USING VISUAL SYSTEMS TO

SUPPORT PUPILS WITH AUTISM

SPECTRUM DISORDER:

EXPLORING SEN TEACHERS’ PERCEPTIONS ON

THEIR IMPLEMENTATION AND EFFECTIVENESS

Claire Skilbeck

Final Year Dissertation

EDUC: 3304

An Extended Essay submitted in partial

fulfilment of the requirements for a BA Honours

in Education Studies with Psychology

at

De Montfort University Leicester

4th

May 2012

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Acknowledgements

I am sincerely grateful and want to thank all of those who have

supported me during my dissertation journey.

I would especially like to thank my initial supervisor, Nicola Savvides

and subsequent supervisor, Cathy Bonner, for their help and support

in focusing my topic and providing considerable advice.

I am extremely grateful to the teachers, especially those at Oaklands

School, Leicester, who kindly participated in my research and

enhanced my dissertation significantly.

Sincere thanks to my kind and dependable friends, who have always

supported me, proof read my work and asked after my progress

throughout.

Special thanks to my wonderful family, especially my Mum and Dad

who have been beside me, had faith in me and encouraged me every

step of the way. Thank you.

Finally I would like to dedicate this piece of work to all of the children

with autism, who I have had the pleasure of working with and

supporting over the years.

It is they who have inspired this dissertation.

Thank you all x

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TABLE OF CONTENTS

Page No.

i.

ABSTRACT 5

ii.

ABBREVIATIONS 6

1

SCOPE AND RESEARCH AIM 7

1.2 SCOPE 7

1.3 KEY ARGUMENT/S 7

1.4 RESEARCH AIM AND KEY QUESTIONS 7

1.5 THE CENTRAL QUESTION OF RESEARCH 8

1.6 METHODOLOGY – BRIEFLY OUTLINED 8

2

INTRODUCTION 9

2.2 CONTEXT – DEFINING AUTISM 9

2.3 AUTISM AND MAINSTREAM EDUCATION 11

2.4 TEACHING STRATEGIES – THE VISUAL APPROACH 13

3 THEORETICAL FRAMEWORK 15

3.2 THE TRIAD OF AUTISM 15

3.3 A THEORY OF AUTISM 17

3.4 A VISUAL STRENGTH 20

4 LITERATURE REVIEW 22

4.2 AUTISM SPECTRUM DISORDER AND INCLUSIVE EDUCATION 22

4.3 AUGMENTED AND ALTERNATIVE COMMUNICATION 24

4.4 INTERVENTIONS IN PRACTICE 29

4.5 LIMITATIONS OF VISUAL SYSTEMS 38

5 METHODOLOGY 43

5.2 RATIONALE 43

5.3 THE CENTRAL QUESTION OF THE RESEARCH 43

5.4 RESEARCH STRATEGY 43

5.5 RESEARCH SITE 44

5.6 RESEARCH SAMPLE 44

5.7 RESEARCH TIME-FRAME 45

5.8 DATA COLLECTION & PROCEDURE 45

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5.9 ANALYTIC STRATEGY 46

5.10 DELIMITATIONS & LIMITATIONS 47

5.11 RELIABILITY 48

5.12 ETHICAL CONSIDERATIONS 48

5.13 PERSONAL BIOGRAPHY 49

6

ANALYSIS & DISCUSSION 51

7

CONCLUSION 57

8

REFERENCES 61

9

APPENDICES 69

9.2 APPENDIX 1 - OBJECTS OF REFERENCE 69

9.3 APPENDOX 2 - PHOTOS OR PICTURE SYMBOLS REPRESENTING

OBJECT OR ACTIVITY 70

9.4 APPENDIX 3 - PECS PHASES 71

9.5 APPENDIX 4 - PECS SENTENCE STRIPS 72

9.6 APPENDIX 5 - TEACCH EXAMPLES 73

9.7 APPENDIX 6 - QUESTIONNAIRE [BLANK COPY] 77

9.8 APPENDIX 7 - ETHICS FORM AND APPROVAL 79

9.9 APPENDIX 8 - DATA SET – PARTICIPANTS QUESTIONNAIRE

RESPONSES 80

9.10 APPENDIX 9 - ANALYSIS OF QUESTIONNAIRE DATA REPRESENTED

IN THEMES 87

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i. Abstract

Individuals on the autistic spectrum have difficulties functioning in key

areas, such as social interaction, verbal and non-verbal communication and

flexibility of thought. These are recognised as the triad of impairments (APA,

2000). However those with autism are argued to have a visual strength in

processing information; therefore educational interventions that are grounded in

visual exchange are recognised as being beneficial in supporting those on the

spectrum (Jones, 2002; Meadan et al., 2011; Hodgson, 1996; Thompson, 2009;

Autism Working Group, 2002; Rao, & Gagie, 2006; Mirenda, 2003; Dodd, 2005).

This study explored, evaluated and critiqued relevant literature and on-going

research into visual systems, their efficacy and the theoretical underpinning

behind their development. Visual supports are understood as: ‘’Tools that are

used to increase the understanding of language, environmental expectations, and

to provide structure and support for individuals with autism spectrum disorders

(ASD)’’ (Thompson, 2010).

The impact of these systems was investigated further by exploring the perceptions

of Special Educational Needs (SEN) teachers. Their perceptions were gained

through open ended questionnaires and their responses were analysed using a

thematic analysis. The study was guided by the following research question:

‘’what impact does the implementation of visual systems, that support pupils with

ASD, have on their educational experience?’’

The research, despite identification of potential limitations, found that visual

systems, within education, are highly effective tools for supporting those with

autism. They have the potential to maximise communication, provide an

environment in which expectations are explicit and information can be processed

effectively and where individuals with autism can achieve their full potential.

Key Words: Education, Autism, ASD, AACs, Visual Supports, Interventions,

Communication, PECS, TEACCH, Teachers’ Perceptions, Thematic Analysis.

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ii. Abbreviations

AAC: Augmented and Alternative Communication

AET: Autism Education Trust

APA: American Psychiatric Association

ASD: Autism Spectrum Disorder

BERA: British Educational Research Association

DfE: Department for Education

DfEE: Department for Education & Employment

DfES: Department for Education and Skills

DoH: Department of Health

DSM: Diagnostic & Statistical Manual of Diseases

PECS: Picture Exchange Communication System

SEN: Special Education Needs

TEACCH: Treatment and Education of Autistic and related

Communication handicapped CHildren

ToM: Theory of Mind

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1. Scope and Research Aim

1.2. Scope

This dissertation considers the implementation and efficacy of visual systems to

support individuals with low functioning autism and minimal or no functional

language, within the wider context of educational interventions for those with a

special educational need (SEN). It will specifically explore, evaluate and critique

relevant literature and ongoing research into visual systems, and their impact will

be further investigated by gaining the perceptions of teachers within the context of

special educational school settings, which have provision for autistic specific

classes for primary aged children (4-11 years of age).

1.3. Key argument/s

It is argued that visual systems, despite potential limitations, are highly effective

tools for supporting those with autism. They assist in maximising communication,

providing an environment in which expectations are explicit and information can

be processed effectively and assisting individuals with autism in achieving their

full potential.

1.4. Research Aim and Key Questions

The aim of this research is to explore SEN teachers’ perceptions of the

implementation and efficacy of visual systems used within the classroom

environment to support pupils with ASD and establish in what way the systems

impact on the pupils’ educational experience. The teachers work in a setting for

children with special educational needs (SEN), which is classified by the

government as individuals with disabilities or developmental delays, making it

more difficult to fully access education and effectively learn (DirectGov, 2012).

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The term ‘perception’ refers to the how the teacher observes their direct

environment based upon experiences with their pupils with ASD, where meaning

and context is sensed and applied to observation of pupils in relation to a specific

implementation (Ahmad & Aziz, 2009). ‘Educational experience’ refers to the

teachers’ objective perception of pupils’ access, engagement and connection with

school within the time frame they have attended and ‘impact’ is recognised as the

teachers perceived efficacy an implementation has had on pupils’ educational

experience.

1.5. The central question of the research:

What impact does the implementation of visual systems, that support pupils with

ASD, have on their educational experience? [A teachers’ perception]

The research will be guided by the following questions:

What types of visual systems have been implemented within the classroom and

school environment to support pupils with ASD? What is the purpose behind

implementation of the strategies? What are the teachers’ perceptions of the

effectiveness of these strategies? And finally have teachers experienced any

unexpected effects from the implementation of strategies?

1.6. Methodology - Briefly Outlined

The research took an interpretive epistemological position and qualitatively

explored seven SEN teachers’ perceptions through the analysis of open-ended

questionnaires. The analytic strategy used was thematic analysis using principles

set out by Braun and Clarke (2006). Ethical considerations were followed

throughout and adhered to the BERA Ethical Guidelines for Education Research

(2011) and ethical approval was received prior to conducting the research.

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2. Introduction

2.2. Context – Defining Autism

“If I had a world of my own, everything would be nonsense. Nothing would be

what it is, because everything would be what it isn't. And contrary wise, what is, it

wouldn't be. And what it wouldn't be, it would. You see?”1

Throughout their lifetime, individuals with Autism Spectrum Disorder (ASD)

experience a myriad of challenges connected to the triad of impairments; this

affects the development of appropriate social interactions, aspects of verbal and

non-verbal communication and flexibility of thought, resulting in an impairment

in imagination (Jones et al., 2008; Autism Working Group, 2002). Arguably the

most problematic features of autism are communication and information

processing (Rao & Gagie, 2006). It is recognised that for any language to be

acquired an individual needs a reason or motivation to communicate. This is often

absent in those with a diagnosis of autism and therefore many fail to ever develop

functional speech (Slater & Bremner, 2003; O’Kane & Goldbort, 1998; Jones,

2002). The following conditions are necessary for successful communication to

take place; an understanding of cause and effect, the intention to communicate, a

method of communication, a communication partner and a communication topic

(Marckel, Neef & Ferreri, 2006). Individuals with autism, defined fully in the

theoretical framework of this dissertation, are recognised as a complex and unique

learning group as they have substantial difficulties in some or all of these areas

and therefore need support in identifying an alternative means of communication

(Jones et al., 2008; Sharp, Ward & Hanklin, 2009; Leblanc, Richardson & Burns,

2009).

1 Carroll, 2010 p.126

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‘’Autism is a puzzling disorder. It begins in early childhood, and disrupts

many aspects of development, leaving the child unable to form social

relationships or communicate in the usual way.’’

(Baron-Cohen &

Bolton, 1993, Blurb)

Due to increased awareness, enhanced diagnosis and improved diagnostic tools,

the prevalence2 and incidence

3 of autism is continually being evaluated.

According to the Medical Research Council (Ashton & Smith, 2002) it is unclear

as to whether there is an ‘actual’ increase in prevalence or the factors relating to

establishing a diagnosis are impacting statistics (Ashton & Smith, 2002). With

this, an understanding of the disorder has grown substantially, with new research

constantly being conducted, to ever increase knowledge in the hope of helping

those with autism more effectively. This insight has also been significantly

informed by adults who have the disorder and who have provided an inside

perspective of living with autism and added significantly to this knowledge base

(The Telegraph, 2012; Jones, 2002; Jones et al, 2008; Roberts, 2003).

There have been many differing labels attached to those with autism which have

been used interchangeably within research and practice4 (Ospina et al., 2008). The

broader term Autism Spectrum Disorder (ASD), developed by Lorna Wing (1996,

as cited in Jones et al, 2008), has been used throughout this dissertation, to refer to

a group of individuals who share common developmental difficulties and display

significant deficits in the core areas, necessary for autism to be diagnosed.

2 Prevalence rate refers to the number of individuals with autism in a particular age

range (Roberts, 2003). 3 Incidence refers to the number of new cases in a specified time in a specified population

(Wing, 1996 as cited in Roberts, 2003). 4 These include; Aspergers Syndrome (AS); High Functioning Autism (HFA); Pervasive

Developmental Delay-Not Otherwise Specified (PDD-NOS); Semi-Pragmatic Disorder

(SPD) Kanner’s Autism and Atypical Autism (AA) (Whitaker, 2001; Jones et al., 2008;

Jordan, Jones & Murray, 1998).

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Awareness of other features that manifest itself in the spectrum of autism have

been acknowledged within this dissertation, however individuals with an absence

of functional language has been the main scope (Whitaker, 2001; Jones et al,

2008; Roberts, 2003). Caution however needs to be made about making general

assumptions about the ASD population. It is evident that for a diagnosis an

individual needs to have an impairment in the three core areas, however, it is

highly important when considering interventions within fields such as education,

the needs of those diagnosed must be considered and supported on an individual

basis, for the most appropriate intervention to be found (Jones, 2002).

2.3. Autism and Mainstream Education

It has been argued that the role and aim of education is one where children receive

skills and knowledge that are culturally valued and that enables their full

participation in society (Jones et al., 2008, Farenga & Ness, 2005; Kassem, Mufti

& Robinson, 2006; Bartlett & Burton, 2007). This entitlement is the same for

children with ASD, however, education additionally needs to support the potential

difficulties faced and find ways of reducing problems that may manifest within

school (Jones et al., 2008). Pupils with ASD, find school is often one of the most

challenging environments where problems are manifested out of coping with the

demands of traditional teaching, which relies heavily upon verbal prompts,

instruction, whole class concentration and the recording of information (Sharp,

Ward & Hankin, 2009; Grandin, 1995; Jones et al, 2008). For individuals with

ASD, this difficulty is likely connected to deficits in communication and

information processing, where challenges are apparent in the comprehension and

organisation of their environment and the inability to retain certain language

based information, evident within traditional classrooms and teaching methods

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(Hodgdson, 1995). Therefore, some mainstream provisions may fail to meet the

needs of those with ASD, especially those towards the severe end of the spectrum,

classified as low-functioning autism (BBC, 2006; Frodsham, 2011). When

difficulties occur in accessing the curriculum and classroom environment, which

can be overly stimulating for those on the spectrum, it may lead to further

withdrawal and associated negative and avoidance behaviours. This can result in

the educational experience of an individual with ASD being anxiety provoking

and ineffective (Sharp, Ward & Hankin, 2009).

Mainstream schools in the past have been reluctant to accept pupils with an SEN,

especially ASD, as they believe they cannot effectively meet the needs of this

complex group of learners (BBC, 2006; Frodsham, 2011). If schools have pupils

who fail to access the curriculum, due to limited expertise of teachers and staff

and an inadequacy of training in autism, it may inevitably jeopardise their position

in league tables (Sharp, Ward & Hankin 2009; Jones, 2002, Jones et al., 2008;

Banda, et al., 2009; Dettmer et al., 2000; Leblanc et al., 2009). There are however,

an increasing number of mainstream provisions that do accommodate the needs of

individuals with ASD and take on board appropriate strategies that can be highly

beneficial (Autism Working Group, 2002). In line with this, there is a growing

number of ‘alternative’ provisions established that are purposely designed for

those on the spectrum and implement specific support. These may be within a

specialist SEN school or an ASD specific unit attached to a mainstream provision

(Autism Working Group, 2002).

The Autism Education Trust (Charman, et al., 2011), was asked by the

Department for Education (DfE) to develop a set of standards to ensure good

Page 13 of 94 p09257913

practice in all educational provision is delivered to pupils with ASD, who were

identified as needing specific support (Charman, et al., 2011; Roberts, 2003). A

summary of the literature identified a combined focus of helping an individual

with ASD to make sense of their surroundings and effectively communicate their

needs; whist actively adapting and providing an environment where they can

successfully function (Charman, et al., 2011). In accordance with this, an increase

in alternative teaching strategies and classroom alterations are becoming more

established to support individuals with ASD, especially those which focus on

visual information exchange (Charman, et al., 2011; Tissot, & Evans, 2003; Rao,

& Gagie, 2006; Preston & Carter, 2009).

2.4. Teaching Strategies – The Visual Approach

Creative, curious, out-of-the-box thinkers, visual learners learn by intuitive

leaps. They remember what they see and forget what they hear.’’5

The visual interventions in use are identified as aided modes of ‘Augmented and

Alternative Communication’ (AAC), which supplement (‘augment’) any existing

speech or act as an ‘alternative’ to verbal communication, if no functional speech

is present (Mirenda, 2003). AACs prompt individuals through a visual method of

communication, helping them process, exchange and retain a concept or message

more successfully (Johnston et al., 2003; Odom et al., 2003). Adaptations of AAC

systems and also combination approaches are often found to be beneficial by

teachers and educational facilitators who endeavour to find the most appropriate

strategy to suit the specific needs of their pupils (Kluth & Darmody-Latham, 2003

as cited in Rao, & Gagie, 2006; Tissot, & Evans, 2003; Marckel, Neef & Ferreri.,

2006).

5 Visual Spatial Resource (2012)

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Some ASD specific provisions who implement these approaches are now

recommended to become ‘centres of excellence’ by the Autism Education Trust

(Charman, et al., 2011), where substantial improvements have been made in

providing an ‘inclusive’ environment that underpins good practice in ASD and

provides an exchange of information between teachers and professionals working

within the field (Jones et al, 2008). Many ASD specialist teachers work

effectively with ASD pupils and have a good understanding of their needs and the

range of visual systems that can be successfully implemented, in order for them to

be supported and achieve their full potential within education (Jones, 2002). This

knowledge and advice is also recognised as being beneficial to disseminate to

other staff working with pupils with ASD, as teachers have a crucial role in

implementing strategies and perceiving the effectiveness of each implementations

in relation to individual pupils (Jones, 2002, Jones et al, 2008).

The significance, benefits and limitations of visual systems have been explored

within this dissertation through the evaluation and critique of relevant literature

and ongoing research. A traditional and conceptual approach was taken to review

the literature, which was critically examined and synthesized, to gain a better

understanding of visual systems, their implementation, efficacy and any potential

limitations (Jesson, Matheson & Lacey, 2011). The impact of visual systems was

investigated further, by gaining the perceptions of SEN teachers through the

analysis of open-ended questionnaires. This small scale research was not validated

by using scientific quantitative methodology; as it aimed to qualitatively explore

teachers’ perceptions as key individuals featured within their pupils’ lives and

established if the themes found are representative of literature related to AACs.

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3. Theoretical Framework

3.2. The Triad of Autism

One of the first pioneers of research into autism is accredited to Leo Kanner (1906

- 1980), who wrote a paper titled ‘Autistic disturbances of affective contact’, and

identified children with infantile autistic traits (Lyons & Fitzgerald, 2007;

Iovannone et al., 2003). The term ‘autism’ used by Kanner in his seminal paper,

originated from Bleuler, a Swiss psychiatrist, who developed the term to describe

individuals with characteristics of schizophrenia (Lyons & Fitzgerald, 2007).

Autism, now recognised as a ‘spectrum’ disorder (Wing, 1996 as cited in Jones,

2002), is a lifelong neurodevelopmental condition (Roberts, 2003; Ospina, et al.,

2008; Autism Working Group, 2002; Prior & Roberts, 2006; Charman, et, al.,

2011; Mills & Marchant, 2011) and has three central features, recognised by the

Diagnostic and Statistical Manual of Mental Disorders (APA, 2000) as the ‘triad

of impairments’6. A deficit in at least one of the triad must be present before the

age of three for a diagnosis to be given. ASD is said to affect one in one hundred

people, however accurate figures do not exist due to the complexities of diagnosis

(Jones et al., 2008, Charman et al, 2011; The National Autistic Society, 2012).

One of the characteristics of the triad is the restricted, stereotypical patters of

behaviours often displayed as a fixation or fascination with patterns of objects or

objects themselves and distress is often presented if attention, or the object itself,

is disturbed (Slater & Bremner, 2003). Repetitive motor behaviours are often

displayed and a general restricted interest is characterised by rituals or the need

6 Triad of Impairments: The development of appropriate social interactions, aspects of

verbal and non-verbal communication and flexibility of thought, resulting in impairment

in imagination (Jones et al., 2008; Autism Working Group, 2002).

Page 16 of 94 p09257913

for ‘sameness’ (APA, 2000; Whitaker, 2001). Individuals with ASD also have

difficulty establishing social friendships with peers or simply initiating more

general interactions with others (APA, 2000; Slater & Bremner, 2003). This is not

typically recognised until the age of three, however characteristics are often

evident in younger years when, as children, those with ASD fail to respond

appropriately to the caregiver, for example not responding to their voice or

reaching out for them as they approach (Slater & Bremner, 2003). This is also

featured in the absence of shared attention, such as pointing at an object to

indicate interest and initiating a response from the caregiver (Slater & Bremner,

2003). Other non-verbal communication is also impaired, which often results in

the delayed development or absence of language altogether, which occurs in one

third of those diagnosed with ASD (Jones, 2002).

Individuals with ASD, as stated, have a deficit in communicating intentionally

(Slater & Bremner, 2003), and often do not understand the purpose behind

communication, furthermore, due to the social aloofness experienced, have an

aversion to interacting with others (Jones, 2002). Pre-verbal communication such

as pointing, eye gaze or eye contact are the foundations that form communication

and typically developing children make the connection that communicating with

others is useful. However individuals with ASD fail to make this association

therefore need to be taught this explicitly (Whitaker, 2001; Preston & Carter,

2009; Charman et al, 2011). A desired item, for example a specific toy, may be

indicated by guiding the caregiver’s hand towards the object, but this is not

accompanied by eye contact or shared attention (Slater & Bremner, 2003). Issues

with pragmatics, the functional use of speech (O’Kane & Goldbart, 1998), are

also evident in individuals with ASD, who also have semantic impairments and

Page 17 of 94 p09257913

display issues deciphering and comprehending messages conveyed in language

(Jones, 2002; Charman et al, 2011). Those who do go on to develop vocabulary,

which is sometimes only ‘echolalic’ responses, still display difficulties in the

pragmatics and semantics of language (Slater & Bremner, 2003).

Many behavioural difficulties and high levels of anxiety are related to all three

features of the triad of impairment. Ritual type behaviours occur and create a

sense of consistency and reduction of anxiety, which manifests out of a failure to

understand the world around them and the demands of society; inclusive of people

they have contact with (Whitaker, 2001). As well as social understanding, the

inability to anticipate the immediate future, due to inflexibility of thought, may

also contribute to increased anxiety and challenging behaviour (Whitaker, 2001).

Arguably, one of most significant causes of negative behaviour patterns in

individuals with ASD is the inability to communicate effectively and express their

needs. This results in high levels of frustration and anxiety which is often

displayed as significant aggressive or defiant actions (Whitaker, 2001; Preston &

Carter 2008).

3.3. A Theory of Autism

There is ongoing theoretical enquiry into the aetiology of ASD, where abnormal

parenting was originally proposed as a potential cause. This has, however, been

contested by research which currently suggests there is a strong biological basis

associated to ASD (Autism Working Group, 2002). Many potential environmental

triggers, such as a virus present within the body throughout life or affecting the

developing foetus, are believed to affect the same areas of the brain which have

then interacted with an existing genetic predisposition, which then manifests itself

Page 18 of 94 p09257913

as autism (Autism Working Group, 2002; Jones et al., 2008; Jones, 2002; Roberts,

2003; Prior & Roberts, 2006). Many psychological theories have been developed

to attempt to explain the cognitive aetiology of ASD and among the most

significant are the ‘Theory of Mind’ (ToM) and ‘Executive Function’ deficit

theories and a theory of ‘Weak Central Coherence’ (Slater & Bremner, 2003).

It has been suggested by Baron-Cohen, Leslie and Frith (1985) that individuals

with ASD lack the ability to meta-represent others’ mental states and interpret

their thoughts and emotions, recognised as having a Theory of Mind (Baron-

Cohen et al., 1985; Jones et al., 2008). This hypothesis potentially accounts for the

social and communication difficulties displayed within the triad of impairments

(Baron-Cohen, 2000 as cited in Jones, 2002). However the ToM deficit has been

suggested as not accurately accounting for the full triad of impairment featured in

ASD. Whilst there is evidently a ToM deficit, this theory cannot fully explain the

repetitive features that an individual with ASD displays. The restricted and

obsessive interests are characterised by an inability to draw perceived information

together and construct an understanding. Due to the poor comprehension of the

environment and a fragmented view of the world, those with ASD become fixated

on specific details, exhibiting behaviour patterns that are meaningless and display

a miss-connection between perception and actions (Slater & Bremner, 2003; Hill

& Frith, 2003). This is presented in executive functioning issues, where

individuals may have an inability to forward plan, shift attention, adapt responses

to suit a new situation or develop new ideas, which presents as a daily challenge

(Jones, 2002; Jones et al., 2008; Hill & Frith, 2003).

Page 19 of 94 p09257913

The third cognitive theory that has been developed is identifies as a ‘Weak

Central Coherence’. This also is said to explain the attention to detail individuals

with ASD display when they present with fixated behaviour patterns. Those with

ASD fail to see the ‘bigger picture’ and instead focus on the specific details of an

object or situation, for example the wheel motion of a toy car rather than the

whole play situation (Hill & Frith, 2003; Jones, 2002). Considered together, these

three cognitive theories can provide some explanation to the defining features of

ASD (Hill, & Frith, 2003). However, no one explanation or theory has yet been

developed, by medicine, psychologists or educators, to adequately account for the

complex spectrum of autism and its aetiology (Odom et al., 2003; Leblanc et al.,

2009; Slater & Bremner, 2003).

It is evident to see that ASD impairs many functions including the ability to

process information, interpret social situations, plan effectively and focus

attention on whole representations instead of specific details (Rao & Gagie, 2006;

Prelock, 2007). In addition to this, many individuals on the spectrum have further

and often severe learning or developmental difficulties that run alongside their

autism (Slater & Bremner, 2003; Jordan, Jones & Murray, 1998; Autism Working

Group, 2002). Research, however, aims to move away from the ‘deficit model’

and endeavours to view those with ASD as having a ‘different’ perspective of the

world and instead aims to work with their autism and see the world through their

point of view (Autism Working Group, 2002). The developed understanding of

ASD, from the theories discussed, has significantly impacted on the development

of certain interventions, especially within education (Autism Working Group,

2002)

Page 20 of 94 p09257913

3.4. A Visual Strength

‘’Spatial words such as over and under had no meaning to me until I had a visual

image to fix them in my memory.’’7

Because of the ability to focus on detail and the superior concentration displayed

by many individuals with ASD, it has been discovered that they have an enhanced

ability to process visual information over information received orally. A potential

deficit in auditory information processing makes information received in this form

often difficult to comprehend (Savner & Myles, 2000; Meadan et al., 2011;

Hodgson, 1996; Thompson, 2009). Language therefore poses significant

challenges and difficulties understanding and developing communication needs to

be recognised and supported appropriately within school settings (Autism

Working Group, 2002). A number of visual supports have been developed to

utilise this visual capacity, enhancing the ability to understand instructions or

cues, but to more significantly assist those with ASD in communicating their

needs and requirements effectively (Autism Working Group, 2002; Rao, & Gagie,

2006).

The use of visual systems to communicate needs and provide an environment

inclusive of clear structure is underpinned by the principles of B.F.Skinner’s

Behavioural Theory (1961). Operant conditioning, often referred to as ‘behaviour

modification’, is employed to support communication by teaching the child to

request a desired item which is reinforced by receiving the item, therefore, in the

expectation of promoting further communicative behaviours (Roberts, 2003; Mills

& Marchant, 2011; Howlin et al., 2007; Tissot & Evans, 2003; Front & Bondy,

7 Temple Grandin, 1995 p.14, author of ‘Thinking in pictures and other reports from my

life with autism’.

Page 21 of 94 p09257913

2002; Passer et al., 2009). The ability to initiate communication using this

technique is especially vital for those who have minimal or no functional speech

which may subsequently decrease the amount of negative behaviours or anxiety

potentially displayed within a school setting (Autism Working Group, 2002; Rao,

& Gagie, 2006; Ganz, 2007; Breitfelder, 2008; Tissot, & Evans, 2003).

Page 22 of 94 p09257913

4. Literature Review

4.2. Autism Spectrum Disorder and Inclusive Education

Ben is seven years old with severe low functioning autism and no

functional speech. One morning he enters his ASD specific classroom and moves

towards his daily visual time-table. Within his class today there is a supply

teacher replacing his usual class teacher who has unexpectedly taken ill. As she is

unaware of the routine she has not put up his timetable. Ben observes this and

immediately throws himself onto the floor, thrashing his arms and legs and crying

uncontrollably. The supply teacher goes to comfort him but Ben is not

comfortable with people he does not know so kicks her with force. It takes fifteen

minutes for Ben to finally calm, assisted by a teaching assistant who periodically

works with Ben during his PECS sessions. She shows Ben a picture card of an

activity he enjoys doing and his outburst replaced with a calm and compliant boy

who takes the picture card to his work station and progresses with the activity. 8

As discussed in the introduction, all children in the United Kingdom, despite their

SEN, are entitled to an education where they receive culturally valued knowledge

and skills (Jones et al., 2008). In order for all children to receive this entitlement,

they need, to an extent, to be able to access the curriculum provided by their

school, which enables them to flourish and learn to the best of their ability (DfES,

2004). A school and classroom that is ‘inclusive of all pupils’ needs’ is vital to

ensure this takes place. It is stated within the ‘National Curriculum Inclusion

Statement’ (DfEE, 1999), that schools should provide ‘effective learning

opportunities for all pupils’. It is good practice within education today that a

school promotes an inclusive ethos, where teachers are able to assess the needs of

the pupils in their class and provide differentiated curriculum support, by adapting

8 Vignette from author’s own experience (A pseudo-name has been used to maintain

confidentiality).

Page 23 of 94 p09257913

the environment, resources and instruction appropriately to meet the learning

needs of individuals (Jones et al., 2008).

As identified in the theoretical framework of this dissertation, individuals with

ASD are a complex learning group and have differing abilities and strengths due

to the heterogeneous spectrum of the disorder (Leblanc, Richardson & Burns,

2009; Jones et al., 2008). The Autism Working Group (2002) developed by the

Department for Education and Skills (DfES) and Department of Health’s (DH)

produced ‘good practice guidance for ASD’, and indicated that ASD friendly

schools should encourage and train relevant staff to gain a better understanding of

ASD and disseminate this information to others who are in contact with any

pupils on the spectrum. The curriculum and environment should be sensitively

tailored to meet the needs of the students and take into account any identified

difficulties to ensure they succeed academically, build on their ability to socially

communicate and aim to prevent any anxieties or behaviour challenges that

manifest, due to a clash between their environment and their autism (Autism

Working Group, 2002; Jones, 2002).

There are usually a number of agencies, at any one time, working with the child,

their parents and their teacher because of the diverse nature of ASD. These are

inclusive of Speech and Language Therapists, Behaviour Support Teams, Autism

Outreach, Paediatricians, Occupational Therapists and Educational and Clinical

Psychologists (Jordan, Jones & Murray, 1998; Jones et al., 2008). Therefore it is

vital a ‘multi-disciplinary’ approach is taken to support schools and teachers,

which is not only a necessity, but also important to ensure a child is getting the

appropriate support to meet their individual needs, following a diagnosis (Jones et

Page 24 of 94 p09257913

al., 2008). Identifying an individual as having an ASD does not mean their teacher

or other professionals automatically know the most appropriate intervention to

support them. However as a result of the increased understanding surrounding

autism, in relation to the cognitive abilities of those with ASD, markers are then

provided for the eclectic and successful approaches that have been developed

(Jordan, Jones & Murray, 1998).

In order for schools to successfully include ASD learners and ensure they are

receiving an education that is effective in working alongside their autism, there

are a number of interventions and supports available to them often recommended

by support agencies or therapists (Jones, 2002). This however poses issues for a

school in determining the most appropriate and effective intervention to meet the

needs of a pupil and often one single intervention is not always sufficient (Jones,

2002).. It is recognised that most individuals with ASD benefit from at least one

support intervention, therefore schools need to continually assess each child on an

individual basis to determine which support or combination of supports will be

most appropriate for that pupil, at that particular time, therefore developing an

individualised approach (Flippin, Reszka & Watson, 2010, Jones 2002; Jones et

al., 2008).

4.3. Augmented and Alternative Communication

In the wider community visual supports of some kind, for example sign posts or

images to represent a meaning, assist most people in ‘’navigating the complexities

of daily life in a busy world’’’ (Arthur-Kelly, 2009. p. 1476). Within schools

aided modes of ‘Augmented and Alternative Communication’ (AAC) are

interventions frequently used, that are grounded in a visual form, recognised

Page 25 of 94 p09257913

within literature as being highly beneficial for those with ASD (Hodgdon, 1996.

Charman et al, 2011). Arthur-Kelly et al. (2009) defined visual supports as:

‘’Pictorial and graphic stimuli that enhance comprehension and learning

in individuals who may otherwise struggle with communication‘’

(Arthur-Kelly, 2009, p

1475).

In the 1990’s sign language was advocated and used as an AAC intervention to

support those with ASD, as it was thought to be accessed more quickly by the

brain than a verbal message (Jordan, Jones & Murray, 1998). However there have

since been some reservations into its effectiveness (Jordan, 1993 as cited in

Roberts, 2003; Dodd, 2005). Despite its visual benefits, sign language, or its

simplified form Makaton9, still remains a transient message and like verbal

communication, is therefore only accessible for a short period of time and a rapid

rate of processing is necessary to decode the message. This ability to effectively

process a message is recognised as a deficit in some individuals with ASD

(Whitaker 2001; Peters, 1997, as cited in Roberts, 2003; Tissot, & Evans, 2003).

In addition, a sign may be easily misinterpreted or missed entirely by the

recipient, which may lead to increased frustration when an attempt to

communicate a message is not understood (Ganz & Simpson, 2004 as cited in

Preston & Carter, 2009; Mirenda, 2003).

The use of concrete and more tangible visual supports are therefore well

established in supporting communication and comprehension as they can be

clearly understood by both the user and receiver (Preston & Carter, 2009; Roberts,

2003; Arthur-Kelly et al., 2009). The three prominent roles of visual supports are

9 Makaton is use widely in SEN educational settings as a method of communication for

those with learning difficulties (Signed Language, 2012).

Page 26 of 94 p09257913

to firstly; provide a framework to support communication and interaction for

those with minimal or no functional language, secondly, to support the

presentation of information by verbal instruction that may be lost due to potential

auditory deficits and finally to increase the understanding of environmental

expectations (Hodgdon, 1996; Jones, 2002, Arthur-Kelly et al., 2009; Savner &

Myles, 2000; Dodd, 2005).

The communication impairment that is evident in many individuals with ASD

manifests itself as an inability to produce functional language and affects their

ability to request specific needs and wants or communicate their feelings

effectively (Mirenda, 2003). The inability to communicate may lead to a highly

isolated existence and it is clear to see why many withdraw themselves further

from situations or alternately display challenging behaviour, resulting from their

frustrations (Arthur-Kelly et al., 2009). Visual systems can therefore be highly

effective interventions in compensating for communication impairment, as they

provide a framework for communication exchange and initiation, which fails to

develop naturally though speech in some individuals on the spectrum (Arthur-

Kelly et al., 2009; Mirenda, 2003; Dodd, 2005). Once a child with ASD makes

the connection that a picture represents a desired object, they can begin to

independently request their needs and preferences, without the requirement for

any functional language to exist or the continued reliance upon a caregiver or

teacher to ‘guess’ what they require (Whitaker, 2001). According to Tager-

Flusberg (1991, as cited in Roberts, 2003), visual systems therefore have a

facilitating effect on communication and provide a platform for language to

potentially develop, as a visual system facilitates the ‘cause and effect’ connection

that is to some extent missing in some individuals with ASD. This enlightens an

Page 27 of 94 p09257913

individual with ASD that the importance of interacting and communicating

intentionally may actually be of some benefit to them (Arthur-Kelly et al., 2009;

Slater & Bremner, 2003; Jones, 2002).

As stated in the introduction, schools are traditionally places where verbal

instruction is the primary mode of passing on information to pupils (Sharp, Ward

& Hankin, 2009; Grandin, 1995; Jones et al., 2008; Wilkinson & Silliman, 2001

as cited in Carnahan, 2006). Due to issues in comprehension, the meaning behind

the spoken word is often lost in individuals with ASD, which also leads to

problems in attention. Therefore the preferred mode of learning and processing

information is through the visual pathway (Hodgson, 1996; Roberts, 2004;

Arthur-Kelly et al., 2009; Whitaker 2001; Meadan, et al., 2011; Savner & Myles,

2000). When language is presented in a verbalised form it takes substantial effort

for an individual with ASD to decipher and comprehend the message content, as

the spoken word, in similarity to sign language, is transient and lasts only a few

thousandths of a second (Whitaker, 2001; Arthur-Kelly et al., 2009). The message

has then the potential to be missed and the child with ASD at a loss, as they are

unable to fully comprehend their environmental verbal cues and respond

appropriately (Whitaker, 2001). Therefore according to Quill (1997, as cited in

Roberts, 2003) the rationale for using visual supports is to ‘match’ the visual

strengths, processing styles and also cognitive profile features of those with ASD.

When requests, instructions or curriculum based information is presented in a

visual form, due to its ‘permanent’ nature, the likelihood of the message being

retained, understood and remembered, is significantly increased, as time can be

taken to construct its meaning (Whitaker, 2001; Roberts, 2003).

Page 28 of 94 p09257913

Another potential for communication breakdown for pupils with ASD within a

school setting, is the inability to predict or anticipate the future (Whitaker. 2001).

As discussed in the theoretical framework, cognitive theories suggest that some

individuals with ASD have an executive function deficit and a weak central

coherence and therefore display fixated behaviours, where they focus on specific

details due to the inability to shift attention or perceive the environment as a

whole (Hill & Frith, 2003). Therefore, visual systems that are presented in a

structuring format, for example a presentation of daily activities via picture form

to assist transition from one activity to the next, provide a predictable

environment that helps pupils comprehend, in context, what is happening next and

reduces any behaviour that may manifest itself out of such anxieties (Whitaker,

2001; Hawlin, 1997 as cited in Roberts, 2003; Quill 1997 as cited in Roberts,

2003).

Visual interventions that support communication, verbal message processing and

provide a structure for individuals with ASD, have the potential to enhance the

quality of life of those using them, by engaging them in social contexts they may

otherwise find problematic. Using AACs as a means of communication

potentially increases autonomy by reducing the reliance on the teacher who

previously provided a medium for communication or explicit instruction (Arthur-

Kelly et al., 2009; Janzen, 1996, as cited in Rao, & Gagie, 2006; Dyrbjerg &

Vedel, 2007). It is important, however, that visual interventions are used to

‘support’ and ‘enhance’ verbal forms of communication and not be used by any

means to replace vocal exchange or used as an ‘alternative’ to speech. They are

most effective when used in conjunction with verbal instruction, in the hope of

Page 29 of 94 p09257913

one day initiating the development of functional language (Tissot & Evans, 2003,

Prelock, 2007; Roberts, 2003).

4.4. Interventions in Practice

It is understood that not one single intervention or approach will meet the needs or

be appropriate for every child due to the diversity of ASD (Jones, 2002; Jones et

al., 2008). Therefore many interventions have been adapted from existing

strategies or designed specifically for individuals with ASD. This chapter focuses

primarily on named interventions that are used within UK practice, identifying

their effectiveness and also potential limitations. According to the National Joint

Committee for the Communicative Needs of Persons with Severe Disabilities

(1992, as cited in Frost & Bondy 2009) ‘’all people have the right to have access

at all times to any needed augmented and alternative communication devices... to

communicate the conditions of their own existence’’ (p vi).

There are a variety of AAC supports available for teachers to implement for their

pupils with ASD and provided in a hierarchy of representation (Dodd, 2005). The

initial use of visual supports is usually developed from iconic representations of

objects that closely resemble the real life article. These are identified as ‘objects

of reference’10

where an object is given to a pupil, for example a dinner tray,

which signifies to the pupil that they are transitioning to dinner time (Erbes, n.d.).

Once a child makes the connection between the object and its particular meaning,

then more advanced visual prompts can be introduced. These include photographs

and picture symbols11

, which are representative of a particular activity, object, or

instruction within the school day (Arthur-Kelly, et al., 2009; Roberts, 2003). As

10

See appendix 1 11

See appendix 2

Page 30 of 94 p09257913

individuals continue to make a cognitive representation of a picture in relation to

an object, they can then be used by the teacher in communicative form, to initiate

interaction by giving a child a choice or allowing them to request a particular item

(Arthur-Kelly et al., 2009). Named interventions used within UK schools, which

are specifically designed to facilitate communication or environmental structure,

include the Picture Exchange Communication System (PECS) and Treatment and

Education of Autistic and related Communication Handicapped CHildren

(TEACCH)12

. These have been developed in appreciation of the challenges those

with ASD face in communication and comprehension of the world they live in

(Preston and Carter, 2009).

The Picture Exchange Communication System (PECS) was developed in the USA

by Frost and Bondy in 1994 (Frost & Bondy, 2002), after they observed preschool

children that had no functional skills in communication. They then went on to

design an approach to enhance the communication opportunities of these children

(Frost & Bondy, 1994, as cited in Jordan, Jones & Murray 1998). With

behavioural principles underpinning its foundations, PECS uses the exchange of

pictures, symbols, photographs or real objects as a means of interaction with

others (Roberts, 2003; Howlin et al, 2007; Pyramid Educational Consultants,

2007). Communication skills are developed for those who have minimal or no

language by giving a picture of something that is desired to a communication

partner, for example a picture of a cup of juice, this picture is then exchanged for

the desired item (Jordan, Jones & Murray 1998).

12

Inclusive of visual timetables/schedules and work stations.

Page 31 of 94 p09257913

“Children using PECS are taught to approach and give a picture of a

desired item to a communicative partner in exchange for that item. By doing so,

the child initiates a communicative act for a concrete item within a social

context.”

(Bondy & Frost, 1994, p.3 as

cited in Flippin, Reszka &

Watson, 2010).

It is therefore vital that a child ‘independently’ initiates the communication and is

not directly prompted by an adult who anticipates they may want a drink (Baker,

1997 as cited in Jordan, Jones & Murray 1998; Howlin et al., 2007). Spontaneous

social communication that can be generalised over situations is therefore key to

PECS and aims to be taught through this specific intervention protocol, which

consists of six phases13

, preceding an initial assessment, where the trainer

identifies appropriate reinforcers for the child in relation to their specific interests

(Bondy & Frost, 1998 as cited in Preston & Carter, 2009). PECS is recognised as

a highly popular intervention that has been widely used in clinical and school

based settings to support the communication of non-verbal children (Howlin et al,

2007; Flippin, Reszka & Watson, 2010; Johnston, et. al., 2003).

The picture symbols used within the PECS system are highly iconic and represent

clearly their referent; therefore, they are recognised easily by the PECS learner

and also the communicative partner. The spontaneity that is connected to PECS is

also highly beneficial, as the learner can directly place a picture into the hand of

the communicative partner, rather than wait for them to notice that a need has

been indicated through either pointing or alternatively using sign language, (Ganz

& Simpson, 2004 as cited in Preston & Carter, 2009; Mirenda, 2003). Another

major strength for PECS and the nature of those it is designed for is not only the

13

See appendix 3.

Page 32 of 94 p09257913

motivational aspects, but the minimal prerequisite skills that are needed to master

its principles. Individuals who use the PECS system do not need to hold eye-

contact, have verbal or advanced motor skills or have the ability to sit in a chair

quietly. As long as they can discriminate between pictures and indicate a desire

for an item, for example, specifically reach for a required item, then other skills

are not necessary. As a result, this makes PECS a well-established and popular

form of communication intervention for those functioning at the lower end of the

autistic spectrum (Frost & Bondy 2002; Flippin, Reszka & Watson, 2010; Howlin

et al, 2007).

PECS, however, still has limitations in its restricted range of functions for

communication. At the start of the program a child independently initiates

communication, which is not ‘directly’ prompted by an adult. They finally

progress to commenting their response to a question, via a sentence strip14

. These

responses however, are argued not to be true self initiated comments, but simply

responses to a prompt, shaped by reinforcers that underline PECS. There is no

opportunity within the PECS system to therefore guide a child to share interests

with others independently (Flippin, Reszka & Watson, 2010). Having said this, an

individual’s ability to develop or have an interest to independently share their

feelings on a social level with others, is potentially impaired by features of their

ASD and something that may never develop despite an intervention being

designed to target this area. In addition it is important to note the aim of the PECS

program is to explicitly enhance ‘functional communication’, therefore it is not

targeted to develop social verbal speech as identified in this criticism (Charlop-

Christy et al., 2002 as cited in Roberts, 2003).

14

See appendix 4.

Page 33 of 94 p09257913

Another criticism of PECS and its communicative functions, in relation to item

refusal, is identified by Flippin, Reszka and Watson (2010). The ability to protest

and refuse items or situations is something that typically developing children

acquire early on in their lifetime, through verbal utterances and non-verbal

communication. However, due to an inability to effectively communicate, a child

with ASD may display these feelings in potentially inappropriate and challenging

ways. Although PECS is recognised as potentially reducing some of the unwanted

behaviours, as a child can request and communicate what they want over

something they do not want, actually protesting or refusing an item is not targeted

directly in the PECS intervention, which again arguably limits the communicative

functions of PECS (Flippin, Reszka & Watson, 2010). However, the ‘choice’

system that is grounded in PECS could be argued as giving those who use the

system an ‘indirect’ sense of refusal, as they are requesting one item above

another. Although this is not explicit or controlled by the PECS user, it is

therefore something that needs to be considered by practitioners when using this

particular intervention.

Early research into the effectiveness of the PECS intervention has been highly

descriptive in nature, providing limited data on its efficacy. Only recently a small

number of studies have included more rigorous and scientific methodological

principles to effectively evaluate this intervention (Preston & Carter, 2009).

Research that has been conducted, found that PECS is an effective evidence based

practice in enhancing ‘functional communication’ ability in individuals with ASD,

especially those who have no speech (Tien, 2008; Jordan, Jones & Murray, 1998).

Users have generally been able to progress through the phases with success and

Page 34 of 94 p09257913

display independent and spontaneous initiation of communication and also show

an increase in dyactic communication. The development of some pro-social skills,

including; improved social communication and decreases in challenging

behaviour, which were not specifically targeted, have also been observed (Dogoe,

Banda & Lock, 2010; Carr & Felce, 2007; Malandraki & Okalidou, 2007; Ganz,

Simpson & Cook, 2008; Charlop- Christy et al., 2002, as cited in Odom et al.,

2003). A number of research papers reported the use of PECS could be

generalised over situations, one of the core skills of PECS’ instruction. This is the

ability to request a desired item in the classroom with a specific teacher and then

be able to transfer this skill to an alternative situation for example, within the

home, increasing the independence and communication opportunities of the

individual across settings (Ganz, Simpson & Cook, 2008; Schwartz, Garfinkle &

Bauer, 1998 as cited in Roberts, 2003; Hart & Banda, 2010).

However, the increase in communicative function, identified in studies, does not

always mean a participant develops verbal skills. A handful of studies showed

some participants went onto develop speech and this gain in verbal ability

continued at the end of training (Bondy and Frost, 1994, as cited in Flippin et al

2010; Magiati & Howlin, 2003 as cited in Flippin et al 2010; Ganz, Simpson &

Cook, 2008; Schwartz, Garfinkle & Bauer, 1998 as cited in Roberts, 2003; Hart &

Banda, 2010). However, some show the effects on speech and maintenance of any

acquired speech remains unclear as results across the board are varied (Flippin et

al 2010; Preston & Carter, 2009; Howlin, et al., 2007). A recent meta-analysis

carried out by Flippin, Reszka and Watson (2010) aimed to review current

empirical evidence for PECS using research form controlled and uncontrolled

studies. Their meta-analysis showed that there was no significant effect for speech

Page 35 of 94 p09257913

acquisition, but a medium effect for improving communication outcomes, which

varied somewhat considerably across the studies. They therefore concluded, what

is echoed in many other research papers, that the efficacy of PECS is still limited

because of a lack of experimental control and anecdotal support. However, PECS,

as an intervention, was ‘promising’ in increasing communication, particularly

non-verbal, although this cannot be assumed for the acquisition of speech. Despite

this, of any of the available interventions that provide communication through

picture exchange, PECS is considered one of the most effective (Flippin et al

2010; Preston & Carter, 2009; Howlin, et al., 2007).

The purpose of the Picture Exchange Communication System (PECS) is to

essentially target the communication deficit that exists in individuals with ASD

and encourage the child to initiate communication. There are other named

interventions however that assist individuals in responding to a prompt (Jordan

Jones & Murray, 1998), target the presentation of information by verbal

instruction and increase the understanding of environmental expectations, which

may be lost due to potential auditory deficits evident in ASD. One of the most

widely used approaches in ASD is the Treatment and Education of Autistic and

related Communication handicapped CHildren (TEACCH) (Roberts, 2003). This

approach which is based fundamentally upon structure, addresses the issues in

organisation and transition, evident for the majority of individuals with ASD,

allowing them to predict and understand expectations (Roberts, 2003; Caranhan,

2006).

In 1972 Division TEACCH was founded by Lord and Schopler in North Carolina

who wanted to provide an intervention that supported those with ASD from

Page 36 of 94 p09257913

preschool to adulthood (Roberts, 2003; UNC, 2012). It aims to cue positive

behaviour by structuring and adapting the environment and helping to remind

those working within the approach to understand and remember what to do in

particular situations (Odom et al., 2003). This visually mediated support is

inclusive of visually presented instructions, timetables, work systems and

structured teaching based within curriculum content15

. These allow the individual

with ASD to develop skills, including educational engagement, but also that of

self-care (Jordan, Jones & Murray, 1998; Roberts, 2003; Jones, 2002; Mesibov,

2009; Mills & Marchant, 2011). It is important that before a child is introduced to

features of TEACCH, such as a visual timetable, they can, like the prerequisite for

PECS, discriminate between pictures, which is a vital skill needed to effectively

use pictorial based systems. The aim is to enable individuals to function as

independently as their autism allows, reducing the need for adult prompt which is

facilitated by the highly structured physical environment recognised as being

extremely beneficial for those on the spectrum and fits successfully into the

‘culture’ of autism (Schopler, 1991 as cited in Roberts, 2003; Ganz, 2007;

MacDuff & And 1993).

In similarity to the PECS intervention, TEACCH shows great promise but does

not have a wide empirical base for its effectiveness and many of the studies

conducted have evident methodological weaknesses (Jones, 2002; Lord, &

Schopler, 1994 as cited in Jordan, Jones & Murray, 1998). However it has been

used in education and home settings for over forty years and had significant

parental satisfaction ratings (Mesibov, 1997, as cited in Jordan, Jones & Murray,

1998). Research conducted into its effectiveness has found increases in IQ scores

15

See appendix 5.

Page 37 of 94 p09257913

(Lord, 1991 as cited in Roberts, 2003; Venter, Lord & Schopler, 1992 as cited in

Roberts, 2003), fine and gross motor skills (Ozonoff, & Cathcart, 1998) and the

improvement of appropriate behaviour and also communication skills (Short,

1984; Ozonoff & Cathcart, 1998; Siaperas & Beadle-Brown, 2006 as cited in

Mills & Marchant, 2011). One major effect of the implementation of TEACCH

was reported by Hume and Odom (2007), who observed increased independence

and reduced requirement of staff prompting after the program had been

implemented, they also reported some off-task challenging behaviours were also

reduced as the pupils were aware of their following transition or expectations,

therefore did not display anxious behaviour as a result of uncertainly (Hume &

Odom, 2007).

Implementing such strategies within education provisions is widely adopted and

provides effective and supportive teaching environments for pupils with ASD and

also an alternative means of instruction for the teacher to ‘reach’ their pupils on

the spectrum (Flippin, Reszka & Watson, 2010, Howlin et al., 2007). Visual

systems such as PECS and TEACCH can be effectively used in combination with

one another, as they are there to target the differing challenges faced by an

individual with ASD. PECS can develop intentional communication ensuring a

child can make requests that are reflective of their needs and with the introduction

of TEACCH, an environment is provided where this communication can flourish,

one that is structured and ‘safe’, providing a clear understanding of expectations

(Jordan, Jones & Murray, 1998).

Page 38 of 94 p09257913

4.5. Limitations of Visual Systems

The implementations of strategies such as visual systems have good ‘common

sense’ face validity in supporting the many challenges of ASD (Charman et al,

2011). However, it is also important to discuss the potential issues and limitations

which have been identified within literature and may alter the way they are

viewed or practiced within education. In the past there has been a minimal amount

of empirical studies conducted into the effectiveness of visual systems, with

numerous identified as having methodological weaknesses and only now is their

actual efficacy being discovered (Dettmer et al., 2000; Rao, & Gagie, 2006; Jones,

2002; Preston & Carter, 2009; Ospina et al, 2008; Roberts, 2003; Jordan, Jones &

Murray, 1998; Mills & Marchant, 2011; Arthur-Kelly, et al., 2009).

In order for an intervention to provide strong evidence for its effectiveness, it

needs to meet a number of experimental criteria. This is often difficult for those

researching complex areas such as ASD, as the specific variables needed in

Randomised Control Design (RCT) experiments are difficult to control, due to

ethical considerations surrounding participants; this is also compounded by the

organic nature of those with ASD (Preston & Carter, 2009; Roberts, 2003; Jones,

2002). RCTs are therefore rare in education with interventions, such as visual

supports, usually determined appropriate or effective by the professional view of

the therapist or teacher, rather than on any scientific grounds (Mills & Marchant,

2011). Despite the gap in research that is evident, interventions such as PECS and

TEACCH are extremely popular within areas such as education, however,

popularity does not reflect efficacy, therefore further research needs to be

conducted as a high priority to address this issue (Charman et al, 2011; Preston &

Carter, 2009; Jordan, Jones & Murray, 1998; Jones, 2002).

Page 39 of 94 p09257913

It has been identified within literature that individuals with ASD are

predominantly visual learners (Hodgson, 1996; Roberts, 2003; Arthur-Kelly et al.,

2009; Whitaker 2001; Meadan, et al., 2011). However, Arthur-Kelly (2009)

believes the use of visual systems should not be an immediate response to a

diagnosis of ASD. Because autism is such a highly heterogeneous spectrum, other

sensory preferences may in fact be superior and are in need of consideration

before the automatic implementation of a visual system (Arthur-Kelly, 2009).

This brings to attention the many differing strengths those with ASD may hold

and therefore when implementing systems within education, attention needs to be

made to each individual. This should be done through careful assessment and

observation to find the system or combination of systems that best reflects their

individuality, processing ability and benefits their needs most effectively (Arthur-

Kelly, 2009; Jones, 2002).

The need for structure has been identified within literature as being highly

beneficial for individuals with ASD and supports the particular cognitive deficits

many have within this area, which can be circumvented by reducing the amount of

stress and anxiety that manifest from misunderstanding the environment (Savner

& Myles, 2000; Hill & Frith, 2003; Roberts, 2003). However, the highly

structured environments, evident in ASD specific classrooms and reflected in the

implementation of the TEACCH approach, have been negatively portrayed as

‘prosthetic’ and have the potential to shield those with ASD from society

(Roberts, 2003), creating an overdependence and reliance on visual supports

(Arthur-Kelly, 2009) and potentially reducing opportunities for natural interaction

and communication to develop (Jones, 2002).

Page 40 of 94 p09257913

Rigidity and restricted patterns of behaviour are featured characteristics of ASD.

It is argued that by introducing visual systems, which are underpinned by

structure, it may, in reality, ‘perpetuate the need for sameness’, making it very

difficult for individuals using them to adapt and exceed their label in any way

independent of this support (Arthur-Kelly, 2009). Because of this potential

drawback, the level of support given by visual systems is recognised as needing to

be reduced as a child moves into adolescence and adulthood. Individuals with

ASD need to understand there are elements of flexibility needed to exist in

society, as situations may change suddenly that are beyond their control. It is

suggested that in a school situation, teachers should aim to provide their pupils

with the appropriate tools to cope with change, such as the observation of ‘natural

environmental cues’ to pick up a potential transition. If these skills are focused

upon, they can then be utilised and developed alongside their visual

implementations which could be beneficial to their ability to cope in adult life

(Whitaker 2001; Arthur-Kelly, 2009).

The use of visual prompts is additionally acknowledged as reducing the reliance

on adult support therefore improving independence. However, this independence

only exists due to the adults that initially put these supports or environmental

alterations in place. So for visual systems to be effective there needs to be a

certain level of adult support evident to implement them initially and oversee

them generally (Arthur-Kelly, 2009; Charman et al, 2011). The need to promote

flexibility and reduce reliance of visual systems is vital, as the level of adult

support in existence in school provisions may not be continued or reflected in

available adult provisions, due to funding or care inadequacies. If a child with

Page 41 of 94 p09257913

ASD has experienced a highly supportive education provision, where a multitude

of implementations had been put into place to reduce their anxiety and enhance

their communication, there is the potential that their adult provision may not be as

supportive, therefore challenging behaviours and increased anxiety may be more

prominent and more difficult to manage than in their childhood (Arthur-Kelly,

2009; Charman et al, 2011).

If visual supports are therefore recommended by multi-disciplinary agencies and

subsequently implemented, then consideration needs to be made into the fact that

these may then need to be in existence throughout adult life (Tissot, & Evans,

2003, Prelock, 2007). Hence, any decision needs to be supported by Government

legislation and any agencies that are affiliated with individuals with ASD to

continue the significant and highly beneficial work that is already evident within

education. If the right implementation is found, following appropriate assessment

and consideration by all involved, then a child with ASD has the potential to make

amazing progress within their education and well into their adult life (Theroux,

2012).

It is clear to see, despite the lack of empirical research into efficacy of visual

systems, they benefit from a strong theoretical underpinning, which is perpetuated

into educational provision, where their potential impact on pupils with ASD is

substantial and early intervention paramount (Prior & Roberts, 2006). Specialist

teachers, who have an enhanced understanding of autism and its spectrum,

observe and work closely with pupils who use such systems and form strong

relationships with them. This enables them to introduce and adjust the use of

visual systems as necessary and in addition have the capacity to comment of their

Page 42 of 94 p09257913

efficacy in relation to specific individuals they teach. Despite this insight, minimal

qualitative studies have been undertaken to explore teachers’ perceptions, as key

professionals, into the efficacy of visual supports and the impact they have on the

children they teach (Jordan, Jones & Murray, 1998; Mirenda, 2003; Arthur-Kelly,

2009).

Page 43 of 94 p09257913

5. Methodology

5.2. Rationale

The rationale behind this research is to investigate SEN teachers’ perceptions of

the implementation of visual systems within the classroom environment to support

pupils with ASD and establish in what way the systems and structures impact on

the pupils’ educational experience.

5.3. The central question of the research

The research was be led by the following question; ‘What impact does the

implementation of visual systems and strategies, to support pupils with ASD, have

on their education experience?’ To assist in answering this question, the research

was guided by the following questions; what types of visual systems have been

implemented within the classroom and school environment to support pupils with

ASD? What is the purpose behind implementation of the strategies? What are

teachers’ perceptions of the effectiveness of these strategies? And finally have

teachers experienced any unexpected effects from the implementation of

strategies?

5.4. Research Strategy

In order to discover teachers’ perceptions on the impact of visual systems in

supporting children with ASD, the research undertook an ‘interpretive’

epistemological position through a ‘qualitative’ research approach. The teachers

perceptions, gained through open-ended questionnaires, were explored to identify

their subjective interpretation of the impact such visual systems have had on the

pupils in their care. For areas that have minimal or no previous research and

Page 44 of 94 p09257913

dependent on the theoretical orientation of research, qualitative data collection

methods can be highly effective. The teachers’ responses were analysed on a

broader level than specific words or phrases, producing rich and intricate data,

obtained by the identification of specific features or themes (Howitt & Cramer,

2008).

5.5. Research Site

The research included perceptions of teachers who worked within three primary

school settings that provide an education for pupils with special educational needs

(SEN). The schools featured in the research have been specifically chosen above

mainstream educational settings. Their nature, as ASD provisions, provided a full

insight into the range of visual systems in use within special education. The

research question will explore the ‘perceived’ impact these systems have had on

the pupils placed within ASD specific class groups, where all of the pupils have a

diagnosis or are under assessment of being on the ASD spectrum.

5.6. Research Sample

To obtain questionnaire data, a purposive sample of seven primary teachers in the

Leicester and Leicestershire area were asked to take part in the research. The

teachers were based in an SEN (ASD specific) setting, all of which have

implemented or have in place one or a number of visual systems to support their

pupils with ASD. A purposive sampling method was chosen on the basis of the

teachers’ relevant knowledge and experience to fulfil the research criteria and

research question (Greig et al., 2007). In addition, the specific number of

participants has been selected on the basis of the time consuming nature of the

analytic strategy used in this research, which includes the process of data

Page 45 of 94 p09257913

collection, transcription and subsequent analysis (Howitt & Cramer, 2008; Punch,

2000).

5.7. Research Time-Frame

A review of the literature was conducted over twelve weeks and questionnaires

were then delivered to the teachers two weeks before analysis. Analysis and write

up took place in the subsequent four week period. Therefore the literature review,

research and analysis took place over an eighteen week period.

5.8. Data Collection & Procedure

For the nature of this research, open-ended structured questionnaires were deemed

the most appropriate form of data collection preceding the specific analytic

strategy used. Interviews were initially considered as they may explore in further

depth the perceptions of the teachers; however, due to the nature of the teachers’

role, in an ASD specific setting, it became increasingly difficult to establish an

interview schedule. Therefore an open-ended questionnaire was developed to

allow for the teacher to independently respond to the study. Open-ended

questionnaires are useful if the research aim is exploratory and are suitable in

researching complexities where a respondent can answer as much as they wish to

in their own terms (Cohen, Manion & Morrison, 2007). A respondent therefore

has the time and space to express themselves and their response is more likely to

reflect the richness and complexity of their views (Denscombe, 2003).

A draft questionnaire was developed using appropriate research and planning

(Punch, 2000). The pre-tested questionnaire determined if the content received

from the participant was sufficient for further analysis, or if further alterations,

Page 46 of 94 p09257913

developments and extensions to the schedule, including additional questions, were

needed to be made. A pre-determined schedule of questions was then developed

for the participants16

from the research criteria and questions, to explore the

respondents’ perceptions effectively, but to also allow them the opportunity to

make a clear reflection and elaborate on emerging issues that the researcher then

explored (Howitt & Cramer, 2008, Punch, 2000). However, it is accepted that a

respondent may not include relevant information if the question fails to evoke an

appropriate response or is deemed too time consuming. This drawback has been

recognised and therefore accounted for (Cohen, Manion & Morrison, 2007;

Denscombe, 2003)

It is important to note that no data collection method comes without its

limitations. The over-involvement of the researcher may potentially lead to bias.

However, this was also accounted for and procedures and steps were taken during

development of the questionnaires to ensure the questions were neutral and open

to interpretation by the respondent and not leading in any way.

5.9. Analytic Strategy

A qualitative Thematic Analysis, using the Braun and Clarke Thematic Analysis

Principles (2006), was undertaken to transcribe and analyse the open-ended

questionnaire responses. For the researcher to best interpret, make sense and

describe teachers’ perceptions of the impact of visuals systems within their

specific setting, this strategy was chosen as the most effective method. Through

the participant’s use of language, either written or spoken, on a particular area of

16

See appendix 6 for a clean copy of the questionnaire.

Page 47 of 94 p09257913

interest, this method was able to identify and describe individual experiences and

perceptions (Howitt & Cramer, 2008; Braun & Clarke, 2006).

The two major aspects of Thematic Analysis are ‘data collection’, including

appropriate questioning to determine the teachers’ perceptions and ‘data analysis’

using a stage technique to establish and develop themes that arise from these

perceptions to adequately reflect the data. The themes were established through

the researcher’s familiarity with the data, which was coded and themes were

subsequently altered and developed that represent substantial sets of these codes

(Howitt & Cramer, 2008; Braun & Clarke, 2006).

.

5.10. Delimitations & Limitations

This research aimed purely to investigate teachers’ perceptions as key individuals

who have insight into their pupil’s educational lives and who can personally

reflect on the implementation, benefits and limitations of visual systems and the

way in which it has impacted on their pupil’s educational experience, for

example; their communication, learning and behaviour.

The research, due to the limiting time constraints, did not therefore investigate the

impact of visual systems through pupil observation prior and post implementation.

However, this is recognised as important, therefore a possible extension or

additional study to enhance findings and validity in potentially needed. In addition

it will not research the impact of visual systems through pupil interview,

questionnaire or ‘participatory research’, as this would present difficulties for the

nature of the pupils in question and their inability to successfully communicate

Page 48 of 94 p09257913

through useful social language therefore potentially excluding the pupils from the

research process.

However it is noted that potential future ‘participatory research’ should be

considered to give a ‘voice’ to pupils with learning disabilities, to ensure their

perceptions are valuable and should be considered as an inclusive part of the

research process, as this research is directly connected to their education (Lewis &

Porter, 2004). For example analysis of drawings, photographs and recognising

perceptions of those with enhanced verbal communication skills.

5.11. Reliability

Triangulation of the research was required to ensure the research carried out to

establish teachers’ perceptions was considered reliable and can be validated. This

was conducted by cross referencing the responses and subsequent themes with

relevant literature and establishing similarities. The teachers were also directly

involved in data verification and authenticity of emerging themes, ensuring they

are a ‘true reflection’ and ‘interpretation’ of their perceptions. Triangulation could

also be achieved by carrying out additional interviews with teachers or parents

and incorporating guidelines mentioned above by including pupils as research

participants.

5.12. Ethical Considerations

Ethical considerations that are appropriate to this research were followed in

accordance to relevant University codes of conduct, where ethical approval was

Page 49 of 94 p09257913

obtained17

in adherence to the BERA Ethical Guidelines for Educational Research

(2011). The participating teachers involved in the research, contributed on an

entirely voluntary basis and were fully informed throughout (BERA, 2011;

McNamee, 2002; Howitt & Cramer, 2008). The participants had a briefing of the

proposed research prior to its start, to provide them with full details of the

objectives, including the research timeframe, the underpinning rational and

theoretical framework and a written description of their involvement. In addition

they were able to request copies of the research proposal and emerging research

content at any point (Howitt & Cramer, 2008).

The teachers’ informed consent was required and a signed acknowledgement by

participants was requested before the research process was undertaken to ensure a

full understanding of the research objectives was achieved (McNamee, 2002;

BERA, 2011). The teachers involved had the freedom to withdraw at any point

during the research process and were alerted to this during the briefing stage

(McNamee, 2002; BERA, 2011). Anonymity of the school, teachers and specific

children discussed within the questionnaires, was upheld throughout and

following research completion. Appropriate records including any research related

information and questionnaire data remained confidential and stored appropriately

on a secured/password protected computer and therefore restricted from public

use (Howitt & Cramer, 2008; BERA, 2011).

5.13. Personal Biography

It is necessary to note some specific details about the researcher that may impact

on the study and additionally the data collection and analysing stage. The

17

See appendix 7 for a copy of the ethics form and ethical approval.

Page 50 of 94 p09257913

researcher’s potential influence on the study has been identified within the data

collection and procedure section of the proposal. The researcher is a white British

female, aged thirty. She has had eight years experience as a nursery nurse/level

three teaching assistant working in a school for children with special educational

needs (SEN) with the majority of her time spent working within and supporting

ASD specific classes. This research was inspired by the researchers interest in the

area of ASD and visual systems to support communication where she has

personally developed, implemented and received training on various aided modes

of ‘Augmented and Alternative Communication’ to support non-verbal pupils on

the autistic spectrum. Her aim was to therefore further explore relevant literature

and establish research, through teachers’ perceptions, that identifies the perceived

effectiveness of visual systems in supporting communication of pupils with ASD.

Page 51 of 94 p09257913

6. Analysis & Discussion

Throughout analysis, seven themes were identified from the data set of teachers’

responses18

, which explored the use and efficacy of visual systems within the

classroom to support pupils with ASD and are discussed in relation to relevant

literature. The themes identified include: Enhancing Communication; Promoting

Independence; Environmental Structure and Adaptation; Positive Behaviour

Management; Curriculum and Learning; the Awareness and Role of the Teachers

and Efficacy Foundations. See table 1 for synopsis presentation of the data set. 19

Table 1

Themes

Quote 20

Key Word

1 Enhancing

Communication

‘’PEC's symbols allow our students to communicate

what they want if they are unable to communicate their

needs through speech.’’

(KP 47)

Connection

2 Promoting

Independence

‘’The symbols help to promote independence and

encourage the students to take responsibility for expressing

what they would like; they can also be used as part of a

wider reward system.’’

(KP 47)

‘’Jigs – lists children can work through to them with a

sequential tasks such as taking off their coat, hang it up,

take diary out, enter classroom. For eating; place food on

fork, put fork in mouth, chew – to develop independence ‘’

(BP 61)

Empower

3 Environmental

Structure &

Adaptation

‘’He then takes the photos from his visual timetable and

places them on his 'now and next board' so that he is aware

of which activities he will experience now and what might

happen later.’’

(KP 2)

‘’The classroom environment is low-stimulation with

less visual clutter on the walls and separate areas,

including workstations designed to minimise visual

distraction.’’

(LS 5)

Awareness

4 Positive

Behaviour

Management

‘’Children demonstrate much less anxiety and unwanted

behaviours as they understand what is expected of them.’’

(LS 82)

Expectation

18

Data Set presented in Appendix 8 [participants questionnaire responses] 19

Full analysis of themes are presented in Appendix 9 20

(Participant initial and line number)

Page 52 of 94 p09257913

‘’Choice pictures and golden time/reward scheme – to

develop independence and the ability to make their own

choices, to reduce unwanted behaviours ‘’

(VB 71)

5 Curriculum

& Learning

‘’For individual children and activities, children are

given task plans to support in structuring their work’’

(LS 3)

‘’We now use PECS as the focus of each literacy

session, so pupils’ learning is focused on communication

skills.’’

(SO 75)

‘’The positives include support with reading as the

timetable is laid out left to right.’’

(LS 94)

Support

6 The Awareness

& Role

of the Teachers

‘’Many children have a particularly visual learning

style, and the use of visual systems promotes their learning.

Many children are non-verbal and so PECS supports their

communication needs.’’

(LS 48)

‘’When .... supported by all teaching staff then the visual

strategies are effective.’’

(KP 80)

Facilitate

7 Efficacy

Foundations

‘’I think the effectiveness is down to the individual using

the visual support strategy and the length of time that the

support has been in place.’’

(KP 81)

‘’In my opinion, once embedded, these strategies are

effective in supporting children with ASD. They do need to

be coupled with structured routines to be fully effective.’’

(LS 82)

Requirement

Theme one21

indicates how important enhancing pupils’ communication is

perceived by the teachers and by providing their pupils the tools and opportunities

to express themselves and connect with others and their environment, which leads

to positive outcomes in their educational experience. This is echoed in research

that suggests individuals with ASD have difficulties in communicating

intentionally and therefore interventions are implemented to support this deficit

and ensure those with ASD can effectively express their needs and facilitating

their communication through visual supports is paramount (Mirenda, 2003;

Arthur-Kelly et al., 2009; Jones, 2002; Slater & Bremner, 2003; Johnston, et. al.,

21

See Appendix 9 p85 for full analysis.

Page 53 of 94 p09257913

2003). This affirmative perception continues into theme two22

which details that

the pupils’ independence is promoted as they are able to communicate a desired

item or a specific choice, without the need for adult prompts. The teachers

believed this therefore empowers them and gives them a sense of control over

their environment, which may be lost due to cognitive deficits evident in ASD

(Hill & Frith, 2003; Jones, 2002; Arthur-Kelly et al., 2009; Janzen, 1996, as cited

in Rao, & Gagie, 2006; Dyrbjerg & Vedel, 2007).

The environmental adaptation teachers practiced was featured in theme three23

in

accordance to theoretical underpinnings of structure and visually presented

information to support individuals with ASD in functioning most effectively

(Autism Working Group, 2002; Rao, & Gagie, 2006; Ganz, 2007; Breitfelder,

2008; Tissot, & Evans, 2003). Teachers believed the systems assisted in

improving their pupils’ deficits in their triad of impairments. The main

environmental adaptations ensured pupils were ‘aware’, ‘prepared’ and conscious

of any expectations throughout their life at school. According to the teachers,

enhanced communication and awareness of environmental expectations, including

behaviour rules, had a positive effect on reducing distress, anxiety and frustration

in many pupils, as featured in theme four24

. This is consistent with literature

which reported negative behaviours were often replaced with appropriate

communication exchange, once visual systems that facilitated this exchange, such

as PECS, were in place and pupils had a enhanced awareness of their environment

and expectations that exist within it (Arthur-Kelly et al., 2009; Whitaker, 2001;

Hawlin 1997 as cited in Roberts, 2003; Quill 1997 as cited in Roberts, 2003).

22

See Appendix 9 p 85 for full analysis. 23

See Appendix 9 p 87 for full analysis. 24

See Appendix 9 p 88 for full analysis.

Page 54 of 94 p09257913

Visual supports were identified in theme five25

as underpinning and supporting

curriculum content and early reading and writing skills, however, curriculum

objectives were identified by the teachers as being secondary to fundamental

communication skills (Jones et al., 2008; Howlin et al., 2007; Jordan, Jones &

Murray, 1998). Teachers, throughout the data set and echoed in theme six26

,

showed continual awareness of ASD, its features, the purpose behind

implementing visual systems and how to achieve upmost efficacy. Teachers’

understanding of ASD was also identified as important in the ‘Autism spectrum

Disorder: Good Practice Guidance’ developed by the DfES and DH’s Autism

Working Group (2002). The teacher’s role as facilitator was also identified as

crucial in ensuring the systems were used effectively and maintained to achieve

upmost benefit. The requirements for enhanced efficacy of a system was

identified in theme seven27

, where teachers recognised that the ‘individual’ using

the system also had a significant impact on how effective it can be and

personalised approaches are utilised to accommodate this individuality. This

suggests, as indicated in research, that visual systems need to be individualistic

and a ‘one size fits all’ approach is arguably ineffective (Flippin, Reszka &

Watson, 2010, Jones 2002; Jones et al., 2008; Research Autism, 2012). The length

of time a system has been in place was also identified by teachers’ perceptions as

also affecting efficacy, this indicates that time frame is important and once

supports are ‘embedded’, within a structured environment, they may have

increased effectiveness.

25

See Appendix 9 p 90 for full analysis. 26

See Appendix 9 p 91 for full analysis. 27

See Appendix 9 p 91 for full analysis.

Page 55 of 94 p09257913

The original research question asked what impact the implementation of visual

systems that supports pupils with ASD, had on their educational experience. In

drawing the themes together it has been identified that teachers perceive visual

systems as having numerous beneficial effects to support their pupils with ASD,

inclusive of curriculum access, engagement and connection with their

environment. These benefits have been enhanced by improved communicative

opportunities embedded in visual supports, which have also provided much

needed structure, awareness of expectations and subsequently improved

behaviour.

The teachers showed a good awareness of the purpose behind the visual systems

implemented within their school environment developed in relation to the

spectrum of autism. They did not record any awareness of significant negativities,

in relation to using the systems, which had been identified within literature during

the review. However this could be due to the nature of the questions asked and a

potential limitation of the research itself. However procedures were taken, when

developing the questionnaire, to avoid any ‘leading’ questions, therefore a

question to determine actual negativities was avoided; these was to ensure

participants were not predisposed into responding about potential negativities and

instead were asked if they had perceived any ‘unexpected’ effects.

The implications of these findings echo what is represented within literature and

significantly linked to the theoretical underpinnings of ASD. Despite potential

limitations identified, this research adds a qualitative dynamic to literature by

exploring teachers’ roles and appreciating their perceptions as primary individuals

in their pupils’ lives. The use of explicit qualitative methodologies, such as the

Page 56 of 94 p09257913

one featured within this research, has been recognised as minimally used as a

methodology within literature to explore efficacy of ASD interventions and

therefore a potential for further research alongside a vital scientific line of

investigation (Jordan, Jones & Murray, 1998).

Page 57 of 94 p09257913

7. Conclusion

The purpose of this dissertation was to explore relevant literature and SEN

teachers’ perceptions into the use and efficacy of visual systems within the

classroom environment to support pupils with ASD, and establish in what way the

systems impacted on their educational experience. The study undertook an

‘interpretive’ epistemological position through a ‘qualitative’ research approach,

highly effective for areas with minimal previous research (Howitt & Cramer,

2008). Theoretical underpinning and subsequent literature identified the complex

aetiology of autism and how children on the spectrum, despite having a deficit in

the triad of impairments, still vary considerably in their needs. This was also

identified in the teachers’ perceptions, where analysis recognised the need for an

individualised approach for each child, in relation to the specific needs and

curriculum objectives. There are clear implications for the teachers who work

alongside individuals with ASD. They were acknowledged as key professionals

who display good practice and work alongside multidisciplinary teams to establish

the most appropriate and accessible environment. Their aim is to ensure pupils

with ASD flourish and their needs, inclusive of their autism, are nurtured

appropriately (Charman, et al., 2011; Autism Working Group, 2002).

This dissertation also explored the AAC interventions available to teachers to

support the needs of those with minimal functional language and communication

skills. Interventions included Sign language, the Picture Exchange

Communication System (PECS) and Treatment and Education of Autistic and

related Communication Handicapped CHildren (TEACCH) approach. The

purpose of these systems was identified as facilitating communication exchange

and also ensuring the environment is altered to enhance and make expectations as

Page 58 of 94 p09257913

explicit as possible (Mirenda, 2003; Arthur-Kelly et al., 2009; Jones, 2002; Slater

& Bremner, 2003; Johnston, et. al., 2003).

There are many implications to such approaches; however, possibly the most

compelling is the need for further research. Many studies into visual systems to

support those on the spectrum have been found to have methodological

weaknesses and this has been argued to be a result of the heterogeneous nature of

autism. As a result a comprehensive understanding of their efficacy is yet to be

discovered, therefore, future methodologically sound and systematic research is

recommended as needing to be conducted (Dettmer et al., 2000; Rao, & Gagie,

2006; Jones, 2002; Preston & Carter, 2009; Ospina et al, 2008; Roberts, 2003;

Jordan, Jones & Murray, 1998; Mills & Marchant, 2011; Arthur-Kelly, et al.,

2009).

Issues attached to visual supports that have been identified within literature, give

rise to further implications. These issues could be argued to be a product of their

actual foundations. The nature of the supports in providing a rigorous structure

and means of communication within a prosthetic environment may isolate the

individual from society; perpetuate their need for sameness, in turn creating a

reliance on these systems, escalating the users’ rigidity and inflexibility (Arthur-

Kelly, 2009; Whitaker 2001). Despite this potential concern, evidence suggests

interventions are generally positive and visual systems have excellent success

outcomes in practice. This is identified within literature (Jones 2002; Jones et al.,

2008; Mirenda, 2003; Hodgdon, 1996. Charman et al, 2011) and was also

acknowledged in the perceptions of the teachers who took part in this research. It

is therefore recommended, that if teachers and also parents appreciate and are

Page 59 of 94 p09257913

aware of the issues surrounding visual interventions and take this into

consideration when implementing the most appropriate support from diagnosis

onwards, then considerable positive impact on communication, social interaction,

behaviour and independence can be experienced both at school and at home.

The interventions that have been developed over the past forty years have

provided hope for many families of children with autism in reducing the strain it

potentially places upon them, giving their children the best possible start in life

and skills essential for their own success. Above all, it is vital that families are

supported and trust that their child can be accepted into an educational provision,

where interventions have been specifically developed to help them process

information, maximise communication and be fully included within that setting.

This is a major implication for educational practice and research supports the view

that individuals benefit from being placed in an environment where their strengths

and abilities are developed by professionals who appreciate and understand the

many difficulties they face, undergo specific training and disseminate their

successful interventions and good practice to other professionals (Autism

Working Group, 2002; Charman, et al., 2011; Jones et al., 2008; Jones, 2002).

Those with ASD will experience many challenges surrounding their autism;

however, communicating the needs of their own existence does not need to be one

of them. Visual interventions therefore empower these individuals, giving them a

‘voice’ and an opportunity for increased autonomy, beyond many of society’s

expectations. As they, like any other person, have the right to be heard and treated

with respect throughout the whole of their lifetime. The poem, titled ‘The Future’

written by Wendy Lawson, an adult with ASD, captures that the future of those

with autism is not dependent on their diagnosis or how it manifests itself within

Page 60 of 94 p09257913

each person, but on the support they are provided by others in order for them to

flourish and thrive (Gray, 2006 as cited in Jones et al., 2008).

The Future

Life on earth is but a moment

Caught within the crease of time.

The seasons come and go again,

You have your life, and I have mine.

The seed that's planted within the ground,

Cannot choose what to become,

A potato, an apple

Or a rose for some.

However, for it to be the very best,

It needs rich soil, not poor.

The sun and the rains must come,

To open that seed’s door.

I may be born to nourish others,

I may delight the senses.

I may grow tall, I may grow small,

I may stay stunted beneath wire fences.

My future may not depend on my stock,

So much as it does upon sources.

Sources of warmth, sources of care,

I depend on the nurture to be for me there.

Then I can blossom and sing with the birds,

Then I can grow my potential.

So plant me in goodness and all that is fine,

Please keep the intruders away.

Give me a chance to develop, in time,

To become who I am, in life's future, one day!

Page 61 of 94 p09257913

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9. Appendices

9.2 Appendix 1 – Object of Reference

(Cup to indicate juice time)

(Spade to indicate sand play session)

(Book to indicate book session)

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9.3 Appendix 2 - Photos or Picture Symbols Representing

Object or Activity

(Erbes, n.d.)

PECS Cards (SAA Organisation,

2011)

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9.4 Appendix 3 – PECS Phases

(Flippin, Reszka &Watson, 2010).

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9.5 Appendix 4 – PECS Sentence Strip

(New Autism Cure, 2011)

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9.6 Appendix 5 - Treatment and Education of Autistic and

related Communication Handicapped CHildren

(TEACCH) Examples.

(AET, 2010)

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(Visual Timetable Developed by Claire Skilbeck,

2008)

(Communication for all, 2011)

Book Time

Numeracy

Soft Play

Dinner Time

Play Time

Home Time

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TEACCH Task (OC SLP Organisation,

2011)

TEACCH Task (Pre-school fun, 2011)

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TEACCH Workstation (Stanley School,

2011)

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9.7 Appendix 6 – Questionnaire [Blank Copy].

USING VISUAL SYSTEMS AND STRATEGIES TO SUPPORT PUPILS

WITH AUTISM SPECTRUM DISORDER:

EXPLORING SEN TEACHERS’ PERCEPTIONS ON THEIR IMPLEMENTATION AND

EFFECTIVENESS

Participant Number: _________

Please read the following paragraph carefully:

I would be grateful if you could spare a few moments of your time to complete

this questionnaire. It will be used to investigate SEN teacher’s perceptions of the

effect of implementing visual systems and strategies within the classroom

environment to support pupils with Autism Spectrum Disorder (ASD), which is

part of my final year dissertation for Education with Psychology (BA Hons) at De

Montfort University.

As this questionnaire is based on your opinions/attitudes, there are no right or

wrong answers so please answer as honestly as possible. You do not have to

answer any questions you do not wish to and all of your answers will be treated in

the strictest confidence and will remain anonymous.

Please be aware that your participation is on an entirely voluntary basis and you

are under NO obligation to take part and may withdraw your participation at any

point. If you agree to participate your data will be kept anonymous and all data

will be stored on a password protected computer, thus ensuring that anonymity is

upheld.

How to contact me:

If you wish to contact me for any reason or if you would like to receive a

summary of the findings once the research is complete, then please use the details

below:

Researcher

Claire Skilbeck

Email: p09257913@myemail.dmu.ac.uk

Research Supervisor

Cathy Bonner

De Montfort University

Room H 00.18c

Education Studies

The Gateway

Leicester LE1 9BH

Email: cbonner@dmu.ac.uk

__________________________________________________________________

Page 78 of 94 p09257913

I have carefully read the above and understand my participation. Therefore I

consent and voluntarily agree to participate in this research.

NAME: (please print)

________________________________________________________________________

SIGNATURE:

_____________________________________________________ DATE: _____

Participant Number: ___________

THE IMPACT OF VISUAL SYSTEMS AND STRATEGIES TO

SUPPORT PUPILS WITH AUTISM SPECTRUM DISORDER

EXPLORING PRIMARY SEN TEACHERS’ PERCEPTIONS

1. What types of visual systems and strategies have been implemented within

your classroom and school environment to support pupils with ASD?

2. What is the purpose behind implementation of the strategies? [Did specific

pupils need support to develop specific areas such as their communication,

learning focus, independence, transition from one activity/area to another,

or to reduce any unwanted behaviours?]

3. In your opinion, are these strategies effective?

4. Have you experienced any unexpected effects from the implementation of

visual systems or strategies? [For example, have you seen a positive or

negative effect on any areas aside from the area it was originally

implemented for?]

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9.8 Appendix 7 – Ethics Form and Approval

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9.9 Appendix 8 – Data Set [Participants Questionnaire

Responses]

Question 1: What types of visual systems and strategies have been implemented within your classroom and school environment to support pupils with ASD?

1. KP: Our students use PEC's symbols in order to communicate their needs and exchange for items of interest. Most students carry their symbols round on their person and then exchange them for the item that they desire e.g. a picture of a CD to request music. We use the Widget software to make the symbols for our students.

2. One student has a 'now and next board' which is used in conjunction with his visual timetable, we use photos from each lesson to cue him in to the activities that he will experience throughout the school day. He then takes the photos from his visual timetable and places them on his 'now and next board' so that he is aware of which activities he will experience now and what might happen later.

3. LS: Children have access to a class visual timetable (this is completed in smaller blocks so as not to cause an overload of information – from am to lunch and then pm). For individual children and activities, children are given task plans to support in structuring their work. For example, simple first and then structures to more complex 4 part instructions including resources needed for children to collect in order to promote their independence.

4. Children have access to PECS, a visual communication system. 5. The classroom environment is low-stimulation with less visual clutter

on the walls and separate areas, including workstations designed to minimise visual distraction.

6. SP: We use PECS to support communicate. PECS and Makaton augment verbal communication and aid comprehension, giving a visual element to auditory learning. Makaton adds a kinaesthetic element to spoken communication and PECS gives a visual cue to word order and content in general.

7. Communicate in Print gives symbol/pictorial cues to worksheets/written work.

8. CiP symbols/ photographs/ objects of reference used on visual timetables/ transition objects aim to reduce stress related to the perceived need to understand what is happening next/ have an order to the day.

9. Within workstations/work areas left to right systems are used, supported by visual systems. The children have their work placed into three separate drawers on their left hand side. They have a laminated sheet in front of them with their own photograph and the work symbol. Underneath that there is a strip of Velcro. They have three symbols on the Velcro strip and a choose symbol at the end. On each

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drawer is a symbol matching that on their strip. They then take the symbol off the strip, match it to the drawer, remove the drawer, complete the work within the drawer, placing it on their right, by the finished symbol, and move onto the next symbol/drawer on their strip.

10. They also provide visual reminders to the behaviour policy/strategies used within school – 1,2,3 chair.

11. Symbols/photographs are used around school in places where words/writing is used

12. BP: Individual visual timetables consisting of symbols for 4 children and objects of reference for 1 child.

13. Feelings board – Picture of child and they choose a symbol of how they are feeling each morning.

14. Behaviour management (Sanctions) – ‘NO HITTING’ symbol followed by ‘1’ ‘2’ and picture of separation room (moving picture of child along as they get each warning.

15. Behaviour management (Rewards) – I am working for boards. Children choose a photograph of the toy they would like to play with at the end of the day and have to gain 2 stars to get it. Stars are mostly given at the end of the morning and afternoon, but can be used for short term reward if I want a child to complete work (ie. 1 star given when an apron is put on, 1 star given when paint is applied to paper).

16. PECS books – used at ‘choosing time’ and ‘snack time’ and for spontaneous exchanges for toilet and food requests.

17. Choosing boards that are linked to curriculum (symbols, I want symbol and a sentence strip) – songs, nursery rhymes, what media they would like to use in Art (pencils, paints, felt tips), cooking utensils, science related (would they like to ‘push’ or ‘pull’ a board with wheels on that children can sit on, communication activities (bubbles, balloons, space hopper, microphone etc), water/juice, fruit they would like in a smoothie. Symbols are usually made for most lessons so that choice in incorporated into the task.

18. Turn taking board – move the arrow to show whose turn it is (paired activity)

19. Turn taking board – children choose a picture of child and give it to them before singing hello to them etc (whole class activity)

20. TEACCH – traffic light system. Children match red, yellow, green, circles on their work baskets, then take out activity. They work from left to right.

21. Toilet symbols on door, with a sentence strip for PECS phase 4 users. 22. Help symbol near coat pegs so children can request help with buttons,

zips etc. 23. Jigs – lists children can work through to them with a sequential tasks

such as taking off their coat, hang it up, take diary out, enter classroom . For eating; place food on fork, put fork in mouth, chew.

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24. Now and Next boards – to take around the school/a different part of the school with you for unexpected or irregular activities such as having an injection, having photograph taken, assemblies in the upper school etc.

25. Visual timetables for sequential tasks such as getting undressed and dressed for PE.

26. VB: Visual timetables 27. Use of symbols to label resources to help children to become more

independent 28. PECs with lower level children 29. Use of communicating in print to make worksheets – support with

reading the sheet using symbols 30. Different coloured mats to sit on – each child has a different colour so

they know where to sit 31. Different coloured chairs at each table 32. Class rules and behaviour for learning rules visually displayed 33. Choice pictures and golden time/reward scheme 34. Use of makaton 35. SO: Visual timetables – on display and on whiteboard (class) 36. Personal visual whiteboards (ind) 37. Communicate in print program to communicate words 38. Objects of reference (will use in relation to PECS too) 39. Use of PECS 40. Personal verbal cue cards (individual sentence strips for a child who is

learning to speak full sentences) 41. Multisensory learning to enable all learners to participate 42. GK: Interactive whiteboard visual timetable 43. Individual timetable 44. Reward puzzles – they get a piece every time they do something well 45. PECS

Question 2: What is the purpose behind implementation of the strategies? [Did specific pupils need support to develop specific areas such as their communication, learning focus, independence, transition from one activity/area to another, or to reduce any unwanted behaviours?]

46. KP: The main reason that we use visual systems and strategies is so that the students are aware of what activities they are about to experience and to reduce the possibility of challenging behaviours due to students not understanding what is expected of them (visual timetables).

47. PEC's symbols allow our students to communicate what they want if they are unable to communicate their needs through speech. The symbols help to promote independence and encourage the students to take responsibility for expressing what they would like; they can also be used as part of a wider reward system.

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48. LS: All children in class show some degree of difficulties in transition between activities and/or focus. Visual systems and separate areas reduce anxiety/distress as children are aware of and can access their daily routines. They are aware of what is expected, including a visual behaviour system. Many children have a particularly visual learning style, and the use of visual systems promotes their learning. Many children are non-verbal and so PECS supports their communication needs.

49. These symbols aid the early stages of reading. They support independence, reduce stress brought on by not knowing what is next etc. aid behaviour plans/strategies, provide the children with aids to communication and supports transition around school/room.

50. BP: All of the above! 51. Individual visual timetables – to develop flexibility of thought;

anticipation of the next activity and accepting changes because they see it on their timetable. To develop a clear and beginning to an activity to aid transitions.

52. Feelings board – to develop an awareness and understanding of feelings, emotions and empathy, linked to social behaviour and communication.

53. Behaviour management (Sanctions) – to reduce unwanted behaviours 54. Behaviour management (Rewards) – to develop positive behaviour 55. PECS books – communication 56. Choosing boards that are linked to curriculum (symbols, I want

symbol and a sentence strip) – to address and develop the autism and the communication needs first and the curriculum objectives second.

57. Turn taking board – to develop communication and social skills. 58. TEACCH – to develop independent learning. To aid transition from one

activity to the next. 59. Toilet symbols on door, with a sentence strip for PECS phase 4 users –

independence and communication. 60. Help symbol near coat pegs so children can request help with buttons,

zips etc. – independence and communication. 61. Jigs – lists children can work through to them with a sequential tasks

such as taking off their coat, hang it up, take diary out, enter classroom . For eating; place food on fork, put fork in mouth, chew – to develop independence

62. Now and Next boards – to reduce anxiety, to develop flexibility of thought and anticipation.

63. Visual timetables for sequential tasks such as getting undressed and dressed for PE – to develop independence

64. VB: Visual timetables – to support transition, reduce unwanted behaviours due to anxiety about not knowing what is coming next, to support ASD children within the class

65. Use of symbols to label resources – to develop independence 66. PECs with lower level children – to develop communication skills

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67. Use of communicating in print to make worksheets – to develop independence, to support the learning of the children

68. Different coloured mats to sit on – to develop independence, reduce unwanted behaviours and to help children to remain focused within circle time activities

69. Different coloured chairs at each table – to support transition and independence

70. Class rules and behaviour for learning rules visually displayed – to reduce unwanted behaviours, to allow children to focus on their learning

71. Choice pictures and golden time/reward scheme – to develop independence and the ability to make their own choices, to reduce unwanted behaviours

72. Use of Makaton – to support children’s communication 73. SO: To develop individual communication skills towards

independence and interaction 74. All strategies will relate to curriculum themes 75. Literacy – we now use PECS as the focus of each literacy session, so

pupils’ learning is focused on communication skills. 76. GK: Behaviour management (puzzle) 77. Help with transitions (personal) 78. Help with routine (whole class) 79. Help with communication (PECS)

Question 3: In your opinion, are these strategies effective?

80. KP: I think the effectiveness is down to the individual using the visual support strategy and the length of time that the support has been in place. When used consistently by the student and supported by all teaching staff then the visual strategies are effective.

81. However in order to ensure the effectiveness of the support systems, staff must be given regular training by Speech and Language therapists and must ensure that the student always has access to their symbols i.e. lost symbols need to be replaced immediately.

82. LS: In my opinion, once embedded, these strategies are effective in supporting children with ASD. They do need to be coupled with structured routines to be fully effective. Children demonstrate much less anxiety and unwanted behaviours as they understand what is expected of them.

83. SP: These strategies have proven to be very success across the day. The verbal communication of the children in Millipedes (and L in Bumbles) has improved a lot. This has also reduced behaviour in children such as UK as this child will now use words instead of actions to get their needs met. These actions were often unwanted behaviours such as pulling hair out of frustration.

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84. Knowing what is next/going to happen throughout the day/ when there is a change to the routine has also reduced anxiety/unwanted behaviours.

85. Increased independence is always a bonus. The children are now able to access activities independently as well as access resources.

86. BP: Visual systems are incorporated into all my teaching and therefore learning. Without them, pupils with autism would have to rely on verbal instructions alone. Not all of the children in my class are verbal and therefore visual systems such as PECS are the only way they communicate. Without visual systems they may not be able to ask for the basic needs to be met, such as wanting a cracker because they are hungry or the toilet. All of the visual systems mentioned above allow the children in my class to learn independently, make choices about their day and develop the difficulties they have with the triad of impairments. In my opinion, visual systems give pupils with autism a voice and control.

87. VB: Yes definitely 88. SO: Yes 89. PECS has been extremely effective to develop children communication 90. Our children in the class have seer learning difficulties as well as ASD

so the use of visual timetables has had limited use as they do not yet discriminate between pictures

91. GK: Yes very effective for the job they are intended. 92. Very ‘visual’ which is what is needed for children with ASD

Question 4: Have you experienced any unexpected effects from the implementation of visual systems or strategies? [For example, have you seen a positive or negative effect on any areas aside from the area it was originally implemented for?]

93. KP: Sometimes students can remove symbols from their 'now and next board' if it is an activity that they do not like, but generally they are very positive.

94. LS: The positives include support with reading as the timetable is laid out left to right.

95. SP: We haven’t seen any unexpected results, more a case at being surprised at how well they have worked.

96. BP: One of the positive effects of using symbols has been that a non-verbal child in my class is now completely toilet trained because he is able to ask for the toilet in so many different ways. For example, he uses his PECS book, points to the toilet symbol all staff and all family wear on their persons, makes a sentence strip using the symbols on the classroom door, or points at the symbols on the toilet doors. He will approach anyone, in any situation and look for the symbol on their person. Without the use of symbols and therefore the opportunity to a specific request, he would still be using nappies and not have the independence he does now.

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97. VB: Just that visual systems were traditionally used to support children with ASD but in my opinion work well with all the children I teach.

98. SO: positive effect of PECS – child speaking in sentences who previously (1 yr ago) hardly spoke – now speaking ion spontaneous sentences to request food / toys / songs.

99. GK: Yes once, when doing a puzzle which consisted of a shoe picture, where child (who is obsessed with shoes) got a shoe to play with when he got all the pieces – started to try and take off other children’s shoes at playtime

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9.10 Appendix 9 – Analysis of Questionnaire Data

Represented in Themes

Themes

Theme 1: Enhancing Communication

Theme 2: Promoting Independence

Theme 3: Environmental Structure and Adaptation

Theme 4: Positive Behaviour Management

Theme 5: Curriculum and Learning

Theme 6: The Role of the Teachers

Theme 7: Efficacy Foundations

Theme 1: Enhancing Communication

There was an emphasis throughout the responses of the importance of

enhancing communication for their pupils with ASD. A framework for

communication exchange using turn-taking opportunities, PECS and Makaton

were put in place to compensate for the pupils’ communication impairment

and this, for some, was their only means of communicating.

‘’PEC's symbols allow our students to communicate what they want if they are

unable to communicate their needs through speech.’’ (KP 47)

‘’Not all of the children in my class are verbal and therefore visual systems

such as PECS are the only way they communicate’’ (BP 86)

A means of expressing the pupils’ own needs, feeling and desires was also

evident within the data and the an essential part of this communication is the

developing of the pupils’ own independence, which is featured in the next

theme.

‘’Without visual systems they may not be able to ask for the basic needs to be

met, such as wanting a cracker because they are hungry or the toilet.’’ (BP

86)

‘’To develop individual communication skills towards independence and

interaction’’ (SO 73)

Theme 2: Promoting Independence

The pupils’ independence was a major characteristic within the data set, with

systems in place to promote this. Pupils were seen to be able to access

activities and resources, communicate independently and spontaneously and to

also use relevant systems to request and express their needs. The pupils were

seen to take some responsibility for these systems by using them without

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explicit support or prompt and to carry visually cued information on their

person.

‘’Most students carry their symbols round on their person and then exchange

them for the item that they desire e.g. a picture of a CD to request music.’’

(KP 1)

‘’Use of symbols to label resources to help children to become more

independent’’ (VB 27)

‘’The symbols help to promote independence and encourage the students to

take responsibility for expressing what they would like; they can also be used

as part of a wider reward system.’’ (KP 47)

‘’Jigs – lists children can work through to them with a sequential tasks such

as taking off their coat, hang it up, take diary out, enter classroom. For

eating; place food on fork, put fork in mouth, chew – to develop independence

‘’ (BP 61)

‘’PECS books – used at ‘choosing time’ and ‘snack time’ and for spontaneous

exchanges for toilet and food requests.’’ (BP 16)

The perception of giving pupils ‘choices’ throughout the school day is also

evident, in relation to curriculum learning, activities or food items, which

teachers believed would not be in existence without the use of visual supports;

therefore it provides a further opportunity for pupils to express their needs out

of the confines of simple requests.

‘’Choice pictures and golden time/reward scheme – to develop independence

and the ability to make their own choices, to reduce unwanted behaviours’’

(VB 71)

‘’Choosing boards that are linked to curriculum (symbols, I want symbol and

a sentence strip) – songs, nursery rhymes, what media they would like to use

in Art (pencils, paints, felt tips), cooking utensils, science related (would they

like to ‘push’ or ‘pull’ a board with wheels on that children can sit on,

communication activities (bubbles, balloons, space hopper, microphone etc),

water/juice, fruit they would like in a smoothie. Symbols are usually made for

most lessons so that choice in incorporated into the task.’’ (BP 17)

The developing independence seen in pupils was perceived by one teacher as a

positive ‘effect’ or ‘outcome’ of using visual systems to support other needs,

most directly communication based. In contrast another teacher perceived the

pupils as having a ‘responsibility’ for using the systems consistently, to

increase efficacy.

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‘’Increased independence is always a bonus. The children are now able to

access activities independently as well as access resources.’’ (SP 85)

‘’When used consistently by the student ....then the visual strategies are

effective.’’ (KP 80)

Visual systems, especially in relation to communication and independence,

were seen as empowering pupils and giving them the tools to be in command

of some aspects of their life that may usually be controlled entirely by others.

‘’All of the visual systems mentioned above allow the children in my class to

learn independently; make choices about their day and develop the difficulties

they have with the triad of impairments. In my opinion, visual systems give

pupils with autism a voice and control’’. (BP 86)

Theme 3: Environmental Structure and Adaptation

All teachers had adapted their classroom environment purposefully to enhance

the pupils’ independence and provide systems that support this. These systems

included visual cues, to cue the children into an activity or transition and also

TEACCH systems inclusive of ‘now and next’ boards, individual workstations

and visual time tables. There were to help increase flexibility of thought,

reduce fixations and the low stimulation classroom helped pupils to focus their

attention onto significant tasks.

‘’One student has a 'now and next board' which is used in conjunction with his

visual timetable, we use photos from each lesson to cue him in to the activities

that he will experience throughout the school day.’’ (KP 2)

‘’The classroom environment is low-stimulation with less visual clutter on the

walls and separate areas, including workstations designed to minimise visual

distraction.’’ (LS 5)

‘’Individual visual timetables – to develop flexibility of thought; anticipation

of the next activity and accepting changes because they see it on their

timetable. To develop a clear and beginning to an activity to aid transitions.’’

(BP 51)

These systems main purpose and effect was to ‘prepare’ pupils, make them

‘aware’ of their day, especially in relation to what is happening next or

prepare them for any changes that might be happening. The systems are also

used to increase awareness of the ‘expectations’ of their environment,

including behaviour rules.

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‘’The main reason that we use visual systems and strategies is so that the

students are aware of what activities they are about to experience and to

reduce the possibility of challenging behaviours due to students not

understanding what is expected of them (visual timetables).’’ (KP 46)

‘’He then takes the photos from his visual timetable and places them on his

'now and next board' so that he is aware of which activities he will experience

now and what might happen later.’’ (KP 2)

‘’CiP (Communicate in Print) symbols/ photographs/ objects of reference

used on visual timetables/ transition objects, aim to reduce stress related to

the perceived need to understand what is happening next/ have an order to the

day.’’ (SP 8)

‘’Visual timetables – to support transition, reduce unwanted behaviours due

to anxiety about not knowing what is coming next.‘’ (64 VB)

‘’They also provide visual reminders to the behaviour policy/strategies used

within school – 1,2,3 chair. ‘’(SP 10)

‘’Class rules and behaviour for learning rules visually displayed’’ (VB 32)

Theme 4: Positive Behaviour Management

Communication, independence and environment alterations were all evident

within the data set as being connected somewhat to pupil behaviour outcomes,

either behaviour management strategies or reduction of challenging

behaviours. Visual systems were used to reward appropriate and positive

behaviour by allowing the children to have a visual representation of their

appropriate behaviour choices. In addition these systems were also used as

sanctions in the teachers’ behaviour management approaches, indicating to the

children, in a visual manner, any behaviour that is unacceptable and the

consequences of this.

‘’Class rules and behaviour for learning rules visually displayed – to reduce

unwanted behaviours, to allow children to focus on their learning’’ (VB 32)

‘’They also provide visual reminders to the behaviour policy/strategies used

within school – 1,2,3 chair.’’ (SP 10)

‘’Behaviour management (Sanctions) – ‘NO HITTING’ symbol followed by

‘1’ ‘2’ and picture of separation room (moving picture of child along as they

get each warning. ‘’ (BP 14)

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‘’Behaviour management (Rewards) – I am working for boards. Children

choose a photograph of the toy they would like to play with at the end of the

day and have to gain 2 stars to get it’’ (BP 15)

‘’Choice pictures and golden time/reward scheme – to develop independence

and the ability to make their own choices, to reduce unwanted behaviours ‘’

(VB 71)

The reduction of challenging behaviour was a major feature of the data,

teachers commented on the systems in helping reduce stress, anxiety, distress

which often resulted in the pupils displaying challenging behaviour. This

reduction was due to children being able to effectively express their needs and

also have the opportunity to choose, therefore not displaying frustration out of

being unable to communicate. In addition the increased awareness of their

environment and expectations within it, which also supported them in their

daily routine and reduced the ‘unknown’ element associated with a lack of

expectation awareness.

‘’The main reason that we use visual systems and strategies is so that the

students are aware of what activities they are about to experience and to

reduce the possibility of challenging behaviours due to students not

understanding what is expected of them (visual timetables).’’ (KP 46)

‘’Different coloured mats to sit on – to develop independence, reduce

unwanted behaviours and to help children to remain focused within circle

time activities’’ (VB 68)

‘’Children demonstrate much less anxiety and unwanted behaviours as they

understand what is expected of them.’’ (LS 82)

‘’This has also reduced behaviour in children such as UK as this child will

now use words instead of actions to get their needs met. These actions were

often unwanted behaviours such as pulling hair out of frustration.’’ (SP 83)

‘’ All children in class show some degree of difficulties in transition between

activities and/or focus. Visual systems and separate areas reduce

anxiety/distress as children are aware of and can access their daily routines.

They are aware of what is expected, including a visual behaviour system.’’

(LS 48)

‘’Knowing what is next/going to happen throughout the day/ when there is a

change to the routine has also reduced anxiety/unwanted behaviours.’’ (SP

84)

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Theme 5: Curriculum and Learning

A number of teachers commented on the link between the visual supports in

place in their setting and their links to the curriculum. The teachers use the

visual systems as a means of delivering the curriculum content in a structure

more accessible manner and also supporting curriculum content.

‘’Visual systems are incorporated into all my teaching and therefore learning.

Without them, pupils with autism would have to rely on verbal instructions

alone.’’ (BP 86)

‘’All strategies will relate to curriculum themes’’ (SO 74)

‘’For individual children and activities, children are given task plans to

support in structuring their work’’ (LS 3)

‘’Communicate in Print gives symbol/pictorial cues to worksheets/written

work.’’ (SP 7)

‘’The children have their work placed into three separate drawers on their left

hand side. They have a laminated sheet in front of them with their own

photograph and the work symbol. Underneath that there is a strip of Velcro.

They have three symbols on the Velcro strip and a choose symbol at the end.

On each drawer is a symbol matching that on their strip. They then take the

symbol off the strip, match it to the drawer, remove the drawer, complete the

work within the drawer, placing it on their right, by the finished symbol, and

move onto the next symbol/drawer on their strip.’’ (SP 9)

‘’We now use PECS as the focus of each literacy session, so pupils’ learning

is focused on communication skills.’’ (SO 75)

A number of teachers pointed out the way visual systems such as visuals time

tables or work stations supported a left to right technique, they believed this is

a preparation of and associated to early reading and writing, which in the UK

is also presented in a left to right format.

‘’The positives include support with reading as the timetable is laid out left to

right.’’ (LS 94)

‘’Within workstations/work areas left to right systems are used, supported by

visual systems.’’ (SP 9)

‘’TEACCH – traffic light system. Children match red, yellow, green, circles

on their work baskets, then take out activity. They work from left to right.’’

(BP 20)

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‘’These symbols aid the early stages of reading’’ (SP 49)

One teacher however stated that their pupils’ communication needs are

paramount and precede curriculum intentions.

‘’Choosing boards that are linked to curriculum (symbols, I want symbol and

a sentence strip) – to address and develop the autism and the communication

needs first and the curriculum objectives second.’’ (BP 56)

Theme 6: The Role of the Teachers

The teachers, throughout their responses, showed an awareness of autism and

its associated complexities and additionally the aim and purpose of the visual

systems put in place to support their pupils.

‘’We use PECS to support communication. PECS and Makaton augment

verbal communication and aid comprehension, giving a visual element to

auditory learning. Makaton adds a kinaesthetic element to spoken

communication and PECS gives a visual cue to word order and content in

general.’’ (SP 6)

‘’Many children have a particularly visual learning style, and the use of visual

systems promotes their learning. Many children are non-verbal and so PECS

supports their communication needs.’’ (LS 48)

‘’Very ‘visual’ which is what is needed for children with ASD’’ (GK 92)

The teachers understood they had a role in ensuring the pupils got the best out

of their visual system and that it is working most effectively and also that

adequate training in necessary to promote effectiveness.

‘’When .... supported by all teaching staff then the visual strategies are

effective.’’ (KP 80)

‘’However in order to ensure the effectiveness of the support systems, staff

must be given regular training by Speech and Language therapists and must

ensure that the student always has access to their symbols i.e. lost symbols

need to be replaced immediately. ‘’ (KP 81)

Theme 7: Efficacy Foundations

Further efficacy was underpinned by factors including the individual who uses

the systems, as many supports, including individual visual timetables, were

personalised to a pupil. The length of time the support had been in place and

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that the supports need be used in conjunction with a structured environment

were also factors in determining efficacy.

‘’I think the effectiveness is down to the individual using the visual support

strategy and the length of time that the support has been in place.’’ (KP 81)

‘’In my opinion, once embedded, these strategies are effective in supporting

children with ASD. They do need to be coupled with structured routines to be

fully effective. Children demonstrate much less anxiety and unwanted

behaviours as they understand what is expected of them.’’ (LS 82)