Process SchemesVisually Cued Instructions

Visual support with a scenario created to

compensate missing inner scenario of a child with

autism.

Process SchemesWe can use process schemes to support: Self care Hygiene House work Food preparation Work skills

Self care

Recommended comentary:1. I take the end of the right sleeve with

my left hand.2. I pull out my hand from the sleeve3. I take the end of the left sleeve with

my right hand.4. I pull out my hand from the sleeve.5. I pull the jumper over my head.

Taking off the jumper

HygienePutting on the lotion

Recommended commentary:1. I take the lotion.2. I open the lotion.3. I take a bit of lotion

with my finger4. I put the lotion on my

face.5. I spread out the lotion

over my face6. I put the lid back on

the lotion.

House workWatering flowers

Recommended commentary:1. I take an empty bottle. 2. I pour water up to the line.3. I turn off the tap. 4. I water a plant.5. I put the bottle back.

Food preparationBaking biscuits

Recommended commentary:

1. I spread the pastry2. I cut out biscuits.3. I put the cut outs on the

bakery dish4. I put the dish into the oven

for 10 minutes5. I take the dish out of the

oven6. I stick two busciuts with jam.7. I put the buiscuits on the

plate.

Hot drink preparationRecommended commentary:1. I pour water into the kettle up to

the line.2. I put the kettle on.3. I take the cup from the cupboard4. I put a tea bag into a cup.5. I pour boiling water into a cup.6. I wait for 5 minutes and take the

tea bag out.7. I put two tea spoons of sugar

into a cup8. I stir the tea.

Work skills1. Paper with scissors2. Start cutting from right

bottom of the paper.3. Cut along the line.4. Cut along the next line.5. Continue cutting till all

strips of paper are cut out.

Process SchemesThe level of abstraction of the process scheme depends on the person, the process scheme is made for.It can use: Words Photographs Pictures Objects

SHOES

Process SchemesMain aim: independence from support of other

people (including also independence from verbal

prompts)

Main reasons of dependency on others: One of the reasons is deficit in socialization - children

with ASD are not motivated by social acceptance by their social environment and during their development the period of

“I do it myself” is missing. Learning by imitation is also affected.

Often there are deficits in motor skills needed to learn some self care activities.

Problems with sensory processing can play role in their behaviour.

Using Process Schemes Reinforcement of independence is the only way to help

a person with autism to function without help of adults. For the future, training in daily living skills from early

age is the best way to prepare for independent life. Before we begin to teach these skills, we need to make

an analysis of specific ability of a child with autism in order to know what steps to include into a process scheme.

By observation we identify which steps a child knows and which steps he/she yet needs to learn. After that we can introduce visual support.

Using Process Schemes We visualize the steps, the child does not yet

know! (eg. washing hands consists of … steps. We visualize only 5)

The visual aids are not meant to be used permanently. If a child is able to do the task without visual support, we gradually stop using them.

Also when we see that a child is able to do a certain step in the process without visual support, we take this step away from the process scheme.

What is the purpose of Process Scheme?

The aim of process schemes is achieving independence so the person does not rely on help of others (including independence from verbal instructions)

The aim of the process scheme is not detailed visualization of the process, but process scheme which maximize his/her independence in accomplishing the entire process.

Process schemes help compensate deficits in ability to process audio inputs. “Visual is real.” (Mesibov, 1996)

What should process scheme look like?

The form of the process scheme is very individual and depends of the level of abstract thinking and generalization of the person.

We can use objects photographs pictures pictures with supporting text text

I take a coat from the hanger. I turn it facing the buttons. I put right hand into right sleeve.

I put my left hand into the sleeve. I do the buttons.

Photographs

Recommended commentary: 1. I take my clothes off2. I stand under the shower3. I put shower on .4. I put soap on my body.5. I wash the soap off.6. I turn the shower off.7. I dry myself with a towel8. I put my clothes on.

Colored Pictures

Black & White Pictures

Planning of development of self care and work skills

When we want to attempt to improve the development of some of the areas of self care using process schemes, first we need to consider the actual level of independence of the person in this area.

We can find out (measure) this level using various developmental scales, which can help us identify the actual age level of this area for the child we work with.

Self care observation sheet putting a cap on

Looking at the capTouching the capRecognizing front and back side of the capHolding the cap with both hands on the sides. Putting a cap on the head.Pulling the cap over ears.Adjust the sides of the cup.

Assessing scale:0 – can not do it at all1 – can do it with a physical and verbal prompt at the same2 – can do it either with verbal or with physical prompt3 – can do it with occasional prompt4 – can do it without any prompts – independently

ObservationWe focus on the area of self care, which we intend to improve:

Our observations has to be based on these key points:

Which of the daily self care activities is the person doing independently and which of them is not and help is necessary?

When identifying deficits it is important to clarify, if these deficits emerge from insufficient skill or from the lack of motivation to do the task.

Is the level of fine motor skills sufficient in order to carry out the self care activities without support (independently)?

Observation Can the person with autism carry out activities in

sequence? What is the level of imitation of the person with

autism? How does the person with autism communicate?

(Verbally, using gestures or signs, pictures, photographs or written text)?

What are the best motivation situations to use in training and teaching independence?

What are the most effective incentives for particular person with autism we want to work with?

Observation and planning

It is important to know a daily routine of the person:

Can he/she wash/bath independently? Can he/she brush teeth, put on/take off clothes,

open lids without help? Can he/she eat, pour liquids into a cup, use

cutlery without help? Can he/she help with house work? Is he/she able to walk to school, go shopping,

organize his/her free time independently?

When answering these questions we have to take into account age and developmental stage of the person as well as preferences of the parents.

Observation and planning

It is important to focus if the observed person has certain abilities to accomplish the task:

Has the person correct gripping movements? Or do we have to first focus on improving this area?

Other key issue is a motivation:

Is it necessary to train independence in daily self care situations?

Is it possible to motivate a person with attractive incentives?

Who with and in which situations a person can carry out certain task?

Training methodsWhen teaching more complex tasks with support of process schemes, we can use following methods:

Teaching in steps from the beginning / chaining from 1st step to last step

Teaching back-stepping / chaining from last step back to the 1st step

Demonstration/Modeling and following imitation Physical guidance (physical prompt), Visualization (use of process schemes) and reinforcing.

Which training method to choose?

When considering appropriate training method we need to reflect the main deficits characteristic for people with autism:

Problems with imitation – we use physical guidance (physical prompts)

Problems with social modeling – we use social demonstration together with a physical prompt in modelled situation,

Problem with sequence memory – we break a task into a sequence of simple steps

Problem with orientation and organization/ focusing on unimportant detail – we stress out (visualize) the important, eg: side of clothes

Problem with understanding of concept of the task – we use so called BACKWARDS CHAINING – meaning: we do as many last steps of the process, as the person is able to follow, in order to make the steps of the process clear.

Which training method to choose?

Problem with time perception – seasons, weather – people with ASD often can not judge correctly what clothes to put on – visual rule is necessary

Problem with perception of social rules and consequences – they are unaware of how their appearance affect other people – they are often unkempt

Problem with understanding of hygiene and health and safety – why it is necessary to wash hands after toilet, etc.

Basic principles when using process schemes

Naturally we want the person with autism be flexible. Our aim is not to teach a person with ASD the sequence of an action mechanically but, if possible, introduce (incorporate) changes into the work scheme, just as it happens in everyday life. (Of course, it is not possible nor appropriate in every situation as it strongly depends on the level of autism of the person.)

In such cases it is very helpful to combine a visual timetable with daily routine, so after each step can person with ASD check what comes next.

Basic principles when using process schemes

It has to be visually clear for the person working with the process scheme Which steps are finished Which step is he/she working at now Which step is next

There are various ways to do visualize this, according to developmental level of the person and his/her fine motor skills and ability to sustain attention, etc.:

Flipping the picture with the step that was accomplished Stamping marked space on the card/picture depicting the accomplish step Marking the accomplished step with a sticker or a peg Crossing out accomplished step Turning the card/picture depicting the accomplished step facing down. Taking away the picture and placing it into a designated container etc…

Basic principles when using process schemes

If the person is able to perform the task without help, then we start removing visual support. However, we need to proceed with caution. If we remove the visual aid too fast, a person with ASD do not have to accept or tolerate it (unintentionally).

We need to learn to see people with autism exactly as they are and not as what we would want them to be.

Visual support with a scenario created to

compensate missing inner scenario of a child with autism.

It is very important to know that these steps can be freely rearranged, skipped or repeatif it is necessary for maximum independence and spontaneous use by a person with autism.

Trainining with a person who uses objects of reference

Example:Task: Dressing up a coat (5 steps)General objective: Training in daily living skillsSpecific objective: Dressing up a coatLevel: objects of reference Method: modeling and full physical prompt; parallel imitation of the person (teacher / parent), who models with his/her coat according to the steps while providing total physical prompt; practicing can be divided into steps the emphasis is on mastering each step

I take a coat from the hanger. I turn it facing the buttons. I put right hand into right sleeve.

I put my left hand into the sleeve. I do the buttons.

Trainining with a person who uses pictures

Example:Task: Dressing up a coat (5 steps)General objective: Training in daily living skillsSpecific objective: Dressing up a coatLevel: picturesMethod: Chaining from the 1st step to the last;Sequence of individual pictures from left to right or from top to bottom. Accoplished step is visualised by turnig the picture facing down. Prompts are given according individual needs of the person.

Trainining with a person who uses words

Example:Task: Dressing up a coat (5 steps)General objective: Training in daily living skillsSpecific objective: Dressing up a coatLevel: words Method: Chaining from the 1st step;Using written instructions of the steps from left to

right. Prompts are given only if a person can not continue or requests help.

Some ideas for inspiration....

How to make a ball

How to cut with scissors

How to cut with scissors

How to stamp with different colours

HOW TO PREPARE A SANDWICH

ear, nose and throat examination

Nose smear

Taking pills

How to draw a fish

In the gym: Rolling over the ball.

In the gym: Ball excercises

In the gym: warm up excercises

Mopping the floor

Preparation for mopping

Mopping Putting mop away

In this presentation we used information and pictures from: VIDIEŤ ZNAMENÁ VEDIEŤ – TO SEE MEANS TO KNOWKATALÓG DIDAKTICKÝCH POMÔCOK – CATALOGUE OF DIDACTIC RESOURCESwritten by: Karen Gašparových, Jiřina Kántorová, Zuzana Peťovská, Andrea Šedibová, Adela Štrpková, Dagmar Šuranová© Autistické centrum Andreas® n.o., 2010

Thank you for your

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