Literature Review
The background and relevance of the research to teaching and learning were adapted from the initial application, from April 2022 to McDowell Foundation, to include findings from Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention (McDowell Foundation Research Grant application, April 20, 2022, contains original background without the addition of evidence from this study):
In her recent article, “How the COVID-19 Pandemic Impacts Students’ Working Memory and Executive Functioning” Margaret Foster explained, “greater recent life stress exposure was associated with worse performance on measures of long-term and working memory, as well as more self-reported memory problems” (Psycom Pro, November 2021). Haig Kouyoumdjian (July 2012) revealed that for all learners, “words are abstract and rather difficult for the brain to retain, whereas visuals are concrete and, as such, more easily remembered” indicating that especially in times of stress, when processing a lot of verbal information may be challenging, that visuals will be easier to process, and to retain. In November 2020, The United Kingdom Office for Standards in Education, Children's Services and Skills (Ofsted) reported “some children, of all ages and backgrounds, have lost some basic skills and learning because of school closures and restrictions on movement.”
At the time of this McDowell Foundation Grant Application, during Fall and Winter 2021-22, Regina Public School teachers would agree with the Ofstead and Psycom reports. Schools were reaching out for support for many young learners and this was reflected in requests for Occupational Therapist and/or Autism Consultant support in mainstream classrooms. At that time, over 50 percent of all requests for mainstream Autism Consultant support, and over 37 percent of all requests for Occupational Therapy support, were for Kindergarten students (in Regina Public Schools). Commonly, Occupational Therapists and Autism Consultants recommend the use of visual supports. But why not use the same support as a class-wide, Tier 1 intervention, and support anxiety reduction, memory, and independence for all learners (as a Universal Design for Learning in Kindergarten classrooms)?
Comments Following Research Conducted During the Study
Although the grade level of study changed, it remained in the primary range, where there were positive outcomes for neurodiverse (all) learners. The use of visual supports as a Tier 1 Strategy was shown to be manageable, and useful, for teachers when teachers were provided with the right supports. Pages 1-7 of the report explain the positive outcomes for youth and adults when visual supports and strategies are used as a Tier 1 intervention and linked documents on pages 18 and 19 can support overcoming barriers to the use of visual supports.
Comments Regarding the Relevance of this Research
While research around the use of visual supports as an evidence-based (evidence-informed) practice for individual learners (as a Tier 2 and/or Tier 3) support was easy to locate, studies looking at what could be learned by using visual supports as a Tier 1 intervention were lacking. Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention affirms that the use of visual supports classroom-wide had positive influences on working memory and executive functioning (especially time management, problem solving, task initiation and task persistence) for all learners. This study also confirmed Haig Kouyoumdjian’s (July 2012) comments about the permanence of visual supports while verbal words are fleeting and so of the benefits of using visuals to support concrete learning (for all learners). Each of the teachers in this study commented about classroom complexity and the varied skills of learners. The United Kingdom Office for Standards in Education, Children's Services and Skills (Ofsted), in 2020, reported that varying skills and, as a result, increased complexity in classrooms, may have been due to pandemic impacts. Regardless, the use of visual supports as a Tier 1 strategy can support learner needs, independence, problem-solving, executive functioning, comprehension, and peer-to-peer interactions to help make management in complex classrooms easier for teachers and supporting adults.
Summary Comments relating to Additional Background, Literature Review, and Citations
Note: updated below from the original McDowell Foundation Grant Proposal April 2022 to include the findings from Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention.
The use of visual supports is an established, evidence-based strategy for autistic learners recommended by both the National Professional Development Centre on Autism Spectrum Disorder (https://autismpdc.fpg.unc.edu/) and the National Standards Project, National Autism Center (https://www.nationalautismcenter.org/national-standards-project/). The National Professional Development Center on Autism Spectrum Disorders, by 2010, had found that “visual supports can be implemented with individuals across the age range, beginning in preschool and extending through middle school age.” Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention found that using visual supports as a Tier 1 strategy was supportive not only of neurodivergent learners, but also of neurodiverse learners. Learners benefitted from the visual supports to support problem-solving, transition support, comprehension, and executive functioning needs, if they were out of the room during a direction, to increase independence in classroom structures and routines, to support peers who asked questions of them, and to reduce the number of questions posed to teachers. There was promise that visual supports, when taught with intention and co-created with learners, could support regulation for learners as well.
Effective visual supports in early childhood settings include visual schedules to increase task engagement, visual scripts to encourage social interaction, and picture cues to support play skill development (National Professional Development Center on Autism Spectrum Disorders, 2010 cites Krantz & McClannahan, 1998; Massey & Wheeler, 2000; Morrison, Sainato, Ben, Chaaban, & Endo, 2002). In elementary and middle school, visual supports such as schedules and picture cues have proven effective in reducing transition time, increasing on-task behavior, and in completing self-help in the home (National Professional Development Center on Autism Spectrum Disorders, 2010 cites Bryan & Gast, 2000; Dettmer, Simpson, Myles, & Ganz, 2000; MacDuff, Krantz, & McClannahan, 1993). Similarly, the use of visual supports is a long-standing evidence-based practice for learners with developmental disabilities including Down Syndrome (Kay, 2011). And there has been evidence that using visual supports in early childhood settings can have a positive impact on social-emotional learning, problem-solving and (pre) literacy learning for both neurotypical and neurodiverse learners (National Professional Development Center on Autism Spectrum Disorders, 2010 cites Whitmore et al, 2019, Edwards and Willis, 2000). The use of written directives, visual models, graphic organizers, and demonstrations has been shown to improve comprehension by students as to classroom and/or task expectations and to support problem-solving for learners with intellectual disability, autism, learning disabilities, visual or hearing impairment and ADHD (Mrachka, 2020). Mrachka found that the use of visual supports was particularly helpful in helping learners to comprehend new concepts and information when advocating for visual supports as a part of a teacher’s Universal Design for Learning in the classroom (2020).
All the above-mentioned visual strategies and supports were used with diverse learners, during Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention, in the classroom to support individual needs or challenges. However, in general, the visuals supported clarity, comprehension of structure and expectations, and routine and consistency, which helped many learners to be productive and use their time well in classrooms. Teachers often report, and reported in this study, that meeting the needs of a diverse group could feel overwhelming. If teachers approached the various interventions that individual learners may need as individual add-ons to their work or lessons, this would be overwhelming. However, when visual supports were part of the planning for lessons and units, and when they were co-created with learners as a part of the lessons and teaching/learning, there were fewer individualized items to create. And, because all learners understood how the visual tools could be used, if the adults in the room explicitly taught this, peers could support each other easily as well, reducing the need for adult intervention for problem-solving. Similarly, teachers have been reporting and did report in this study, that COVID did impact emotional regulation, social interaction/social skills, independence, and readiness skills for learners in these early years of school (who had less group learning experiences than students who entered grade 1 and 2 classrooms pre-COVID). As such, the use of visual supports is worth the investment given visuals will not only support the neurodivergent learners, who whether diagnosed or not during the primary grades, will comprise between 7 and 20 percent of students in the class (University of North Texas, 2018). Neurodivergent learners often require visual supports to succeed to their full capability. However, visual supports were also shown to benefit many other learners within the classroom. There was no risk of reliance or overuse of visual supports for those who did not/no longer required the support – these students (as revealed in triangulation interviews) simply were aware the support was there if they ever did need it (and were comforted by this). Students reported not using visual supports for which they had mastered the content. Therefore, the availability of visual supports was harmful to no learner.
While focused on changing nursing practice, Kuney et al (2015) found “internal force that drives change included institutional avenues to receive direct staff nurse input and empowerment to review and implement EBP, clear and open communication with administrative levels, and the recognition of working toward change for the benefit of the patient.” The same was proven by Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention to be true in education - as a teacher or classroom staff member grows in confidence, and sees success for their students, from adding one evidence-based practice to their teaching, there is a higher likelihood that the teacher will either maintain and/or grow the use of this strategy into future teaching years, or to incorporate other evidence-based or evidence-informed practices into their teaching. Specifically regarding the use of visual supports, the payoff for adults supporting their use in cost and time savings (if the right supports are in place in schools to support the creation and use of visual supports) is well worth the investments teachers made to incorporate their use.
Literacy and numeracy support visuals, followed by directive visuals, were the most commonly seen in the primary grade classrooms that participated in this study. Use of written directives, visual models, graphic organizers, and demonstrations were shown, over the course of the research phase of Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention, to improve comprehension by students with regard to classroom and/or task expectations and to support problem-solving for English Language Learners and newcomer students, learners with mild intellectual disability, autism, ADHD, oppositional behaviors, anxiety or anxiousness, and, indeed, all learners in the four classrooms who participated.
Please note that Supporting Neurodiverse Learners by Using Visual Supports as a Tier One Intervention did not specifically examine literacy development or the impact visual supports could have on the development of reading and writing in the primary grades. This would be an excellent follow-up project. (To discuss undertaking this research with Mary Barrow, please email powerofvisuals@outlook.com.)
The Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention Study was funded by McDowell Foundation and was supported by Regina Public Schools. For additional information, please see Summary of Study Findings - Supporting Neurodiverse Learners by Using Visual Supports as a Tier 1 Intervention.