# Visual supports at home: a UK parent's guide > Visual supports are objects, photos, symbols or written words that show your child what is happening now, what comes next and what they can choose. Unlike spoken words, a picture stays put, so your child can check it as often as they need. That makes the day easier to predict. You can make simple ones at home with photos, card and Velcro, with or without a diagnosis. - Canonical page: https://rocksmakepebbles.co.uk/guides/visual-supports - Publisher: Rocks Make Pebbles (https://rocksmakepebbles.co.uk) - Topic: Routines and visual supports - Applies to: UK - Last updated: 28 September 2026. Checked against sources: 28 September 2026 - Professional review: Not yet reviewed (waiting for review by a speech and language therapist and early years or SEN teacher) - Drafted with the help of AI tools and checked against the sources listed below. Editorial policy: https://rocksmakepebbles.co.uk/editorial-policy ## Key points - Visual supports show your child what is happening, what comes next and what they can choose. - Start small, with a Now and Next board and photos of your child's own things. - Match the picture to what your child understands: objects, photos, symbols or written words. - Put nice things on the board too, and never use pictures as a threat or a bribe. - Use the same pictures and words at home, nursery and school. - You don't need a diagnosis to start. ## What are visual supports? [Visual supports](https://rocksmakepebbles.co.uk/glossary#visual-supports) are things your child can see that help them understand what is happening. They can be real objects, photos, symbols or written words. Some families and schools call them "visuals" or "visual cards". They help answer questions many autistic children find hard: what is happening now, what comes next, how long it will last and what they can choose. NICE's guideline on supporting autistic children and young people (CG170) asks professionals to take account of the places where children are supported and cared for, including by "providing visual supports, for example, words, pictures or symbols that are meaningful for the child or young person" ([NICE CG170](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations)). You can use the same ideas at home. | Visual support | What it looks like | What it is for | |---|---|---| | [Now and Next board](https://rocksmakepebbles.co.uk/glossary#now-and-next-board) | Two pictures side by side | Showing what is happening now and what comes next | | [Visual timetable](https://rocksmakepebbles.co.uk/glossary#visual-timetable) | A row or list of pictures in order | Showing part or all of the day | | [Visual timer](https://rocksmakepebbles.co.uk/glossary#visual-timer) | A sand timer, or a timer where a coloured area shrinks | Showing how long is left before a change | | [Choice board](https://rocksmakepebbles.co.uk/glossary#choice-board) | Two to four pictures of real options | Choosing without needing words | | Picture sequence | The steps of one task in order | Tasks like handwashing, dressing or using the toilet | | [Social narrative](https://rocksmakepebbles.co.uk/glossary#social-narrative) | A short story with photos or drawings | Preparing for something new, like a haircut or a new class | A Now and Next board is a good place to start, and you can build up to a timetable. There are step-by-step guides to [Now and Next boards](https://rocksmakepebbles.co.uk/guides/now-and-next-boards) and [visual timetables](https://rocksmakepebbles.co.uk/guides/visual-timetables). Some visual supports help your child understand you, and others, like choice boards, help your child tell you things. For picture boards, signing and talking apps, see [signing, pictures or an AAC app](https://rocksmakepebbles.co.uk/guides/aac-signing-and-picture-communication). ## Why do visual supports help? Visual supports make the day more predictable. Spoken words disappear as soon as they are said, but a picture stays where your child can see it. Your child can check it again when they are unsure, without having to ask or remember. Not knowing what will happen can be stressful for many autistic children, and changes can be hard. NICE lists "changes to routines or personal circumstances" and "the absence of predictability and structure" among the factors that may increase the risk of behaviour that challenges. It recommends care plans that include "increasing structure and minimising unpredictability" ([NICE CG170](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations)). Scotland's Autism Toolbox says visual supports "support communication", and lists among their benefits "Providing structure, routine and predictability by showing what is coming next" ([Autism Toolbox](https://www.autismtoolbox.co.uk/supporting-learners-and-families/effective-partnerships-and-communication/visual-supports/)). Visual supports also give your child more say. They can point to a picture to make a choice, move a picture when something is finished, or check the plan for themselves. The National Autistic Society's [SPELL framework](https://rocksmakepebbles.co.uk/glossary#spell-framework) puts it this way: "Structure supports autonomy and helps people feel safe and secure" ([NAS](https://www.autism.org.uk/learn/what-we-do/training/the-spell-framework)). ## Which kind of picture should I use? Use the kind of picture your child already understands. Some children move through these levels over time, but there is no rush, and you can mix them. | Level | Example for bath time | Often suits children who | |---|---|---| | Real object | A bath toy or sponge | Are at an early stage of communication | | Photo | A photo of your own bath | Recognise familiar things in photos | | Symbol or drawing | A simple bath symbol, with the word | Understand that a drawing stands for a real thing | | Written word | The word "bath" | Read, or are learning to | Scotland's Autism Toolbox describes the same range, from objects for children at an early, pre-verbal stage who may not yet understand symbols, through photographs and symbols to written words ([Autism Toolbox](https://www.autismtoolbox.co.uk/supporting-learners-and-families/effective-partnerships-and-communication/visual-supports/)). Photos of your child's own things are often a good first step. A photo of their cup, their car seat or their nursery door is easier to recognise than a general drawing of "a cup". Research with minimally speaking autistic children suggests colour photographs can help children connect a picture with the real thing ([Hartley and Allen 2015](https://pubmed.ncbi.nlm.nih.gov/24916452/)). - Write the word under every picture, so every adult uses the same word. - Keep each picture clear and simple, with one thing in it. - If your child uses a picture board, signs or a communication aid, use the same pictures and words. - A [speech and language therapist](https://rocksmakepebbles.co.uk/glossary#speech-and-language-therapist) can advise which level suits your child. The Autism Toolbox says speech and language therapists "are well placed to advise on an individual's stage of communication development and what types of visuals would be most suitable" ([Autism Toolbox](https://www.autismtoolbox.co.uk/supporting-learners-and-families/effective-partnerships-and-communication/visual-supports/)). > **Myth:** "Using pictures will stop my child learning to talk." Research does not support this. A review of the best studies of signs, picture boards and other communication aids found that none of the 27 people studied lost speech, and most gained some, though the gains were often modest ([Millar, Light and Schlosser 2006](https://pubmed.ncbi.nlm.nih.gov/16671842/)). Keep saying the words as you point. ## How do I start using visual supports at home? Start small, with one routine and two pictures. Add other supports once that feels easy. ### Start with a Now and Next board 1. Pick one moment of the day that is often hard, such as leaving the house, bath time or turning off a tablet. 2. Choose the level your child understands: an object, a photo, a symbol or a word. 3. Make a Now and Next board: a strip of card with two spaces, plus a pocket or box for "finished". The [free Now and Next board printable](https://rocksmakepebbles.co.uk/printables/now-and-next-board) has one ready to print. 4. Show the board just before the change. Point and use the same few words each time: "Now bath. Next story." 5. When the first activity ends, say "finished". Let your child put that picture in the finished box, then move the next picture across. 6. Use it the same way, at the same moment, every day, before deciding whether it works. 7. Once your child knows the routine, add a third picture, then a short timetable for part of the day. The [free visual timetable printable](https://rocksmakepebbles.co.uk/printables/visual-timetable) can help. 8. Tell your child's nursery or school what you are using, and ask what they use. > **Try this:** For the first few days, make the "next" picture something your child enjoys, like bubbles or a snack. That way the board comes to mean "something good is coming", not only "time to stop". ### Add a choice board A choice board shows two to four pictures of things your child can really have or do. Your child points to a picture, or hands it to you, and you respond straight away. - Start with two options, both things your child likes. - Only offer what is really available right now. - Build choices into everyday routines: which cup, which song, which park. - Add "break" and "help" pictures, so your child has a way to ask for them. The [calm choices board printable](https://rocksmakepebbles.co.uk/printables/calm-choices-board) is a ready-made board of calming activities to choose from. ### Use picture sequences for tricky tasks A picture sequence breaks one task into small steps, in order: for example, taps on, wet hands, soap, rub, rinse, dry. Put it where the task happens, at your child's eye level. The National Autistic Society suggests using "a visual sequence beside the toilet" when toilet training ([NAS](https://www.autism.org.uk/advice-and-guidance/behaviour/toileting/parents)), and the continence charity ERIC suggests "photos of your bathroom" and pictures of each step ([ERIC](https://eric.org.uk/children-additional-needs/)). See the [toileting sequence printable](https://rocksmakepebbles.co.uk/printables/toileting-sequence). You can use the same idea for getting dressed, brushing teeth or a visit to the dentist: see [dentists, haircuts and appointments](https://rocksmakepebbles.co.uk/guides/dentist-haircuts-and-appointments). Paper or app? Both can work. An app can be handy, but keep a paper version too, for nursery, the car and bath time. > **Good to know:** You don't need a diagnosis to use visual supports. They cost little, and you can change or stop them at any time. If you are waiting for an assessment, see [what you can do while you wait](https://rocksmakepebbles.co.uk/guides/waiting-for-an-autism-assessment). ## How do I keep home, nursery and school the same? Use the same pictures and the same words everywhere you can. Scotland's Autism Toolbox stresses that every adult, in every setting, should use visuals in the same way ([Autism Toolbox](https://www.autismtoolbox.co.uk/supporting-learners-and-families/effective-partnerships-and-communication/visual-supports/)). An NHS speech and language therapy leaflet on Now and Next boards also asks that all the adults working with a child know about the board and how to use it ([Cambridgeshire and Peterborough NHS Foundation Trust](https://www.cpft.nhs.uk/download/using-picture-symbols-to-support-a-childs-understanding-of-whats-happening-next.pdf?ver=19134&doc=docm93jijm4n10367.pdf)). - Ask your child's key person, teacher or [SENCO](https://rocksmakepebbles.co.uk/glossary#senco) which symbols and words they use. Copy them at home, or share your photos with them. - Agree one word for the end of an activity, such as "finished", and use it everywhere. - Put "nursery" or "school" on your home timetable, with a photo of the building or the door your child goes in. - Ask to be told about changes early, such as a trip or a new teacher, so you can show them at home. NHS advice is to "let them know about changes as soon as you can" ([NHS](https://www.nhs.uk/conditions/autism/supporting-a-child/)). - Keep a spare Now and Next board in your child's bag. In England, nurseries and schools can give extra help called [SEN support](https://rocksmakepebbles.co.uk/glossary#sen-support) without a diagnosis. The SEND legal charity IPSEA says "A child does not need a formal diagnosis in order to receive support in school" ([IPSEA](https://www.ipsea.org.uk/blog/the-myth-of-needing-a-diagnosis-before-you-can-get-support)). For schools, the [SEND Code of Practice](https://assets.publishing.service.gov.uk/media/5a7dcb85ed915d2ac884d995/SEND_Code_of_Practice_January_2015.pdf), still in force in September 2026, says the support should be agreed with you, with the expected impact and "a clear date for review" (para 6.48). You can ask for visual supports to be part of it. > **Scotland, Wales and Northern Ireland:** School support has different names: additional support for learning in Scotland, additional learning needs in Wales, and SEN in Northern Ireland. The National Autistic Society explains each system for [Scotland](https://www.autism.org.uk/advice-and-guidance/education/getting-help-at-school/education-plans-and-asn-support-in-scotland), [Wales](https://www.autism.org.uk/advice-and-guidance/education/getting-help-at-school/individual-development-plans-and-aln-support-in-wales) and [Northern Ireland](https://www.autism.org.uk/advice-and-guidance/education/getting-help-at-school/statements-of-sen-and-school-support-in-northern-ireland). Asking for the same pictures at home and school works in every nation. ## How do I use visual supports kindly, not as a threat? Visual supports are there to help your child understand the day and have some say in it, not to make them do what adults want. The NHS leaflet puts it plainly: "It is important not to think of 'first-then'/ 'now-next' visuals as a behaviour support to encourage compliance with an adult chosen task" ([Cambridgeshire and Peterborough NHS Foundation Trust](https://www.cpft.nhs.uk/download/using-picture-symbols-to-support-a-childs-understanding-of-whats-happening-next.pdf?ver=19134&doc=docm93jijm4n10367.pdf)). - **Put nice things on the board too:** favourite activities, rest, snacks and time with you. If the board only ever shows jobs your child dislikes, it becomes a sign that something unwelcome is coming. - **Never use pictures as a threat,** such as "Now shoes, next no tablet", and never take pictures away as a punishment. - **Keep it separate from rewards.** A Now and Next board shows what happens next. It is not a bribe or a reward chart. - **Offer real choices** where you can: which cup, which song, which order. In a small study of three students with high support needs, being given choices reduced serious distressed behaviour ([Dyer, Dunlap and Winterling 1990](https://doi.org/10.1901/jaba.1990.23-515)). - **Respect "no".** If your child points to "no", "stop" or "break", respond to it, even if you can't always change the plan. ## What if visual supports don't seem to work? It often takes time. Try one small change at a time before giving up. | What is happening | What often helps | |---|---| | Your child ignores the pictures | Try an easier level, like photos or objects, and go through them together at the moment of change | | Your child pulls pictures off or throws the board | Make moving pictures part of the routine; check that "next" is not always something they dread | | Your child gets upset at the "next" picture | Show it earlier, add something worth moving to, and offer a way back later | | Your child doesn't seem to trust it | Only show what will really happen, and change the board when plans change | | It works at home but not at nursery | Share your pictures and words, and ask for the same routine there | | It worked, then stopped | Look for changes: illness, tiredness, a new picture or too many pictures at once | Throwing or pushing a board away is often a way of saying "no" or "I don't want the next thing". That is communication, not naughtiness. The guide to [Now and Next boards](https://rocksmakepebbles.co.uk/guides/now-and-next-boards) has more on each of these, and the guide to [transitions and changes](https://rocksmakepebbles.co.uk/guides/transitions-and-change) covers the moments that stay hard. ## What does the research say about visual supports? Visual supports have more research behind them than most everyday strategies, but the studies are mostly small. - A large US review of autism research published between 1990 and 2017, by the National Clearinghouse on Autism Evidence and Practice (NCAEP), classed visual supports as one of 28 evidence-based practices. It counted 65 studies, covering ages from infancy to early adulthood ([NCAEP 2020](https://ncaep.fpg.unc.edu/wp-content/uploads/EBP-Report-2020.pdf)). - A review of 31 studies of picture schedules, 16 of acceptable quality, concluded they can be considered evidence-based, "especially when used in combination with systematic instructional procedures" ([Knight, Sartini and Spriggs 2015](https://doi.org/10.1007/s10803-014-2201-z)). In everyday terms, schedules worked best when adults also taught children how to use them, step by step. - Pictures do not make every change easy. In a small study of two autistic children, picture schedules on their own did not reduce distressed behaviour when the children had to move from an activity they liked to one they liked less ([Waters, Lerman and Hovanetz 2009](https://doi.org/10.1901/jaba.2009.42-309)). - Research on picture schedules on tablets and phones is thin: a 2025 review found 17 studies with 58 participants in total ([Hammond et al. 2025](https://doi.org/10.3109/13668250.2025.2499009)). > **Evidence check:** In the NCAEP review as a whole, 83% of studies were single-case designs, which follow one or a few children closely, and studies that found no effect were left out ([Hume et al. 2021](https://doi.org/10.1007/s10803-020-04844-2)). So visual supports are a sensible place to start, not a guarantee. Watch how your child responds and adjust. ## When should I ask for more help? Ask for advice if you are not sure which pictures suit your child, or if they still find most of the day very hard after you have used visual supports for a while. - **Speech and language therapy:** the Royal College of Speech and Language Therapists says its members' work with autistic people includes environmental supports and support with transitions, at home and at school ([RCSLT](https://www.rcslt.org/speech-and-language-therapy/clinical-information/autism/)). How to get a referral varies by area. In Cambridgeshire and Peterborough, for example, parents of preschool children can book a telephone advice appointment, while school-age referrals go through the school SENCO ([Cambridgeshire and Peterborough NHS Foundation Trust](https://www.cpft.nhs.uk/speech-and-language-therapy-referrals/)). Ask your GP, [health visitor](https://rocksmakepebbles.co.uk/glossary#health-visitor) or SENCO how it works where you live. - **Waiting times:** in April 2026, 66,695 children and young people in England were on waiting lists for speech and language therapy ([UK Parliament written answer](https://questions-statements.parliament.uk/written-questions/detail/2026-06-22/11799)). You can start visual supports while you wait. - **Private therapy:** [ASLTIP](https://rocksmakepebbles.co.uk/where-to-get-help#asltip) lists independent speech and language therapists. - **Information and advice:** the [National Autistic Society](https://rocksmakepebbles.co.uk/where-to-get-help#nas), [Contact](https://rocksmakepebbles.co.uk/where-to-get-help#contact) and your local [SENDIASS](https://rocksmakepebbles.co.uk/where-to-get-help#sendiass) can help with next steps. If changes to routine cause your child severe distress most days, talk to your GP. The National Autistic Society says support may be needed if routines "become so rigid that unplanned changes cause significant distress" ([National Autistic Society](https://www.autism.org.uk/advice-and-guidance/about-autism/preference-for-order-predictability-or-routine)). ## Where our app, Pebble, fits Pebble's My day screen shows Now and Next side by side, or a list for older children, and can print a matching picture strip for the fridge or the nursery bag. A home-made paper board works just as well. What matters is using the same pictures in the same way every day. Pebble by Rocks Make Pebbles is our free app for autistic children, used together with a grown-up. This guide is written to be useful without it. More: https://rocksmakepebbles.co.uk/pebble ## Questions parents ask ### Is it OK to use pictures if my child can talk? Yes. Visual supports are not only for children who don't talk. Scotland's Autism Toolbox says they can also help more confident communicators, for example by helping to avoid a build-up of anxiety and stress. A picture stays in place after spoken words have gone, so it can still help a child who talks when they are tired, worried or somewhere new. Keep talking as you use the pictures. ### Will using pictures stop my child from talking? Research does not support this worry. A review of the best studies of signs, picture boards and other communication aids found that none of the 27 people studied lost speech, and most gained some, although the gains were often modest. Using pictures alongside words gives your child two ways to understand you, so keep saying the words as you point to the pictures. ### Should I use photos or symbols for my autistic child? Use whatever your child already understands. Many children find photos of their own things, like their cup or their bath, easier to recognise than symbols, so photos are a good place to start. Children at an early stage of communication may understand real objects best. Once your child links pictures to real things, you can move to symbols with the word written underneath, and later to written words. A speech and language therapist can advise. ### What age can you start using visual supports? There is no minimum age. Research on visual supports covers ages from infancy to early adulthood, so they can help toddlers, school-age children and teenagers. What changes with age and stage is the type of support. A toddler may do best with real objects or photos, while an older child who reads may prefer a written list or a checklist they tick off themselves. ### Do I need a diagnosis to use visual supports? No. You can start using visual supports at home at any time, whether or not your child has been assessed. They cost little, and you can change or stop them whenever you like. In England, nurseries and schools can also give extra help, called SEN support, without a diagnosis, because it is based on what a child needs rather than on a label. ### Where can I get free visual cards for autism? You can make your own for free by taking photos of your child's things and places on your phone, printing them and writing the word underneath. This site also has free printable Now and Next board and visual timetable templates. Ask your child's nursery, school or speech and language therapist which symbols they use, so the pictures at home match theirs. ## Sources 1. [Autism spectrum disorder in under 19s: support and management (CG170), recommendations](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations), NICE, June 2021 2. [Visual supports](https://www.autismtoolbox.co.uk/supporting-learners-and-families/effective-partnerships-and-communication/visual-supports/), Autism Toolbox (Scotland) 3. [The SPELL framework](https://www.autism.org.uk/learn/what-we-do/training/the-spell-framework), National Autistic Society 4. [Using picture symbols to support a child's understanding of what's happening next (Now and Next boards)](https://www.cpft.nhs.uk/download/using-picture-symbols-to-support-a-childs-understanding-of-whats-happening-next.pdf?ver=19134&doc=docm93jijm4n10367.pdf), Cambridgeshire and Peterborough NHS Foundation Trust, children's speech and language therapy 5. [Iconicity influences how effectively minimally verbal children with autism and ability-matched typically developing children use pictures as symbols in a search task (Hartley and Allen)](https://pubmed.ncbi.nlm.nih.gov/24916452/), Autism (via PubMed), 2015 6. [The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities (Millar, Light and Schlosser)](https://pubmed.ncbi.nlm.nih.gov/16671842/), Journal of Speech, Language, and Hearing Research (via PubMed), 2006 7. [Toileting: a guide for parents](https://www.autism.org.uk/advice-and-guidance/behaviour/toileting/parents), National Autistic Society 8. [Children with additional needs: toilet training](https://eric.org.uk/children-additional-needs/), ERIC, The Children's Bowel & Bladder Charity 9. [Supporting an autistic child](https://www.nhs.uk/conditions/autism/supporting-a-child/), NHS, 6 May 2026 10. [The myth of needing a diagnosis before you can get support](https://www.ipsea.org.uk/blog/the-myth-of-needing-a-diagnosis-before-you-can-get-support), IPSEA, 25 April 2025 11. [Special educational needs and disability code of practice: 0 to 25 years](https://assets.publishing.service.gov.uk/media/5a7dcb85ed915d2ac884d995/SEND_Code_of_Practice_January_2015.pdf), Department for Education and Department of Health, January 2015 12. [Education plans and ASN support in Scotland](https://www.autism.org.uk/advice-and-guidance/education/getting-help-at-school/education-plans-and-asn-support-in-scotland), National Autistic Society 13. [Individual Development Plans and ALN support in Wales](https://www.autism.org.uk/advice-and-guidance/education/getting-help-at-school/individual-development-plans-and-aln-support-in-wales), National Autistic Society 14. [Statements of SEN and school support in Northern Ireland](https://www.autism.org.uk/advice-and-guidance/education/getting-help-at-school/statements-of-sen-and-school-support-in-northern-ireland), National Autistic Society 15. [Effects of choice making on the serious problem behaviors of students with severe handicaps (Dyer, Dunlap and Winterling)](https://doi.org/10.1901/jaba.1990.23-515), Journal of Applied Behavior Analysis, 1990 16. [Evidence-based practices for children, youth, and young adults with autism (NCAEP report, Steinbrenner et al.)](https://ncaep.fpg.unc.edu/wp-content/uploads/EBP-Report-2020.pdf), National Clearinghouse on Autism Evidence and Practice, University of North Carolina, 2020 17. [Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders (Knight, Sartini and Spriggs)](https://doi.org/10.1007/s10803-014-2201-z), Journal of Autism and Developmental Disorders, 2015 18. [Separate and combined effects of visual schedules and extinction plus differential reinforcement on problem behavior occasioned by transitions (Waters, Lerman and Hovanetz)](https://doi.org/10.1901/jaba.2009.42-309), Journal of Applied Behavior Analysis, 2009 19. [Review of research on digital visual schedules for autistic people (Hammond et al.)](https://doi.org/10.3109/13668250.2025.2499009), Journal of Intellectual and Developmental Disability, 2025 20. [Evidence-based practices for children, youth, and young adults with autism: third generation review (Hume et al.)](https://doi.org/10.1007/s10803-020-04844-2), Journal of Autism and Developmental Disorders, 2021 21. [Autism: clinical information](https://www.rcslt.org/speech-and-language-therapy/clinical-information/autism/), Royal College of Speech and Language Therapists, October 2023 22. [Speech and language therapy referrals](https://www.cpft.nhs.uk/speech-and-language-therapy-referrals/), Cambridgeshire and Peterborough NHS Foundation Trust 23. [Written question 11799: speech and language therapy waiting lists (answered 1 July 2026)](https://questions-statements.parliament.uk/written-questions/detail/2026-06-22/11799), UK Parliament, 1 July 2026 24. [Preference for order, predictability or routine](https://www.autism.org.uk/advice-and-guidance/about-autism/preference-for-order-predictability-or-routine), National Autistic Society --- General information for families in the UK, not medical, legal or financial advice. If you are worried about your child's health, contact your GP or call NHS 111 (in Northern Ireland, your GP out of hours service). In an emergency, call 999.