If you have a child with autism, then you’ve probably heard already that visual supports can help you solve problems with transitions and other activities or tasks that are difficult for your child. The truth is, many families are so overwhelmed by the litany of resources out there, they might throw their hands up and say “this is too much! I’ll just keep doing it the way I’ve been doing it,” and not try something new.
When you’re in the thick of every day life, you might be reluctant to introduce new strategies or plans, because they take time and energy. You can’t go through your day on autopilot – which is sometimes what we all need to be able to do to make it from morning wake-up to bedtime – while you’re establishing a new routine or system.
That’s why it can be helpful to break down visual supports into different categories and types. I recommend tackling one thing new at a time. For example, if a member of your family has recently started at a new school or a new job, it might not be the best time to try to introduce brand new visual schedules into the mix.
On the other hand, visual supports can help provide structure during times of change or uncertainty in family life. That’s why it is good to familiarize yourself with the different types of visual supports and how they can be useful, so that you’ll be better able to use them in a pinch when things get chaotic.
In this article, we’ll look at one specific type of visual support: the first-then schedule.
What is it?
A first-then schedule is exactly what it sounds like: a visual with an image of the task, activity, or item your child needs to complete or obtain before accessing a preferred item, toy, or activity – which is the second image on the first-then schedule. Often, first-then schedules are placed on a laminated sheet of paper with two squares of velcro adjacent to each other. Then, the first-then pictures can be swapped and exchanged depending on what’s happening at that moment. First-then schedules can also be structured with the “first” picture at the top, and the “then” picture below it.
First-then schedules often use simple, clip-art or Boardmaker style pictures as the images, but they can also be filled with actual photos or even words in text for children who can read – or are learning to read, with the word typed below the image.
First then schedules are sometimes labeled with the words “first” and “then” above their respective spots on the paper, but this isn’t absolutely necessary. The words are meant to be a cue for the adult who is facilitating use of the schedule to remember to use the “first…then…” language consistently.
How does it work?
A first-then schedule works based on something called the Premack principle. The Premack principle simply means that low-probability behaviors can be encouraged and increased by following them directly with high-probability behaviors. For the purposes of a first-then schedule, think of low-probability behaviors as anything your child doesn’t want to do or that is hard for them, and high-probability behaviors as anything they like to do a lot.
For example, picking up toys (low-probability behavior) could be encouraged by following it directly with reading a favorite book or doing a favorite short, low-mess and low-clutter activity like blowing bubbles. Taking a taste of an unfamiliar food that is a strange texture (an “adventure bite”) could be encouraged by following it directly with a bite of a familiar favorite food.
Over time, using the first-then process can actually increase the chances that your child will start to do those non-preferred tasks more independently and more frequently, or with less reminders and help. They may accept prompting to complete transitions between activities more easily. This is a simple way that the concept of reinforcement helps parents guide their children to new levels of independence and fluency with skills that were once new and difficult territory.
How do I do it?
For parents new to the first-then schedule, I recommend a strategy that may seem non-intuitive at first: use a neutral or even somewhat preferred activity that your child already knows how to do as the “first” item, followed by a highly preferred “then” item. Over time, you will be able to introduce difficult and unknown or even disliked activities as the “first” item, but you and your child need to learn the first-then process itself to begin with. Given that the first-then schedule is in and of itself a new and unfamiliar, and sometimes difficult, process, you need to focus on that as your “one new thing” in the beginning of incorporating first-then into your family’s lifestyle.
For example, if your child is good at taking their shoes out of the closet when it’s time to put them on and go somewhere, and they REALLY love bubbles, you could start your first-then schedule with “first, get shoes; then, bubbles!”.
Create your schedule ahead of time. It doesn’t have to be fancy! Some families also use a personal-size whiteboard and dry erase pen that they have hanging on a hook or in an easily accessible cabinet. This way you can adjust your first-then items on the fly.
However, especially at first, it can be helpful to have pictures printed ahead of time, for maximum clarity for your child.
You can also use your phone or a tablet if this is preferred for your family’s lifestyle. Simply use a picture-stitching app or the notes application on your phone to create the first-then schedule with two pictures, in advance.
When you introduce the schedule for the first time, get down on your child’s level so you can show them the first-then schedule at their eye level. It’s also helpful if you have the actual item handy and in their line of sight. For example, if you are using bubbles as the “then” activity, have the container of bubbles out in addition to the first-then schedule, and show it to your child.
Finally, walk through the first-then experience in real time. Say “first, get shoes. Then, bubbles!” while pointing at the pictures or words. Help your child complete the “first” task as needed. Then, do the “then” task with them. And you’re done!
Once your child gets the hang of the first-then schedule, they will start to give you cues, such as pointing to the pictures themselves, or demonstrating excitement when it’s time for the “then” activity. As your child begins to demonstrate these cues, you can look for additional opportunities to use the first-then schedule, and build on the activities you already incorporated with harder, more difficult, and more lengthy “first” activities.
However, make sure you continue to monitor your child’s engagement with the “then” activities, too. Chances are, if their excitement and enjoyment of the “then” activity starts to fade, a disengagement with regards to the “first” activities might be next. To help with this, you can incorporate multiple “then” activities and consistently change them up based on your child’s current favorite things.
Now, you’re ready to try first-then schedules with your family!
Courtney Gutierrez, M.Ed., BCBA, LBA Courtney is a behavior analyst, educator, and writer in the Pacific Northwest. She has over fifteen years of experience in the field of autism services, and over ten years of master’s level experience in classroom teaching and ABA therapy. Her areas of expertise include infant and toddler development, parent coaching, ABA clinical leadership and training, P-12 special education, and case consultation for children and young adults with autism and other special needs. Courtney lives in Seattle with her husband and two children.