Visual Supports for Transitions

Enrichment Therapies

November 19, 2018

This past weekend, we (the staff at the Des Moines location) had the opportunity to share information about modifications and accommodations for a presentation at the Inclusive Ministry Conference. As a speech-language pathologist, a portion of my piece of the presentation focused on the prompting hierarchy and applying it to visual supports for children that struggle with transitions.

What is a Prompting Hierarchy?

The prompting hierarchy breaks down how we prompt our kids to complete tasks. There are a variety of prompts, and the hierarchy goes from most supportive to least supportive. Every child and situation is different, so sometimes you may work from most to least prompting, and other times you might work from least to most prompting. We want to provide each child with the supports they need to be successful, and then fade the supports as their independence grows. Another name for this process is scaffolding — breaking the learning into chunks and providing a tool or structure with each chunk. Here’s a peek at the prompting hierarchy & an example of how to move through it:

Prompting Hierarchy Example

Let’s use completing a simple puzzle as an example. Let’s say it’s a farm animal puzzle.

Full Physical prompting: This is when you use hand-over-hand assistance to help the child place the puzzle piece in its place.

Partial Physical prompting: This is when you may gently touch the child’s elbow or arm to guide them towards the correct place for the puzzle piece.

Model prompting: This is when you provide a model of what is expected. So you would put the puzzle in its place and then undo it so the child could imitate your action.

Gestural prompting: This is when you provide a gesture as a prompt. In this example, you would point to the puzzle piece and point to its place on the board.

Direct Verbal prompting: This is when you provide direct instruction verbally such as, “Put the cow on top of the matching cow.”

Verbal prompting: You may provide a more general verbal prompt such as, “Do the puzzle.”

Indirect prompting: You may provide an indirect prompt such as, “What should we do next?” These prompts typically get a child started but don’t directly cue them on what to do.

Independence: No prompting! This is the goal. The child is able to complete the activity on their own.

Applying the Prompting Hierarchy to Visual Supports

When introducing visual supports for transitions, I typically think in a prompting hierarchy framework, and I first try the least supportive strategy and then move my way up until the child is successful. Over time you can fade these prompts to work towards independence in transitions. Here is my prompting hierarchy for visual supports for transitions:

1. Provide a Verbal Cue

      • This might be as simple as “Five more minutes until the next activity.” Verbal cues provide verbal warnings for upcoming transitions.

2. Use a timer 

      • Visual timers work really well so children can see how much time is left in an activity and then the “beep-beep-beep” signals when an activity is over.

3. First-Then

      • First-Then boards allow a child to know what is coming next. I find these work best when you are starting with a non-preferred activity followed by a preferred activity. For example, “First read a book, next play with toys.”

4. Visual Schedule

      • Visual Schedules take many forms, they can be written out on a whiteboard, be printed out with pictures, or use picture symbols that can be moved around to adjust the order. Visual schedules can break down a child’s entire day or a half-hour therapy session. These help a child see what’s next and how much they have completed.

5. Task Analysis

      • A task analysis takes a visual schedule one step further. This provides step-by-step information for one task. For example, if you wanted to provide visual supports for washing your hands you could use the visual pictured above.

6. Video Model

      • To provide even more support for a task, you can provide a “how-to” video with each step. These can be of the child doing the task and then they can watch themselves complete it or they can be of an adult completing a task as an example. Have the child watch the video prior to completing the task to prepare them for what is expected. 

Overall, it is important to remember each child is different – what works for one child may not be right for another. It may take some trial and error to find the supports that make a child most successful. The end goal is to fade those supports so the child can be independent in transitions. 

Enrichment Therapy & Learning Center has locations in the Iowa City, IA area and Des Moines, IA area. We provide individual speech-language therapy and tutoring as well as offering small group academic programs.  At Enrichment Therapy & Learning Center our passion is to help kids achieve effective communication skills and gain academic success.  Contact us for more information on how we can help your child succeed.

740 Community Drive, Unit A

North Liberty, IA 52317


5530 West Pkwy, Suite 300

Johnston, IA 50131


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