Visual Supports: Evidence-Based Practice and Common Misconceptions

 

Visual supports are a well-established, evidence-based strategy for supporting individuals with autism-but there are persistent misconceptions about how and why these supports work. It is critical to understand that children with autism do not have a genetic predisposition for understanding visuals-they must be explicitly taught what pictures, icons, and symbols mean, just like any other learner.

Why and How Visual Supports Work

  • Not Innate: There is nothing inherent in autism that grants a unique ability to interpret pictures or symbols. Individuals learn what visuals represent, and the process often begins with real objects or identical photographs before moving to more abstract or symbolic images.

  • Concrete and Lasting: Visuals (like objects, pictures, or written symbols) are semi-permanent, unlike spoken words, which are fleeting, giving more time for processing, referencing, and understanding.

  • Developmental Sequence: Some learners grasp image-based communication before complex receptive or expressive language develops because the representation is more direct and less abstract.

  • Generalization Not Guaranteed: Many students do not immediately understand non-identical pictures or different symbolic representations (e.g., an icon of an apple versus a photo), and these skills need to be taught systematically.

Visual supports are not only tools for basic understanding-they are powerful strategies for building complex communication skills, including both receptive understanding of spoken language and expressive language through systems like PECS® (Picture Exchange Communication System®).

When used systematically, visual supports can bridge the gap between objects and language, fostering comprehension of spoken words, instructions, and cues by providing concrete, lasting visual representations alongside verbal communication. This dual exposure helps many learners process and retain language.

PECS® exemplify this: while designed for nonverbal communication, research consistently shows PECS® can facilitate and even accelerate the development of spoken language in individuals with the ability or potential to speak. By pairing words with visual representations, PECS® teaches the meaning and function of language, building foundational communication skills that generalize as the learner grows.

Visual supports thus enhance and supplement spoken language, enabling children to acquire receptive and expressive skills and laying the groundwork for more advanced communication, autonomy, and participation in daily life.

When Visual Supports "Fail"

Too often, staff rely on rings of picture cards or visual icons, flashing them repeatedly without seeing behavioral change. This is a clear sign the visual support is not functioning for the learner-if it works, it clarifies the message and results in a meaningful response (e.g., compliance, communication, task initiation).

  • Repeatedly presenting visual cues without response indicates the association has not been made.

  • This practice reflects good intentions, but not best practice-it is essential to assess comprehension by direct teaching, not assumption.

Effective Teaching of Visual Supports

  • Pair visuals with objects and direct teaching to foster understanding.

  • Assess not just rote matching, but understanding and functional use-can the child use the picture to request, refuse, comment, or transition?

  • Teach the function of images: For communication systems (like PECS®), explicit instruction and systematic progression from object/picture discrimination (Phase III) to functional use is vital (Phase I-VI).

  • Progressive ABA: Utilize reinforcement, prompting, and systematic fading to build real language-including visual language-skills that transfer across environments and purposes.

Visual Supports for Real-World Application 

Visual supports take on even greater importance as children transition to community settings, navigate expectations, and (potentially) rely on picture communication systems for more advanced or social uses.

Visual supports are powerful when taught and implemented properly. They are not an autism-specific “superpower,” but a learned skill that, when mastered, can open doors to independence and communication for many students on the spectrum or other learner needs.

*Misunderstanding or misusing visual supports and picture communication systems can sometimes lead to the premature prescription of speech-generating devices (SGDs) for individuals with autism. When devices are chosen before the foundational skills of understanding and using picture communication are established, these tools may wind up unused-left on a shelf or in a backpack rather than supporting meaningful communication and learning in daily life.

It’s critical that SGD's are introduced only when a student shows readiness, interest, and foundational picture-based communication skills (PECS® Phase IV), to ensure the device becomes a meaningful part of their communication toolkit rather than an expensive item gathering dust.

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