9 are examples of devices with programmed
messages that can be used during structured activities at home or
at school. The student with an SGD that provides these types of
messages, and who has been trained on the use of the SGD, now
has the potential to independently respond, interact, and successfully
access the curriculum in the least restrictive environment.
For example, Figure 1.7 shows how students can participate in
typical group weather activities. Figure 1.8 shows how students may
respond to structured group questions such as:
• How old are you?
• Who do you want to be your helper?
• Whose turn is it?
29
• How many girls are here today?

• How old are you?
• What color is my shirt?
Figure 1.9 shows how SGDs can enable a student to:
• request basic wants and needs in the classroom
• ask questions to request help
• request additional materials
• make comments.
SGDs can also help students to participate in home activities by
making choices, giving structured responses, naming vocabulary
items, and expressing vocabulary during repetitive books.
Communication personality
Communication personality considers the specific attributes of a
student’s personality when determining use of an SGD. As with verbal
students, there are extroverted and introverted AAC users. Students
exhibit varied levels of desire to speak in a classroom environment
irrespective of their ability to generate messages on their device. Some
students seek the center of attention and will communicate freely in
the classroom setting while others prefer not to interact. These same
cloudy
sunny
rainy
Today is snowy
cold
hot
Figure 1.7 Weather
30
Figure 1.8 Circle or group time
Figure 1.9 Interaction in the classroom
31
attributes should be considered when using a device. The need and

desire to communicate, and in what settings, are variables to consider
when determining appropriate device use and vocabulary.
It is also important to remember to use content vocabulary
as well as comment vocabulary. Most speakers interject related
comments when communicating for various purposes. Neglecting to
include these comments often strips individuals of personality when
speaking. Comments about how they feel add motivation, interest,
and personality to the device users’ communication (Burns 2005).
Figures 1.10–1.12 offer overlays that may be used in SGDs that
include appropriate comments for the topics. For example, at meal or
snack time, students can:
• request food items
• ask for help
• indicate when more is desired
• indicate when finished
• make general comment about food items.
In free time students can:
• make choice of desired activity
• make comments or requests about activity. For example,
during a bubble-blowing activity, the student can make
comments such as “pop it”, or “big bubble”
• Integrate self into activity by using messages such as “my
turn”, he’s cheating”, and “I’m next”.
Communication technique
Communication technique involves how the SGD is used and affects
the speed of communication. SGD users who know how to access
vocabulary are more adept in their communication. Those who are not
familiar with their device may have a difficult time generating desired
messages within a reasonable time. They may become discouraged
when impatient communication partners interrupt or respond prior
to message completion. It is therefore essential to teach the use,
purpose, function, and operation of the device to ensure maximum
communicative success (Burns 2005).
32
Figure 1.10 Meal or snack time
Figure 1.11 Free time (a)
33
Figure 1.12 Free time (b)
W When teacher participation is a factor

H
E According to Burns (2005), teacher levels of participation involve
N three primary areas:
• Teaching activity.
• Communication activity.
• Peer activity.
These individual levels focus on teaching language skills, creating
opportunities for communication in a natural environment, and
allowing activities with peers to promote familiarity with the device
and make it an extension of the user’s personality rather than a toy
or high-tech gadget.
Teaching activity
Teaching activities for device users include, but are not limited to, the
classroom assignments presented to all the students in a class. All too
often, SGD users are handed a device and expected to communicate.
This is done when many non-verbal students have deficits in language
34
abilities as well as limited knowledge on where and how to find

words on the device. Devices can be set up, if properly planned,
to incorporate lesson-plan material for student participation in the
classroom while they are learning to use the device more effectively
(Burns 2005).
Communication activity
Communication activities may include show and tell, oral book
reports, games, and story telling. These kinds of activities provide
opportunities for long varied language utterances that can be pre-
planned and rehearsed. Additionally, students are provided with the
opportunity for inclusion in talk time activities along with classmates
providing practice with SGDs. Being the caller in a Bingo game or
playing a game of Uno can offer varied, yet predictable, opportunities
for expression.
Figure 1.13 is an example of a Bingo overlay that may be used
in an SGD. Figure 1.14 is an overlay that offers vocabulary for
communicating information between school and home.
The messages can be elaborate, describing activities or events that
occurred at school. They can also be as simple as using the SGD to
let parents know to look in the book bag for a note from the teacher.
Students can also use the device to:
• request desired food items
• indicate when they are hungry
• express when more is desired
• choose a TV program to watch
• express feelings
• express need for help.
Peer activity
Peer activities utilize other students as communicative partners.
Including the students’ friends as in expressive language activities
offers a less threatening, more fun opportunity to use SGDs. The
student is in a more casual and comfortable situation, removed from
the sense of being tested and timed, and released from the fear of
35
Figure 1.13 Bingo
“ I played in the
“School was
playground.”
fun today.”
“I had a good lunch.”
“Lunch was awful.”
“My teacher was absent.”
Figure 1.14 Messages from school to home
36
providing a wrong answer. Group and playtime activities offer many

opportunities for communication and fun. SGDs should include
commands and fun statements based on the activity.
When peer participation is a factor W

H
Peers throughout the school, at home, or in the community may E
be used for dual purposes. Peer activity and classroom involvement N
are affected at this participation level. Peers may include classmates
as well as same-aged peers throughout the school and community.
Verbal students from clubs or extracurricular groups may engage in
activities with the SGD user. AAC users may find they can be more
involved in student activities with help from verbal peers.
Where can you get help? W

Burns, C. (2005) Classroom AAC: Communication through Participation. Contact author
H
E
at [email protected] to request this publication. R
CeDIR (Center for Disability Information and Referral) (2003) Augmentative and E
Alternative Communication Introduction. Available at www.rehabtool.com/forum/
discussions/98.html, accessed on 15 June 2009.
Downey, D., Daugherty, P., Helt, S. and Daugherty, D. (2004) “Integrating AAC
into the classroom: low-tech strategies.” Asha Leader, 21 September, pp.6–7, 36.
Hartsell, K. and McIntosh, K. (2005) “Integrating assistive technology into the
general education curriculum for students with high incidence disabilities.”
Closing the Gap 24, 3, 4–6, 36.
START (Special Needs Technology Assessment Resource Support Team) (1996)
Meeting the Needs of Students with Communication Difficulties. Berwick, NS:
Annapolis Valley Regional School Board. Available at www.nsnet.org/start/
communication.pdf, accessed on 15 June 2009.
37
2 Picture Exchange
Communication System
(PECS)
W Who uses the Picture Exchange Communication

H
o System (PECS)?
The Picture Exchange Communication System (PECS) was originally
developed at the Delaware Autistic Program for children with autism.
When it was originated, its primary purpose was to teach children
with autism to initiate communication. Subsequently, it has been
found that PECS is appropriate for individuals who are non-verbal as
well as those with limited expressive language. This group includes
those with phonetic problems, apraxia, few communicative partners,
or no initiation (Wallin 2004). The system can be implemented
successfully with children as young as two years of age.
W What is PECS?
H
a PECS is an augmentative communication system designed to facilitate
t quick, effective, functional communication. Vicker (2002) describes it
as a modified applied behavior analysis program established to teach
non-verbal symbolic communication. It is a concrete visual-based
program that does not require the more difficult motor planning that
many signs in sign language require. Although speech emerges with
some individuals and verbal speech is indirectly encouraged, PECS
is not specifically designed to teach speech. Its primary objective
is to establish an understanding about the purpose and method
38
Picture Exchange Communication System (PECS)
of communication exchanges, and to facilitate communication by

providing the opportunity to relay messages through pictures.
Why use PECS? W

H
The initial suggestion to parents to use PECS with their child often Y
evokes hesitancy, disappointment, and disagreement stemming from
their conception that the use of this communication system means
their child will never talk, or that speech will no longer be addressed.
This is discouraging for parents because the hope that their child will
someday talk is immediately destroyed, and the fear that their child
will never talk is affirmed. Research demonstrates the opposite is
true. The implementation of PECS can enhance a student’s language
development (Frost and Bondy 2002). PECS has many advantages
including the following:
• Communication exchanges are clearly intentional and readily
understood.
• Interactions are initiated by the student, thereby eliminating
prompt dependency.
• Exchanges are meaningful and motivating.
• Materials are inexpensive, simple to fabricate, and portable.
• A communicative partner does not need specific training to
understand a message. Anyone willing to participate in an
exchange is a potential communicative partner. The student
therefore has few limits in communicative opportunities
(Wallin 2004).
How does PECS work? H

O
During implementation of each of the six phases in PECS, an W
individual chooses a picture from a variety available, then gives
the picture to a communication partner. Knowing the individual’s
request, the partner can then provide the requested item or fulfill a
desired need.
According to Frost and Bondy (2002), the six phases of PECS
are:
39
Phase I. Purpose: To initiate communication

During the first phase, a facilitator and message receiver is needed
to work with the child. The child is presented with a previously
determined desired item. When the desired item is presented and
the child reaches for it, the facilitator physically redirects the child’s
reach to the picture of the item and assists them in picking up the
picture and giving it to the message receiver in exchange for the item.
Physical guidance by the facilitator is gradually faded. The goal of
the PECS is to teach spontaneous initiation of communication and
not to prompt responses to our requests. It is therefore important
to resist talking too much. Phrases with, “give me” should never
be used for they teach one step directions rather than spontaneous
initiation of a response. The desired item is to motivate the picture
exchange. The facilitator physically demonstrates the process and
very little language is needed. Figure 2.1 on p.42 depicts the picture
exchange process implemented with the student and two helpers.
Phase II. Purpose: To teach distance and persistence

A PECS book or board is provided with one picture presented at
a time. During this phase, PECS users are taught to move longer
distances to complete exchanges for a desired item. They are
taught to locate their book or board and move longer distances to
communication partners for the exchange. Figure 2.2 on p.43 depicts
the use of one picture in the beginning stages of picture exchange.
Phase III. Purpose: To discriminate between pictures or

symbols
A desirable is paired with a non-desirable on communication
book. The child exchanges using one of the pictures and receives
the requested item. When the desired item is exchanged, the child
receives the item and social reinforcement from the message receiver.
When the non-desired item is exchanged, they receive that item
and error correction steps are taken. The message receiver may ask,
“What do you want?” or the facilitator may physically prompt the
child to the desired picture. Once the child increases accuracy in
discriminating between two items, additional items are gradually
added. Figure 2.3 on p.44 depicts multiple PECS pictures set up
40
with an item that is desirable for the user along with a non-desirable
or neutral item to facilitate discrimination.
Phase IV. Purpose: To begin using sentence structure

Icons for carrier phrase, “I want” are provided as sentence starters
to be combined with a picture request. A sentence strip is with the
sentence starter added to the front of the PECS book and the child
learns to build a sentence by adding the desired picture to the strip
and exchanging the entire strip. The message receiver then turns
the strip toward the student and reads the phrase and provides the
child with the desired item. Figure 2.4 on p.45 depicts the use of a
sentence structure format with the pictures.
Phase V. Purpose: To answer a direct question

The student is taught to answer the question, “What do you want?”.
The use of additional words may be taught during this phrase to
refine message meaning. For example, the child may replace “I want
lego”, with “I want red lego”.
Phase VI. Purpose: To begin to develop commenting

The child learns to communicate more than just their wants and
needs. During this phase, the purpose for exchanges no longer is
only for requesting. Exchanges for the purposes of commenting and
providing information are now taught by using the carrier phrases,
“I see” and “I have”. Icons for “I see” and “I hear” are introduced one
at a time on the communication board in a systematic fashion.
(Frost and Bondy 2002)
When do you implement PECS? W

H
It is appropriate to use PECS when addressing the expressive E
communicative needs of individuals who are non-verbal, primarily N
echolalic, or have unintelligible speech, and those who have only a
small set of meaningful words or signs in their repertoire. PECS is
used when addressing many communicative needs and when working
41
with various populations. The training is not limited by age and can
be offered to an adult with a cognitive impairment as well as to a
young child with no cognitive impairments (Vicker 2002).
PECS is often introduced to students with autism; however, it is
not limited to this population. Careful consideration of the program
and its strengths and weaknesses should play an important role in
program selection for each prospective communication learner.
There is a small set of criteria that helps determine when PECS
may be used (Vicker 2002).
Figure 2.1 Phase 1 Picture exchange (a) In Figure 2.1 the communicator (child)
is being physically prompted by the facilitator to exchange a picture with the
message receiver. The physical prompts are faded as soon as possible.
Intention to communicate
The candidate for PECS training should demonstrate at least some
instances of intention to communicate by trying to gain attention
in conjunction with a purposeful communicative attempt. The child
who pulls another person to a desired object has at least some
understanding of intentionality. Those who make attempts and
42
Figure 2.2 Phase 2 Picture exchange (b) Figure 2.2 shows training in the exchange
of pictures when a desired item is placed on top of the communication binder
while opportunities are created to encourage multiple trials for the communicator
to exchange the picture. The communicator is then taught to locate the binder
and travel to the message receiver.
gestures to acquire a desire or need without purposefully gaining,

or checking to see if they have, the attention of another, may not be
intentional and may need a different approach before PECS training.
Interests and preferences

It is important that the child demonstrates interests and preferences,
along with having intentionality. PECS helps to teach the concept of
the purpose and power of alternative communication.
If the individual displays few or no interests that will facilitate a
desire to communicate, it may be more difficult to understand and learn
the purpose and power of effective alternative communication while
using PECS. Identifying preferences is a first step before beginning
PECS training. It is beneficial to list interests and dislikes of various
types of foods, activities, or items through informal assessments prior
to initiating PECS.
43
Picture discrimination ability

In Figure 2.3 a desired item is placed on the top of the binder with
a non-desired item to facilitate discrimination between pictures.
Additional pictures are introduced as discrimination abilities improve.
Picture discrimination ability is not required for accurate use
of PECS although individuals with good discrimination skills
may progress faster initially. There are other individuals who have
spontaneously demonstrated that they can already discriminate
pictured material and already know how to use pictures to
communicate. These are individuals who are indicating their desires
by finding pictures within their environment and taking them
to a message receiver independently. Those observed doing this
may benefit from different AAC programs that would allow for
the generation of an increased number of new and more complex
messages. (Vicker 2002).
Figure 2.3 Phase 3 Picture discrimination
44
Figure 2.4 Phase 4 “I want” The phrase “I want” is used as a sentence starter to
introduce sentence structure. The communicator completes the phrase with the
desired item and exchanges the complete phrase.

Frost, L.A. and Bondy, A. (2002) The Picture Exchange Communication System Training
H
E
Manual. Newark, DE: Pyramid Educational Products Inc. R
Vicker, B. (2002) What is the Picture Exchange Communication System or PECS? Available E
at www.isdd.indiana.edu/irca/communication/whatisthepec.html, accessed on
26 June 2009.
Wallin, J. (2004) Visual Supports: PECS. Available at www.polyxo.com/visualsupport/
pecs.html, accessed on 26 June 2009.
45
3 Symbolic
Language
Systems
W Who would benefit from symbolic language

H
O systems?
A symbolic language system is appropriate for any individual who
exhibits limited expressive and receptive communication abilities.
Anyone who cannot relay messages with enough intelligibility for
the listener to understand would benefit from the use of symbolic
language systems. This type of communication method is appropriate
to augment or replace the expressive and receptive communication
for a wide range of individuals with minimum to complex
communication needs. Symbolic language systems vary in complexity,
use, and structure and are individualized to meet the cognitive,
physical, communicative and social needs of the user. It is therefore
not limited to a particular population offering benefits to many.
Anyone who possesses the ability to discriminate and interpret visual
representations may use a type of symbolic language system. It is also
important to note that individuals who use another communication
system as their primary expressive method may also benefit from a
symbolic language system to supplement their communication.
W What is a symbolic language system?

H
A We define symbolic language systems as any method of communication
T that utilizes an action or material, assigns specific messages to it,
and uses it consistently to relay meaning to the listener. A symbolic
46
Symbolic Language Systems
language system, a type of AAC, provides a consistent and easy-

to-interpret method of relaying messages when a verbal message
cannot be presented intelligibly. Pictures of items or places, labels
of products, objects, gestures, and vocalizations are most commonly
used to depict representations of desired messages. The type of
symbol used is dependent upon the skills, abilities, and preferences
of the individual. Objects provide a more concrete representation
of the desired message that is often easier for the communicator
to understand, but less concrete, more abstract materials, such as
photographs, line drawings, symbols, and printed words, may also be
used to represent the desired message.
Symbolic language systems offer the individual with limited
communication skills an organized, simplistic, readily available way
to relay functional and desired messages. There are many types of
symbolic language systems. Each system is customized to the specific,
cognitive, communication, social, and physical needs of the user. One
way of rising above the fear factor associated with communicating
with a child who has limited expressive abilities is to equip the child
with a symbolic language system. The following are descriptions of
some of the most commonly used symbolic language systems.
Communication page
The communication page is a topic-specific page of symbols to
relay messages with a variety of partners in different environments.
Vocabulary necessary for the topic of the page is combined on one
sheet. Sample topics might include a restaurant order page, circle time
vocabulary page, TV channel or program choice page, or student
personal information page.
Figure 3.1, on p.56 is an example of a communication page. These
pages are used to communicate rapid, simple, predictable vocabulary
during appropriate communicative settings.
Communication board
The communication board is a single-layer type of symbolic language
system that offers varied vocabulary within boundaries. It differs from
a communication page in that the vocabulary is not topic-specific and
vocabulary options are limited to the space available on the board.
47
The board contains grids where pictures are inserted to represent

messages. The vocabulary is typically separated by parts of speech to
provide an easier method of vocabulary identification and message
generation. The communication board user points to pictures to relay
messages. Figure 3.4 on p.60 is an example of a communication
board. An advantage of the communication board is that all of the
vocabulary options are available in this one location and page turning
or other physical manipulation is not needed to access vocabulary.
This is significant for the individual who exhibits limitations in gross
and fine motor abilities. A disadvantage to using communication
boards is that the messages the user can generate is limited by the
size of the board and the number of pictures that can be displayed.
Communication binder
The communication binder is often a three-ring notebook that
contains sheets to which communication symbols may be attached.
The sheets are typically a collection of communication pages in that
each sheet within the binder is a topic-specific page of symbols to
communicate messages for a communicative situation. The pages
being organized by topic or category assist the user in the ease of
locating desired symbols. The binder may be created to have as many
or as few pages as the individual can physically and cognitively
handle. The vocabulary is dependent on the communicative desires
and needs of the individual. Figure 3.5 has examples of vocabulary
separated by category on communication pages that may be included
in a communication binder.
Communication wallet
The communication wallet is similar to the communication binder
but smaller. The wallet provides categorized pages of vocabulary in a
smaller wallet size so it can be transported more readily.
Symbolic communication methods are not limited to picture-
based materials. Other representations are classified under the
umbrella of symbolic language systems. Any method that gives a
specific communicative meaning to a previously general or generic
item or action is a type of symbolic language system.
48
Objects
Using objects to represent a message is one of the most concrete
symbolic language systems. They are easier for some individuals to
interpret and understand. Generally, an object commonly used or
associated with the desired message is presented as a symbol for the
message. For example, a spoon is used to represent “eat” and a CD
is used to represent “listen to music”. Objects are sometimes bulky,
making it more difficult, cumbersome, or unrealistic to always have
them readily available. A portion or piece of an object may be used
when actual items are too large to use as an expressive representation
for a message. A few pieces of a chain link may be used to represent
“I want to go on the swing” and a swatch of a towel to represent “I
want to take a bath”. A shortcoming with objects is that it is difficult
to represent some abstract messages with an object. A common desire
for many individuals is to express “leave me alone”. Finding an object
to adequately represent this message is challenging.
Sign language
Sign language is a system that employs gestures made with the hands
and other cues, including facial expressions and postures of the body.
The use of this structured language system provides a comprehensive,
rapid method of communication. A disadvantage of sign language is
that it is complex, requiring learned knowledge in order to interpret
it. Any communication partner unfamiliar with sign language will not
comprehend the message.
Gestures
The use of gestures is a crude method of communication that is
used to relay messages learned between the communicator and the
partner. Any movement that is consistently used for specific desired
messages and is learned by the communication partner can be
considered a type of gestural symbolic language system. The inability
of unfamiliar partners to interpret some gestures, and the limitation
of the number of gestures that can be consistently used, are a couple
of the shortcomings of this method.
49
Vocal approximations
Often individuals with speech impairments do not have the ability
to execute the intricate fine motor movements of the articulators and
coordinate them with respiration in order to render intelligible speech.
These same individuals, however, often do possess the ability to
produce distinct variations in their vocalizations. Varied vocalizations
may be used consistently for specific messages. Just as in gestures, any
vocalization that is consistently used for specific desired messages
and is learned by the communication partner can be considered a
symbolic language system. The disadvantages of vocal approximations
mirror those of gestures in that unfamiliar listeners who have not
learned the patterns of the approximations cannot interpret them.
Individuals who rely on this method of communication are also
limited in the number of vocal approximations that can be included
in their communicative repertoire.
W Why use a symbolic language system?

H
Y The ability to use symbols for expressive and receptive communication
is a valuable skill for individuals with severe cognitive and speech
disabilities (Stephenson and Linfoot 1996). Symbolic language
systems are used to develop and facilitate communication during
structured and unstructured settings. There are multiple reasons to
use symbolic language systems. Three of the most common reasons
are as follows.
Easy to access materials

A perfectly effective and efficient symbolic language system may be
created using as little as paper, glue, common objects, and pictures from
magazines or product containers. We worked with preschool teachers
who saved the paper lids from different cereal bowl containers. These
paper lids were presented to enable the students to choose the cereal
they desired. A message page may also be produced using magazine
pictures or actual objects that represent a message (e.g. spoon for
“eat,” ball for “play,” small pillow for “go to bed”). Computer software
that allows for rapid and specific generation of pictures to be used
in symbolic language systems are also available. Some of the more
50
popular software titles include “Boardmaker” and “Picture This”.

The internet is also a convenient source of free representations. The
images section of the Google website (www.google.com) contains
photographs, line drawings and other illustrations that may be
used when fabricating symbolic language systems. Photographs
of real objects with which a child is familiar may also be used to
communicate messages in symbolic language systems.
Minimum cost to produce

Not only are the materials used in symbolic language systems easy
to access, they are usually cost effective too. The cost to generate
materials can be minimal, as with the cereal bowl lids that teachers
and families might collect, or the development of digital photos that
represent desired messages. Symbolic representations may be drawn,
common objects that are already owned may be collected, or images
may be downloaded free from the internet. These free and low-cost
options for symbol generation provide the materials needed to create
an effective and efficient communication system.
Useful as secondary communication system

At times, symbolic communication systems are easier to access and
have the capacity to generate messages faster than other AAC options.
A child who uses a speech generating device (SGD) has the advantage
of being able to produce more complex novel messages compared
to a symbolic language system. However, the SGD generally needs
additional time to set up and complete the multiple activations
required to generate one message. Symbolic communication systems
can relay simple messages in a much shorter period by pointing to
one picture. For example, in order to tell someone what is desired for
breakfast, it might be more practical to quickly point to a picture that
is readily accessible to the communicator, rather than to use an SGD
to generate the message. In this case, the secondary communication
system is the most effective and efficient method of communication.
51
H How do you use a symbolic language system?

O
W The techniques used to introduce and teach communication symbols
play a significant role in why some users of symbolic communication
become very successful while others are very poor. When individuals
are non-verbal and have a language disorder, the techniques used for
the introduction of symbols becomes even more important (Carlson
1997). First, determine which visual representation system the child
understands and responds to most (objects, photographs, drawing,
etc.; see Chapter 4), and in what contexts. The use of pictures as
representative symbols is a much more complex skill and requires
the individual to use the picture as a referent in various contexts
(Stephenson and Linfoot 1996). Pictures may be used during activities
such as sorting by category, using pictures to share information,
or as a visual support to assist in structured comprehension tasks.
These skills are required for efficient use of many AAC systems and
SGDs. Many children who can identify and match pictures have
difficulty using pictures for functional purposes. The following tips
are practical strategies by Carlson (1997) for introducing symbols for
communication and using them to enhance language skills.
Tip 1: Provide consistency within symbol categories or groups

Providing the same symbol to represent the same item is consistency.
Consistency may also be thought of as how symbols are organized.
When symbols are used for communication, they sometimes do
not follow the rules of consistency. Consistency, however, may be
achieved with the use of colors and locations. On communication
boards, people are depicted on a yellow background and verbs are
depicted on a green background. Some representations such as “yes,”
“no,” “name,” and “bathroom” are consistently placed in the same
location throughout the pages of one symbolic system in order
to make it easier to identify vocabulary on other systems when
newly introduced (Carlson 1997).These shared common visual
characteristics assist the child who uses symbolic representations to
generalize meaning and use of a system. It is therefore important to
be consistent when organizing systems and providing instruction.
52
Tip 2: Challenge “developing” language skills

Choose organizational strategies that will facilitate and enhance the
development of expressive and receptive language skills. Symbolic
materials should adhere to the activity procedure, grammatical
structures, and semantic categories. Organizing and arranging the
vocabulary according to the activity provides the child who is using
the symbolic system with the appropriate vocabulary. Organizing and
arranging the vocabulary in a symbolic language system according to
the sentence structure may be done for sentence-based methods. A
communication board organized from left to right with columns for
people then verb, then location would provide a visual cue to sentence
structure. The child could easily generate the message “I go store”
with left-to-right progression as in speech. Finally, using categories
to organize vocabulary can help the child understand language and
how words fit into semantic categories.
Tip 3: Provide access to a large vocabulary set

In addition to the developmental educational vocabulary established
for the child’s age and cognitive levels, it is important to allow the
child who will use the symbolic representation system to help select
words and symbols to be placed on the system. Involving the child
provides an excellent opportunity to gather vocabulary that is relevant
and motivating. People in their lives, age appropriate vocabulary,
social emotional requests (i.e. “Leave me alone”, “I’m tired”), and
vocabulary common to the child’s culture and dialect are examples
of vocabulary that may be important to the child. These messages
are integrated with the academic and social vocabulary utilized in
everyday educational and therapy activities providing personalization
that is comfortable and gratifying for the child.
53
W When do you use symbolic language systems?

H
E Symbolic language systems are used when:
N • vocabulary is predictable
• there is a reasonable limit to the number of vocabulary or
messages needed
• it is an easier, faster method to generate desired messages.
Symbolic language systems are flexible, and individualized
communication systems are customized to the particular
communicative needs of the child. They may be used when the child
consistently engages in activities on a regular basis (e.g. lunch, free-
time choices, circle time). The flexibility that many symbolic language
systems offer allows for multiple uses of the systems during varied
communicative settings.
Predictable vocabulary
Symbolic language systems are used in communicative settings
that offer predictable, static vocabulary. There should be reasonable
limitations in the number of vocabulary options that may be
expressed. An example of this is a restaurant topic page where menu
items are listed or pictured and the child’s desired choices may be
readily accessed.
Figure 3.1 depicts an example of a fast-food menu that may be used
for ordering. This menu page may be used specifically for instances
when a child is going to a fast-food restaurant while at school or with
a family. Using this page makes it easier to communicate the order.
It is faster to generate the message, easy to carry, and requires less
effort to relay the message. The available vocabulary is limited to the
communicative needs for this occasion.
Classroom group activities (e.g. morning circle, weather, activity
requests, and counting activities) that require a predictable finite
number of vocabulary options is another example of a communicative
setting that would be appropriate for a symbolic language system.
54
Figure 3.1 Fast-food menu
55
Figure 3.2 depicts the types of pages that may be included in a

communication binder during a morning circle group activity. The
binder contains multiple pages. Each page is topic-specific, containing
vocabulary that relays messages within that topic.
(a) Basic
vocabulary
(b) The weather (c) People at school
Figure 3.2 Sample pages for a communication binder
56
Limitations in vocabulary
Symbolic language systems are used when there are limitations in
communicative or vocabulary needs. A symbolic language system may
sufficiently accommodate the communicative needs of individuals
who have limited language capacity or communicative needs. Due
to limitations in the number of pictures that may be included in
symbolic systems, the most desired or needed vocabulary is selected.
Figure 3.3 is an example of an eye gaze chart that may be used by
children to relay basic wants and needs, especially when physical
limitations prohibit the use of symbolic language systems that require
the ability to point or turn pages.
Figure 3.3 An eye gaze chart
Alternative communication methods

There are circumstances that make using a symbolic language system
a more efficient method of communication. This is the case when
symbolic language systems are used as a secondary method of
communication. They are often used with the child who has an SGD
as the primary method of communication. When the device is not
operational and in need of repair or merely unavailable, expressive
57
communication may be supplemented using a symbolic language

system. This system will not offer the same message capacity; however,
basic wants and needs can be relayed effectively.
There are also circumstances when the use of symbolic language
systems may be more time efficient to use. For example, the time it
would take to start an electronic device and complete the multiple
sequences necessary to generate a message would be significantly
longer than using a fast-food restaurant page where items to be
ordered are included and the user can point to desired items. It is
also easier for children to use a TV show and channel page, which
includes their favorites, than for them to use an SGD to communicate
their requests to their parents.
Symbolic language systems may also be used when the primary
SGD cannot be easily managed in a particular setting. At times,
symbolic language systems are taken on shopping trips or quick
trips in the community because they are portable and easily
accessible.
Finally, symbolic language systems are used when the
communication partner has difficulty understanding or interpreting
the desired message. Communication breakdowns might occur when
the individual is using sign language, gestures, or vocal approximations.
The partner needs specific training or prior experience with the
communicator to interpret these messages. Symbolic language
systems often do not require prior training or knowledge to interpret
accurately.
Symbolic language systems are used when relaying concrete and
predictable messages. They may be applied to any communicative
environment throughout the school day and at home.
Figures 3.4–3.7 are examples of vocabulary that may be
used in symbolic language systems for various communicative
situations.
Symbolic language systems are generally not optimal when:
• the communicative needs of the child surpass the vocabulary
capacity of the systems
• the communicator is in an environment in which new
messages are needed.
58
Figure 3.4 A communication board
*Figure 3.5a Personal information page
59
Figure 3.5b Calendar words
Figure 3.5c Dates in the month
60
Figure 3.6 I am feeling…
*Figure 3.7 Activities
61
W Where can you get help?

H Carlson, F. (1997) Creating Communication Displays. Unity, ME: Poppin and Co.
E
R Stephenson, J. and Linfoot, K. (1996) “Pictures as Communication Symbols for
E Students with Severe Intellectual Disability.” Augmentative and Alternative
Communication 4, 244–255.
62
PART II
Strategies
to Support
Learning
Part II of Rising to New Heights provides a wealth of information to assist

individuals facing the unique challenges of addressing the needs of
children who do not respond to the typical techniques and strategies
for learning. Children with ASD and significant developmental delays
often fall into this category. The limited ability to address the specific
needs of these children may lead to an environment for the educator
that is disruptive, chaotic, unsuccessful, and at times combative. It is
no wonder that the reality of working with these children strikes a
cord of fear, at least to some degree, in individuals who are presented
with the challenge of teaching this population.
It often appears that fear is precipitated by a sheer lack of
understanding. Educators, therapists, and parents ask why children
behave in a certain manner, and what can be done to help them?
Ironically, teachers’ fears and lack of understanding are often identical
to those of the children they are charged to teach. In Part II, readers
will learn that many of the behaviors displayed by a child with autism
or other pervasive developmental disabilities are prompted by the
inability to clearly answer the following questions:
• Where do I need to be?
• What do I need to do?
• How much do I need to do?
• What comes next?
63
The inability to answer these same questions creates anxiety and

avoidance for educators, therapists, and parents when presented
with the challenge of working with these children. Strategies are
provided in Part II in an attempt to assist the interventionists in
answering the questions, and to equip them with enough information
to help children answer the above questions. Visual strategies and
social stories give added information and tools to allow children
to comprehend the instructions and communication of others. This
added information supports the interventionists’ efforts to address
the specific needs of the child. Part II provides strategies to support
learning by considering the individual learning styles of the child.
Interventions are offered, with information detailing Who would
benefit; What is entailed; Why, How and When the strategies should
be used; and Where to get further help.
We have written Part II with the intent that readers will:
• understand and overcome their initial fear when working
with children with ASD or other developmental disabilities
who are not responsive to typical teaching strategies
• develop a better understanding of the children and what
prompts their behavior, language, and learning
• develop goals and implement strategies that address the
specific learning patterns of children
• achieve consistent progress and success in individual goal
attainment.
64
4 Visual
Supports
Who would benefit from visual supports? W

H
A world full of words is frequently too overwhelming for many O
children to comprehend. For children with a PDD such as an ASD or
a developmental disability accompanied by difficulty understanding
auditory input, verbal instructions might cause confusion, anxiety,
or seemingly non-compliant behavior. In our work with students
or young children with PDD, multiple disabilities, orthopedic
handicaps or emotional impairment, visual tools have supported the
comprehension and expression of language. With similar findings,
Hodgdon (2003), and Massey and Wheeler (2000) also reported that
benefit from visual supports may be gained by individuals diagnosed
with developmental delay, aphasia, dyslexia, behavior disorder,
attention deficit disorder, language delay or disorder, and mental
impairment, among other conditions.
To assist with understanding instructions and expectations,
families, teachers, speech language pathologists, and other educators
may employ visual strategies to support and improve a child’s receptive
language. Hodgdon (2003) proposed that by utilizing visually
mediated communication (VMC), focus shifts to improvement of
receptive abilities. Hodgdon contended that relying upon a collection
of visual tools enhances a child’s comprehension, participation,
and, ultimately, expressive communication. While visual strategies
have been shown to improve the involvement, participation, and
65
comprehension of children with autism, the tools may be equally

successful for those with other diagnoses as well.
W What are visual supports?

H
A There are a number of different types of visual strategies used to
T promote a child’s success. In Rising to New Heights, we begin discussion
of visual supports with an examination of schedules. Other visual
strategies (to be presented subsequently) include mini-schedules,
calendars, work systems, social stories, choice boards, task organizers,
checklists, photos, and symbols. Each of these supports may be
viewed by the child with autism, as may other naturally occurring
supports such as facial expressions, gestures and body language, and
various items in the environment that children can look at and learn
how to interpret. The ability to look at the supports boosts the child’s
comprehension, especially when auditory difficulties exist, as in many
children with autism or other disabilities that affect their ability to
learn or communicate.
Schedules
A picture schedule is an example of a visual tool that offers
information to children with autism or other challenges to learning
and communication (Hodgdon 2003). Schedules may inform
students of regular events that are to occur, new activities that might
ensue, changes to the normal routine, the sequence of daily activities,
or when an activity is to happen or end (Hodgdon 2003, PaTTAN
2006).
Whether in object, photographic, symbolic, or written form,
schedules have the potential to provide structure to both classroom
and home routines. Schedules help clarify verbal instructions, aid
children in organizing and predicting activities, and may motivate
them to complete tasks when notified of upcoming transitions or
reinforcing activities (TEACCH 2006).
Schedules may be constructed for home implementation, general
classroom use, customized for individual use, or created to visually
represent steps within a routine (a mini-schedule). In the schedule
shown in Figure 4.1, the vertical schedule instructs the child on
66
Visual Supports
each phase of the mealtime routine, in which two additional mini-

schedules are embedded. First, the hand-washing routine illustrates
the sequence of steps necessary to wash hands appropriately. Similarly,
the second mini-schedule shows the steps children are to take when
getting their food. Mini-schedules break down the sequence of steps
for an activity that is difficult for the child to complete independently.
By segmenting the task into smaller steps, it is easier for children
to engage successfully in the routine. Figure 4.2 on p. 68 shows a
FIRST/THEN mini-schedule, while Figure 4.3 shows a similar
NOW/NEXT tool (D’Amore 2005). The mini-schedules in Figure
4.4 on p. 69 present children with a reward system, indicating that IF
they do as requested THEN they will be rewarded with a desirable
item or activity.
Figure 4.1 Mealtime, with two mini-schedules
67
(a) (b)
Figure 4.2 “FIRST/THEN” boards
Figure 4.3 “NOW/NEXT” board
68
Visual Supports
Figure 4.4 “IF/THEN” board
Tool time: putting other visual supports to work

A variety of additional materials may be utilized to lend visual support
to improve a child’s communication, behavior, learning, and social
interactions. Calendars are a familiar tool for both classroom and home.
At school, a calendar can inform the child not only of regular activities
and events, but also of changes to the normal schedule, thereby
preparing the child and accommodating unexpected occurrences.
Figure 4.5a on p. 71 shows a home schedule, while Figure 4.5b shows
one that can be created and applied at school. Calendars (Figure 4.6 on
p. 71) are valuable organizational tools that provide information, while
helping children comprehend time and events.
Family or educational team members may improve a child’s
ability to comprehend and express language, with a choice board.
A choice board informs children of the items from which they may
choose. A board may be constructed to easily and readily depict
choices in an array of settings, such as mealtime at home, school, or
a restaurant; materials to select in a work station; or rewards for good
behavior with a babysitter. Choices may be represented by actual or
69
miniature objects, photographs, line drawings, or other media readily

understood by the user. A child, who typically becomes frustrated by
an inability to communicate preferences, may be assisted to do so via
a choice board.
Bloomfield (2005) has created several teaching tools designed to
clarify information effectively for students with autism or other special
learning needs. The “Fold-up” is a portable material that groups six
supports into one handy tool, applicable across various environments.
One component of Bloomfield’s “Fold-up” is the “Wait card” that
helps children understand they must temporarily stop an activity they
can return to later. The “Wait card” is also useful in instructing that it
is not time for a particular task or event – that the child must wait until
the card is removed, before initiating the activity. The “Count down
card” informs children how much longer an activity will last and is
useful in assisting them to transition to the next routine or activity.
In a different approach, Bloomfield applies the “Bumper sticker” as a
reminder of positive, desirable behavior. Symbols represent what the
child is to do, rather than reiterating typical classroom “Don’t rules”.
We have created similar supports, which visually remind students of
what they are to do or where they are to be. Our “Reminder strips”
may be mounted to a student’s desk or carried in a wallet when in the
community. Our symbolic directives may be bound in a “Flip book”
worn around an adult’s neck. The adult first teaches the children
how the tool is used, and then, when they experience difficulty with
compliance or comprehension of instructions, they are shown a
symbol depicting the target behavior, in a more positive approach.
Figure 4.7 on p. 72 illustrates Bloomfield’s “Fold-up” visual support.
70
Visual Supports
(a) Getting ready for school
(b) Arrival at school
Figure 4.5 Morning routines
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
1 School, 2 School 3 School 4 No

school,
Doctor Return
books Visit Nana
5 Church 6 School 7 No 8 School 9 School 10 School 11 No

school, school
Gym clothes Zoo trip, $$ Return Sissy home
Conferences books
(a) Home
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
1 2 Library 3 Art 4 No
school
5 No 6 Phys Ed 7 Music 8 Zoo trip 9 Library 10 Art 11 No

school school
(b) Classroom
Figure 4.6 Calendars
71
(a) Waiting, visual directives (b) Count down
Figure 4.7 Visual reminders for improving behaviour
W Why use visual supports?

H
Y It is critical for a student with autism or other disabilities to know
what is expected in the daily routine, and what comes next. When
such information is lacking, behavior problems may occur, along
with difficulty with organization and transitioning between activities
(Rogers and DeFoore 2004). Wheeler and Carter (1998) and Hodgdon
(2003) agree that behavioral problems in children with autism often
stem from poor communication skills. Visual supports help bridge
the gap, by facilitating comprehension, thus assisting children with
learning difficulties to understand the myriad of demands placed
upon them better, and consequently, decreasing behavior problems.
Schedules, one type of visual support, are an effective method
of helping children function more independently and increase their
72
Visual Supports
on-task behavior (Bopp et al. 2004, Massey and Wheeler 2000,

Zimbelman et al. 2006). According to Bopp et al., use of visual
schedules by children with autism has been associated with a decrease
in disruptive behavior, aggression, tantrums, and property destruction.
In older children, use of visual schedules enhances learning and
improves the ability to perform daily living tasks (Bopp et al. 2004;
Kimball et al. 2003, Wheeler and Carter 1998, Zimbelman et al.
2006). Independent use of visual schedules permits some children
with learning or behavior problems to demonstrate appropriate on-
task behavior and self-management skills.
For many children, verbal instructions may come and go too
quickly for them to grasp. Visual supports give added information
and tools to allow children to comprehend the instructions and
communication of others. Because children with autism typically
demonstrate auditory processing deficits (Edelson 2007), they, and
those displaying other disabilities, are at a disadvantage in a world-
of-words they do not understand. The outcome is frequently apparent
non-compliance, disruption, tantrums, emotional melt-downs, or off-
task behavior.
Edelson (2007) suggests children with autism and those with
auditory processing deficits may hear speech sounds, but not perceive
their meaning. Teachers, families, and others may misinterpret the
lack of speech comprehension as an unwillingness to comply. Visual
strategies in general, and schedules in particular, supply the tools
necessary to build an effective method of presenting information
to children who cannot rely upon comprehension of the spoken
word alone. The visual tools create an atmosphere of understanding,
awareness of expectations, and an environment of familiarity,
success, and high functioning, whether at home, in school, or
in the community. Such a learning environment, conducive to
comprehension and success, is possible because visual cues provide
the structure students require in order to participate effectively and
avoid behavior problems.
While auditory skills might be affected adversely by a PDD,
through implementation of visual strategies, a platform for enhanced
communication, behavior, and learning is built. Primary reasons
for using visual tools then, according to Hodgdon (2003), are to
(a) improve language comprehension and expression, (b) give
73
information, (c) offer support throughout life routines, (d) teach skills,
(e) prevent problems, and (f ) intercede when a problem occurs. While
these are explicit advantages for children, adults in their world may
also benefit from the use of visual tools. The overwhelming fear factor
may be dissipated through the understanding and completion of
strategies that improve a child’s comprehension, expression, behavior,
and social interactions. The intention of this guide is to assist families
and interventionists in equipping children with the tools needed to
succeed.
H How do you develop a visual support system?

O
W A daily schedule is designed to represent visually the activities to
be conducted throughout the day. The schedule may be a general
one, depicting the sequence of classroom events, or a specific one
developed for an individual student or activity.
Each visual schedule system must be unique to the student for
whom it is intended, or to the classroom where it will be applied. It
will be helpful to take the following factors into consideration when
developing a visual schedule system:
Important factors to consider when developing visual

supports
• Student’s interests, strengths, and abilities.
• Collaboration among team members (families, teachers,
assistant, speech-language pathologist, occupational therapist,
other interventionists).
• Team’s acceptance of and commitment to using visual
supports.
• Team’s understanding of and training in visual supports and
schedules.
• Team’s consistent use of schedules.
• Physical structure and organization of room (see Chapter 6).
• Consistent location of schedule.
74
Visual Supports
• Student’s comprehension and recognition of objects,

photographs, line drawings, icons, or words.
• Visual schedule representation obvious to the student.
• Availability of the tools required to successfully complete the
activity.
• Carryover use of schedules from school and home to other
settings (Kamp and McErlean 2000; Wheeler and Carter
1998).
Selecting schedule representations: what to use?

The selection of visual representations might follow a hierarchy such
as this, shown in Figure 4.8 on p.76:
• Real objects.
• Miniature real objects.
• True object-based icons (drawing, photograph, box remnant)
cut into actual shape or outline of the item.
• Photographs.
• Detailed drawings.
• Line drawings.
• Written words (Wisconsin Assistive Technology Initiative
2000).
For young children, or those at a very concrete receptive language
stage, it may be best to begin by introducing real objects. Small or
doll’s house toys may be used to represent a number of activities in a
child’s day. For instance, a doll’s chair may depict that it is time to sit
at the table or work station to complete a task. A spoon may be used
for mealtime, or a miniature tennis shoe may be carried as the child
walks to the gym. Choose an item that is easily recognized by the
child and associated with the routine.
Once created, the schedule must become a consistent part of the
child’s daily routine. Whether developed for use at home or school,
the family, teacher, or other interventionist is to begin the day by
discussing with the child the upcoming events and the accompanying
expectations. An aligned strategy, which also visually supports the
75
(a) Real objects (b) Miniature real objects
(c) Photograph (d) Container remnant
raisins
(e) Detailed drawing (f) Written words
Figure 4.8 Hierarchy of visual representations
76
Visual Supports
child in understanding upcoming events, is the social story, discussed

in Chapter 5. Adults might find social stories an effective method
of further preparing children for specific events, particularly those
which are problematic for them.
When first introducing a schedule or mini-schedule, the adult
is to model the expected behavior. In this manner, the child is more
likely to learn not only the sequence of events, but also exactly how
the tasks are to be completed. The adult examples of appropriate
behavior may be withdrawn gradually, until the child is able to
complete the routines independently (Kimball et al. 2003). Again, it is
important to teach children how to perform and behave, then provide
visual supports so they will do so successfully and independently.
By supporting children’s receptive language and understanding of
events, improvement should occur in expressive language as well.
“Musts” for creating schedules

Developing an effective visual support system is a time-consuming
endeavor; therefore, you must plan for the success of its
implementation. By following the suggestions appearing later, adults
will assist children in predicting and comprehending their activities,
thus eliminating an element of fear from their lives. A number of
decisions must be reached during the process of developing a visual
support system. Here, we share what we believe you must do, must
avoid, and must have in order to create and implement effective visual
strategies.
Must do
Team up!
Elicit commitment and input from all team members (e.g parents,
teachers, paraprofessionals, speech-language pathologists,
occupational therapists, other interventionists)
Get organized!
Plan for use of the support.
Who’s who?
77
• Who will create the support?

• Who is the intended user (adult or child)?
What’s what?
• What is the intended purpose of the support?
• What is the expected outcome (e.g. improved comprehension,
expression, behavior, transitions)?
When’s the best time?
• Review the daily schedule of activities.
• Decide when the support is required.
Do be choosy!
Select type of representation (e.g. objects, photographs, drawings,
words), size, and color.
Where in the world?

Where will the support be located (e.g. home or school, specific
classroom or location, during transitions)?
Semi-permanent, movable, or portable?
All aboard!
Train all members on appropriate use of the support.
Get set! Go!

Create the system, after considering the “Must do” list and gathering
the “Must haves”.
Introduce system to the child.
Engage in trial runs.
Modify as necessary.
Must not do
Fail to teach the child to use the supports.
78
Visual Supports
Give up if the system does not appear to work immediately.

Overlook the child’s interests, abilities, skills, and preferences.
Use supports that are cluttered; instead, use clear, concise
representations.
Be inconsistent with the use of the system.
Neglect to continuously collaborate and communicate with other
team members, especially families.
Must have
Appropriate objects, remnants, cut-outs, and other picture sources.

Digital images (e.g. internet search, graphic software clipart, photo
CD)
Line drawings.
Digital camera.
Computer and printer.
Laminator, sheet protectors, and sheet self-stick laminate.
Poster board, sentence strips, and card stock.
Velcro®, magnets, paper clips, hooks, metal rings, and lanyard.
Determination to provide the necessary support to allow children to
succeed.
Motivation to overcome the fear factor.
Flexibility, willingness to change, listen, share, and learn from others.
When is it appropriate to use visual strategies? W

H
It is appropriate to implement visual schedules when educating or E
providing interventions for students with PDD, multiple disabilities, N
orthopedic handicaps, or emotional impairment, or young children.
It is essential to offer visual supports when students need strategies to
help them prepare for and organize their day, as well as to anticipate
changes and transitions that might occur. As stated earlier in this
chapter, we contend that visual supports are useful when seeking to
79
improve language skills, behavior problems, social skills, and ability

to learn.
The type of schedule created (objects, photographic, drawings,
symbols, or word-based) is dependent upon the needs and abilities of
the children involved.
Figure 4.8 shows a hierarchy of visual representations one might
use when selecting the representation that best matches a child’s
abilities. (Wisconsin Assistive Technology Initiative)
Introducing visual strategies?

When first introducing a visual schedule to a young non-reader with
autism and language delays, a teacher might begin by using real
objects. A spoon might represent lunch, whereas a marker might be
used with a young girl who is a visual learner. She would remove the
marker from the schedule and carry it as she walks to the Art Room.
The support not only signals what is next, but it is also useful in
the transition from one room to the next, by serving as a reminder
of what is to come. For children who understand icons, the object
(marker, in our example) might be replaced with a symbol for art,
along with the printed word to support literacy skills. This approach
would be applicable to students in the class who comprehend that the
symbol represents art class.
Introducing different types of visual supports

Figure 4.9 illustrates four possible types of schedules, using real
objects, photographs, line drawings, or words. The strategy selected
will be decided based upon the needs and abilities of the students.
A checklist (Figure 4.10) might be used when employing
visual schedules with children who are readers. With modeling and
repetition, children become independent in their ability to refer to
and check-off the activities of the day, as they are completed. They
review the schedule to determine what is coming next. Initially, it may
be helpful to begin with separate morning and afternoon schedules.
When developing a visual schedule, in order to keep an
introductory support system manageable, it is advisable to begin first
with the major events of the day. The teacher, family member, or
80
Visual Supports
Figure 4.9 Four types of visual schedules
Time Activity Completed

9:00 Arrive/Breakfast √
9:30 Occupational therapy √
10:00 Reading √
10:30 Art
11:00 Speech therapy
11:30 Work station
12:00 Lunch
Figure 4.10 Checklist schedule
81
other adult models how to engage in tasks and activities depicted by

the schedule, and how to indicate their completion.
Indication of completion may be accomplished by turning over a
symbol that has been clipped to the schedule. Alternately, a symbol
or object that has been attached with Velcro® may be removed and
placed in a “FINISHED” envelope or container.
As children learn the routine of following the schedule, many
eventually become able to manage it without adult intervention.
Ability to adhere to the schedule independently is a goal of visual
support use. As discussed previously, positive outcomes of visual
strategies may include improved comprehension, expression,
behavior, and learning opportunities.
Using mini-schedules
When including the major routines of the day is not enough for
children who require increased structure and support, then mini-
schedules may be utilized.
One type of schedule that belongs in this category is a “FIRST/
THEN” board. Using pictures or small objects to represent what is to
be done, children learn that first they must complete one action, then
another one is to occur.
Figure 4.5a is a mini-schedule informing the child that the first
activity will be reading group, followed by math work. Figure 4.5b
is similar; however, this support assists the student with transitioning
from the preferred routine of computer time to the next activity of
going to the vocational workshop. This visual strategy informs the
students of what they are to do and where they are to be now, while
preparing them for what will happen next. As discussed previously,
when the work or activity has been completed, the picture or object
is to be placed in the FINISHED container.
D’Amore (2005) published a similar mini-schedule (Figure 4.3)
that follows a “NOW/NEXT” hierarchy. This tool is most effective
when used to display what the child is currently doing, and what
comes next, thus lessening anxiety due to uncertainty and transitions.
A similar visual tool is the “IF/THEN” board. This support
differs, however, in its use as a reward system. Families may use
82
Visual Supports
the board in Figure 4.4 to indicate that IF the child eats breakfast,
THEN painting is next. Upon completion of the activity, pictures are
put in the designated FINISHED location, keeping consistency and
expectancy in the routine.
Mini-schedules are useful in targeting certain events or tasks in
the daily schedule that a child has difficulty completing. It breaks a
larger task into smaller steps that are easier for the child to handle.
As children begin their day, the use of schedules is to start at
home. Families will likely find their morning activities proceed more
smoothly when children are provided with a visual representation of
each upcoming activity. The day gets off to a smooth start, which is
then continued at school. In this manner, not only is the fear factor
reduced in adults, but for children as well. In Rising to New Heights, we
contend that visuals reduce children’s anxiety regarding the unknown
or resistance to change by preparing them with information and
strategies to cope.
Figure 4.5a shows a mini-schedule of “Getting ready for school”
routine, while Figure 4.5b illustrates the steps children take when
arriving at school.
When visual strategies are utilized, whether a visual support of
the “Arrival at school” routine, or a real object depicting the departure
activities at the end of the school day, the unfolding of the day is
anticipated and controlled. Continuity of expectations and control
is paramount; therefore, there is never a time to abandon the use of
schedules. Students’ appropriate use indicates their understanding of
the schedule and ability to gain from it, not that they have “learned”
it and no longer need the support.
The importance of timing

One of the most important factors to consider regarding when to use
visual schedules is to use them consistently. Not only are children
expected to use schedules regularly to organize their activities, but
adults must also take the initiative in making the supports a consistent
part of classroom and home routines.
Just as important as consistency, an integral part of successful
visual strategy use is allowing for change. It is crucial to allow for
83
changes to the daily routine, and to prepare students in advance for

their occurrence. Educators might not know well in advance when a
change will arise; yet, they must be ready with a symbol or strategy
to depict that something different will occur. This may consist of the
universal sign indicating that a particular routine is cancelled for
the day.
In Figure 4.5b on p. 71, an X has been placed over the work shop
activity, meaning that it will not take place that day. A symbol for
the alternate event would be posted instead. A clear plastic container
lid, piece of laminate, or transparency could be used to draw the null
symbol or X.
Using other types of visual strategies

As with using schedules, calendars may be implemented at
school as well as at home. Calendars are discussed each night to
inform the child of what will occur the following day. They are
then reviewed the next morning, to reinforce upcoming events and
inform of any changes, so the unfolding of the day is predictable.
In this manner, protests, tantrums, and non-compliance are less
likely to occur.
Calendars may be used to assist children in organizing their
day. Figure 4.6 shows calendars that are used at home or at school,
respectively. The tool supports children by preparing them for what is
to occur, particularly for activities that depart from the normal routine.
According to Bloomfield (2005), the best time to introduce visual
strategies, such as her “Fold-up” support, is when adults want to assist
children with transitioning smoothly or behaving appropriately. The
Fold-up may be used across settings because it is easily portable. The
display of symbols assists children, such as those with autism or other
disabilities who have difficulty understanding verbal language. The
tool promotes positive behavior, and through direct instruction the
children learn the expected behavior. Bloomfield (2005) cautions that
it is advisable to present the tool at the beginning stages of behavioral
difficulties, rather than when an incident has escalated.
It is important to customize visual supports according to the
needs of the child involved. Figure 4.7 shows components similar
84
Visual Supports
to those contained in Bloomfield’s Fold-up—that is, Waiting, Visual

directives and Counting down. However, educators or families who
construct a similar tool would base it upon the individual needs of
the child. One child might need a visual reminder to wait, while
another might be better supported by a visual cue to line up at the
appropriate time.
When deciding to use visual strategies,

take these factors into consideration
• Child’s comprehension level.
• Type of representation.
• Consistent use of strategy.
• Method of indication that routine has ended.
• Child’s knowledge of what to do next.
• Provisions for change.

Bloomfield, B. (2005) Available at www.icontalk.com/downloads/Directions.pdf,
H
E
accessed on 26 June 2009. R
Bopp, K.D., Brown, K. and Mirenda, P. (2004). “Speech-language pathologists’ roles E
in the delivery of positive behavior support for individuals with developmental
disabilities.” American Journal of Speech-Language Pathology 13, 1, 5–19.
D’Amore, D. (2005) Available at www.SpeechPage.com, accessed on 26 June 2009.
Edelson, S.M. (2007) Auditory Processing Problems in Autism. San Diego, CA: Autism
Research Institute.
Hodgdon, L. (2003) Visual Strategies for Improving Communication. Troy, MI:
QuirkRoberts Publishing.
Kamp, L. and McErlean, T. (2000) Available at www.setbc.org/download/Public/
VSS.pdf, accessed 15 June 2009.
Kimball, J.W., Kinney, E.M., Taylor, B.A. and Stromer, R. (2003) “Lights, camera,
action! Using engaging computer-cued activity schedules.” Teaching Exceptional
Children 36, 40–45.
Massey, N.G. and J.J. Wheeler (2000) “Acquisition and generalization of activity
schedules and their effects on task engagement in a young child with autism in
an inclusive pre-school classroom.” Education and Training in Mental Retardation
and Developmental Disabilities 35, 3, 326–335.
85
PaTTAN (Pennsylvania Training and Technical Assistance Network) (2006)

Pennsylvania Department of Education. Visual Strategies. Available at www.
pattan.net/files/instruction/visualstrat.pdf, accessed on 26 June 2009.
Rogers, L. and DeFoore, P. (2004) “How the HighScope approach supports children
with autism spectrum disorders: visual strategies.” HighScope ReSource 23, 1, 1–4.
TEACCH (2006) Structural Teaching: TEACCH Staff. Available at www.teacch.com/
educational-approaches/structured-teaching-teacch-staff, accessed 26 June
2009.
Wheeler, J.J. and Carter S.L. (1998) “Using visual cues in the classroom for learners
with autism as a method for promoting positive behavior.” B.C. Journal of Special
Education 21, 3, 64–73.
Wisconsin Assistive Technology Initiative (2000) Assistive Technology Tools and
Strategies Assessment Manual for Children with Autism Spectrum Disorder. Oshkosh,
WI: Polk Library.
Zimbelman, M., Paschal, A., Hawley, S.R., Molgaard, C.A. and St. Romain, T.
(2006) “Addressing physical inactivity among developmentally disabled
students through visual schedules and social stories.” Research in Developmental
Disabilities 28, 4, 386–396.
86
5 Social
Stories™
Who would benefit from Social Stories? W

H
Social Stories were developed by Carol Gray, President of the Gray O
Center. They are intended for children who display incompetence
during social situations. It is for those children who find some typical
daily activities such as transitioning, turn taking, and playtime
difficult and confusing. The child who would benefit from the use
of Social Stories often has inappropriate, inaccurate, and offensive
responses during social situations. This book, Rising to New Heights,
identifies individuals who may benefit from Social Stories in order to
alleviate or reduce negative, unexpected, unpredictable, disruptive, or
repulsive behaviors resulting in dislike and fear of working with the
student.
What is a Social Story? W

H
A Social Story is a relatively short, detailed, written description of A
social situations specifically highlighting what a child is to expect T
from a situation and what is expected of the child. Social Stories
provide children with accurate information about those situations
that they may find difficult or confusing. The situation is described
in detail and focus is given to a few key points: the important social
cues, the events and reactions the children might expect to occur in
87
the situation, the actions, and reactions that might be expected of

them and why (Wallin 2004).
W Why use a Social Story?

H
Y Wallin (2004) describes many of the benefits of using Social Stories.
They help children understand a social situation, reduce their anxiety
when encountering a situation, and suggest appropriate responses for
the social situation in question. They provide children with realistic
insight and perspective on what is happening, and help them better
understand, predict, and respond to the actions of others in the
situation. Social Stories also provide information on social situations
in a structured and consistent manner. This lends itself perfectly to the
learning styles of individuals with autism, particularly when dealing
with the abstract spontaneous skills and behaviors that occur in social
interactions. Social Stories also teach social information through
pictures and text, as opposed to speech or observation, which are
notable areas of weakness for individuals with autism. Finally, Social
Stories create a stress-free environment in which to teach appropriate
behaviors in a social situation that may be difficult for the student,
thereby creating the opportunity to practice with much less anxiety.
H How do you write a Social Story?

O
W In this chapter, techniques and procedures for writing Social Stories
are described that will assist in intercepting the anxieties often
experienced when addressing the challenges of students with social
and behavioral difficulties. The first step in writing a Social Story is to
identify the social situations in which a child displays inappropriate
behaviors and responses, and then to choose one to focus on. The
writing of the story can now begin. Social Stories are usually
written in the first person and present tense. Each should provide
enough information about a social situation to equip a child with the
knowledge needed to be prepared and respond appropriately when
such situations are encountered. There are four types of sentences
used to present this information in a Social Story (Gray 2000):
88
Social Stories™
1. Descriptive sentences provide detailed information about

where the situation happens, who is involved, what is being
done, and why it is being done. Example: When I am in the
lunchroom, it sometimes gets very noisy because there are a
lot of kids in there and they are all talking at the same time.
2. Perspective sentences give insight into the thoughts of
those involved in a story; they provide details about what
others are feeling and thinking. Example: The children are
all talking because it is their free time and they like talking
to their friends.
3. Directive sentences provide suggestions of appropriate
responses specific to a child’s needs. Example: When I hear
all the noise, I know that there is not a problem and I can
ignore it.
4. Control sentences are created by children as a “catch phrase”
to help remind them of what has been learned; they help
them remember a story or deal with a situation. They are
not used often and only with high-functioning children.
Example: Lunchroom noise is okay.
According to Carol Gray (2000), the recommended formula for
writing Social Stories is to use five descriptive sentences for each
directive sentence, which may include perspective sentences. Studies
have indicated that Stories following this ratio are most effective.
When writing your Story, it is important to be mindful of the
child’s cognitive and maturity levels by using appropriate vocabulary
and type size. Each Social Story should reflect the type and level
of other literature the child may be encountering at home and at
school. A kindergarten Story may consist of a single idea per page,
with illustrations. A middle-school student might have a much
longer Story, with more text and smaller font size. Figures 5.1–
5.4 in illustrate sample Social Stories for different age groups. It is
also important to remember that Social Stories are not merely to
list desired or expected behaviors; rather, they are descriptions of
social situations which helps children to understand social situations,
thereby encouraging their ability to develop or learn appropriate
positive interactions. It is therefore recommended to avoid the use
89
of sentences that are inflexible and stated as a “command”. Replace

phrases like “I can” and “I will” with “I will try” or “I will work on” in
directive sentences. “Usually” and “sometimes” should be used instead
of “always,” in perspective and descriptive sentences. An appropriate
sentence for when disruptive behavior occurs after a visitor knocks
on the door may be “I will try to remain calm and not run outside”.
As children become more successful with social stories, directive
sentences may be eliminated making it the children’s responsibility to
develop behavioral responses that work best for them—the ultimate
goal of Social Stories.
While text on paper is probably the easiest presentation to prepare
and use, it may not be the most appropriate for every child, such as
a non-reader. There are, however, a variety of presentation styles and
options, such as those shown here, which may be used to meet the
individual needs of children (Wallin 2004).
Illustrations
A child is provided with illustrations or photographs on each page
depicting social situations and adding interest and visual cues about
the intended message. It is important to use images that are simple,
in order to ensure that a child with autism focuses on the intended
image and not the background.
Symbols
The text of a Story may be supplemented with pictures representing
any of the words or ideas in the Story. A true object-based icon,
such as a cereal box label, may be used. A detailed drawing, a line
drawing, or symbols generated from computer software such as
Boardmaker are additional options that may be used in Social Stories.
For beginning readers, PECS symbols or simple line drawings may
be used instead of text for words that are unknown. A complete
idea may be represented by one large symbol on a particular page.
Figure 5.1 is an example of a Social Story augmented with pictures
included to assist in the comprehension of the text.
90
Social Stories™
There are lots of fun things to do at I like to color, play with blocks, and
school. play with the doll house.
When there are too many kids in an When the teacher says I cannot play
area I want to play in, my teacher right now, I sometimes get angry.
says I cannot play there right now.
I do not have to get angry because if When I wait, my classmates can play
I wait I will get a turn soon. There are too and they can have fun and this
other fun things I can do while I wait. makes them happy.
Having fun with the toys at school I will take turns when I play with toys
makes me happy. at school.
Figure 5.1 Sample Social Story for a young child for school
91
Social Stories on tape

When given a cue to turn the page, a child may read the written Story
along with an on tape audio recording of the text.
Video
A child is videotaped acting out the expected behaviors in a social
situation. The text is captioned on a video and eventually faded.
The information about expected or appropriate behaviors in social
situations is eventually provided by text alone.
Story boxes
Understanding of information provided and interest in Social Stories
may be enhanced by children role-playing the social scene with
props like small toy figures. This method is particularly beneficial for
non-readers.
Wallin (2004) recommends that Social Stories are introduced and

implemented with monitoring and fading strategies. A Story should
be used with others involved with the children on a daily basis
at school and at home as a way of reinforcement. After becoming
familiar with a Story, the children should then retell it to others
using their most effective expressive method whether it is speech,
a symbolic language system or an SGD. When consistent success is
noted at retelling the Story, the educational staff or family can refer
to it when the appropriate social situations arise. Finally, an ongoing
evaluation process is essential to gauge the effectiveness of a strategy
used. Use data collection methods to obtain objective measures of the
occurrence of targeted behaviors over time.
W When do you use Social Stories?

H
E It is appropriate to use Social Stories for any situation a child finds
N difficult to manage for whatever reason. They can be written for
situations as common as appropriate behavior when transitioning
between classrooms. Stories may also be written for individual
difficulties that are not as common but specific to a child, such as
appropriate items to eat.
92
Social Stories™
Social Stories are used when children need answers to questions

or clarification of uncertainties they have about social situations
(Wallin 2004). There are instances throughout time spent in school
and at home that may warrant a Social Story to answer questions
children have about situations in which they find themselves. During
arrival time, a Social Story may be written to assist children with
where to go after getting off the bus, what to do when they get
to where they should be, how to respond, and what to do next.
Addressing these questions through Social Stories offer children a
sense of comfort and familiarity that helps prevent inappropriate,
negative, or otherwise undesired responses. Figure 5.1 is an example
of a Social Story that may be used at arrival time for a young child.
There is no wrong time to do a Social Story. Any time a behavior
consistently garners a response that is not beneficial to a child’s
academic, socio-emotional, health or safety status, a Social Story may
be used as intervention. Some examples of when Social Stories may
be used at school are meal or snack time, bathroom time, group time,
independent work time, free time, and dismissal. Some situations that
Social Stories may be used at home for are morning routines, bedtime,
welcoming known or unknown visitors, and eating out. These are
merely a few examples of when Social Stories may be used. There
are an infinite number of opportunities for different Stories because
they are individualized to a child’s unique needs. Boxes 5.1–5.3 are
examples of Social Stories that may be used at home.
Going for walks
When I walk, I sometimes grab strangers’ hands and go with them.
This makes my mom very upset because she says

it is not safe to do this.
When I see a stranger, I will say “Hi” and continue to

walk with my mom.
Box 5.1 Sample Social Story for home
93
Sharing with Mom and Dad
I have lots of fun things to play with!
I have toys.
I have a Walkman®.
I have lots of music I like to listen to too.
Sometimes Dad or Mom need to use one of my fun things

like a toy or an ipod.
This is okay.
These things are mine, but it is okay for Mom and Dad to borrow.
When Mom or Dad say, “Can I borrow this?” I can say, “Okay!”
Mom or Dad will take very good care of my things.
They love me and they respect my things.
I will try to say, “Okay” when Mom or Dad want to borrow my things.
This will make them very happy!
Maybe I can borrow something of Mom’s or Dad’s someday too!
Box 5.2 Sample Social Story for home
94
Social Stories™
When I feel angry
Sometimes I feel angry.
All people feel angry at one time or another.
When I get angry I will find my teacher, Mommy, Daddy, or another

adult.
When I find them I will try to use words to tell them that I am angry.
I can say “I’m angry!” or “That makes me mad!”
It is okay to use words when I feel angry.
They will talk to me about what happened and about how I feel.
This might help me to feel better.
Wherever I am I can try to find someone to talk to about how I feel.
Box 5.3 Sample Social Story for an older child for home

Gray, C. (2000) The New Social Story Book. Arlington TX: Future Horizons, Inc.
H
E
Wallin, J. (2004) An Introduction to Social Stories. Available at www.polyxo.com/ R
socialstories/introduction.html, accessed on 3 August 2009. E
95
6 Structured
Environments
W Who would benefit from a structured physical

H
O environment?
Young children or individuals with developmental disabilities, ASDs,
behavior problems, or any condition that adversely affects their
ability to learn, may benefit from structured, organized classroom
and home environments. Characteristics of such children include:
(a) organizational and directionality problems; (b) an auditory
processing disorder or sensitivity to auditory stimuli; (c) impairment
of other senses, including visual, tactile, vestibular, olfactory, and
proprioceptive; (d) receptive language deficits, demonstrated through
challenges to comprehension of directions, expectations, and rules;
(e) memory problems, particularly for locations, the sequential order
of tasks, or the schedule of events; (f ) signs of being distracted easily;
or (g) rigidity in routines and rituals. Whether in the home or at
school, setting the stage, by engineering the physical environment,
is essential to providing exceptional needs children with successful
learning and functional experiences. In this book we provide readers
with specific ideas on structuring the environment in order to improve
learning opportunities for children.
96
Structured Environments
What is meant by a structured physical W

H
environment? A
A classroom that is structured effectively is one that is well organized, T
in terms of physical arrangement and the use of developmentally
appropriate practices, activities, and materials. A structured classroom
affords optimal interaction and social climate, and is orderly, due to
the use of visual supports and routines (Alter and Conroy 2005).
A well-designed room has designated areas, with clear boundaries
for particular tasks. Materials are easily accessible, so children will
know where to find required items, and also where they personally
are supposed to be in order to complete tasks and participate in
activities (TEACCH 2006). Classrooms or areas within the home that
are arranged in this manner help reduce the fear factor in children by
providing predictability, structure, and organization. Interventionists
and families also benefit from working or living in a space that is
orderly and arranged for optimum functionality.
To organize a room most appropriately, families and teachers must
take into account the individual needs and abilities of the children.
Increased visual supports and structure may be required for lower
functioning children or those with problematic behaviors. Conversely,
older children or students whose disabilities have less impact on
comprehension or behavior may not need as much structure. Figure
6.2 illustrates a classroom designed to meet the needs of students
with autism or other exceptional needs.
Why structure the physical environment? W

H
According to researchers, students’ appropriate behaviors increase, Y
and inappropriate behaviors are more likely to decrease, when
the environment is designed effectively (Alter and Conroy 2005;
TEACCH 2006). When incorporating visual strategies into the
classroom or home, such supports increase children’s comprehension,
independent functioning, and on-task behavior. Displayed schedules,
choice boards, and sequential task prompts are among the tools that
frequently reduce apparent non-compliance, disruption, or tantrums
because they provide children with information, communicate
expectations, and offer predictability.
97
A room arranged with intention informs children where they are

supposed to be and what they are to do. The establishment of work
stations clearly delineates workspace, tasks, and expectations. Well-
designed workstations will further instruct children as to what is to
be completed when the current work is finished. Work systems assist
learners in several ways. They help: (a) when children have difficulty
with verbal directions and the steps of an activity; (b) by using an
organized and structured approach to teaching specific skills; (c)
through alleviation of the frustration of not knowing expectations;
and (d) when children learn by using visual supports (Do2Learn n.d.).
H How do you organize the environment?

O
W We propose that the first step in organizing a classroom for children
with exceptional needs is to consider the general environment.
Location is key; therefore, ideally, a classroom for students with
autism, for example, would be located near children of the same
age. This would eliminate the stigma faced by an older child in a
special education class located near much younger students. Having
a bathroom nearby is an asset, especially if students are being toilet-
trained or primed for independent movement for short distances
throughout the school. For safety reasons, it is advisable to avoid
classrooms with multiple exits, or exits to busy streets or external
grounds, particularly if any of the students have a tendency to run
away.
Children with autism and other exceptional needs frequently
display dysfunctional sensory systems, necessitating consideration
of their sensitivity to environmental stimulation. A child might be
sensitive to light, especially fluorescent, requiring adjustment of the
lighting. Sights might easily cause distractibility, as might particular
sounds. A child might be tactile defensive and resistant to touch.
The child’s home and school teams must collaborate to determine
a comprehensive sensory profile and modify the environment
appropriately, while increasing the child’s ability to adapt.
Room size is a crucial element in classroom organization, with a
large room being preferable, allowing adequate space for workstations,
centers, storage, screened areas, and optimal configurations. Size is
also important when structuring a child’s bedroom or play area at
98
home. A small, cluttered space may interfere with sleep and attention
to tasks, or may reduce opportunities for social interaction with family
members and others in the home (TEACCH 2006). For children with
sensory sensitivities, environmental factors such as lighting and noise
levels must also be considered when determining location at home
or at school. If not well planned, behavior problems may result, in
response to over-stimulation, irritation, or distraction.
Once the space has been selected, the next step is to make specific
arrangements within the room. Strategies for effectual organization
may be based upon the basic configuration and subsequent
modification of the room. Determine where work areas and stations
are to be located within classrooms. For individual stations, the
availability of a blank wall is an advantage because it reduces visual
distractions. Desks and tables are faced toward the wall, helping the
children focus on the work at hand. The height of furniture, chairs,
sinks, and counters must be matched appropriately to the size of the
children.
Portable dividers may be placed in the classroom to separate each
child’s space and work areas. Cabinets, bookcases, and shelving units
may also be used to define specific areas and boundaries. Placing
work areas near storage units facilitates independence, because
the children are able to access required materials easily. The items
required to complete a task are to be located where the work is done.
For example, the table where puzzles are completed is located near
the shelf where puzzles are stored. A literacy corner will be furnished
with comfortable seating, including mats or beanbag chairs, and will
have books of high interest on hand.
Placement of furniture in a housekeeping corner defines the
boundaries, informs the children of what is expected to occur in that
area, and indicates where objects are to be stored when finished.
Additional methods of marking out a particular part of the room are
by placing a carpet or a taped area on the floor. The use of labels is
also helpful in structuring the environment. Labels can (a) indicate
where materials belong, (b) identify children’s work area, personal
belongings, lockers or coat area, mailboxes, etc., and (c) improve
language skills by showing the names of various objects in the room,
around the school, or in the house (Hodgdon 2003). Labeling has
the added advantage of increasing visual information to children,
99
allowing them to access and replace materials in the proper location

independently, and to understand where certain activities occur. With
these supports, children with autism or other PDD are more likely to
succeed in an environment that provides information giving meaning
to locations, activities, and materials (Rogers and DeFoore 2004).
Another method of structuring the environment is to assign each
child an individual symbol. John’s symbol may be a yellow triangle,
while Tamara’s is a red square. When mounted properly, the symbols
show John and Tamara where to sit, work, store their belongings,
stand in line, or wait. An alternate strategy is to mount children’s
photographs to identify their areas.
To prevent behavior meltdowns (e.g. tantrums, crying, disruptive
behavior), a designated area should be available where the child
may take a break or choose a substitute activity, prior to a situation
getting out of control. Parents are very astute at recognizing when
meltdowns are about to occur. Increasing awareness of the triggers
at home and describing them to school staff might help to reduce
incidents of problem behavior and to rise above the disruption these
cause both child and adult. With the assistance of the speech-language
pathologist, the child will be given a method of communicating
a desire to change activities, take a break, or move to a different
space. Provision of choice boards (as described in Chapter 4) or
photographs of various room stations and activities is an effective
strategy for supplying children with a method of communicating
their wants and needs.
These strategies are applicable to both home and school, although
usually used in a smaller space at home. Environmental factors and
room arrangement are equally important in each setting. In all
settings, it is crucial to be able to monitor children; therefore, dividers
and other boundary-setting furniture must be at a height where an
adult is able to see the children at all times.
Using the TEACCH approach

The Treatment and Education of Autistic and related Communication
Handicapped Children (TEACCH) approach, designed for those
with autism spectrum disorder or communication deficits, places the
individual at the core of its methods by focusing on the person’s
100
skills, interests, and needs (TEACCH 2006). Acknowledging a

culture of autism, members of the TEACCH organization suggest
that people with autism are part of a distinctive group with common
characteristics (such as those described previously) who are different
from, but not inferior, to others.
TEACCH (2006) recommends taking the following factors into
consideration when arranging a child’s environment:
• Is there adequate space for individual and group work?
• Are workstations available for students who require them?
• Are work areas in the least distractible settings?
• Are work areas marked so students can perform independently?
• Can the teacher visually monitor all work areas?
• Are there places for finished work?
• Are materials easily accessible and located near work areas?
Defining hallmarks of the TEACCH approach are provision of work
stations, learning within a predictable work session, and use of a
structured work system. TEACCH recommends work systems, like
Shoebox Tasks®, that are simple and developmentally appropriate,
with the potential for independent completion. Families and school
staff establishing teaching and learning routines for children with
autism will find such activities beneficial. Activities may be constructed
with all required materials housed within a single container (e.g.
basket, shoebox, or bag). Task requirements are visually clear,
helping children organize their actions in order to complete tasks
successfully and independently. In our experience, these activities
are equally applicable for use with young learners and those with
developmental disabilities, PDD, motor, auditory, or visual deficits.
Inspired by commercially available task materials, teachers, therapists,
and families have become very creative when fabricating their own
activities to be completed during a structured work session. Whether
purchased or custom-made, tasks must be clear, age- and ability-
appropriate, motivating, and able to be completed independently,
while under adult supervision.
Figure 6.1 presents a typical work station organized so children
will easily know the answer to the following questions:
101
• How much work is there to do?

Tasks are located to the child’s left, within easy reach. The
number of tasks (at the discretion of the adult) tells the child
how much work there is to do.
• What is the work?
The child knows what the work is by the visual structure of
each task.
• When is the work finished?
When all the tasks have been completed and placed in the
finished basket, located to the child’s right.
• What happens next?
Directly after the child has finished working, there is a toy,
treat, or indication of where to go next.
(TEACCH 2006)
Once the physical structure of the setting is well organized, families

and school staff must also be aware of the interpersonal atmosphere,
as well. Are adults attentive, patient, and caring? Do they reward
appropriate behavior and provide assistance when necessary? The
creation of a calm, comfortable environment, where caregivers
and educators offer positive support, is expected to result in more
appropriate behavior. As we stated earlier during our discussion
on visual strategies, there is a need for consistency, in the physical
environment, expectations, and interactions with adults. Setting the
stage, by engineering the physical environment, assists children in
overcoming the fear factor by providing them with predictability,
routines, and expectations.
102
According to TEACCH (2006), the organization of the work

environment and presentation of tasks answer the relevant questions
in the following ways.
1. How much work is there to do?
Tasks are located to the student’s left, within easy reach. The
number of tasks, as determined by the teacher, tells the student
the amount of work to be completed.
2. What is the work?
By the visual structure of each task, the student knows what the
work is.
3. When is the work finished?
Placement of all completed tasks in a FINISHED container, located
to the student’s right, indicates that the work is finished.
4. What happens next?
Directly after the student has finished all tasks, a toy, treat, or
signal of where to go indicates what to do next.
Teacher/Parent
FINISHED/
container
Student
Tasks to be completed
Work presented from left to right
Figure 6.1 Structured TEACCH work session
When is it appropriate to structure W

H
the environment? E
The TEACCH approach is one method of structuring the environment N
effectively.
TEACCH is beneficial when children with autism or other exceptional

needs are beginning to learn.
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TEACCH strategies or similar approaches that organize the setting

are to be applied when the child needs to know how much work
there is to do, what the work is to be done, when the work will be
finished, and what will happen next.
Figure 6.1 depicts a typical work station utilizing a left-to-right
orientation, which clearly informs the child about the tasks to be
completed.
Figure 6.2 illustrates a preschool classroom for children with
disabilities. The room is clearly arranged into areas for working,
playing, and eating. There are spaces for high-energy activities in
the play area, as well as quiet reading or listening. Schedules, located
throughout the classroom, provide visual support and predictability
to the environment.
Each child is assigned a symbol, which is placed in several
locations in the environment. Upon arrival, children locate their
symbols in their cubbies. In the group area, each child sits on a chair
or mat with the appropriate symbol. In the waiting area, when it is
Figure 6.2 Structured classroom
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time to transition to another room or activity, children know to wait

on their individual symbol.
With such provisions, children, families, and interventionists are
supported in their efforts to offer a setting conducive to learning. As
noted previously, when equipped with adequate knowledge, families
and educators are able to move past the fear factor some individuals
experience when questioning how to structure a child’s day, behavior,
and surroundings.

Alter, P.J. and Conroy, M.A. (2005) “Environmental arrangements and visual supports
H
E
to prevent problem behavior.” Paper presented at the Addressing Challenging R
Behavior: The National Training Institute on Effective Practices Supporting E
Young Children’s Social/Emotional Development conference, Clearwater
Beach, Florida, May.
Do2Learn (n.d.) Build a classroom. Available at www.do2learn.com/organizationtools/
classroom/buildaclassroom/index.htm, accessed on 3 August 2009.
Hodgon, L. (2003) Visual Strategies for Improving Communication. Troy, MI:
QuirkRoberts Publishing.
Rogers, L. and DeFoore, P. (2004) “How the High/Scope approach supports
children with autism spectrum disorders: visual strategies.” HighScope ReSource
23, 1, 1–4.
TEACCH (2006) Structures Teaching: TEACCH Staff. Available at www.teacch.com/
educational-approaches/structured-teaching-teacch-staff, accessed 26 June
2009.
105
PART III
Resources
The purpose of Part III is to provide basic introductory information

on topics related to the themes presented in Rising to New Heights.
Because the subjects may be of interest to families and school
personnel, they are included here but not broadly enough to warrant
full chapters. The following topics are discussed: sensory integration,
applied behavior analysis, the Hanen Centre, routines, Chileda,
and the S.U.C.C.E.S.S. ApproachSM, and national organizations that
provide information on autism and other developmental disabilities
are also listed.
107
7 Information
on Related Topics
Sensory integration
Individuals with autism or other developmental disabilities may have
a dysfunctional sensory system, with one or more of the senses being
under- or over-reactive to stimulation (Hatch-Rasmussen 1995).
According to Mailloux and Smith Roley (2001), sensory integration
refers to neurological functioning, as well as to a specific theory
and intervention approach emerging from the field of occupational
therapy, propagated initially by Dr. A. Jean Ayres. Hatch-Rasmussen
(1995) explained that sensory integration, an innate neurobiological
process, refers to the brain’s integration and interpretation of sensory
stimulation from the environment. Sensory integrative dysfunction,
conversely, is a disorder in which sensory input is not integrated or
organized properly in the brain and may produce varying degrees of
problems in development, information processing, and behavior.
A child with dysfunction within the tactile, vestibular, or
proprioceptive systems may exhibit or fluctuate between the extremes
of an overly high or low response to sensory input or activity level, or
between constant motion and easy fatigue (Hatch-Rasmussen 1995). A
normal tactile system sends information to the brain regarding touch,
pain, temperature, and pressure, via nerves under the skin’s surface.
The vestibular system, within the inner ear, detects movement and
changes in the position of the head, while the proprioceptive system
refers to aspects of the muscles, joints, and tendons that provide one
109
with awareness of body position (Hatch-Rasmussen 1995). When

the three systems are dysfunctional, fine or gross motor coordination
problems may be present, possibly resulting in speech and language
delays or lowered academic performance. A child’s sensory integrative
dysfunction may also be exhibited through impulsivity, distractibility,
lack of planning, or reacting to new situations with frustration,
aggression, or withdrawal (Hatch-Rasmussen 1995).
Primarily utilized in pediatric treatment, interventionists employ
sensory integration therapy to help a child with autism play like other
children. The purpose of sensory integration therapy is to assist the
child in (a) functioning more appropriately throughout daily activities
by improving the ability of the brain to process sensory information,
(b) inhibiting and modulating sensory information, and (c) processing
a more organized response to sensory stimuli (Dempsey and Foreman
2001; Hatch-Rasmussen 1995).
Adapting to changes in the sensory characteristics of the
environment poses challenges to children with autism or other
developmental disabilities. Through assessment, occupational
therapists or other interventionists analyze a child’s engagement and
participation in daily activities, from a sensory-integration perspective
(Mailloux and Smith Roley 2001). Evaluation results indicate
the sensory and motor underpinnings of the child’s choices and
capabilities while participating in daily life activities. Because children
with autism have difficulties with cognition, language, attention,
transitions, and social reciprocity, standardized tests are often an
inappropriate method of determining sensory functioning (Mailloux
and Smith Roley 2001). Rather, observations, in conjunction with
family and teacher interviews, provide valuable information during
assessment. Evaluation results lead interventionists to the goal of
establishing or restoring a healthy lifestyle for children and their
families by engaging the youngsters in meaningful occupations
(Parham and Primeau 1997). According to Mailloux and Smith
Roley, sensory integration therapy that seeks to achieve this goal is
based upon the following framework:
• Use of a structured sensory environment that highlights the
proprioceptive, vestibular, and tactile systems.
• A focus on tapping the inner drive of the child.
110
Information on Related Topics
• Delivery of intervention in the context of play.

• “Artful vigilance” on the part of the therapist.
• Child-directed sessions.
• Elicitation of adaptive responses.
• Delivery of the “just right” level of challenge.
• Emphasis on active versus passive participation where the
engagement in the activity is its own reward (Mailloux and
Smith Roley 2001, p.117).
The Ohio Center for Autism and Low Incidence (OCALI) suggests
families, educators, and interventionists may want to introduce the
following supports to children with an ASD:
• Sensory integration activities.
• Sensory diet.
• Scheduled breaks for sensory activities.
• Desensitization strategies (ear plugs, iPod, shaping tolerance,
etc.).
• Visual cueing strategy.
• Auditory integration therapy (AIT).
• Vestibular stimulation (such as swinging).
• Tactile stimulation (such as brushing parts of a child’s body).
• Traditional occupational therapy.
• Environmental supports (workstations, waiting chairs, etc.).
Further information
American Occupational Therapy Association
4720 Montgomery Lane
PO Box 31220
Bethesda
MD 20824-1220
Tel: +1 (301) 652 2682
www.aota.org
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Applied behavior analysis

Applied behavior analysis (ABA) is a systematic process of studying
and modifying observable behavior through manipulation of the
environment. ABA has been defined by numerous professionals in
vastly different ways. Each interpretation of ABA tends to reflect the
personal philosophies, experiences, and preferences of the individual.
Saffran (2007) suggests that ABA is just as much about maintaining
and using skills as it is about learning. According to Saffran, “applied”
means practice, rather than research or philosophy. Behavior analysis
may be read as learning theory—that is, understanding what leads
to (or doesn’t lead to) new skills. ABA principles are derived from
extensive basic research, often with animals, but have realized
popularity in applied therapy with autism and other developmental
disorders. The process consists of an experimental approach to
manipulating the environment and tracking alterations in behavior
(Chiesa 1994).
Typically, most children learn basic language, socialization, and
play skills through their daily activities, experiences, and observations.
Children with autism learn much less from the environment. They are
capable of learning, but it takes a very structured environment where
conditions are optimized for acquiring the same skills that typically
developing children learn naturally. ABA is a rule-governed approach
for setting up the environment to facilitate learning (Saffran 2007).
ABA therapy is used to teach behaviors to individuals with autism
who may not otherwise acquire these behaviors spontaneously
through imitation. ABA teaches these skills through use of behavioral
observation and positive reinforcement or prompting to teach each
step of a behavior (Simpson 2001). Generally, ABA involves intensive
training of the therapists, extensive time spent in ABA therapy
(20–40 hours per week), and weekly supervision by experienced
clinical supervisors known as certified behavior analysts (Shook and
Neisworth 2005).
Key aspects of the ABA process include:
• observing current behavior for topography (what the
movement looks like), frequency, antecedents, and
consequences
112
• breaking down desired skills into steps

• teaching the steps through repeated presentations of discrete
trials
• tracking performance data to show changes over time (Autism
Treatment Info 2005).
Discrete trial teaching

The most common and distinguishing type of intervention based on
applied behavior analysis is discrete trial teaching. In discrete trial
training, behaviors are segmented into basic functional units that are
then presented, as explained by Wallin (2004). Wallin described the
first step as involving teacher instruction. If a teacher thinks a child
needs help responding correctly, he or she will provide a prompt, cue,
or model to assist. Then, either with help or without, the child gives
some response to the instruction. If the child responds incorrectly, the
teacher provides further instruction and then gives the child another
chance. If the child responds accurately, the teacher gives a reward
or praise as encouragement. After the discrete trial is completed, the
teacher pauses before continuing, to indicate that one step has been
completed prior to continuing on to the next trial (Wallin 2004).
Saffran (2007) lists the following additional techniques commonly
associated with ABA.
Chaining
The skill to be learned is broken down into small units for easy
learning. For example, a person learning to brush teeth independently
may start with learning to unscrew the toothpaste cap. Once this is
learned, the next step may be squeezing the tube, and so on.
Prompting
The parent or therapist provides assistance to encourage the desired
response from the student. Prompts are faded systematically and as
quickly as possible from a more intrusive prompt to the least intrusive
prompt, with completely independent responding as the goal.
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Fading
The overall goal is for an individual, eventually, to not need prompts.
This is why the least intrusive prompts are used, so the child does not
become overly dependent on them when learning a new behavior
or skill. Prompts are gradually faded out as new behavior is learned.
Generalization
Once a skill is learned in a controlled environment (usually during
structured learning activities), it is taught in more general settings.
Perhaps the skill will be taught in the natural environment. If the
child has successfully mastered learning colors at the table, the teacher
or parent may take the student around the house or school and then
re-teach the skill in these natural environments.
Shaping
Shaping involves gradually modifying the existing behavior into the
desired behavior. If a young boy engages with a dog by hitting it, he
could have his behavior shaped by reinforcing interactions in which
he touches the dog more gently. Over many interactions, successful
shaping would replace the hitting behavior with patting or other
gentler behavior.
Differential reinforcement
Reinforcement provides a response to the student’s behavior that will
most likely increase that behavior. It is “differential” because the level
of reinforcement varies depending on the student’s response. Difficult
tasks may be reinforced heavily whereas easy tasks may be reinforced
less heavily. Therapists must systematically change the reinforcement
so that the student will eventually respond appropriately under
natural schedules of reinforcement (occasional) with natural types of
reinforcers (social).
Video modeling
One teaching technique found to be effective with some students,
particularly young children, is the use of video modeling (the use of
taped sequences as exemplars of behavior). It can be used by therapists
114
to assist in the acquisition of both verbal and motor responses, and in

some cases for long chains of behavior.
ABA has experienced its share of controversy over the years and has
had many ethical challenges. Critics argue that it does not actually
improve the skills of individuals with autism, but instead only teaches
them to mimic neurotypical behavior without really understanding
the meaning of the social cues they are using. Critics also argue that
ABA teaches individuals with autism to suppress natural and harmless
stimulatory behavior (stimming). Since the use of ABA has become
widespread relatively recently, its long-term consequences and risks
have not been studied.There have been claims that ABA is successful
only because of the use of aversives that often cause post-traumatic
stress disorder, anxiety, and clinical depression later in life (Dawson
2004). Dawson, a researcher, autism rights activist, and individual
with autism, published an article challenging the ethical practices and
claiming the scientific effectiveness of ABA.
The Hanen Centre

The Hanen Centre supports parents and professionals in their
efforts to assist young children to communicate effectively, and to
rise to new heights. Hanen’s mission is to increase knowledge and
provide training to help families and professionals develop a child’s
best possible language, social, and literacy skills. Described here are
the major programs the Centre offers to families, speech-language
pathologists, early childhood educators, family support professionals,
and healthcare professionals.
The first program, “It takes two to talk”, has as its goal to
enable parents to become their child’s primary language facilitator,
consequently enhancing opportunities for the development of
communication in everyday situations. The objectives of the program
are parent education, early language intervention, and social support.
“Learning language and loving it” is a research-based
developmental approach to promoting children’s social, language,
and literacy development. Designed for early childhood educators
whose students include children with language delays or disorders,
the program is applicable to a variety of settings including childcare,
115
preschool, nursery school, and kindergarten. The program offers

training that aids teachers (a) in preventing language delays, or
providing early language intervention to children with identified
disorders, by creating a language-rich, highly interactive environment,
or (b) in building upon the existing language skills of typically
developing children.
The program for parents of late talkers, “Target word”, teaches
families how to facilitate expressive language development during
everyday routines and activities.
For parents of children on the autism spectrum, More than words
provides practical tools with which to help children communicate. The
program emphasizes everyday activities as the context for learning
to communicate, incorporating current best practice guidelines,
underscoring the importance of affect, predictability, structure, and
the use of visual supports to enhance learning in children with autism.
The four major goals of the program are:
• improved two-way interaction
• more mature and conventional ways of communicating
• better skills in communicating for social purposes
• an improved understanding of language.
These goals and strategies, to be implemented in the home, are
elaborated upon in the book, More Than Words (Sussman 2004). The
book, published by the Hanen Centre, is a primary resource for our
discussion on routines, which follows next.
Routines
Daily routines, such as dressing, mealtime, or getting ready for school,
can be shaped into repetitive interactions that help children make
sense of their world and improve the way they comprehend, express,
predict, and behave (Sussman 2004). Because one of the defining
characteristics of autism is resistance to changes in routine, frequently
to the extent of insistence upon following rigid individualized rituals,
it may be an effective strategy to incorporate the use of appropriate
routines into a child’s daily activities. The expected outcome is a
structured environment that increases calm behavior, attention, and
116
responsiveness to learning, particularly essential for children with

autism and other developmental disabilities. The degree of structure
required is dependent upon the needs of the child, diagnosis, age,
and abilities, and is essentially more effective when coupled with
routines and visual supports. The reader may refer to Chapters 4
and 6, where we presented research that supports strategies based
on utilizing visual supports, engineering the environment, and
following routines. Because of the previous coverage of these topics,
only a brief discussion of routines will be included here.
In order to build work skills and create a comfortable learning
environment educators must develop and teach within routines. Just
as routines are effective in teaching functional, leisure, and vocational
skills at school, they are equally relevant to the home environment. It
is suggested that families build routines into everyday activities such
as bathing, setting the table, or getting dressed. Doing so provides
the predictability children with autism crave. The Hanen Centre’s
approach to structuring routines, known as the ROCK Approach,
consists of the following steps.
R. Repeat what you say and do when you start the routine, during the
routine, and when ending the routine.
O. Offer opportunities for the child to take turns by planning when to
offer a turn, planning what turns the child can take, and offering
new opportunities for turn taking, upon progressing.
C. Cue the child to take turns by using visual aids and engineering
the situation.
K. Keep it fun and keep it going (Sussman 2004).
Routines are to be segmented into small steps, directed at the
child’s level of cognition and communication. Although the ROCK
approach was designed for use by families, it can be applied just
as effectively to the school setting. TEACCH (2006) also supports
the use of routines and offers suggestions for their use in enhancing
communication skills. According to this organization, the two reasons
for using communication are (a) to regulate others and get needs
met, and (b) to share attention and experiences with others. Using
routines is beneficial because they are of high interest to children
with autism who seek predictability, who learn they can share
117
experiences with others and have fun while doing so, and who learn
that communication is part of the process.
To be successful, it is advisable to teach routines in a meaningful
and functional context, use the child’s interests and strengths, set
up the environment, and then introduce the activity. In the previous
chapters on visual strategies and structuring the environment, we
first described how to integrate the use of routines into a child’s
daily activities, in order to improve communication, behavior, and
predictability.
Chileda
Chileda was selected for inclusion in this chapter, not because it
is a one-of-a-kind organization, but rather because it typifies the
kind of comprehensive vision, mission, and services that we adopt.
Chileda provides services to children and young adults who have
developmental disabilities, mental retardation, seizure disorders,
cerebral palsy, autism, physical handicaps, genetic liabilities, or
challenging behavior disorders. The members of Chileda are
committed to the progressive education and personal empowerment
of children with developmental disabilities, and focused on meeting
individual needs and assisting clients to realize their fullest potential.
Chileda offers residential, vocational, respite, outreach, evaluation,
day school, summer school, and emergency care support, through the
following programs:
• Special education.
• Vocational services.
• Occupational therapy.
• Speech and language pathology.
• Physical education and physical therapy.
• Creative arts.
• A 60-day to 9-month assessment program (SNAP).
Because of synergy with our views on utilizing visual supports,
structuring the environment, and enhancing communication,
Chileda’s list of ten of the most effective strategies for teaching
118
students with autism spectrum disorders serves as the model for the
following classroom approaches.
1. Use visual schedules to make daily routines predictable,
with clear expectations.
2. Consider visual and auditory stimulation in the classroom
environment.
3. Structure the environment visually, assisting children to see
clearly and understand expectations, through use of defined
work stations and boundaries, with cues indicating what
and how much work needs to be done, when the work will
be finished, and what to do next.
4. Use an AAC system for non-verbal children, such as PECS,
SGDs, or communication binders.
5. Provide direct instruction in social skills, to include social
stories.
6. Begin literacy instruction at an early age, as a support to
communication and SGD use.
7. Complete a sensory profile to create and implement sensory
integration and a sensory diet.
8. Offer a program that is consistent daily, with clear
expectations.
9. Build upon students’ strengths and interests.
10. Develop a strong functional curriculum that emphasizes
daily living skills, community skills, recreation, leisure, and
employment; and functional academics for students in an
inclusive setting.
With collaboration among all team members, these strategies may be
modified and implemented at home as well as at school. The methods
have been discussed throughout this book, and it is anticipated that
this comprehensive list will be a useful reminder of how to acquire
knowledge, implement strategies, and then rise above the fear factor
frequently associated with caring for or educating children with
autism and other developmental disabilities or challenges to learning.
119
The S.U.C.C.E.S.S. approachSM

The Strategic Use of Critical Curriculum Elicits Supported Sense-
making (S.U.C.C.E.S.S.) utilizes a transdisciplinary approach to
meeting a child’s individual needs (Scotese-Wojtila, n.d.). Teams
of therapists and educators work together to treat the whole child
who seeks to connect with the world. Because children with
autism spectrum or PDD display complex behaviors, they require
an approach that integrates theories and strategies from a realm of
perspectives (Scotese-Wojtila). For the S.U.C.C.E.S.S. Approach to be
of value, the team must (a) be able to communicate effectively among
members, (b) apply methods consistently across disciplines, and (c)
share theoretical perspectives among interventionists. In addition
to both listening and asking questions, team members must also be
willing to cross train, role release, and respect the point of view of
others.
During treatment of children with autism spectrum or PDD, team
members serve each child differently, respecting individual learning
styles rather than adhering to a particular doctrine. The child is
viewed as a dynamic, complex, developing individual. With a strong
emphasis on communication, children learn not only how to act,
but also how to interact and learn about themselves, others, and the
environment.
In Phase I of the S.U.C.C.E.S.S. Approach, a variety of
interventionists (e.g. psychologist; speech, occupational, physical,
music therapists; and special education teacher) work collaboratively
to assess a child’s needs and develop treatment strategies. Families are
encouraged to observe and practice the approach during clinic visits.
In Phase II, visits to the clinic decrease as children require
less therapy, and families are better equipped to apply the learned
techniques at home. In the final Phase III, fewer sessions are necessary,
as families become empowered with the tools to carry over strategies
and apply them confidently in the home. The underpinning of the
S.U.C.C.E.S.S. Approach is the recognition that autism doesn’t just
affect the child; rather, autism has a profound effect on the entire
family. We value the approach as an effective method of reducing the
fear factor, by educating and training families and school personnel to
treat the child as an individual human being, with particular interests
and needs, using a transdisciplinary method.
120
Further reading on sensory integration

Dempsey, I. and Foreman, P. (2001) “A review of educational approaches for
individuals with autism.” International Journal of Disability, Development and
Education 48, 1, 103–116.
Hatch-Rasmussen, C. (1995) Sensory Integration. San Diego, CA: Autism Research
Institute. Available at www.autism.com/families/therapy/si.html, accessed on
30 April 2010.
Mailloux, Z. and Smith Roley, S. (2001) “Sensory integration.” In H. Miller-
Kuhaneck (ed.) Autism: A Comprehensive Occupational Therapy Approach. Bethesda,
MD: The American Occupational Therapy Association, Inc., pp.101–131.
Ohio Center for Autism and Low Incidence (OCALI) Sensory Processing 101:
Implications of Sensory Challenges in ASD. Available at www.ocali.org/view.
php?nav_id=101, accessed on 26 June 2009.
Parham, L.D. and Primeau, L.A. (1997) “Play and occupational therapy.” In L.
Parham and L. Fazio (eds) Play in Occupational Therapy for Children. St. Louis,
MO: Mosby. pp.2–21.
Further reading on ABA

Chiesa, M. (1994) Radical Behaviorism: The Philosophy and the Science. Sarasota, FL:
Authors Cooperative Inc., p.241.
Dawson, M. (2004) The Misbehavior of Behaviourists: Ethical Challenges to the Autism-
ABA Industry. Available at www.sentex.net/~nexus23/naa_aba.html, accessed
on 28 October 2009.
Saffran, R. (2007) What is Applied Behavior Analysis? Available at www.rsaffran.tripod.
com/whatisaba.html#more, accessed on 23 October 2009.
Shook, G.L. and Neisworth, J.T. (2005) “Ensuring appropriate qualifications for
applied behavior analyst professionals: the behavior analyst certification
board.” Exceptionality 13, 1, 3–10.
Simpson R.L. (2001) “ABA and students with autism spectrum disorders: issues and
considerations for effective practice.” Focus on Autism and Other Developmental
Disabilities 16, 2, 68–71.
Wallin, J. (2004) An Introduction to the Discrete Trial. Available at www.polyxo.com/
discretetrial, accessed on 30 April 2010.
Autism Treatment Info (2005) What is a Discrete Trial? Available at www.autismtreatment.
info/What+is+a+Discrete+Trial.aspx, accessed on 10 May 2010.
Further reading
Chileda Organization (2005) 10 Effective Ways to Teach an ASD Child. Accessed 14
September 2008.
Scotese-Wojtila, L. (2003) The S.U.C.C.E.S.S Approach. Available at www.
awetismproductions.com, accessed on 1 May 2010.
Sussman, F. (2004) More Than Words. Toronto, ON: The Hanen Centre.
121
Appendix 1
National organizations
We do not endorse these organizations, but include their websites for

the convenience of our readers. It is to the discretion of the reader to
determine their value or worth.
Australia
Australian Advisory Board on Autism Spectrum Disorders
This board establishes and lobbies for appropriate policies to ensure the
needs of individuals with autism spectrum disorder (ASD) are met. They are
staunch advocates for the needs of individuals with autism, and distribute
pertinent information about issues surrounding ASD.
c/o 41 Cook Street Forestville
NSW 2087
Australia
Telephone: +61 (0)2 8977 8300
www.autismaus.com.au/
Autism Aspergers Advocacy Australia (A4)

A4 is a national grassroots organization for individuals with autism and
their families, promoting a national autism spectrum disorder policy and
priorities. Its network of people communicate via email and the Internet,
conduct activities targeting autism/ASD awareness and policy in the federal
government, and complement the work of the Australian Advisory Board
on Autism Spectrum Disorders, and give voice to advocacy for autism.
www.a4.org.au/a4/node/7
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Appendix 1 National organizations
Autism Association of Western Australia

They pledge to provide for the needs and interests of individuals with
autism by offering services based on evidence-based research. Their
mission is to promote community involvement and enhance individual and
social growth.
37 Hay Street
Subiaco 6008
Australia
http://www.autism.org.au/
Autism Spectrum Australia (Aspect)

They are committed to offering services to individuals with autism of all
ages. They utilize evidence-based approaches to ensure quality and effective
interventions, services, and information.
Forrestville
NSW 2087
Australia
Telephone: 1-800-069978
www.autismspectrum.org.au
Canada
Autism Awareness Centre, Inc.
This global website offers links to Canada, Europe, Global, United
Kingdom, and the United States. Visitors to the Canada link may click
on a province or territory on the map shown to find autism help in their
area. Each country lists organizations, professionals, research centers,
projects, and various aspects related to services provided to individuals
with autism and their families and caregivers, and healthcare providers.
Blogs, newsletters, conferences are included.
www.autismawarenesscentre.com
Autism Canada Foundation

The intent of this organization is to engage, educate, and unite people
to find a cure for autism. The Autism Canada Foundation supports
Canadians by providing biomedical and behavioral treatment information
to help those affected by autism, expand the knowledge of healthcare
professionals, influence governmental policy, and enable research into
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causes and treatment for autism. The website offers current findings on
these topics, as well as opportunities to get involved, a calendar of events,
and other areas of interest.
www.autismcanada.org
Autism Society Canada

ASC’s website provides visitors with reliable information on autism and
referrals to helpful services and resources, whether sought by a person
with an autism spectrum disorder, parent, caregiver, volunteer, researcher,
educator, or healthcare or social services professional. ASC places a special
emphasis on families seeking support for children with autism, and aims
to assist with making successful community connections, information
dissemination, and providing whatever families need to ensure people
with ASD reach their full potential as participating members of their
communities.
www.autismsocietycanada.ca/index_e.html
Ministry of Children and Family Development-Autism Initiatives

Branch
This British Columbia government agency provides early behavioral
intervention, autism funding for children under age six and those aged 6–18
years. Information included on this website offers community resources
and programs, publications, leisure and recreational opportunities, and
news related to those affected by autism spectrum disorders.
www.mcf.gov.bc.ca/autism
United Kingdom
Autism Initiative UK
Addresses the unique abilities of individuals with autism to establish
individualized needs and provide support through a range of services.
7 Chesterfield Road
Liverpool
Merseyside
L23 9XL
UK
Telephone: 0151 330 9500
www.autisminitiatives.org/
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Autism Services Directory

An all-inclusive resource where individuals with autism, caregivers, and
professionals may locate services and supports that may address their
specific needs.
www.autism.org.uk/en-gb/directory.aspx
Derbyshire Autism Services Group

The Derbyshire Autism Services Group (D.A.S.G.) is a parent-led registered
charity that utilizes a volunteer board of directors and members. The
members are from a variety of backgrounds enabling them to provide
priceless services to individuals with autism spectrum disorders, care
givers, as well as professionals. The services D.A.S.G. offer include support
groups, family events, trainings/inservices, short-term respite care, social
skills training, and advice.
28D High Street
Ripley
Derbyshire
DE5 3HH
UK
Telephone: (01773) 741221
E-mail: [email protected]
www.autismsupport.co.uk/default.asp
The National Autism Society

The National Autism Society is the most prominent charity for individuals
with autism in the UK. Comprehensive services are provided to assist
individuals seeking information, support, and increased public awareness
about the needs for individuals with autism. This website offers caregivers
information, advice, support, and individualized assessment of their needs.
The individual with autism may receive education/vocational training
opportunities, social skills training, and assistance in gaining employment.
http://www.autism.org.uk/
Research Autism
A cumulative directory of autism research exclusive to the topics of
interventions for education, social skills, health and other areas are offered.
125
Westbourne House
14-16 Westbourne Grove
London
W2 5RH
UK
Telephone: 020 7317 5785
www. researchautism.net/
The UK Autism Foundation

A British autism charity providing comprehensive information about
the latest research and news on the topic of autism. The foundation is
looking to establish an unprecedented Autism Centre in London to educate
individuals with autism and create provisions for those needing financial
assistance to access appropriate training.
Woodford Business Centre
113-115 George Lane
South Woodford
London
E18 1AB
UK
Telephone: 020 8989 4810
www.ukautismfoundation.org/
USA
Asperger Syndrome Education Network ASPEN
A national non-profit organization providing education and support to
families and individuals affected by Asperger syndrome, PDD-NOS, high-
functioning autism, and related disorders.
9 Aspen Circle
Edison
NJ 08820
Tel: +1 (732) 321 0880
www.aspennj.org
Association for Behavior Analysis International (ABAI)

The ABAI promotes the experimental, theoretical, and applied analysis
of behavior, encompassing contemporary scientific and social issues,
126
theoretical advances, and the dissemination of professional and public

information.
550 West Centre Avenue
Suite 1
Portage
MI 49024
Tel: +1 (269) 492 9310
www.abainternational.org
Autism Research Network

This network provides information about two major research networks
dedicated to understanding and treating autism. The Collaborative Programs
of Excellence in Autism (CPEA) network conducts research to learn about
the possible causes of autism, including genetics, immunological, and
environmental factors, as well as diagnosis, early detection, behavioral and
communications characteristics, and treatment of autism. The Studies to
Advance Autism Research and Treatment (STAART) network focuses on
the causes, diagnosis, early detection, prevention, and treatment of autism.
www.nimh.nih.gov/health/topics/autism-spectrum-disorders-perva-
sive-developmental-disorders/nih-initiatives/staart/index.shtml
Autism Society
The Autism Society, the nation’s leading grassroots autism organization,
improves the lives of all affected by autism by increasing public awareness
about the day-to-day issues faced by people on the spectrum, advocating for
appropriate services for individuals across the lifespan, and providing the
latest information regarding treatment, education, research, and advocacy.
4340 East-West Highway
Suite 650
Bethesda
MD 20814
Tel: +1 (301) 657 0881
www.autism-society.org
Autism Speaks
Autism Speaks’ goal is to change the future for all who struggle with ASDs.
It is dedicated to funding global biomedical research into the causes,
prevention, treatments, and cure for autism; raising public awareness about
127
autism and its effects on individuals, families, and society; and bringing
hope to all who deal with the hardships of this disorder.
2 Park Avenue
11th Floor
New York
NY 10016
Tel: +1 (212) 252 8584
www.autismspeaks.org
Autism Treatment Network

An online global resource with main links to the Autism Treatment, Autism
Society, Children with Autism, Autism Diagnosis, Autism Spectrum, and
Autism Resources. Related searches may be made on a number of topics, to
acquire comprehensive information related to autism spectrum disorders.
www.autismtreatmentnetwork.org
Centers for Disease Control and Prevention (CDC)

CDC’s mission is to collaborate to create the expertise, information,
and tools that people and communities need to protect their health—
through health promotion, prevention of disease, injury and disability, and
preparedness for new health threats.
1600 Clifton Road
Atlanta
GA 30333
Tel: +1 (800) 232 4636
www.CDC.gov
Developmental Disabilities Clinic at the Yale Child Study Center

The autism program, an interdisciplinary group of clinicians and scholars,
provides comprehensive clinical services to children with ASDs and their
families. One of the leading research centers in the world, Yale was recently
recognized as a National Institute of Health autism center of excellence.
The program involves individuals with autism and related disorders, and
integrates highly experienced professionals from the fields of clinical
psychology, neuropsychology and neuroimaging, child psychiatry, speech-
language pathology, social work, genetics, and the biological sciences, as
well as psychopharmacology and psychiatric nursing.
128
Yale University
230 South Frontage Road
New Haven
CT 06520
Tel: +1 (203) 785 3420
www.childstudycenter.yale.edu/autism
Family Center on Technology and Disability (FCTD)

This Center is a resource to support organizations and programs that work
with families of children and youth with disabilities. It offers a range of
information and services on assistive technologies. Network members
are committed to providing useful information and resources to help
children fulfill their potential and ensure members receive the most current
information on developments in the field of assistive technology.
Academy for Educational Development (AED)
1825 Connecticut Avenue NW
7th Floor
Washington
DC 20009-5721
Tel: +1 (202)884 8068
www.fctd.info
Gray Center
The Gray Center is a non-profit organization that strives to assist
individuals with autism spectrum disorder (ASD) and their communicative
partners with a mutual understanding of social learning. It is the goal of
the Gray Center to create more effective communication exchanges by
equipping both the individuals with ASD and those who interact with
them with information and strategies about social differences and why
they occur. The individual with ASD gains an improved understanding
of social rules and the reasons for them. Those who interact with this
person gain a clearer understanding of their perspective. In their efforts to
promote social understanding, members of the Gray Center provide many
worthwhile resources that benefit individuals with autism and others who
work alongside them.
100 Pine Street
Suite 121
Zeeland
MI 49464
Tel: +1 (616) 748 6030
www.thegraycenter.org
129
Indiana Resource Center for Autism (IRCA)

This Center conducts outreach training and consultations, engages
in research, and develops and disseminates information on behalf of
individuals across the autism spectrum. Efforts are focused on providing
communities, organizations, agencies, and families with knowledge and
skills to support children and adults in typical early intervention, school,
community, work, and home settings.
Indiana Institute on Disability and Community
2853 E. 10th Street
Bloomington
IN 47408-2696
Tel: +1 (812) 855 6508
www.iidc.indiana.edu/irca
Interactive Autism Network (IAN)

IAN is an innovative online project designed to accelerate the pace of
autism research by linking researchers and families. Anyone affected by an
ASD can become part of IAN’s online community to stay informed about
autism research, provide feedback, and make their voices heard.
www.ianproject.org
Learning Disabilities Association of America (LDA)

LDA is a national network of state-based advocacy groups for families
affected by learning disabilities. It has been very supportive of issues
surrounding some of the learning difficulties common to children with
severe social disability, such as those characterized by non-verbal learning
disability (NLD).
4156 Library Road
Pittsburgh
PA 15234-1349
Tel: +1 (412) 341 1515
www.ldanatl.org
130
National Autism Center

The National Autism Center is a new non-profit organization dedicated to
supporting effective, evidence-based treatment approaches and providing
direction to families, practitioners, organizations, policy makers, and
funders. The Center is bringing nationally renowned experts together to
establish national treatment standards, model best practices, and conduct
applied research, thereby serving as a vital source of information, training,
and services.
41 Pacella Park Drive
Randolph
MA 02368
Tel: +1 (877) 313 3833
www.nationalautismcenter.org
National Dissemination Center for Children with Disabilities

(NICHCY)
This Center serves the nation as a central source of information on:
• disabilities in infants, toddlers, children, and youth
• The Individuals with Disabilities Education Improvement Act
(IDEA) 2004, which is the law authorizing special education
• The No Child Left Behind (NCLB) Act 2001 (as it relates to
children with disabilities)
• research-based information on effective educational practices.
1825 Connecticut Avenue NW
Suite 700
Washington
DC 20009
Tel: +1 (202) 884 8200
www.nichcy.org
Online Asperger Syndrome Information and Support (OASIS)

The Online Asperger Syndrome Information and Support (OASIS) center
has joined with MAAP Services for Autism and Asperger Syndrome to
serve as a single resource and support for families, individuals, and medical
professionals who deal with the challenges of Asperger Syndrome, autism,
and other pervasive development disabilities (PDD).
More advanced individuals with Autism, Asperger’s syndrome, and
Pervasive developmental disorder (MAAP) are served by a non-profit
131
organization providing information and advice to families. Through The

MAAP, its quarterly newsletter, parents and professionals network with
others in similar circumstances and learn about more advanced individuals
within the autism spectrum.
The website includes featured articles support boards, blogs, chatrooms,
and other comprehensive information.
www.aspergersyndrome.org
Professional Development in Autism (PDA) Center

This Center provides training and consulting to school teams that work
with students with ASD from diagnosis through age 21. The goal is to
increase the capacity of school teams so every child with ASD can access a
high-quality public education.
Locations: University of Washington, University of Colorado at
Denver, Maryland Coalition for Inclusive Education, University of South
Florida, and University of Oklahoma.
www.depts.washington.edu/pdacent
TalkAutism
TalkAutism is a communication service used by many organizations which
share a common database of resource directories, distance learning libraries,
and special message boards.
Box 1348
Princeton
NJ 08540
Tel: +1 (888) 355 7161
www.talkautism.org
Technical Assistance Center on Positive Behavioral Interventions

and Supports (PBIS)
This Center, founded by the Office of Special Education Programs (OSEP)
was established to address the behavioral and discipline systems needed
for successful learning and social development of students. It provides
capacity-building information and technical support about behavioral
systems to assist states and districts in the design of effective schools.
www.pbis.org
132
Treatment and Education of Autistic and related

Communication Handicapped Children (TEACCH)
TEACCH utilizes an approach for treatment that focuses on the person with
autism and the development of a program around the individual’s skills,
interests, and needs. TEACCH provides clinical services, conducts training,
and provides consultation for teachers, residential care providers, and other
professionals. Research activities include psychological, educational, and
biomedical studies. Administrative headquarters are in Chapel Hill, North
Carolina.
Tel: +1 (919) 966 2174
www.teacch.com
Global websites
Action for Autism (AFA)
AFA is the pioneering, national and non-profit autism society of India,
providing support and services to individuals with autism, their families,
and those who work with them in South Asia. The mission of AFA is
to facilitate a barrier-free environment, empower families of persons with
autism, and to act as a catalyst for change, enabling their full participation
as contributing members of the community. Research, training, events,
referrals, education and information dissemination are located on the
website and offered by the organization.
www.autism-india.org/afa_autisminindia.html
Autism Organizations Worldwide

This website, maintained by Action for Autism, India, is an alphabetical list
of mostly national and some regional autism organizations. Direct links to
individual contacts and addresses are listed and actively updated to provide
the most recent information on autism for children and their families to
over 100 sites.
www.autism-india.org/worldorgs.html
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Appendix 2
Goals and Objectives
Chapter 1: Speech Generating Devices (SGDs)

GOAL: Using a speech generating device (SGD), the child will relay basic
needs, wants, or information, during structured activities at home and at
school.
OBJECTIVES: Using an SGD, the child will do the following:

• Communicate at least five simple messages (e.g. need to use the
bathroom, hungry, more, finished) ____% of the time, during ____
opportunities.
• Choose a free-time activity (e.g. computers, reading area, puzzles,
manipulatives, TV, rest) upon request ____% of the time, during
____ opportunities.
• Independently communicate requests during meal or snack time
(e.g. more or no more, help, choices of food) ____% of the time.
• Independently request materials needed to complete a structured
art activity (e.g. crayon, scissors, glue, paper) ____% of the time,
during ____ opportunities.
• Refrain from using negative behaviors and use device to gain the
attention of a communicative partner ____% of the time, while in
the classroom, home, or community setting.
• Identify peers and adults in structured group or play activities
with____% accuracy.
• Label at least _____ items from each of the categories of foods,
animals, clothing, colors, shapes, school supplies, and common
items, with ____% accuracy.
134
Appendix 2 Goals and Objectives
• Use the appropriate vocabulary _____% of the time when

describing given action pictures.
• Use the appropriate preposition _____% of the time when
describing spatial location of objects during structured activities.
Chapter 2: Picture Exchange Communication System

(PECS)
GOAL: The child will communicate basic wants, needs, and simple messages
independently, in both school and home settings.
OBJECTIVES: Given the PECS, as recommended by Frost and Bondy

(2002), the child will do the following:
• Upon seeing a desired item or object, and with a picture of it
within reach, pick up the picture, reach to the person holding the
item who is within 1 foot (33cm), and release the picture into that
person’s hand independently ____% of the time.
• Upon seeing a desired item or object, and with a picture of it alone
on a communication book within reach, remove the picture from
the book, seek out the communication partner who is within (1
foot; 33cm) (5 feet; 2m) (10 feet; 4m) (across the room) away, and
give the picture to complete requests independently ____% of the
time.
• Upon seeing a desired item or object, and with a picture of it
alone on a communication book, go to the book that is (1 foot;
33cm) (5 feet; 2m) (10 feet; 4m) (across the room) away, remove the
picture, move to the communication partner, and give the picture to
complete requests independently ____% of the time.
• Upon seeing a desired item or object, and with a picture of it on a
communication book, along with a picture of a distracter item, give
the communication partner the correct picture. (a) Give the correct
picture ____% of the time (b) Give the correct picture ____% of
the time when the book and partner are more than 2 feet (66 cm)
away.
• Upon seeing a variety of reinforcing items, go to the communication
book, select an appropriate picture from all those available (on the
cover or inside), remove and give the picture to the communication
partner, and then, when told to “Go ahead and get it”, retrieve the
corresponding item independently ____% of the time.
135
• With reinforcing items not in sight, go to the communication book,

select a picture from any page within it, remove and give the picture
to the communication partner, and then, when told to “Go ahead
and get it,” get the corresponding item independently ____% of
the time, across a variety of objects, activities, communication
partners, and environments.
• Given a communication book with a variety of pictures and a
sentence strip with an “I want” symbol attached to the left end,
attach a symbol of the desired item or object to the right end
of the strip. Then, give the strip to the communication partner
independently ____% of the time, across a variety of objects,
activities, communication partners, and environments.
• Given a communication book with a variety of pictures and a
sentence strip with an “I want” symbol attached to the left end,
remove the “I want” symbol and affix it to the left end of the sentence
strip. Then, remove the symbol of a desirable item from the book,
affix it to the right end of the sentence strip, and independently
give the entire strip to the communication partner ____% of the
time, across a variety of objects, activities, communication partners,
and environments.
• Locate the communication book, construct an entire sentence strip,
go to the communication partner, and exchange the strip for the
desirable item independently ____% of the time, across a variety
of objects, activities, communication partners, and environments.
(Frost and Bondy 2002)
Further reading on PECS

Frost, L.A. and Bondy, A. (2002) The Picture Exchange Communication System Training
Manual. Newark, DE: Pyramid Educational Products Inc.
Chapter 3: Symbolic Language Systems

GOAL: The child will relay basic wants and needs using an effective method
of communication consistently at home, school, or in the community.
OBJECTIVES: Using a symbolic language system that has been taught

and practiced (e.g. icons, photographs, sign language, gestures, vocal
approximations, communication wallet, SGD), the child will do the
following:
136
• Request a desirable item (e.g. snack, toy, activity) when prompted

____% of the time.
• Choose a free-time activity (e.g. computers, reading, puzzles,
manipulatives, TV, rest) when prompted ___% of the time.
• Communicate at least five simple messages (e.g. needs to use the
bathroom, hungry, more, finished) ____% of the time, during ____
opportunities.
• Communicate requests independently during meal or snack time
(e.g. more or no more, help, choices of food) ____% of the time.
• Request materials needed to complete a structured art activity (e.g.
crayon, scissors, glue, paper) independently ____% of the time.
• Gain the attention of a communication partner appropriately (e.g.
raise icon, gesture, sign language, SGD message), while refraining
from using negative behaviors ____% of the time.
• Identify peers and adults in structured group or play activities
expressively, with ____% accuracy.
GOAL: The child will use appropriate vocabulary when relaying messages
and sharing basic information, using an effective method of communication
consistently at home, school, or in the community.
OBJECTIVES: Using a symbolic language system that has been taught

and practiced (e.g. icons, photographs, sign language, gestures, vocal
approximations, communication wallet, SGD), the child will do the
following:
• Label at least ____ items from each category of foods, clothing,
animals, household items, feelings, and body parts, with____%
accuracy.
• Describe with ___% accuracy, at least ten pictures from each
category of colors, shapes, and prepositions.
• Respond to ____ (number of ) “who”, “what”, and “where” questions
about ___ (number of ) composite pictures, with ____% accuracy.
• Formulate sentences of at least ____ words, when describing _____
composite pictures ____% of the time.
• Use the correct pronoun or noun, verb form, and tense when
describing _____ pictures ____% of the time.
137
• Use at least ____ words or ____ sentences to re-tell an event or

story after a short delay, when given picture or verbal cues ____%
of the time.
• Answer ten simple “Wh-” questions related to personal wants,
needs, daily activities, or play _____% of the time, during ____
opportunities.
• Provide personal information (e.g. name, address, phone number,
school) upon request ____% of the time, with ____% accuracy.
Chapter 4: Visual Supports

GOAL: The child will participate in and respond to requests and activities
in the classroom or home settings appropriately.
OBJECTIVES: Given direct instruction, practice, and visual supports (e.g.

Wait card, timer, picture schedule, Social Story, Count down card, Flip
book, reminder strip, sign language or gestural cues), the child will do the
following:
• Transition between classroom activities or home routines within
____ seconds of request ____% of the time.
• Follow simple behavioral directions (e.g. sit down, line up, hands
down, clean up, quiet) ____% of the time.
• Complete at least ____ structured activities (e.g. shoebox-type
activity or pre-vocational activity) independently, at individual
work station ____% of the time, during ___ (minutes/hours) time
periods.
• Complete an activity, put in a FINISHED container, refer to schedule
to learn what to do next, and start a new activity independently
____% of the time.
• Follow at least ____ directional instructions (e.g. where to sit, wait,
work, line up, play) independently ____% of the time.
• Complete three- to five-step tasks during routine activities (e.g.
breakfast, arrival at school, ready for bed routine, brush teeth
routine, toileting routine, hygiene routine) independently ____%
of the time.
• Store belongings (e.g. coat, back pack, homework assignments,
dirty clothes) independently in designated areas ____% of the time.
138
GOAL: The child will appropriately respond to social situations in the

classroom, home, or community settings.

following:
• Demonstrate appropriate turn-taking behavior during structured
group activities ____% of the time.
• Demonstrate comprehension of socially appropriate behavior
by naming ___ acceptable behaviors during structured learning
activities ____% of the time.
• Tolerate sharing play space with peers without engaging in
inappropriate physical behaviors ____% of the time.
• Replace negative behaviors (e.g. inappropriate touching,
inappropriate greetings, negative mealtime behavior, emotional
outbursts) with acceptable behavior ____% of the time, during
structured social activities.
• Initiate conversation and maintain topic when responding to
statements and answering simple questions ____% of the time.
• Participate appropriately in ____ life skill activities (e.g. phone
manners, table manners, interactions with strangers, interactions
with visitors) ____% of the time.
• Remain with the group when transitioning through the educational
or community setting ____% of the time.
Chapter 5: Social Stories

GOAL: The child will respond appropriately to and interact in structured
social situations in the classroom, home, or community settings.
OBJECTIVES: Given a Social Story describing desired behaviors, presented

consistently, the child will do the following:
• Display appropriate attention-getting behaviors (e.g. gesture, SGD
message, raised icon) _____% of the time.
• Reduce inappropriate noises at school and home _____% of the
time.
• Greet others appropriately _____% of the time.
139
• Respond appropriately to questions and comments of others

_____% of the time.
• Comply with safety directions (e.g. stay with the group, watch for
cars, listen to a familiar adult, don’t leave with a stranger) ____%
of the time.
Chapter 6: Structured Environments

GOAL: The child will complete work tasks, and follow rules and routines
independently at home and in school.

following:
• Move to an area to reorganize self with needed sensory input
_____% of the time, given a designated calming area to prevent an
escalation of inappropriate behaviors.
• Transition between areas in the classroom or at home within ____
seconds of request ____% of the time.
• Transition independently to an appropriate area (e.g. locker, work
station, restroom) ____% of the time.
• Remain in designated area (e.g. circle time area, work station, rest
area) for _____ minutes ____% of the time, provided there are
structural barriers.
• Independently complete _____ structured tasks that are located in
a work area _____% of the time.
• Store materials in appropriate areas at school and home ____% of
the time.
• Complete routines (e.g. school arrival routine of storing belongings,
given labeled areas or containers; setting dinner table, given place
mat with place-setting outline; hygiene routine, brushing teeth,
using deodorant, bathing) independently ____% of the time.
GOAL: The teacher or family will organize and arrange the child’s
environment to facilitate learning, behavior, and communication.
OBJECTIVES: The teacher or family will do the following:
140
• Label and provide sufficient space for work areas; label storage
areas to identify where items belong.
• Remove distractions from work and rest areas.
• Make readily available and accessible the materials necessary to
complete an activity (e.g. hygiene items, dishes, shoebox-type
activities, structured assignments).
• Provide visual supports that indicate to the child how much work
there is to do, what the work is, when it will be finished, and where
to go next.
• Visually monitor the child’s activities at all times.
• Display and discuss visual cues that communicate information
about upcoming events (e.g. activity schedule, transition pictures,
calendar).
• Make readily available and accessible, and encourage use of the
child’s communication system (e.g. photographs, communication
binder, PECS, SGD).
141
Index
Alter, P.J. 97 Bloomfield, B. 70, 84, 85 communication page 46,

Alternative Augmentative Bondy, A. 39, 41, 135, 56
Communication 136 communication wallet 48
techniques (AAC) Bopp, K.D. 73 Conroy, M.A. 97
definition of 19–20 Burns, C. 26, 29, 32, 35 curriculum
and Picture Exchange and speech generating
Communication devices 29–30
calendars
System 38–45
as visual supports 69,
and speech generating
71, 84 D’Amore, D. 67
devices 21–37
Carlson, F. 52 Dawson, M. 115
and symbolic language
Carter, S.L. 72, 73, 75 DeFoore, P. 72, 100
systems 46–62
CeDIR 25 Dempsey, I. 110
American Psychiatric
Centers for Disease Do2Learn 98
Association (APA) 12
Control and Downey, D. 23
applied behavior analysis
Prevention (CDC) 12,
(ABA) 112–15
14, 16, 17
autism Edelson, S.M. 73
Chiesa, M. 112
characteristics of 12–
Chileda 118–19
14, 16–17
choice boards “FIRST/THEN” boards
defined by American
as visual supports 67–8, 82
Psychiatric
69–70 “Fold-up” visual supports
Association (APA)
communication 70, 72, 85
12
and learning support Foreman, P. 110
defined by Individuals
strategies 63–4 Frost, L.A. 39, 41, 134,
with Disabilities
and Picture Exchange 135
Education
Communication
Improvement Act
System 40, 42–3
14 gestures
initial detection of and symbolic language
devices 32–4, 35
16–17 systems 49
and visual supports
and parents of child Gray, C. 87, 88, 89
73–4
with 17–18
communication binder 48
and stages of mourning
communication board Hanen Centre 115–16,
11–12
47–8, 59 117
Autism Treatment Info
113 Hartsell, K. 22
142
Index
Hatch-Rasmussen, C. 109, National Dissemination picture schedules

110 Center for Children hierarchy of 75–7
Hodgdon, L. 65, 66, 72, with Disabilities and visual supports
73, 99 (NICHCY) 12, 14 66–8, 72–3, 74–9
Neisworth, J.T. 112 Picture Exchange
“NOW/THEN” boards Communication
“IF/THEN” boards 67,
67–8 System (PECS)
69, 82–3
and communication
Individuals with
40, 42–3
Disabilities Education objects
criteria for using 41–5
Improvement Act and symbolic language
description of 38–9
(IDEA 2004) 14 systems 49
goals and objectives
Ohio Center for Autism
135–6
and Low Incidence
Jean Ayres, A. 109 and language
(OCALI) 111
development 39
phases of 39–41
Kamp, L. 75 and picture
parents
Kimball, J.W. 73, 77 discrimination
of children with autism
Kubler-Ross, E. 11 44–5
17–18
and Picture Exchange and questioning 41
language development Communication and sentence structure
and Picture Exchange System 39 41
Communication and stages of mourning and student interests
System 39 11–12 and preferences 43
and symbolic language Parham, L.D. 110 as symbols 40–1
systems 52 PaTTAN 66 use of 38
learning support strategies PECS see Picture Exchange Primeau, L.A. 110
and communication Communication
63–4 System
Rogers, L. 72, 100
and Social Stories peer participation
ROCK Approach 117
87–95 and speech generating
routines 116–18
and structured physical devices 35–7
environments personality
96–105 and speech generating Saffran, R. 112, 113
and visual supports devices 30–2 Scotese-Wojtila, L. 120
65–86 pervasive developmental sensory integration
Linfoot, K. 50, 52 disorder (PDD) 109–11
and stages of mourning Shook, G.L. 112
11–12 sign language
McErlean, T. 75 defined by American and symbolic language
McIntosh, K. 22 Psychiatric systems 49
Mailloux, Z. 109, 110, Association (APA) Simpson, R.L. 112
111 12 Smith Roley, S. 100, 109,
Massey, N.G. 65, 73 picture discrimination 110, 111
mini-schedules 82–3 ability social interaction
More Than Words and Picture Exchange and speech generating
(Sussman) 116 Communication devices 26–9
System 44–5
143
Social Stories S.U.C.C.E.S.S. approach Vicker, B. 38, 42, 44

benefits of 87 120 visual supports
description of 87–8 Sussman, F. 116, 117 and behavior 70, 72–3
goals and objectives symbolic language systems benefits of 65–6
138–9 benefits of 46 and calendars 69, 71,
and story boxes 92 communication binder 84
and symbols 90 48 and choice boards
and use of video 92 communication board 69–70
when to use 88, 92–3 47–8, 59 and communication
writing 88–92 communication page 73–4
speech generating devices 46, 56 customizing 84–5
(SGDs) communication wallet description of 66
benefits of 21 48 development of 74–9
and communication cost of 51 “Fold-up” 70, 72, 85
32–4, 35 description of 46–50 goals and objectives
and consistency 52 and gestures 49 138–9
and curriculum 29 goals and objectives introducing 80–2
examples of 21–2 136–8 and mini-schedules
goals and objectives and language 82–3
134–5 development 53 and picture schedules
in peer participation materials for 50–1 66–8, 72–3, 74–9
35–7 objects for 49 reasons for using 72–4
reasons for using 22 and predictable and timing 83–4
and social interaction vocabulary 54 when to use 79–80
26–9 reasons for using 50–1 vocal approximations
and student as secondary and symbolic language
participation 26–34 communication systems 50
and student personality system 51, 57–8
30–2 and sign language 49
Wallin, J. 38, 39, 88, 90,
and teacher and students with
92, 93, 112
participation 34–7 limited vocabulary
Wheeler, J.J. 65, 72, 73,
as teaching tool 34–5 57
75
types of 21–2 and vocabulary sets 53
Wisconsin Assistive
ways of using 23–4 and vocal
Technology Initiative
when to use 25–6 approximations 50
75, 80
START 21, 22, 23 ways of using 52–3
Stephenson, J. 50, 52 when to use 54–8
structured physical Zimbleman, M. 73
environments
TEACCH 66, 97, 99, 117
benefits of 96
and structured physical
description of 97
environments
goals and objectives
100–5
140–41
teaching
organizing 98–100
reasons for 97–8
devices 34–5
and TEACCH 100–5
when to use 103–5
144

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Rising to New Heights of

Carol L. Spears and

Jessica Kingsley Publishers

Copyright © Carol L. Spears and Vicki L. Turner 2011

Library of Congress Cataloging in Publication Data

British Library Cataloguing in Publication Data

ISBN 978 1 84905 837 7

PART I: Alternative-Augmentative Communication

PART II: Strategies to Support Learning 63

PART III: Resources 107

Appendix 1 National Organizations 122

effective strategies that facilitate learning, improve behavior, and

(b) Failure to develop peer relationships appropriate to

B. Delays or abnormal functioning in at least one of the following

What do we currently know?

what is the cure? In Rising to New Heights, we do not address either

• When is the strategy best used (with examples and

• have trouble understanding other people’s feelings or talking

Especially for parents

or other disability. The balloon rises at the onset of mourning and

Imagine initiating an exchange with another individual, only to

to relay mutually understood messages. Instruction on Alternative

Who would benefit from the use of speech W

What are SGDs? W

a dedicated system is the Vantage Lite (manufactured by Prentke

W Why are SGDs used in the classroom setting?

How should SGDs be integrated in the classroom? H

Important factors to consider when using SGDs

ôÃ´ classroom or subject teacher

When should SGDs be used? W

Burns (2005) identified classroom settings as priceless

W When student participation is a factor

Figure 1.1 Greeting on arrival at school (a)

Figure 1.2 Greeting on arrival at school (b)

“Would you help

Figure 1.3 Communicating on arrival (a)

“There’s a note from

Figure 1.4 Communicating on arrival (b)

Figure 1.5 Answering questions on arrival (a)

Figure 1.6 Answering questions on arrival (b)

Do you want breakfast?

• How many girls are here today?

Figure 1.7 Weather

Figure 1.8 Circle or group time

Figure 1.9 Interaction in the classroom

attributes should be considered when using a device. The need and

Figure 1.10 Meal or snack time

Figure 1.11 Free time (a)

Figure 1.12 Free time (b)

W When teacher participation is a factor

abilities as well as limited knowledge on where and how to find

Figure 1.13 Bingo

“I had a good lunch.”

“Lunch was awful.”

“My teacher was absent.”

Figure 1.14 Messages from school to home

providing a wrong answer. Group and playtime activities offer many

When peer participation is a factor W

Where can you get help? W

W Who uses the Picture Exchange Communication