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Visual Schedules and Autism Ranking: Insufficient/Mixed evidence

Child with autism

Visual schedules (also known as daily schedules, across-task schedules, within-task schedules or mini-schedules) are a type of visual prompt used to help individuals predict or understand upcoming events.

Visual schedules are based on the idea that autistic individuals may have difficulty understanding what will happen next. Visual schedules use pictures to show which activities will occur and in what sequence.

A visual schedule can be created using photographs, pictures, written words, physical objects or any combination of these items. Schedules can be put into notebooks, onto a wall or schedule board or onto a computer.

Visual schedules have been used for a variety of purposes including to increase independence, to improve on-task behaviour, to improve communication and social skills, and to reduce problem behaviours.

Visual schedules are sometimes used alongside other interventions (such as video modeling) or within multi-component programmes (such as the SPELL programme and the TEACCH programme).

Our Opinion

There is no high quality research evidence to suggest that visual schedules have any effect on the core features of autism or provide any other benefits.

There is some very low quality research evidence (one group study and over 20 single case design studies) to suggest that visual schedules may provide some benefits (such as increased independence) for some autistic children. However, the research also suggests that visual schedules may only work if the children have been taught how to use them and are prompted and rewarded for using them.

Visual schedules are relatively cheap and easy to make, can be used for a range of different activities and in different settings, and can be readily adapted to meet the needs of different individuals. Because of this, we believe that they may be a useful intervention for some autistic children, provided that they are personalised to meet the needs of each child.

There is a need for further research which uses more scientifically robust, experimental methodologies with larger numbers of participants. That research should examine issues such as which elements of visual schedules (such as different formats, providers, settings etc.) if any, are the most important for which outcomes for which groups of people.

Disclaimer

Please read our Disclaimer on Autism Interventions


Audience

Visual schedules were originally developed for use with autistic children. According to Banda and Grimmett (2008), there are several reasons why visual schedules may be especially helpful to autistic people.

“Individuals with autism may have difficulty processing auditory information, instead responding to visual input as their primary source of information. Also, they often prefer objects over people, and when observing another person they tend to focus on physical features rather than attending to the person as a whole. Visual support systems may prompt students with autism to perform a specific action, anything from the next step in a sequenced activity to transitioning to the next class in their schedule. In addition, visual systems may provide predictability and concrete steps that need to be completed within a daily schedule (e.g., classroom transitions) or within a single activity (e.g., brushing).”

Aims and Claims

Aims

According to Lequia et al (2012), different visual schedules may have different aims.

“The aim or purpose of activity schedules can vary. For example, some schedules may be used to increase predictability in a daily schedule, whereas others may be used to promote self-management. According to Quill, the purposes of activity schedules range from anticipating events of the day to organizing time, space and instructional procedures. Providing children with activity schedules to supplement verbal input during and between activities or routines may reduce the likelihood of challenging behavior. This combination of verbal and visual communication may increase the likelihood that children with ASD will understand behavioral expectations and anticipate the next step in their routine.”

Claims

A number of people have made claims about the use of visual schedules for autistic individuals. For example,

  • Banda and Grimmett (2008) claimed that “Results across studies indicate that activity schedules enhanced social interactions and on-task and transition behaviors. Also, investigators in some studies used activity schedules to decrease students’ tantrums and other problem behaviors during transitions.”
  • Knight et al (2015) claimed that “Visual supports, like VAS [visual schedules], are non-intrusive prompts that can be used to assist students with ASD in transitioning from one activity to the next (e.g., math to reading), or within an activity (e.g., calendar to singing songs as part of circle time). The use of visual supports can reduce student dependence on caregivers if the student learns to use the visual support independently to stay on-task and on-schedule.”

Key Features

Visual schedules (also known as daily schedules, across-task schedules, within-task schedules or mini-schedules) are a type of visual prompt used to help autistic individuals to predict or understand upcoming events.

Visual schedules use pictures to show which activities will occur and in what sequence. A visual schedule can be created using photographs, pictures, written words, physical objects or any combination of these items. The actual materials used may depend upon the individual’s abilities as well as on what the schedule maker has available. Schedules can be put into notebooks, onto a wall or schedule board or onto a computer.

A daily or across-task schedule shows the individual all of the activities he or she will undertake during a single day. A within-task or mini-schedule shows the individual all of the steps he or she needs to take to complete a specific activity, such as eating a meal.

Visual schedules can be used between routines (such as moving from a classroom to a physical education setting) or within the student’s daily routines (such as moving from shaving to brushing teeth during a hygiene activity).

Visual schedules are usually created by a teacher or parent who then teaches the child how to use them. The teacher or parent may use a range of behavioural techniques (physical or verbal prompts and/or praise and rewards) to encourage the child to use the schedules. Over time, the teacher or parent may reduce the support they provide so that the child is able to use the schedules by themselves. Eventually the child may learn to create their own schedules.

Visual schedules are sometimes used alongside other interventions (such as video modeling) or within multi-component programmes (such as the SPELL programme and the TEACCH programme).

Cost and Time

Cost

The costs of using visual schedules will depend on who is creating the schedules, the processes and materials they use to create them, how many of them they create and how long it takes to teach the recipients to use them.

Time

The time to create visual schedules will depend on who is creating the schedules, the processes and materials they use to create them, how many of them they create etc. In practice, it is possible to create some schedules within a minute or two.

The amount of time it takes to actually use the schedule will depend on how long it takes to teach the child to use it, how often the child needs to look at it, and whether the child changes the schedule (for example, by removing an item) once an activity is completed and so on.

Risks and Safety

Hazards

There are no known hazards for visual schedules. However Lequia et al (2012) noted that, in some circumstances, the use of visual schedules could lead to challenging behaviour in some children and that appropriate strategies should be put in place.

“… the findings of several studies suggest that activity schedules, when used in specific situations, may themselves elicit challenging behavior. In a study conducted by O’Reilly et al. (2005), there was a consistent increase in challenging behaviors when transitioning from a play condition to a demand condition. Similarly, in another study (Massey and Wheeler, 2000) higher rates of challenging behavior were observed during leisure activities when an activity schedule was implemented. These findings suggest that activity schedules are often antecedents to demands, or are considered demanding themselves, and when used to prompt a student to transition from a highly desired activity (i.e., play) to a non-preferred activity (i.e., classroom instruction) may be associated with challenging behavior. During such transitions, children with ASD may engage in challenging behavior to escape non-preferred activities or to obtain a preferred activity or item. In such situations, teachers, parents, and other caregivers should be prepared to implement additional behavior intervention strategies.”

Contraindications

There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for visual schedules.

 

Suppliers and Availability

Suppliers

Visual schedules can be created by anyone anywhere using very simple materials.

Credentials

There are no formal qualifications for people using visual schedules, since any individual, parent or carer can create and use them.

History

According to Knight et al (2015), visual schedules were developed as one of the components of the TEACCH model.

“Originating from the Treatment and Education of Autistic and Communications-Handicapped Children (TEACCH) model, VAS [visual schedules] are part of an overarching category known as visual supports. Visual supports include visually-enhanced physical environments, organization of materials (e.g., shoe box tasks), instructions (e.g., picture instructions, graphic organizers, structured worksheets) and instructional techniques (e.g., color highlighting, Comic strip conversations), as well as visual cues to support receptive and expressive communication (e.g., TEACCH and PECS).”

Current Research

We have identified more than 20 studies* of visual schedules as an intervention for autistic individuals published in English language, peer-reviewed journals. These studies included more than 100 participants aged from three years old to adult but the majority of studies looked at children.

Some of the visual schedules were created by academic researchers, some by teachers and some by parents. Some were presented as line drawings, some were presented as photos, some were presented as videos, and some were presented in multi-media formats via electronic devices.

The studies were conducted in a variety of locations including schools, clinics and family homes although most were conducted in schools.

Most of the studies looked at visual schedules as standalone interventions, while a small number of the studies looked at visual schedules combined with other interventions (such as graduated guidance) or compared visual schedules with other interventions (such as video modelling).

  • Some of the studies (such as Newman et al, 1995) reported improvements in dealing with transitions in the participants.
  • Some of the studies (such as MacDuff et al, 1993) reported improvements in complying with tasks or in trying out new tasks in the participants.
  • Some of the studies (such as Mechling and Savidge (2011) reported improvements in adaptive skills (such as cooking) in the participants, although another study (Mechling and Gustafson, 2008) reported mixed results when trying to teach cooking skills.
  • Some of the studies (such Breslin and Rudisill, 2011) reported improvements in motor skills in the participants.
  • Some of the studies (such as Krantz et al, 1993) reported improvements in a wide range of areas (such as increases in children's engagement and social initiations and decreases in disruptive behavior).

*Please note:

  • Because there are so many studies on this topic we have not included those studies with fewer than three participants in this section. However, you can find details of some of those studies, and other publications on visual schedules, in our publications database.
  • We have not included studies where visual schedules were one component of multi-component interventions such as TEACCH.

Status Research

There are a number of limitations to all of the research studies published to date. For example

  • The overwhelming majority of studies consisted of single-case designs with 6 or fewer participants.
  • The single group design study was a randomised controlled trial but it had only 14 participants.
  • Some of the single-case design studies used relatively weak methodologies (such as an ABAB design or convenience samples).
  • Some of the studies did not provide enough details about the participants, such as whether they had a formal diagnosis of autism, intellectual ability etc.
  • Some of the studies did not independently verify the diagnosis of autism using established diagnostic tools like the ADOS or ADI-R.
  • Some of the studies did not examine key aspects of the intervention (such as the role of instruction and reinforcement alongside the use of visual schedules).
  • Some of the studies did not examine the effectiveness of visual schedules when transitioning from play or free time to more demanding conditions (such as compliance with teacher instructions).
  • Most of the studies did not identify if visual schedules had any beneficial effects in the medium to long term.
  • Some of the studies did not identify if visual schedule had any benefits in real world settings.
  • There are no studies which involved autistic people in the design, development and evaluation of those studies.

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’

Future Research

Summary of Existing Research

Individual studies

There is no high quality research evidence to suggest that visual schedules have any effect on the core features of autism or provide any other benefits.

There is some very low quality research evidence (one group study and over 20 single case design studies) to suggest that visual schedules may provide some benefits (such as increased independence) for some autistic children. However, the research also suggests that visual schedules may only work if the children have been taught how to use them and are prompted and rewarded for using them.

Research reviews

There are a number of scientific reviews of visual schedules stories as an intervention for autistic individuals, all of which have concluded that visual schedules can be effective. For example, Knight et al (2015) reported that

“Results suggest that VAS [visual schedules] can be considered an [evidence based practice] for individuals with ASD, especially when used in combination with systematic instructional procedures. VAS can be used to increase, maintain, and generalize a range of skills of individuals from preschool through adulthood in a variety of settings (e.g., general education, community).”

However it is important to note that some of these reviews accept single-case design studies with small numbers of participants as evidence-based practice whereas we do not. This means that we do not necessarily agree with all of their conclusions, particularly in terms of whether or not visual schedules are an evidence-based practice.

Recommendations for Future Research

Future studies should

  • Use more scientifically robust, experimental methodologies with larger numbers of participants.
  • Provide more details about the participants, such as whether they had a formal diagnosis of autism, intellectual ability etc.
  • Examine which elements of visual schedules (such as different formats, providers, settings etc.) if any, are the most important for which outcomes for which groups of people.
  • Examine the role of instruction and reinforcement when using visual schedules.
  • Examine the effectiveness of visual schedules when transitioning from play or free time to more demanding conditions (such as compliance with teacher instructions).
  • Compare visual schedules with other interventions which are designed to achieve similar results, such as video modelling or other behavioural techniques.
  • Continue to examine how important visual schedules are as one of the elements within comprehensive, multi-component, treatment models (such as TEACCH).
  • Identify if visual schedules can be used in areas not previously examined, for example, improving study skills.
  • Identify if visual schedules have any beneficial effects in the medium to long term.
  • Identify if visual schedules have any beneficial effects in real world settings
  • Involve autistic people in the design, development and evaluation of those studies.

Studies and Trials

This section provides details of scientific studies into the effectiveness of visual schedules for autistic people which have been published in English-language, peer-reviewed journals.

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Studies and Trials


Other Reading

This section provides details of other publications on this topic.

You can find more publications on this topic in our publications database.

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Other Reading


Updated
17 Jun 2022
Last Review
01 Nov 2017
Next Review
01 Feb 2024