Claire Skilbeck - Dissertation Doc pdf

USING VISUAL SYSTEMS TO
SUPPORT PUPILS WITH AUTISM
SPECTRUM DISORDER:
EXPLORING SEN TEACHERS’ PERCEPTIONS ON
THEIR IMPLEMENTATION AND EFFECTIVENESS
Claire Skilbeck
Final Year Dissertation
EDUC: 3304
An Extended Essay submitted in partial
fulfilment of the requirements for a BA Honours
in Education Studies with Psychology
at
De Montfort University Leicester
4th
May 2012

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Acknowledgements
I am sincerely grateful and want to thank all of those who have
supported me during my dissertation journey.
I would especially like to thank my initial supervisor, Nicola Savvides
and subsequent supervisor, Cathy Bonner, for their help and support
in focusing my topic and providing considerable advice.
I am extremely grateful to the teachers, especially those at Oaklands
School, Leicester, who kindly participated in my research and
enhanced my dissertation significantly.
Sincere thanks to my kind and dependable friends, who have always
supported me, proof read my work and asked after my progress
throughout.
Special thanks to my wonderful family, especially my Mum and Dad
who have been beside me, had faith in me and encouraged me every
step of the way. Thank you.
Finally I would like to dedicate this piece of work to all of the children
with autism, who I have had the pleasure of working with and
supporting over the years.
It is they who have inspired this dissertation.
Thank you all x

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TABLE OF CONTENTS
Page No.
i. ABSTRACT 5
ii. ABBREVIATIONS 6
1 SCOPE AND RESEARCH AIM 7
1.2 SCOPE 7
1.3 KEY ARGUMENT/S 7
1.4 RESEARCH AIM AND KEY QUESTIONS 7
1.5 THE CENTRAL QUESTION OF RESEARCH 8
1.6 METHODOLOGY – BRIEFLY OUTLINED 8
2 INTRODUCTION 9
2.2 CONTEXT – DEFINING AUTISM 9
2.3 AUTISM AND MAINSTREAM EDUCATION 11
2.4 TEACHING STRATEGIES – THE VISUAL APPROACH 13
3 THEORETICAL FRAMEWORK 15
3.2 THE TRIAD OF AUTISM 15
3.3 A THEORY OF AUTISM 17
3.4 A VISUAL STRENGTH 20
4 LITERATURE REVIEW 22
4.2 AUTISM SPECTRUM DISORDER AND INCLUSIVE EDUCATION 22
4.3 AUGMENTED AND ALTERNATIVE COMMUNICATION 24
4.4 INTERVENTIONS IN PRACTICE 29
4.5 LIMITATIONS OF VISUAL SYSTEMS 38
5 METHODOLOGY 43
5.2 RATIONALE 43
5.3 THE CENTRAL QUESTION OF THE RESEARCH 43
5.4 RESEARCH STRATEGY 43
5.5 RESEARCH SITE 44
5.6 RESEARCH SAMPLE 44
5.7 RESEARCH TIME-FRAME 45
5.8 DATA COLLECTION & PROCEDURE 45

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5.9 ANALYTIC STRATEGY 46
5.10 DELIMITATIONS & LIMITATIONS 47
5.11 RELIABILITY 48
5.12 ETHICAL CONSIDERATIONS 48
5.13 PERSONAL BIOGRAPHY 49
6 ANALYSIS & DISCUSSION 51
7 CONCLUSION 57
8 REFERENCES 61
9 APPENDICES 69
9.2 APPENDIX 1 - OBJECTS OF REFERENCE 69
9.3 APPENDOX 2 - PHOTOS OR PICTURE SYMBOLS REPRESENTING
OBJECT OR ACTIVITY 70
9.4 APPENDIX 3 - PECS PHASES 71
9.5 APPENDIX 4 - PECS SENTENCE STRIPS 72
9.6 APPENDIX 5 - TEACCH EXAMPLES 73
9.7 APPENDIX 6 - QUESTIONNAIRE [BLANK COPY] 77
9.8 APPENDIX 7 - ETHICS FORM AND APPROVAL 79
9.9 APPENDIX 8 - DATA SET – PARTICIPANTS QUESTIONNAIRE
RESPONSES 80
9.10 APPENDIX 9 - ANALYSIS OF QUESTIONNAIRE DATA REPRESENTED
IN THEMES 87

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i. Abstract
Individuals on the autistic spectrum have difficulties functioning in key
areas, such as social interaction, verbal and non-verbal communication and
flexibility of thought. These are recognised as the triad of impairments (APA,
2000). However those with autism are argued to have a visual strength in
processing information; therefore educational interventions that are grounded in
visual exchange are recognised as being beneficial in supporting those on the
spectrum (Jones, 2002; Meadan et al., 2011; Hodgson, 1996; Thompson, 2009;
Autism Working Group, 2002; Rao, & Gagie, 2006; Mirenda, 2003; Dodd, 2005).
This study explored, evaluated and critiqued relevant literature and on-going
research into visual systems, their efficacy and the theoretical underpinning
behind their development. Visual supports are understood as: ‘’Tools that are
used to increase the understanding of language, environmental expectations, and
to provide structure and support for individuals with autism spectrum disorders
(ASD)’’ (Thompson, 2010).
The impact of these systems was investigated further by exploring the perceptions
of Special Educational Needs (SEN) teachers. Their perceptions were gained
through open ended questionnaires and their responses were analysed using a
thematic analysis. The study was guided by the following research question:
‘’what impact does the implementation of visual systems, that support pupils with
ASD, have on their educational experience?’’
The research, despite identification of potential limitations, found that visual
systems, within education, are highly effective tools for supporting those with
autism. They have the potential to maximise communication, provide an
environment in which expectations are explicit and information can be processed
effectively and where individuals with autism can achieve their full potential.
Key Words: Education, Autism, ASD, AACs, Visual Supports, Interventions,
Communication, PECS, TEACCH, Teachers’ Perceptions, Thematic Analysis.

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ii. Abbreviations
AAC: Augmented and Alternative Communication
AET: Autism Education Trust
APA: American Psychiatric Association
ASD: Autism Spectrum Disorder
BERA: British Educational Research Association
DfE: Department for Education
DfEE: Department for Education & Employment
DfES: Department for Education and Skills
DoH: Department of Health
DSM: Diagnostic & Statistical Manual of Diseases
PECS: Picture Exchange Communication System
SEN: Special Education Needs
TEACCH: Treatment and Education of Autistic and related
Communication handicapped CHildren
ToM: Theory of Mind

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1. Scope and Research Aim
1.2. Scope
This dissertation considers the implementation and efficacy of visual systems to
support individuals with low functioning autism and minimal or no functional
language, within the wider context of educational interventions for those with a
special educational need (SEN). It will specifically explore, evaluate and critique
relevant literature and ongoing research into visual systems, and their impact will
be further investigated by gaining the perceptions of teachers within the context of
special educational school settings, which have provision for autistic specific
classes for primary aged children (4-11 years of age).
1.3. Key argument/s
It is argued that visual systems, despite potential limitations, are highly effective
tools for supporting those with autism. They assist in maximising communication,
providing an environment in which expectations are explicit and information can
be processed effectively and assisting individuals with autism in achieving their
full potential.
1.4. Research Aim and Key Questions
The aim of this research is to explore SEN teachers’ perceptions of the
implementation and efficacy of visual systems used within the classroom
environment to support pupils with ASD and establish in what way the systems
impact on the pupils’ educational experience. The teachers work in a setting for
children with special educational needs (SEN), which is classified by the
government as individuals with disabilities or developmental delays, making it
more difficult to fully access education and effectively learn (DirectGov, 2012).

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The term ‘perception’ refers to the how the teacher observes their direct
environment based upon experiences with their pupils with ASD, where meaning
and context is sensed and applied to observation of pupils in relation to a specific
implementation (Ahmad & Aziz, 2009). ‘Educational experience’ refers to the
teachers’ objective perception of pupils’ access, engagement and connection with
school within the time frame they have attended and ‘impact’ is recognised as the
teachers perceived efficacy an implementation has had on pupils’ educational
experience.
1.5. The central question of the research:
What impact does the implementation of visual systems, that support pupils with
ASD, have on their educational experience? [A teachers’ perception]
The research will be guided by the following questions:
What types of visual systems have been implemented within the classroom and
school environment to support pupils with ASD? What is the purpose behind
implementation of the strategies? What are the teachers’ perceptions of the
effectiveness of these strategies? And finally have teachers experienced any
unexpected effects from the implementation of strategies?
1.6. Methodology - Briefly Outlined
The research took an interpretive epistemological position and qualitatively
explored seven SEN teachers’ perceptions through the analysis of open-ended
questionnaires. The analytic strategy used was thematic analysis using principles
set out by Braun and Clarke (2006). Ethical considerations were followed
throughout and adhered to the BERA Ethical Guidelines for Education Research
(2011) and ethical approval was received prior to conducting the research.

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2. Introduction
2.2. Context – Defining Autism
“If I had a world of my own, everything would be nonsense. Nothing would be
what it is, because everything would be what it isn't. And contrary wise, what is, it
wouldn't be. And what it wouldn't be, it would. You see?”1
Throughout their lifetime, individuals with Autism Spectrum Disorder (ASD)
experience a myriad of challenges connected to the triad of impairments; this
affects the development of appropriate social interactions, aspects of verbal and
non-verbal communication and flexibility of thought, resulting in an impairment
in imagination (Jones et al., 2008; Autism Working Group, 2002). Arguably the
most problematic features of autism are communication and information
processing (Rao & Gagie, 2006). It is recognised that for any language to be
acquired an individual needs a reason or motivation to communicate. This is often
absent in those with a diagnosis of autism and therefore many fail to ever develop
functional speech (Slater & Bremner, 2003; O’Kane & Goldbort, 1998; Jones,
2002). The following conditions are necessary for successful communication to
take place; an understanding of cause and effect, the intention to communicate, a
method of communication, a communication partner and a communication topic
(Marckel, Neef & Ferreri, 2006). Individuals with autism, defined fully in the
theoretical framework of this dissertation, are recognised as a complex and unique
learning group as they have substantial difficulties in some or all of these areas
and therefore need support in identifying an alternative means of communication
(Jones et al., 2008; Sharp, Ward & Hanklin, 2009; Leblanc, Richardson & Burns,
2009).
1
Carroll, 2010 p.126

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‘’Autism is a puzzling disorder. It begins in early childhood, and disrupts
many aspects of development, leaving the child unable to form social
relationships or communicate in the usual way.’’
(Baron-Cohen &
Bolton, 1993, Blurb)
Due to increased awareness, enhanced diagnosis and improved diagnostic tools,
the prevalence2
and incidence3
of autism is continually being evaluated.
According to the Medical Research Council (Ashton & Smith, 2002) it is unclear
as to whether there is an ‘actual’ increase in prevalence or the factors relating to
establishing a diagnosis are impacting statistics (Ashton & Smith, 2002). With
this, an understanding of the disorder has grown substantially, with new research
constantly being conducted, to ever increase knowledge in the hope of helping
those with autism more effectively. This insight has also been significantly
informed by adults who have the disorder and who have provided an inside
perspective of living with autism and added significantly to this knowledge base
(The Telegraph, 2012; Jones, 2002; Jones et al, 2008; Roberts, 2003).
There have been many differing labels attached to those with autism which have
been used interchangeably within research and practice4
(Ospina et al., 2008). The
broader term Autism Spectrum Disorder (ASD), developed by Lorna Wing (1996,
as cited in Jones et al, 2008), has been used throughout this dissertation, to refer to
a group of individuals who share common developmental difficulties and display
significant deficits in the core areas, necessary for autism to be diagnosed.
2
Prevalence rate refers to the number of individuals with autism in a particular age
range (Roberts, 2003).
3
Incidence refers to the number of new cases in a specified time in a specified population
(Wing, 1996 as cited in Roberts, 2003).
4
These include; Aspergers Syndrome (AS); High Functioning Autism (HFA); Pervasive
Developmental Delay-Not Otherwise Specified (PDD-NOS); Semi-Pragmatic Disorder
(SPD) Kanner’s Autism and Atypical Autism (AA) (Whitaker, 2001; Jones et al., 2008;
Jordan, Jones & Murray, 1998).

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Awareness of other features that manifest itself in the spectrum of autism have
been acknowledged within this dissertation, however individuals with an absence
of functional language has been the main scope (Whitaker, 2001; Jones et al,
2008; Roberts, 2003). Caution however needs to be made about making general
assumptions about the ASD population. It is evident that for a diagnosis an
individual needs to have an impairment in the three core areas, however, it is
highly important when considering interventions within fields such as education,
the needs of those diagnosed must be considered and supported on an individual
basis, for the most appropriate intervention to be found (Jones, 2002).
2.3. Autism and Mainstream Education
It has been argued that the role and aim of education is one where children receive
skills and knowledge that are culturally valued and that enables their full
participation in society (Jones et al., 2008, Farenga & Ness, 2005; Kassem, Mufti
& Robinson, 2006; Bartlett & Burton, 2007). This entitlement is the same for
children with ASD, however, education additionally needs to support the potential
difficulties faced and find ways of reducing problems that may manifest within
school (Jones et al., 2008). Pupils with ASD, find school is often one of the most
challenging environments where problems are manifested out of coping with the
demands of traditional teaching, which relies heavily upon verbal prompts,
instruction, whole class concentration and the recording of information (Sharp,
Ward & Hankin, 2009; Grandin, 1995; Jones et al, 2008). For individuals with
ASD, this difficulty is likely connected to deficits in communication and
information processing, where challenges are apparent in the comprehension and
organisation of their environment and the inability to retain certain language
based information, evident within traditional classrooms and teaching methods

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(Hodgdson, 1995). Therefore, some mainstream provisions may fail to meet the
needs of those with ASD, especially those towards the severe end of the spectrum,
classified as low-functioning autism (BBC, 2006; Frodsham, 2011). When
difficulties occur in accessing the curriculum and classroom environment, which
can be overly stimulating for those on the spectrum, it may lead to further
withdrawal and associated negative and avoidance behaviours. This can result in
the educational experience of an individual with ASD being anxiety provoking
and ineffective (Sharp, Ward & Hankin, 2009).
Mainstream schools in the past have been reluctant to accept pupils with an SEN,
especially ASD, as they believe they cannot effectively meet the needs of this
complex group of learners (BBC, 2006; Frodsham, 2011). If schools have pupils
who fail to access the curriculum, due to limited expertise of teachers and staff
and an inadequacy of training in autism, it may inevitably jeopardise their position
in league tables (Sharp, Ward & Hankin 2009; Jones, 2002, Jones et al., 2008;
Banda, et al., 2009; Dettmer et al., 2000; Leblanc et al., 2009). There are however,
an increasing number of mainstream provisions that do accommodate the needs of
individuals with ASD and take on board appropriate strategies that can be highly
beneficial (Autism Working Group, 2002). In line with this, there is a growing
number of ‘alternative’ provisions established that are purposely designed for
those on the spectrum and implement specific support. These may be within a
specialist SEN school or an ASD specific unit attached to a mainstream provision
(Autism Working Group, 2002).
The Autism Education Trust (Charman, et al., 2011), was asked by the
Department for Education (DfE) to develop a set of standards to ensure good

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practice in all educational provision is delivered to pupils with ASD, who were
identified as needing specific support (Charman, et al., 2011; Roberts, 2003). A
summary of the literature identified a combined focus of helping an individual
with ASD to make sense of their surroundings and effectively communicate their
needs; whist actively adapting and providing an environment where they can
successfully function (Charman, et al., 2011). In accordance with this, an increase
in alternative teaching strategies and classroom alterations are becoming more
established to support individuals with ASD, especially those which focus on
visual information exchange (Charman, et al., 2011; Tissot, & Evans, 2003; Rao,
& Gagie, 2006; Preston & Carter, 2009).
2.4. Teaching Strategies – The Visual Approach
Creative, curious, out-of-the-box thinkers, visual learners learn by intuitive
leaps. They remember what they see and forget what they hear.’’5
The visual interventions in use are identified as aided modes of ‘Augmented and
Alternative Communication’ (AAC), which supplement (‘augment’) any existing
speech or act as an ‘alternative’ to verbal communication, if no functional speech
is present (Mirenda, 2003). AACs prompt individuals through a visual method of
communication, helping them process, exchange and retain a concept or message
more successfully (Johnston et al., 2003; Odom et al., 2003). Adaptations of AAC
systems and also combination approaches are often found to be beneficial by
teachers and educational facilitators who endeavour to find the most appropriate
strategy to suit the specific needs of their pupils (Kluth & Darmody-Latham, 2003
as cited in Rao, & Gagie, 2006; Tissot, & Evans, 2003; Marckel, Neef & Ferreri.,
2006).
5
Visual Spatial Resource (2012)

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Some ASD specific provisions who implement these approaches are now
recommended to become ‘centres of excellence’ by the Autism Education Trust
(Charman, et al., 2011), where substantial improvements have been made in
providing an ‘inclusive’ environment that underpins good practice in ASD and
provides an exchange of information between teachers and professionals working
within the field (Jones et al, 2008). Many ASD specialist teachers work
effectively with ASD pupils and have a good understanding of their needs and the
range of visual systems that can be successfully implemented, in order for them to
be supported and achieve their full potential within education (Jones, 2002). This
knowledge and advice is also recognised as being beneficial to disseminate to
other staff working with pupils with ASD, as teachers have a crucial role in
implementing strategies and perceiving the effectiveness of each implementations
in relation to individual pupils (Jones, 2002, Jones et al, 2008).
The significance, benefits and limitations of visual systems have been explored
within this dissertation through the evaluation and critique of relevant literature
and ongoing research. A traditional and conceptual approach was taken to review
the literature, which was critically examined and synthesized, to gain a better
understanding of visual systems, their implementation, efficacy and any potential
limitations (Jesson, Matheson & Lacey, 2011). The impact of visual systems was
investigated further, by gaining the perceptions of SEN teachers through the
analysis of open-ended questionnaires. This small scale research was not validated
by using scientific quantitative methodology; as it aimed to qualitatively explore
teachers’ perceptions as key individuals featured within their pupils’ lives and
established if the themes found are representative of literature related to AACs.

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3. Theoretical Framework
3.2. The Triad of Autism
One of the first pioneers of research into autism is accredited to Leo Kanner (1906
- 1980), who wrote a paper titled ‘Autistic disturbances of affective contact’, and
identified children with infantile autistic traits (Lyons & Fitzgerald, 2007;
Iovannone et al., 2003). The term ‘autism’ used by Kanner in his seminal paper,
originated from Bleuler, a Swiss psychiatrist, who developed the term to describe
individuals with characteristics of schizophrenia (Lyons & Fitzgerald, 2007).
Autism, now recognised as a ‘spectrum’ disorder (Wing, 1996 as cited in Jones,
2002), is a lifelong neurodevelopmental condition (Roberts, 2003; Ospina, et al.,
2008; Autism Working Group, 2002; Prior & Roberts, 2006; Charman, et, al.,
2011; Mills & Marchant, 2011) and has three central features, recognised by the
Diagnostic and Statistical Manual of Mental Disorders (APA, 2000) as the ‘triad
of impairments’6
. A deficit in at least one of the triad must be present before the
age of three for a diagnosis to be given. ASD is said to affect one in one hundred
people, however accurate figures do not exist due to the complexities of diagnosis
(Jones et al., 2008, Charman et al, 2011; The National Autistic Society, 2012).
One of the characteristics of the triad is the restricted, stereotypical patters of
behaviours often displayed as a fixation or fascination with patterns of objects or
objects themselves and distress is often presented if attention, or the object itself,
is disturbed (Slater & Bremner, 2003). Repetitive motor behaviours are often
displayed and a general restricted interest is characterised by rituals or the need
6
Triad of Impairments: The development of appropriate social interactions, aspects of
verbal and non-verbal communication and flexibility of thought, resulting in impairment
in imagination (Jones et al., 2008; Autism Working Group, 2002).

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for ‘sameness’ (APA, 2000; Whitaker, 2001). Individuals with ASD also have
difficulty establishing social friendships with peers or simply initiating more
general interactions with others (APA, 2000; Slater & Bremner, 2003). This is not
typically recognised until the age of three, however characteristics are often
evident in younger years when, as children, those with ASD fail to respond
appropriately to the caregiver, for example not responding to their voice or
reaching out for them as they approach (Slater & Bremner, 2003). This is also
featured in the absence of shared attention, such as pointing at an object to
indicate interest and initiating a response from the caregiver (Slater & Bremner,
2003). Other non-verbal communication is also impaired, which often results in
the delayed development or absence of language altogether, which occurs in one
third of those diagnosed with ASD (Jones, 2002).
Individuals with ASD, as stated, have a deficit in communicating intentionally
(Slater & Bremner, 2003), and often do not understand the purpose behind
communication, furthermore, due to the social aloofness experienced, have an
aversion to interacting with others (Jones, 2002). Pre-verbal communication such
as pointing, eye gaze or eye contact are the foundations that form communication
and typically developing children make the connection that communicating with
others is useful. However individuals with ASD fail to make this association
therefore need to be taught this explicitly (Whitaker, 2001; Preston & Carter,
2009; Charman et al, 2011). A desired item, for example a specific toy, may be
indicated by guiding the caregiver’s hand towards the object, but this is not
accompanied by eye contact or shared attention (Slater & Bremner, 2003). Issues
with pragmatics, the functional use of speech (O’Kane & Goldbart, 1998), are
also evident in individuals with ASD, who also have semantic impairments and

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display issues deciphering and comprehending messages conveyed in language
(Jones, 2002; Charman et al, 2011). Those who do go on to develop vocabulary,
which is sometimes only ‘echolalic’ responses, still display difficulties in the
pragmatics and semantics of language (Slater & Bremner, 2003).
Many behavioural difficulties and high levels of anxiety are related to all three
features of the triad of impairment. Ritual type behaviours occur and create a
sense of consistency and reduction of anxiety, which manifests out of a failure to
understand the world around them and the demands of society; inclusive of people
they have contact with (Whitaker, 2001). As well as social understanding, the
inability to anticipate the immediate future, due to inflexibility of thought, may
also contribute to increased anxiety and challenging behaviour (Whitaker, 2001).
Arguably, one of most significant causes of negative behaviour patterns in
individuals with ASD is the inability to communicate effectively and express their
needs. This results in high levels of frustration and anxiety which is often
displayed as significant aggressive or defiant actions (Whitaker, 2001; Preston &
Carter 2008).
3.3. A Theory of Autism
There is ongoing theoretical enquiry into the aetiology of ASD, where abnormal
parenting was originally proposed as a potential cause. This has, however, been
contested by research which currently suggests there is a strong biological basis
associated to ASD (Autism Working Group, 2002). Many potential environmental
triggers, such as a virus present within the body throughout life or affecting the
developing foetus, are believed to affect the same areas of the brain which have
then interacted with an existing genetic predisposition, which then manifests itself

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as autism (Autism Working Group, 2002; Jones et al., 2008; Jones, 2002; Roberts,
2003; Prior & Roberts, 2006). Many psychological theories have been developed
to attempt to explain the cognitive aetiology of ASD and among the most
significant are the ‘Theory of Mind’ (ToM) and ‘Executive Function’ deficit
theories and a theory of ‘Weak Central Coherence’ (Slater & Bremner, 2003).
It has been suggested by Baron-Cohen, Leslie and Frith (1985) that individuals
with ASD lack the ability to meta-represent others’ mental states and interpret
their thoughts and emotions, recognised as having a Theory of Mind (Baron-
Cohen et al., 1985; Jones et al., 2008). This hypothesis potentially accounts for the
social and communication difficulties displayed within the triad of impairments
(Baron-Cohen, 2000 as cited in Jones, 2002). However the ToM deficit has been
suggested as not accurately accounting for the full triad of impairment featured in
ASD. Whilst there is evidently a ToM deficit, this theory cannot fully explain the
repetitive features that an individual with ASD displays. The restricted and
obsessive interests are characterised by an inability to draw perceived information
together and construct an understanding. Due to the poor comprehension of the
environment and a fragmented view of the world, those with ASD become fixated
on specific details, exhibiting behaviour patterns that are meaningless and display
a miss-connection between perception and actions (Slater & Bremner, 2003; Hill
& Frith, 2003). This is presented in executive functioning issues, where
individuals may have an inability to forward plan, shift attention, adapt responses
to suit a new situation or develop new ideas, which presents as a daily challenge
(Jones, 2002; Jones et al., 2008; Hill & Frith, 2003).

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The third cognitive theory that has been developed is identifies as a ‘Weak
Central Coherence’. This also is said to explain the attention to detail individuals
with ASD display when they present with fixated behaviour patterns. Those with
ASD fail to see the ‘bigger picture’ and instead focus on the specific details of an
object or situation, for example the wheel motion of a toy car rather than the
whole play situation (Hill & Frith, 2003; Jones, 2002). Considered together, these
three cognitive theories can provide some explanation to the defining features of
ASD (Hill, & Frith, 2003). However, no one explanation or theory has yet been
developed, by medicine, psychologists or educators, to adequately account for the
complex spectrum of autism and its aetiology (Odom et al., 2003; Leblanc et al.,
2009; Slater & Bremner, 2003).
It is evident to see that ASD impairs many functions including the ability to
process information, interpret social situations, plan effectively and focus
attention on whole representations instead of specific details (Rao & Gagie, 2006;
Prelock, 2007). In addition to this, many individuals on the spectrum have further
and often severe learning or developmental difficulties that run alongside their
autism (Slater & Bremner, 2003; Jordan, Jones & Murray, 1998; Autism Working
Group, 2002). Research, however, aims to move away from the ‘deficit model’
and endeavours to view those with ASD as having a ‘different’ perspective of the
world and instead aims to work with their autism and see the world through their
point of view (Autism Working Group, 2002). The developed understanding of
ASD, from the theories discussed, has significantly impacted on the development
of certain interventions, especially within education (Autism Working Group,
2002)

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3.4. A Visual Strength
‘’Spatial words such as over and under had no meaning to me until I had a visual
image to fix them in my memory.’’7
Because of the ability to focus on detail and the superior concentration displayed
by many individuals with ASD, it has been discovered that they have an enhanced
ability to process visual information over information received orally. A potential
deficit in auditory information processing makes information received in this form
often difficult to comprehend (Savner & Myles, 2000; Meadan et al., 2011;
Hodgson, 1996; Thompson, 2009). Language therefore poses significant
challenges and difficulties understanding and developing communication needs to
be recognised and supported appropriately within school settings (Autism
Working Group, 2002). A number of visual supports have been developed to
utilise this visual capacity, enhancing the ability to understand instructions or
cues, but to more significantly assist those with ASD in communicating their
needs and requirements effectively (Autism Working Group, 2002; Rao, & Gagie,
2006).
The use of visual systems to communicate needs and provide an environment
inclusive of clear structure is underpinned by the principles of B.F.Skinner’s
Behavioural Theory (1961). Operant conditioning, often referred to as ‘behaviour
modification’, is employed to support communication by teaching the child to
request a desired item which is reinforced by receiving the item, therefore, in the
expectation of promoting further communicative behaviours (Roberts, 2003; Mills
& Marchant, 2011; Howlin et al., 2007; Tissot & Evans, 2003; Front & Bondy,
7
Temple Grandin, 1995 p.14, author of ‘Thinking in pictures and other reports from my
life with autism’.

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2002; Passer et al., 2009). The ability to initiate communication using this
technique is especially vital for those who have minimal or no functional speech
which may subsequently decrease the amount of negative behaviours or anxiety
potentially displayed within a school setting (Autism Working Group, 2002; Rao,
& Gagie, 2006; Ganz, 2007; Breitfelder, 2008; Tissot, & Evans, 2003).

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4. Literature Review
4.2. Autism Spectrum Disorder and Inclusive Education
Ben is seven years old with severe low functioning autism and no
functional speech. One morning he enters his ASD specific classroom and moves
towards his daily visual time-table. Within his class today there is a supply
teacher replacing his usual class teacher who has unexpectedly taken ill. As she is
unaware of the routine she has not put up his timetable. Ben observes this and
immediately throws himself onto the floor, thrashing his arms and legs and crying
uncontrollably. The supply teacher goes to comfort him but Ben is not
comfortable with people he does not know so kicks her with force. It takes fifteen
minutes for Ben to finally calm, assisted by a teaching assistant who periodically
works with Ben during his PECS sessions. She shows Ben a picture card of an
activity he enjoys doing and his outburst replaced with a calm and compliant boy
who takes the picture card to his work station and progresses with the activity. 8
As discussed in the introduction, all children in the United Kingdom, despite their
SEN, are entitled to an education where they receive culturally valued knowledge
and skills (Jones et al., 2008). In order for all children to receive this entitlement,
they need, to an extent, to be able to access the curriculum provided by their
school, which enables them to flourish and learn to the best of their ability (DfES,
2004). A school and classroom that is ‘inclusive of all pupils’ needs’ is vital to
ensure this takes place. It is stated within the ‘National Curriculum Inclusion
Statement’ (DfEE, 1999), that schools should provide ‘effective learning
opportunities for all pupils’. It is good practice within education today that a
school promotes an inclusive ethos, where teachers are able to assess the needs of
the pupils in their class and provide differentiated curriculum support, by adapting
8
Vignette from author’s own experience (A pseudo-name has been used to maintain
confidentiality).

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the environment, resources and instruction appropriately to meet the learning
needs of individuals (Jones et al., 2008).
As identified in the theoretical framework of this dissertation, individuals with
ASD are a complex learning group and have differing abilities and strengths due
to the heterogeneous spectrum of the disorder (Leblanc, Richardson & Burns,
2009; Jones et al., 2008). The Autism Working Group (2002) developed by the
Department for Education and Skills (DfES) and Department of Health’s (DH)
produced ‘good practice guidance for ASD’, and indicated that ASD friendly
schools should encourage and train relevant staff to gain a better understanding of
ASD and disseminate this information to others who are in contact with any
pupils on the spectrum. The curriculum and environment should be sensitively
tailored to meet the needs of the students and take into account any identified
difficulties to ensure they succeed academically, build on their ability to socially
communicate and aim to prevent any anxieties or behaviour challenges that
manifest, due to a clash between their environment and their autism (Autism
Working Group, 2002; Jones, 2002).
There are usually a number of agencies, at any one time, working with the child,
their parents and their teacher because of the diverse nature of ASD. These are
inclusive of Speech and Language Therapists, Behaviour Support Teams, Autism
Outreach, Paediatricians, Occupational Therapists and Educational and Clinical
Psychologists (Jordan, Jones & Murray, 1998; Jones et al., 2008). Therefore it is
vital a ‘multi-disciplinary’ approach is taken to support schools and teachers,
which is not only a necessity, but also important to ensure a child is getting the
appropriate support to meet their individual needs, following a diagnosis (Jones et

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al., 2008). Identifying an individual as having an ASD does not mean their teacher
or other professionals automatically know the most appropriate intervention to
support them. However as a result of the increased understanding surrounding
autism, in relation to the cognitive abilities of those with ASD, markers are then
provided for the eclectic and successful approaches that have been developed
(Jordan, Jones & Murray, 1998).
In order for schools to successfully include ASD learners and ensure they are
receiving an education that is effective in working alongside their autism, there
are a number of interventions and supports available to them often recommended
by support agencies or therapists (Jones, 2002). This however poses issues for a
school in determining the most appropriate and effective intervention to meet the
needs of a pupil and often one single intervention is not always sufficient (Jones,
2002).. It is recognised that most individuals with ASD benefit from at least one
support intervention, therefore schools need to continually assess each child on an
individual basis to determine which support or combination of supports will be
most appropriate for that pupil, at that particular time, therefore developing an
individualised approach (Flippin, Reszka & Watson, 2010, Jones 2002; Jones et
al., 2008).
4.3. Augmented and Alternative Communication
In the wider community visual supports of some kind, for example sign posts or
images to represent a meaning, assist most people in ‘’navigating the complexities
of daily life in a busy world’’’ (Arthur-Kelly, 2009. p. 1476). Within schools
aided modes of ‘Augmented and Alternative Communication’ (AAC) are
interventions frequently used, that are grounded in a visual form, recognised

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within literature as being highly beneficial for those with ASD (Hodgdon, 1996.
Charman et al, 2011). Arthur-Kelly et al. (2009) defined visual supports as:
‘’Pictorial and graphic stimuli that enhance comprehension and learning
in individuals who may otherwise struggle with communication‘’
(Arthur-Kelly, 2009, p
1475).
In the 1990’s sign language was advocated and used as an AAC intervention to
support those with ASD, as it was thought to be accessed more quickly by the
brain than a verbal message (Jordan, Jones & Murray, 1998). However there have
since been some reservations into its effectiveness (Jordan, 1993 as cited in
Roberts, 2003; Dodd, 2005). Despite its visual benefits, sign language, or its
simplified form Makaton9
, still remains a transient message and like verbal
communication, is therefore only accessible for a short period of time and a rapid
rate of processing is necessary to decode the message. This ability to effectively
process a message is recognised as a deficit in some individuals with ASD
(Whitaker 2001; Peters, 1997, as cited in Roberts, 2003; Tissot, & Evans, 2003).
In addition, a sign may be easily misinterpreted or missed entirely by the
recipient, which may lead to increased frustration when an attempt to
communicate a message is not understood (Ganz & Simpson, 2004 as cited in
Preston & Carter, 2009; Mirenda, 2003).
The use of concrete and more tangible visual supports are therefore well
established in supporting communication and comprehension as they can be
clearly understood by both the user and receiver (Preston & Carter, 2009; Roberts,
2003; Arthur-Kelly et al., 2009). The three prominent roles of visual supports are
9
Makaton is use widely in SEN educational settings as a method of communication for
those with learning difficulties (Signed Language, 2012).

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to firstly; provide a framework to support communication and interaction for
those with minimal or no functional language, secondly, to support the
presentation of information by verbal instruction that may be lost due to potential
auditory deficits and finally to increase the understanding of environmental
expectations (Hodgdon, 1996; Jones, 2002, Arthur-Kelly et al., 2009; Savner &
Myles, 2000; Dodd, 2005).
The communication impairment that is evident in many individuals with ASD
manifests itself as an inability to produce functional language and affects their
ability to request specific needs and wants or communicate their feelings
effectively (Mirenda, 2003). The inability to communicate may lead to a highly
isolated existence and it is clear to see why many withdraw themselves further
from situations or alternately display challenging behaviour, resulting from their
frustrations (Arthur-Kelly et al., 2009). Visual systems can therefore be highly
effective interventions in compensating for communication impairment, as they
provide a framework for communication exchange and initiation, which fails to
develop naturally though speech in some individuals on the spectrum (Arthur-
Kelly et al., 2009; Mirenda, 2003; Dodd, 2005). Once a child with ASD makes
the connection that a picture represents a desired object, they can begin to
independently request their needs and preferences, without the requirement for
any functional language to exist or the continued reliance upon a caregiver or
teacher to ‘guess’ what they require (Whitaker, 2001). According to Tager-
Flusberg (1991, as cited in Roberts, 2003), visual systems therefore have a
facilitating effect on communication and provide a platform for language to
potentially develop, as a visual system facilitates the ‘cause and effect’ connection
that is to some extent missing in some individuals with ASD. This enlightens an

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individual with ASD that the importance of interacting and communicating
intentionally may actually be of some benefit to them (Arthur-Kelly et al., 2009;
Slater & Bremner, 2003; Jones, 2002).
As stated in the introduction, schools are traditionally places where verbal
instruction is the primary mode of passing on information to pupils (Sharp, Ward
& Hankin, 2009; Grandin, 1995; Jones et al., 2008; Wilkinson & Silliman, 2001
as cited in Carnahan, 2006). Due to issues in comprehension, the meaning behind
the spoken word is often lost in individuals with ASD, which also leads to
problems in attention. Therefore the preferred mode of learning and processing
information is through the visual pathway (Hodgson, 1996; Roberts, 2004;
Arthur-Kelly et al., 2009; Whitaker 2001; Meadan, et al., 2011; Savner & Myles,
2000). When language is presented in a verbalised form it takes substantial effort
for an individual with ASD to decipher and comprehend the message content, as
the spoken word, in similarity to sign language, is transient and lasts only a few
thousandths of a second (Whitaker, 2001; Arthur-Kelly et al., 2009). The message
has then the potential to be missed and the child with ASD at a loss, as they are
unable to fully comprehend their environmental verbal cues and respond
appropriately (Whitaker, 2001). Therefore according to Quill (1997, as cited in
Roberts, 2003) the rationale for using visual supports is to ‘match’ the visual
strengths, processing styles and also cognitive profile features of those with ASD.
When requests, instructions or curriculum based information is presented in a
visual form, due to its ‘permanent’ nature, the likelihood of the message being
retained, understood and remembered, is significantly increased, as time can be
taken to construct its meaning (Whitaker, 2001; Roberts, 2003).

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Another potential for communication breakdown for pupils with ASD within a
school setting, is the inability to predict or anticipate the future (Whitaker. 2001).
As discussed in the theoretical framework, cognitive theories suggest that some
individuals with ASD have an executive function deficit and a weak central
coherence and therefore display fixated behaviours, where they focus on specific
details due to the inability to shift attention or perceive the environment as a
whole (Hill & Frith, 2003). Therefore, visual systems that are presented in a
structuring format, for example a presentation of daily activities via picture form
to assist transition from one activity to the next, provide a predictable
environment that helps pupils comprehend, in context, what is happening next and
reduces any behaviour that may manifest itself out of such anxieties (Whitaker,
2001; Hawlin, 1997 as cited in Roberts, 2003; Quill 1997 as cited in Roberts,
2003).
Visual interventions that support communication, verbal message processing and
provide a structure for individuals with ASD, have the potential to enhance the
quality of life of those using them, by engaging them in social contexts they may
otherwise find problematic. Using AACs as a means of communication
potentially increases autonomy by reducing the reliance on the teacher who
previously provided a medium for communication or explicit instruction (Arthur-
Kelly et al., 2009; Janzen, 1996, as cited in Rao, & Gagie, 2006; Dyrbjerg &
Vedel, 2007). It is important, however, that visual interventions are used to
‘support’ and ‘enhance’ verbal forms of communication and not be used by any
means to replace vocal exchange or used as an ‘alternative’ to speech. They are
most effective when used in conjunction with verbal instruction, in the hope of

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one day initiating the development of functional language (Tissot & Evans, 2003,
Prelock, 2007; Roberts, 2003).
4.4. Interventions in Practice
It is understood that not one single intervention or approach will meet the needs or
be appropriate for every child due to the diversity of ASD (Jones, 2002; Jones et
al., 2008). Therefore many interventions have been adapted from existing
strategies or designed specifically for individuals with ASD. This chapter focuses
primarily on named interventions that are used within UK practice, identifying
their effectiveness and also potential limitations. According to the National Joint
Committee for the Communicative Needs of Persons with Severe Disabilities
(1992, as cited in Frost & Bondy 2009) ‘’all people have the right to have access
at all times to any needed augmented and alternative communication devices... to
communicate the conditions of their own existence’’ (p vi).
There are a variety of AAC supports available for teachers to implement for their
pupils with ASD and provided in a hierarchy of representation (Dodd, 2005). The
initial use of visual supports is usually developed from iconic representations of
objects that closely resemble the real life article. These are identified as ‘objects
of reference’10
where an object is given to a pupil, for example a dinner tray,
which signifies to the pupil that they are transitioning to dinner time (Erbes, n.d.).
Once a child makes the connection between the object and its particular meaning,
then more advanced visual prompts can be introduced. These include photographs
and picture symbols11
, which are representative of a particular activity, object, or
instruction within the school day (Arthur-Kelly, et al., 2009; Roberts, 2003). As
10
See appendix 1
11
See appendix 2

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individuals continue to make a cognitive representation of a picture in relation to
an object, they can then be used by the teacher in communicative form, to initiate
interaction by giving a child a choice or allowing them to request a particular item
(Arthur-Kelly et al., 2009). Named interventions used within UK schools, which
are specifically designed to facilitate communication or environmental structure,
include the Picture Exchange Communication System (PECS) and Treatment and
Education of Autistic and related Communication Handicapped CHildren
(TEACCH)12
. These have been developed in appreciation of the challenges those
with ASD face in communication and comprehension of the world they live in
(Preston and Carter, 2009).
The Picture Exchange Communication System (PECS) was developed in the USA
by Frost and Bondy in 1994 (Frost & Bondy, 2002), after they observed preschool
children that had no functional skills in communication. They then went on to
design an approach to enhance the communication opportunities of these children
(Frost & Bondy, 1994, as cited in Jordan, Jones & Murray 1998). With
behavioural principles underpinning its foundations, PECS uses the exchange of
pictures, symbols, photographs or real objects as a means of interaction with
others (Roberts, 2003; Howlin et al, 2007; Pyramid Educational Consultants,
2007). Communication skills are developed for those who have minimal or no
language by giving a picture of something that is desired to a communication
partner, for example a picture of a cup of juice, this picture is then exchanged for
the desired item (Jordan, Jones & Murray 1998).
12
Inclusive of visual timetables/schedules and work stations.

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“Children using PECS are taught to approach and give a picture of a
desired item to a communicative partner in exchange for that item. By doing so,
the child initiates a communicative act for a concrete item within a social
context.”
(Bondy & Frost, 1994, p.3 as
cited in Flippin, Reszka &
Watson, 2010).
It is therefore vital that a child ‘independently’ initiates the communication and is
not directly prompted by an adult who anticipates they may want a drink (Baker,
1997 as cited in Jordan, Jones & Murray 1998; Howlin et al., 2007). Spontaneous
social communication that can be generalised over situations is therefore key to
PECS and aims to be taught through this specific intervention protocol, which
consists of six phases13
, preceding an initial assessment, where the trainer
identifies appropriate reinforcers for the child in relation to their specific interests
(Bondy & Frost, 1998 as cited in Preston & Carter, 2009). PECS is recognised as
a highly popular intervention that has been widely used in clinical and school
based settings to support the communication of non-verbal children (Howlin et al,
2007; Flippin, Reszka & Watson, 2010; Johnston, et. al., 2003).
The picture symbols used within the PECS system are highly iconic and represent
clearly their referent; therefore, they are recognised easily by the PECS learner
and also the communicative partner. The spontaneity that is connected to PECS is
also highly beneficial, as the learner can directly place a picture into the hand of
the communicative partner, rather than wait for them to notice that a need has
been indicated through either pointing or alternatively using sign language, (Ganz
& Simpson, 2004 as cited in Preston & Carter, 2009; Mirenda, 2003). Another
major strength for PECS and the nature of those it is designed for is not only the
13
See appendix 3.

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motivational aspects, but the minimal prerequisite skills that are needed to master
its principles. Individuals who use the PECS system do not need to hold eye-
contact, have verbal or advanced motor skills or have the ability to sit in a chair
quietly. As long as they can discriminate between pictures and indicate a desire
for an item, for example, specifically reach for a required item, then other skills
are not necessary. As a result, this makes PECS a well-established and popular
form of communication intervention for those functioning at the lower end of the
autistic spectrum (Frost & Bondy 2002; Flippin, Reszka & Watson, 2010; Howlin
et al, 2007).
PECS, however, still has limitations in its restricted range of functions for
communication. At the start of the program a child independently initiates
communication, which is not ‘directly’ prompted by an adult. They finally
progress to commenting their response to a question, via a sentence strip14
. These
responses however, are argued not to be true self initiated comments, but simply
responses to a prompt, shaped by reinforcers that underline PECS. There is no
opportunity within the PECS system to therefore guide a child to share interests
with others independently (Flippin, Reszka & Watson, 2010). Having said this, an
individual’s ability to develop or have an interest to independently share their
feelings on a social level with others, is potentially impaired by features of their
ASD and something that may never develop despite an intervention being
designed to target this area. In addition it is important to note the aim of the PECS
program is to explicitly enhance ‘functional communication’, therefore it is not
targeted to develop social verbal speech as identified in this criticism (Charlop-
Christy et al., 2002 as cited in Roberts, 2003).
14
See appendix 4.

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Another criticism of PECS and its communicative functions, in relation to item
refusal, is identified by Flippin, Reszka and Watson (2010). The ability to protest
and refuse items or situations is something that typically developing children
acquire early on in their lifetime, through verbal utterances and non-verbal
communication. However, due to an inability to effectively communicate, a child
with ASD may display these feelings in potentially inappropriate and challenging
ways. Although PECS is recognised as potentially reducing some of the unwanted
behaviours, as a child can request and communicate what they want over
something they do not want, actually protesting or refusing an item is not targeted
directly in the PECS intervention, which again arguably limits the communicative
functions of PECS (Flippin, Reszka & Watson, 2010). However, the ‘choice’
system that is grounded in PECS could be argued as giving those who use the
system an ‘indirect’ sense of refusal, as they are requesting one item above
another. Although this is not explicit or controlled by the PECS user, it is
therefore something that needs to be considered by practitioners when using this
particular intervention.
Early research into the effectiveness of the PECS intervention has been highly
descriptive in nature, providing limited data on its efficacy. Only recently a small
number of studies have included more rigorous and scientific methodological
principles to effectively evaluate this intervention (Preston & Carter, 2009).
Research that has been conducted, found that PECS is an effective evidence based
practice in enhancing ‘functional communication’ ability in individuals with ASD,
especially those who have no speech (Tien, 2008; Jordan, Jones & Murray, 1998).
Users have generally been able to progress through the phases with success and

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display independent and spontaneous initiation of communication and also show
an increase in dyactic communication. The development of some pro-social skills,
including; improved social communication and decreases in challenging
behaviour, which were not specifically targeted, have also been observed (Dogoe,
Banda & Lock, 2010; Carr & Felce, 2007; Malandraki & Okalidou, 2007; Ganz,
Simpson & Cook, 2008; Charlop- Christy et al., 2002, as cited in Odom et al.,
2003). A number of research papers reported the use of PECS could be
generalised over situations, one of the core skills of PECS’ instruction. This is the
ability to request a desired item in the classroom with a specific teacher and then
be able to transfer this skill to an alternative situation for example, within the
home, increasing the independence and communication opportunities of the
individual across settings (Ganz, Simpson & Cook, 2008; Schwartz, Garfinkle &
Bauer, 1998 as cited in Roberts, 2003; Hart & Banda, 2010).
However, the increase in communicative function, identified in studies, does not
always mean a participant develops verbal skills. A handful of studies showed
some participants went onto develop speech and this gain in verbal ability
continued at the end of training (Bondy and Frost, 1994, as cited in Flippin et al
2010; Magiati & Howlin, 2003 as cited in Flippin et al 2010; Ganz, Simpson &
Cook, 2008; Schwartz, Garfinkle & Bauer, 1998 as cited in Roberts, 2003; Hart &
Banda, 2010). However, some show the effects on speech and maintenance of any
acquired speech remains unclear as results across the board are varied (Flippin et
al 2010; Preston & Carter, 2009; Howlin, et al., 2007). A recent meta-analysis
carried out by Flippin, Reszka and Watson (2010) aimed to review current
empirical evidence for PECS using research form controlled and uncontrolled
studies. Their meta-analysis showed that there was no significant effect for speech

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acquisition, but a medium effect for improving communication outcomes, which
varied somewhat considerably across the studies. They therefore concluded, what
is echoed in many other research papers, that the efficacy of PECS is still limited
because of a lack of experimental control and anecdotal support. However, PECS,
as an intervention, was ‘promising’ in increasing communication, particularly
non-verbal, although this cannot be assumed for the acquisition of speech. Despite
this, of any of the available interventions that provide communication through
picture exchange, PECS is considered one of the most effective (Flippin et al
2010; Preston & Carter, 2009; Howlin, et al., 2007).
The purpose of the Picture Exchange Communication System (PECS) is to
essentially target the communication deficit that exists in individuals with ASD
and encourage the child to initiate communication. There are other named
interventions however that assist individuals in responding to a prompt (Jordan
Jones & Murray, 1998), target the presentation of information by verbal
instruction and increase the understanding of environmental expectations, which
may be lost due to potential auditory deficits evident in ASD. One of the most
widely used approaches in ASD is the Treatment and Education of Autistic and
related Communication handicapped CHildren (TEACCH) (Roberts, 2003). This
approach which is based fundamentally upon structure, addresses the issues in
organisation and transition, evident for the majority of individuals with ASD,
allowing them to predict and understand expectations (Roberts, 2003; Caranhan,
2006).
In 1972 Division TEACCH was founded by Lord and Schopler in North Carolina
who wanted to provide an intervention that supported those with ASD from

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preschool to adulthood (Roberts, 2003; UNC, 2012). It aims to cue positive
behaviour by structuring and adapting the environment and helping to remind
those working within the approach to understand and remember what to do in
particular situations (Odom et al., 2003). This visually mediated support is
inclusive of visually presented instructions, timetables, work systems and
structured teaching based within curriculum content15
. These allow the individual
with ASD to develop skills, including educational engagement, but also that of
self-care (Jordan, Jones & Murray, 1998; Roberts, 2003; Jones, 2002; Mesibov,
2009; Mills & Marchant, 2011). It is important that before a child is introduced to
features of TEACCH, such as a visual timetable, they can, like the prerequisite for
PECS, discriminate between pictures, which is a vital skill needed to effectively
use pictorial based systems. The aim is to enable individuals to function as
independently as their autism allows, reducing the need for adult prompt which is
facilitated by the highly structured physical environment recognised as being
extremely beneficial for those on the spectrum and fits successfully into the
‘culture’ of autism (Schopler, 1991 as cited in Roberts, 2003; Ganz, 2007;
MacDuff & And 1993).
In similarity to the PECS intervention, TEACCH shows great promise but does
not have a wide empirical base for its effectiveness and many of the studies
conducted have evident methodological weaknesses (Jones, 2002; Lord, &
Schopler, 1994 as cited in Jordan, Jones & Murray, 1998). However it has been
used in education and home settings for over forty years and had significant
parental satisfaction ratings (Mesibov, 1997, as cited in Jordan, Jones & Murray,
1998). Research conducted into its effectiveness has found increases in IQ scores
15
See appendix 5.

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(Lord, 1991 as cited in Roberts, 2003; Venter, Lord & Schopler, 1992 as cited in
Roberts, 2003), fine and gross motor skills (Ozonoff, & Cathcart, 1998) and the
improvement of appropriate behaviour and also communication skills (Short,
1984; Ozonoff & Cathcart, 1998; Siaperas & Beadle-Brown, 2006 as cited in
Mills & Marchant, 2011). One major effect of the implementation of TEACCH
was reported by Hume and Odom (2007), who observed increased independence
and reduced requirement of staff prompting after the program had been
implemented, they also reported some off-task challenging behaviours were also
reduced as the pupils were aware of their following transition or expectations,
therefore did not display anxious behaviour as a result of uncertainly (Hume &
Odom, 2007).
Implementing such strategies within education provisions is widely adopted and
provides effective and supportive teaching environments for pupils with ASD and
also an alternative means of instruction for the teacher to ‘reach’ their pupils on
the spectrum (Flippin, Reszka & Watson, 2010, Howlin et al., 2007). Visual
systems such as PECS and TEACCH can be effectively used in combination with
one another, as they are there to target the differing challenges faced by an
individual with ASD. PECS can develop intentional communication ensuring a
child can make requests that are reflective of their needs and with the introduction
of TEACCH, an environment is provided where this communication can flourish,
one that is structured and ‘safe’, providing a clear understanding of expectations
(Jordan, Jones & Murray, 1998).

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4.5. Limitations of Visual Systems
The implementations of strategies such as visual systems have good ‘common
sense’ face validity in supporting the many challenges of ASD (Charman et al,
2011). However, it is also important to discuss the potential issues and limitations
which have been identified within literature and may alter the way they are
viewed or practiced within education. In the past there has been a minimal amount
of empirical studies conducted into the effectiveness of visual systems, with
numerous identified as having methodological weaknesses and only now is their
actual efficacy being discovered (Dettmer et al., 2000; Rao, & Gagie, 2006; Jones,
2002; Preston & Carter, 2009; Ospina et al, 2008; Roberts, 2003; Jordan, Jones &
Murray, 1998; Mills & Marchant, 2011; Arthur-Kelly, et al., 2009).
In order for an intervention to provide strong evidence for its effectiveness, it
needs to meet a number of experimental criteria. This is often difficult for those
researching complex areas such as ASD, as the specific variables needed in
Randomised Control Design (RCT) experiments are difficult to control, due to
ethical considerations surrounding participants; this is also compounded by the
organic nature of those with ASD (Preston & Carter, 2009; Roberts, 2003; Jones,
2002). RCTs are therefore rare in education with interventions, such as visual
supports, usually determined appropriate or effective by the professional view of
the therapist or teacher, rather than on any scientific grounds (Mills & Marchant,
2011). Despite the gap in research that is evident, interventions such as PECS and
TEACCH are extremely popular within areas such as education, however,
popularity does not reflect efficacy, therefore further research needs to be
conducted as a high priority to address this issue (Charman et al, 2011; Preston &
Carter, 2009; Jordan, Jones & Murray, 1998; Jones, 2002).

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It has been identified within literature that individuals with ASD are
predominantly visual learners (Hodgson, 1996; Roberts, 2003; Arthur-Kelly et al.,
2009; Whitaker 2001; Meadan, et al., 2011). However, Arthur-Kelly (2009)
believes the use of visual systems should not be an immediate response to a
diagnosis of ASD. Because autism is such a highly heterogeneous spectrum, other
sensory preferences may in fact be superior and are in need of consideration
before the automatic implementation of a visual system (Arthur-Kelly, 2009).
This brings to attention the many differing strengths those with ASD may hold
and therefore when implementing systems within education, attention needs to be
made to each individual. This should be done through careful assessment and
observation to find the system or combination of systems that best reflects their
individuality, processing ability and benefits their needs most effectively (Arthur-
Kelly, 2009; Jones, 2002).
The need for structure has been identified within literature as being highly
beneficial for individuals with ASD and supports the particular cognitive deficits
many have within this area, which can be circumvented by reducing the amount of
stress and anxiety that manifest from misunderstanding the environment (Savner
& Myles, 2000; Hill & Frith, 2003; Roberts, 2003). However, the highly
structured environments, evident in ASD specific classrooms and reflected in the
implementation of the TEACCH approach, have been negatively portrayed as
‘prosthetic’ and have the potential to shield those with ASD from society
(Roberts, 2003), creating an overdependence and reliance on visual supports
(Arthur-Kelly, 2009) and potentially reducing opportunities for natural interaction
and communication to develop (Jones, 2002).

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Rigidity and restricted patterns of behaviour are featured characteristics of ASD.
It is argued that by introducing visual systems, which are underpinned by
structure, it may, in reality, ‘perpetuate the need for sameness’, making it very
difficult for individuals using them to adapt and exceed their label in any way
independent of this support (Arthur-Kelly, 2009). Because of this potential
drawback, the level of support given by visual systems is recognised as needing to
be reduced as a child moves into adolescence and adulthood. Individuals with
ASD need to understand there are elements of flexibility needed to exist in
society, as situations may change suddenly that are beyond their control. It is
suggested that in a school situation, teachers should aim to provide their pupils
with the appropriate tools to cope with change, such as the observation of ‘natural
environmental cues’ to pick up a potential transition. If these skills are focused
upon, they can then be utilised and developed alongside their visual
implementations which could be beneficial to their ability to cope in adult life
(Whitaker 2001; Arthur-Kelly, 2009).
The use of visual prompts is additionally acknowledged as reducing the reliance
on adult support therefore improving independence. However, this independence
only exists due to the adults that initially put these supports or environmental
alterations in place. So for visual systems to be effective there needs to be a
certain level of adult support evident to implement them initially and oversee
them generally (Arthur-Kelly, 2009; Charman et al, 2011). The need to promote
flexibility and reduce reliance of visual systems is vital, as the level of adult
support in existence in school provisions may not be continued or reflected in
available adult provisions, due to funding or care inadequacies. If a child with

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ASD has experienced a highly supportive education provision, where a multitude
of implementations had been put into place to reduce their anxiety and enhance
their communication, there is the potential that their adult provision may not be as
supportive, therefore challenging behaviours and increased anxiety may be more
prominent and more difficult to manage than in their childhood (Arthur-Kelly,
2009; Charman et al, 2011).
If visual supports are therefore recommended by multi-disciplinary agencies and
subsequently implemented, then consideration needs to be made into the fact that
these may then need to be in existence throughout adult life (Tissot, & Evans,
2003, Prelock, 2007). Hence, any decision needs to be supported by Government
legislation and any agencies that are affiliated with individuals with ASD to
continue the significant and highly beneficial work that is already evident within
education. If the right implementation is found, following appropriate assessment
and consideration by all involved, then a child with ASD has the potential to make
amazing progress within their education and well into their adult life (Theroux,
2012).
It is clear to see, despite the lack of empirical research into efficacy of visual
systems, they benefit from a strong theoretical underpinning, which is perpetuated
into educational provision, where their potential impact on pupils with ASD is
substantial and early intervention paramount (Prior & Roberts, 2006). Specialist
teachers, who have an enhanced understanding of autism and its spectrum,
observe and work closely with pupils who use such systems and form strong
relationships with them. This enables them to introduce and adjust the use of
visual systems as necessary and in addition have the capacity to comment of their

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efficacy in relation to specific individuals they teach. Despite this insight, minimal
qualitative studies have been undertaken to explore teachers’ perceptions, as key
professionals, into the efficacy of visual supports and the impact they have on the
children they teach (Jordan, Jones & Murray, 1998; Mirenda, 2003; Arthur-Kelly,
2009).

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5. Methodology
5.2. Rationale
The rationale behind this research is to investigate SEN teachers’ perceptions of
the implementation of visual systems within the classroom environment to support
pupils with ASD and establish in what way the systems and structures impact on
the pupils’ educational experience.
5.3. The central question of the research
The research was be led by the following question; ‘What impact does the
implementation of visual systems and strategies, to support pupils with ASD, have
on their education experience?’ To assist in answering this question, the research
was guided by the following questions; what types of visual systems have been
implemented within the classroom and school environment to support pupils with
ASD? What is the purpose behind implementation of the strategies? What are
teachers’ perceptions of the effectiveness of these strategies? And finally have
teachers experienced any unexpected effects from the implementation of
strategies?
5.4. Research Strategy
In order to discover teachers’ perceptions on the impact of visual systems in
supporting children with ASD, the research undertook an ‘interpretive’
epistemological position through a ‘qualitative’ research approach. The teachers
perceptions, gained through open-ended questionnaires, were explored to identify
their subjective interpretation of the impact such visual systems have had on the
pupils in their care. For areas that have minimal or no previous research and

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dependent on the theoretical orientation of research, qualitative data collection
methods can be highly effective. The teachers’ responses were analysed on a
broader level than specific words or phrases, producing rich and intricate data,
obtained by the identification of specific features or themes (Howitt & Cramer,
2008).
5.5. Research Site
The research included perceptions of teachers who worked within three primary
school settings that provide an education for pupils with special educational needs
(SEN). The schools featured in the research have been specifically chosen above
mainstream educational settings. Their nature, as ASD provisions, provided a full
insight into the range of visual systems in use within special education. The
research question will explore the ‘perceived’ impact these systems have had on
the pupils placed within ASD specific class groups, where all of the pupils have a
diagnosis or are under assessment of being on the ASD spectrum.
5.6. Research Sample
To obtain questionnaire data, a purposive sample of seven primary teachers in the
Leicester and Leicestershire area were asked to take part in the research. The
teachers were based in an SEN (ASD specific) setting, all of which have
implemented or have in place one or a number of visual systems to support their
pupils with ASD. A purposive sampling method was chosen on the basis of the
teachers’ relevant knowledge and experience to fulfil the research criteria and
research question (Greig et al., 2007). In addition, the specific number of
participants has been selected on the basis of the time consuming nature of the
analytic strategy used in this research, which includes the process of data

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collection, transcription and subsequent analysis (Howitt & Cramer, 2008; Punch,
2000).
5.7. Research Time-Frame
A review of the literature was conducted over twelve weeks and questionnaires
were then delivered to the teachers two weeks before analysis. Analysis and write
up took place in the subsequent four week period. Therefore the literature review,
research and analysis took place over an eighteen week period.
5.8. Data Collection & Procedure
For the nature of this research, open-ended structured questionnaires were deemed
the most appropriate form of data collection preceding the specific analytic
strategy used. Interviews were initially considered as they may explore in further
depth the perceptions of the teachers; however, due to the nature of the teachers’
role, in an ASD specific setting, it became increasingly difficult to establish an
interview schedule. Therefore an open-ended questionnaire was developed to
allow for the teacher to independently respond to the study. Open-ended
questionnaires are useful if the research aim is exploratory and are suitable in
researching complexities where a respondent can answer as much as they wish to
in their own terms (Cohen, Manion & Morrison, 2007). A respondent therefore
has the time and space to express themselves and their response is more likely to
reflect the richness and complexity of their views (Denscombe, 2003).
A draft questionnaire was developed using appropriate research and planning
(Punch, 2000). The pre-tested questionnaire determined if the content received
from the participant was sufficient for further analysis, or if further alterations,

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developments and extensions to the schedule, including additional questions, were
needed to be made. A pre-determined schedule of questions was then developed
for the participants16
from the research criteria and questions, to explore the
respondents’ perceptions effectively, but to also allow them the opportunity to
make a clear reflection and elaborate on emerging issues that the researcher then
explored (Howitt & Cramer, 2008, Punch, 2000). However, it is accepted that a
respondent may not include relevant information if the question fails to evoke an
appropriate response or is deemed too time consuming. This drawback has been
recognised and therefore accounted for (Cohen, Manion & Morrison, 2007;
Denscombe, 2003)
It is important to note that no data collection method comes without its
limitations. The over-involvement of the researcher may potentially lead to bias.
However, this was also accounted for and procedures and steps were taken during
development of the questionnaires to ensure the questions were neutral and open
to interpretation by the respondent and not leading in any way.
5.9. Analytic Strategy
A qualitative Thematic Analysis, using the Braun and Clarke Thematic Analysis
Principles (2006), was undertaken to transcribe and analyse the open-ended
questionnaire responses. For the researcher to best interpret, make sense and
describe teachers’ perceptions of the impact of visuals systems within their
specific setting, this strategy was chosen as the most effective method. Through
the participant’s use of language, either written or spoken, on a particular area of
16
See appendix 6 for a clean copy of the questionnaire.

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interest, this method was able to identify and describe individual experiences and
perceptions (Howitt & Cramer, 2008; Braun & Clarke, 2006).
The two major aspects of Thematic Analysis are ‘data collection’, including
appropriate questioning to determine the teachers’ perceptions and ‘data analysis’
using a stage technique to establish and develop themes that arise from these
perceptions to adequately reflect the data. The themes were established through
the researcher’s familiarity with the data, which was coded and themes were
subsequently altered and developed that represent substantial sets of these codes
(Howitt & Cramer, 2008; Braun & Clarke, 2006).
.
5.10. Delimitations & Limitations
This research aimed purely to investigate teachers’ perceptions as key individuals
who have insight into their pupil’s educational lives and who can personally
reflect on the implementation, benefits and limitations of visual systems and the
way in which it has impacted on their pupil’s educational experience, for
example; their communication, learning and behaviour.
The research, due to the limiting time constraints, did not therefore investigate the
impact of visual systems through pupil observation prior and post implementation.
However, this is recognised as important, therefore a possible extension or
additional study to enhance findings and validity in potentially needed. In addition
it will not research the impact of visual systems through pupil interview,
questionnaire or ‘participatory research’, as this would present difficulties for the
nature of the pupils in question and their inability to successfully communicate

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through useful social language therefore potentially excluding the pupils from the
research process.
However it is noted that potential future ‘participatory research’ should be
considered to give a ‘voice’ to pupils with learning disabilities, to ensure their
perceptions are valuable and should be considered as an inclusive part of the
research process, as this research is directly connected to their education (Lewis &
Porter, 2004). For example analysis of drawings, photographs and recognising
perceptions of those with enhanced verbal communication skills.
5.11. Reliability
Triangulation of the research was required to ensure the research carried out to
establish teachers’ perceptions was considered reliable and can be validated. This
was conducted by cross referencing the responses and subsequent themes with
relevant literature and establishing similarities. The teachers were also directly
involved in data verification and authenticity of emerging themes, ensuring they
are a ‘true reflection’ and ‘interpretation’ of their perceptions. Triangulation could
also be achieved by carrying out additional interviews with teachers or parents
and incorporating guidelines mentioned above by including pupils as research
participants.
5.12. Ethical Considerations
Ethical considerations that are appropriate to this research were followed in
accordance to relevant University codes of conduct, where ethical approval was

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obtained17
in adherence to the BERA Ethical Guidelines for Educational Research
(2011). The participating teachers involved in the research, contributed on an
entirely voluntary basis and were fully informed throughout (BERA, 2011;
McNamee, 2002; Howitt & Cramer, 2008). The participants had a briefing of the
proposed research prior to its start, to provide them with full details of the
objectives, including the research timeframe, the underpinning rational and
theoretical framework and a written description of their involvement. In addition
they were able to request copies of the research proposal and emerging research
content at any point (Howitt & Cramer, 2008).
The teachers’ informed consent was required and a signed acknowledgement by
participants was requested before the research process was undertaken to ensure a
full understanding of the research objectives was achieved (McNamee, 2002;
BERA, 2011). The teachers involved had the freedom to withdraw at any point
during the research process and were alerted to this during the briefing stage
(McNamee, 2002; BERA, 2011). Anonymity of the school, teachers and specific
children discussed within the questionnaires, was upheld throughout and
following research completion. Appropriate records including any research related
information and questionnaire data remained confidential and stored appropriately
on a secured/password protected computer and therefore restricted from public
use (Howitt & Cramer, 2008; BERA, 2011).
5.13. Personal Biography
It is necessary to note some specific details about the researcher that may impact
on the study and additionally the data collection and analysing stage. The
17
See appendix 7 for a copy of the ethics form and ethical approval.

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researcher’s potential influence on the study has been identified within the data
collection and procedure section of the proposal. The researcher is a white British
female, aged thirty. She has had eight years experience as a nursery nurse/level
three teaching assistant working in a school for children with special educational
needs (SEN) with the majority of her time spent working within and supporting
ASD specific classes. This research was inspired by the researchers interest in the
area of ASD and visual systems to support communication where she has
personally developed, implemented and received training on various aided modes
of ‘Augmented and Alternative Communication’ to support non-verbal pupils on
the autistic spectrum. Her aim was to therefore further explore relevant literature
and establish research, through teachers’ perceptions, that identifies the perceived
effectiveness of visual systems in supporting communication of pupils with ASD.

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6. Analysis & Discussion
Throughout analysis, seven themes were identified from the data set of teachers’
responses18
, which explored the use and efficacy of visual systems within the
classroom to support pupils with ASD and are discussed in relation to relevant
literature. The themes identified include: Enhancing Communication; Promoting
Independence; Environmental Structure and Adaptation; Positive Behaviour
Management; Curriculum and Learning; the Awareness and Role of the Teachers
and Efficacy Foundations. See table 1 for synopsis presentation of the data set. 19
Table 1
Themes Quote 20
Key Word
1 Enhancing
Communication
‘’PEC's symbols allow our students to communicate
what they want if they are unable to communicate their
needs through speech.’’
(KP 47)
Connection
2 Promoting
Independence
‘’The symbols help to promote independence and
encourage the students to take responsibility for expressing
what they would like; they can also be used as part of a
wider reward system.’’
(KP 47)
‘’Jigs – lists children can work through to them with a
sequential tasks such as taking off their coat, hang it up,
take diary out, enter classroom. For eating; place food on
fork, put fork in mouth, chew – to develop independence ‘’
(BP 61)
Empower
3 Environmental
Structure &
Adaptation
‘’He then takes the photos from his visual timetable and
places them on his 'now and next board' so that he is aware
of which activities he will experience now and what might
happen later.’’
(KP 2)
‘’The classroom environment is low-stimulation with
less visual clutter on the walls and separate areas,
including workstations designed to minimise visual
distraction.’’
(LS 5)
Awareness
4 Positive
Behaviour
Management
‘’Children demonstrate much less anxiety and unwanted
behaviours as they understand what is expected of them.’’
(LS 82)
Expectation
18
Data Set presented in Appendix 8 [participants questionnaire responses]
19
Full analysis of themes are presented in Appendix 9
20
(Participant initial and line number)

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‘’Choice pictures and golden time/reward scheme – to
develop independence and the ability to make their own
choices, to reduce unwanted behaviours ‘’
(VB 71)
5 Curriculum
& Learning
‘’For individual children and activities, children are
given task plans to support in structuring their work’’
(LS 3)
‘’We now use PECS as the focus of each literacy
session, so pupils’ learning is focused on communication
skills.’’
(SO 75)
‘’The positives include support with reading as the
timetable is laid out left to right.’’
(LS 94)
Support
6 The Awareness
& Role
of the Teachers
‘’Many children have a particularly visual learning
style, and the use of visual systems promotes their learning.
Many children are non-verbal and so PECS supports their
communication needs.’’
(LS 48)
‘’When .... supported by all teaching staff then the visual
strategies are effective.’’
(KP 80)
Facilitate
7 Efficacy
Foundations
‘’I think the effectiveness is down to the individual using
the visual support strategy and the length of time that the
support has been in place.’’
(KP 81)
‘’In my opinion, once embedded, these strategies are
effective in supporting children with ASD. They do need to
be coupled with structured routines to be fully effective.’’
(LS 82)
Requirement
Theme one21
indicates how important enhancing pupils’ communication is
perceived by the teachers and by providing their pupils the tools and opportunities
to express themselves and connect with others and their environment, which leads
to positive outcomes in their educational experience. This is echoed in research
that suggests individuals with ASD have difficulties in communicating
intentionally and therefore interventions are implemented to support this deficit
and ensure those with ASD can effectively express their needs and facilitating
their communication through visual supports is paramount (Mirenda, 2003;
Arthur-Kelly et al., 2009; Jones, 2002; Slater & Bremner, 2003; Johnston, et. al.,
21
See Appendix 9 p85 for full analysis.

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2003). This affirmative perception continues into theme two22
which details that
the pupils’ independence is promoted as they are able to communicate a desired
item or a specific choice, without the need for adult prompts. The teachers
believed this therefore empowers them and gives them a sense of control over
their environment, which may be lost due to cognitive deficits evident in ASD
(Hill & Frith, 2003; Jones, 2002; Arthur-Kelly et al., 2009; Janzen, 1996, as cited
in Rao, & Gagie, 2006; Dyrbjerg & Vedel, 2007).
The environmental adaptation teachers practiced was featured in theme three23
in
accordance to theoretical underpinnings of structure and visually presented
information to support individuals with ASD in functioning most effectively
(Autism Working Group, 2002; Rao, & Gagie, 2006; Ganz, 2007; Breitfelder,
2008; Tissot, & Evans, 2003). Teachers believed the systems assisted in
improving their pupils’ deficits in their triad of impairments. The main
environmental adaptations ensured pupils were ‘aware’, ‘prepared’ and conscious
of any expectations throughout their life at school. According to the teachers,
enhanced communication and awareness of environmental expectations, including
behaviour rules, had a positive effect on reducing distress, anxiety and frustration
in many pupils, as featured in theme four24
. This is consistent with literature
which reported negative behaviours were often replaced with appropriate
communication exchange, once visual systems that facilitated this exchange, such
as PECS, were in place and pupils had a enhanced awareness of their environment
and expectations that exist within it (Arthur-Kelly et al., 2009; Whitaker, 2001;
Hawlin 1997 as cited in Roberts, 2003; Quill 1997 as cited in Roberts, 2003).
22
See Appendix 9 p 85 for full analysis.
23
24

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Visual supports were identified in theme five25
as underpinning and supporting
curriculum content and early reading and writing skills, however, curriculum
objectives were identified by the teachers as being secondary to fundamental
communication skills (Jones et al., 2008; Howlin et al., 2007; Jordan, Jones &
Murray, 1998). Teachers, throughout the data set and echoed in theme six26
,
showed continual awareness of ASD, its features, the purpose behind
implementing visual systems and how to achieve upmost efficacy. Teachers’
understanding of ASD was also identified as important in the ‘Autism spectrum
Disorder: Good Practice Guidance’ developed by the DfES and DH’s Autism
Working Group (2002). The teacher’s role as facilitator was also identified as
crucial in ensuring the systems were used effectively and maintained to achieve
upmost benefit. The requirements for enhanced efficacy of a system was
identified in theme seven27
, where teachers recognised that the ‘individual’ using
the system also had a significant impact on how effective it can be and
personalised approaches are utilised to accommodate this individuality. This
suggests, as indicated in research, that visual systems need to be individualistic
and a ‘one size fits all’ approach is arguably ineffective (Flippin, Reszka &
Watson, 2010, Jones 2002; Jones et al., 2008; Research Autism, 2012). The length
of time a system has been in place was also identified by teachers’ perceptions as
also affecting efficacy, this indicates that time frame is important and once
supports are ‘embedded’, within a structured environment, they may have
increased effectiveness.
25
26
27

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The original research question asked what impact the implementation of visual
systems that supports pupils with ASD, had on their educational experience. In
drawing the themes together it has been identified that teachers perceive visual
systems as having numerous beneficial effects to support their pupils with ASD,
inclusive of curriculum access, engagement and connection with their
environment. These benefits have been enhanced by improved communicative
opportunities embedded in visual supports, which have also provided much
needed structure, awareness of expectations and subsequently improved
behaviour.
The teachers showed a good awareness of the purpose behind the visual systems
implemented within their school environment developed in relation to the
spectrum of autism. They did not record any awareness of significant negativities,
in relation to using the systems, which had been identified within literature during
the review. However this could be due to the nature of the questions asked and a
potential limitation of the research itself. However procedures were taken, when
developing the questionnaire, to avoid any ‘leading’ questions, therefore a
question to determine actual negativities was avoided; these was to ensure
participants were not predisposed into responding about potential negativities and
instead were asked if they had perceived any ‘unexpected’ effects.
The implications of these findings echo what is represented within literature and
significantly linked to the theoretical underpinnings of ASD. Despite potential
limitations identified, this research adds a qualitative dynamic to literature by
exploring teachers’ roles and appreciating their perceptions as primary individuals
in their pupils’ lives. The use of explicit qualitative methodologies, such as the

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one featured within this research, has been recognised as minimally used as a
methodology within literature to explore efficacy of ASD interventions and
therefore a potential for further research alongside a vital scientific line of
investigation (Jordan, Jones & Murray, 1998).

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7. Conclusion
The purpose of this dissertation was to explore relevant literature and SEN
teachers’ perceptions into the use and efficacy of visual systems within the
classroom environment to support pupils with ASD, and establish in what way the
systems impacted on their educational experience. The study undertook an
‘interpretive’ epistemological position through a ‘qualitative’ research approach,
highly effective for areas with minimal previous research (Howitt & Cramer,
2008). Theoretical underpinning and subsequent literature identified the complex
aetiology of autism and how children on the spectrum, despite having a deficit in
the triad of impairments, still vary considerably in their needs. This was also
identified in the teachers’ perceptions, where analysis recognised the need for an
individualised approach for each child, in relation to the specific needs and
curriculum objectives. There are clear implications for the teachers who work
alongside individuals with ASD. They were acknowledged as key professionals
who display good practice and work alongside multidisciplinary teams to establish
the most appropriate and accessible environment. Their aim is to ensure pupils
with ASD flourish and their needs, inclusive of their autism, are nurtured
appropriately (Charman, et al., 2011; Autism Working Group, 2002).
This dissertation also explored the AAC interventions available to teachers to
support the needs of those with minimal functional language and communication
skills. Interventions included Sign language, the Picture Exchange
Communication System (PECS) and Treatment and Education of Autistic and
related Communication Handicapped CHildren (TEACCH) approach. The
purpose of these systems was identified as facilitating communication exchange
and also ensuring the environment is altered to enhance and make expectations as

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explicit as possible (Mirenda, 2003; Arthur-Kelly et al., 2009; Jones, 2002; Slater
& Bremner, 2003; Johnston, et. al., 2003).
There are many implications to such approaches; however, possibly the most
compelling is the need for further research. Many studies into visual systems to
support those on the spectrum have been found to have methodological
weaknesses and this has been argued to be a result of the heterogeneous nature of
autism. As a result a comprehensive understanding of their efficacy is yet to be
discovered, therefore, future methodologically sound and systematic research is
recommended as needing to be conducted (Dettmer et al., 2000; Rao, & Gagie,
2006; Jones, 2002; Preston & Carter, 2009; Ospina et al, 2008; Roberts, 2003;
Jordan, Jones & Murray, 1998; Mills & Marchant, 2011; Arthur-Kelly, et al.,
2009).
Issues attached to visual supports that have been identified within literature, give
rise to further implications. These issues could be argued to be a product of their
actual foundations. The nature of the supports in providing a rigorous structure
and means of communication within a prosthetic environment may isolate the
individual from society; perpetuate their need for sameness, in turn creating a
reliance on these systems, escalating the users’ rigidity and inflexibility (Arthur-
Kelly, 2009; Whitaker 2001). Despite this potential concern, evidence suggests
interventions are generally positive and visual systems have excellent success
outcomes in practice. This is identified within literature (Jones 2002; Jones et al.,
2008; Mirenda, 2003; Hodgdon, 1996. Charman et al, 2011) and was also
acknowledged in the perceptions of the teachers who took part in this research. It
is therefore recommended, that if teachers and also parents appreciate and are

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aware of the issues surrounding visual interventions and take this into
consideration when implementing the most appropriate support from diagnosis
onwards, then considerable positive impact on communication, social interaction,
behaviour and independence can be experienced both at school and at home.
The interventions that have been developed over the past forty years have
provided hope for many families of children with autism in reducing the strain it
potentially places upon them, giving their children the best possible start in life
and skills essential for their own success. Above all, it is vital that families are
supported and trust that their child can be accepted into an educational provision,
where interventions have been specifically developed to help them process
information, maximise communication and be fully included within that setting.
This is a major implication for educational practice and research supports the view
that individuals benefit from being placed in an environment where their strengths
and abilities are developed by professionals who appreciate and understand the
many difficulties they face, undergo specific training and disseminate their
successful interventions and good practice to other professionals (Autism
Working Group, 2002; Charman, et al., 2011; Jones et al., 2008; Jones, 2002).
Those with ASD will experience many challenges surrounding their autism;
however, communicating the needs of their own existence does not need to be one
of them. Visual interventions therefore empower these individuals, giving them a
‘voice’ and an opportunity for increased autonomy, beyond many of society’s
expectations. As they, like any other person, have the right to be heard and treated
with respect throughout the whole of their lifetime. The poem, titled ‘The Future’
written by Wendy Lawson, an adult with ASD, captures that the future of those
with autism is not dependent on their diagnosis or how it manifests itself within

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each person, but on the support they are provided by others in order for them to
flourish and thrive (Gray, 2006 as cited in Jones et al., 2008).
The Future
Life on earth is but a moment
Caught within the crease of time.
The seasons come and go again,
You have your life, and I have mine.
The seed that's planted within the ground,
Cannot choose what to become,
A potato, an apple
Or a rose for some.
However, for it to be the very best,
It needs rich soil, not poor.
The sun and the rains must come,
To open that seed’s door.
I may be born to nourish others,
I may delight the senses.
I may grow tall, I may grow small,
I may stay stunted beneath wire fences.
My future may not depend on my stock,
So much as it does upon sources.
Sources of warmth, sources of care,
I depend on the nurture to be for me there.
Then I can blossom and sing with the birds,
Then I can grow my potential.
So plant me in goodness and all that is fine,
Please keep the intruders away.
Give me a chance to develop, in time,
To become who I am, in life's future, one day!

Claire Skilbeck - Dissertation Doc pdf

Claire Skilbeck - Dissertation Doc pdf

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