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One of the most common challenges faced by individuals on the spectrum is anxiety. This is prominent during situations where there is less structure to the day, or when an activity is planned that is not inherently motivating for the child to do. Anxiety can also occur in situations where there is a change to a planned routine, and this is not communicated to the child ahead of time.

Research tells us that creating a structured environment and following a predictable routine goes a long way in managing anxiety levels for individuals on the spectrum. While there are many ways we can do this, I will be sharing a simple tool in this blog post called “First-Then” or “First-Next” Boards. I will begin by sharing what First-Then Boards are, how to use this tool, and how to prepare these boards for your own use at home or in school.

What are First-Then boards?
First-Then boards are visual tools that allow you to add structure to your child’s routine, make the environment more predictable and motivate them to complete non-preferred tasks. Just like adults, it benefits children to know their routines and predict what is coming up next. While this is helpful for all individuals, it is especially beneficial for children on the spectrum. Instead of communicating the routine in language, in a First-Then board you will use visuals to represent the activities.

Look at the example below. Imagine you want your child to first complete their yoga class then have lunch. You can present this information to your child by adding visuals in the appropriate column.

From my experience the best aspect about using First-Then boards is the visual nature of the tool. Challenges associated with language processing are reduced. Additionally this tool is ideal for students who are not yet able to follow a full day’s schedule, and are still developing sequencing skills.
In the beginning the best way to introduce this to your child is to combine one non-preferred task with an activity that acts as a reward that they earn and is highly motivating. Most commonly this might include combining academic tasks with time to watch YouTube, or performing activities of daily living with earning a sensory break. Below are some examples of how I have used this tool.

How to use “First-Then” boards?
The best aspect about using “First-Then” boards is that they can easily be carried around to different places such as your study area, kitchen, car, etc. Place it where it is visible to your child. Initially it helps to go through the two activities with your child before starting with their work so that they can understand how this tool works.

The second thing you would need is some velcro or double-sided tape that you can use to replace the visuals for different uses. After one activity is completed, have the child remove the visual to indicate that they are finished. This is similar to the feeling of accomplishment we get as adults when we cross off things from our to-do list ! Here are some examples:

With this being said, you will notice that in some of the images shown above, some of the visuals cannot be removed. Rather they have been printed out straight into the “first-then” board. This technique can be used for activities that occur in the child’s routine everyday and hence is useful to have ready in this format. Here is an example:

Lastly, it is helpful to have a tray or a box to put your child’s finished work. This makes it visually very clear for the child that their work is getting completed, and almost acts as a kind of signal to transition to the next activity. Here is an example:

How can you make this tool at home?
“First-Then” boards are low prep tools. You do not need to spend a lot of time or money preparing the materials, rather it should be customized for your child or student. You do not have to laminate, although this helps your materials last longer.

Here is an example of a quick handwritten First-Then board I made on the spot. I simply found an A4 size chart paper I had at home and used a marker to write the words “first” and “then”. Using the existing visuals and double sided tape, I quickly created a first-then board with only a few supplies. Here are some pictures:

I use a software called “Widgit Online” for creating all my visuals. However you do not have to purchase special softwares to create visuals. You can easily take live pictures of

the activities and places that your child goes to regularly and print this out. For example if your child has an OT session then you can print a picture of your therapist to represent OT class. If you want to represent “play time” then you can do this by taking a picture of your child’s favorite toys. Alternatively take a picture of the bathroom or study table to indicate to the child that it is time to bath or do some work. Your visuals do not have to make sense for anybody except your child ! However, do try to keep it consistent as this avoids confusion for the child.

Some things to remember:
● The reward or break that the child earns acts as a reinforcer. Hence you can choose items or activities that the child prefers and would enjoy. Initially you can pick out items that you know would be enjoyed by your child, but gradually can have the child choose between two or three items that they wish to “earn”.
● As with everything else, this tool might need to be customized further. As parents and teachers who know your child the best feel free to add or remove elements that you feel will support your child !
● If it doesn’t work, remember that you tried. This is what matters ! Take a short break and when you feel ready, remember that there are plenty more evidence based practices for you to explore !

You can also download the template attached above and print it as per your convenience.