Visual and anticipatory supports

• spoken instructions are easily forgotten
• uncertainty creates distress
• transitions are difficult
• routines involve several steps
• the young person repeatedly needs the same information
• understanding improves when information is shown rather than only said

Approach type: Practical strategy
Primary purpose: Communication
Also supports: Executive functioning · Participation · Regulation · Learning
Scope: Individual · Classroom · Whole setting
Tier: Universal → individualised

These describe possible implementation settings, not equivalent evidence across populations or tiers. The strongest fit in the reviewed literature is specific, taught schedule use for defined tasks; ordinary information access is also supported by guidance.

• covering every wall in symbols
• replacing useful spoken communication
• using infantile materials with older young people
• rigidly enforcing a visual schedule when circumstances change

The adult changes the availability and usability of information: identify what is being lost or misunderstood, make that information persistent in an accessible format, check its meaning with the young person, and update it when the plan changes. Include how to ask for help, question a step or respond when the expected sequence is no longer accurate. A display on the wall is not enough if the person cannot understand it or reach it when needed.

Keep the target clear. Making instructions available is different from teaching the reading skills needed to decode those instructions. When reading itself is difficult, check a demonstrated, pictured, object-based or other accessible route rather than assuming a written list solves the information barrier. Record any literacy teaching separately; following a displayed sequence does not show that decoding was taught.

Distinguish the function

These functions can coexist. American Speech-Language-Hearing Association (ASHA)’s AAC guidance includes visual schedules within aided AAC and describes systems that combine modes and components. A step display therefore may belong within AAC, while still not describing the whole expressive system. Keep the person’s communication available alongside the display. ASHA supports this functional boundary, not a comparative effectiveness claim.¹² The social-narrative distinction follows the existing A021 article boundary.

This is a constructed illustration, not a reported case or an observed outcome.

Imagine a pupil who loses part of a spoken instruction to put equipment away, collect a coat and meet transport at reception. The pupil also finds the words on a written checklist difficult to decode. Repeating the whole sentence or handing over more written directions leaves the actual information barrier unresolved.

The adult checks which part was understood and tries a short sequence using familiar photographs, objects or a demonstration, with the pupil helping select a usable format. Each step remains available at the point it is needed. The pupil has a way to ask for clarification, and the adult updates the sequence if the meeting point changes instead of treating the old display as a rule.

Review would examine whether the pupil could identify and return to the relevant step, whether adult information stayed accurate, and what effort or help was needed. Any support for reading would have its own teaching goal and review. Finishing the sequence would not establish improved decoding, reduced distress or that the same format works elsewhere.

Accessible format

The support must be understandable to the person using it.

Relevant information

Include what genuinely helps rather than every possible detail.

Availability

The information needs to remain accessible at the point it is needed.

Consistency

Adults should understand how the support is intended to work.

Respectful design

Materials should be appropriate to the young person's age, preferences and communication style.

Possible formats include:

• written lists
• photographs
• symbols
• drawings
• objects
• timers
• calendars
• maps
• checklists
• flowcharts
• digital reminders
• worked examples

Making information accessible can be part of ordinary educational practice. Adults need to check what the person understands, how the support is accessed, and who will keep it accurate. National Institute for Health and Care Excellence (NICE) recommends visual information meaningful to the individual; this is guidance, not a school-programme trial.¹³

More specialist communication input may be useful where a young person has significant receptive-language or AAC needs. ASHA describes individual assessment of communication modes, symbols and access.¹²

A persistent cue gives the person something to return to after speech has ended. As a practical rationale, this may reduce the need to hold an instruction or sequence in mind. It is not evidence that every visual support improves working memory, language processing or time perception. Written words, pictures and objects all still require an accessible meaning.

Schedule studies generally test whether people complete or move between activities after being taught to use the schedule. That outcome should not be renamed a change in an underlying cognitive ability. Anticipatory information addresses uncertainty only when missing or unclear information is part of the difficulty; it does not change an aversive destination merely by making it predictable.¹⁰

Simple materials offer options for an individual trial, but cost, preparation, teaching and updating vary. The reviewed evidence does not establish that every application is inexpensive or effortless.

Taught activity-schedule packages can support more independent performance of particular sequences. This is narrower than saying that all visual aids reduce prompting or increase independence. A picture-sequence study with four students with intellectual disability reported better completion after verbal directions and community transfer, but only its abstract was accessible for this review.⁷

Visual support will not solve a demand that is inherently intolerable.

Making something predictable does not necessarily make it manageable.

Check whether the material adds clutter, effort, frustration or unwanted attention for this person. These are matters to ask about and monitor, not quantified harm rates from this review.

The evidence distinguishes completing a transition from feeling safe, understanding it, or wanting to participate. Those outcomes need separate review.

• avoid visual clutter
• do not assume symbols are easier than written words
• avoid using visual systems to enforce compliance
• update information when plans change
• remove supports that no longer help rather than allowing them to accumulate indefinitely

1. identify which information is repeatedly lost or misunderstood
2. decide whether making it persistent would help
3. choose the simplest accessible format
4. introduce it clearly
5. ensure it is available where needed
6. review the intended outcome: access to the information, correct use, needed help, effort and the young person’s experience; record task completion separately
7. adapt according to the young person's feedback

A decrease in adult prompts can be useful when it reflects usable independent access. It should not become a requirement to remove a support the person still chooses or needs.

The evidence belongs to particular uses and packages. It does not justify one effectiveness rating for every timetable, picture, object, written list, warning or communication aid.

Activity and task schedules. The recent academic review included 10 single-case studies with 31 autistic participants aged 4–19. Schedules were usually combined with prompting or reinforcement; improvements in engagement or task performance therefore concern those packages. Maintenance was less consistently examined, and autistic participants’ views were mixed.³ The foundational photographic-schedule study also taught schedule use through graduated guidance. Its accessible abstract reports independent activity sequences and generalisation; it does not show that merely presenting pictures teaches a new task.⁶

Transition information. Advance notice is not reliably sufficient on its own. In a small component study, visual schedules alone did not reduce transition-related behaviour, whereas extinction plus differential reinforcement did, with or without schedules.⁴ That finding establishes an attribution limit, not a reason to copy a restrictive procedure. A later two-child study found schedule-plus-choice effects more consistent than schedule alone, but it did not isolate choice alone or directly measure task accuracy.⁵ Review the reason the transition is difficult and the acceptability of the next activity rather than escalating reminders because a picture has been shown.

Broad reviews and guidance. National Clearinghouse on Autism Evidence and Practice (NCAEP) classifies visual supports as an evidence-based category, but that category includes scripts, work systems and other forms, often in combined interventions.¹ A 2026 synthesis of transition interventions found heterogeneous and statistically inconclusive overall effects; it searched selected behaviour-analytic journals only through July 2023 and did not formally appraise study bias.¹¹ Neither result establishes an A006-wide effect on anxiety or distress. Guidance supporting meaningful accessible information and continued AAC access has a different role from comparative efficacy evidence.¹²¹³

What remains uncertain. The reviewed sources do not establish a single effect, optimal dose, best format or cost for this whole approach. They do not show that a displayed sequence teaches decoding, changes time perception, or improves everyone’s wellbeing. Staff ratings and task performance cannot substitute for the person’s account. The accompanying evidence profile records study designs, co-components, access limits and conflicting source counts; no inherited headline rating has been adopted.

1. 1.

   Evidence-Based Practices for Children, Youth, and Young Adults with Autism. Steinbrenner et al.; UNC NCAEP, 2020 report; updated ASI terminology in available version. Access: Official full PDF; methods, Table 3.1 and VS appendix inspected.

   ↩1
2. 3.

   The use of visual schedules to increase academic-related on-task behaviors of individuals with autism: a literature review. Liang, Lee, Zuo & Liang; online 12 September 2024; current issue 72(6):1326–1339. Access: Publisher indexed full-text methods/results/discussion available; direct reopen/PDF failed; embedded tables not inspected.

   ↩1
3. 4.

   Separate and combined effects of visual schedules and extinction plus differential reinforcement on problem behavior occasioned by transitions. Waters, Lerman & Hovanetz; JABA 42(2):309–313 (2009); DOI 10.1901/jaba.2009.42-309. Access: Complete original article PDF via ERIC.

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4. 5.

   Reducing Escape-Maintained Challenging Behavior in Children with Autism Spectrum Disorder through Visual Activity Schedule and Instructional Choice. Lory, Rispoli, Gregori, Kim & David; Education and Treatment of Children 43:201–217 (2020). Access: Public author-posted full text inspected; publisher metadata/abstract; no login/paywall bypass.

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5. 6.

   Teaching children with autism to use photographic activity schedules: maintenance and generalization of complex response chains. MacDuff, Krantz & McClannahan; JABA 26(1):89–97 (1993). Access: Original publisher abstract; open PMC scans could not be accessed.

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6. 7.

   The Effects of a Picture Activity Schedule for Students With Intellectual Disability to Complete a Sequence of Tasks Following Verbal Directions. Duttlinger, Ayres, Bevill-Davis & Douglas; online October 2012; 28(1):32–43 (2013). Access: Publisher abstract/metadata only; full-text retrieval unsuccessful.

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7. 10.

   Advance Notice for Transition-Related Problem Behavior: Practice Guidelines. Brewer, Strickland-Cohen, Dotson & Williams; Behavior Analysis in Practice 7(2):117–125 (2014). Access: Full PMC article text inspected.

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8. 11.

   Interventions for Transition-Related Challenging Behavior in Individuals with Disabilities: A Targeted Research Synthesis and Meta-Analysis of Studies Published in Behavior Analytic Journals. Kim, Ravichandran, Moeyaert, Ditzler, Ryan & Fienup; Behavior Modification 50(3):212–247 (2026). Access: Full publisher PDF; methods, results and limitations inspected.

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9. 12.

   Augmentative and Alternative Communication (AAC). American Speech-Language-Hearing Association; current undated practice portal inspected 11 September 2026. Access: Full web text; AAC Systems/Forms/Symbols and visual schedules sections inspected.

   ↩1 ↩2 ↩3
10. 13.

    Autism spectrum disorder in under 19s: support and management, CG170. NICE; published 28 August 2013, updated 14 June 2021. Access: Official recommendation text and metadata retrieved in indexed results; full current guideline/PDF not successfully opened.

    ↩1 ↩2

This review retains the source-specific findings and limits of the September 2026 review. This is a targeted review, not an exhaustive systematic review, a formal evidence grade or a completed specialist consultation. It does not determine which support is right for an individual young person.

These working tags describe the approach’s focus. Conditional connections depend on the particular barrier, goal and application. They do not replace professional delivery roles.

Direct focus

• 02 Thinking, attention & action — Keeping sequence, upcoming events and changes available supports tracking what happens and what comes next.
• 03 Communication & connection — Making important information understandable, persistent and available is central throughout this approach, including instructions, choices and changes.

Conditional connections

• 01 Emotional life & regulation — Relevant when the support addresses distress associated with uncertainty or change; predictability alone does not establish reduced distress.
• 06 Agency, safety & participation — Relevant when accessible information and options help the young person navigate a chosen activity or request a change.

These entries offer related reading for the situations described. A link expresses the specific connection below; it does not establish individual suitability or an effect of the approach.

• E005 Difficulty with transitions — Read alongside this approach when information about ending, moving or arriving is missing or difficult to retain. Check which part of the transition is difficult; a sequence does not resolve an unsafe or intolerable destination.
• E014 Difficulty understanding spoken instructions — Read alongside this approach when spoken meaning or a multi-step instruction is lost before it can be used. Match and check the persistent format; written directions do not automatically provide access when reading is difficult.
• E043 Difficulty managing uncertainty — Read alongside this approach when known plans, changes and usable alternatives can be made clearer. Mark what is known and unknown; the support must not promise certainty that adults cannot provide.