ATN@Work: Visual supports ease medical visits for kids with autism

This article is written by David Crnobori, education and behavior consultant with the Center for Child Development at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center, in Nashville. Vanderbilt is one of 14 sites in the Autism Speaks Autism Treatment Network.

When a child with autism arrives for an appointment at our clinic, there are some of the important questions we try to answer visually. We know that individuals with autism respond well to visual information. Behavioral therapists and special-education teachers have long used visual supports in the classroom. Here at Vanderbilt, we’re expanding their use in pediatric healthcare.

Merriam-Webster defines a prosthesis as “an artificial device to replace or augment a missing or impaired part of the body.” I think this definition applies so well to visual supports. 

I’ve come to view visual supports as more than another autism intervention. I see them as prosthetic devices. Merriam-Webster defines a prosthesis as “an artificial device to replace or augment a missing or impaired part of the body.” I think this definition applies so well to visual supports. We use them to support the neurological and developmental differences shared by many individuals with autism. 

Our goal is to provide the best care possible for children with developmental disabilities. This includes providing the necessary supports to turn our clinic into an autism-friendly environment.  

Visual supports in pediatric healthcare

From the time our patients check in to the time they leave, we provide visual supports to help address as many of their concerns as possible.  Here are some examples of how we do this:

• What am I going to do today? In the waiting room, we start the visit with a customized picture schedule with photos of each step of the child’s appointment. Our visual schedules are portable so the patient and his or her parents can carry them through the clinic.
• What are you going to do to me? In addition to the visual visit schedule, we have visual task lists and instructions for each procedure that will take place. For example, we have a task list for taking vitals such as blood pressure, weight and height. 
  • We use another visual support to help communicate the instructions required to complete each task. 
  • We encourage our patients to remove pictures from their schedules as they complete each task, a step that helps provide them with a sense of control over the situation. 
• When am I finished? Removing pictures from their schedules provides our patients with a tangible way to track their progress to the end of the visit. Some patients appreciate a little more support in this regard. A visual timer such as the visual app I have on my smart phone. Appointments typically have set times. But if needed, I’ll consult with the providers on time estimates and set the timer accordingly.  
  • The last picture on the visual schedule – right after the visit to the treasure chest – shows a child leaving the clinic with the caption “all done.” 

In addition to easing clinic visits for our young patients, our extensive use of visual supports allows us to demonstrate their usefulness to parents. We send many of our parents home with packets of visual supports, including a copy of the Autism Speaks ATN/AIR-P Visual Supports Tool Kit. 

We love hearing parents describe how they’ve put these powerful tools into action in their children’s lives. We also welcome their questions on how apply them in different situations.