How to Make and Use Visual Supports at Home: A Step-by-Step Guide

What are visual supports?

A visual support is anything a person can see that helps them understand, remember, predict or communicate. Adults use them constantly: shopping lists, wall calendars, signs on doors, the map at a train station. For children who find spoken language hard to process quickly, the same idea can make the day far easier to follow.

The reason is simple. Spoken words last about as long as it takes to say them. A picture stays put. A child can look at it again after they have been distracted, after they have calmed down, or when they need reassurance that the plan has not changed. A card also says the same thing every time, in the same tone, which is more than any tired adult can promise.

Common visual supports include daily schedules, now-next strips, first-then boards, choice boards, task strips that break a job into steps, wait cards, help and break cards, countdowns, feelings boards, social narratives and communication passports.

Do visual supports really help? What does the evidence say?

Most of the formal research is about autistic children and young people, and the guidance is consistent. The UK's National Institute for Health and Care Excellence guideline on supporting autistic children and young people (CG170) asks services to take the physical environment into account, including by providing visual supports such as words, pictures or symbols that are meaningful for the child or young person.

In the US, the National Clearinghouse on Autism Evidence and Practice (NCAEP) published a 2020 review of intervention research from 1990 to 2017 covering children and young people from birth to 22, and confirmed visual supports as an evidence-based practice. The National Autism Center's National Standards Project lists Schedules and Story-based Intervention among its established interventions for people under 22.

In everyday practice, schools and therapists also use visual supports with children who have ADHD, language disorders, learning disabilities and anxiety. A common worry is that pictures will stop a child from talking. The American Speech-Language-Hearing Association states that available research does not support the idea that augmentative and alternative communication reduces a child's motivation to speak, and notes it can help natural speech. If you have concerns about your own child's speech, ask a speech and language therapist.

How do I choose the right visual support?

Start with the hard moment, not the product. A full-day schedule is excellent for a child who does not know what is coming next, but it does nothing for a child who struggles with the end of screen time or the feeling of a hair wash. Name exactly when things go wrong, make your best guess at what is hard, then match a support to it.

Should I use photos, symbols or written words?

Think of a ladder from real to abstract: a real object (the actual cup), a photo of that cup, a drawn symbol of a cup, and the written word. Children differ in which rungs they can use, and many use several at once. A quick check: put two real objects in front of your child and ask for one by name, then try the same with photos, then symbols, then words. Start one rung below the highest level that worked easily.

Keep cards simple: one idea per card, a plain background, a thick outline and a short label in the words your family actually uses. Trial cards on paper for a week before you laminate them. If school already uses a particular symbol set for key words such as toilet, help and finished, use the same pictures at home.

How do I make a visual schedule step by step?

A schedule works when it is short, truthful and owned by the child. Here is a simple way to set one up.

• Choose the length: three or four steps for a young child or new user, rarely more than six.
• Choose one direction, top to bottom or left to right, and keep it the same everywhere.
• Put it where your child passes often, at their eye height.
• Decide what finished looks like: turning the card over, a finished pocket or a small box.
• At each change: show the card, say one or two words, do the activity, and let your child move the card.
• If plans change, show the change on the schedule before you explain it out loud.

How do I use a first-then board without it becoming a bribe?

A first-then board shows one less-preferred activity followed by one your child wants. Used well, it simply makes the order visible and promises the second part. Used badly, it turns into a threat or a bribe, which damages trust.

Keep it kind with four rules. The then activity is genuinely wanted, chosen with your child, and always delivered. The first activity is short and realistic for today. The board is shown before trouble starts, never in the middle of distress. And it is never used to withhold comfort, food, the toilet or a break. If a child cannot manage the first activity even with a clear picture, treat that as information: the activity may be too hard, too loud or too long.

How do I give my child more choice and voice?

Choice boards let your child tell you things. Offer only real options, start with two, and accept every way of choosing: pointing, looking, reaching, a word, a sign or a device. Include a way to say none of these, and respect it. Teach help, break, stop and finished cards early and honour them every time while your child learns to trust them.

If your child has little reliable speech, or seems to have much more to say than they can show, ask for an assessment by a speech and language therapist, who can advise on augmentative and alternative communication. If your child already uses AAC, keep it within reach during every routine.

How do I use visual supports for outings, healthcare visits and school?

Visual supports help most when everyone uses them the same way. A support used at home but not at school, or by one adult and not another, tends to work less well, because children notice the difference. Share a short guide that explains which cards your child uses, what each means and the exact words to say. A communication passport, written with your child, tells new adults how they say yes, no, help, stop and finished, and what helps when they are upset.

Before outings, use a simple board: where we are going, how we get there, what will happen there, and then home. Always show the end, because knowing when something finishes makes the middle easier. For healthcare visits, ask when booking whether a first or last appointment, a quiet place to wait or extra time is possible. Find photos of the building and waiting room, read a short social narrative on calm days beforehand, and hand the communication passport to the nurse or doctor at the start.

• Take a small ring of key cards everywhere: help, break, toilet, too loud and finished.
• Use a countdown of sleeps for holidays, visits and big events.
• Keep at least one familiar routine going every day when everything else is new.

How do I keep visual supports working over time?

Visual supports are living tools. Every four to six weeks, ask whether each one is being used, whether it is helping, whether it still matches life, whether your child could do more of it alone, and what your child thinks. Then keep, change, fade or stop it.

Fade one thing at a time: fewer cards, more abstract pictures, less prompting, or your child setting up their own schedule. Go back a step without fuss during illness, holidays or big changes. Teenagers may prefer phone checklists or planners, and some people use picture supports throughout life, which is entirely fine. It helps to turn the routine into an if-then plan, for example 'If it is 7.30, then I show the morning strip'. Jobulary has a practical guide to if-then plans that make habits stick.

If you would like a ready-made set of original printables, a planner that tracks use and review dates, and templates for school, The Visual Supports Kit from Bodhih Training brings the whole method together. Parents who want to reflect on their own caregiving decisions can also try the Family and Elder Caregiving Judgment on AssessAll.