Use of a Picture Schedule to Prepare Children with ASD for Participation in a Research Study

Background: Autism Spectrum Disorders (ASD) are characterized by a need for routine and predictability. Individuals with autism often have great difficulty with transitions and novel situations.  The resulting anxiety can cause significant stress and lead to maladaptive behavioral responses.  In addition to teaching appropriate behaviors, Social Stories (Gray 1994, 2000) have been used to increase participation in new routines.  Picture schedules have been similarly effective in helping ASD children adjust to changes in routine (McClannahan and Krantz, 1999; Dettmer et al., 2000) and to be prepared for novel events (Ivey et al., 2004).  

Objectives: We investigated the usefulness of a picture schedule to prepare children with autism for participation in a research study on intestinal permeability.

Methods: Parents of children with autism (n=51; diagnoses confirmed by ADOS and SCQ) and parents of children with a history of typical development (n=26) participating in a study of intestinal permeability were sent a picture schedule illustrating the procedures involved in the research study.  Medical procedures included drinking a sugar solution, 6 hour urine collection, and a blood draw.  Parents were instructed to review the picture schedule with their child prior to the appointment.  At the end of the study, parents were asked to complete a five question survey about their satisfaction with the picture schedule.

Results: Forty-eight (63%) families completed the survey on the use of the picture schedule.  Twenty-six out of 30 with ASD (87%) and 14 out of 18 with typical development (77%) reported using the picture schedule. Of those that responded, 96% of the parents of children with ASD and 100% of the parents of typically-developing children rated the picture schedule as either “Somewhat Helpful” or “Very Helpful”.   Child report was also solicited through the parents, and of the 17 families who recorded an answer for their child, 82% of the participants with ASD felt that the picture schedule was either “Somewhat Helpful” or “Very Helpful”.  One hundred percent of the typically developing subjects responded that it was either “Somewhat Helpful” or “Very Helpful”.  One hundred percent of parents from both groups said that they would recommend picture schedules to other families preparing their child for a visit to the hospital. 

Conclusions: Our study suggests that picture schedules illustrating medical procedures are acceptable to families and may be helpful for both research and clinical projects.  Future studies employing random assignment to groups (e.g., with and without pictures) and using more rigorous measures of feasibility, acceptability, child anxiety and parent stress would be a very good next step.  Researchers may want to consider routinely incorporating picture schedules into their protocols to reduce the stress children experience when participating in a study.